CHAPTER VII. i.IKS OP TUB HEAD. From April 1, 1855, to the end of the the returns show a total of 630 cues of gun-shot wounds of the head attended by contusion merely, more or less severe, and 8 deaths are recorded among these cases. Of gun-shot fracture without known depression, 61 cases appear, and 23 deaths therefrom. Of cases of fracture and depression, followed by seasonal disturbance, 74 cases are mentioned, and 53 deaths therefrom; while of wounds penetrating the cranium, 67 cases and 67 deaths are recorded. Of 19 cases in which the skull was perforated, all died. The trephine was employed 28 times, and of these cases 24 ended fatally. f MR. GUTHRIE has said, with much truth, that " injuries of the head affecting the brain are difficult of distinction, doubtful in character, treacherous in their course, and, for the most part, fatal in their results." Of all the accidents met with in practice, these are, beyond doubt, tin- most serious, both directly and remotely the most confusiiiir in their manifestations, and least determined in their treatment, although they have engaged tin attention of the master-minds of all ages and countries.
IP-HI tintime of the old surgeon of Cos, down to the The returns are not complete before the date specified. f Alcock reports 28 cases of fracture of the skull from gun-shot, and JJ Meniere gives 10 penetrating wounds by balls, all of whom died half on the day of admission. In the medical reports from ln<lia. I tin. I uiilv 9 cases to detailed as to be useful. They were all penetrating wounds, and!iem died. Lentf, in his statistics of the New York hospital, mentions cases of fracture of the skull attended by death in 106 instances. Several of these were fractures of the base, and none by gun-shot. present day. Such men as Petit, Quesney, Ledran, Pott, Dease, Heister, Cooper, Dupuytren, Bell, Velpeau, Larrey, Brodie, and a host of other honoured names, have thrown the light of their large experience and commanding genius on the subject; even minor points connected with it have been made the theme of whole libraries, and of innumerable discussions in the first medical societies of the world; still, there is no accident which the surgeon takes charge of with more fear and hesitation, as in no class of cases does he feel so much the mystery which surrounds and guards our life: for while in some cases death follows the most trivial injury, in others, a vast amount of destruction, and even removal of brain-matter, causes little, if any disturbance.
In war, injuries of the head of all descriptions are presented to us. Those by contre-coup, especially such as implicate the base of the skull, are certainly rare; but these also at times do occur. The comparative rarity of this form of injury in military, as compared with civil practice, is possibly accounted for by the less frequent occurrence of such accidents as are fitted to injure the base, and by the fact that war-projectiles seldom present a surface so large as to supply those conditions, which the experiments of Bichat would show are necessary to produce fracture of the skull by counter-stroke. It is, however, by no means true, that the " punctured fracture," as it is termed, is the only species of injury to which soldiers in the field are liable.