Fig. 14.—“Terraced” Fracture of the Left Parietal Bone near the Sagittal Suture, caused by the Lower Part of the Rim of a Round-Headed Hammer. The blow was struck from the right side. ½ natural size.
We may truly say that wounds of the head are dangerous in proportion as they affect the brain. The existence of affection of the brain may be hard to tell from the appearances, for an injured person may recover from the first effects of a comparatively slight wound and yet die suddenly later.
Concussion is the name applied to one of the effects on the brain of a more or less violent blow directly on the head or transmitted indirectly to the head. Though the term “concussion” implies a functional rather than an organic lesion, yet in the majority of cases it is equivalent to laceration of the brain. With laceration of the brain there is usually more or less effusion of blood which may be limited to a very thin layer. Concussion may exist without laceration of the brain. Even death has been known to occur from concussion of the brain without any visible signs of injury to the brain, so that the concussion must have been functional and the fatal result due to shock of the nervous system. Fatal concussion does not, therefore, necessitate the existence of compression or visible injury of the brain. Concussion may sometimes be due to a violent fall upon the feet, in which case the shock is transmitted through the spinal column to the head with or without fracture of the base of the skull. It was in this way that the Duke of Orleans, the son of Louis Philippe, died.
Fig. 15.—Fractures of the Skull caused by a Four-sided Hammer. One caused by the Corner, the Other by the End of the Head of the Hammer. ¼ natural size.
Fig. 16.—Four-sided Fracture caused by a Hatchet-Shaped Instrument, the Edges Formed by Depression of the Broken Outer Table of the Skull.
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The symptoms of concussion show all degrees of severity. Thus the injured person may become confused and giddy with or without falling, he may become pallid and nauseated and may vomit, but after a short period he recovers gradually.
