SURGICAL SHOCK 39 



2. Male, aged 40. Arthroplasty of hip ; patient 

 feeble, with ankylosed spine. Took one and a half 

 hours. Pulse soft and feeble, disappeared at intervals. 

 Blood-pressure near end, 85 ; temperature after 

 operation, 96-6°. Specific gravity at beginning, 1-062. 

 Specific gravity at end, 1-063. Sequel, recovered. 

 Blood-pressure three days later, 115. 



3. Female, aged 18. Extensive burns seven hours 

 before, involving abdomen, buttocks, thighs, hands, 

 and arms. Pulse good, but looked ill ; vomiting ; 

 thirsty. Specific gravity, 1-072. Next day, specific 

 gravity, 1-072. Twelve days later specific gravity, 

 1-059. Sequel, recovered. 



It will be observed that Cases i and 2 showed 

 every sign of grave shock, but there was no con- 

 siderable alteration of specific gravity ; nothing but 

 a rise of o-oio would influence blood-pressure. 



In Case 3 and in other burn cases, however, there 

 was a very remarkable rise, corresponding to a loss 

 of fluid of about one quart, and lasting over twenty- 

 four hours. Probably this is the cause of some of 

 the symptoms of a severe burn, and obviously the 

 administration of saline is urgently indicated. 



A third point of interest is with reference to two 

 cases of Wertheim's hysterectomy. It was observed 

 that the specific gravity before operation was very 

 low — 1-048 and 1-046, instead of 1-057. This was 

 probably the result of prolonged loss of blood. Both 

 cases died from shock. It has been found by Douglas 

 that a fall in the specific gravity of the blood is 

 common in cancerous cachexia. We may have here 

 an easy means of detecting cases whose general 



