^Concussion of the Brain. 8i 



matter as seen in the brain of the animal suddenly killed by the 

 blow of a hammer. The return of consciousness or semi-con- 

 sciousness is connected with the resumed freedom of the cerebral 

 circulation. The later convulsions, stupor or coma, usually imply 

 active congestion or the effusion of blood on the brain surface, or 

 in its substance. 



Diagnosis from fracture must be made mainly by manipula- 

 tion of the bone in the seat of the blow, and by the absence of 

 the increasing stupor and coma which attend on pressure from 

 a gradually increasing blood clot. From epilepsy it is to be dis- 

 tinguished by the evidence of mechanical inj ury, by the absence 

 of spasms at the first, by the suspension of breathing and the 

 absence of froth about the lips. 



Treatment. Keep the patient still and prostrate until there are 

 signs of returning respiration and free cerebral circulation. This 

 may be hastened, however, by active rubbing of the limbs and 

 body, by giving guarded inhalations of ammonia, or even by 

 friction of the skin with ammonia and oil. Sometimes reaction 

 is favored by dashing cold water on the head, while in other 

 cases hot water to the poll will prove more effective, or the 

 two may be used alternately with good results. 



If, after partial recovery, there is marked restlessness, or ir- 

 ritability it may be met with bromides. If secondary uncon- 

 sciousness supervenes effusion of serum or blood is to be feared, 

 or extreme congestion, and blood may be drawn from the jug- 

 ular or by cups from the cranium, and ice bags or cold water 

 may be applied to the head. Hot foot baths or mustard embro- 

 cations applied to the limbs, and even derivation toward the 

 bowels may be used. The indications for treatment come to be 

 for meningo-encephalitis. 



