SURGICAL SHOCK 47 



we have been speaking. As a result a powerful 

 athlete is immediately reduced to a mass of quivering, 

 unstrung flesh, and may die outright. In a word, 

 he is in a state of shock. 



Perhaps it may be found possible to localize with 

 accuracy the nuclei which are principally affected 

 in surgical shock by histological examination for 

 chromatolysis. Dolley and Crile have published 

 very remarkable observations on changes in the 

 nerve-cells in shocked or hunted animals, showing 

 dissipation of the Nissl granules. These changes 

 were best marked, not in the vasomotor centre as 

 Crile's theory would demand, but in the Purkinje 

 cells of the cerebellum. Tyrrell Gray and Parsons 

 found changes in the cuneate and gracile nuclei of 

 the medulla. 



I have so far had the opportunity of examining 

 the brain of only one case by this laborious method, 

 and therefore must express conclusions with all 

 reserve. The patient was a healthy man who died 

 two and a half hours after a fall from a ladder which 

 caused a fractured pelvis, fractured humerus, and 

 retroperitoneal hsematoma. The brain-stem and 

 cerebelliun were removed, hardened in formalin, 

 sectioned with the freezing microtome, and stained by 

 Nissl's method. The examination of a number of 

 sections showed the following changes. Purkinje cells 

 of cerebellum : all full of Nissl granules ; no abnormal 

 cells found in some hundreds examined. Cells of 

 dentate nucleus of cerebellum : practically all normal. 

 Cells of various motor nuclei in medulla : all normal. 

 Cells of inferior olive : the majority normal ; a few 



