There are many cases on record in which an injury, particularly a gunshot wound of the skull, though showing no external wound, has caused death by producing a fracture of the internal table of the cranium. Pare gives details of the case of a nobleman whose head was guarded by a helmet and who was struck by a ball, leaving no external sign of injury, but it was subsequently found that there was an internal fracture of the cranium. Tulpius and Scultetus are among the older writers reporting somewhat similar instances, and there are several analogous cases reported as having occurred during the War of the Rebellion. Boling reports a case in which the internal table was splintered to a much greater extent than the external.
Fracture of the base of the skull is ordinarily spoken of as a fatal injury, reported instances of recovery being extremely rare, but Battle, in a paper on this subject, has collected numerous statistics of nonfatal fracture of the base of the brain, viz.:--Male. Female.
Anterior fossa, . . . . . . . . . . . 165Middle fossa, . . . . . . . . . . . . 506Posterior fossa,. . . . . . . . . . . 101Middle and anterior fossae, . . . . . 155Middle and posterior fossae,. . . . . 41Anterior, middle, and posterior fossae,10------ ------
9618 Total, 114.
In a paper on nonmortal fractures of the base of the skull, Lidell gives an account of 135 cases. MacCormac reports a case of a boy of nine who was run over by a carriage drawn by a pair of horses. He suffered fracture of the base of the skull, of the bones of the face, and of the left ulna, and although suppuration at the points of fracture ensued, followed by an optic neuritis, an ultimate recovery was effected. Ball, an Irish surgeon, has collected several instances in which the base of the skull has been driven in and the condyle of the jaw impacted in the opening by force transmitted through the lower maxilla.
The tolerance of foreign bodies in the brain is most marvelous.
In the ancient chronicles of Koenigsberg there is recorded the history of a man who for fourteen years carried in his head a piece of iron as large as his finger. After its long lodgment, during which the subject was little discommoded, it finally came out by the palatine arch. There is also an old record of a ball lodging near the sella turcica for over a year, the patient dying suddenly of an entirely different accident. Fabricius Hildanus relates the history of an injury, in which, without causing any uncomfortable symptoms, a ball rested between the skull and dura for six months.
Amatus Lusitanus speaks of a drunken courtesan who was wounded in a fray with a long, sharp-pointed knife which was driven into the head. No apparent injury resulted, and death from fever took place eight years after the reception of the injury. On opening the head a large piece of knife was found between the skull and dura. It is said that Benedictus mentions a Greek who was wounded, at the siege of Colchis, in the right temple by a dart and taken captive by the Turks; he lived for twenty years in slavery, the wound having completely healed. Obtaining his liberty, he came to Sidon, and five years after, as he was washing his face, he was seized by a violent fit of sneezing, and discharged from one of his nostrils a piece of the dart having an iron point of considerable length.
In about 1884 there died in the Vienna Hospital a bookbinder of forty- five, who had always passed as an intelligent man, but who had at irregular intervals suffered from epileptic convulsions.
An iron nail covered with rust was discovered in his brain; from the history of his life and from the appearances of the nail it had evidently been lodged in the cerebrum since childhood.
Slee mentions a case in which, after the death of a man from septic peritonitis following a bullet-wound of the intestines, he found postmortem a knife-blade 5/16 inch in width projecting into the brain to the depth of one inch. The blade was ensheathed in a strong fibrous capsule 1/2 inch thick, and the adjacent brain-structure was apparently normal. The blade was black and corroded, and had evidently passed between the sutures during boyhood as there was no depression or displacement of the cranial bones. The weapon had broken off just on a level with the skull, and had remained in situ until the time of death without causing any indicative symptoms. Slee does not state the man's age, but remarks that he was a married man and a father at the time of his death, and had enjoyed the best of health up to the time he was shot in the abdomen. Callaghan, quoted in Erichsen's "Surgery,"remarks that he knew of an officer who lived seven years with a portion of a gun-breech weighing three ounces lodged in his brain.
Lawson mentions the impaction of a portion of a breech of a gun in the forehead of a man for twelve years, with subsequent removal and recovery. Waldon speaks of a similar case in which a fragment of the breech weighing three ounces penetrated the cranium, and was lodged in the brain for two months previous to the death of the patient.
Huppert tells of the lodgment of a slate-pencil three inches long in the brain during lifetime, death ultimately being caused by a slight head-injury. Larry mentions a person who for some time carried a six ounce ball in the brain and ultimately recovered.
Peter removed a musket-ball from the frontal sinus after six years' lodgment, with successful issue. Mastin has given an instance in which the blade of a pen-knife remained in the brain six months, recovery following its removal. Camden reports a case in which a ball received in a gunshot wound of the brain remained in situ for thirteen years; Cronyn mentions a similar case in which a bullet rested in the brain for eight years. Doyle successfully removed an ounce Minie ball from the brain after a fifteen years' lodgment.