The Distribution of Blood in Shock. 193 



factory for maintenance and growth. Lysin and tryptophan are 

 both present. Other experiments by Osborne and Mendel indi- 

 cate that lysin and tryptophan in the diet are both necessary for 

 growth. If lysin be present without tryptophan maintenance is 

 secured, but not growth. The writers found lysin N in both 

 corn and cotton seed. The qualitative tests for tryptophan were 

 positive. Unfortunately the determination of tryptophan by 

 hydrolysis with acids has never yielded satisfactory results, it 

 being thought that the tryptophan complex is broken down. 



117 (1049) 



The distribution of blood in shock. 



By H. H. Janeway and Holmes C. Jackson. 



[From the Department of Physiology, University and Bellevue 

 Hospital Medical College.] 



In a recent communication we have shown that the essential 

 factor of shock is a disturbance in the normal distribution of the 

 blood. This disturbance is of such a character that the normal 

 quota upon the arterial side of the circulation is diminished and 

 this diminution is maintained so that, as a consequence, even 

 after the original cause of the disturbed distribution of the blood, 

 whether of a mechanical, toxic or inhibitory nature, is removed 

 the abnormal diminution of the blood upon the arterial side of 

 the circulation not only persists but, in fatal cases, progresses from 

 local peripheral causes alone until death occurs. 



The reality and nature of these local factors in the production 

 of shock is made clearest in that form of shock which is produced 

 by mechanical means alone, because in shock created in this 

 manner no other factor can enter except the consequences of a 

 primary disturbance of the normal distribution of the blood. 



The mechanical means which we adopted for the production of 

 shock was that used for the reduction of blood pressure when 

 testing out the shock-producing effect of trauma to the peripheral 

 sensory nerves. It consisted in partially occluding the inferior 

 vena cava within the chest by passing a thread around the vein 

 and drawing out the two ends through the incision in the wall of 



