An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![placed ill tlio reeuiiibciit j)()sitioii, if it is not already so. l{esj)iration should be kept free from impediment, and when practicable thestiinulatiiiiT effect of inhala- tions of oxyijen should be resorted to. Tloat should be applied not only to the extremities, but to tlie whole surface of the body as far as juacticahle. Hot- water bottles and hot blankets should iiave been ])r(»vided for this j)urpose. In cases of severe shock an ellicient and S})eedy method of api)lyiii<f heat is to wrap the whole body in bhmkets wrung out of hot water. Diffusive stimulants should be instantly and freely administered. The most (juickly acting and reliable stimulation is obtainable by an intravenous injection of a hot (48.3°- 44.5° C.: 110°-112° F.) normal saline solution (.^ to ()j). Such injection is especially important when the injury has been accompanied with loss of blood. As the right heart feels the pressure of the injected fluid, the lieart- beats become lengthened and more forcible, and the blood-pressure in the peripheral vessels rises. To ensure permanence in this cardiac and vascular reaction the amount of fluid thrown in should be large—from one to two quarts; or, better, repeated injections of smaller quantities—twenty to forty fluidounces—should be made; renewal of the injection being made as the effects of the previous one are found to be waning. Ilypodermoclysis—an injection into the subcutaneous cellular tissue—is valuable as a substitute for intravenous injection, in cases of less emergency, or in the absence of facil- ities for its proper performance. The injecting-needle may be thrust into the loose tissue under each breast, where from twenty to thirty ounces of fluid can be readily forced into the connective-tissue spaces. (The technique of transfusion and of hypodermoclysis, and the best formula for the solution, will be found under Minor Surgery.) High enemata of hot liquids, a quart or more, are of great value, either alone or as an adjuvant to the measures named. An infusion of black coffee (f.5iij) and whiskey (f.^), or an emul- sion of turpentine (f 5ss of the turpentine), adds additional stimulating power to such enemata. Strychnia, in dose of -^^ grain, repeated every half-hour until four doses have been given, and afterward at intervals of four hours, is most valuable in maintaining cardiac energy. It should be used in connection with the diff'usible stimulants. Nitroglycerin, in doses of -^^ grain, may be given with the strychnia. In the lesser degrees of shock dependence may be placed on Avhiske}^ half an ounce by the mouth every half-hour, or one dram under the skin every fifteen minutes, till reaction has been secured. Recovery from shock under proper treatment, if it occurs at all, is usually quite speedy ; delay in recovery or alternations of improvement and relapse, as has already been stated, are due to the nature of the injury itself or to new complications in- troduced, and are not to be attributed to or classed as shock. Death from shock may be immediate or gradual. When instantaneous death takes place the nerve-centers must be considered as having been overwhelmed beyond the power of resistance. In some such cases the heart has been found contracted and empty. More commonly the fatal issue occurs only after some minutes or hours of struggle against the inevitable. The fatal approach is then more gradual; the action of the heart becomes more and more feeble; the pulse, weak and thready and counted with difficulty on account of its rapidity, becomes finally lost; the extremities become cool, the face pinched and haggard; the mind, apathetic, gradually sinking into unconsciousness; the temperature continues to fall until it becomes a degree or more subnormal; the respiration is feeble and shallow, until finally, by combined respiratory and cardiac failure, death closes the scene.](https://iiif.wellcomecollection.org/image/b21217014_0131.jp2/full/800%2C/0/default.jpg)
