Concussionofthe Brain

Concussion of the Brain. The symptoms of brain injury have been referred by surgeons into two groups. The term concussion of the brain is applied, roughly speaking, to those cases in which a head injury produces insensibility unaccompanied by any actual paralysis; while if, on the other hand, paralysis is developed, the condition is said to be one of compression of the brain. In thus drawing a hard and fast line between two classes of symptoms, the origin of the terms concussion and compression is practically ignored. When the word concussion was first employed by surgeons it was intended to be applied to those cases where, as the result of injury, the brain was shaken, but not affected by any gross lesion. While to other cases, where the injury produced rupture of blood vessels within the cranium, with effusion of blood, and resulting pressure upon the brain, the term compression was applied. Inasmuch, however, as the sudden increase of pressure within the skull, produced by the rupture of a blood-vessel, is frequently productive of some form of paralysis, the existence of paralysis came to be associated with compression, and its absence with concussion. The symptoms of concussion are those of shock (q.v.). The patient is unconscious, with pale face, cold skin, feeble and often irregular pulse, and shallow and feeble, attempts at respiration. This first stage or stage of collapse, as it is called, may terminate fatally, or may be rapidly followed by recovery, but it usually passes into what is termed the stage of reaction. In this last event consciousness returns, and some febrile movement is set up, which is either after lasting a few days followed by convalescence, or, in unfavourable cases, passes into an inflammatory stage. Treatment of the initial symptoms of concussion consists in placing the patient in bed. keeping him warm, and as quiet as possible. Stimulants should be avoided. Medical advice must, of course, be at once obtained, as a head injury severe enough to produce unconsciousness is no trifling matter. Concussion of the spinal cord is a disease which has sprung into notoriety of quite recent years in connection with railway accidents. The difficulty of arriving at a clear apprehension of the nature of the symptoms produced in such cases has been much enhanced by the fact that the matter has been complicated by questions of compensation, and concussion of the cord has figured largely in medico-legal literature.