Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    171/976 (page 151)
    before any symptoms have been complained of, though they may really have existed for some hours. Whatever may be the state of the countenance, if there have been many stools, or frequent vomiting, symptoms of depression appear; the pulse begins to lose its strength and soundness, and the temperature of the surface falls. Within six or seven hours of the onset of the purging, or even much earliei, the pulse may dwindle down to the faintest thread, or may entirely dis- appear from the wrist for many hours ; in others, even in well-marked cases, though in milder forms of the disease, never quite ceasing to be felt at the wrist. This period is one of the greatest interest to the surgeon. With the utmost anxiety he watches, hour after hour, the waning, or the stationary, or the returning strength of the pulse, its maintenance or its extinction heralding either a happy issue in the first stages, or a future struggle of the deepest danger through the next stage, that of collapse. In some cases the balance oscillates for hours. If it turn adversely, with the failing circulation come the shrunken face, the lessening of bodily warmth, and the greater ex- haustion ; and the patient passes into the stage of collapse. Stage of Collapse. — Algide Stage. — This is very much more dangerous than the last. Evacuations from the stomach and bowels are now less frequent and copious. The alvine discharges generally contain less liquid ; sometimes still of many ounces in each, at others merely a little clear fluid with gelatinous mucous-like flakes or masses. The stomach often acts, violently, perhaps, but with less discharge. In the extreme state of the collapse the patient nearly resembles a corpse. There is the utmost depression possible with a capability of recovery. When this stage is fully formed, the patient no louger rises from his bed, though he often tosses about on it with sudden and frantic jerks, throwing off all covering, as if intensely hot, and seeking for cool air. Or he half springs up in bed shrieking from agonizing cramps, or he is still more exhausted with irregular paroxysmal gasping for breath, which subsides to be again renewed, and may end in the respiration being more constantly embarrassed. He passes stools under him, heedlessly or with indifference. Now, the features are shrunk and livid, the eyeballs small and buried in their orbits, the lower lid drooping, and the eye half open. The surface is deadly cold, except, perhaps, sometimes the forehead or precordia, the tongue icy to the touch, the very breath a cold air stream, the temperature in the mouth 79° to 88° Farenheit; in the axilla 90° to 97°. The general surface is pale, bluish, or livid ; often bathed in cold profuse sweats, as may be the forehead, and the shrivelled hands and feet; the hands looking as if they had been long soaked in water ; the pnlse absent from the°wrist