Imágenes de página


when the

ciency, its motion will be checked and enfeebled: the brain Gen. VI.

Spec. I. and respiratory organs will participate in the debility, and si syncope be a frequent result. And hence, we may account simplex.

Swooning. for the fainting that frequently takes place on the com

flow in an mencement, and sometimes on the close of venesection. equal and On tying the arm for this purpose, a considerable stream uniform

stream. of supply is cut off, and ten ounces of blood flows, in

1 Whence perhaps five minutes, into a bason, which would other- swooning in wise have flowed into the heart in the same period of time. ve

as well when The volume of blood is hence diminished, and the heart the blood

first flows must collapse or contract itself in proportion. In many

my from the habits this is done with great facility: but in others, and puncture, as particularly where there is a feeble supply of motific or

ligature is irritative power, the contraction takes places slowly and removed. 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 when any extensive range of blood vessels that have been

opening . pressed upon by any other means, suddenly acquire a large abe

power of dilatation, as when a large cavity is formed in sc


scesses or

Ted; and oled, or cherom the bus

om viole

tions and

Gen. VI. the abdomen by the process of tapping for an ascites, of Spec. I.

to on opening an extensive abscess in any other quarter. simplex. But the flow of sensorial power from the brain may

ooning also be suddenly exhausted, or checked, or perhaps its on tapping in dropsies. secretion impaired ; and syncope may ensue from this Syncope source, the action of the heart being diminished not prialso if there

marily, but secondarily, or by sympathy with the state be not a regular sup- of the sensorium. In fainting, from entonic passions or ply of sen

r. emotions, as a sudden shock of vehement joy, the sensorial

om Hence power is perhaps abruptly expended, as also in severe fainting

pain t. In fainting, under the influence of the atonic pasmental emo- sions, as fear or heart-sick grief, this power is unquestion

ably checked in its regular flow, and probably checked also severe pain. Fainting

" in its secretion : as we have reason to believe it is where

in from par. fainting occurs from a repulsion or retrocession of gout, ticular

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 faSwooning from in tigue, long-fasting, or a sudanition,

den and excessive discharge of any fluid, whether natural or morbid, accompanied with

odours in certain idiosyncrasies.


• Meckel, Epist. ad Hallen. Script. Vol. 11. Eph. Nat. Cur. Dec. II. Ann. v. Obs. 53.

+ Amat. Lusitan. Cent, 11. Cur. 1. Plater, Observ. II. p. 431,

a sense of inanition, and great Gen. VI.

Spec. I. prostration of strength.

Syncope B Doloris.

Preceded by severe pain or ir- simplex. Swooning from acute ritation of body, internal, as pain.

from poisons, flatulency, or worms; or external, as from

wounds or other injuries. g Pathematica. Preceded by an exercise of Swooning from men- some sudden and overwhelmtal emotion.

ing passion or emotion. 8 Metastatica.

Accompanied with a retrocesSwooning from me- sion or repulsion of gout, extastasis.

anthems, or other diseases. The degree and duration of the paroxysm depend upon Degree and the peculiarity or the violence of the cause, the extent of i

f duration of the sensorial exhaustion, or the nature of the constitution, oxysm on and hence must greatly differ in different individuals. pendent.

what deIn 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. M. Portal has hence justly remarked that " we may

bodi thot so we mov Sometimes

apparent have apparent death from syncope as well as from as- death, which phyxy, and that, from not attending to this, we may 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.” *

mis. taken for

* Mémoires sur la Nature et le Traitement de plusieurs Maladies. Tom. Ir. 8vo. Paris, 1819.



aided by

Gen. VI. When not assisted by medicine the system recovers

Spec. I. Syncope

itself by the gradual accumulation of sensorial energy that simplex. must necessarily take place, so long as the living princiSwooning.

ple continues, during such a state of quietism ; aided, Recovery commonly unquestionably, by the continual action of the instinctive, effected or remedial power of nature, which is always aiming to without medical aid; repair what is amiss. The process of recovery, however, and why. varies almost as much as that of sinking. Some revive

less of almost immediately without any inconvenience or sense of recovery

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. Yet may be As this disease is always attended with an irregularity medical

in the flow of nervous power, and some degree of spasmodic action, entastic or clonic, about the heart, the best re

medies we can have recourse to, during the paroxysm, are process.

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.

means. Remedial



osification of shown

rious form of

sease than

structural misaffection




This is, in most cases, a far more serious form of syncope Gen. VI.

Spec. II. than the preceding, and is commonly ascribed to some

e Commonly structural disease of the heart or the large arteries that a more seimmediately issue from it, as an ossification of the valves, polypous concretions, an enlargement or thickening of the the last, substance of the heart, an accumulation of water in the

We dependent pericardium, or an aneurism.

upon some 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, .

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.

But there are causes of a different and much slighter But not alkind that I cannot avoid believing frequently operate in the production of recurrent syncope, and that, too, with being from many of the peculiar symptoms just enumerated. And

causes. 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.

ways so:


« AnteriorContinuar »