CAUSES OF SIIOCX. 397 



eretliismic form. The latter is then to be regarded sometimes 

 as an independent condition, and sometimes as a second stage 

 of the torpid form. 



Botli forms of shock sometimes terminate in death, while at 

 other times, according to Mr. Travers,* instead of the continu- 

 ance and fatal increase of the symptoms of prostration, they 

 may gradually give place to a partial and defective reaction, 

 protracting life but scarcely improving the prospect of restora- 

 tion, which remains doubtful for several days in succession ; 

 or, on the contrary, an efficient and healthy degree of reaction 

 may be quickly established consequent upon symptoms threat- 

 ening the most unfavourable issue. " Again and again," he 

 continues, " I have left the bedsides of patients brought into the 

 hospital pulseless, and apparently moribund without any exter- 

 nal injury, having suffered falls or blows so serious as to have 

 induced the symptoms of prostration to an alarming extent, 

 and have found them on the succeeding day, to my great 

 surprise, restored to the tone and tranquillity, comparatively 

 speaking, of health. Eeaction has in these cases been spon- 

 taneous, or nearly so, although gradual enough to occupy a 

 period of many hours." "ISTow, had such persons suffered 

 topical injuries of a severe though reparable description, it 

 is to my mind more than probable that reaction w^ould have 

 failed altogether ; but had it, by favour of circumstances, been 

 established, it is at least equally probable that it would have 

 taken the form of excitement. In other cases days have 

 elapsed before a perfect reaction and complete relief have been 

 obtained." 



Having said so much regarding the symptoms of shock, let 

 us shortly run over its causes. The cases already related 

 show us that it readily follows a blow on the abdomen, some- 

 times even when the blow is by no means severe. Injury to- 

 the genitals is another important cause of shock. Hardly 

 anyone finishes his school days without receiving a blow on 

 the testicles, either at cricket or during the struggles at foot- 

 ball, and ever afterwards he bears vividly in mind the dreadful 

 depression, weakness and sickness which instantly overpowered 



* Travers, op. cit., p. 409. 



