Evident hemorrhage, such as that from a cut vessel, with external bleeding has long been recognized as a factor of importance in traumatic shock. In certain instances during a surgical operation, when the blood is distributed on a large number of sponges, sheets and towels, the full extent of the hemorrhage is sometimes not realized. But at least it is recognized as being a factor of importance and is treated by methods intended to restore the loss of circulating fluid.
On the other hand, there are many instances in which the hemorrhage is hidden and not recognized. The shocklike symptoms that develop in patients so affected are attributed to the action of a variety of ill defined agents, such as the toxic action of traumatized tissue, anociassociation, etc. The exact relationship between the cause and the condition being indirect and uncertain, the treatment is equally indefinite. It is with the
HARKINS HN, ROOME NW. CONCEALED HEMORRHAGE INTO TISSUES AND ITS RELATION TO TRAUMATIC SHOCK. Arch Surg. 1937;35(1):130-139. doi:10.1001/archsurg.1937.01190130133006