The wound completely healed, the bone being bridged over by dense tissue, and the cicatrix sunk in a narrow furrow, the pulsations of the brain remaining visible. His pulse never exceeded eighty. The supra-orbital ridge remains much below its proper position, and the right eye is destroyed. OF Tin: tions; as to operate in cases <>t' mere concussion, or in a state of inflammation, would be murder yet, how to discriminate, is a practical puzzle in many cases 11 v in a lanre number which fall to be treated in the fild. when the period of their coming under observation is very uncertain, and when no account can be got of their history, or early symptoms. It require s li it the most cursory reading of surgical works to determine, that the utmost confusion has always Itad between these various pathological conditions; even Sir A-tley Cooper, with all his habitual clearness, has n.t ui i freq ue n tly confounded them.
It is little wontliat it should be so, as their clear distinction is only in books, and their interdependence and mutual t. as well as the uncertainty of their etive manifestations, all contribute to deceive " the pride <if our penetration," and lead us into error. The absence of any ascertainable cause, and the threatening symptoms which were present in the following case of concussion, interested me a good deal at the time. In former days it would have been infallibly ascribed to the wind of a ball. Quin, a private in the U'-yal Irish, suddenly tell down in dvance on the Redan, early in the morning of the of.lime. He never could tell this happened. seini: aware of any injury.
He was brought into my v nsilile a tew hours afterwards. 11 is symp' those of severe concussion. The surface of his body was cold, hi'on was slow and regular, were contracted. No injury o.uld either then wards be di.-ci.veivd. Warmth, air: enema of the arom. sp. of ammonia, helped to restore him to consciousness, after he had vomited. He continued, however, for some hours like a man half-drunk. Reaction was so violent as to call for bleeding, cold t< tinhead, antimonials, and purging, to moderate it. Some days afterwards he suddenly became delirious, with injected eyes, one pupil being contracted, and the other a little dilated. He complained much of his head, which he afterwards said had felt all the time as if strongly bound by a cord.
There was never any paralysis, or subsequent unconsciousness. By free purging, shaving the head, applying cold, restricting him to very meagre diet, and latterly, by the use of blisters to the nape of the neck, he completely recovered, though for about a month he suffered from severe headache, double vision, and a pulse unusally slow, and little changed on assuming the erect posture. The danger occasioned by head will depend much on the part struck. At some places the ball is more apt to glance off than at others, while the strong processes of bone, the situation of bloodvessels, and the apparently greater necessity to life of some parts of the brain than others, introduce many elements into the calculation of the result.
Notwithstanding all this, however, the curious eccentricities which characterize these injuries the slight disturbance created by some, which, to all appearance and experience, are ten times more severe than others that prove fatal, upset our preconceived opinions; and, while they puzzle us to account for the difference, they prove the truth of Liston's aphorism, that "no injury of the head is too slight to be despised, or too severe to be despaired of." i N.I!; Tin: HI: A P. lly speaking, it appears tolerably certain that wounds nf tlie side of the head, especially anterior to the ear, antinmost dangerous to life; and that a ndinir si-ale will give the following order the fore-part, the vertex, and the upper part of the occipital region; tin' last being decidedly tin- least dangerous.