The principles and practice of modern surgery / by Robert Druitt.
- Robert Druitt
- Date:
- 1848
Licence: Public Domain Mark
Credit: The principles and practice of modern surgery / by Robert Druitt. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![Terminations.—The process of recovery from collapse is commonly called fcaction ; and the manner in which the case may terminate must depend on the nature and degree of that reaction. Thus, First, if it is healthy and moderate, and especially if the collapse arise merely from conacssion (or violent shaking) of an organ, without actual injury to its structure, it will lead to complete recovery. Thus it very often happens that a slight blow on the testicle or stomach causes an ex- treme degree of sickness and faintness, which, however, pass off gradu- ally, and leave no ill consequences.* Secondly. If reaction be excessive, the state of collapse will be gradu- ally succeeded hy Jever, symptomatic of the inflammation to which the local injury has given origin. Thirdly. If reaction be imperfectly developed, it will be converted into the state of prostration with excitement, of which we shall speak in the next chapter. Fourthly. If reaction be altogether wanting, the collapse will terminate in death. And death may occur immediately on the receipt of the injury, if it be of extreme severity ; or otherwise the patient may die more slowly, the pulse at the wrist becoming fainter, and finally ceasing; and the res- piration more and more slow and oppressed, till life is gradually extin- guished.! * A case has lately been published in the Medical Journals, in which a man had his testicles crushed during some barbarous sports, and the shock to the nervous system was so great as to be speedily mortal. ■\ VAnious MODES OF DYisG.—So long as the functions of circulation, and respiration, and the action of the nervous system, are properly performed, life continues ; but if any one of these functions is suspended, the others also fail, and life soon ceases. But the order, and the manner, in which the various phenomena of life are extinguished vary extremely in different cases, so that we may enumerate several modes of dying; and the surgeon ought to be well acquainted with these in order to counteract the tendency to dissolution in any particular case. The first is death by syncope, or by anfEmia :—that is, from profuse loss of blood, as after severe wounds, bursting of aneurisms, &,c. The symptoms observable are cold skin, weak fluttering pulse, gasping respiration, and convulsions. In this mode, death occurs because there is not a sufficiency of blood for the heart to propel, and so the res- piratory and nervous functions cease in consequence. After death the heart is found contracted. The second is death by asthenia.—This is caused by circumstances producing a de- pressing effec-t on the system, either sudden and violent, or prolonged. The heart ceases to act, not from want of blood, as in the preceding mode, but from want of power to propel its contents; and therefore after death it is found full and distended, the left ca- vities with red blood. Sudden death from shocks to the nervous system ; from tiie con- dition, in fact, wiiich forms the subject of the present chapter; and gradual death from nervous exhaustion, from severe i)ain, (as after burns and scalds,) and from tetanus and hydrophobia, are instances of death by asthenia. Where this forin of death occurs gradually, (as in inllamination of the bowels) the pulse is very freqiu'ut ami feeble, but the intellect perfect, and senses acute to the last. The tliird is death by upnaa. or from interruiition to respiration. (Dr. Watson lias jiidiciou.sly substituted the term apntra for asphyxia, wliich is generally used to denote this kind nf death, although incorrectly, since asphyxia literally signifies want of pulse.) Fatniliiir iiifinnccs of this mode are airorded by the various forms of suHocation, drown- ing, violent infiannnalion of the lungs; injiny to the spinal cord in the cervic-al region, &.C. The iniinediat(; cllects of the privation of air, are, a stagnation of blood in the limgs, iliccircniiition of venous blood to the brain and tiody, and consequent impairment of their functions. After death, the ripht side of the heart is found/«// of black lilood, which it lui.M been unable to propel through the densely congested hmgs ; the /f/V side partially full of lilnek Idoorl. When this mode of death is slow, as in crou]i, Sic, tlio phenoirieiia are, great dyspntra, with lividiiy of the countenance, and delirium arising from the circulation of venous blood in the head.](https://iiif.wellcomecollection.org/image/b21049737_0032.jp2/full/800%2C/0/default.jpg)
