The Surgery of the Skull and Brain

by Louis Bathe Rawling

It is obvious, therefore, that many factors require consideration in estimating the extent of the osseous lesion and the nature of the complications existent in any given case. Due allowance must also be paid to other factors entering into the case, more especially in relation to the weapon used—pistol, revolver, gun, &c.

Injury to the bone.

The various injuries to bone may be classified as follows:—

Fractures limited to the external table.

Fractures limited to the internal table.

Gutter fractures.

The complete fractures produced by a penetrating wound.

The complete fractures produced by a perforating wound.

Fractures limited to the external table.

Fractures of this nature are of exceedingly rare occurrence. They are produced by a bullet which strikes the skull in such an oblique direction that the scalp and external table are torn away (‘gutter’ fractures), or by a bullet which, directed against the outer wall of the frontal sinus, possesses sufficient force to comminute the outer wall of that sinus, but, from loss of momentum, is incapable of penetrating further.