COMA.
The cause of the coma must he determined before any form of rational treatment can be decided on. A head injury, meningeal inflammation, apoplexy, sunstroke, opium or alcohol-poisoning, uremia or hvperpyrexia may be the cause, and should be promptly met by the treatment as detailed under the heading of the individual primary affection. The large dose of Calomel suitable to an apoplectic patient may cause the death of a patient seized with coma from diseased kidney. To treat the coma of opium as one would treat the profound unconsciousness caused by hyper pyrexia would be to allow the patient to speedily pass beyond the reach of remedies.
If no previous history can be obtained of the cause of the coma, say in a subject picked up in the streets, Sinapisms may be applied to the back of the neck, spine, abdomen or back of the legs. A smart purgative (one drop of Croton Oil) is safe, and can do no harm; often the Cold Douche may be used. If there be even a suspicion of poisoning, the soft tube of the stomach pump should be passed, and the contents drawn off and examined. No harm can come from such procedure, whilst, should the
patient die without this having been done, and subsequent information he forthcoming at the coroner's court, serious blame will be meted out to the attcndanr, even though pumping would have been useless. Valu able information may be obtained by using the catheter in such cases and examining the urine drawn off. The coma due to a general toxaemia causes symptoms which are always bilateral, both sides of the body being equally flaccid and powerless, whilst even in the severe cerebral lesions causing complete unconsciousness some variation of the motility of the limbs may he found by a careful comparison of each side of the body, and pupil changes or deviation may be detected. (Sec the treatment of each of the primary affections under its heading—i.e., Apoplexy, Diabetes, Craetnia, Poisoning by Opium, Alcohol, &c.)