A healed bony puzzle: an old gunshot wound to the head

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The Institute of Forensic Medicine, as a part of the Uni-versity of Belgrade, School of Medicine, was founded in1923 by Professor Milovan Milovanovic´ (1884–1948). Inthe intermediate period of the two World Wars, he estab-lished a forensic collection and founded a small forensicmuseum at the Institute. This is one of his cases, which isinteresting even to this day.Case history and clinical presentationThe presented case is labelled ‘‘police investigation No.214/36, of the District Court of the City of Belgrade’’. Inthis case, the deceased was a 52-year-old male who was aretired supervisor of the State Ministry of Finance and whowas married with two children. He died in the State Gen-eral Hospital on January 9th, 1936, a few hours after beingadmitted. The clinical diagnosis given is ‘‘Apoplexiacerebri. Haemiplegia lat. dex. Coma…’’. In the autopsyrecord, and in an old-fashioned style by professorMilovanovic´ himself, there is data written in Cyrillic, in inkand by hand (Fig. 1): ‘‘His uncles were drunkards. And hewas as well. Since 1920, he had taken only strong drinks.He was dead drunk everyday… and was short-tempered…Lately, after drinking, he had been suffering pains in hisheart and stomach… On the 13th Of October, 1930, he shothimself: a gunshot injury to the forehead. As a result, hewas in hospital for 5 days, conscious; but he left the hos-pital, having recovered. On the 1st of January, 1936, hewas as drunk as a lord. Until the 8th of January, he felt verybad… On the 9th of January, at noon, he unexpectedlysuffered a series of epileptiform seizures… Between theseizures, he was unconscious. Due to this, he was trans-ported to hospital. Lately, he had been intellectually ruined,forgetful, lazy, tired…’’.Autopsy record and findingsThe date of the autopsy was January 10th, 1936: ‘‘Autopsy LNo. 44 for the year 1936, forensic case No. 15’’ reads:‘‘Male…Length of the body 173 cm…On the left forehead,a linear scar… The diameters of the skull are 175 and145 mm, the skull thickness is 5–8 mm. In the outer tableplate of the left section of the frontal bone, there is anirregular defect that is 3 9 2 cm in diameter, and has wellrounded, thick, and smooth margins. From this defect, thereare two linear old fractures running out of the frontal and leftparietal bone. In the left section of the orbital portion of thefrontal bone, there is a pea-shaped hole, covered by dura…In this spot, the dura is brownish-red and has fused with theleft frontal lobe. This part of the left frontal lobe is mollifiedin a diameter of a walnut and is brownish-red in appearance;unrecognizable in its structure… The brain is quite edema-tous… The bronchi full of pus… The abdominal cavity isfilledwithapproximately300 ml ofclear yellowishliquid…The spleen has doubled in size…A liver has also doubled insize, and is firm, nodular in appearance, yellowish… Thetissue of the pancreas is firm, fibrotic… Several smallstomach ulcers are present…’’.The autopsy record also includes two seal-stampedschemes of the lower inner and outer surface of the skull.Professor Milovanovic´ marked and described the bonelesions in red pencil (Fig. 2). The irregular defect of the