DOI: 10.7925/drs1.ucdlib_280505
title: Necrosis of frontal bone

description: Watercolour medical illustration depicting necrosis of frontal bone. It has the alternative reference number 1389, 24a and P18 on the front. The Richmond Hospital Museum reference is C.a.47 but there is no entry for this in P263/1 on pg. 20. The artist's name is in the bottom right corner 'J. Connolly Delt.' and in the left corner 'David Knowles Aet 50'. The typescript note on the back begins 'Injury of the Head; Death of the Bone; Softening of left Hemisphere; two Abscesses in the Substance of the right'.
description: Scope and content: The full typescript note on the back reads 'Injury of the Head; Death of the Bone; Softening of left Hemisphere; two Abscesses in the Substance of the right – Dr Hutton presented the recent specimens, exhibiting great extent of disease in the brain, which had been but little indicated by symptoms during life. The subject had been admitted into the Richmond Hospital, under Dr MacDonnell, on the 19th December, 1842. He was a bricklayer, who was at work on an arch of brick, which had suddenly given way beneath him. In his fall with the ruins, he received a flap wound of the scalp; the occipito-frontalis and the periosteum were torn down, and formed a flap hanging over the right eye; the man was but little stunned, and after a short time he very foolishly cut away the flap. There were no urgent symptoms when he was admitted into the hospital, and the shock to the system appeared to have been but slight. He went on well for some days, the sloughs were separating, and there were no symptoms of the brain having been injured; granulations formed from the margin of the wound; gradually the case began to assume an unfavourable aspect; there was no matter lodged under the scalp, but the wound began to look unhealthy, and more of the bone was laid bare. On 15th of January he complained of pain in the interior of the head, and especially towards the occiput; his mind gradually became clouded, and in course of a few days he had become quite stupid. There was no paralysis except of the sphincters; the faeces and urine were discharged involuntarily; the respiration was diaphragmatic. The stupidity increased to such a degree that he no longer replied to questions, though he could still speak distinctly; there was no strabismus until the last three or four days; the pules was rarely above 90 at any period of the case; the body became greatly emaciated, and the skin was harsh and dry towards the conclusion of the case; he died on 29th of January. The appearances observed in the examination after death were these: the scalp was detached from the right half of the frontal bone; the surface of the bone itself was yellow and cribriform; the coronal suture was separated, and the processes of indentation had been absorbed; the death of the bone had passed beyond the suture, both externally and internally; the dura mater presented the appearance usual in necrosis of both tables; it was rough, and had lymph deposited on it; there was subarachnoid effusion; the pia mater was injected, the substance of the left hemisphere was softened. At the base of the brain there was purulent lymph effused, particularly at the pons varolii, the medulla oblongata, and the optic nerves. When an incision was made into the right hemisphere, parallel to the longitudinal fissure, an abscess was discovered, situated immediately under or in the cortical substance; there was another abscess of a larger size contained in a sac, which communicated with the right ventricle; this sac was full of a tenacious matter, which had also passed into all the ventricles; their serous lining was inflamed, and layers of lymph could be raised from the serous surface; there were cysts in the choroid plexus, which had become vascular, and were covered with lymph: the thalami of the optic nerves, the corpus striatum, and the anterior lobes of the brain had also undergone a degree of ramollissement. It was remarkable that in this case there had been no convulsions, and no paralysis, except of the sphincter and slight sporadic contractions of the biceps.'
description: Numbering/sequence: Original reference number: 1389.