252 MEDICAL JURISPRUDENCE Fig. 116.—Depressed comminuted fracture of skull caused by a blunt weapon. If not associated with an external wound fracture of the vault is not always easily diagnosed. In such cases it is best to rely on the general symptoms resulting from injury to the meningeal vessels, cerebral sinuses and brain. - Fractures of the vault, though dangerous, do not always end in death. I have seen cases in which recovery occurred after the vault of the skull was fractured. A boy, ten years old, was hit on the head with a lathi and sustained a lacerated wound, 3" by i", along the right side of the crown of the head with a fissured fracture of the right parietal and occipital bones and partial paralysis of the left upper limb. After nine days he was admitted into the King George's Hospital, Lucknow, and was discharged cured after three weeks. Dawson3 relates the case of a girl, about 8 years old, who was knocked down by a motor lorry and sustained fractures of the parietal, temporal and frontal bones with frac- ture extending into the base of the skull. At the operation it was found that the dura mater was torn through which the brain matter was escaping. The patient recovered in a month's time. Tichborne4 also relates the case of a woman who was brutally assaulted by her husband, and who received five wounds on the head with complete compound fractures of the vault of the skull. The fractures were situated on the left temporal, frontal, right and left parietal, and occipital bones, the fracture on the occipital bone being 5" long and 1J-" gaping. All these fractures communicated with the surface of the brain, and in all cases the cerebral meninges were exposed. After three days she was taken to hospital, where the severed muscles and the torn scalp seemed sloughing and a general septic state prevailed. The patient did live and attended the court three months later. The Base of the SkuilL—Frac- ture of the base of the skull is generally caused by a blow or fall upon the vertex as the head is pressed on the other side of the spinal column. It may be caused "by a direct blow from the point of an umbrella or stick thrust through the roof of the orbit or up the nose through the cribriform plate, by a violent blow on the chin or by a gunshot wound through the roof of the mouth. It may also result from extension of a fracture of the vault, or may be caused indirectly by a heavy fall upon the feet or nates. The symptoms observed in fractures of the base are— (1) Signs of concussion or compression of the brain. (2) Effusion of blood in the subconjunctival tissue, or in the sub- occipital and mastoid regions. Fig. 117.—Fractures of skull caused by a banka (cutting weapon). 3. Ind. M«L Gaz., Feb. 1926, p. 65. 4. Lancet, Sept. 22, 1928, p. 599.