SHOCK (MDutch schock, Dutch schok, 011G. scot., shock, jolt; connected with AS. sracan, secacan, Eng. shake). A sudden depression of the vital powers due to injury or profound men tal emotions. Through this depression of the nerve centres a circulatory paresis is induced, which results in the accumulation of the hlood in the large abdominal vessels, with a correspond ing loss to the cerebral and peripheral circula tion. This is shown by the lowering of the sur face temperature, and disturbance of voluntary cerebration. Shock may be slight and transient or severe and prolonged, or it may be almost in stantly fatal. Surgical shock results from acci dental injuries such as extensive burns, gunshot wounds, crashing of the limbs, blows or pene trating wound of the abdomen, injuries to the base of the skull, with concussion of the brain. It is apt to follow extensive operations, especially those upon the abdominal viscera. Sudden and profuse hemorrhage, and occasionally anesthet ics. cause shock. Mental shock is induced by sud den grief, fright, or other powerful mental im pressions. The condition of shock is denoted by a subnormal temperature, a rapid and feeble pulse, pinched features, a skin cold, pallid, and clammy, or covered with profuse perspiration, shallow and irregular respiration, diminution or loss of sensibility to pain, and a tendency to uri nary suppression. The patient is usually con scious, replying to questions, but has no volition either of movement or speech. Delirium is some times present, and, in children, convulsions. Shock is increased by cold, loss of blood, and age. Recovery is followed by a period of reaction, which often lasts for several hours. This may
be preceded by vomiting. Beginning reaction is indicated by returning color, increased tempera ture, and improvement in the pulse, respiration, and inclination to voluntary movement. De ferred shock is a curious condition in which the symptoms do not develop until some time after the occurrence of a violent mental impression. This variety may he more severe than that pro (bleed by bodily injury.
The treatment of collapse is as follows: The patient is placed in a horizontal position with the head slightly lower than the rest of the body, and the feet raised. Surface temperature is maintained by hot-water bottles and blankets. Hypodermic injections of brandy. ether, strych nine, atropine, or digitalis are given according to indications. Hot coffee o• brandy may be given by the month, the stomach retaining these better than anything else. Mustard plasters may be placed over the heart, pit of the stomach, or spine, or a stimulating enema containing turpen tine may be given. One of the most useful and frequently employed measures in shock is the in jection either through the veins, rectum. or con nective tissues of Lot. normal saline solution. Enormous quantities of fluid may thus lie taken into the circulation, with remarkably quick and certain results. In severe cases bandaging the limbs in order to increase the blood supply of the brain and vital centres is a resort. Opera tion should never be done during shock except when imperatively necessary to save life.