The Therapy of Shock: Some Lessons from Military Surgery.

The state of peripheral circulatory failure, referred to as "shock," is so frequentlv associated with the extensive injuries incurred during military operations, it may properly be called a malady of warfare. Not only is it encountered more frequently, but its severity far exceeds that ordinarily seen in civilian practice. It is thus possible to draw from the experiences of military surgery many points of practical value in the treatment of shock. Because the term "shock" has been used quite loosely to indicate any form of peripheral circulatory collapse, this discussion will be prefaced by a brief definition and classification. Shock is defined as a "state of actual, or impending, peripheral circulatory failure due to a reduction of the effective blood volume not primarily cardiac in origin." This excludes from discussion all forms of peripheral circulatory collapse in which failure of the heart is the primary cause. Depending upon the mechanisms involved, three types of shock may be recognised: neurogenic, a state of sudden loss of vasomotor tone with a redistribution and pooling of blood in dependent portions of the body; vasogenic, a consequence of direct injury to capillaries or small vessels; and hematogenic, the result of a primary loss of fluid from the circulation.4 The term "decompensated shock" is used to indicate the state of -advanced collapse which follows a prolonged reduction of the effective blood volume, irrespective of the original cause or causes.