(_a_) =Aran’s theory of irradiation.= This theory states that ‘fractures of the base result as extensions from fractures of the vault, the fracture following the shortest anatomical route to the base’. Although this theory must be accepted as offering a satisfactory explanation for the occurrence of a certain proportion of basic fractures, such, for instance, as result from a blow applied directly to the vertex, it certainly cannot be accepted as accounting for the great majority of basic fractures. The theory was advanced on the hypothesis that basic and vault fractures were necessarily co-existent. That combined lesions of this nature are frequently in evidence is not to be doubted for one instant. It is, however, ‘putting the cart before the horse’ to say that the vault fracture is always the primary lesion. Such is by no means the case.
(_b_) =The bursting and compression theories.= The skull is here regarded as an highly elastic sphere, compression of which leads to diminution in the diameter along the axis of greatest pressure, bulging occurring in other diameters. The bulging exceeding the limits of elasticity a fracture occurs, the line of fracture varying according to the different features present. Thus, when the lines of fracture run parallel to the direction of the compressing force the bone bursts open along the convexity (bursting fractures), and when the lines of fracture run at right angles to the direction of the compressing force a fracture by compression is said to result (compression fractures).
These theories are based on experiments carried out on the cadaver, the skull being enclosed in a tight-fitting box and subjected to pressure sufficing to bring about a fracture. Undoubtedly, the head may be compressed between two forces, as, for instance, when a person is knocked down in the street, the vehicle passing over the head, or, as in a case recently under my care, where a boy, hanging by his feet from the side of a barge, was crushed between the barge and the wharf as the vessel swung inwards with the tide. Cases of bilateral compression are, however, of infrequent occurrence, the great majority of basic fractures resulting from blows applied directly at the region of the level of the base of the skull (see p. 76), or from the forward propulsion of the body, the head coming into violent contact with a resisting object, as, for instance, when a person is thrown out from a motor-car, the head striking against a tree, brick wall, &c. In the first case, there can be no question of bilateral compression, and in the second the compression is exerted between the vertex and the occipital condyloid region.