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V. P. BLAIR, A.M., M.D.
JAMA. 1914;LXIII(10):863-866. doi:10.1001/jama.1914.02570100049014.
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The emergency service in the City Hospital of St. Louis gives, I believe, exceptional opportunities for the study of intracranial injuries. In the two years, 1910 and 1912 during which I was on the Visiting-Staff, I devoted my spare time to a study of them.

Of course, all cases presenting external or neurologic signs of localized head injury, that can be directly approached, are treated accordingly, but a great many suggest no special point of surgical attack, mostly cases in which the injury is at the base of the brain; these are usually generalized as fractures of the base of the skull. In very few of these is a fracture, if present, the most important lesion, the immediately grave symptoms arising from a concussion injury of the brain and its coverings.

A composite picture of such cases might be presented as follows:

The patient is unconscious or semiconscious, pulse slow,


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