SURGICAL SHOCK 43 



showing the largest quantity of adrenahn was a 

 woman who died as the result of a street accident 

 producing multiple fractures and leading to a fatal 

 issue in four and a half hours. Adrenalin exhaustion, 

 therefore, is not the cause of surgical shock. 



WHAT, THEN, IS THE NATURE OF SURGICAL 



SHOCK? 



We have failed to discover any evidence that 

 changes in the blood are the essential factor in the 

 production of surgical shock, and are left face to face 

 again with the crucial problem, how to find an 

 explanation for a falling blood-pressure with a normal 

 heart and vasomotor centre and contracted peri- 

 pheral arteries. Since the examination of the blood 

 has not helped us, we must return to the central 

 nervous system. 



There is a condition well known to experimental 

 physiologists called spinal shock. In monkeys, and 

 to a much less extent in cats and dogs, a high tran- 

 section of the spinal cord is followed by grave 

 interference with the functions of the cord distal 

 to the section. For a period varying from hours to 

 days no reflexes can be obtained, muscular tone is 

 abohshed, and the peripheral blood-vessels dilate. 

 In human surgery we see the like condition in spinal 

 concussion, in which, after a blow on the back, 

 sensation, voluntary power of movement, and reflexes 

 may be abolished, but after a day or two are all 

 restored to normal. 



Professor Sherrington has made some important 

 investigations into the nature of spinal shock. In 



