Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman.
- Fritz de Quervain
- Date:
- 1913
Licence: Public Domain Mark
Credit: Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![The following maxim will epitomize the diagnosis :— Any cerebral symptoms manifested by a patient immediatelv after an injurx to the sluill—eitlier of unconsciousness, of disturbance in the nu'dulla, of irritability or paralysis—point to his suffering from con- cussion of the brain. ]Ve cannot tell ivhether there be anx further mischief, for ivhich zee must aivait subsequent developments. Such a statement will save both ourselves and the relatives from being consoled with a simple concussion, while the patient shortly succumbs to pressure on the brain. The further mischief refers, as already stated, to brain contusion on the one hand, and meningeal haemor- rhage, with gradually increasing pressure, on the other hand. (2) CONTUSION OF THE BRAIN. We will now proceed to consider contusion of the brain. This consists of mechanical damage to the nerve tissue. This clearly differentiates it from concussion, which is a circulatory disturbance. But nevertheless there are numerous intermediate forms in which it is difficult to decide between the two, even at the autopsy, let alone during life. Experiment and histological research have shown that a severe blow causes, not only circulatory disturbance, but also mechanical damage to the nerve elements and interference with their mutual connections. Although no naked eye changes be produced, the severest functional disorders may follow, and even death. The difference between these changes and foci of contusion visible at an autopsy is only one of degree. There is a whole series of connecting links between an obvious contusion and the microscopic changes which are present in what is clinically a simple concussion. How can we clinically diagnose a contusion ? As in the case of concussion there is immediate onset of the symptoms after the injury. But the principal clinical difference between the two concerns the matter of duration. Again, in contusion focal symptoms predominate; there are signs of irritation or paralysis in cortical areas whose functions we know, whereas in pure concussion the general symptoms are more evident. But too much importance is generally attached to this distinction. There are many cortical areas whose functions we do not yet know, so that we cannot ascertain clinically whether they have been damaged. When a patient is unconscious it is not possible to test whether all the areas are functional, as for instance the occipital cortex. Some of the slighter and of the moderately severe symptoms must really, as a rule, be referred to the accompanying concussion. A definite contusion of the medulla produces so rapid a death by paralysis of the vital centres, that no time is allowed for diafjnostic reflections. But there is alwavs one](https://iiif.wellcomecollection.org/image/b2121010x_0028.jp2/full/800%2C/0/default.jpg)
