then a tablespoonful of whisky or brandy in water may prove reviving, if you are sure there is no head injury. Mild epilepsy may be mistaken for fainting (see p. 312).

Head Injuries.-The simplest form of unconsciousness resulting from a fall or blow on the head is that accompanying concussion of the brain. Here the insensibility may be short, the patient may be pale and confused, and have nausea or vomiting on recovery. In the severer form the patient is unconscious, but may reply in monosyllables if one shouts at him. If all the limbs are moved there is no paralysis. There may be convulsions occasionally. Recovery of consciousness usually occurs within twenty-four hours, but headache, dizziness, and incapacity for mental work may persist for a considerable time. There is a possibility of abscess or brain trouble, epilepsy, or relapse into unconsciousness after a time, particularly if the patient does not have proper care. The general treatment stated is advisable, with cold to the head, employing cold cloths if ice cannot be used, and heat to the feet. The patient must lead a quiet life for some time afterwards, not returning to business for several weeks.

In the more dangerous head injuries, resulting in bleeding and clots upon or in the substance of the brain, or fracture or breaking of the bones of the skull, with pressure on the brain, there are: complete unconsciousness so that the patient does not respond to any

effort to arouse him; noisy, snoring breathing; slow pulse; and wide pupils. In fracture there is often no external sign, although there may be a depression in the skull, or the broken bones may be felt grating together when the part is manipulated. A continuous flow of blood or watery fluid from the ear is usually a sign of fracture, or the appearance of blood staining of the white of the eye or lid a day or two after the accident. A surgeon should be summoned at any cost in any case of delayed unconsciousness.

The treatment, until skilled assistance is obtained, should be that recommended for concussion.

Alcoholism. In drunkenness there may be an alcoholic breath and history of drinking. The face is apt to be flushed, and the breathing deep but not noisy and snoring as in apoplexy, and the patient will generally reply in a muttering way if roused by shouting or shaking. There may be some twitching of the muscles, but there are not real convulsions. The pulse and breathing are not noticeably slow, as in opium poisoning.

If the patient has been exposed to cold, put hotwater bottles about him and rub the surface vigorously. If he can swallow, give a dessertspoonful of mustard with a teaspoonful of salt in a glass of tepid water, to empty the stomach, and some cathartic, as five grains of calomel (see Poisons, Vol. II, p. 429). Half a teaspoonful of aromatic spirit of ammonia in water often aids recovery.

Opium.-In poisoning by opium or morphine the patient, although unconscious, can usually be roused by shouting and shaking; the breathing and pulse are very slow, and the pupils of the eyes are reduced to pin points. There may be a history of having taken some medicine. For treatment, see Vol. II, p. 434.

Sunstroke.-Unconsciousness from sunstroke usually occurs when we have the favorable conditions for sun- or heat-stroke, and the history of exposure to the heat. For treatment, see Heat-stroke, Vol. II, p. 329.

Kidney Disease.-It will often be impossible for the layman to have any correct idea as to the existence of this disease. A previous history of vomiting and watery diarrhea with dizziness may be obtained, and there may be swelling of the face and ankles from dropsy. The unconsciousness is often preceded by convulsions, as in epilepsy, but the tongue is not injured and the patient does not so rapidly return to consciousness.

Diabetes. The unconsciousness of diabetes resembles closely that of kidney disease, but the breath in diabetic coma has a peculiar sweet odor like pears, apples, or chloroform. The physician in such cases can determine the nature of the unconsciousness by drawing the urine and examining it.

Epilepsy. The insensibility begins with the fit; the tongue may be bitten and there may be a history of such attacks, and the patient regains consciousness and apparent health in a short time (see p. 311).

APOPLEXY.-This is more likely to attack men over fifty. The breathing is often loud, rattling, and snoring in character, and irregular. The patient moves arm and leg on one side of the body, while the other lies motionless, showing paralysis of one side of the body. The face may also be paralyzed on one side, the lips being puffed out on that side in breathing. There is, usually, complete insensibility, so that the patient cannot be roused. The pupils of the eyes differ in size. The patient may be also under the influence of alcohol. The limbs are entirely relaxed or stiff on the paralyzed side of the body, and the face is often drawn toward the opposite (unparalyzed) side.

The patient should be put on his back with the head raised, or turned on his side if the breathing is very noisy. Cold cloths or ice should be placed on the head, and hot water in bottles to the feet. Do not try to give food or drink while the patient is unconscious. Five grains of calomel may, however, be dropped on the root of the tongue, and the soft-rubber catheter used after being boiled, to empty the bladder. After a variable time, from a few hours to days, the patient may return to consciousness, usually to suffer from paralysis for a longer or shorter period. Death may occur during the unconsciousness. Patients who are in bed for long periods, especially when paralyzed, must be kept very clean, and be turned from time to time to avoid bedsores about the lower part of the back from pressure. Bathe such parts frequently with

alcohol and water, and see that the bedclothing is smooth under them.

DELIRIUM TREMENS ("The Horrors").— Delirium tremens does not occur in those given to occasional sprees of drinking, even if prolonged, but in the habitual, heavy drinker, and is brought on by an unusual excess in drinking, or by some nervous shock, as happens when the person suffers from bodily injury or an acute disease, especially pneumonia. The attack begins with sleeplessness, depression, and restlessness, for a day or two, and then the patient experiences a mental change. He talks continually in a rambling, disconnected manner, and is in constant motion, wanting to go out to attend to this or that matter, and is commonly filled with fear on account of objects which he imagines he sees, such as rats, snakes, and monsters, all of which drives him into such a state of terror that he is continually desiring to escape, and may try to jump out of the window or attempt suicide. There is generally some fever, a weak and rapid pulse, muscular weakness, and trembling of the hands and tongue.

Recovery is the rule from the first attack, unless some other condition is complicated with delirium tremens, as pneumonia or surgical accident.

After three or four days the patient will secure a good sleep, which is usually the favorable turning point of the disorder, when rapid improvement follows. In fatal cases the ravings, sleeplessness, and restless