Shock, Exhaustion, and Restoration in War

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The word shock is not scientific. It expresses neither the state of the patient nor the cause of his condition. The term is ordinarily used to denote a state of physical exhaustion which has been rapidly developed by traumatic, toxic, or thermal stimuli. But if a soldier with a crushcd toe limps in an imperative retreat for several days in pain and distress, without food, drink, or sleep, and is finally found prostrated, is he in shock or exhaustion, or both? Can the most complete microscopic and clinical study determine the cause of his death? Even when there is a paramount cause, it can hardly be dissociated from other factors. There is probably no ultimate difference between the bloodless, intangible causes of exhaustion and the bloody, tangible causes of shock. These states have interchangeable values; they depend on some common biologic principle. When the mechanism of fatigue and exhaustion is understood, the mechanism of shock will be understood.

Shock presents a special problem in war, since soldiers are commonly subjected to factors causing depression and exhaustion. Contributing factors are intensely exciting emotions such as fear; extreme physical exertion as in forced marches; loss of sleep; hunger and thirst; excessive heat or cold; and physical injury involving great pain and loss of blood.

Although the state of shock is difficult to define, some of the forces that control shock—the forces that control life and death -can be measured and expressed in physical terms. A physical phenomenon constantly associated with living. . .



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