CONCUSSION. 61 



The constitutional treatment required may be different in the early 

 stages from the latter, being antiphlogistic or tonic, as the symptoms 

 demand. 



Wou7ids of the Scalp. — Simple incised wounds of the scalp give 

 little trouble but that of hemorrhage, which is best arrested by a 

 ligature or torsion ; a curved needle will be found more convenient 

 to secure the vessels than the tenaculum. The edges are to be 

 drawn together by adhesive straps, in preference to stitches, on 

 account of the danger of erysipelas. When a large portion of the 

 scalp is lacerated, and hangs like a flap, it is not to be cut, even 

 though it is attached by a very small process ; but, after being care- 

 fully cleaned, it is to be adjusted accurately, and retained in its place 

 by proper bandaging. It thus protects the bone from exposure, and 

 by granulation becomes firmly united to the adjacent parts. Blind- 

 ness may result from a wound upon the forehead injuring the supra- 

 orbital nerve. 



CONCUSSION. 



Concussion. — By this is meant a jarring or shaking of the brain 

 without any great lesion, though function is temporarily impaired ; 

 inflammation is apt to follow. The force may be directly from a 

 blow upon the head, or indirectly, from alighting upon the feet. The 

 patient is stunned, is somewhat insensible, lies motionless, pale and 

 cold. Insensibility is not complete, for questions will be answered, 

 and pain manifested by pinching ; respiration is feeble, the pulse is 

 rapid, small, and fluttering ; the pupils are insensible to light, some- 

 times contracted, and sometimes dilated ; nausea and vomiting often 

 follow. After reaction, inflammatory symptoms commence, the pulse 

 becomes full and hard, the skin hot and dry, the face flushed, the 

 eyes bloodshot, great pain, especially in the head, restlessness and 

 delirium. 



Treatment. — In the first stage, that of prostration, the chief care 

 of the surgeon is to prevent some bystander from bleeding the pa- 

 tient, in common with the vulgar notion. No active treatment 

 should be resorted to until reaction has taken place. In the mean- 

 time the patient should be undressed and put to bed, and his limbs 

 carefully examined ; the head should be shaved, wounds dressed, &c. 



Should the prostration continue, and danger impend from syn- 

 cope, stimulation is to be resorted to in the most gradual and cautious 

 manner; warm frictions are to be employed, small quantities of tea, 

 wine, and water are to be administered with care, lest they pass into 

 the air-passages, and produce asphyxia. After reaction commences, 

 stimulants are to be suspended, lest they increase subsequent inflam- 

 mation. By hurrying on reaction, life is as often endangered as by 

 the too early abstraction of blood. So soon as inflammatory symp- 

 toms fairly manifest themselves, we should endeavour to repress 



