400 PATHOLOGY AND TREATMENT OF SHOCK AND SYNCOPE. 



abdominal viscera are injured from within, just as when they 

 receive a blow from without. Thus the intense irritation which 

 corrosive poisons, such as sulphuric and other mineral acids, 

 or large doses of arsenic, occasion in the stomach, produces, in 

 addition to local pain, coldness and pallor of the surface, 

 sighing respiration and weak or imperceptible pulse. The 

 same thing occurs when perforation takes place in the stomach 

 or intestines, and their contents escape into the peritoneal 

 cavity. The occurrence of shock after parturition, especially in 

 cases of twins, is probably partly due to nervous influence and 

 partly to the removal of pressure from the abdominal vessels 

 by the loss of such a large portion of the abdominal contents, 

 which must almost unavoidably occasion more or less relaxa- 

 tion of the vessels. 



To recapitulate shortly what we have said under this head, 

 the symptoms of shock are : pallor and coldness of the skin, 

 weak pulse, oppressed and sighing respiration, dilated pupils 

 and sickness. 



The causes of sliock are : painful impressions — more espe- 

 cially extensive burns — injuries to bones, and, above all, injuries 

 to the abdominal viscera and genitals. 



We have now to consider our second head, viz. : The pathology 

 of shock ; or, the causes of each symptom. I ought properly tO' 

 take up every one and trace it back to its cause, but I shall 

 not attempt to do this, because it would occupy too much time, 

 and I am not sure I could at present succeed in the attempt. 

 I shall, therefore, be content to glance at a few of the principal 

 symptoms only. 



And first : — Why should the pulse be small and weak and 

 the tension in the artery low, so that a slight pressure with the 

 finger is sufficient to compress its walls and completely arrest 

 its pulsations ? The smallness of the pulse wave under such 

 conditions at once informs us that only a little blood is sent 

 into the arteries at each contraction of the heart. This may be 

 owing to the heart acting so feebly and imperfectly that it only 

 sends out a small portion of the blood with which its cavity 

 was filled, or it may be that it is doing its duty perfectly but 

 has no blood to send out. It would be very hard to say which 



