On middle meningeal haemorrhage / by W.H.A. Jacobson.

Jacobson, Walter Hamilton Acland, (1847-1924)

Date:: [1885?]

Credit: On middle meningeal haemorrhage / by W.H.A. Jacobson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$masses of cancellous tissues whicli it meets with in the mastoid and frontal bones, from which, as from abutments, the parietal bone springs like an arch. But a blow too violent to be weakened and dissipated by the above means, as from a fall from a height on to the head where the cranial bones are violently compressed between the ground and the weight of the trunk, is very Kkely to cause a fracture which, running down through the middle meningeal area, i. e. the parietal, squamous; and great wing of sphenoid, and rupturing an arterial branch, makes its way into the middle fossa and inflicts the further grave injury of fracture of the base of the skull. Vice versa a fracture beginning in the base of the skull and involving the sphenoid bone may send a fissure upwards and outwards through the thin spot represented by the anterior inferior angle of the parietal bone and thus cause a rupture of the artery. The importance of the above facts, the evident result which they have of interfering with, and adding diflBculties to, the diagnosis, and of rendering grave the prognosis by the com- plicated injuries which they produce, need only be alluded to here. Before considering what part of the brain is subjacent to the middle meningeal area, it will be well to recall the land- marks of the chief sutures which are met with between the bones in that region. The point where the coronal suture, the anterior limit of the parietal bone, leaves the sagittal may be found by drawing a line from a point just in front of the external auditory meatus straight upwards on to the vertex; from this point, the bregma (Woodcut 1*), the coronal suture runs downwards and forwards roughly speaking to the middle of the zygomatic arch, or more exactly, to join the temporal part of the great wing of the sphenoid, which^it meets an inch and a half above the zygoma and not quite an inch behind the external angular process of the frontal bone. Fig. 3, PI. IV, shows what has been pointed out at p. 4, the thinness of the bone in the neighbourhood of the coronal suture, just behind which large branches of the middle meningeal artery are running. The occipito-parietal or lambdoidal suture (Woodcut 1**), the posterior limit of the parietal bone, will be marked out by$

On middle meningeal haemorrhage / by W.H.A. Jacobson.

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