408 PxVTHOLOGY AND TREATMENT OF SHOCK AND SYNCOPE. 



In shock we have two conditions to remove. The first of 

 these is the feebleness of the heart itself, which is due to the 

 action of the vagus. To counteract this we apply stimulants. 

 Now, one of the most powerful stimulants to the heart is heat. 

 It is true that it dilates the vessels, but in shock we have nothing 

 to fear from dilatation of the vessels near the surface of the body, 

 where circulation is hardly going on at all, nor is it likely that 

 it will increase the dilatation of those in the interior. We 

 therefore pursue a plan of treatment directly the opposite of 

 that which we employ in fainting, and apply warmth instead of 

 cold to the surface, especially to the cardiac region, over which 

 a hot poultice or india-rubber bottle filled with hot water should 

 be placed. At the same time, and for a similar purpose, we give 

 brandy and ether internally. The second and most important 

 indication for treatment is to cause contraction of the great 

 vessels, especially the veins in the abdominal and thoracic cavi- 

 ties, so that the blood, instead of stagnating uselessly in them, 

 may be sent onwards to the heart, and thence to the rest of the 

 body. I have already described the effect of acetic acid and 

 ammonia held before the nose, but this is only one example of 

 the general rule that all powerful impressions on sensory nerves 

 cause contraction of the blood-vessels. Painful impressions 

 made upon the skin, for example, have this effect, and Goltz has 

 shown tliat pinching the toes of a frog, or irritating them by 

 acetic acid, prevents the vessels from dilating when the abdomen 

 is struck, or causes them to contract and propel the blood to the 

 heart if dilatation has already taken place. If I may judge 

 from my own experience, persons not unfrequently take uncon- 

 scious advantage of this effect of pain, and medical students 

 occasioDally prevent themselves from fainting, when witnessing 

 an operation, by biting their lips or pinching their fingers. Its 

 beneficial action in shock is very great, and my friend Dr. Fayrer 

 informs me that he has succeeded in recovering a patient from 

 a state of collapse by thrashing his feet and the calves of his 

 legs with switches after other means had failed. Mustard plas- 

 ters are often applied for a similar purpose. Sometimes the 

 performance of an operation during shock is attended by a 

 marked improvement in the patient's condition, and it seems to 



