106 PARTICULAK FRACTURES. 



covers from the first shock, and symptoms of compression 

 afterwards appear, and gradually increase ; there are then just 

 grounds for supposing that they arise from extravasation of 

 blood within the cranial cavity. 



When the compression arises from the formation of pus, the 

 symptoms do not ]3resent themselves for several days after the 

 accident, and are preceded by those of inflammation of the brain 

 or its meninges. The history of the case will here be most use- 

 ful in guiding the practitioner to arrive at a proper conclusion as 

 to the cause of the compression. 



There is no certain correspondence between the symptoms of 

 compression and the extent to which a portion of bone may be 

 depressed. In some cases, where depression has been slight, the 

 symptoms have been very marked ; whilst in others, the symp- 

 toms have been slight and the depression considerable. It is 

 also a remarkable fact that injury to one table of the bone 

 scarcely ever corresponds to that of the other ; the inner being 

 nearly always fractured to a greater extent than the outer, and 

 its actual depression much greater than would appear from 

 examination of the parts external to the fracture. 



The treatment must be pursued in accordance with the symp- 

 toms. In the absence of compression, the indication is to prevent 

 inflammation ; and for that purpose purgatives must be given, 

 and low diet with rest and quietude enjoined. It is also 

 necessary to keep the head cool by means of cold wet cloths, and 

 after the period of collapse — which immediately succeeds the 

 injury — has passed off, abstraction of blood may be advisable. 

 The administration of sedative medicines had better be withheld, 

 as they may produce an impression upon the brain, predisposing 

 to inflammatory action. 



If compression be present, the practitioner must, without 

 delay, attempt to relieve the brain from pressure. If the bone 

 be not depressed to any great extent, and the symptoms not 

 urgent, bleeding, purging, and the application of cold to the 

 head may be sufficient; for it is sometimes found that the 

 brain becomes accommodated to its new condition, and that the 

 symptoms disappear; but if these means should not succeed, 

 the depressed bone must be elevated. Wlien the symptoms of 

 compression are strongly marked, and the bone depressed to 

 such an extent as to leave no hope from other treatment, the 



