SYMPTOMS OF SHOCK. 39o 



and a degree centigrade in the rectum, below the norinah 

 Sensibility is much blunted over the whole body, and only 

 when a very painful impression is made on the patient does he 

 fretfully pull a wry face and make a languid defensive movement. 

 He does not move a single limb spontaneously, but after being 

 repeatedly and urgently requested, he shows that he can still 

 execute limited and brief movements with his extremities. 

 If the limbs are lifted and then let go, they immediately fall as 

 if dead. The sphincters remain closed in our patient, at least- 

 passage of urine and faeces has not been noticed since he came 

 into the hospital. When drawn off with the catheter, the urine 

 is found to be scanty and dense, but free from any traces of 

 sugar or albumen. The pulse is almost imperceptible, irregular, 

 unequal, anid very rapid. The arteries are small, and the tension 

 very low While the patient was being brought to the hospital 

 the pulse became quite imperceptible, and the cardiac sounds 

 very irregular and intermittent. The patient is perfectly con- 

 scious : he replies very slowly and only when repeatedly and 

 importunately questioned, but his answers are quite to the point. 

 You heard how he gave the details of the accident reluctantly 

 and imperfectly, but in the main correctly Only while he was 

 being brought to the hospital did he refuse to answer at all. 

 His voice is hoarse and weak, but his articulation is good. On 

 being repeatedly questioned the patient complains of cold, 

 faintness, formication and deadness of the extremities. When 

 he shuts his eyes he becomes sick and giddy. His senses are 

 perfectly acute. His respiration appears to be irregular, and 

 abnormally long, deep and sighing inspirations alternate with 

 very superficial ones, which are scarcely visible or audible. 

 While being brought to the hospital he vomited several times, 

 and nausea and hiccup still remain. Anyone who knew the 

 patient, or had seen him shortly before the accident, could hardly 

 recognise him now. His appearance, cold skin, and hoarse voice 

 immediately recall the appearance of a cholera patient to the 

 memory of the attentive observer ; the characteristic dejections 

 are alone wanting to make the resemblance complete." 



But cases of shock do not always present these appearances. 

 If we call the form just described the torpid one, we can readily 



