SURGICAL SHOCK 49 



In the treatment of shock, the failure of the simpler 

 theories leaves us sadly bereft of our weapons for 

 meeting it. It was so easy to give pituitary extract 

 for paralyzed vasomotors, carbon dioxide for 

 acapnia, intravenous or subcutaneous saline for 

 oligasmia, and adrenalin injections for exhaustion of 

 the suprarenals, and so hard to understand why 

 they might one and all fail. But what can one do 

 for paralysis of the nerve-cells of all the vital centres ? 

 Evidently it is not enough merely to raise the blood- 

 pressure, although that may help a little by driving 

 more blood to the brain, and so give the damaged 

 nerve-cells the most favourable conditions for 

 recover}/. Saline transfusion or infusion has its 

 value in maintaining the output of the heart. Re- 

 cently the use of sodium bicarbonate instead of 

 chloride has been advocated by several American 

 writers on experimental grounds, though they fmd 

 it hard to give a satisfactory explanation of its 

 action. 



It is doubtful if pituitary extract or adrenalin do 

 any good, and Crile's teaching as to the futility of 

 strychnine and alcohol is probably correct. Happily 

 it is possible, to some extent, to exert pressure on 

 the dilated veins and so replace the deficient muscular 

 tone by means of elastic bandages for the limbs and 

 abdomen, taking care not to impede the action of 

 the diaphragm. Intraperitoneal saline fluid in large 

 quantity would help in the same way. In cases of 

 shock from burns, the indications for introducing 

 plenty of saline are clear. 



It is to the prevention of shock that we must look 



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