A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy.

Date:: 1877

Credit: A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$present, when supposed to be absent. Dangerous or fatal symptoms may come on several days, or even weeks, or perhaps months, after the concussion and first injury. [Dr. Taylor refers to “ Medical Times and Gazette,” Juno 30, 1860, p. 645.] The Authors knew a case in Torquay, where some thieves attacked a gardener on his return from market, and knocked him about the head. He did not suffer any serious symptoms from it, but did his work for six weeks. He then began to get ill, and died from it after about five weeks more. An abscess of the brain was caused by the blows. In such cases it is often alleged for the defence, that there must be some intervening cause, or some second injury or violence. The experience, however, of practical surgeons quite con- tradicts this. [See Regina v. KeVper, Lewes Summer Assizes, 1871; also Travers’ “Constitutional Irritation,” p. 445 ; Hoffbauer, “ Ueber die Kopfverletzungen,” 1842, p. 57. Taylor, p. 617 ; and the works quoted above.] In some of the severer cases of concussion, the spine or the base of the brain, may be severely injured. In the Duke of Orleans’ case the base of the brain was fractured by a fall. [“ Med. Gazette,” vol. xxxvi., p. 368.] We shall return to the question of diagnosis, after reviewing the symptoms of compression. 2. Concession of the brain is the result of either extravasation of blood, or blood and serum, within the brain, with or without fracture of the skull, or of the pressure of depressed bone in fractures, and severe contusions, or of suppuration occurring within the cranium. The symptoms are essentially those of apoplexy. There is insensibility (coma); paralysis, either one-sided, or general; dilated* and insensible pupil [the pupils are often,unequal]; slow labouring pulse; skin often hot and perspiring, retention of urine, or involuntary evacuation of this, and of fseces, through paralysis of the sphincters; stertorous breathing (due to paresis of the velum pendulum palati). There may be convulsions or twitchings. as well as paralysis, and usually on the opposite side to the paralysis. The paralysis may involve the muscles more or less deeply, or may be confined to special nerve-tracks. Thus we get— (1) Hemiplegia, with paralysis of one side of the face; (2) Facial paralysis alone, or with anaesthesia (loss of sensation, due to the fifth nerve ; the portio dura of the seventh pair producing the facial paralysis); (3) We may have paresis of the ocular muscles; ptosis, or dropped (upper) eyelid, with various forms of squint [third, fourth, and sixth, nerves]; (4) There may be complete paralysis on both sides of the body (double hemiplegia); or, (5) Paraplegia, paralysis of the lower extremities ; and (6) Of the sphincters. Compression generally comes on after symptoms of concussion. Indeed, after the first shock, the patient often rallies for a time, some- times even for some hours. Then the symptoms described come on, at first like apoplexy of the ingravescent form; the injured man seems drowsy, and wants to sleep. These symptoms may be mistaken for poisoning by opium and other narcotics, for drunkenness, and for apoplexy. No surgeon who has studied at a large hospital, ought to confound them with concussion, except in a few rare cases, where the symptoms are equivocal. The extravasated blood may be—(1) Between * Tlic pupils are sometimes contracted, especially in large extravasations, or those about the l’ons and fourth ventricle.$