272 COKTEX 



A large group of cases of shock occur under conditions in 

 which simple hemodynamics does not explain the condition 

 as easily as in the above described cases. Thus in the so-called 

 cases of surgical shock, or in the shock following excessive trau- 

 matic injuries, the local changes are not sufficient to account 

 for the observed collapse of the circulation. In cases of this 

 sort in which emboli (fat or air) have been released into the 

 circulation it is obviously to embolism that we must attribute 

 the observed shock. In certain cases, however, neither emboli 

 nor the release into the circulation of toxic products can ac- 

 count for the development of shock. Thus crushing of the 

 testicles has been utilized experimentally to reproduce the 

 condition in animals. In this form of shock, which also in- 

 cludes many cases of surgical and traumatic shock, we must 

 assume that the mechanical injury has released a stream of 

 impulses which have resulted in the collapse of the circulation. 

 The existence of such reflex impulses in response to trauma is 

 easily conceivable when we consider the normal responses of 

 the circulation to minor stimuli. 243 



The present discussion of the supposed role of the adrenals 

 in the causation of shock has been prefaced by the above con- 

 siderations in order to indicate that shock is a symptom com- 

 plex due to a variety of possible causes and is not to be con- 

 sidered as a disease entity whose causation must be sought in 

 some particular gland or condition. A failure to appreciate 

 this has undoubtedly led to the many theories advanced for the 

 condition, none of which has withstood the test of time. It 

 would be wise perhaps if we were to cease using the term shock 

 with the connotation of a disease entity of mysterious etiology 

 and always modify the term by some expression indicative of 

 its origin. 



The fact that epinephrine raises the blood pressure so spectac- 

 ularly when injected and the fact that hypotension is one of 

 the chief symptoms of shock led to the earlier theories relating 



