Numerous theories have been advanced to account for the symptoms
seen in shock. Until recent years it was customary to suppose
the vaso-motor centres had failed, being overcome by exhaustion
consequent upon excessive stimulation by a greatly increased number
of afferent impulses from the periphery of the body. It was suggested
that as a result there was a general dilatation of the vascular
system, especially in the abdominal veins, and therefore a general
impairment of the circulation. Various hypotheses were, in addition,
formulated, to account for the vaso-motor failure. These included
the ideas of deficient carbon dioxide in the blood, exhaustion
of the adrenal secretion, and exhaustion of nerve-cells in the
higher centres. All these theories found their supporters and much
experimental evidence was brought forward, but none was susceptible
of final proof. The whole theory of vaso-dilatation and the idea that
the patient “bleeds into his own abdominal veins” were eventually
disposed of by observation of the clinical facts. Many extensive
abdominal operations have been performed upon shocked patients, but
the accumulation of blood in the splanchnic area has never been
demonstrated. It has, on the other hand, been found that in the limbs
the arteries and arterioles are strongly contracted. It is also by
no means unusual to meet with the condition known as venospasm; the
veins are collapsed and their walls contracted, so that it becomes
necessary to use a considerable positive pressure before any fluid
can be induced to flow into them. It has, in addition, been shown
that the vaso-motor system is still active, and the heart, although
beating rapidly, still responds to reflex stimulation and to increase
of intracranial tension.
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