CONCUSSION OF THE BRAIN (COMMOTIO CEREBRI) Concussion of the brain is described by Si111011 as follows: "The condition consists in a contusion, a displacement of the brain as a whole without injury to the brain substance. It results in diminished irritability of all the centres in the cerebral cortex and this loss of irritability may, under certain circumstances, go on to complete functional disability." The symptoms are loss of consciousness, vomiting, slowing of the pulse, retention of urine and, sometimes, transitory palsies and aphasia. Cases with palsy and aphasia justify the assumption of a local contusion of the brain, usually due to contrecoup. In the more frequent milder cases the above-mentioned cerebral symptoms are slight and often disappear before the child is seen by the physician.
Concussion of the brain is not frequent in childhood. In infants particularly it is rarely observed. The reason of this probably is that children rarely fall fronr a great height and, on the other hand, the child ish skull is soft and yielding and therefore offers less resistance to dis placement of the brain. On the other hand, on account of the thinness
of the cranial bones there is a predisposition to fracture.
The course and the prognosis in concussion of the brain are on the whole favorable. After a few hours, or rarely days, complete recovery takes place and no permanent disturbances remain as a rule. Cases of severe head injuries are observed in which the brain symptoms gradually increase and the child ultimately dies. In these cases it is natural to suspect a cerebral haqnorrhage and the suspicion is confirmed by the gradually progressive character of the symptoms. However, concussion of the brain may sometimes end fatally without any complications (von Bergmann).
The treatment consists in rest, lowering the head, keeping up the activity of the bowels and kidneys (catheter), regular diet and possibly the administration of heart tonics.