usness
gradually fades away, and he falls in a heap on the floor.

Sometimes vomiting ensues before the patient completely loses
consciousness, and the muscular exertion entailed may ward off the
actual faint. This is frequently seen in threatened syncopal attacks
during chloroform administration.

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.

_Treatment._--The head should at once be lowered--in imitation of
nature's method--to encourage the flow of blood to the brain, the
patient, if necessary, being held up by the heels. 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. The application of
volatile substances, such as ammonia or smelling-salts, to the nose; the
administration by the mouth of sal-volatile, whisky or brandy, and the
intra-muscular injection of ether, are the most speedily efficacious
remedies. In severe cases the application of hot cloths over the heart,
or of the faradic current over the line of the phrenic nerve, just above
the clavicle, may be called for.

#Surgical Shock.#--The condition known as surgical shock may be looked
upon as a state of profound exhaustion of the mechanism that exists in
the body for the transformation of energy. This mechanism consists of
(1) the _brain_, which, through certain special centres, regulates all
vital activity; (2) the _adrenal glands_, the secretion of
which--adrenalin--acting as a stimulant of the sympathetic system, so
controls the tone of the blood vessels as to maintain efficient
oxidation of the tissues; and (3) _the liver_, which stores and delivers
glycogen as it is required by the muscles, and in addition, deals with
the by-products of metabolism.

Crile and his co-workers have shown that in surgical shock histological
changes occur in the cells of the brain, the adrenals, and the liver,
and that these are identical, whatever be the cause that leads to the
exhaustion of the energy-transforming mechanism. These changes vary in
degree, and range from slight alterations in the structure of the
protoplasm to complete disorganisation of the cell elements.

The influences which contribute to bring about this form of exhaustion
th