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Abstract
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Reprint of: An Address on Concussion Injuries of the Visual Apparatus in Warfare, of Central Origin. By S. A. Kinnier Wil son. The Lancet, No. 4897, Vol. CXCIII.
Cerebral Concussion and Commotio : In most cases of severe blows on the head which have proved fatal, examination has shown the presence of capillary hemorrhages, and consequent disintegration of myelin, such as are sufficient to account for the clinical symptoms.
In non-fatal cases it is justiciable to assume organic lesions such as have been enumerated, which have not, however, been sufficiently widespread or serious to affect permanent impairment of the cere bral function.
The question of molecular concussion or commotio presents from the clinical side features of importance. Clinically there is, at the one extreme, a total motor and sensory paraplegia ; at the other, the tremulous, weakness, paresthesia, and exaggerated reflectivity of " functional " disease. Experiments performed by Alan Newton suggest that there is an organic basis for the transient disturbances of function seen in so-called " railway spine " and allied conditions of traumatic neurasthenia, and they bear out what has adready been remarked that " functional " symptoms may be the expression of minimal organic changes. They also prove the occurrence of a relatively surprising amount of tissue change from a feeble impacton the exposed cord, and show that the blow capable of producing merely a molecular concussion must be slight.
While gross contusion lesions of the central visual apparatus are common enough one may have to seek far and wide ere one can find a case which for the purposes of this communication may be admitted into the category of visual concussion, where, one may suppose, the organic disturbances are of the trivial nature that has already been described.
After two and one-half years one is still looking for a case where a direct blow on the head from any form of projectile, withoutgross wounding, has resulted in an uncomplicated visual commotio analogous to the cases of spinal-card or peripheral-nerve commotio that have been, relatively speaking, common.
Let it be observed that all cases of visual disturbances from shell explosions in the vicinity of the individual concerned are purposely excluded.
Language: en |