The course of events in secondary wound shock / W.B. Cannon.

  • Walter Bradford Cannon
Date:
1919
Catalogue details

Licence: Public Domain Mark

Credit: The course of events in secondary wound shock / W.B. Cannon. Source: Wellcome Collection.

    6/20 page 4
    aspects of shock by prolonged stimulation of nerves, by severe and long-continued manipulation of exposed intestines, by the application of acid to the abdominal viscera, by vigorous over-ventilation of the lungs, by repeated punching of the diaphragm, or by injecting | into the circulation large amounts of cream. It is possible that such procedures induce changes similar to those which may occur naturally in shock; but no one can successfully argue that such procedures repro- duce the circumstances which occasion shock after. ordinary wounds or injury. Obviously, it is desirable to duplicate so far as possible the actual conditions which give rise to shock and then to analyze them to determine what factor among them is operative. | Shock occurs in warfare on an enormous scale. To find evidence of the interest which the subject of shock has aroused at:times of fierce strife one needs only to look through any large catalogue of medical literature and observe the dates of publication of arti- cles. In warfare the shock state occurs characteristic- ally in association with extensive and severe wounds— wounds in which large tissue masses are shredded, torn or crushed; as, for example, when there has been rupture and mashing of muscle by shell fragments. Similarly in civil life, traumatic shock is seen charac- teristically after injuries under car wheels or in machinery, when limbs have been badly mangled. ‘As Cowell® pointed out, there are certain very severe wounds in which death is certain to occur soon because of the anatomic damage which has been done. The patient’s condition may be seriously complicated by abundant hemorrhage. In such cases, symptoms of shock are seen immediately; and from the earliest moment there is low pressure. This may be called “primary wound shock.’ On the other hand, there is testimony from a variety of sources* that after large wounds the state of shock commonly does not appear at once, but develops in the course of a few hours. This is Cowell’s “secondary wound shock.” When shock thus develops it may be attended by little hemor- 3. Cowell, E. M.: The Initiation of Wound Shock, J. A. M. A. §0:607 (March 2) 1918. 4, Archibald and McLean: Ann. Surg. 66: 280 (Sept.) 1917. Sant: Bull. Mém. Soc. de Chir, 44: 207 (Feb. 6) 1918. Quénu: Presse méd. ‘26:69 (Feb. 7) 1918. ;
    No text description is available for this image
    No text description is available for this image
    No text description is available for this image