+ 
- ra : . * ” 
snip mS ae 91 
ous breathing; éc;, go off gradually : he begins to bout in bed, 
raises his eyelids, and makes some feeble attempts to __ But if 
these favorable circumstances do not. appear immediately. . 
operation, we are not to despair of success; for when the brain has 
been long compressed, it does not always recover its functions imme- 
diately... Besides, it often happens that the brain. has receiyed a 
violent shock or concussion, in which case the sy mptoms do not de- 
pend entirely on the’compression. ‘T'wo causes, viz.: infla 
of the membranes of the brain, and concussion of the age 
may yet interfere and render the cure more doubtful thaneyver, A 
surgeon ought not, therefore, to imagine that all his busineaid is 8 SIGE 
- when the operation is finished. Peg 
If, after all the evident-causes of compression are moved, the 
pulse is slow and soft, if the patient remains torpid, and especially 
if the pupilsdo not contract on exposure to light, there is much cause 
to suspect that a concussion of the substance of the brain has taken 
place. _ But, when, instead of these Symptoms, there is some return 
of sensibility, as is indicated by the patient's becoming unmanagea- 
ble and moving from one part of the bed to another ; if the pulse 
become full, firm and quick ; if the eye appears. inflamed and the 
pupil contracts strongly in the light; we may suspect that in- 
flammation of the-membranes of the brain has taken place, These 
membranes are susceptible of inflammation to a remarkable degree ; 
and where it is once induced it extends over the whole of them with 
rapidity ; a circumstance that easily aceounts for the high degree of 
infismmation which is often observed in the eyes, and t the severe de- 
ain which their exposure to much light in this, situation 
produce. Sage. 
When in Beation is found to have taken place, blood-letting be- - 
comes requisite, together with blisters, smart purgatives, mild sudori- 
fics, and low diet. But when the symptoms appear toarise from concus- , 
sion, the only evacuation that should be advised is gentle purging ; for 
in this case, blood-letting certainly does harm. In both situations, the 
patient should be kept perfectly quiet, excluded from the light, and 
his food of the mildest. kind, together with diluent drinks. 
' In the mean-time, the state of the wound requires particular atten- 
tion ; for after the.operation the membranes of the brain are 
inflame. and become gangrenous, » Nothing so certain! 2 
as a free. suppuration upon the i injured m aap ith. 
emollient poultices and fomentations should be applied over the dres- 
sings, and renewed every two or three hours, which scon.promete _ 
a plenti ‘tow of matter from the perforations of the skull, remoye = - 
the tension and render. the symptoms less violent. aaaes : 
At every dressing, the matter Testing in th uinaigie should 
be removed with a piece of soft sponge en 
speedily covered. with a pledget of any mild, 
When the eure goes on properly granulations soon appear upen 
dura mater, or lining of the inside of the skull, as well as on the x 
the wound; and these.continuing to advance, the different 
made by the trepan_are at last completely filled uP, and t 
~bejng brought ee at r i 
