HEAD INJURIES

In recent years two dominant influences have prevailed in the treatment of trauma to the brain. The first is the demonstration of the four classic stages of brain compression by Kocher and Cushing. The second is the observation of Weed and his collaborators that increased intracranial tension can be influenced by changing the osmotic pressure of the blood through the agency of hypertonic and hypotonic solutions. The treatment of cerebral injuries has been designed also on the concept that cerebral compression is the prime factor in the production of the symptoms. The application has resulted in treatment by cerebral decompression—by lumbar puncture and by dehydration. Thus Battle,¹ after a recent study of 200 cases of traumatic injuries of the head, has reported that the lowest mortality in the seriously injured occurred in the cases treated by repeated lumbar punctures and dehydration.

Now, however, comes evidence that the postulates on