Note 791 — ON INJURIES OF THE HEAD.

This, it will readily be perceived, is the fractura per resonitum, that is to say, the fracture par contre-coup, or counter-fissure of modern authorities. Except Paulus Ægineta, I am not aware that any of the ancient authorities question the occurrence of this species of the accident, and with the exception of Vidus Vidius, Guido, Fallopius, and Dinus de Garbo, it is generally recognized by the best modern authorities, from Bertaphalia and Andreas à Cruce, down to Sir Astley Cooper and Mr. Liston. Mr. Guthrie, indeed, remarks, that in recent times there has been no well-authenticated instance of fracture on the one side of the head from a blow on the other. Such cases, however, are not wanting in the works of the earlier modern authorities. Quesnay writes thus: “We find in authors, also, many cases of fracture by contre-coup, from one part of the head to the part opposite: and in honor of the ancients we may cite the case related by Amatus, who applied the trepan to the part of the head opposite to the wound, when he found that the symptoms were not relieved by applying it on the side wounded, and that the patient suffered from severe pain on the other side. This second trepan proved very apropos, for it allowed the escape of pus, which had collected under the skull.” (On the use of the Trepan.) All our modern authorities, including Mr. Guthrie, admit the reality of the case in which fracture of the base of the skull is produced by a blow on the upper part of the head. In imitation of our author, this case was denominated “infortunium” by the earlier authorities, such as Asellius and Porralius, being accounted an irremediable misfortune, because its seat could not be detected; and it is noticed in the following terms by Sir Astley Cooper, who did not trouble himself much about the writings of his predecessors, but formed his opinions from actual observation: “When the basis of the skull is fractured from a high fall, from the whole pressure of the body resting upon that part, on opening the brain and tearing up the dura mater, extravasated blood is commonly observed; this kind of fracture must inevitably prove fatal, nor can it be discovered till after death.” (Lectures, xiii.)