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Inflammation of the Brain following a skull fracture.
It begins one, two or three weeks after the infliction of the injury. Its course is, in some cases, abrupt and severe, terminating in a short time in the death of the patient; in other cases, the disease begins insidiously, and may not be suspected for some time, until the patient suddenly becomes unconscious or paralyzed.
Symptoms.-The patient complains of sharp and severe pain in the head, aggravated by motion, by exposure to the light, and by noise. At the same time there is apt to be some nausea and vomiting; the pulse becomes rapid and the mind somewhat confused.
After these symptoms have lasted a day or two, the patient has a severe chill, followed by high fever; the pulse becomes very rapid and full. The pain in the head is by this time excruciating, the pupils of the eyes become very small; light and noise cause the patient extreme pain and annoyance. There is obstinate vomiting, and the bowels are constipated. In many cases delirium and convulsions follow, terminating in unconsciousness.
After these symptoms have lasted for a few days or a week, there is an entire change in the appearance of the patient. He no longer complains of pain or of annoyance from light or sound ; he is apt to lie unconscious or in a state of low delirium. In many cases the muscles of the face are paralyzed, so that the patient squints and exhibits various distortions of the countenance ; the pulse is slow and dull, the breathing deep and labored.
If there be much discharge of matter from the wound, the patient usually has several chills at irregular intervals. The edges of the wound become dry and swollen ; the matter usually disappears and a thin watery liquid escapes in its stead. If any bone be exposed, it becomes dry and white.
If there be no wound, the vicinity of the injury becomes swollen and doughy.
The condition arises from inflammation of the brain. This inflammation usually proceeds to the formation of matter. When examined after death, the surface of the brain is found to be covered with matter. There may also be formed collections of matter- abscesses-in different parts of the brain, though these are more frequently found some months or years after the injury. Treatment*-The treatment of inflammation of the brain consists of local applications and of remedies to be taken internally.
The head should be closely shaven and surrounded with ice contained in rubber bags or wrapped in soft cloths. In some cases benefit is derived from the application of fly-blisters to the nape of the neck. Mustard plasters may be applied to the feet and to the calves of the leg.
Internally medicines are administered to cause free evacuation of the bowels. For this purpose we may give the following prescription:
Bicarbonate of soda, - Two drachms.
Mix, and make eight powders ; take one four times a day. If this does not suffice to secure copious evacuation of the bowels, we may administer one or two drops of croton oil, placing it upon the tongue.
It will be necessary also to support the patient's strength, since the disease rapidly causes exhaustion. For this purpose we should see that the diet is nutritious and easily digestible. If there be so much vomiting that the stomach is unable to retain food, milk and broths should be administered as injections into the rectum. An ounce of milk mixed with the same quantity of whisky maybe injected every four hours if the patient seems feeble.
Two grains of quinine should also be given four times a day.
In many cases all these measures are unavailing ; the patient sinks rapidly and dies within ten days after the first signs of inflammation were manifested. In some of these cases it becomes evident that the brain is being compressed by the accumulation of matter on its surface ; in such cases surgeons have frequently relieved the patient and have sometimes effected a cure by an operation called trepanning. This consists in boring through the skull and removing a piece of the bone. In this way the matter can be evacuated and the pressure upon the brain removed. This operation is, however, extremely dangerous, and is not always successful in saving the life of the patient.
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