The Story of Blood for Shock Resuscitation: How the Pendulum Swings.

Whole blood transfusion (WBT) began in 1667 as a treatment for mental illness, with predictably poor results. Its therapeutic utility and widespread use were initially limited by deficiencies in transfusion science and antisepsis. James Blundell, a British obstetrician, was recognized for the first allotransfusion in 1825. However, WBT did not become safe and therapeutic until the early 20th century, with the advent of reliable equipment, sterilization, and blood typing. The discovery of citrate preservation in World War I allowed a separation of donor from recipient and introduced the practice of blood banking. During World War II, Elliott and Strumia were the first to separate whole blood into blood component therapy (BCT), producing dried plasma as a resuscitative product for "traumatic shock." During the 1970s, infectious disease, blood fractionation, and financial opportunities further drove the change from WBT to BCT, with few supporting data. Following a period of high-volume crystalloid and BCT resuscitation well into the early 2000s, measures to avoid the resulting iatrogenic resuscitation injury were developed under the concept of damage control resuscitation. Modern transfusion strategies for hemorrhagic shock target balanced BCT to reapproximate whole blood. Contemporary research has expanded the role of WBT to therapy for the acute coagulopathy of trauma and the damaged endothelium. Many US trauma centers are now using WBT as a front-line treatment in tandem with BCT for patients suffering hemorrhagic shock. Looking ahead, it is likely that WBT will once again be the resuscitative fluid of choice for patients in hemorrhagic shock.

Walter B. Cannon's World War I experience: treatment of traumatic shock then and now.

Walter B. Cannon (1871-1945), perhaps America's preeminent physiologist, volunteered for service with the Army Expeditionary Force (AEF) during World War I. He initially served with Base Hospital No. 5, a unit made up of Harvard clinicians, before moving forward to the front lines to serve at a casualty clearing station run by the British. During his time there, he performed research on wounded soldiers to understand the nature and causes of traumatic shock. Subsequently, Cannon performed animal experimentation on the causes of traumatic shock in the London laboratory of Dr. William Bayliss before being assigned to the AEF Central Medical Laboratory in Dijon, France, where he continued his experimental studies. During this time, he also developed and taught a curriculum on resuscitation of wounded soldiers to medical providers. Although primarily a researcher and teacher, Cannon also performed clinical duties throughout the war, serving with distinction under fire. After the war, Cannon wrote a monograph entitled Traumatic Shock (New York: Appleton, 1923), which encapsulated the knowledge that had been gained during the war, both from direct observation of wounded soldiers, as well as laboratory experimentation on the causes and treatment of traumatic shock. In his monograph, Cannon elucidates a number of principles concerning hemorrhagic shock that were later forgotten, only to be "rediscovered" during the current conflicts in Iraq and Afghanistan. This paper summarizes Cannon's wartime experiences and the knowledge gained concerning traumatic shock during World War I, with a comparison of current combat casualty care practices and knowledge to that which Cannon and his colleagues understood a century ago.

[Ludwig Wittgenstein (1889-1951) and the "wound shock"]. / Ludwig Wittgenstein (1889-1951) et le "wound shock".

Ludwig Wittgenstein was born in 1889 in Vienna. As a scholar in Cambdrige University, his philosophical achievements are still major regarding the foundations of mathematics and language. In 1939, he took a job as a porter at London Guys' Hospital then under the Blitz. Wittgenstein met Drs. Grant and Reeve who worked in a dedicated "traumatic shock" under the auspices of the Medical Research Council unit, a unit which then moved to the Royal Victoria Infirmary in Newcastle; Wittgenstein followed them as a technician and improved the preparation of fine pieces of histology fixed by paraffin. He also invented a new device to record pulse pressure and paradoxical pulse search in laboratory rats. At the end of the war, he returned to Cambridge until 1949 and died in 1951.

How was the Turin Shroud Man crucified?

