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March 20, 1948


JAMA. 1948;136(12):831. doi:10.1001/jama.1948.02890290021008

Romano and Engel1 stated that encephalograms taken during actual loss of consciousness may be classified in three groups: the emotional type of fainting, the epileptic type and the syncopal or vasodepressor type. Rook similarly classified 500 cases of impairment of consciousness in pilots and air crew studied at the Central Medical Establishment, Royal Air Force. He considered the pathologic processes that led to the attack to result from three separate mechanisms: disturbances of the highest cortical levels; hypersensitivity of the nerve cells at the lower level leading either to explosive discharge or to pathologic inhibition, and alterations in the quantity or quality of the blood supply to the brain. The essence of loss of consciousness affirmed Rook, must be some change in the nerve cells themselves, whether brought about by mechanical, chemical or electrical agencies. Rarely in any case is only one of these pathologic processes at work. For

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