In the early stage a brisk mercurial purge is often of value.  Alcohol should be withheld, unless failing of the pulse strongly indicates its use, and then it should be given along with the food.

A delirious patient must be constantly watched by a trained attendant or other competent person, lest he get out of bed and do harm to himself or others.  Mechanical restraint is often necessary, but must be avoided if possible, as it is apt to increase the excitement and exhaust the patient.  On account of the extreme restlessness, there is often great difficulty in carrying out the proper treatment of the primary surgical condition, and considerable modifications in splints and other appliances are often rendered necessary.

A form of delirium, sometimes spoken of as #Traumatic Delirium#, may follow on severe injuries or operations in persons of neurotic temperament, or in those whose nervous system is exhausted by overwork.  It is met with apart from alcoholic intemperance.  This form of delirium seems to be specially prone to ensue on operations on the face, the thyreoid gland, or the genito-urinary organs.  The symptoms appear in from two to five days after the operation, and take the form of restlessness, sleeplessness, low incoherent muttering, and picking at the bedclothes.  It is not necessarily attended by fever or by muscular tremors.  The patient may show hysterical symptoms.  This condition is probably to be regarded as a form of insanity, as it is liable to merge into mania or melancholia.

The treatment is carried out on the same lines as that of delirium tremens.

CHAPTER XIV

THE BLOOD VESSELS

Anatomy—­INJURIES OF ARTERIES:  Varieties—­INJURIES OF
    VEINS:  Air Embolism—­Repair of blood vessels and natural
    arrest of haemorrhage—­HAEMORRHAGE:  Varieties;
    Prevention; Arrest—­Constitutional effects of
    haemorrhage—­Haemophilia—­DISEASES OF BLOOD VESSELS: 
    Thrombosis; Embolism—­Arteritis:  Varieties;
    Arterio-sclerosis—­Thrombo-phlebitis—­Phlebitis: 
    Varieties—­VARIX—­ANGIOMATA—­Naevus:  Varieties;
    Electrolysis—­Cirsoid aneurysm—­ANEURYSM:  Varieties;
    Methods of treatment—­ANEURYSMS OF INDIVIDUAL ARTERIES.

#Surgical Anatomy.#—­An artery has three coats:  an internal coat—­the tunica intima—­made up of a single layer of endothelial cells lining the lumen; outside of this a layer of delicate connective tissue; and still farther out a dense tissue composed of longitudinally arranged elastic fibres—­the internal elastic lamina.  The tunica intima is easily ruptured.  The middle coat, or tunica media, consists of non-striped muscular fibres, arranged for the most part concentrically round the vessel.  In this coat also there is a considerable proportion of elastic tissue, especially in the larger vessels.  The thickness of the vessel wall depends chiefly on the development of the muscular coat.  The external coat, or tunica externa, is composed of fibrous tissue, containing, especially in vessels of medium calibre, some yellow elastic fibres in its deeper layers.