As the literature is not exhaustive with reference to the way the Turin Shroud (TS) Man was crucified, and it is not easy to draw significant information from only a "photograph" of a man on a linen sheet, this study tries to add some detail on this issue based on both image processing of high resolution photos of the TS and on experimental tests on arms and legs of human cadavers. With regard to the TS Man hands, a first hypothesis states that the left hand of the TS Man was nailed twice at two different anatomical sites: the midcarpal joint medially to the pisiform between the lunate/pyramidal and capitate/uncinate bones (Destot's space) and the radiocarpal joint between the radio, lunate and scaphoid; also the right hand would have been nailed twice. A second hypothesis, preferred by the authors, states that the hands were nailed only once in the Destot's space with partial lesion of the ulnar nerve and flexion of the metacarpophalangeal joint of the thumbs. With regard to the TS Man feet, the imprint of the sole of the right foot leads to the conclusion that TS Man suffered a dislocation at the ankle just before the nailing. The entrance hole of the nail on the right foot is a few inches from the ankle, and excludes a double nailing. The nail has been driven between the tarsal bones. The TS Man suffered the following tortures during crucifixion: a very serious and widespread causalgia due to total paralysis of the upper right limb (paradoxical causalgia); a nailing of the left wrist with damage to the ulnar nerve; a similar nailing of the right wrist; and a nailing to both feet using one only nail that injured the plantaris medialis nerves. The respiratory limitation was probably not sufficient to cause death by asphyxiation. Also considering the hypovolemia produced by scourging and the many other tortures detectable on the TS, the principal cause of death can be attributed to a myocardial infarction.

Shock, diaschisis and von Monakow.

The concept of shock apparently emerged in the middle of the 18th century (Whyett) as an occurrence observed experimentally after spinal cord transection, and identified as "shock" phenomenon one century later (Hall). The concept was extended (Brown-Séquard) and it was suggested that brain lesions caused functional rupture in regions distant from the injured one ("action à distance"). The term "diaschisis" (von Monakow), proposed as a new modality of shock, had its concept broadened, underpinned by observations of patients, aiming at distinguishing between symptoms of focal brain lesions and transitory effects they produced, attributable to depression of distant parts of the brain connected to the injured area. Presently, diaschisis is related mainly to cerebrovascular lesions and classified according to the connection fibers involved, as proposed by von Monakow. Depression of metabolism and blood flow in regions anatomically separated, but related by connections with the lesion, allows observing diaschisis with neuroimaging.

Shock, diaschisis and von Monakow / Choque, diasquise e von Monakow

The concept of shock apparently emerged in the middle of the 18th century (Whyett) as an occurrence observed experimentally after spinal cord transection, and identified as "shock" phenomenon one century later (Hall). The concept was extended (Brown-Séquard) and it was suggested that brain lesions caused functional rupture in regions distant from the injured one ("action à distance"). The term "diaschisis" (von Monakow), proposed as a new modality of shock, had its concept broadened, underpinned by observations of patients, aiming at distinguishing between symptoms of focal brain lesions and transitory effects they produced, attributable to depression of distant parts of the brain connected to the injured area. Presently, diaschisis is related mainly to cerebrovascular lesions and classified according to the connection fibers involved, as proposed by von Monakow. Depression of metabolism and blood flow in regions anatomically separated, but related by connections with the lesion, allows observing diaschisis with neuroimaging.

O conceito de choque aparentemente surgiu em meados do século 18 (Whyett), como ocorrência observada experimentalmente após seção transversa da medula, e foi identificado como fenômeno de "choque" um século mais tarde (Hall). O conceito foi estendido (Brown-Séquard) e sugeriu-se que lesões cerebrais produziam ruptura funcional em regiões distantes à da lesão ("action à distance"). O termo "diásquise" (von Monakow), proposto como nova modalidade de choque, teve seu conceito ampliado, fundamentado em observações em pacientes. Visava distinguir sintomas de lesões cerebrais focais de efeitos transitórios que produziam, atribuíveis à depressão de partes distantes do cérebro conectadas à área lesada. Atualmente, diásquise é relacionada principalmente a lesões cerebrovasculares e classificada de acordo com as fibras de conexão envolvidas, como proposto por von Monakow. Depressão do metabolismo e fluxo sanguíneo em regiões anatomicamente separadas, mas relacionadas por conexões à lesão, permitem observar diásquise por meio de neuroimagem.

