Medical Jurisprudence And Toxicology

250 MEDICAL JURISPRUDENCE

to the fingers on palpating it. The- diagnosis is not easy in such cases. In
a hsematoma there is pitting on pressure and there may be a pulsation if
any large artery is involved. Its edge is raised above the surface of the
skull, and, if subcutaneous, is moveable on its surface, while in a depressed
fracture the edge is at or about the level of the rest of the skull and is
sharper, mere irregular, and less evenly circular than in a hsematoma.

Wounds of the scalp usually heal rapidly, though in rare cases fatal
results may follow from the supervention of cellulitis or erysipelas, or sup-
puration may set in, and travel into the brain through the blood vessels or
through necrosis of bone resulting from cellulitis, or through an unnoticed
fissured fracture. Thus, cases have occurred in which scalp wounds have
apparently healed, and yet death has occurred from septic meningitis or
brain abscess after a few days or weeks.

The following are a few of the cases brought to my notice : —

1. In 1912, a Hindu male, aged 45 years, went walking to the Thomason Hospital
at Agra, three or four days after receiving a lacerated wound on the head. He was
admitted to the surgical ward, where he died after four days. At the necropsy the
cause of death was found to be septic meningitis due to a fissure in the right temporal
bone.

2. A Hindu male, 22 years old, received seven lacerated wounds on the head on
the 24th May 1919. Four days afterwards he was admitted to the Police Hospital at
I/ueknow, from where he was discharged at his own request as the wounds had almost
healed with the exception of two which were infected with pus. On the 18th June,
he got an attack of paralysis and was, therefore, removed to a dispensary at Malihabad,
where he died on the 28th June. On examination of the body necrosis of the left
parietal bone in an area of one inch by three-quarters of an inch and a fissure in the
right parietal and temporal bones were found. There was a collection of pus between
the dura mater and the skull under the fissured fracture. That portion of the dura
mater was almost blackened and pus was seen on the upper surface of the brain, espe-
cially on the right side,

3. A woman, 70 years old, was injured on the head by dacoits on the 12th March
1921, and on the 22nd March, she succumbed to the injuries. On post-mortem examina-
tion on the following day a lacerated wound, two inches by three-quarters of an inch,
covered with pus, was found along the left side of the crown of the head, one inch and
a half above the forehead, exposing the bone which was denuded of its periosteum.
The skull bones were intact. The membranes of the brain were congested, and covered
with a deposit of lymph. Pus had collected in an area of one inch square on the left
upper surface of the brain under the wound.

4. On the 22nd June 1924, a Hindu male of Police-Station Malihabad, District
Lucknow, 45 years old, was admitted into the King George's Hospital, Lucknow, for the
injuries inflicted on his head with a blunt weapon and died on the 14th July 1924, at
6-35 p.m. Post-mortem examination on the next day revealed a comminuted fracture
of the left frontal bone and a fracture of the right anterior and middle fossae of the base
of the skull. The brain substance had sloughed away in an area of 3" X 3" on the
undersurface of the frontal lobe on the left side. There was pus underneath the slough
in an area of 2" X 2" X 4"-

5. On August 20, 1932, a Hindu male, aged 38, was struck on the head with a heavy
cutting weapon, while he was asleep, and he sustained a linear fracture of the right
temporal bone with an incised wound on the right side of the head. He was quite
conscious and able to answer questions rationally till August 31, when he developed
the signs of cerebral irritation which deepened into coma, and died on September 9.
Post-mortem examination revealed an abscess of the middle and posterior portions
of the right hemisphere of the brain in addition to fracture of the skull bone.

6. A Hindu male, 50 years old, sustained a lacerated wound, 2i" by J", across the
crown of the head to the right of the middle line and 2" above the forehead as a result
of a blow from a blunt weapon on the 13th November 1932. He was almost unconscious
and was suffering from cerebral irritation and partial paralysis of the right upper limb.
On the_ 22nd November, he regained consciousness, and was able to speak, although
not rationally. He died from pneumonia on the 28th November. At the autopsy I
found a fissured fracture of the right parietal and right temporal bones with effusion
of clotted blood over the membranes which were congested. There was a contusion,
1" by 1", with softening over the right temporo-sphenoidal lobe. The left lung was
pneumonic.