TWO FORMS OF SHOCK — HEART AND VESSELS. 4:):j 



heart had either not been stopped at all, or had speedily 

 recovered itself ; but the abdominal veins had been so dilated tliat 

 all the blood in the body could hardly fill them sufficiently to 

 leave a driblet over for the general circulation, although a little 

 still did trickle into the heart so long as the patient remaineLl 

 in the recumbent posture. 



We have, then, two forms of shock, according as the injury 

 produces its effect chiefiy on the heart or chiefly on the vessels. 

 But it is not merely blows on the abdomen which have the 

 power of producing shock ; irritation of other parts can do so 

 likewise ; and this seems to be peculiarly the case with regard 

 to bones. Thus Pirogoff records two cases in which death 

 occurred during operations before the introduction of chloro- 

 form. In both, the pain and loss of blood during the operation 

 was only a little greater than usual ; yet in both, immediateh/ 

 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. 



The symptoms in these cases of Pirogoff s are almost exactly 

 the same as those of Mr. Cock's case I have already described ; 

 but Pirogoff's deaths were put down to the operation, because no 

 chloroform had been given ; while the death in Cock's case was 

 ascribed to the ana3sthetic, because some chloroform had been 

 administered ; although, on account of the operator's unwilling- 

 ness to give it at all, the quantity was probably very small. 



In all three, it is evident that the heart stopped suddenly ; 

 and this in itself was sufficient to cause death, though it is 

 highly probable that dilatation of the abdominal vessels also 

 occurred. 



In Mr. Solly's case, the dilatation of the abdominal vessels 

 £eems to have been the chief cause of death ; for the pulse 

 became gradually, though rapidly, weaker and weaker, and then 

 stopped altogether, just as we would expect it to do if the heart 

 suddenly ceased to be supplied with blood. 



In the third case I have described, probably the heart was 

 chiefly affected ; for, just as the fourth stump of a tooth was 

 removed, the pulse was felt to be exceedingly weak, and almost 

 immediately afterwards became imperceptible. 



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