Shock. It is well known that some forms of injury, as, for example, a blow on the pit of the stomach, may occasion death without leaving any visible trace of their operation in the body; and, indeed, life may occasionally be destroyed even by sudden and powerful mental emotions. In such cases as these death is said to result from shock, the actual cause of death being the sudden arrest of the heart's action, consequent on the violent disturbance given to the nervous system. The effects of shock may be manifested in all degrees from the transient feeling of faintness (see FAINTING) or sickness produced by a sudden emotion, or an unexpected and unpleasant sight, &c., to the disastrous result above described. In cases of moderate severity the condition known as collapse is induced, in which the patient lies in a state of utter prostration, and apparently on the verge of dissolution. The face, and even the lips, are pale and bloodless; the skin is cold and clammy, and drops of sweat are often seen on the forehead. The features are contracted, and there is great languor in the general expression. There is extreme muscular debility, and the sphincter muscles sometimes relax, so that there is involuntary discharge of the contents of the bowels and the bladder. The pulse is quick, and so feeble as often to be almost imperceptible, and the respiratory movements are short and weak, or panting and gasping. The patient is in some cases bewildered and incoherent, in others drowsy, and sometimes almost insensible. In less severe cases nausea and vomiting, with hiccup, are not unfrequent symptoms; and in the case of children convulsions are often present.
When a person recovers from a state of collapse he passes into a condition termed reaction, which often lasts for several hours. The first symptoms of this favourable change are improvements in the state of the pulse and the respiratory actions, recovery of the power of swallowing, an increased temperature, and an inclination to move from the supine position to one side. A slight degree of feverishness then often ensues, after which the skin becomes moist, the patient falls asleep, and awakes convalescent. As a general rule, the longer the symptoms of reaction are delayed the greater is the danger, and if several hours pass without any sign of the commencement of reaction there is little hope of recovery.
The principal causes of shock in its severer forms are sudden and severe or extensive injuries, whether due to accident or operation, particularly if they involve any of the viscera, joints, or other organs abundantly supplied with nerves. 'Pain alone, when intense and protracted, has proved fatal in this way; and it appears in a case related by Sir A. Cooper that sudden relief from great agony was attended by the same untoward result. Certain poisons operate in this manner, depressing the system so suddenly and severely as to produce a state of collapse; tobacco, for example; and drastic purgatives have in some cases induced a similar condition.'
The effects of shock are aggravated by loss of blood; and hæmorrhage alone, if sudden and profuse, will produce collapse. General debility and old age favour the influence of the shock, and much depends upon the idiosyncrasy of the patient; an injury which will produce no apparent effect on one man often producing a serious and persistent impression on another.
The following are the most important points in regard to treatment: The patient should be kept in a horizontal position, with the head on the same level as the body, and he should not be raised till decided symptoms of reaction appear. The best stimulant is brandy, in moderate and carefully regulated doses, given in the form of hot brandy and water. At the same time heat should be applied to the pit of the stomach and the extremities, by means of hot flannel, hot-water tins, or, in their absence, bottles containing hot water, and other appliances. Nourishment, in the form of beef-tea, should closely follow the stimulants; the two may be combined with the greatest advantage, and as the system rallies the latter may be entirely replaced by the former. See Holmes's System of Surgery.