Abstract
Because of its mysterious onset and nature, traumatic shock has long suggested problems of unusual clinical and scientific interest. Its frequent occurrence, especially in association with severe wounds and extensive surgical operations, renders a solution of these problems particularly important. Notwithstanding the large amount of attention which it has received and the resulting voluminous literature devoted to this subject, the conception of the -ultimate nature of the phenomenon of shock at the present time stands not in universal agreement. | It would be of little practical value to examine in detail all the literature available on the subject, for many of the older ideas relevant to the nature of traumatic shock have been definitely disproven. Furthermore, much of the literature shows extensive recapitulation. However, references will be made to some of the more notable attempts to solve the problem by certain prominent investigators. As a result of observations made during the first World War and World War II by members of the Shock Commission, a number of facts stand out to disprove many old theories and provide a basis for new ones. In my estimation, outstanding among these researchers was Cannon, Professor of Physiology at Harvard, whose brilliant work at Bethune perhaps contributed more toward the modern conception of traumatic shock than that of any other investigator. | It is the purpose of this thesis to set forth primarily the definition of shock, the clinical picture of shock, the historical concepts of shock, the theories of shock production, and the modern conception of traumatic shock. | In the literature it appears to me that traditionally a tremendous amount of space has commonly been devoted to the theories of shock which various investigators have supported by argument and experiment. It is accepted, I believe, by all to theorise where available facts fail to account for the phenomena which are observed. The clinical phenomena of shock will be considered and the clinical picture of shock presented. As far as a presentation of the theories of shock are concerned, I shall not break the tradition of allotting considerable space to certain theories of shock; certainly not all, but also to a critical evaluation of the more acceptable theories. Throughout the presentation of the facts and theories of shock the reader will become aware that even at this time our knowledge of shock is still deficient in spite of the tremendous work by medical investigators during and after World War II and during the present Korean conflict. Hence, despite a considerable increase in our knowledge of shock, there still remains much work to be done before we shall have elucidated all the factors which play a role in its establishment and the proper therapy of this still mysterious phenomenon. Through the very generous offerings of Dr. Frederick K. Allen this paper will afford us a problem embracing the production of traumatic shock and an individual research project on the evaluation of the treatment of irreversible hemorrhagic and tourniquet shocked dogs with acid saline. It is to be clearly understood that this project is being carried out in full collaboration with Dr. F. K. Allen who originated the idea of such proposed therapy and to whom I express sincere appreciation in affording us this problem and guidance.