GEN. VI. SPEC. 1. flow in an stream. Whence venesection as well when the blood first flows from the puncture, as when the ligature is removed. ciency, its motion will be checked and enfeebled: the brain and respiratory organs will participate in the debility, and Syncope syncope be a frequent result. And hence, we may account simplex. Swooning. for the fainting that frequently takes place on the commencement, and sometimes on the close of venesection. equal and On tying the arm for this purpose, a considerable stream uniform of supply is cut off, and ten ounces of blood flows, in perhaps five minutes, into a bason, which would other swooning in wise have flowed into the heart in the same period of time. The volume of blood is hence diminished, and the heart must collapse or contract itself in proportion. In many habits this is done with great facility: but in others, and particularly where there is a feeble supply of motific or irritative power, the contraction takes places slowly and irregularly, and with a considerable degree of flutter, or, as we have already explained it, clonic spasm; and fainting or a temporary failure of sensation, is the necessary consequence: during which the alternating systole is very feeble, and the blood ceases to flow at the puncture. This effect is ordinarily ascribed to a loss of the stimulus of distention; and there may be some degree of truth in such an explanation. But that there is a something beyond this is certain, because on removing the ligature from the arm this stimulus is once more obtained; for the blood, instead of flowing away at the venous orifice, now takes its proper course, and flows back to the heart. Yet we see almost as often a syncope produced at this moment, and consequently by a renewal of the distention, as by an interruption of it. The fact is, that the heart, which by this time has accommodated itself to the diminished volume of the returning current, has now once more to change its diameter, and to expand itself in proportion to the increased measure and momentum of the inflowing tide. And as a change in its diameter produced a syncope in the former case, a change in its diameter in like manner produces it in the latter. For the same reason we may see swooning take place Whence swooning on when any extensive range of blood-vessels that have been opening , pressed upon by any other means, suddenly acquire a large ab power of dilatation, as when a large cavity is formed in scesses or the abdomen by the process of tapping for an ascites, or on opening an extensive abscess in any other quarter *. But the flow of sensorial power from the brain may also be suddenly exhausted, or checked, or perhaps its secretion impaired; and syncope may ensue from this source, the action of the heart being diminished not primarily, but secondarily, or by sympathy with the state of the sensorium. In fainting, from entonic passions or emotions, as a sudden shock of vehement joy, the sensorial power is perhaps abruptly expended, as also in severe paint. In fainting, under the influence of the atonic passions, as fear or heart-sick grief, this power is unquestionably checked in its regular flow, and probably checked also in its secretion: as we have reason to believe it is where fainting occurs from a repulsion or retrocession of gout, exanthems, or various other discases. And to the same cause may be referred those cases of swooning, which, in some idiosyncrasies, or indispositions of body, are well known to take place on exposure to particular odours, as those of cheese, apples, or, as we have already had occasion to observe, of roses, lilies, and other fragrant plants. Where it has followed instantly upon acrid poisons, there can be no doubt that these have induced a rigid or entastic spasm upon the muscular fibres of the heart; and, where the poisons are purely narcotic, the living or instinctive stimulus is suddenly extinguished or carried off, and the nervous system becomes an exhausted receiver. Syncope then, in its simple state, as unconnected with any structural disease of the heart or its adjoining vessels, seems to appear under the following modified forms or varieties: a Inanitionis The swooning produced by fa tigue, long-fasting, or a sudden and excessive discharge of any fluid, whether natural or morbid, accompanied with Meckel, Epist. ad Hallen. Script. Vol. 1. Eph. Nat. Cur. Dec. I. Ann. v. Obs. 53. + Amat. Lusitan. Cent. 11. Cur. 1. Plater, Observ. I. p. 431. B Doloris. Swooning from acute pain. y Pathematica. Swooning from mental emotion. Metastatica. Swooning from metastasis. a sense of inanition, and great prostration of strength. Preceded by severe pain or ir ritation of body, internal, as from poisons, flatulency, or worms; or external, as from wounds or other injuries. Preceded by an exercise of some sudden and overwhelming passion or emotion. Accompanied with a retrocession or repulsion of gout, exanthems, or other diseases. GEN. VI. SPEC. I. Syncope simplex. Swooning. duration of the par oxysm on what dependent. The degree and duration of the paroxysm depend upon Degree and the peculiarity or the violence of the cause, the extent of the sensorial exhaustion, or the nature of the constitution, and hence must greatly differ in different individuals. In some cases it ceases in a few minutes, and the patient, though incapable of speaking, retains