Note 783 — ON INJURIES OF THE HEAD.

I need scarcely remark, that if by this is strictly meant that wounds in the posterior part of the head are less dangerous than those in the anterior, the statement is at variance with the experience of certain modern authorities. See, in particular, Pott and Liston, p. 46. At the same time, it is, no doubt, anatomically correct, that the occipital bone can bear more violence, without being seriously fractured, than the frontal or parietal bones, and it is worthy of remark, that the views and experience of Mr. Guthrie are very consonant with those of Hippocrates. He says: “The result of my experience on this point is, that brain is more rarely lost from the fore part of the head with impunity, than from the middle part; and that a fracture of the skull, with even a lodgment of a foreign body, and a portion of the bone in the brain, may be sometimes borne without any great inconvenience in the back part.... I have never seen a person live with a foreign body lodged in the anterior lobe of the brain, although I have seen several recover with the loss of a portion of the brain at this part. My experience, then, leads me to believe, that an injury of apparently equal extent is more dangerous on the forehead than on the side or middle of the head, and much less so on the back part than on the side. A fracture of the vertex is of infinitely less importance than one of the base of the cranium, which, although not necessarily fatal, is always attended with the utmost danger.” (On Injuries of the Head, p. 3.) I feel difficulty in reconciling these discordant results of modern experience. Perhaps the fact of the matter is, that injuries on the upper part of the occipital region are the least dangerous of any, whereas those in the lower part of it, are particularly fatal.