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in some cases death may result after some days from inflammation or com-
pression of the brain.
In cases after recovery there is often complete loss of memory of the
accident and even of the events occurring before and after it extending over
a period of from a fortnight to a month or more. An old man narrated the
incident and mentioned the names of his assailants soon after he received
four lacerated wounds on the head, five incised wounds on the face and
twenty-nine bruises and abrasions on various parts of the body on the morn-
ing of July 1, 1932, but in the afternoon of the next day he completely forgot
the assault, and vividly described the accident which had occurred to him
about seven years ago.
In addition to loss of memory, headache, weakness, mental irritability,
neurasthenia, and loss of hearing, vision or speech persist for weeks and
months after recovery. Occasionally the patient develops symptoms of
delusional or melancholic insanity.
Post-mortem Appearances.—In most cases there may be nothing more
than slight congestion of the brain with minute capillary haemorrhages in
its substance. In some cases there may be a contusion or laceration of the
brain on the undersurface of the frontal and temporal lobes with haemorrh-
age into the subarachnoid space.
Cerebral Irritation.—This is a clinical condition which sometimes occurs
after concussion has passed off. It usually results from slightly severe
injuries caused by a blow or a fall on the forehead, temple or occiput, and
is caused by a superficial lace-
ration of the brain, which is
accompanied after a few hours
by cerebral oedema and hyper-
The symptoms usually ap-
pear twelve to twenty-four
hours after the injury. The
patient lies on his side in a
position of general flexion
with the legs drawn up, the
knees bent, and the arms,
hands and fingers flexed. He
is restless and tosses about,
but does not lie fiat on the
"back. He keeps his eyes
closed probably due to mark-
ed photophobia, and resists
every attempt to open them.
The pupils are equal and contracted. The temperature is slightly raised.
The pulse is slow and weak, and the respirations are regular and almost
normal. The sphincters are usually in a normal condition, but the bladder
may have to be emptied by means of a catheter owing to retention of the
The patient is conscious, but takes no heed of what is passing around
him. When disturbed, he becomes highly irritated, gnashes his teeth,
frowns and growls. At the end of a period varying from four or five days
to a week to two the patient begins to show marked improvement in his
condition, lies flat on his back and is less irritable. The pulse and tempera-
ture are normal, but his mind is still weak, and is sometimes garrulous and
excitable. He suffers from loss of memory and has no recollection of the
accident. He recovers slowly after several months. Occasionally the
Fig. 118.—Laceration of brain.