AN
UNCOMMON FRACTURE OF THE
By T. H.
SKULL.
KEATES, CAPTAIN,
m.p.
(London),
I. M.S.
notes of
a The following medico-legal ease may be of interest owing to the unusual position of the fracture of the skull.
The deceased, a man of about thirty-five years of age, was on September 4th, at 8 p.m., hit on the forehead, over the inner angle of the right " orbit with a sanghan" (wooden pitch-fork), which was held by the handle ; one of the iron bolts which fasten the two prongs together coming in contact with his forehead and making a three-cornered punctured wound. He is said fallen senseless to the to have immediately ground. He was removed to hospital next morning, when he was found to be completely comatose, He died at with a temperature of 106?. 10 A.M. on the 5th with respiratory failure, the heart beating strongly till the end. Artificial respiration was kept up for one hour, but it was of no avail. Post-mortem: a contused three-cornered wound f in. in diameter was found over the POSITION OF ENTERMAl WOUND
FRACTURE
.ANT.
FOSSA
internal angular process of the frontal bone on the right side, just above the root of the nose. The wound went down to the bone. There was great ecchymosis of the right upper eyelid, and
THfc
468
INDIAN MEDICAL GAZETTE.
sub-conjunctival haemorrhage of the right eye. The right pupil was dilated and the left somewhat contracted. There was some blood issuing from the left ear, a point which had been remarked on before death. On reflecting the scalp, the outer surface of the skull was seen to be intact, there was no fracture at the site of the injury, and the right orbital crest was intact. On removing the skull cap, the right lobe of the cerebrum showed a good deal of subarachnoid ecchymosis over the whole of its outer surface. When the brain was removed, a subdural haemorrhage was seen occupying the right oz. of blood-clot was anterior fossa. About present, this had somewhat hollowed out the under surface of the right frontal lobe, and had extended from there into the right sylvian fissure, which was entirely filled up with blood-clot, that had completely surrounded and pressed on the Island of Reil. The bleeding was seen to have come from a fracture in the centre of the orbital plate of the frontal bone. This fracture was something like a bullet-hole, oval in form and about one inch in its greatest diameter. The bone occupying this area had been split into fragments, which had forced through, and torn the dura mater in this position. Thus a hole had been formed leading straight through into the orbital cavity, which was filled with blood-clot. The haemorrhage had probably come from the anterior meningeal artery. This was the only fracture present. There was no fracture in the middle fossa on the left side, and so the bleeding from the left ear had probably only been due to an injury of the external meatus. It
seems
very curious that the delicate cribriform
plate of the ethmoid lacrymal bone were uninjured, for they were much nearer to the original point of contact. The actual fracture was nearly two inches distant from the point, at which
the force was applied. What was the of the fracture being formed in this way ; and why did one not get the usual linear fracture extending across the anterior fossa from the point originally struck ? It appeared as if the weakest and thinnest part of the anterior fossa had just cracked and collapsed, like an egg shell when squeezed. reason
The symptoms also were somewhat anomalous. The high temperature of course was due to compression. But how was it that the respiration failed so much before the heart; or rather why was it that the respiratory centre alone was affected ? There was no injury to the medulla or haemorrhage into the ventricular system of the brain, which might have interfered with the respiratory centre. Could this have been possibly due to the pressure on the Island of Eeil ? Can anyone inform me as to the functions of
[Dec.,
this part of the brain ? I cannot find definite about it in the literature.
1911.
anything
UNCOMMON FRACTURE OF THE
By T. H.
SKULL.
KEATES, CAPTAIN,
m.p.
(London),
I. M.S.
notes of
a The following medico-legal ease may be of interest owing to the unusual position of the fracture of the skull.
The deceased, a man of about thirty-five years of age, was on September 4th, at 8 p.m., hit on the forehead, over the inner angle of the right " orbit with a sanghan" (wooden pitch-fork), which was held by the handle ; one of the iron bolts which fasten the two prongs together coming in contact with his forehead and making a three-cornered punctured wound. He is said fallen senseless to the to have immediately ground. He was removed to hospital next morning, when he was found to be completely comatose, He died at with a temperature of 106?. 10 A.M. on the 5th with respiratory failure, the heart beating strongly till the end. Artificial respiration was kept up for one hour, but it was of no avail. Post-mortem: a contused three-cornered wound f in. in diameter was found over the POSITION OF ENTERMAl WOUND
FRACTURE
.ANT.
FOSSA
internal angular process of the frontal bone on the right side, just above the root of the nose. The wound went down to the bone. There was great ecchymosis of the right upper eyelid, and
THfc
468
INDIAN MEDICAL GAZETTE.
sub-conjunctival haemorrhage of the right eye. The right pupil was dilated and the left somewhat contracted. There was some blood issuing from the left ear, a point which had been remarked on before death. On reflecting the scalp, the outer surface of the skull was seen to be intact, there was no fracture at the site of the injury, and the right orbital crest was intact. On removing the skull cap, the right lobe of the cerebrum showed a good deal of subarachnoid ecchymosis over the whole of its outer surface. When the brain was removed, a subdural haemorrhage was seen occupying the right oz. of blood-clot was anterior fossa. About present, this had somewhat hollowed out the under surface of the right frontal lobe, and had extended from there into the right sylvian fissure, which was entirely filled up with blood-clot, that had completely surrounded and pressed on the Island of Reil. The bleeding was seen to have come from a fracture in the centre of the orbital plate of the frontal bone. This fracture was something like a bullet-hole, oval in form and about one inch in its greatest diameter. The bone occupying this area had been split into fragments, which had forced through, and torn the dura mater in this position. Thus a hole had been formed leading straight through into the orbital cavity, which was filled with blood-clot. The haemorrhage had probably come from the anterior meningeal artery. This was the only fracture present. There was no fracture in the middle fossa on the left side, and so the bleeding from the left ear had probably only been due to an injury of the external meatus. It
seems
very curious that the delicate cribriform
plate of the ethmoid lacrymal bone were uninjured, for they were much nearer to the original point of contact. The actual fracture was nearly two inches distant from the point, at which
the force was applied. What was the of the fracture being formed in this way ; and why did one not get the usual linear fracture extending across the anterior fossa from the point originally struck ? It appeared as if the weakest and thinnest part of the anterior fossa had just cracked and collapsed, like an egg shell when squeezed. reason
The symptoms also were somewhat anomalous. The high temperature of course was due to compression. But how was it that the respiration failed so much before the heart; or rather why was it that the respiratory centre alone was affected ? There was no injury to the medulla or haemorrhage into the ventricular system of the brain, which might have interfered with the respiratory centre. Could this have been possibly due to the pressure on the Island of Eeil ? Can anyone inform me as to the functions of
[Dec.,
this part of the brain ? I cannot find definite about it in the literature.
1911.
anything
