wounded, his blood volume was diminished. Water is a valuable remedy and, as absorbed from the alimentary canal, it is very effective in restoring the blood volume. As we shall see, it is the actual volume of the blood, rather than its dilution, that is of consequence. Unfortunately, the vomiting frequently present in shock prevents this treatment in many cases. Water or saline solution may, however, be given by the rectum.
Cold. Exposure to cold has a very potent exaggerating effect in shock. It may happen that spontaneous recovery takes place in the comparative comfort of the casualty clearing station, but, for the reason to be given below, it is not well to wait long if no sign of improvement is seen in a short time. It is difficult to give precise reasons why cold is so markedly deleterious. It may be the result of the generally depressing effect on all bodily functions, which would naturally be greater in states of inadequate circulation of blood.
Anxiety and Fear are recognized also as predisposing factors of shock. Perhaps the depressing effect is the cause, as with cold.
Treatment. Since the cause of the trouble is the deficiency of blood in circulation, it is obvious that the chief remedy is to increase this. Much attention was given during the war to improving the methods of transfusing blood and there seems no doubt that many lives were saved by this means. But donors are not always available and it is clearly a matter of importance to possess, if possible, an artificial solution which can be used in unlimited amount. Simple saline or glucose solutions were soon found to be useless. They disappear from the blood in less than an hour. To prevent this disappearance, it is necessary to add to the solution some colloid which has an osmotic pressure equal to that of the colloids in normal blood. This is done in the " gum-saline " introduced by Bayliss. The solution contains 6 % or 7 % of pure gum arabic in addition to 0-9 % sodium chloride. The reason for the addition of the colloid may be stated thus: the blood-vessels are impermeable to colloids, hence the osmotic pressure of these substances can manifest its effects. The important point is that it causes an attraction of water and thus prevents any rapid filtration by the blood pressure on the arterial side and brings about a reabsorption in the capillary and venous regions, where the blood pressure is lower than the osmotic pressure of the colloid. Thus a solution containing a sufficient amount of gum arabic is not lost from the circulation.
Of course, the blood actually in circulation is diluted by such injections, but the work of Gesell shows that the greater flow more than compensates for the lesser oxygen-carrying capacity per unit volume. Moreover, as the circulation improves, the capillaries begin to give up their stationary corpuscles to the general mass of blood.
When the state of shock is complicated by haemorrhage it might seem that the addition of blood itself is imperative. It is remarkable, however, that in actual experience the benefit of gum-saline was more obvious after haemorrhage than in severe cases of wound-shock without haemorrhage. It seems probable that these latter cases were such as to have arrived at that stage in which a second action of histamine shows itself. To this we may now turn. After large doses or prolonged action of smaller ones, the capillary blood-vessels become permeable to the colloids of blood as well as to the salts. The addition of solutions of col- loids or even blood itself is'useless in this stage. They are quickly lost. It was found by observations on wounded men that the plasma of the blood transfused was lost rapidly. Whether the effect on the capillaries is a direct one or whether it is due to the asphyxial state brought about by the low blood pressure is not clear at present. Krogh brings evidence that, when the capil- laries are rapidly and widely dilated, there may be formed minute pores between the cells of their walls, which allow colloids to pass through. The fact warns us, in any case, not to allow the state of low blood pressure to last for any length of time.
Cases of shock in this stage were generally regarded as hope- less. It was not found possible to restore them either by blood or by gum-saline. Some experiments made later by Bayliss suggest, however, the possibility that further repeated injections might in some cases have been effective. Although the greater part of the fluid of the first injection was lost, it seemed that some im- provement in the state of the capillaries resulted, since a second injection produced a slight permanent rise in the blood pressure and a third injection recovery.
Owing to the fact that gum-saline is quite innocuous and can now be obtained in sterilized form from the dealers, it should al- ways be at hand in operations for use if shock threatens, as also for accidents or serious haemorrhage from any cause.
