Page 717 - My FlipBook

SHOCK. 727

be languid and unusually slow. The face is pale, and the thermometer
shows a slight reduction of the temperature. The patient is finally dis-
charged, and goes her way without any very decisive sign that there is
anything wrong ; but she has a restless night, and the next day there is
slight fever. This is of a mild type perhaps, and occasions no great
uneasiness, or it may be more severe and accompanied with a feeling of
great weariness. In the more ordinary cases this passes away in from
three to five days with complete restoration to health, but occasionally
the patient falls into a state of nervous exhaustion from which she
rallies very slowly.
I might give a number of cases coming under my observation illustra-
tive of this, but one or two must suffice. One of the most notable of
these was observed some ten years ago. A young lady of eighteen came
from a distance by appointment to have carious teeth filled. Upon exam-
ination it was found that there were two exposed pulps, besides other
smaller cavities. Both the young lady and her parents insisted that all
should be done that day if it was possible, it being necessary that they
should return on account of important engagements : the lady said that
she had no fears as to bearing any necessary operation, even the direct
removal of the exposed pulps. The operations were proceeded with,
and everything was borne without a murmur. My patient was a fine
specimen of physical development, and I soon found that she prided
herself on her powers of endurance. The pulps were, at her urgent re-
quest that there should be no delay, removed directly with the broach,
and the filling proceeded with. After three hours of continuous ope-
rating the patient was discharged for two hours' rest. She returned
promptly, but something in her appearance arrested my attention as not
being just right, yet in answer to questions she said she felt perfectly
well, only a little tired. The operations were resumed, and all went
well at first, but after an hour, the latter part of which had been occu-
pied in the excavation of a very sensitive cavity, I found that the pulse
had become very easily compressible and other evidences of shock were
becoming very apparent. Gutta-percha fillings were placed in the cav-
ities excavated and operations suspended. I found it necessary to assist
her to a couch, as it was evident that she was unable to walk steadily.
After two hours in the recumbent posture she seemed better, and was
taken to the train by her parents, and went home, some fifty miles by
rail, and I saw her no more. I afterward learned from her mother that
her condition became much worse en route home, and that for four or
five days she was in " a stupid condition," and after this she passed into
a nervous fever which continued for several months. Up to the time I
last heard from her, four years after the incident, she had been more or
less an invalid.
In dental practice the temptation to overtax patients who are so situ-
ated that it is very inconvenient for them to make frequent visits is very
great, and great care should be exercised to avoid evil results. The
case I have given is aii extreme one, it is true, but many cases of a less
grave character occur, and from much more trivial operations. Only
a short time ago I placed fillings in two lower molars for a lady of
about twenty-three, at the time in rather delicate health, though she