112 PAKTICULAK FKACTURES. 



POST MORTEM APPEARANCES. 



These will vary according to the length of time intervening 

 between the injury and the death of the patient. In cases that 

 are almost instantaneously fatal, laceration of the brain is often 

 observed. In other cases the dura mater is separated from the 

 inner plate ; and this is a very common condition. Again, the 

 venous sinuses are found lacerated ; and, in other cases, the con- 

 cussion proves fatal without any lesion being visible either in 

 the brain or its membranes. 



In the cases where death occurs at a more advanced stage, 

 traces of inflammation will be present, such as increased vascu- 

 larity of the membranes, small specks of blood in the brain, 

 various kinds of inflammatory products, lymph, serum, pus, or a 

 combination of these conditions. 



It has been supposed, where no lesion is apparent, that the 

 sudden shock disturbing the circulation of the brain is the cause 

 of death; and, again, that the structures are injured, and the 

 injury not discoverable by dissection. Others think that the 

 fatal result arises from condensation of the brain. One writer, 

 Mr. Liston, says — " When a blow is inflicted on the skull, only 

 a slight commotion of the brain is induced ; the cranial contents 

 are, as it were, slightly jumbled, and a temporary and trifling 

 disturbance of its functions follows. When, however, the 

 stroke is more severe, the brain is separated from its cranial 

 attachments, both at the point struck and at the part directly 

 opposite. It is thrown upon itself towards its centre ; its sub- 

 stance is thereby condensed, its diameter in the direction of the 

 impulse diminished, and a separation between the brain and the 

 cranium is formed at each extremity of that diameter." 



By post mortem examinations it has been ascertained that 

 condensation of the substance of the brain does exist in cases of 

 severe concussion. Such condensation may be sufficient to 

 cause instantaneous extinction of life; or the brain may 

 gradually resume its former condition, or only with such incited 

 action as may be required to reunite the dura mater with the 

 inner table of the skull. 



Treatment. — In the first stage, when the symptoms of depres- 

 sion are very great, and there is danger of death from failure 

 of the heart's action, stimulants, as ammonia, should be ad- 



