1. Hemorrhage

Under this head, a disease is included which is of frequent occurrence in the skull of the new-born child, namely, the sanguineous tumor - thrombus neonatorum, cephalhematoma, - a disease on which far too much has been written.

It consists of a circumscribed collection of blood, which is poured out beneath the pericranium, in sufficient quantity to form a swelling, that feels doughy or fluctuating. It is distinguished by its situation from the extravasations, which so commonly occur in the new-born child between the pericranium and the aponeurotic expansion above it; and by the quantity of blood extravasated, and the consequent swelling which is formed, it may be distinguished from another extravasation, which forms a thinner layer, with an indistinctly defined margin, on the cranial, and especially on the parietal bones, and is extremely frequent, and indeed almost constant, in new-born children. This last extravasation is indeed of considerable importance, inasmuch as it is only a less degree of that hemorrhage which constitutes the thrombus.

The usual situation of cephalhematoma, is the parietal bones, and, as it seems, particularly the right: on this bone, too, it attains its greatest size. It is found with less frequency on the frontal bone, and still more rarely on the occipital. Usually only one exists, and that on one or other of the parietal bones; but cases are not altogether uncommon, in which a second smaller thrombus is found on the frontal bone, and there may be even a third on the occipital. In size it may not exceed a hazelnut, or it may form a tumor extending over the whole parietal bone.

When cephalhematoma reaches a considerable size, its shape is remarkable. On the parietal bone, especially, it generally resembles a kidney: its greater and arched margin lies along the sagittal border of the bone, and its concave edge or hylus embraces the parietal prominence. Neither on the parietal, nor on any of the other bones, which have been mentioned, does it probably ever commence on the "punctum ossificationis," but always external to that point. Not unfrequently, however, it spreads over the punctum as well as the rest of the bone.