Compression of the Brain.—This is a not uncommon condition in injuries of the head, arising from various causes. In whatever way this condition is brought about, from the pressure of extravasated blood, of pus or other in flammatory exudate, of a depressed por tion of bone from fracture or new growth, or from a foreign body lodged there, the symptoms, although present ing some differences, are, for the most part, constant. The patient lies in a state of lethargy, stupor, or coma, more or less completely paralyzed, heavy, in sensible, and drowsy, either not respond ing when addressed or only when spoken to in a loud tone of voice, and perhaps only when violently shaken. The respirations are slow and deep, with stertor or snoring, and usually a peculiar blowing sound. Paralysis of the velum palati, which, hanging down as a cur tain, is thrown into vibrations during expiration, seems to cause the stertor; the distension of the cheeks and the blowing sound are due to muscular pa ralysis of the lips and cheeks. The pulse is full and often slow; one or both pupils are dilated; paralysis of the sphincter ani causes involuntary evacua tion of the feces, and paralysis of the bladder generally causes retention of the urine; the skin may be cool, but is, in many cases, rather warm and covered with perspiration. Frequently the con dition of stupor alternates with parox ysms of delirium or of local convulsive action. This condition of coma may be
come complicated by the appearance of symptoms of inflammation. Unless the cause that produces the compression is removed, death quickly follows, the coma deepening and the patient dying in an apoplectic condition. In rare cases, the coma may continue for many weeks or months, until the cause of com pression is removed, when consciousness will return and the symptoms suddenly disappear. The treatment of this con dition is obvious.
Wounds of the Brain.—These are pro duced by severe blows or falls; by kicks; by the penetration of knives, swords, bayonets, rifle-balls, etc. by sharp spicula of depressed and by contrecoup with or without fracture. These wounds may be received on sides or vault of the cranium or through the mouth, nose, or orbit. These wounds are usually accompanied by fracture of the skull: in many eases punctured fractures of most dangerous character. They are all more or less septic in char acter, with laceration of the brain-sub stance, the deposition of foreign bodies (fragments of bone, hair, clothing, bul lets, etc.), more or less severe hemor rhage, and in many cases with loss of brain-substance. More rarely — as in children—the wound may be received through the fontanelle, or in adults through a large parietal opening with out accompanying fracture.