. Railway and other accidents with relation to injury and disease of the nervous system : a book for court use . esions of the ventricles, and the medulla and upper cord suffered. Occip-ital blows were less serious, while violence directed to the lateral aspect ofthe head was the cause of general disturbance, and the intraventricularpressure was decidedly modified, giving rise to a less serious train of symp-toms suggestive of irritation. Some years ago Duret in the same mannerexperimentally produced a lesion of the fourth ventricle by striking the fron-tal bones forcibly, the explanation bein
. Railway and other accidents with relation to injury and disease of the nervous system : a book for court use . esions of the ventricles, and the medulla and upper cord suffered. Occip-ital blows were less serious, while violence directed to the lateral aspect ofthe head was the cause of general disturbance, and the intraventricularpressure was decidedly modified, giving rise to a less serious train of symp-toms suggestive of irritation. Some years ago Duret in the same mannerexperimentally produced a lesion of the fourth ventricle by striking the fron-tal bones forcibly, the explanation being that the cerebro-spinal fluid Wasdriven violently back through the lateral ventricles into the fourth. INJURIES 01 THE CKANEUM 93 In laceration especially the occurrence of hemorrhageis usually immediate and sometimes extensive, leading toincrease of intracranial tension, the meningeal arteriesbeing most often ruptured. Laceration is a far moreserious condition than contusion, and its effects are asa rule shown more quickly. Contusion of the brain islooked upon as a very common effect of trauma, even of a. Fig. 13.—Contusion of Brain. (Vibert.) slight kind, and most writers emphasize its importance,some perhaps unduly. The most serious cases are thosewhich are basal (Fig. 13). A certain number of obser-vers consider what is known as commotio cerebri as but aform of contusion, although a distinction is made bythose who would explain all persistent cases of traumaticneurasthenia in this way, especially those of the doubtfulkind, in which there are suspicious expressions of centraldisease. When there is no fracture, but serious indica- 94 J^A/LWAV OTHER ACCIDENTS. tions of a suspected cerebral contusion or laceration, anexamination of the cerebro-spinal fluid, drawn by lumbarpuncture, may clear up the real condition. In such acase, when a man had been hit upon the head, with re-sulting mental symptoms of a light grade with aphasia,and it was believed that no fracture had
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