48 SURGICAL SHOCK 



showed reduction of Nissl granules. Cells of Deiters' 

 nucleus (lateral vestibular) : some normal cells ; 

 majority showed considerable reduction of the 

 granules, and many cells had practically none left. 

 Cells of gracile and cuneate nuclei : very remarkable 

 absence of Nissl granules : scarcely a granule to be 

 found in the whole nucleus. We know that reduc- 

 tion of the Nissl granules is usually an evidence of 

 exhaustion of nerve-cells, but it must distinctly be 

 understood that we have no evidence that if a nerve 

 cell is paralyzed it must necessarily show histological 

 changes, and absence of chromatolysis would not 

 therefore prove that certain nuclei were able to 

 function properly. 



THE DIAGNOSIS, TREATMENT, AND PRE- 

 VENTION OF SHOCK. 



It must regretfully be admitted that such a con- 

 ception of shock makes diagnosis and treatment 

 much more difficult. And first, diagnosis is difficult 

 because we may no longer place implicit reliance 

 upon the blood-pressure. No doubt a fall of pressure 

 is our best sign of shock, but it ceases to be infallible. 

 For instance, crushing the testis may induce a reflex 

 depression through the vasomotor centre, which is 

 perfectly recoverable without any other symptom of 

 shock. Again, and surely we have all learned only 

 too well the truth of this, a patient may be far worse 

 than the pulse and pressure would lead one to think. 

 A diagnosis of shock nowadays must take into 

 account the whole clinical picture described by 

 Sir Watson Cheyne, as well as the readings of the 

 sphygmomanometer. 



