Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
_Treatment._--The immediate treatment is the same as that of shock.
Absolute rest and quietness are called for. When the symptoms begin to
pass off, the head should be raised on pillows to prevent congestion
and to diminish the risk of bleeding from damaged blood vessels in the
brain. The value of applying an ice-bag or Leiter's tubes with a view
to arresting hæmorrhage inside the skull, is more than doubtful.
Lumbar puncture, venesection, or the application of leeches over the
temple or behind the ear may be employed with benefit. The use of
small doses of atropin and ergotin was recommended by von Bergmann.
The bowels should be thoroughly opened by calomel, croton oil, or
Henry's solution, and a light milk diet given. The patient is kept in
a shaded room, and should be confined to bed for from fourteen to
twenty-one days. It is often difficult to convince the patient of the
necessity for such prolonged confinement, but the responsibility for
curtailing it must rest upon him or his friends. Reading,
conversation, and argument must be avoided to ensure absolute rest to
the brain.
#Cerebral Irritation.#--In some cases of injury to the
head--particularly of the anterior part and the parietal region--as
the symptoms of concussion are passing off, the patient begins to
exhibit a peculiar train of symptoms, which was graphically described
by Erichsen under the name of cerebral irritation. "The attitude of
the patient is peculiar, and most characteristic: he lies on one side
and is curled up in a state of general flexion. The body is bent
forwards and the knees are drawn up on the abdomen, the legs bent, the
arms flexed, and the hands drawn in. He does not lie motionless, but
is restless, and often, when irritated, tosses himself about. But,
however restless he may be, he never stretches himself out nor assumes
the supine position, but invariably maintains an attitude of flexion.
The eyelids are firmly closed, and he resists violently every effort
made to open them; if this be effected, the pupils will be found to be
contracted. The surface is pale and cool, or even cold. The pulse is
small, feeble, and slow, seldom above 70. The sphincters are not
usually affected, and the patient will pass urine when the bladder
requires to be emptied; there may, however, though rarely, be
retention.
"The mental state is equally peculiar. Irritability of mind is the
prevailing characteristic. The patient is unconscious, takes no heed
of what passes, unless called to in a loud tone of voice, when he
shows signs of irritability of temper or frowns, turns away hastily,
mutters indistinctly, and grinds his teeth. It appears as if the
temper, as much as or more than the intellect, were affected in this
condition. He sleeps without stertor.
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