The first lines of the theory and practice of surgery: including the principal operations (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: The first lines of the theory and practice of surgery: including the principal operations (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    Another fact which deserves notice is, that, when pressure exists only on one side of the head, the paralysis generally manifests itself in parts on the opposite side of the body. Complete hemiplegia, however, is much more rarely the consequence of accidental inju- ries of the head, than of apoplexy; a difference, perhaps, referable in these cases to the difference in the situation of the effused blood. With respect to paralysis, though it is a common symptom of pressure, various facts prove, that it may also arise from concussion. Too much attention cannot be paid to one circumstance, fre- quently throwing considerable light on these cases. I allude to the patient sometimes recovering his senses, after having been stunned by the blow, and then relapsing into a drowsy condition, which is soon followed by all those symptoms already specified as denoting compression of the brain. That these symptoms cannot depend upon concussion is manifest; for then the patient would not have re- gained his senses for a time, a fact proving that the stunned condition of the patient, or the immediate effect of the concussion, had sub- sided. That the symptoms cannot depend upon a depressed frac- ture is equally manifest, because the patient would have been sense- less from the first, and have continued so ivithout remission. That the same symptoms cannot depend upon the lodgment of matter beneath the skull is certain, because there has not been time enough for inflammation and suppuration to occur. The real cause of the return of the loss of sense, then, under these circumstances, be- comes tolerably evident, and is accounted for by the extravasation continuing slowly to increase, and to produce more and more pres- sure, and its usual consequences, notwithstanding it had not advan- ced sufficiently at first to prevent the return of the mental faculties, on the subsidence of the immediate effects of the concussion which the brain had sustained. When no interval of sense takes place, but the patient lies insen- sible and motionless from the first, then we can only form a judg- ment of the cause of this state of the system by the consideration of other symptoms. Frequently cases of this kind are particularly unfavorable, as being complicated ones, combining concussion and compression together; and not only these evils, but a wound or la- ceration of the brain, and even a fracture at the base of the skull or elsewhere. Extravasations of blood between the dura mater and the base of the cranium are mostly fatal. When the blood lies between the dura mater and the tunica arachnoides, it is often widely diffused so as not to admit of being effectually discharged. When situated on one of the hemispheres, between the cranium and the dura ma- ter, however, it is often circumscribed, and may be discharged by a perforation of the bone. There is frequently extreme difficulty in forming an opinion about