Chapter XVIII 



THE ADRENALS AND SURGICAL SHOCK 



Our ignorance of the function of the adrenals has made these 

 glands the natural butt of theories purporting to explain the 

 condition of shock. At first, dysfunction of the medulla was 

 held responsible for the development of shock. With the shift 

 of interest in the adrenals from the medulla to the cortex, 

 these glands were again linked with shock, the absence of the 

 cortical hormone being now held responsible for its develop- 

 ment instead of epinephrine as in the older theories. 



Shock is a rather loosely defined term applied to a condition 

 marked by a failure of the circulation manifested particularly 

 by a fall in blood pressure. Shock occurs under a variety of 

 conditions — after surgical operations, traumatic injuries, in 

 toxic conditions, after excessive hemorrhage, in psychic dis- 

 turbances, and the like. Many theories have been advanced 

 to explain the underlying pathology which brings about a state 

 of shock but none of these theories has proven satisfactory. 

 Shock, like prostration, asthenia, or the like, is a term describing 

 a condition rather than a disease entity and results undoubt- 

 edly from a variety of causes quite unrelated to one another 

 but having in common only the fact that they all cause a seri- 

 ous collapse of the mechanism which normally maintains the 

 circulation. One can explain the occurrence of shock under 

 most conditions by a consideration of the underlying pathology 

 accompanying the condition. Thus in a sudden widespread 

 dilatation of the capillaries, the great increase in the capacity 

 of the circulatory bed must necessarily result in a dangerous drop 

 in blood pressure and a condition of shock. Similarly a sudden 

 failure of the heart or the loss of a large volume of the circulat- 

 ing fluid (as in hemorrhage) must result in shock. 



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