1911 Encyclopædia Britannica/Shock

SHOCK, or Collapse, in surgery, the enfeebled condition of body which comes on after a severe physical injury, such as a blow upon the head or a kick in the abdomen, or as the result of grievous mental disturbance, as on seeing a ghastly sight or hearing sad news. It is the condition which the prize-fighter desires to inflict upon his adversary by giving what is called the “knock-out blow” upon the point of the jaw, over the heart or in the lower part of the chest.

In severe shock the individual falls “all of a heap,” as the saying is, which is exactly expressed by the word “collapse” (collapsus, collabor, fall in ruins). The explanation of the condition is that the heart is suddenly deprived of its power to pump blood up to the brain which, like the face itself, is left anaemic and has no power to send out control to the muscles. The blood at once sinks into, and remains stagnant in, the large veins of the abdomen. And inasmuch as the condition of collapse is due to anaemia of the brain, it is met with in those cases in which a sudden and serious loss of blood has been sustained, as in the “flooding” of child-bed, the giving way of an aneurism, or the opening of some large blood-vessel. It may also supervene on the rupture of a gastric ulcer, and is then the result of the injury to which the network of nerves in the interior of the abdomen has been subjected by the sudden escape on to them of the contents of the stomach.

In severe shock the patient is pale, and bathed in clammy perspiration; his sensibility is blunted; his pulse is small and weak, sometimes, indeed, it is imperceptible, and even on laying the hand over the heart no cardiac impulse may be felt. The person is unable to make any exertion, but lies indifferent to external circumstances, and can be roused only with difficulty or not at all. He complains of a feeling of cold, and he may have a distinct shivering. These symptoms may continue for some hours. The first evidence of improvement is that he shifts his position, becomes restless and complains of the injury. Perhaps he vomits. The pulse becomes stronger, and he then passes from the state of shock into that of reaction. If the improvement continues, recovery takes place; but if it is only transient, he sinks back again into a drowsy condition, which may end in death, for it must be clearly understood that shock may end fatally. Sometimes there is no rallying, death following the injury immediately. In cases where there is no reaction, the patient gradually becomes weaker, and his pulse feebler, till death ensues. Shock is due to an impression conveyed to the medulla oblongata, by which the nerve-centres are so affected that a partial paralysis of the voluntary and involuntary muscular fibres in the body takes place, the patient being, perhaps, unable to lift his arm or move his leg. The respiratory functions are performed wearily, and the muscle of the heart contracts feebly. The walls of the blood-vessels lose their tonicity and the vessels dilate, the blood collecting in the large venous trunks, more especially of the abdomen. The vessels of the skin being emptied of blood, marked pallor ensues. The heart beats feebly because its nervous energy is lowered, and because it has not a sufficient quantity of blood upon which to act. An understanding of these facts gives the general indications for treatment, which comprise external stimulation over the heart by mustard poultices or turpentine stupes; elevation of the limbs—to cause the blood to gravitate towards the heart, and so to the brain; manual pressure on the abdominal cavity from below upwards—to encourage the flow of blood from the overloaded abdominal veins into the heart. In urgent cases an injection may be given into the veins of warm water in which table salt (60 grains to a pint) is dissolved. These different measures may be supplemented by the administration of stimulants by the mouth, or, if the patient cannot swallow, by subcutaneous injection of brandy, ether or a solution of strychnine. In all probability many men have been left for dead upon the field of battle who were only in a state of extreme collapse; in the future many such cases will be saved by the prompt injection of ether over the region of the heart.

In syncope from mental emotion the weakened heart cannot drive a sufficient quantity of blood to the brain; the patient feels dizzy and faint, and falls down insensible. The condition is transitory and the recumbent posture, assisted if need be by elevation of the limbs, causes the blood to gravitate to the heart, which is thereby stimulated to contract. A sufficient quantity of blood is then driven to the brain, and the insensibility passes off. If the patient is in the sitting posture when he feels faint, the head should be depressed between the knees, which will cause the blood to flow to the brain, and the faintness will pass off. Otherwise he should be laid flat on his back, his head being kept low. When a collapsed person is put to bed, no pillow should be allowed, and the foot of the bed should be raised above the level of the head.  (E. O.*)