HEAD.
Gunshot Fracture of the Skull, with Lodgment of the Missile.
The bullet in this case was so badly deformed by ricochet that part of both core and jacket were lost. While the appearance of the shadow seems to indicate a direct impact of the nose of the bullet, the line of contact with the skull must have been tangential, with some laceration of the scalp; otherwise a cursory examination of the scalp wound would have revealed the slightly protruding end of the bullet. The dark shadow above the projectile is due to material used in dressing. The great thickening of the scalp in the region of the wound shows a marked cellulitis. Small particles of the lead core of the bullet can be seen about the wound.
In such cases there is often a marked infection of the scalp without extension of infection to the cranial cavity, except from neglect. This is a case, though apparently simple, in which the radiograph was necessary for correct diagnosis without exploration.
The treatment in such cases is conservative, with removal of the projectile and care of the superficial infection or subsequent complications.
Plate 2.
Rifle—Plate 2.
HEAD.
Gunshot Wound of the Head, with Lodgment of the Missile.
Wound of entrance, near outer canthus, with course through eyeball to ethmoid body.