Memorandum upon surgical schock and some allied conditions.

Date:
1917
Catalogue details

Licence: Public Domain Mark

Credit: Memorandum upon surgical schock and some allied conditions. Source: Wellcome Collection.

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    circulatory system and mitigates the effect of deficient blood-volume. The tendency of adrenaline to produce obstruction to the circulation through the liver, as described above, makes it probable that the use of this substance would, in some cases, eventually aggravate the condition which it was designed to cure ; its action is, in any case, so fugitive as to be of little value. The action of pituitary extract is free from both these drawbacks; its value in some cases is already well recognised, and, with the ordinary measures for restoring and conserving the body-temperature, needs no further mention. The failure of injections of physiological saline in fully-developed shock has already been mentioned. Experiments already made seem to indicate that better results might be obtained by the use of intra- venous injections of hypertonic saline, the value of which in the treatment of cholera and bacillary dysentery is already familiar. Whether the action of these is entirely due to the passage of water into the vessels by osmosis, or in part to a restorative effect of the hypertonic solution on capillary tone, is not clear. In this connection it may be recalled that calcium ions have been found to have a specific action in reducing abnormal permeability of capillaries (cf. Wright ; also several papers from the Vienna school). It seems reasonable, therefore, to suggest that a fluid representing a con- centrated Ringer solution should be used, rather than one in which only the proportion of sodium chloride is increased. The following formula might be tried :— sodium “Chioride “0°. .7' . 2 ee er animes: Potassium: Chloride’ 52 72 ee Oe 2. Calciunr Chioride .... U2 9h. os SB 010e =; Water 2/2) LOG: Cire; and the value of increasing the relative calcium content beyond this proportion might cautiously be tested. The deficient oxidation occurring in any condition of circulatory failure will lead to an abnormal acidity of the tissues, and thereby tend to raise the concentration and viscosity of the blood in the capillaries. Administration of alkalies should, therefore help to relieve the condition, and injections of sodium bicarbonate, as recom- mended by Wright for the treatment of gas-gangrene, should form a valuable addition to large injections of a hypertonic saline mixture. The limited solubility of calcium bicarbonate makes it advisable to give the bicarbonate solution as a separate injection. Hogan and Fischer recommend the following formula for an alkaline hypertonic saline :-— Sodium Chloride... ... .... ... 28:grammes. Sodium Carbonate (crystalline) ... 20 . Distilled water BaD ot hae TPE eS: Bayliss recently drew attention to the importance of the factor of viscosity in solutions used to replace blood lost by hemorrhage. He considered that gum acacia was a suitable substance to add to saline for such purposes, as imparting the requisite viscosity and as being a colloid with a definite osmostic pressure. Hogan and Fischer, on different theoretical grounds, have recommended the addition of 2 per cent. of gelatine to a saline solution for intravenous infusion. It will be evident, from what has been said above, that the aim in