CONCUSSION AND COMPRESSION OF THE BRAIN AND SPINE.
The subject of concussion has received very close study owing to the large number of cases of injury in war caused by the detonation of high explosives where the enormous increase in atmospheric pressure is brought to bear upon the cerebro-spinal fluid. This will be referred to under Shell Shock.
The treatment of concussion of the brain differs materially from that of ordinary shock, though the two conditions are pathologically associated. Absolute rest in a darkened room, with silence and freedom from all exciting surroundings, with the patient lying flat upon a firm mattress, should he insisted upon. When the unconsciousness or dazed condition shows signs of passing off, the head should be elevated and the ice-cap used, and if the symptoms of reaction arc well marked leeches should be applied to the temples. A drop of Croton Oil with 5 grs. Calomel should he administered, and no food given save a few spoonfuls of diluted milk.
The danger of hemorrhage is increased by administering saline injections and stimulants; application of Ammonia to the nostrils, which may excite sneezing and raise the vascular tension, is also to be condemned. The
period of rest and quiet must be prolonged till a considerable interval after all symptoms have passed away; at least to to 20 days should be spent in absolute quiet, and if the condition known as cerebral irritation should supervene, the rest and quiet must be maintained for several weeks and no animal food of any kind administered.
Concussion of the spinal cord should be treated upon the same lines and the same precautions taken to avoid haemorrhage.
Compression of the brain is due to increase in the intracranial pressure, and may supervene upon concussion when one or more haemorrhages follow after contusion or laceration of the brain substance, in which case trephining or lumbar puncture will be indicated. The treatment of com pression of the brain will be detailed under the heading of each organic condition which causes it, as Head Injuries, Meningitis, &c.