ve known a deer to be killed by
the impact of a heavy rifle-ball against one horn, although there was
no evidence of fracture of the skull. On the other hand, game animals
often escape after such injuries not directly involving the brain,
although temporarily rendered unconscious, as I have observed in
several instances, the diagnosis undoubtedly being concussion of the
brain.

"Slight injury to the brain, and especially if it be unilateral, then,
may not produce unconsciousness. It is not very uncommon for a missile
from a heavy weapon to strike the skull, and be deflected without the
production of such a state. Near the town in which I formerly
practiced, the town-marshal shot at a negro, who resisted arrest, at a
distance of only a few feet, with a 44-caliber revolver, striking the
culprit on the side of the head. The wound showed that the ball struck
the skull and plowed along under the scalp for several inches before
emerging, but it did not even knock the negro down, and no
unconsciousness followed later. I once examined an express-messenger
who had been shot in the occipital region by a weapon of similar size,
while seated at his desk in the car. The blow was a very glancing one
and did not produce unconsciousness, and probably, as in the case of
the negro, because it did not strike with sufficient directness."

Head Injuries with Loss of Cerebral Substance.--The brain and its
membranes may be severely wounded, portions of the cranium or cerebral
substance destroyed or lost, and yet recovery ensue. Possibly the most
noted injury of this class was that reported by Harlow and commonly
known as "Bigelow's Case" or the "American Crow-bar Case." Phineas P.
Gage, aged twenty-five, a foreman on the Rutland and Burlington
Railroad, was employed September 13, 1847, in charging a hole with
powder preparatory to blasting. A premature explosion drove a
tamping-iron, three feet seven inches long, 1 1/4 inches in diameter,
weighing 13 1/4 pounds, completely through the man's head. The iron was
round and comparatively smooth; the pointed end entered first. The iron
struck against the left side of the face, immediately anterior to the
inferior maxillary and passed under the zygomatic arch, fracturing
portions of the spheroid bone and the floor of the left orbit; it then
passed through the left anterior lobe of the cerebrum, and, in the
median line, made its exit at the junction of the coronal and sagittal
sutures, lacerating