SHOCK, COLLAPSE, AND REACTION. It is well known that some forms of injury, as, for example, a blow ou the pit of the stomach. may occasion death without leaving any visi ble 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. Instead of actual death, the condition known as collapse is more frequently 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 gasp ing. The patient is in some cases bewildered and incoherent, in others drowsy, and sometimes almost insensible. Nausea and vomiting, with hiccup, are not unfrequent symptoms; and in the ease 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 favorable 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. If the reaction is imperfectly developed, a condition may super•' vene which is known as "prostration with excitement." which may terminate either. fatally or favorably, and into the smyptoms of which our limited space will not arrow us to enter further than to remark that a peculiar delirium, closely resembling ddiriurn tremens, is most commonly present.
The principal causes bf collapse (as by Mr. Savory in his article " Collapse, and the General Effects of Shock upon the System," in Holmes's System of Surgery) are: "Injuries sudden and severe, or extensive, as contused and lacerated wounds, involv ing a considerable amount of texture—the crushing of a limb, for instance. Burns pre sent familiar and striking examples of extreme collapse, produced by this cause. tinder this head, too, come capital operations. Injuries of very important organs, as the liver
or other of the viscera, or of the joints, or other organs abundantly supplied with nerves. Pain alone, when intense and protracted, has proved fatal in this way; and it appears is a case related by sir A. Cooper that sudden relief from great agony wits attended by the same untoward result. Certain poisons operate in this manner, deores.sing the system so suddenly and severely as to produce it 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 liemmorrhage alone, if sudden and profuse, will produce collapse. General debility and old age favor the influence of the shock, and much depends upon the idiosyncracy 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 ho should not be raised till decided symptoms of reaction appear. The best stim ulus is brandy, given in the form of hot brandy and water. " Its effects," says Mr. Savory, are most certain and decided, and it suits the stomach best. It will remain when all other stimulants are rejected. The state of the circulatiou and the temperature are the guide to its use. If no effects are apparent after au ounce or two have been swallowed, it is very questionable if any advantage will be gained front a larger quan tity," 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 con taining 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.
In those eases in which a patient is in a state of extreme collapse front an injury requiring a capital operation, such as the amputation of a limb, the operation should be performed as soon as his condition will admit of it; and although it should not be under taken while the prostration is extreme, it is not necessary, or even advisable, in Mr. Savory's opinion, to wait for complete reaction; and this is the opinion of most of our best surgeons. Moreover, in these cases, the use of chloroform is not expedient; for, in the first place, it cannot lie safely administered to a patient so depressed; and, secondly, the chief reason for its employment is wanting, for a person in a state of collapse is comparatively insensible to pain, For further information on this'snbject, the reader is referred to Travers On anistitutional Irritation, and to the excellent article a Mr. Savory from which we have freely borrowed.