Subarachnoid Haemorrhage

controlled trial, they are able to state that for ruptured aneurysms of the inte carotid artery at or near the origin of the posterior communicating vessel, c ligation in the neck produces results far superior to conservative treatment, proVr^j1e that the patients are not unconscious or dying of an intra-cranial haematoma. trial is still proceeding and it is anticipated that further pronouncements for aneur) at other sites will be made later. These are awaited with great interest. It may seem presumptuous to add a further contribution to the literature on 1 arachnoid haemorrhage at the present time. Any such communication that disc the relative merits of medical and surgical treatment would most certainly de {il this criticism. It is generally agreed that the problem of the physician in a Hospital, and of the general practitioner at the bedside, is to decide which Pato a should be investigated by angiography. In many areas this involves transfer gj neurosurgical unit where the requisite facilities exist. Brinton (i960) has reVl]aIjtf the distribution of neurologists and neuro-surgeons throughout the country. A & vVj]l at his map, which indicates the situation of the various neuro-surgical units, f| show that responsibility for making the decision is often considerable. In this RJ I shall discuss the early assessment of the patient, as did Holmes (1957 and 195 '' rjl Henson (1957). A small unselected group of 154 cases admitted to two g -0n hospitals is reported, which is considered to give a reasonably clear overall irnpr of subarachnoid haemorrhage as it presents in the practice of general medicine-