The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
Morphine alone, or in combination with ether as a general anesthetic,
reduces susceptibility to shock, and appears to be an equalizer of
pressure and a tranquillizer of an excited heart. Nitroglycerin and
the nitrites usually fail to raise or even sustain pressure. _Saline
infusion_ and _adrenalin_ are the _reliable and efficient means_ to
be used in combating shock and collapse; _they always raise blood
pressure_, and the latter is the most powerful of all known vasomotor
constrictors. Adrenalin always produces rise of blood pressure,
even after cocainization of the medulla and cord or destruction of
the medulla, division of the splanchnics, or arrest of the heart by
powerful electrical currents (2300 volts, alternating). Even after
death by decapitation and an interval of fifteen minutes, adrenalin
salt solution thrown into the veins causes a rise of blood pressure.
If this be combined with artificial respiration and rhythmic pressure
over the heart, resuscitation is possible in most extreme cases. In one
case, reported by Crile, a human heart which had stopped beating for
nine minutes was made to resume its pulsation for thirty-two minutes.
From all this it will appear that the heart stimulants, so called, have
a very limited applicability.
Crile further experimented by raising the atmospheric pressure
surrounding the animal, and found that blood pressure was somewhat
exalted. The reverse was also found to be true. When he so arranged his
experiment that an animal inhaled air under increased pressure he found
the tendency was rather to impairment of heart action, blocking the
circulation and reducing pressure. Changing the experiment and causing
the animal to breathe air at normal pressure while the body was under
increased atmospheric pressure, blood pressure was notably raised, but
respiration became labored and the heart’s action impaired. After death
the heart and the pulmonary vessels were found engorged.
This has its practical interest because it concerns not alone the
general treatment of shock, but the management of those cases where
the thorax must be opened, as in the surgery of the heart, the lungs,
the esophagus, etc., and the mechanical devices recently suggested
for maintaining differences of atmospheric pressure, and preventing a
traumatic collapse of the lungs.
Public-domain text, read in full here on John Shaqi.
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