

SYNCOPE. 475 



purpose general sedatives Opium especially are valuable 

 adjuvants to the more direct measures. 



(b) It is also desirable to take the pressure of the circula- 

 tion off the bleeding point by dilatation of a vascular area in the 

 neighbourhood, and in anastomotic connection ; or by inducing 

 a watery flux from it. Thus we employ purgatives in haemor- 

 rhage from the stomach, due to portal congestion, in haemop- 

 tysis or bleeding from the respiratory passages, and in 

 cerebral haemorrhage, so as to dilate the mesenteric vessels and 

 produce a hydragogue action on the bowels. 



(c) The local measures employed for haemorrhage are va- 

 riously known as local haemostatics, styptics, or local vascular 

 astringents. They are imitations or adjuvants of the natural 

 means just analysed, and belong to three distinct classes, ac- 

 cording as they act upon, (1) the blood, (2) the vessel walls, 

 or (3), the perivascular tissues. 



(1) Haemostatics may act upon the blood, hastening co- 

 agulation or precipitating albumen, and thus stopping the 

 bleeding point. Such are Tannin, and the many vegetable 

 substances containing it Kino, Rhatany, Catechu, Logwood, 

 Galls, Oak -bark, etc. ; Alum, Persalts of Iron, Sulphate of 

 Copper, Sulphate of Zinc, Acetate of Lead, Nitrate of Silver, and 

 Diluted Mineral Acids. Matico probably acts physically. 



(2) The haemostatics which promote contraction of the broken 

 vessel are Nitrate of Silver and Acetate of Lead both very 

 powerful ; Ergot ; and local cold. 



(3) Substances acting upon the perivascular tissues may be 

 made to arrest hemorrhage by combining with the connective 

 tissues, coagulating or precipitating their albuminous substances, 

 and rendering them more compact than normal, or constringed 

 so that the bleeding vessels are compressed and closed. Such 

 are Tannin and its allies just enumerated, Lead, Silver, 

 Persalts of Iron, and Alum. 



Syncope. Syncope demands prompt treatment. Nature 

 suggests the first step : the patient must be laid down, with the 

 head at least as low as the heart, so as to restore the pressure and 

 the blood in the cardiac centre. Every possible means must then 

 be used to restore the suspended action of the heart, including 

 direct and indirect cardiac stimulants. The most available of 

 these internally are Ammonia and Alcohol in the form of spirits, 

 or wine ; externally, the application of cold, fresh air, flagel- 

 lation or flicking with wet towels, ammonia held to the nostrils, 

 and the continuous current to the praecordium. Nitrite of Amyl 

 acts quickly in some cases. If swallowing be impossible, Brandy 

 or Ether must be injected into the rectum, or under the skin. 



