Traumatic injuries of the brain and its membranes : with a special study of pistol-shot wounds of the head in their medico-legal and surgical relations / by Charles Phelps.

Date:: 1898

Credit: Traumatic injuries of the brain and its membranes : with a special study of pistol-shot wounds of the head in their medico-legal and surgical relations / by Charles Phelps. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$bony layers.” This may be possible in so thin and fragile laminae as the orbital plates, but it is insufficient to explain the Assuring of bony parts so dense as the petrous portion of the temporal, or the floor of a middle or posterior basic fossa. There are also the special defects in Mr. Long- more’s explanation of the counterfracture in the case quoted, that it ignores the fact that the direction of force was parallel to the orbital surfaces, and that it fails to account for the upward dislocation of the fragments. In simple counterflssure of the base, it would seem more probable that the distant lesion was due to the direct trans- mission of force through the bone. In view of the numer- ous instances in which force is transmitted for a limited distance through the lateral wall of the vault before cleav- age begins, it is not illogical to suppose that in others exceptionally noted its course should have been even longer continued before its eruption. In counterflssures conflned to the petrous portion or to the contiguous basic fossae, it is scarcely possible to conceive, though the skull might be compressed to the point of bursting, that the rupture should have occurred in its most rigid if not abso- lutely inelastic portion. The effect of distant violence, in causing not only indirect fracture but limited osteal hyper- aemia and extravasation, is illustrated in Case CXXV. of the appended series and represented in Fig. 44. There are occasional indirect basic fractures which are more readily explicable, or even necessarily dependent, upon the suppo- sition that the skull has been violently compressed. In Case CIV. of the appended series, the circumstances of in- jury and the effects which it produced concur to make this explanation inevitable. The head was struck upon the occiput by a descending elevator and forced forward, with$