A man committed suicide by means of a pistol-bullet fired through the mouth. The bullet lodged against the under surface of the petrous bone, tearing the jugular vein and lacerating the nerves passing through that foramen. In another case the patient was admitted with a fractured base. He progressed favourably until the tenth day when, on sitting up suddenly in bed, he was seized with rigors, dyspnœa, and dysphagia, dying shortly afterwards. A basic fracture was found, practically dividing the skull into two parts and involving the jugular foramen. Displacement had occurred with consequent compression of the ninth, tenth, and eleventh nerves. _The twelfth nerve._ The anterior condyloid foramen is most favourably situated with respect to the course pursued by posterior fossa fractures. No instance of its involvement has come under my own observation. Stierlein records a case in which the tenth and twelfth nerves were injured, with inability to speak or swallow, paralysis of the right half of the tongue, soft palate, vocal cords and pharyngeal constrictions. Death resulted in seven weeks. The late Professor von Bergmann[22] mentions a case of hypoglossal paralysis together with paralysis of the sterno-mastoid and trapezius muscles (eleventh nerve). For _treatment_ of basic fractures, see p. 116. FRACTURE OF THE BASE OF THE SKULL: SUMMARY OF SYMPTOMS ----------------------+----------------------+---------------------- _Anterior Fossa._ | _Middle Fossa._ | _Posterior Fossa._ ----------------------+----------------------+---------------------- _Hæmorrhages._ | _Hæmorrhages._ | _Hæmorrhages._ Subconjunctival. | Into the temporal | Into the nuchal Palpebral. | region. | region. Peripalpebral. | From the mouth. | Into the occipital Orbital. | From the nose. | region. Retinal. | From the ear. | Into the From the nose. | | post-auricular From the mouth. | | region. | | _Cerebro-spinal | _Cerebro-spinal | _Cerebro-spinal fluid._ | fluid._ | fluid._ From the nose. | From the nose. | None. From the mouth. | From the mouth. | | From the ear. | | | _Brain-matter._ | _Brain-matter._ | _Brain-matter._ From the nose. | From the ear. | None. | | _Air-escape._ | _Air-escape._ | _Air-escape._ From the frontal | From the mastoid | From the mastoid sinus. | antrum. | antrum. From the ethmoidal | | cells. | | | |