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June 11, 1949

Shock and Allied Forms of Failure of the Circulation

JAMA. 1949;140(6):575. doi:10.1001/jama.1949.02900410071027

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This work gives an extensive if not complete analysis of the pertinent literature. Each of the seventeen chapters closes with a bibliography. The text contains fourteen tables and fifty-five figures; one wishes the photomicrographs were better. A brief historical review is followed by twenty-six proposed definitions for shock, including one by the author.

Shock is recognized in numerous clinical conditions, and classified in seven categories: traumatic, hemorrhagic, burn, obstetrical, medical, anesthetic and operative. The author explains shock as "the triphasic response to stress"; i.e., to various conditions which disturb the internal environment of the organism. "The final result of all forms of stress, if sufficiently severe, will be anoxia of varying degree." The first phase is that of anoxic injury to cells. The second or catabolic phase is breakdown of body constituents, evidenced by increased nonprotein nitrogen, urea, creatinine and polypeptides in the blood, hemolysis, hemoglobinuria and fever. The third

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