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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    such a rise of hazmoglobin value was observed, concurrently with the onset of the shock, as to indicate a serious depletion of the plasma- volume. In others a less profound shock was obtained, with a ten- dency to spontaneous recovery when the abdominal wound was closed and the animal left to itself under the anesthetic; in these no significant change in the hemoglobin value was observed. In these cases, also, the manipulated bowels became conspicuously reddened and ultimately blueish in appearance, but the blood-pressure could be temporarily driven almost to its original high level by compress- ing the whole mass of intestinal coils and so driving the blood out of their capillaries into the general circulation. In these cases, there- fore, such shock as was obtained seemed to be due purely to stasis in the abdominal capillaries, as previously described by Mann. Meanwhile, Captain Marshall, R.A.M.C., had commenced a series of observations in France on the hemoglobin content of the blood in the different classes of case met with in a Casualty Clearing Station. The Committee understand that among Captain Marshall’s observations are some on shock, which support the view that loss of plasma into the tissues is an important factor in the condition. i. 3, Iminazolylethylamine (Histamine) was chosen by Dale and Laidlaw for this investigation as a pure substance, producing effects of the kind under investigation in exact dosage. Effects of the same general type are produced by many products of protein digestion, bacterial products, etc. Among such effects, those due to the so- called toxeemia of gas-gangrene is of special importance at present. The resemblance between the symptoms of this condition and those of surgical shock, or of a severe hemorrhage, has frequently been described. An investigation is now being carried out by H. H. Dale and J. McIntosh into the symptoms presented by animals dying after a local infection of the limb-muscles by organisms of the gas-gangrene group, isolated from material obtained from fatal human cases. The onset of a fatal shock-like condition in such experiments has again been found to be associated with a progressive rise in the cor- puscular content of the blood pointing to a steady loss of plasma. It may be pointed out that such an effect was perhaps to be ex pected. The capillaries in the tissues surrounding the infected muscle are so affected that an enormous local outpouring of plasma occurs. Whether the general symptoms are due to passage of the infecting organisms into the general circulation, or to the absorp- tion through the lymph channels of toxic products of the local break- down of muscle, effects on the general vascular endothelium of « similar kind, though much less in degree than those produced by the concentrated local action, might be expected. A general loss of capillary tone and a morbid increase of permeability of capillary walls might therefore be expected to result from absorption into the general circulation of the fluids from the infected area. The evidence as yet available confirms this expectation, and suggests that there is a fundamental similarity of origin, underlying the similarity of symptoms, between the toxemia of gas-gangrene and other shock-