ART. I.-Injuries of the Skull—their relation to Medical evidence, with reports of cases, and remarks upon the employment of the Trephine. By C. C. F. GAY, M. D. Surgeon of the Buffalo General Hospital.

Injuries of the head are so often associated with crime or criminal intent, or at least, their infliction so often becomes a subject of legal investigation, that Surgeons as experts, are called into court to testify how an injury is produced, by what kind of missile or instrument, the amount of danger caused and the probable results to be expected.

The amount of damages to be paid by individuals or corporations or the degree of punishment-whether by imprisonment or death, largely depends upon the testimony of the Surgeon.

But a few days since, the enquiry was made by the able District Attorney, Mr. Williams, whether or not a blow upon the head which did not fracture the skull might be considered as dangerous, or even more dangerous than another blow that fractured the skull. To which I replied affirmatively. He said a case had occurred in court during his term of office, wherein endeavor was made to elicit this fact from medical witnesses, but that there was conflict of opinion.

One of the purposes of the writer in preparing this article, is to

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examine this question, in order to ascertain if there be any valid reason why medical opinions should not be uniform, and testimony devoid of discrepancy.

The fact, elicited by the question propounded by the District Attorney, is probably well established, still there may be vacillation and uncertainty in the minds of some; if so, I hope to give additional evidence of the fact, by report of cases of injury to the skull, selected from among several recorded in my note-book. The report of the cases themselves it is believed will not be wholly barren of interest.

CASE 1.-Compound fracture of parietal bone.-Thomas Manning, aged 30 years, admitted to Hospital on April 1st, 1873, was at work excavating earth, when the stone foundation of a building caved in upon him, causing compound fracture of the cranium. I saw the patient soon after the injury was inflicted. He has scalp wound extending from forehead over the vertex to occipital bone down behind the ear, almost entirely denuding the right cranial hemisphere. The parietal bone is fractured through its entire vertical diameter, the fracture runing obliquely downwards in the direction of the posterior inferior angle and depressed quite one quarter of an inch, and three inches or more in extent. Symptoms of compression present. There is no consciousness nor sensibility. Pupils contracted, pulse 30 per minute and intermitting. Assisted by Drs. Van Peyma and Slacer, and Mr. Bartow I removed a section of bone with the trephine. By the opening thus made I was able, with the use of the handle of strong forceps to elevate the bone. To accomplish this, much strength in the instrument was required and force of muscle necessary to be employed on account of over-riding of the bones.

By a canting motion of the elevator the bone was made to fly back to its normal position with a snapping sound which was audible in the most remote part of the ward.

The elevation of bone was perfect throughout the entire extent of the fracture. Anæsthetics were unnecessary, and were not used. Almost simultaneous with the elevation of depressed bone, the patient became sensible and conscious. His pulse went up to 60