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March 20, 1943


Author Affiliations

University of California Medical School, San Francisco.

JAMA. 1943;121(12):966. doi:10.1001/jama.1943.02840120068025

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To the Editor:—  I was interested in the editorial on cooling in shock (The Journal, February 6, p. 432). My own thoughts have been similar to those which you express. I think you will be interested to hear of observations told me by a nurse with a British surgical unit in loyalist Spain during the war there. She said that they were up front in two heavy attacks, one in the mountains in the winter and one in the dry plains in the summer. Troops, diets and injuries were comparable. That the degree of shock, especially for lesser injuries, was so much greater in the summer fighting, with repeated fatalities from minor wounds, was the subject of repeated and prolonged staff conferences, without reaching any conclusions. Under war conditions dehydration complicates the analysis of the effect of temperature alone. According to her description, the temperature contrasts were pronounced, as both

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