The Rude Unhinging: A Study of Shock

Abstract

In the early 19th century, the basic intellectual tenets of medicine underwent significant change. From a practice of nosology, disease classification, and a focus on the subjective and the symptom emerged an epistemology that looked for objective clinical signs that denoted the presence in the body of disease-defining pathologic lesions. Yet this physical, tangible identity of disease was challenged by the presence of functional diseases, which were readily identified but difficult to define, as they left no diagnostic mark upon their sufferers’ bodies. Shock, a readily apparent, omnipresent phenomenon which could complicate injury, childbirth, certain disease states, and medical therapies, was one such condition. This study looks at how physicians and surgeons in the 19th century attempted to create an intellectual model for shock, so as to better define, recognize, and treat it. We will explore how technological change and social conditions affected this understanding, and how both traditional and novel theoretical models were invoked to explain it. We will also look at attempts to understand shock as examples of Kuhnian normal science, for even as technology changed in the early 20th century, and shock could be expressed and described in very modern-seeming ways, the underlying models and concepts that defined shock changed very little.