enough of percepton and sensation to be conscious of his own disorder, and to understand what is passing around him. The pressure and irritation of flatulency in dyspeptic and hypochondriacal habits are often sufficient of themselves to produce a fainting of this kind. In other cases the general feeling and understanding fail totally, and the pulse is scarcely perceptible. Occasionally, the sensorial power has been totally as well as suddenly exhausted, and the syncope has run into asphyxy, and even proved fatal. Sometimes apparent taken for M. Portal has hence justly remarked that " we may have apparent death from syncope as well as from as- death, which phyxy, and that, from not attending to this, we may mis- may be mistake, and bury the living with the dead. I have seen, real. he adds, a man who, after a violent fit of colic, remained Exemplified. for many hours in a state of syncope without pulse, with the colour and coldness of death, and without any respiratory motion of the chest whatever. After some hours of such apparent death he passed a bilious concretion, and the fainting vanished."* • Mémoires sur la Nature et le Traitement de plusieurs Maladies. Tom. IV. 8vo. Paris, 1819. GEN. VI. SPEC. I. Syncope simplex. Swooning. Recovery commonly effected without medical aid, and why. Process of recovery varies. Yet may be aided by medical means. Remedial process. When not assisted by medicine the system recovers itself by the gradual accumulation of sensorial energy that must necessarily take place, so long as the living principle continues, during such a state of quietism; aided, unquestionably, by the continual action of the instinctive, or remedial power of nature, which is always aiming to repair what is amiss. The process of recovery, however, varies almost as much as that of sinking. Some revive almost immediately without any inconvenience or sense of weakness whatever: while others improve slowly and almost imperceptibly, and require many hours before they fully regain their self-possession. In various cases the head becomes clear as soon as the pulse becomes regular; while, not unfrequently, the recovery is accompanied with a confusion of ideas, vertigo, and head-ache. As this disease is always attended with an irregularity in the flow of nervous power, and some degree of spasmodic action, entastic or clonic, about the heart, the best remedies we can have recourse to, during the paroxysm, are antispasmodics and stimulants; and those that are the most volatile are the most useful. Hence the advantage of admitting a free current of cold air, sprinkling cold water over the face, and pouring a little of it, if possible, down the throat. And hence, also, the advantage of holding ammonia, the strongest vinegar, or any other pungent odours, to the nostrils. A recumbent position is always adviseable, as most favourable to an equable circulation of the blood; and irritating and warming the extremities by the friction of the hand or the application of rubefacients will commonly be found to expedite the recovery, upon the principle we often had occasion to advert to, that, in a chain of organs united by sympathy or continuity, an impression produced on the one extremity is sure to operate on the other. As soon as the patient is capable of swallowing, some spirituous cordial, as a glass of wine, brandy and water, fetid tincture, or the aromatic spirit of ammonia or of ether, should be administered; and the occasional cause should be sedulously avoided in future. SPECIES II. SYNCOPE RECURRENS. Fainting-Fit. RECURRING AT PERIODS MORE OR LESS REGULAR; OCCA- GEN. VI. Commonly SPEC. II. rious form of THIS is, in most cases, a far more serious form of syncope than the preceding, and is commonly ascribed to some structural disease of the heart or the large arteries that a more seimmediately issue from it, as an ossification of the valves, disease than polypous concretions, an enlargement or thickening of the the last, substance of the heart, an accumulation of water in the as usually pericardium, or an aneurism. dependent upon some structural misaffection Each of these may possibly be a cause in some instance or other; and where, during the paroxysm, the breathing, of the heart though feeble, is anxious and obstructed, the face livid, arteries. or larger and the patient in the midst of the swoon shows a tendency to jactitation, or an uneasiness on one side or on the other; and, more especially still, where no ordinary exciting cause can be assigned, and it has commonly followed upon some unusual exertion, or hurry of the blood through the lungs, it would be imprudent not to suspect some such lurking mischief. many cases causes. But there are causes of a different and much slighter But not alkind that I cannot avoid believing frequently operate in ways so: the production of recurrent syncope, and that, too, with being from many of the peculiar symptoms just enumerated. And slighter I now allude to any of the ordinary causes of syncope, as set down under the first species, or any other incidental irritation whatever, occuring in a constitution of great mobility and excitability, or where the heart alone, or in conjunction with the whole arterial system, is peculiarly disposed to that irregular and clonic action which we have noticed under the species PALPITATION, and particularly under the first and second varieties. |