‘A man fell down an area and suffered from continuous hæmorrhage from the ear. He remained in bed for a few days, and then, becoming tired of confinement, got up, walked some distance on a cold and frosty day, and visited a _sage femme_. On returning home he complained of feeling ill, the hæmorrhage from the ear ceased, and shortly afterwards he became unconscious and died. The autopsy showed an extensive fracture of the petrous bone with extensive extra-dural hæmorrhage from a torn lateral sinus and from a lacerated meningeal artery.’[18] The man had remained fairly well so long as the extra-dural blood was permitted a free means of escape through the tegmen tympani and external auditory meatus, but, so soon as clotting occurred, compression symptoms developed and the man died in that condition. ‘A man, 50 years of age, fell down, striking his head against the kerb. On admission it was seen that blood was trickling freely through a torn membrana tympani. He rapidly became unconscious and died. The post-mortem examination revealed a fracture involving the middle ear and external auditory meatus, passing backwards across the lateral sinus, in which region there was a large extra-dural extravasation of blood.’[19] The above statements are confirmed by Dwight,[20] who, in 146 autopsies, found that, in 69 per cent. cases of fracture of the middle fossa of the skull, there was bleeding from the ear, and that in 29 per cent. cases the fracture was associated with laceration of branches of the middle meningeal artery. Although hæmorrhage from the external auditory meatus may be regarded as almost diagnostic of a middle fossa fracture, especially of that variety previously described as the ‘typical basic fracture’, yet the blood may be derived from a torn membrana tympani or from laceration of the lining cuticle of the external meatus. Aural examination will soon prove whether the blood is coming through a rent in the membrane, in which case the diagnosis is clear. Sometimes bleeding takes place from both ears, a symptom practically diagnostic of the transverse middle fossa fracture known as the ‘typical basic fracture’. The following statistics will supply further information as to the relative frequency with which hæmorrhage occurs from ears, nose, and mouth, and the proportionate mortality. The cases were collected and tabulated by Crandon and Wilson. -------------------------+--------+--------+-------+------------- |_Cases._|_Lived._|_Died._|_Mortality._ -------------------------+--------+--------+-------+------------- Hæmorrhage from the ear | 281 | 170 | 111 | 39 per cent. Hæmorrhage from both ears| 47 | 16 | 31 | 66 per cent. Hæmorrhage from the nose | 44 | 17 | 27 | 61 per cent. Hæmorrhage from the mouth| 168 | 73 | 93 | 33 per cent. -------------------------+--------+--------+-------+-------------