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726 GENERAL PATHOLOGY.
be constantly dozing ; and the stomach is often irritable. In a word,
there is an absence of ' sympathetic fever.'
In these paragraphs we tind an expression of conditions that not
unfrequently follow as a result of dental operations. They are closely
akin to what is known as nervous exhaustion, but approach closer still
to the condition of true shock in its lighter manifestations. These
two conditions grade into each other in such a way that no exact
line can be drawn. The major forms of shock occur suddenly from
some impression that overpowers the nervous system at a single stroke,
producing a marked dilatation of the whole vascular system, so as to
leave the heart without a due supply of blood. Nervous exhaustion
comes on very slowly from some cause that continues to act, and is often
very insidious in its approach. It occurs oftenest, perhaps, from too
continuous employment, mental strain, or any continuous condition that
overtaxes the nervous enero-ies for a considerable time. In manv cases
the minor forms of shock do not occur so suddenly as is usually the
case in the major forms, nor so slowly as in nervous exhaustion, but are
usually the result of more or less prolonged pain, nervous irritation,
mental excitement, or some form of extraordinary effort. On this
point Mr. Savory, after describing the more immediate results of
shock, says : " But the effects of a shock to the system are not always
thus limited in their nature and duration. Those which have been
described may be termed primary or direct, but sometimes these are
succeeded by those that are more remote and secondary, including per-
haps, after a shorter or longer interval, grave mischief, or it may be
even death. It is not uncommon to have various forms of local disease
or disturbance of the general health referred to some previous shock
which the system has sustained. ' He has never been the man he was
—
since ' is a familiar allusion to a case of this kind ; and after making
every allowance for exaggeration and misinterpretation, the relation of
cause and effect between some j)revious shock and present mischief may
often be clearly and unequivocally established."
Such results as these arc liable to hajipen occasionally in dental prac-
tice, and the lighter manifestations of shock are of frequent occurrence.
A patient, perhaps a lady, presents herself at the time of her appoint-
ment to have several fillings inserted. There may be some special
reason on her part or on the part of the operator for a long sitting. As
the operations j^rogress it is found that they are very painful, yet the
patient is anxious to have them done with, and makes an heroic effort to
bear the pain so that their accomplisliment may not be delayed. Thus
the ojierations go forward for one, two, three, and it may be four hours
continuously. The operator may even be encouraged to persist by the
not unusual fact that the patient flinches less in the third hour than in
tlie first ; but if he would follow up the pulse from hour to hour, he
would find certain changes taking ])lacc. It will have lost markedly
in tone and volume, and as it passes under the finger may perhaps
present a peculiar thrill that was not ])resent at the beginning of the
operations. Sometimes it will be more frequent, sometimes less. There
is also a ]ierceptible change in the character of the motions of the
patient. They may be quick, with a slight inclination to jerkiness, or
726 GENERAL PATHOLOGY.
be constantly dozing ; and the stomach is often irritable. In a word,
there is an absence of ' sympathetic fever.'
In these paragraphs we tind an expression of conditions that not
unfrequently follow as a result of dental operations. They are closely
akin to what is known as nervous exhaustion, but approach closer still
to the condition of true shock in its lighter manifestations. These
two conditions grade into each other in such a way that no exact
line can be drawn. The major forms of shock occur suddenly from
some impression that overpowers the nervous system at a single stroke,
producing a marked dilatation of the whole vascular system, so as to
leave the heart without a due supply of blood. Nervous exhaustion
comes on very slowly from some cause that continues to act, and is often
very insidious in its approach. It occurs oftenest, perhaps, from too
continuous employment, mental strain, or any continuous condition that
overtaxes the nervous enero-ies for a considerable time. In manv cases
the minor forms of shock do not occur so suddenly as is usually the
case in the major forms, nor so slowly as in nervous exhaustion, but are
usually the result of more or less prolonged pain, nervous irritation,
mental excitement, or some form of extraordinary effort. On this
point Mr. Savory, after describing the more immediate results of
shock, says : " But the effects of a shock to the system are not always
thus limited in their nature and duration. Those which have been
described may be termed primary or direct, but sometimes these are
succeeded by those that are more remote and secondary, including per-
haps, after a shorter or longer interval, grave mischief, or it may be
even death. It is not uncommon to have various forms of local disease
or disturbance of the general health referred to some previous shock
which the system has sustained. ' He has never been the man he was
—
since ' is a familiar allusion to a case of this kind ; and after making
every allowance for exaggeration and misinterpretation, the relation of
cause and effect between some j)revious shock and present mischief may
often be clearly and unequivocally established."
Such results as these arc liable to hajipen occasionally in dental prac-
tice, and the lighter manifestations of shock are of frequent occurrence.
A patient, perhaps a lady, presents herself at the time of her appoint-
ment to have several fillings inserted. There may be some special
reason on her part or on the part of the operator for a long sitting. As
the operations j^rogress it is found that they are very painful, yet the
patient is anxious to have them done with, and makes an heroic effort to
bear the pain so that their accomplisliment may not be delayed. Thus
the ojierations go forward for one, two, three, and it may be four hours
continuously. The operator may even be encouraged to persist by the
not unusual fact that the patient flinches less in the third hour than in
tlie first ; but if he would follow up the pulse from hour to hour, he
would find certain changes taking ])lacc. It will have lost markedly
in tone and volume, and as it passes under the finger may perhaps
present a peculiar thrill that was not ])resent at the beginning of the
operations. Sometimes it will be more frequent, sometimes less. There
is also a ]ierceptible change in the character of the motions of the
patient. They may be quick, with a slight inclination to jerkiness, or
