Context of (Ununited) Anterior half of calvarium. Punctured fracture at three points with depression of the internal table. One fracture occurred at the frontal protuberance; the second, 4cm distant, just within the temporal ridge; and the third near the anterior inferior angle of the left parietal 4cm from the sutures; these punctured openings are 5mm to 7mm in diameter. On the external surface these openings are as clean as though made with a sharp cutting punch. No fissures radiate from them. Small fough framents of the internal table project inwards from the margin of the holes at which they maintain their connection with the sound bone. One of these is a centimeter long, is connected with the fracture of the frontal portuberance. Case of R.C., aged 16, a factory hand who fell upon a large wheel covered with spikes of polished iron 9 cm long, sharp at the points and 6mm thick at the base. It was a revolving comb for disentagling hemp. The boy fell upon it, became impaled by the hooks. It required two men to release him. When drawn off the hooks, the boy was perfectly conscious, did not think he was much hurt and wished to walk home. He was admitted to the Episcopal Hostpital, Philadelphia. Eight or ten large lacerated wounds of the back of the right hand and arm and a fracture of the left molar[sic] bone were also found. There were no brain symptoms whatever at the time of admission. The lacerations were reflected and secured by sutures and water dressings applied to the head and face. The boy did well till the third day when there were intervals of delirium. On the fifth day, hemiplegia of the right side occurred. On the sixth day, difficulty in separating the jaws, especially on the left side; trismus; risus sardonicus; hard abdominal muscles; rectum and bladder. Tetanus continued till the tenth day when the boy died unconscious. Besides the injury to the bones, the brain and its membranes were found lacerated at points corresponding to the fracture. The right anterior cerebral lobe was more lacerated than the middle one and was the seat of a large abscess. There was no particular congestion of the base and medulla. The spinal cord was not examined. Abscess about the left knee joint. The wounds in the arms appeared to be in good condition. Trans. Coll. Phys. Phila. Vol 3, new series, p.466



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