clammy sweat, and beads of perspiration stand out on the forehead.  The pulse becomes feeble, soft, and rapid, and the patient is dull and listless, and complains of extreme thirst.  The temperature is usually sub-normal; and the respiration rapid, shallow, and sighing in character.  Abnormal visual sensations, in the form of flashes of light or spots before the eyes; and rushing, buzzing, or ringing sounds in the ears, are often complained of.

In extreme cases, phenomena which have been aptly described as those of “air-hunger” ensue.  On account of the small quantity of blood circulating through the body, and the diminished haemoglobin content of the blood, the tissues are imperfectly oxygenated, and the patient becomes extremely restless, gasping for breath, constantly throwing about his arms and baring his chest in the vain attempt to breath more freely.  Faintness and giddiness are marked features.  The diminished supply of oxygen to the brain and to the muscles produces muscular twitchings, and sometimes convulsions.  Finally the pupils dilate, the sphincters relax, and death ensues.

Young children stand the loss of blood badly, but they quickly recover, as the regeneration of blood takes place rapidly.  In old people also, and especially when they are fat, the loss of blood is badly borne, and the ill effects last longer.  Women, on the whole, stand loss of blood better than men, and in them the blood is more rapidly re-formed.  A few hours after a severe haemorrhage there is usually a leucocytosis of from 15,000 to 30,000.

#Treatment of the Bloodless State.#—­The patient should be placed in a warm, well-ventilated room, and the foot of the bed elevated.  Cardiac stimulants, such as strychnin or alcohol, must be judiciously administered, over-stimulation being avoided.  The inhalation of oxygen has been found useful in relieving the urgent symptoms of dyspnoea.

The blood may be emptied from the limbs into the vessels of the trunk, where it is more needed, by holding them vertically in the air for a few minutes, and then applying a firm elastic bandage over a layer of cotton wool, from the periphery towards the trunk.

Introduction of Fluids into the Circulation.—­The most valuable measure for maintaining the circulation, however, is by transfusion of blood (Op.  Surg., p. 37).  If this is not immediately available the introduction of from one to three pints of physiological salt solution (a teaspoonful of common salt to a pint of water) into a vein, or a 6 per cent. solution of gum acacia, is a useful expedient.  The solution is sterilised by boiling, and cooled to a temperature of about 105 F. The addition of 5 to 10 minims of adrenalin solution (1 in 1000) is advantageous in raising the blood-pressure (Op.  Surg., p. 565).

When the intra-venous method is not available, one or two pints of saline solution with adrenalin should be slowly introduced into the rectum, by means of a long rubber tube and a filler.  Satisfactory, although less rapidly obtained results follow the introduction of saline solution into the cellular tissue—­for example, under the mamma, into the axilla, or under the skin of the back.