CASE.—Colonel Thomas Ruffin, 1st North Carolina Cavalry, aged 37 years, was wounded at Bristow Station​, Virginia, October 14th, 1863, by a conoidal ball, which struck the skull, near the junction of the coronal and sagittal sutures, and passed along the latter a distance of four inches, fracturing both tables. He was admitted to the 2d division hospital at Alexandria on the following day, being perfectly conscious. No paralysis existed and the pupils were normal. On the 17th there was slight delirium occurring at intervals. The bowels being constipated, half an ounce of castor oil was administered. He retained full possesion​ of his faculties until a minute before his death, which occurred suddenly on the 18th. On the removal of the skull-cap, it was found that the inner table was shattered for a space of one and a quarter inches in diameter; spiculæ being lodged in the membranes and driven into the substance of the brain. As this organ was taken from the cavity for special examination, two ounces of blood collected in the back of the skull; and two clots containing somewhat more than an ounce of fluid, with about three ounces of a sero-purulent character, were found lying upon the left anterior lobe, beneath the dura mater. A flattened piece of the missile was found in the right anterior lobe, on a level with the corpus callosum, directly beneath the wound of entrance. The pathological specimen is No. 1734, Sect. I, A. M. M. The fractured and depressed portion measures three-fourths by one inch. A fissure one inch in length runs downward in the centre of the frontal bone. The fragments removed consist entirely of diploë and inner table. The fragments of the outer table remain in situ. The specimen and history were contributed by Acting Assistant Surgeon T. H. Stillwell.