3. =Skull-Cap.= The measurements (circumference, 49-65 cms.; long.
diam., 18 cms.; trans. diam., 13-15 cms.), form, asymmetry, character
of surface (normally smooth and moist), color of cranial bones,
character of sutures and fontanels (easily traced?), supernumerary
sutures and bones, consistence (softened in craniotabes, purulent
inflammations, syphilis, neoplasm), new-formations of bone,
perforations (syphilis, neoplasms, Pacchionian granulations, purulent
inflammation), elevations, depressions, fractures, areas of erosion
or absorption, thickenings of external surface (crater-like due to
organized cephalhæmatoma, chronic periostitis, neoplasm or gumma),
radiating scars or indurations (syphilis), red, soft, spongy
thickenings (rachitis). The temporal and frontal regions are most
frequently the seat of syphilitic (corona veneris) and rachitic
changes (frontal and temporal bosses, square forehead, etc.) Note
ease or difficulty in sawing, relation of external table, diploë and
inner table, measure thickest and thinnest portions, character and
amount of diploë, weight of skull-cap (heavy in sclerosis, light
in atrophy), dural adhesions, examine by transmitted light (color,
blood-content, presence of pus in diploë may be shown by greenish
or yellow color), smooth or rough inner table, erosions (rough,
more or less reddened), grooves of meningeal vessels, Pacchionian
erosions, hyperostosis, exostosis, osteoma, osteophytes (not uncommon
in pregnant women, also in hydrocephalus, acromegaly), atrophy (old
age, craniotabes, hydrocephalus), sclerosis (syphilis). In marked
cachexias (cancer of stomach) the inner table often shows a high
degree of erosion and atrophy.
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