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Show 29$ or concussion. INFLAMMATION or Inn Blirtlh. . With the function of the nerv ous system, the powers of ti . circ ulating vessels also return ; and now they correspond witllb the disturbance oi the matter of the brain, and the vess els i the brain run into the extreme of over action. h 0 If the patient, recovered in a degree, again falls low with the symptoms of oppression from vasc ular action, the ,face is full, the features more in action, the pulse full and risen to .120 or 140, and the breathing stertorous. 01‘,a"ain as the msensibility is removed, the high exci tement of th: brain suc- 295 return of complaints with rigor, restlessness, and fever, it is a disease entirely different from the first nervous affection.- Having no direct relation to concussion, it proceeds probably from some local affection of the skull or brain. In the universal inflammation of the brain, which is occasioned by concussion, there is no such interval (as far as I have had experience) betwixt the first purely nervous effect and the rising of the inflammatory symptoms. I dissected the brain of a man who had been imagined to ceeds; the pulse becomes stro nger, the eye sensible to ligh lie ill of nervous fever, and in whom the inflammatory stage lerance of light, a flushing of the countenance a wild, look and incoherence, an impatience and restlessness; then hie‘h de- had followed the concussion, without the insensibility being much alleviated. The whole brain was inflamed, and very vascular, particularly one hemisphere; and on the surface t and the iris moveable ; there succeeds a contracted pupil :nd' into 4 hrlum, and this changing into the low delirium of opprston Wthh yields only to insensibilit y and death-As this stage advances, as the pulse rises and is full, the eyes become vivid there were large flakes of opaque coagulable lymph thrown out. There was fracture and depression of the temporal bone, which put the nature of the injury out of doubt; but or inflamed, and the check, fro m the paleness of the first effect, becomes flushed. We must now bleed largely and repeatedly, apply leeches to the temp les, blister the head ur e and afterwards keep the bowels open ; and it werehfielfl' think, if a nausea were kept up by small doses of tartarised antimony. But I beg leave furt her to remark that when this treatment overcomes the vasc ular action, the ,patient will be apt to fall into extreme feeblene ss. We see, from this View of the acce ssion of symptoms why evacuations are not required imm ediately upon receiviri" the inyury~for then there is a fear of death from the inamefliatc anury ; why they should not be great in the first starve and more profuse when the pulse rises. Often, however tliae ,mlse does not rise to this violence of inflainmatory action., An op1 ~ pression, like to that describe d as th e effect of pressure on the brain, immediately succeeds to the debility preduced in the iirst Instance, with apoplectic char acter, and stertorous breathing, total insensibility to light, involuntary passin" of the urine and fieces, and finally deat h. If the pain verti‘ro con~ fusion of sight, and nausea, which innnediately i'ollowb a'bIOW on the head, are removed, and if, after some days, there is a near that depression the surface of the brain was as natural as I any part of the whole, while the greater degree of inflammation was removed from opposite the fracture, and was chiefly where the brain is in contact with the falx. There was little if any fluid extravasation, and there were exhibited the marks of the greatest degree of active inflammation which I have ever seen in the brain. Though the skull was fractured, yet as the inflammation was not great in the neighbourhood of the fractured bone, and as there was no adhesion, nor tendcn~ cy to ulceration, in the brain or dura mater, near the injured bone, I construed this into the pure case of inflammation from concussion. When a patient is recovering from the effects of concussion, the mind is for a long time very irregularly exert»- ed; there is confusion of ideas, and partial loss of memory. Sometimes he remains long silly ; or his speech is afl‘ected, or his limbs are feeble and almost paralytic. OI‘ INFLAMJ‘IAIION OF 'l'llll BRAIN. I CANNOT allow myself to make a distinction betwixt the inflammation of the brain and the pia mater. This mfm- ii wan M09917! |