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January 26, 1946


Author Affiliations

New York

From City Hospital.

JAMA. 1946;130(4):185-189. doi:10.1001/jama.1946.02870040001001

In war, problems of shock and trauma attain even more than their usual importance. A more general understanding of the newer ideas and methods may sometimes improve therapeutic results.

In 1939 Allen1 proposed the theory of a dual mechanism in shock. The physical factor is evident in cases in which the edema of injured tissues withdraws sufficient fluid from the circulation to account for death, without an assumption of a toxic factor. On the other hand, severe shock can be fatal with a smaller local fluid extravasation, and the toxic explanation seems obligatory when death occurs after injections of plasma or other fluid have maintained an adequate circulatory volume at all stages. The desired direct proof of the toxic hypothesis has been furnished in the demonstration by the Chambers group2 of circulating substances with vasoexcitor or depressor properties corresponding to the different stages of shock. The variable picture

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