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August 5, 1939


JAMA. 1939;113(6):503-504. doi:10.1001/jama.1939.02800310041014

Many a surgeon has watched a patient sinking into traumatic shock and realized that all that he could do by infusion of saline solution, transfusion of blood, use of epinephrine, lifting the foot of the bed and other measures still left the failing circulation inadequately supported. Many a physician has observed a patient exhausted by illness sinking in essentially the same manner. Some element in the mechanics of the circulation has remained inadequately defined and therefore beyond therapeutic control.

Forty years ago the progressive weakening of the pulse and of the sounds of the heart in these conditions was interpreted as a progressive failure of the force of the heart. Then, as the conception of the nervous control of arterial pressure was developed by physiologists, as the sphygmomanometer was introduced into clinical medicine and as the failure of the circulation was found to be expressed always in a progressive fall