Page 709 - My FlipBook

SHOCK. 719 ;
injurv to the nervous structures is manifest in the delirium and other
perturbations of the mental faculties that so generally accompany severe
fevers. In severe and long-continued attacks the muscles are especially
affected by the destruction of the sarcose element of the fibres. In this
way portions of the fibres of certain muscles are occasionally injured to
such an extent as to cause lameness for some time after recovery. The
general emaciation has been spoken of: this is the usual result of fever
all of the tissues suffer \vaste, but the fatty tissues are perhaps destroyed
to a greater extent than any others.

Shock.
Shock is a sudden and notable depression of the vital powers result-
ing from an injury more or less grave, or from an impression made on
the nervous system through the medium of the sensorium, as by fright,
sudden and overpowering mental emotion, etc. In its phenomena it
seems to consist of a sudden check of the circulation brought about
througli the agency of the nervous system : this may be so grave as to
cause instant death, or may result in prostration more or less prolonged,
with or without a successful reaction following it. It was lonij ago
noted that death sometimes resulted suddenly after injuries that left no
trace of their destructive effects on the vital organs, and that many
instances in which death was less immediate could not be explained by
the visible effects of the injury sustained. It frequently occurs that
persons who have sustained some injury sink into a state of prostration
not to be accounted for by the severity of the hurt, such persons, even
though apparently moribund, being sometimes within a day or two
restored to their usual health and vigor. These cases can be explained
in no way other than upon the supposition that the nervous system had
been suddenly overpowered. Hence the term shock. Collapse is also
used in the same sense.
It is not to be inferred that there is actually no tissue-change in these
cases, but there certainly is none that can be recognized by our physical
senses through either macroscopic or microscopic examination. It can-
not be supposed, however, that such grave symptoms can occur Ayithout
some molecular disturbance in the nerve-cells which for the time renders
them incapable of the proper performance of their functions.
The cause of shock has been a subject of much inquiry, especially
among surgeons, who are continually brought in contact with the
graver forms of this condition. The general nature of shock remains
the same, no matter whether it result from bodily injury or mental
impressions. Diminished energy of the nervous system, resulting in
enfeeblement of the circulation, is prominent in every symptom, and
the general reduction of the vital powers seems to depend on this for
its inauguration and continuance. The injury to the nervous system is
especially manifest in the demeanor of the sufferer, and this is expressed
in a variety of ways. In one case a person Avho has received a serious
injury may for a time apparently disregard it ; he seems not to suffer
pain, and is possessed of a calmness that under the circumstances is
entirely unnatural, while at the same moment the surgeon will perhaps