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Show .)' ' coo LXIRAVASATIOX or BLOOD. or THE rcxccs cannnnr. 3502 I find a man who has fallen from a great height lying co~ matose, with a very feeble pulse. He is trepaned, and a coagulum of blood is found under the skull, an inch in depth. The coagulum is cleaned away; the man considerably revives ; but there is no new flow of blood. Surely it could not be that an artery had been torn, and that this artery had bled with such impetuosity that it tore up the adhesions of the dura mater to the bone 9 Would not an artery that had force to tear up the (lura mater bleed still when the coagulum was taken away by operation 1' The truth, I fancy, is, that by the shock the dura mater is shaken from the bone, and that in consequence of this the blood is poured out by innumerable small vessels, which soon cease to bleed; and not from large vessels which, were we lql‘fllH Urn, litikllifll‘ t F even to allow that they throw out this coagulum, are not able to tear up the adhesions ; which indeed I with (litiicult‘. sometimes can do with my hands. This explanation is the suggestion of my brother, arising first in his mind, if I rceol» lect from the circumstances of a case in which I was operatin g. The shock which thus explains to us the extravasation, w ill also occasion the symptoms to be complicated with the effect of concussion, or a shock on the brain. I have never seen oppression purely characterised, when it proceeded from mere external injury. But I have seen cases where there was reason to suppose that the breathing was more sonorous , and pen formed with greater difficulty and heaving, and a more lanv guid pulsation of the artery, in consequence of this oppression, from extravasation combined with the eflect of concussion. I doubt very much if we ought to use the trepan for the evacuation of supposed coagula. Slighter eii‘usions may be OF THE MORE \VHEN the skull is fractured by a smart blow, the effect is different from that of a fall, or from the injury produced by a. heavy block falling on the head. There is more of local inju- ry, with less general concussion. .A‘.‘1-‘QK‘,.'-.""" - - I have in such a case per~ reived the part of the brain beneath the fractured bone, with- out any wound of the dura mater, to be injured by the sharp percussion, and the beating in of the skull. In this case the injured part falls into inflammation, exhibiting on dissection many spots of extravasated blood, and in the centre an ulcer and abscess. In general, although the ulcer has not penetrats ed to the ventricles, the whole surface of the lateral ventricle of the side diseased will be found bedewed with coagulable lymph and pus. With this deep disease of the brain, there is very little mark of general inilarrunation in its substance. Under this complaint the patient continues long rational, with only an obtuse pain in his head. But he is pale and feeble, and has tremors. When he puts out his tongue, it trembles like that of one in fever ; it is foul ; and there is sickness and vomiting. He has rigors from time to time; indulges in bed; is with difficulty roused; insensibility en- croaches upon his faculties, and he makes only confused at: tempts to speak, like one in a dream. The opposite side of the body lies still, whilst he moves the leg and hand of the same side more freely. Lingering thus, with a weak, flutter~ lug pulse, he dies. or rm: ruxcrs ccarsm. If, however, the bones be at the same time broken, and the coagulum exposed, we should en~ ‘gh OF THE BRAIX, \VITII ULCER. absorbed ; and if the blood is exposed, the dura mater will be more likely to suppurate. PARTIAL INFLAMMATION deavour to take it entirely away, to allow the dura mater to I HAVE dissected only two cases of that tumour called Fins gus Cerebri, which rises from the perforation of the skull and rise. dura mater. But the observations which I have made, and the opinion I have formed, are so different from those of my WON! M09 |
