Apoplexy is usually of sudden onset if it causes loss of consciousness. There are signs of a focal cerebral lesion such as a hemiplegia. There are signs of a subarachnoid bleeding ha occurred and there may also be cardiac disorder associated with embolism. Meningitis: Coma is of gradual once inmost types being preceded by meningeal irritation and fiver but in meningococcal meningitis these signs may only have been present for a few hours. The cerebrospinal fluid is turbid and contains polymorph nuclear leucocytes.

Fainting causes loss of consciousness which is rapid but never so abrupt as in epilepsy. It is associated with pallor, and feeble, show or irregular pulse, syncope is due to temporary cerebral anoxia. It is commonly due to emotional causes but may be associated with disorders causing temporary insufficiency cardiac output or with cerebra vascular insufficiency. Prolonged syncope may cause an epileptic fit. There is a history of trauma and there may be signs of external injury. In concussion the face is pale, reflexes diminished or decent, and pupils equal dilated and sluggish, if there is compression due to intracranial hemorrhage the face may be flushed, breathing is torturous and the reflexes maybe asymmetrical. The pupil on the injured side first contracts and then dilates and the other pupil subsequently unconscious or incapable for some reason other than trauma may fall and injure his skull.

The attack is sudden, usually without warning. There maybe a history of a previous fit or evidence such as incontinence or a bitten tongue. Post epileptic unconsciousness does not usually last longer than about 30 minutes, but during period these pupils may be dilated tendon jerks absent and plantar reflexes extensor. Hysteria: Attacks usually occur before a witness and often have a purpose. The patient though apparently unconscious usually shows some evidence of reaction to external stimuli. Attempts to open the eyelids in order to elicit the corneal reflex often provoke spasm of the orbicular ocular muscles. The limbs may be thrown about with a violence which increase in proportion to any resistance offered by an attendant but rarely damages the affected limbs. There is no evidence of organic disease of the nervous system. It should be remembered that a confused person may react in hysterical manner and a genuine epileptic fit may be followed by similar behavior.

The state consciousness is associated with cortical activity activated by impulse from the thalamus and mid brain. The reticular formation receives collateral axons from the cortex and sends fibers to the cortex which it alerts. The lower part of the reticular formation projects to the spinal cord for regulation of muscles tone. Disorders of the cortical or brain stem poles of this system, but particularly the latter, are associated with disturbance of consciousness. Loss of consciousness is graded into arbitrary stages required to cause arousal. In the same way coma can be arbitrary graded according to the degree of loss of reflex activity. The ‘vital’ reflexes of coughing. Deepening coma and in treatment h patient must be protected form the consequences of their loss. Coma may be difficult to differentiate from some psychotic conditions of depression from amniotic autism in stimuli. If he is watched continuously it is seen that he is no wholly out of touch with his surrounding and his vital reflexes psychological abnormality can usually be obtained from a relative region of ht third ventricle but will be associated with signs of cerebral damage.

There must be a problem to be solved or interrelationship to be found. The results or accomplishments of discussion are related directly to the preparation of the group members with facts, general information, and ideas about the problem being discussed. a discussion group is no place to keep ideas a secret; each member must be willing to share information. Good discussion is based on and requires objectives thinking. Discussion that follows the steps of problem solving and decision making is more effective than unorganized and random discussion. Listening is vital to discussion; each member must hear every other member and do some thinking about what he hears. Good discussion depends upon individual contributions. The designated leader must be qualified and have the necessary experience and training to lead a group discussion successfully. The domination of discussion by one or more persons will limit the effectiveness and use of this technique.

Contribute relevant facts, points of view, and experiences to the group when and as they are needed. State facts and views as contributions to the discussion, rather than as final thought on the ideas under discussion. as a general rule contribute when requested to do so by the leader or other members of the group. Volunteer when confident the contribution will help move the group toward its objective. Help the group at the close of a discussion to supplement the results and record of their discussion. Be prepared at the close of a discussion to suggest further steps for the group to take in their discussions or in applying their conclusion in following action. Work closely with the discussion leader, observe, and record as a member of the leadership team.

