The symptoms may come on
suddenly or gradually. Wounds of the brain present very great
difficulties, and vary greatly in their effect, very slight wounds
producing severe symptoms, and _vice versa_. A person may receive an
injury to the head, recover from the first effects, and then die with
all the symptoms of compression from internal haemorrhage. This is due to
the fact that the primary syncope arrests the haemorrhage, which returns
during the subsequent reaction, or on the occurrence of any excitement.
Inflammation of the meninges or brain may follow injuries, not only to
the brain itself, but to the scalp and adjacent parts, as the orbit and
ear. Inflammation does not usually come on at once, but after variable
periods.
2. =Injuries to the Spinal Cord= may be due to concussion, compression
(fracture-dislocation), or wounds. That the wound has penetrated the
meninges is shown by the escape of cerebro-spinal fluid. The cord and
nerves may be injured (1) by the puncture; (2) by extravasation of blood
and the formation of a clot; and (3) by subsequent septic inflammation.
Division or complete compression of the cord at or above the level of
the fourth cervical vertebra is immediately fatal (as happens in
judicial hanging).
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