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was 6 3/4 inches in the longitudinal diameter； and 5 3/4 inches in the short oval diameter。 The dressing occupied an hour； at the end of which the patient arose to his feet and changed his clothes as though nothing had happened。 Twenty…six years after the accident there was slight unsteadiness of gait； and gradual paralysis of the left leg and arm and the opposite side of the face； but otherwise the man was in good condition。 In place of the parietal bone the head presented a marked deficiency as though a slice of the skull were cut out。 The depressed area measured five by six inches。 In 1887 the man left the hospital in Buffalo with the paralysis improved； but his mental equilibrium could be easily disturbed。 He became hysteric and sobbed when scolded。
Buchanan mentions the history of a case in a woman of twenty…one； who； while working in a mill； was struck by a bolt。 Her skull was fractured and driven into the brain comminuted。 Hanging from the wound was a bit of brain…substance； the size of a finger； composed of convolution as well as white matter。 The wound healed； there was no hernia； and at the time of report the girl was conscious of no disturbance； not even a headache。 There was nothing indicative of the reception of the injury except a scar near the edge of the hair on the upper part of the right side of the forehead。 Steele； in a school…boy of eight； mentions a case of very severe injury to the bones of the face and head； with escape of cerebral substance； and recovery。 The injury was caused by falling into machinery。
There was a seaman aboard of the U。S。S。 〃Constellation；〃 who fell through a hatchway from the masthead； landing on the vertex of the head。 There was copious bleeding from the ears； 50 to 60 fluid…ounces of blood oozing in a few hours； mingled with small fragments of brain…tissue。 The next day the discharge became watery； and in it were found small pieces of true brain…substance。 In five weeks the man returned to duty complaining only of giddiness and of a 〃stuffed…up〃 head。 In 1846 there is a record of a man of forty who fell from a scaffold； erected at a height of 20 feet； striking on his head。 He was at first stunned； but on admission to the hospital recovered consciousness。 A small wound was found over the right eyebrow； protruding from which was a portion of brain…substance。 There was slight hemorrhage from the right nostril； and some pain in the head； but the pulse and respiration were undisturbed。 On the following day a fragment of the cerebral substance； about the size of a hazel…nut； together with some brood…clots； escaped from the right nostril。 In this case the inner wall of the frontal sinus was broken； affording exit for the lacerated brain。
Cooke and Laycock mention a case of intracranial injury with extensive destruction of brain…substance around the Rolandic area； there was recovery but with loss of the so called muscular sense。 The patient； a workman of twenty…nine； while cutting down a gum…tree； was struck by a branch as thick as a man's arm； which fell from 100 feet overhead； inflicting a compound comminuted fracture of the cranium。 The right eye was contused but the pupils equal； the vertex…wound was full of brain…substance and pieces of bone； ten of which were removed； leaving an oval opening four by three inches。 The base of the skull was fractured behind the orbits； a fissure 1/4 inch wide was discernible； and the right frontal bone could be easily moved。 The lacerated and contused brain…substance was removed。 Consciousness returned six days after the operation。 The accompanying illustrations （Figs。 196 and 197） show the extent of the injury。 The lower half of the ascending frontal convolution； the greater half of the sigmoid gyrus； the posterior third of the lower and middle frontal convolutions； the base and posterior end of the upper convolution； and the base of the corresponding portion of the falciform lobe were involved。 The sensory and motor functions of the arm were retained in a relative degree。 There was power of simple movements； but complex movements were awkward。 The tactile localization was almost lost。
Morton mentions a patient of forty…seven； who was injured in a railroad accident near Phoenixville； Pa。； there was a compound comminuted fracture of the skull involving the left temporal； spheroid； and superior maxillary bones。 The side of the head and the ear were considerably lacerated； several teeth were broken； and besides this there was injury to the aura and cerebral substance。 There was profound coma for ten days and paralysis of the 1st； 2d； 3d； 4th； 6th； and 7th cranial nerves； particularly affecting the left side of the face。 There was scarcely enough blood…supply left to the orbit to maintain life in the globe。 The man primarily recovered； but ninety…one days from the injury he died of cerebral abscess。
There is the record of a curious brain…injury in a man of twenty…two； who was struck on the skull by a circular saw。 The saw cut directly down into the brain； severing the superior longitudinal sinus； besides tearing a branch of the meningeal artery。 The wound was filled with sawdust left by the saw while it was tearing through the parts。 After ordinary treatment the man recovered。
Bird reports a compound comminuted fracture of the left temporal region； with loss of bone； together with six drams of brain…substance； which； however； was followed by recovery。 Tagert gives an instance of compound depressed fracture of the skull； with loss of brain…substance； in which recovery was effected without operative interference。 Ballou； Bartlett； Buckner； Capon； Carmichael； Corban； Maunder and many others； cite instances of cranial fracture and loss of brain…substance； with subsequent recovery。 Halsted reports the history of a boy of seventeen； who； while out fowling； had the breech…pin of a shot…gun blown out； the sharp point striking the forehead in the frontal suture； crushing the os frontis； destroying 1 3/4 inches of the longitudinal sinus； and causing severe hemorrhage from both the longitudinal and frontal sinuses。 The pin was pulled out by the boy； who washed his own face； and lay down； he soon became semi…comatose； in which condition he remained for some days； but； after operation； he made complete recovery。
Loss of Brain…substance from Cerebral Tumor。Koser is accredited with reporting results of a postmortem held on a young man of twenty who suffered from a cerebral tumor of considerable duration。 It was stated that； although there was a cavity in the brain at least five inches in length； the patient； almost up to the time of death； was possessed of the senses of touch； taste； hearing； and smell； showed considerable control over his locomotor muscles； and could talk。 In fact； he was practically discommoded in no other way than by loss of vision； caused by pressure on the optic centers。 It was also stated that the retention of memory was remarkable； and； up to within two weeks of his death； the patient was able to memorize poems。 The amount of involvement discovered postmortem in cases similar to the preceding is astonishing。 At a recent pathologic display in London several remarkable specimens were shown。
Extensive Fractures of the Skull。 Jen