OPERATION DANGERS.

Evening Post, Volume LXXXII, Issue 93, 17 October 1911, Page 10

OPERATION DANGERS.

'A DISCOURSE ON SHOCK. FEAR AS T" FACTOR. At the recent Medical Conference in Sydney, Dr. X H. Embley (Melbourne) spoke on the subject of " Syncope, collapse, and shock," in connection with surgical operations. He had chosen that subject, he said, not because he could offef much that was new, but because it seemed necessary that someone should make an effort to clear up the indefinitenws which at present surrounded the limit of these conditions. Syncope was often called shock ; shock, syncope ; and syncope, collapse. Syncope he described as a eudden, complete, or partial, cessation of the circulation, from which recovery rapidly occurred, except in cases of advanced myocardial disease, myocardia poisoning, or the profoundly shocked. Collapse was a. condition oi circulatory depression, resulting from sudden loss of blood, or of fluid from the blood. If the depression occurred rapidly, it might be attended by syncope. Further, if the loss of blood be great, the heart might cease, from low coronary arterial tension. Shock waa a. state of depression of circulation, respiration, heat production, etc., which varied front a condition in which, a small fall of blood pressure occurred to one of low blood pressure, with • the other indications of profound shock. The onset might be slow or frapid. If recovery occurred it was relatively slow. If death occurred suddenly, it was from the intercurrehce of syncope ; if slowly, it was from cardio-vascular failure. He emphasised that in this classification sudden death in either collapse or shock was always due to syncope. The speaker dealt at length with the effects of syncope, seeking to establish that it was inhibitory and not paralytic. In animate with unimpaired hearts, the occurrence of syncope was never found to prove fatal, but when the myocardium had been damaged by chloroform of other myocardial poison, recovery wa!s not const-ant. It was hot easily possible to confuse collapse with shock or syncope. The causation wa* usually so evident, though the physical signs might closely resemble those of shock. From available ■evidence, it appeared that the pulse was, in uncomplicated collapse, unaltered in rate. If complicated by syncope, it was slow, of it ceased alto"gether j if shock followed it wae quickened. The two principal factors concerned in the causation of shock were paralysis of the nervous mechanism which controlled the arteriolar adjust' ment, and paralysis 6f the nervous mechanism, which controlled the tonus of the veins. Among thp secondary phenomena, of shock were the diminution of the excitability and contractibility of th« heart muscle. THE EFFECTS OF FEAR. Dr. A. A. Martin (Palmetston North) said the two great dangers in all surgical operations were blood-poisoning and shock, and, though they had almost eliminated the danger of the former, it was the sounder surgery to prevent the onset of the latter. Both the operator and the anaesthetist must work together to prevent the onset of shock. They must consider the- patient, the physique, the stamina, the nature and duration of the operation, and the surroundings. Too largo a dose of ansasthetie would produce shock. In deep narcosis under chloroform the blood pressure fell very markedly. Chloroform was a.n active I agent in producing shock. Ether was the safest of all the general anaesthetic* for avoiding its onset. Any degree of impeded respiration under a general anaesthetic showed a fall of blood pres-' sure. The influence of fear had a decided bearing on shock. Many patients approached an operation in a state of terror. Fear wae a great mental factor to be combated and allayed ; for certain diseases it was a predominant and challenging factor. In this connection Dr. Martin spoke of the advisability of sometimes placing a nervous patient beside a convalescent from a surgical operation. If l*o convalescent was of a cheery nature, and was happy in his or hpr surroundings, the effect on the nervous patient would be good. After referring to the "means to be adopted to combat shock, he pointed out that the surgeon should, if possible, prepare his patient some days previous to the operation, which should be performed early an the morning, so that after the nij^t's rest there was no long waiting, a factor of some importance being that the surgeon, pa.tient, and the nurse? were at their bost in the morning. Speed in operations was essential. The rapid operation, other things being equal, obtained the best results. Delay increased the risk oi shock. Earl^ diagnosis and early operations were to be their ideals. Early operation forestalled sepsis, and sepsis was a profound agent in producing chock.