Session III: Introductory Remarks

Abstract

For many years, interest in toxic factors in shock has waxed and waned. This area of research has gotten off to a rather slow start compared to hemodynamic studies, which have made tremendous inroads in the treatment of shock patients. The early workers, Cannon and Bayless, were stimulated by the fact that wounded soldiers pinned under fallen timbers in World War I appeared to deteriorate rapidly when their limbs were freed. This suggested to observers at that time that some toxic material was being released from the limb. Similar findings were also noted after sudden release of a tourniquet; and it was known that, if one proceeded with an amputation before removing the tourniquet, death was less likely to occur. Cannon and Bayless were stimulated to answer the following question: Is death, following a pressure injury, caused by toxic agents liberated from damaged tissues or is it due to loss of fluid at the site of injury? They concluded that it was probably due to release of toxic materials, despite the observations of Keith, Robertson, and others who clearly documented that all patients in shock with this sort of injury always had a decreased blood volume. Also, Dale and Richards had described histamine and its overt effects very shortly before that.