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Compression and Concussion of the Brain Coma

person, roused, shock, occurs and apoplexy


Coma is a state of stupor with loss of con sciousness. According to the degree of coma the person may be roused with difficulty, and then he lapses back, or he may not be able to be roused at all. It has been mentioned as occurring in inflammation of the brain and apo plexy. It also occurs in epilepsy, but in epilepsy it is of brief duration. It occurs also in disease of the kidney where the urine is suppressed. It occurs also in poisoning from alcohol and opium. The unconsciousness due to apoplexy or injury to the brain, and that caused by drunkenness, are very difficult to distinguish between. In the cases of persons found lying unconscious in the streets, who are roused with difficulty, the chance of apoplexy or brain injury being the cause ought always to be remembered.

In compression the brain is pressed on, it may be by blood which has escaped from ruptured vessels, as in apoplexy, or by a piece of bone, as in fracture of the skull, or by some body such as a bullet, which may by violence have gained entrance to the brain, or by other agents. The condition produced is similar to the comatose state due to apoplexy with bleed ing, and the treatment adopted is the same. (See p. 157.) In concussion or shock the brain is shaken, as may occur in a railway accident, for instance, where no apparent injury is done. The shock caused by a high jump, or a fall, or a blow, may produce concussion.

Symptoms.—The person becomes suddenly unconscious after the shock and lies motionless.

He may be roused to give some short answer to a question, and then he lapses back. In a short time he begins to come round, moves his limbs, perhaps becomes sick and vomits, and then be comes sensible. For a time he remains giddy, confused, and sleepy. In more severe forms the stupor is more profound, the skin is pale and cold, the pupils of the eyes wide, the pulse quick and feeble, and the breathing perhaps scarcely perceptible. After recovery has taken place there is danger of inflammation of the brain.

Treatment is directed first to recovery, and second, to prevent subsequent inflammation, or excessive reaction as it is called. To aid re covery, place the patient in bed, with the head on a level with the chest, not high. Let warmth be restored by warm clothing, by rubbing the limbs, and, if necessary, by warm applications to the feet. Stimulants should not be given. Stimu lants are allowable only when no attempt to rally occurs for a considerable time, and the person is still lying with cold, clammy skin and feeble pulse and unable to be roused. When the immediate shock is recovered from, the person should be kept quiet, in a dimly-lighted room, and should receive light diet and opening medicine. These precautions snould continue till danger is past. If excitement threatens, let a strong purgative be given, and let iced cloths be applied to the head. The person should be watched for several weeks after a severe shock.