Thus (1) =when the temperature remains subnormal= the patient is in a condition of severe cerebral shock, due, in the majority of cases, to contusion or laceration of the brain, the grosser lesion being most commonly situated either at the apex of the temporo-sphenoidal lobe or at the anterior inferior part of the frontal lobe. The patient is, however, suffering from shock, and the treatment advocated for that condition in general is equally applicable to these cases in particular. The patient should be placed in the so-called head-down position, and the extremities firmly bandaged from below upwards. The vaso-motor depression should be combated by the administration of rectal or intra-venous infusions of saline solution, to each pint of which is added 1 drachm of a 1 in 1,000 solution of Adrenalin Chloride. It is at once obvious that, whilst combating the condition of shock, this mode of treatment may tend at the same time to encourage fresh bleeding if the brain should have been lacerated, or if intracranial vessels should have been torn. For this reason I regard rectal infusion as the more safe of the two methods, in spite of the fact that intra-venous infusion brings about a more rapid improvement in the patient’s condition. The effect of the infusion must be carefully observed, and as soon as the blood-pressure rises and the temperature shows a tendency to rise--say from the subnormal to the normal--the infusion process must be stopped, and the further progress of the case observed.
The risks attendant on this mode of treatment are obvious, but in their consideration, it must also be borne in mind that if the patient remains in the collapse stage, without evidencing any sign of reaction, he will inevitably die. If the treatment advocated should tide the patient over this stage and induce a definite reaction, as exemplified by rise of blood-pressure and elevation of temperature, the further treatment of the case can be considered under the next group.
(2) =When the temperature rises progressively= the patient evidences symptoms pointing to compression of the brain--coma, slow pulse, noisy and stertorous respiration, hot skin and turgid face. Later on, as a result of the increasing pressure, the medullary centres begin to show signs of exhaustion, the pulse-rate increasing, and the respiration becoming Cheyne-Stokes in character.