Cerebral compression : its physiological basis and therapeutic indications : address delivered at the annual meeting of the Medical Society of Nova Scotia, Windsor, July, 1907 / by Edward Archibald.
- Archibald, Edward William, 1872-1945.
- Date:
- [1907]
Licence: In copyright
Credit: Cerebral compression : its physiological basis and therapeutic indications : address delivered at the annual meeting of the Medical Society of Nova Scotia, Windsor, July, 1907 / by Edward Archibald. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![a relief maintained for two days, when unfortunately, the patient died of pneumonia. Finally a fifth chart served to slujw the diagnostic value of blood-pres- sure examinations in distinguishing between concussion and compression. A man suffering from concussion (presumably) was admitted to the Royal Victoria Hospital about i p. m. His blood-pressure was 95; at 8 p. m., it was 92; at midnight, 98; 3 a. m., 102 ; 8 a. m., 122 ; and at this normal figure it remained. It is char- acteristic of most cases of concussion to show a subnormal blood-pressure; but if compession from intracranial bleeding be superadded, this will show itself in a rise of blood-pressure above normal. In this case, the slow recovery of blood-pressure and its re- maining at the normal level were strong evidence that the brain was not suffering material compression and that the case was one of pure concussion.] To discuss at all fully the operative indications that may rationally be deduced from these physiological premises, would carry us too far. I fear I have already over- stepped my time—I shall therefore add but a few words. The treatment of compression in the light of these considerations must be to relieve the compresion—not to lower a high blood pressure, which as we have seen is Nature’s attempt to overcome the obstruction ; there- fore bleeding and depressing drugs are in general contraindicated; while operation, either to remove the com- pressing body or to give more room is indicated. On the one hand we have the radical operation, on the other the palliative or “decompres- • J) sive. In intracranial hemorrhage from injury, there is of course no doubt as to operation if the bleeding come from the middle meningeal arteiy. But with regard to those cases in which the bleeding is inside the dura mater from pial vessels, I believe we must enlarge the limits of the indica- tions for operation and interfere to re- lieve dangerous pressure even where gross localising signs are absent. I think it is important that in hospitals the neurologist should be called in consultation early for traum.atic cases, as well as for tumour cases. He may perceive the finer localizing signs which the surgeon may miss. Or else the surgeon must acquire a good neurological knowledge him- self, which of course is the desidera- tum. I believe we shall soon be operat- ing to evacuate the clot from the cerebral substance in dangerous cases of apoplexy. I believe the obstetri- cian should call the surgeon in con- sultation for the intracranial haemorr- hages of the new born, where con- vulsions and a bulging tense fon- tanelle indicate high intracranial ten- sion. As to tumour, the general practitioner and the internist must learn to recognise them early, and not wait until the optic neuritis has gone on to blindness, and the vomit- ing and headache have reduced the patient to a sadly weak condition be- fore they call in the surgeon. In these cases surgeons are getting bril- liant results, both from radical opera- tion and in the relief of symptoms from the palliative decompressive operation, consisting in the removal of bone sufficient to relieve tension without invading the brain itself. This last for cases where diagnosis of the seat of the disease is impos- sible. It must be remembered that we can now localise the seat of a tum- our in 50 oer c'^nt. more cases than](https://iiif.wellcomecollection.org/image/b22419445_0012.jp2/full/800%2C/0/default.jpg)
