36 SURGICAL SHOCK 



{oligcemia = scanty blood) the blood-pressure would 

 fall and yet the heart and vasomotor centre might 

 act well and the arteries be constricted. Sherring- 

 ton and Copeman have shown that intraperitoneal 

 operations and also scalds in animals do, as a matter 

 of fact, raise the specific gravity of the blood. An 

 intestinal anastomosis lasting a quarter of an hour 

 raised the specific gravity in one animal from i'054 

 to I"062. 



Roy and Cobbett opened the abdomen in dogs 

 and cut, pulled, or ligatured the intestines for 12 to 18 

 hours continuously under an ansesthetic. At first 

 the blood showed no change, then its specific gravity 

 rose steadily, as much as by o'oi4 at the end of the 

 prolonged manipulations. The specific gravity of 

 the intestines fell ; that of the muscles rose. The 

 blood-pressure began to drop some hours after the 

 specific gravity of the blood rose. Cobbett has 

 published these researches with the suggestion that 

 a similar concentration of the blood is the causative 

 factor in surgical shock, and Vale has attempted to 

 establish the theory by blood examinations in man. 

 On this view shock and collapse are identical. The 

 suggestion is, of course, that the fluid lost has been 

 poured out into the injured area, Griinbaum is 

 quoted by Cobbett as having examined the blood 

 after three laparotomies in man, and in each case 

 there was a rise of from 5 to 7 points, but no details 

 are given. Vale made observations on four patients, 

 estimating the specific gravity by the Roy method. 

 In the first case an abdominal fistula was closed by 

 operation ; the specific gravity before operation was 



