Intravenous injection in wound shock : being the Oliver-Sharpey lectures delivered before the Royal College of Physicians of London in May 1918 . ENOUS INJECTION Ether readily produces a fall of blood pressureafter the alkaline reserve has been decreased byinjection of acid or by want of oxygen. Fig. 48 serves to illustrate this fact,which has been noticed byCannon, by Dale, and bymyself, but is not yet ex-plained. Since it is scarcely pos-sible to avoid some fall ofblood pressure in operations,there may be risk when theblood pressure is alreadylow. For this reason, it hasbeen found of benefit
Intravenous injection in wound shock : being the Oliver-Sharpey lectures delivered before the Royal College of Physicians of London in May 1918 . ENOUS INJECTION Ether readily produces a fall of blood pressureafter the alkaline reserve has been decreased byinjection of acid or by want of oxygen. Fig. 48 serves to illustrate this fact,which has been noticed byCannon, by Dale, and bymyself, but is not yet ex-plained. Since it is scarcely pos-sible to avoid some fall ofblood pressure in operations,there may be risk when theblood pressure is alreadylow. For this reason, it hasbeen found of benefit toraise the pressure before orduring the operation by theinjection of cases reported byDrummond and Taylor(1918, Nos. 18, 19, and 24,p. 8) are to the point. InNo. 18 there were shellwounds of abdomen, knee-joint, leg, and pressure on admission,135 mm. Fell to 80 duringoperation. Restored to 104mm. by injection of gum,and maintained. In No. 19, although the bloodpressure was 120 on admission, it fell to 80 by theend of the operation. Gum-saline was given, theblood pressure was restored to 118 and remained. Fig. 48.—Effect of Etherafter Acid. pressure a. Height of blood under ether. b. Height after acid injection, combined with 26 per cent,loss of blood and replace-ment by gum. Ether de-creased, owing to failure ofrespiration. c. Fall of blood pressure with ether at its original line at 100 IN WOUND SHOCK 127 there. In No. 24, a case of severe multiple wounds,the blood pressure was between 86 and 64 on ad-mission. Gum was given before operation, raisingthe pressure to 124. A second infusion was givenduring the operation and, at the end, the pressure was92 mm., although the patient died twelve hours is difficult to realise, experimentally, the appro-priate conditions ; but, in some cases where therewas apparently some fall of blood pressure due tothe anaesthetic, gum-saline was found to be ofbenefit. But
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