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.

    9/14 (page 7)
    way. It would be of interest to know whether different types of shock can be clinically recognised; in particular, whether a type with circulatory obstruction in the liver, as shown by swelling of this organ and congestion of the portal vein and its tributaries, can be differentiated from a type without this feature; and, if so, whether the nature of the primary cause of the shock has any relation to the type produced. (c.) Prevention.—If shock is, indeed, due to oligeemia, its many points of similarity to the collapse produced by a dangerous hemorrhage need no explanation. It will further be obvious that an antecedent hemorrhage, insufficient in itself to produce collapse, may be an important factor in the subsequent onset of shock, in so far as this condition is due to defective volume, apart from increased viscosity of the blool. The normal reaction to a simple hemorrhage, of sufficient severity to diminish the output of the heart and lower the blood pressure, consists in the abstraction of fluid from the tissues until the volume of the blood is again adequate to maintain the cardiac output. Dale and Laidlaw find that a similar dilution of the blood normally accompanies, and tends to correct, a fall of pressure due to arterial dilatation. In shock, according to the indications of the experiments already described, this restorative reaction fails com- pletely, and fluid continues to pass from the blood, though the arte- rial pressure has fallen to a very low level. It will be evident, there- fore, that, when shock is already imminent, a relatively small hemorrhage may have a serious influence in determining its onset. Any other causes tending to diminish the blood volume, such as fatigue, exposure, or prolongued astinence from food and water, may be expected to predispose to shock for a like reason. Mention should be made also of the possibility that measures preparatory to an operation in hospital, if they include free saline purgation and severe abstinence from food and water, may contribute to the danger. Cases for urgent operation must constantly present them- selves to the military surgeon, in which the antecedent conditions are those mentioned above as tending to depletion of the blood- volume, and therefore predisposing to shock. A free supply of fluid, by infusion of physiological saline into the rectum or the subcu- taneous tissues, as already used by many surgeons, may be expected to have a special preventive value in such cases. The indications, however, are that such measures, to have any value, must be begun before or early in the operation. When once the condition of shock has been developed, physiological saline, or Ringer’s solution, even if injected intravenously in large volume, appears to have a very limited and temporary value ; for the diluted plasma passes with increased rapidity through the slack and permeable walls of the capillaries, and the fluid leaves the circulation almost as quickly as It 1S run Jn, (D.) Treatment. Unfortunately, little can be said as yet as to the treatment of shock and allied conditions when once developed. Suggestions only can be made of measures which may be tested with possible advantage and without danger. It is hoped that further experiment may warrant more positive recommendations at a later Stage. Pituitary extract causes a prolonged and general contraction of the arterioles, and thereby diminishes the total capacity of the