Alexis Thomson

“ During an operation the onset of syncope is often recognised by the cessation of oozing from the divided vessels before the general symptoms become manifest. _Clinical Features._--When a person is about to faint he feels giddy, has surging sounds in his ears, and haziness of vision; he yawns, becomes pale and sick, and a free flow of saliva takes place into the mouth. The pupils dilate; the pulse becomes small and almost imperceptible; the respirations shallow and hurried; consciousness gradually fades away, and he falls in a heap on the floor. ”

“ The colour improves; the pulse becomes full and bounding; the respiration deeper and more regular; the temperature rises to 100 F. or higher; and the patient begins to take notice of his surroundings. The condition of neurasthenia which sometimes follows an operation may be associated with the degenerative changes in nerve cells described by Crile.
In certain cases the symptoms of traumatic shock blend with those resulting from toxin absorption, and it is difficult to estimate the relative importance of the two factors in the causation of the condition. ”

“ The patient imagines that he sees all sorts of horrible beings around him, and is sometimes greatly distressed because of rats, mice, beetles, or snakes, which he fancies are crawling over him. The pulse is soft, rapid, and compressible ”

“ In most cases the symptoms begin to pass off in three or four days; the patient sleeps, the hallucinations and tremors cease, and he gradually recovers. In other cases the temperature rises, the pulse becomes rapid, and death results from exhaustion. ”

“ Thirst is best met by giving small quantities of warm water by the mouth, or by the introduction of saline solution into the rectum. Ice only relieves thirst for a short time, and as it is liable to induce flatulence should be avoided, especially in abdominal cases. ”

“ Delirium may also, of course, be a symptom of insanity.
Often there is merely incoherent muttering regarding past incidents or occupations, or about absent friends; or the condition may assume the form of excitement, of dementia, or of melancholia; and the symptoms are usually worst at night.
Delirium Tremens# is seen in persons addicted to alcohol, who, as the result of accident or operation, are suddenly compelled to lie in bed. Although oftenest met with in habitual drunkards or chronic tipplers, it is by no means uncommon in moderate drinkers, and has even been seen in children. ”

“ All tight clothing, especially round the neck or chest, must be loosened. The heart may be stimulated reflexly by dashing cold water over the face or chest, or by rubbing the face vigorously with a rough towel. ”

“ Recovery begins in a few seconds, the patient sighing or gasping, or, it may be, vomiting; the strength of the pulse gradually increases, and consciousness slowly returns. In some cases, however, syncope is fatal. ”

“ The exaggerated afferent impulses reaching the brain as a result of trauma, inhibit the action of the nuclei in the region of the fourth ventricle and cerebellum which maintain the muscular tone, with the result that the muscular tone is diminished and there is a marked fall in the arterial blood pressure. ”

“ Pressure over the skin does not cause the colour to disappear as in ordinary cyanosis. It has been shown by Wright of Boston, that the coloration is due to stasis from mechanical over-distension of the veins and capillaries; actual extravasation into the tissues is exceptional. ”

“ The digestion is markedly impaired, and there is often vomiting. Patients in this condition are peculiarly insensitive to pain, and may even walk about with a fractured leg without apparent discomfort. ”