SURGICAL SHOCK 23 



of blood-pressure. It will not be necessary here to 

 set forth the arguments by which this view was 

 defended. Surgery undoubtedly owes a great debt 

 to Crile's researches. He has established for us the 

 importance of the sphygmomanometer in measuring 

 shock, the value of nerve-blocking in preventing it, 

 and the general principles of its avoidance and 

 treatment. Nevertheless, it is scarcely going too 

 far to say that the theory is beyond doubt erroneous. 

 It has been maintained by a number of competent 

 observers, both on clinical and experimental grounds, 

 (a) That the peripheral arteries may be contracted, 

 not dilated, during shock ; and (b) That the vaso- 

 motor centre is not necessarily exhausted, even in 

 extreme shock. If the failure of the vasomotor 

 centre was the main factor in the genesis of shock, 

 an examination of the pulse and blood - pressure 

 would be a sure indication of the patient's condition. 

 No doubt a bad pulse and a fall of tension are grave 

 signs, but no surgeon, anesthetist, or practitioner 

 accustomed to judge of the prospects of a patient 

 after a severe operation will dare to maintain that 

 because the pulse is good and the blood-pressure 

 normal there can be no fear of death from shock. 

 Only too commonly, in spite of an apparently efficient 

 vasomotor centre when the patient leaves the table, 

 severe depression of all the vital functions comes on 

 a few hours later, and death follows. There may be 

 shock, then, with a normal blood-pressure. 



Again, Mr. J. D. Malcolm has repeatedly pointed 

 out that the condition of a patient in shock does 

 not correspond with the clinical picture of vaso- 



