THE COURSE OF EVENTS IN SECONDARY WOUND SHOCK
1919; American Medical Association; Volume: 73; Issue: 3 Linguagem: Inglês
10.1001/jama.1919.02610290016008
ISSN2376-8118
Autores Tópico(s)Medical History and Innovations
Resumocreating a strong suspicion of a gas infection.His condition was so critical that a member of the shock team attached to our outfit, seeing him lifted out of the ambulance and recognizing the urgency of aid, had him carried directly to the operating room.Any kind of operation then would have meant death ; so while he was being given 500 c.c. of blood, which were, fortunately, obtainable, I simply removed the foot with one stroke of the knife and put on a band¬ age-trusting to luck concerning later developments.It was remarkable how that boy picked up.Within a few hours, aided by hot water bottles and some hot drinks, he had taken a new lease on life.Nor did he slip back in the slightest-even when, twenty-four hours later, the signs of gas infection were unmis¬ takable.He withstood an amputation above the knee without a quiver and, a few days later, was evacuated to the rea-*', a well, happy boy, smoking the inevitable cigaret.I could cite other instances like this one, equally gratifying ; but one example is as good as a dozen in the same class of cases.So much, then, for the acute hemorrhage and shock of the battle casualties.The need for blood was great and urgent; the supply, pitifully small.Substitutes were tried and found wanting.Further to the rear, where conditions were a bit less strenuous than in the forward areas, it was possible to secure blood more often, and in greater quantities.Thus, in the base hospitals, a great light was shed on the value of blood transfusion in the anemias secondary to battle wounds.These were very common and most distressing.The men would lie pale, inert, unable to eat, nervous, day by day slipping back just a little, while their wounds not only failed to heal but became increasingly dirty, until all bodily resistance being finally overcome, sep¬ ticemia ensued, and death resulted.Particularly was this true of bone and joint cases.We transfused a number of these men, and in nearly every instance a prompt improvement followed.One of them had a huge wound of the buttocks with a great area of bone involvement-always a sad con¬ dition.He was having rough going until he got some blood, after which his improvement was rapid and continuous.Another man had a big thigh wound and a septicemia-staphylococcus, I think.He over¬ came the septicemia, as many did, but his anemia was so profound that he did not improve.With two or three doses of blood, however, he took on renewed life and finally recovered, though the leg had finally to be removed.Still a third, and a most remarkable demonstration of the efficacy of blood transfusion, was that of a young lieutenant of aviation who, being wounded through the chest, crashed to earth, sustain¬ ing a compound fracture of both bones of his right forearm, a similar condition of the bones of his left lower leg, and a compound fracure of the bones of his right foot.Two months later, when I saw him, he was a mere skeleton, and, in addition to his fractures, had three intractable bedsores and a knee joint involved in a metastatic infection necessitating the turning back of the patella.It was clearly a case of too much absorption from too many foci of infec¬ tion.In all, this man .received four transfusions.After the second, his right leg was removed just above the knee for, with the foot hopelessly crippled and the knee joint badly infected, it was simply pulling him down without offering him anything in case of his recovery.tension were then analyzed, with the result that the low pressure was ascribed to "exemia"; that is, a
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