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April 1929


Author Affiliations

From the Neurological Laboratory of the Henry Phipps Psychiatric Clinic, Johns Hopkins University.

Arch Surg. 1929;18(4):1078-1118. doi:10.1001/archsurg.1929.01140130166008

In this paper I have made an effort to classify, according to clinical and postmortem observations, the large group of patients with lesions commonly spoken of as "fractured skulls." The early classifications were based chiefly on the type of bone lesion; the later studies were concerned chiefly with the degree of increased intracranial pressure. During recent years, the classification on the first basis has fallen into disuse in favor of that based on the degree of pressure and the accompanying neurologic symptoms. Dowman,1 in classifying the cases, made use of both methods, and called attention to the importance of classifying the cases before determining the type of treatment.

Postmortem and experimental laboratory observations offer a basis for a classification which makes the determination of the type of treatment easier. My observations permit of a division into seven groups, the first two of which are designated according to the skull