398 TATIIOLOGY AND TREATMENT OF SHOCK AND SYNCOPE. 



liim. The same tiling takes place in operations, and Mr. 

 Ericlisen* has observed that at the moment of division of the 

 spermatic cord in castration the pulse sinks, even though 

 the patient has been fully anaesthetised. Still more striking are 

 the effects occasionally observed on the passage of a catheter 

 or bougie. They are thus described by Sir Astley Cooper if " A 

 person has a bougie passed into his urethra for the first time ; 

 the urethra is irritated by it; he says, I feel faint,' becomes 

 sick, looks pale, and, without care, he drops at your feet. His 

 pulse has nearly ceased, and his body is covered with a cold 

 perspiration. You place him on a sofa with his head a little 

 lower than his body, and as soon as the blood freely enters the 

 brain all his functions are restored. Thus, oy irritating the 

 urethra the stomach is influenced, the actions of the head and 

 heart are suspended, and the powers of the mind vanish.'* 



Injuries to bones have a peculiar power to induce shock. 

 It is, perhaps, more frequently observed as a consequence of 

 the crushing of bones in railway accidents than of any other 

 oause whatever. It may be said that in such cases all the 

 textures of the limb, skin, fascia, muscles, vessels and nerves are 

 injured as much as the bones , but two cases of PirogoffsJ seem 

 to show that it is to injury of the latter rather than of the 

 former structures that the effect is to be attributed 



In two amputations of the thigh which he performed, before 

 the introduction of chloroform, death occurred on the operating 

 table. One case was for severe traumatic injury, the other for 

 chronic disease of the knee-joint, which had greatly weakened 

 the patient. In both cases the pain and loss of blood during 

 the operation were only a little greater than usual, yet in both, 

 immediately after the bone had been sawn through, the face 

 became pale, the eyes staring, the pupils dilated, a peculiar 

 rigidity of the body occurred and death immediately took place. 



Extensive burns frequently cause shock in a marked degree, 

 ■and such, says Mr. Travers,§ is the effect of the transient bodily 



* Science and Art of Surgery, 4tli edit., p. 6. 



f Lectures on Surgery, from notes hy Tyrrell, 1824, vol. i, p. 9. 



X Quoted by Fischer, op. cit., p. 10. 



§ Travers, op. cif.y p. 74. 