See Special Reports, Nos. 25, 26, 27, Medical Research Council (London H.M. Stationery Office, 1919) ; E. Quenu, La Toxemie traumatique (Paris, Alcan, 1919) ; Bayliss, Intravenous Injections in Wound-Shock (London, 1918). (W. M. B.)
SHORT, SIR FRANCIS JOB (1857- ), English engraver (see 24.1007), was elected R.A. in 1911, and in the same year was Knighted. In 1910 he became president of the Royal Society of Painters, Etchers and Engravers. His later work exemplifies
every type of his activity. Among etchings, " On the Banks of the Bure " and " The White Mill, Canterbury " show his adherence to the use of line in that medium, and a version of Turner's
" Ehrenbreitstein to Coblentz " continues his series of translations of paintings. He also added " Moonlight on the Medway at Chatham " and " Dumbarton Rock " to the plates in etching and
mezzotint completing Turner's " Liber Studiorum." Two aqua-
tints, " The New Moon " (1918) and " 'Twixt Dawn and Day, "
show broad handling and remarkably rich quality in the darks;
and two mezzotints, "Orion over the Thames" (1913-4) and
" The Night Picket Boat at Hammersmith " (1914-5), are among
his finest plates in a medium peculiarly his own.
SHORTER, DORA (Sigerson) (1866-1918), Irish poet, was born in Dublin, Aug. 16 1866. She was the daughter of Dr. George Sigerson, the Celtic scholar, and married in 1896 Clement K. Shorter (b. 1857), editor of the Sphere and other London
illustrated papers (see 19.563). Her first volume of verse appeared in 1894, and she established a considerable reputation as a writer of lyrics and ballads; the subjects often religious, or drawn
from the treasures of Irish legend, or in praise of the Irish country. Her Collected Poems were published in 1909, and she wrote one novel, Through Wintry Terrors (1907). She died in
London, Jan. 6 1918. Two posthumous volumes of poems
appeared in 1918 and 1919, as well as A Dull Day in London and
other sketches, with a preface by Thomas Hardy, in 1920.
SHORTT, EDWARD (1862- ), British lawyer and politician, was born at St. Anthony's Hall, Newcastle-on-Tyne, March 10 1862. He was educated at Durham school and University, and in 1890 was called to the bar. In 1907 he became recorder of Sunderland and in 1910 a K.C. In 1910 he entered
the House of Commons as Liberal member for Newcastle. In May 1918 he became Chief Secretary for Ireland, but in 1919
resigned and was appointed Home Secretary.
SIAM (see 25.2). For the purposes of administration the kingdom of Siam is divided into 17 provinces (Monthons), the
area of which is given officially at 484,128 sq. kilometres. The
revised census figures for 1910-1 gave a pop. of 8,149,847, and
the official estimate of the pop. for the year 1920 was 9,022,000.
On the death in 1910 of King Chulalongkorn he was succeeded by his son, the Crown Prince Maha Vajiravudh, who in 1917 assumed the title of King Rama VI. Under this monarch the work of consolidation and development progressed steadily. To foster the idea of the duty of national service among the elder generation the " Wild Tiger " Corps was established. The Sia- mese boy scout organization, of which the King became presi- dent, educates the younger generation on the same lines. The number of boy scouts was in 1920 over 15,000.
Among various changes may be noted the royal decree that all privy purse property should be subjected to ordinary taxation, the abolition of lottery farms and public gambling-houses, the strict regulation of the opium traffic, and the great development of football and other athletic sports. Under the patronage of the King, a Navy League was established, and the Red Cross Society was reorganized. The Red Cross Society has under its direction the Chulalongkorn hospital, the Pasteur institute and laboratories for the preparation of vaccines and serums.
The calendar has been revised. The Siamese year formerly dated from the foundation of Bangkok. It now corresponds with the Buddhist era. The new year begins on April I and terminates on March 31. Hence April 1921 to March 1922 is, in the Siamese calendar, B.E. 2464. The day is divided into two periods of 12 hours each as in Europe, except in the railways and the post and telegraph department, where the 24-hour day is used.
