ture rises, the pulse becomes rapid,
and death results from exhaustion.

The main indication in _treatment_ is to secure sleep, and this is done
by the administration of bromides, chloral, or paraldehyde, or of one or
other of the drugs of which sulphonal, trional, and veronal are
examples. Heroin in doses of from 1/24th to 1/12th grain is often of
service. Morphin must be used with great caution. In some cases hyoscin
(1/200 grain) injected hypodermically is found efficacious when all
other means have failed, but this drug must be used with great
discrimination. The patient must be encouraged to take plenty of easily
digested fluid food, supplemented, if necessary, by nutrient enemata and
saline infusions.

In the early stage a brisk mercurial purge is often of value. Alcohol
should be withheld, unless failing of the pulse strongly indicates its
use, and then it should be given along with the food.

A delirious patient must be constantly watched by a trained attendant or
other competent person, lest he get out of bed and do harm to himself or
others. Mechanical restraint is often necessary, but must be avoided if
possible, as it is apt to increase the excitement and exhaust the
patient. On account of the extreme restlessness, there is often great
difficulty in carrying out the proper treatment of the primary surgical
condition, and considerable modifications in splints and other
appliances are often rendered necessary.

A form of delirium, sometimes spoken of as #Traumatic Delirium#, may
follow on severe injuries or operations in persons of neurotic
temperament, or in those whose nervous system is exhausted by overwork.
It is met with apart from alcoholic intemperance. This form of delirium
seems to be specially prone to ensue on operations on the face, the
thyreoid gland, or the genito-urinary organs. The symptoms appear in
from two to five days after the operation, and take the form of
restlessness, sleeplessness, low incoherent muttering, and picking at
the bedclothes. It is not necessarily attended by fever or by muscular
tremors. The patient may show hysterical symptoms. This condition is
probably to be regarded as a form of insanity, as it is liable to merge
into mania or melancholia.

The _treatment_ is carried out on the same lines as that of delirium
tremens.

CHAPTER XIV

THE BLOOD VESSELS

Anatomy--INJURIES OF ARTERIES: _Varieties_--INJURIES OF
VEINS: _Air Embolism_--Repair of blood ve