84 SURGICAL SHOCK 



failure of enough blood to get back to the heart to 

 continue the circulation, on account of the oligaemia 

 and the dilated toneless veins. 



Whilst fully recognizing the great value of this 

 research, the labour expended upon it, and the 

 learning with which it has been supported, the 

 present writer, although at first attracted by the 

 theory, has felt compelled to abandon it as an 

 explanation of routine surgical shock in man. No 

 doubt it is possible to induce a condition resembling 

 shock by acapnia in animals, and probably in man, 

 and enthusiastic anaesthetists who are experimenting 

 with the intratracheal administration of ether will 

 do well to study Yandell Henderson's original papers. 



The objections to acapnia as an explanation of 

 human surgical shock following injury or operation 

 are as follows. Some purely physiological criticisms 

 are omitted, (i) Hyperpnoea from painful stimuli 

 is not sufficiently severe or prolonged, one would 

 have thought, to reduce the CO.2 from 40 to 50 per 

 cent, the normal, down to 10 per cent, as in some 

 of Henderson's analyses of the blood in shocked 

 animals. Shock often comes on quite soon, in half 

 an hour or less. (2) If the theory were true, shock 

 would be impossible during an operation where a 

 Clover's inhaler was used throughout. Some anses- 

 thetists believe that the Clover is better than open 

 ether in averting shock, but no one will suggest 

 that any operation, however severe, can be performed 

 with safety provided the patient is kept blue. 

 (3) Even in animals in a condition of acapnia it 

 was not found possible to save their lives by carbon 



