394 PATHOLOGY AND TREATMENT OF SHOCK AND SYNCOPE. 



Cooper in his lectures on surgery.* " A healthy labourer be- 

 longing to the India House was attempting to lift a heavy weight, 

 when another labourer came up and said, ' Stand on one side ; 

 let an abler man tr)'/ At the same time he gave the former a 

 slight blow on the region of the stomach, when the poor fellow 

 immediately dropped down and expired. On examination of 

 his body there was not any mark of violence discovered." 

 This may be regarded as a typical instance of instant death 

 from shock, but cases like it are comparatively rare. Usually 

 the injury is succeeded by a period of depression of all the 

 vital functions, and this may either end in death, pass into a 

 state of excitement, or gradually disappear and give place at 

 once to health without any intervening excitement. 



The symptoms ordinarily observed in shock are well illus- 

 trated by a case which Profc3sor Fischer has described in a 

 clinical lecture on this subject.! From this I have made the 

 following extracts : — " The patient, a strong and perfectly 

 healthy young man, was struck in the abdomen by the pole of 

 a carriage drawn by runaway horses. No serious injury was 

 done to any of the internal organs, at least we have not been 

 able after a careful examination to find any trace of one. 

 Nevertheless, the grave symptoms and the alarming look which 

 he still presents made their appearance immediately after the 

 accident. He lies as we see perfectly quiet, and pays no atten- 

 tion whatever to anything going on around him. His coun- 

 tenance is sunk and peculiarly elongated, his forehead is wrinkled, 

 and his nostrils dilated. His weary, lustreless eyes are deeply 

 sunk in their sockets, half-covered by his drooping eyelids, and 

 surrounded, by broad, dark rings. The pupils are dilated, and re- 

 act slowly to the light. He stares purposelessly and apathetically, 

 straight before him. His skin and such parts of the mucous 

 membranes as are visible are pale as marble, and his hands and 

 lips have a bluish tinge. Large drops of sweat hang on his 

 forehead and eyebrows. His whole body feels cold to the hand, 

 and a diminution in temperature is readily detected by the 

 thermometer, which indicates a degree and a half in the axilla, 



* Lectures on Surgery, from notes hy Tyrrell, 1824, vol. i, p. 10. 

 f Volkmann's Sammlung Klinischer Vortrdye, No. 10. 