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Serve on the leadership team with the special assignment of viewing the group in action and reporting his findings. Meet with the other members of the discussion leadership team and discussion and operation of each member of the team. Observe what is happening during the discussion and report this to the group. Examine objectively the group’s method of procedure and operation how the group works rather than what it does. Help the group functions effectively by supplying insights into the operations of the group process. Keep removed from participations in the discussion. Describe for the group the process being used as it works. Make an oral report to the group. Describing and summarizing how the group is operating (how the dynamics of the group are being utilized). The decision on how and when this should be done should be reached with the leader. Stimulate the group to evaluate its patterns of operation and to work toward more efficient operation.

Meet with the leader and other members of the discussion leadership team in advance and discuss the function of the team particularly the recorder in the group. Record the sense of the discussion, not every word that is spoken. Note the issues and questions discussed, the decisions reached, the proportion of the group in agreement, and significant minority opinions. Ask for clarification of ideas, decisions, etc., for the record. Ask the leader to poll the group if in doubt whether an idea or statement should be recorded. Make sure agreements, disagreements, or decisions actually exist or are made. Remind the group when they get off the subject. This assists the leader in keeping discussion “on the beam.” report on discussion progress during a discussion period when called upon by the leader or group members. Make a summary of main points, agreements, disagreements, and decisions at the close of the meeting. Work with the discussion leader, the observer, and the resource personnel as a member of a team. Edit and prepare a copy of the discussion notes for the record as soon as possible.

Prepare for the discussion in advance of the meeting if possible. Contribute to the discussion and assume any role the group needs to have filled. Help the group defines its discussion goal or purpose. Encourage participation and help keep the atmosphere permissive. Supply or seek facts and opinions when needed by the group. Put personally centered roles aside and admit error if the situation demands. Try to understand what other members say and also what they mean. Encourage the group and consciously try to build a feeling of “we-ness” assume leadership responsibility when necessary. Accept the conclusions of the group if arrived at by democratic processes. Confine remarks to short periods of time. Two to three minutes is the maximum time for a contribution. Express views and ideas without waiting to be prodded by the leader or other members.

Meet with other members of the leadership team and discuss the function and operations of the team. Assist the group to define clearly their problem or objective. Aid the group in establishing the necessary structure to accomplish their objective. Encourage the expression of ideas by all members of the group. refer questions back to the group. See that facts are made available when needed. Ask question and make summaries without letting personal views intrude, see that all aspects if the question problem under discussion are explored. Help the group into distinguish facts and sound argument from prejudice and opinions. Call for frequent statement o progress from the discussion. Establish and maintain an informal, cooperative, and permissive group Climate. Help the recorder by drawing summary statements from the group for the record. Keep the discussion on the subject and keep it progressing toward the objective established by the group. Make suggestion instead of giving directions. Stimulate and maintain a spontaneous exchange of ideas and of thinking. When necessary bring in appropriate humor to enliven the atmosphere. Translate poorly worded statement into clear statements that communicate.

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Have the group objective clearly in mind and the meeting, or segment, in which the technique is to be used. Consider alternative means that might be used to accomplish the objective. Make sure the group has a problem, idea, concern, or issue that is worthy of discussion. Select or provide for the selection of a chairman who can think rapidly and clearly, who can ask pertinent questions and not take sides, who can stimulate thinking, and who can summarize well. Select a meeting place appropriate to the size of the group. Arrange the group in a circle or square so each person can see every other person. Provide table space if convenient for the entire group. Keep it informal by having all members, including the leader, stay seated during the discussion. Have proper equipment, such as blackboard chalk, and paper, available. Appoint a discussion recorder. Give everyone a chance to talk but agree there will be no ‘speech-making”. Encourage ease, informality, good humor, and friendly disagreement. Keep the discussion directed and on the track-but let the group laid its own track. Take time at appropriate intervals, at least every 10 or15 minutes, to summarize and draw loose ends together. Keep the group conscious of accomplishment and of the objectives by frequent statements of progress by the chairman and/or recorder. Discuss with fairness and objectivity, and avoid fault finding, bias, and cynicism.