When the insensibility has begun to diminish, the patient can be roused
with less difficulty; if pinched, he complains of it by uttering some
inarticulate sounds, or by attempting to move himself further from the
quarter whence he supposes the injury to come; he answers, though with
unwillingness, loud questions regarding the pain which he suffers, and
points to the part where it is chiefly felt. As the stupor goes off,
symptoms of inflammatory action, or a threatening of it in a greater
or less degree, manifest themselves. The pulse becomes more rapid and
sharp, the skin is hot and dry, the face is flushed, the conjunctiva
is redder than usual, and the pupils are often much contracted: the
patient is restless, and tosses about in bed; mutters confusedly to
himself; often attempts to enact a part in some fanciful scene which he
supposes to be passing around him, or talks rapidly and incoherently
concerning circumstances which have formerly occurred. His flitting
ideas are often of an alarming nature; he endeavours to get out of bed,
and struggles violently if opposed. He frequently puts his hand towards
his head, and gives other indications of suffering acute pain in that
region, much increased by any movement of the part.
Such symptoms are often followed by vomiting and rigors, and too
frequently by convulsions, more furious delirium, and coma. On
examination after death, an increased vascularity of the cerebral
membranes is observed; there is an effusion of gelatinous-looking
matter on the surface of the membranes, and in the cellular tissue
beneath the arachnoid. In more advanced cases, thin patches of lymph,
or more extensive strata of it, cover the arachnoid and the inner
surface of the dura mater; a puriform fluid is found effused between
these membranes, and sometimes blood and matter are deposited in
some part of the cerebral substance; bloody serum is effused into
the cavities, and at the base of the brain. The above symptoms and
appearances sometimes follow injuries not at first thought severe, but
are most frequently the result of such as are attended with læsion of
the bone, or of the internal parts.
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