CHAPTER VII. 

 SURGICAL SHOCK. 



DEFINITION.— The word "shock" is now pretty gen- 

 erally applied in various forms of collapse that follow trau- 

 matisms, either accidental or surgical. It includes "true 

 shock," "secondary or delayed shock," "traumatic syncope," 

 "fainting" and other various forms of more or less mysteri- 

 ous collapsing states which leave no identifying lesions be- 

 hind. In a word, true shock is still a mystery, Dififerent 

 authors, from the earliest history of surgery until the pres- 

 ent day, have, interpreted it differently. By some it is at- 

 tributed to an exhaustion of the nervous system; others as- 

 scribe the entire phenomena to a disturbance in the equi- 

 librium of the circulatory apparatus; while still others refer 

 to it as a reflex inhibition. Whatever is the real feature of 

 the condition, shock, so far as it concerns animal surgery, 

 must be defined as a sudden collapse of the functions of the 

 whole body due to physical injury, prolonged pain, loss of 

 blood, or circulatory disturbance. It is, in fact, a depression 

 of the whole body, without reaction. 



More recently shock has been attributed to the accumu- 

 lation in the nerve centers of the products of destructive 

 metamorphosis in excess of their elimination. That is to 

 say, it is an autointoxication. The nerve centers and the 

 nerves poison themselves by not being capable of eHminat- 

 ing wastes, and thus causing the general depression of all 

 the functions, which in turn accounts for the unusual symp- 

 toms seen in typical shock. The flow or stagnation of blood 

 in the splanchnics is explained by the fact that while all of 

 the blood vessels are dilated the former offer a "point of 



179 



