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November 1939


Arch Intern Med (Chic). 1939;64(5):952-970. doi:10.1001/archinte.1939.00190050058005

The physician confronted with a gravely ill patient, pallid and cyanotic, with a rapid, hardly palpable pulse and frequent, shallow breathing, thinks of heart failure and injects digitalis. This procedure, however, is the right one in only part of the cases, for frequently the condition described has nothing to do with poor heart action. I must admit that I have made this mistake myself on several occasions. I have needed much time to realize how little is generally achieved by stimulation.

One must always consider whether the heart has caused this serious condition or whether the picture should be ascribed to peripheral circulatory failure. In the latter case one speaks of the shock syndrome. A precise knowledge of the symptoms will always enable the physician to differentiate the two conditions.

In medical literature and especially in common parlance there is much confusion about shock. Though I have chosen to term