Volume 1

Surgery : its principles and practice / by various authors ; edited by William Williams Keen.

Date:
1907-1913
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Surgery : its principles and practice / by various authors ; edited by William Williams Keen. Source: Wellcome Collection.

    983/1036 (page 939)
    nitroglycerin, are given, singly or in various combinations. In France ergotin is frequently given; in Germany, strychnin. The methods of supporting the blood-pressure may be classified as therapeutic and mechanical. The value of certain therapeutic stimu- lants, such as strychnin, digitalis, alcohol, nitroglycerin, caffein, camphor, ammonia, etc., has been subjected recently to inquiry, giving rise to considerable doubt as to their efficacy.Mummery has stated the more advanced position in his allusion to the use of strychnin as fol- lows: “The administration of strychnin in shock is like beating a dying horse; it may call forth an effort if we beat hard enough, but it hastens the end.” It is quite probable that the so-called heavy stimulation has done much harm. By the use of adrenalin the blood-pressure may be raised through its action upon the vessels themselves while not modifying the vasomotor center. Mummeryregards certain preparations of ergot favorably for the same reason. The shortcomings of adrenalin are obvious when it is recalled that the effect of the drug is fleeting, becoming inert on oxi- Fig. 254.—Crile’s Pneumatic Suit. dation. The administration of 10 to 15 c.c. of adrenalin chloric! in 500 c.c. of saline solution, given subcutaneously, may be of benefit. There are few drugs that have much value in the support of the blood-pressure in cases of true shock. Mechanical Means.—The head-down posture, making the patient as comfortable as possible, is one of the most practical and effective meth- ods of securing an increased determination of blood not only to the brain but to the heart and lungs as well. In addition to this, the extremities and abdomen may be bandaged. An effective ])lan lor this consists in covering the parts to be bandaged with non-absorbent elastic cotton in heavy layers so as to permit an elastic press\ire. It is not well to apply the bandage directly upon the skin, but bandaging with broad flannel bandages over heavy layers of cotton is less objectionable to the patient, obviates the risk of cutting off the blood-su]3])ly, minimizes the slipping of the bandages, retains heat, and definitely raises the blood-pressure. A similar pressure evenly distributed may be even more