Vol. 60, 1909 - University of North Carolina at Chapel Hill

KDITORIAL.
Charlotte Medical Journal
''^^'" '^"'^ ^^^ 'p'"^^ ^o"^^ a"d therefore
less blood is carried to the failing vaso-
Publlshcd Monthly. motor centres. A vicious circle is estab-
EDWARD C. REGISTER. M. D., EDITOR I'^hed in this way, and eventually the blood
CHARLOTTE. N. C. pressure sinks to nil, unless in some way
suRoiG^b SHOOK
- tli's vicious circle can be broken and the
311
Vasomotor centres oiven a chance to recover
under an increased blood supplv. Strych-
1 he importance of surgical shock is so "iue and whiskey act principallv by direct
great that its consideration from any view- stimulation of these centres, and their adpoint
IS worth while. In all probability, ministration is followed by the desired reas
Muhlberg says, surgical shock is allied suits, provided the nerve cells are not beto
the physiological phenomena of inhibi- yond the capability of reaction. When
tion, but differs from the physiological con- however, the nerve cells are powerfully
dition in that It involves to a greater or less shocked, a direct stimulation apparently
degree the entire nervous system. Of the depresses rather than stimulates them
important nerve centres in the nervous sys- The injection of normal saline solution is
tem. the vasomotor centres take first rank, more often followed by favo able e u It
Hence, ,n surgical shock it i. the vase- because the liquid, bv mechanicallv fil in.
motor inhibiion which calls most urgently the blood-vessels, partiallv compensates or
for treatment. In vasomotor collapse it is the loss of tone produced" by t^.e relaxed
theartenolesthat are principally involved; arterioles. Atropine bv its stimulaUno ef
the heart, probably through its connection feet on the vasomotor centre and perin Teral
with the nervous system, is also implicated, arterioles, its depressing effect oi/die va4
butmuch ess seriously. The heart is an is /«. ..r..//.... the dependable drug hi ccn'
organ that wil stand a great many insults ditions of shock. According to Takamine
and much hard treatment, as those who adrenalin, injected into the circuSion'
'"""''' are aware: but the
Zn„,°," r 7 causes an enormous rise in blood pres ire;
I«H Zn'^V'-T f"' " ^^'^^^'''.S'-^' 'silive due not so f much to the stimulauon of th^
-'
Tm? r v,^ Tf,"" '"- •^""^- ^^««'"°'0'- ^^"tres
"'r'^" ^ as to the direct
mgstimula- a relaxation of the arterioles through- tion of the heart and arterioles. It produces
.Ut the bod;, In . consequence of this, the its effects almost as well on the hLrt and
ood-pressure falls the pulse weakens or blood-vessels isolated from the centra ne^
iisappears, and unless some heroic method ous system hen they are in physiologi
ion is adopted the patient dies cal connection with their
> resusci . ,.^ ^ ,,„wc..i uics uai connecuon wuu tueir nerve centres. It
f collapse. Ihe heart continues beating however, is verj- evanescent in its action
or some time after the arterioles relax, but
ts contractions are feeble and often irregu-
typhoid revBR.
ar. I ater on, the heart stops its contrac- As was pointed out by Schottmuller
ions: bu
as
here again the cause lies not so long ago as 1902, typhoid fever mu.st be renuch
,n the hear as in the falling blood- garded as a primary .septicaemia The
^.en'tlien "T '""'''',^'^r^r'^^ ^^"^'""^ ''^^ ^eeii found in the blood re
Vhen the blood-pressure sinks, blood can peatedly by the fourth day of the disease
.0 longer be forced into the coronary arte- Kayser cultivated the micro-organism from
les, and the heart stops in consec|uence of the blood with his bile medium in 100 per
I lack of oxygen. It ,s for this reason that cent, of the twentv-one cases he
he
examined
mammaluin heart does not beat rhyth- during the first week. Working with the
nically when excised from the body; its Strassburg typhoid commission, Brion
emoval
and
stops the coronary circulation, and Kayser had the opportunitv to make several
^^'''"" '^'^^- examinations during
?.?.*?ir\rT'"''''';"^-, the incubation sta.e,
inatecl Wood is transfused through the and in no instance recovered typhoid bacilli
OTonary ve.s.sels. the mammalian heart can from the stools. The tvphoid bacilli
)emade
quickly
to resuine its contractions outside pass from the blood into the bile
ne When
body. It is the vasomotor system, then, injected into the ear vein of a rabbit as
atner
has
than the heart, which requires treat- been done on numerous occasions notably
iienl 111 conditions of collapse. There is by Pratt, Peabody and Long in the Laboraiso
another factor in vasomotor collapse tory of Clinical Pathology at Harvard Uni-
/hich must not be overlooked. When in ver.sity, typhoid bacilli were recovered the
onsequence of over stimulation or of some following day from the gall bladder IJorr
oibon III the blood, the vasomotor centres in fact, obtained tvphoid bacilli from the
lye way and the arterioles relax, the circu- bile in less than eight hours after they had
itioii m the central iit-rvous system, where been introduced into the circulation Pratt
asomotor centres reside, is interfered with, in IWl, reported that the typhoid bacillus
ks a result less blood circulates through the was cultivated from the gall bladder in