matters than his
own condition,--as, for example, during the heat of a battle or in the
excitement of a railway accident or a conflagration,--even severe
injuries may be unattended by pain or shock at the time, although when
the period of excitement is over, the severity of the shock is all the
greater. The same thing is observed in persons injured while under the
influence of alcohol.

_Clinical Features._--The patient is in a state of prostration. He is
roused from his condition of indifference with difficulty, but answers
questions intelligently, if only in a whisper. The face is pale, beads
of sweat stand out on the brow, the features are drawn, the eyes
sunken, and the cheeks hollow. The lips and ears are pallid; the skin of
the body of a greyish colour, cold, and clammy. The pulse is rapid,
fluttering, and often all but imperceptible at the wrist; the
respiration is irregular, shallow, and sighing; and the temperature may
fall to 96 F. or even lower. The mouth is parched, and the patient
complains of thirst. There is little sensibility to pain.

Except in very severe cases, shock tends towards recovery within a few
hours, the _reaction_, as it is called, being often ushered in by
vomiting. The colour improves; the pulse becomes full and bounding; the
respiration deeper and more regular; the temperature rises to 100 F. or
higher; and the patient begins to take notice of his surroundings. The
condition of neurasthenia which sometimes follows an operation may be
associated with the degenerative changes in nerve cells described by
Crile.

In certain cases the symptoms of traumatic shock blend with those
resulting from toxin absorption, and it is difficult to estimate the
relative importance of the two factors in the causation of the
condition. The conditions formerly known as "delayed shock" and
"prostration with excitement" are now generally recognised to be due to
toxaemia.

_Question of Operating during Shock._--Most authorities agree that
operations should only be undertaken during profound shock when they are
imperatively demanded for the arrest of haemorrhage, the prevention of
infection of serous cavities, or for the relief of pain which is
producing or intensifying the condition.

_Prevention of Operation Shock._--In the preparation of a patient for
operation, drastic purgation and prolonged fasting must be avoided, and
about half an hour before a severe operation a pint of saline solution
should be slo