OP BLOOD-PRESSURE 61 



adrenalin has been proved to be absent.* The 

 blood-pressure is extraordinarily low, and the various 

 functions of the sympathetic are more or less 

 paralysed. The vasomotor control is very deficient. 

 Adrenalin is so extensively used as a haemostatic, 

 and as an injection for various purposes, that it is 

 important to realize its dangers and danger signs. 

 It is not at all improbable that some so-called deaths 

 from anaesthesia, especially in operations on the 

 nose, have been due to the injection of too much 

 of this potent drug. The symptoms of an overdose 

 are not at all unlike those of chloroform poisoning 

 pallor, salivation, dilated pupil, and small pulse ; 

 but the pulse rate may be slow. In animals its 

 prolonged use may cause glycosuria of pancreatic 

 type. 



SURGICAL SHOCK. 



We shall next set forth the important researches 

 of Crile and Mummery on surgical shock, and the 

 means of combating it. It has been well said that 

 the surgeon has triumphed over pain by means of 

 anaesthetics, and over sepsis by means of sterilization, 

 but that shock remains as the great barrier to perfect 

 success. 



The clinical measure of surgical shock is the blood- 

 pressure, as recorded by some form of sphygmo- 

 meter. For this purpose, as for most, the Riva- 

 Rocci instrument is preferable. As shock deepens, 

 the blood-pressure falls ; as it passes off, the 



* A. Rendle Short, " Blood-Pressure and Pigmentation in 

 Addison's Disease, Lancet, 1906, (ii.), p. 285. 



