22 SURGICAL SHOCK 



It will be useful first to quote from an esteemed 

 writer the symptoms of shock as they appeared 

 before attempts had been made to fit them into 

 any of the modern theories. Sir W. Watson Cheyne 

 wrote in 1898 : " The patient who is suffering from 

 shock is usually found lying in a state of complete 

 muscular relaxation, or if he makes any movements 

 they are very irregular and feeble. The face is pale 

 and drawn, the pupils dilated, there is sweating 

 about the head, the reflexes are very slight, there is 

 diminished sensibility, but not absolute unconscious- 

 ness. The patient can answer questions when 

 spoken to, but if not disturbed will generally lie in a 

 semi-conscious condition. The respirations are feeble, 

 irregular, and sighing. The pulse is small, frequent, 

 and dicrotic. At first the pulse-rate is generally 

 slowed, and increased frequency of the heart beat 

 is regarded by some as a sign of the commencement 

 of reaction. The skin is cold ; the temperature 

 subnormal." With the possible exception of the 

 statements concerning the pulse-frequency, this 

 clinical picture will command universal assent. We 

 shall have to refer to it again later. 



THE THEORY OF CRILE AND MUMMERY. 



The essence of the theory is that the vasomotor 

 centre in the brain is first stimulated and then 

 exhausted by painful, or as we should now say 

 nociceptive, impulses coming to it from the afferent 

 nerves. All the phenomena of shock are due to 

 this primary exhaustion of the vasomotor centre. 

 The most characteristic index of shock is the fall 