The crucifixion of Jesus: review of hypothesized mechanisms of death and implications of shock and trauma-induced coagulopathy.

The crucifixion of Jesus is arguably the most well-known and controversial execution in history. Christian faithful, dating back to the time of Jesus, have believed that Jesus was executed by crucifixion and later returned physically to life again. Others have questioned whether Jesus actually died by crucifixion, at all. From review of medical literature, physicians have failed to agree on a specific mechanism of Jesus' death. A search of Medline/Pubmed was completed with respect to crucifixion, related topics, and proposed mechanisms of Jesus' death. Several hypotheses for the mechanism of Jesus' death have been presented in medical literature, including 1) Pulmonary embolism 2) Cardiac rupture 3) Suspension trauma 4) Asphyxiation 5) Fatal stab wound, and 6) Shock. Each proposed mechanism of Jesus' death will be reviewed. The events of Jesus' execution are described, as they are pertinent to development of shock. Traumatic shock complicated by trauma-induced coagulopathy is proposed as a contributing factor, and possibly the primary mechanism, of Jesus' death by crucifixion.

Recalling war trauma of the Pacific War and the Japanese occupation in the oral history of Malaysia and Singapore.

The Pacific War and the Japanese Occupation were traumatic periods in the lives of people now over seventy years old in Malaysia and Singapore. This study traces why individuals interviewed for oral history of the Pacific War and the Japanese Occupation have often been able to tell stories of trauma without being overwhelmed by their reminiscences. It emphasizes that memories of traumatic experiences of the Pacific War and the Japanese Occupation in Malaysia and Singapore are mediated and eased by supportive social networks that are part of the interview subject's community. The individual's personal memories of traumatic war experiences are positioned in the context of the collective memory of the group and, thus, are made easier to recall. However, for individuals whose personal memories are at variance with the collective memory of the group they belong to, recalling traumatic experiences is more difficult and alienating as they do not have the support in their community. The act of recalling traumatic memories in the context of the collective memory of a group is particularly relevant in Malaysia and Singapore. These countries have a long history of being plural societies, where although the major ethnic groups -- the Malays, Chinese, and Indians -- have lived side by side peacefully, they have lived in culturally and socially separate worlds, not interacting much with the other groups. The self -- identity of many older people who lived through the Pacific War and the Japanese Occupation is inextricably bound up with their ethnicity. Oral history on war trauma strongly reflects these identities.

One surgeon's Army experience with "wound shock" from Pearl Harbor to the present.

The Army has had extensive experience in the study and treatment of shock, beginning with the American Civil War and continuing to the present. This is the story of one Army surgeon's experience, both in research and treatment of shock, from Pearl Harbor to the present.

Battlefield trauma, traumatic shock and consequences: war-related advances in critical care.

Over the course of history, while the underlying causes for wars have remained few, mechanisms of inflicting injury and our ability to treat the consequent wounds have dramatically changed. Success rates in treating war-related injuries have improved greatly, although the course of progress has not proceeded linearly. From Homer's Iliad to the Civil War to Vietnam, there have been significant improvements in mortality, despite a concurrent increase in the lethality of weapons. These improvements have occurred primarily as a result of progress in three key areas: management of wounds, treatment of shock, and systems of organization.

Sepsis and septic shock: a history.

Infectious disease has been a leading cause of death in humans since the first recorded tabulations. From Hippocrates and Galen, to Lister, Fleming and Semmelweiss, this article reviews the notable historical figures of sepsis research. The early descriptions and theories about the etiology (microbial pathogens), pathogenesis (toxins and mediators), and treatment of sepsis-associated disease are also discussed.

A Columbine study: giving voice, hearing meaning.

On a quiet spring morning, the 20th of April 1999, Columbine High School emerged from relative anonymity as a typical suburban high school and became internationally recognized as a symbol of school violence and tragic loss. As a parent whose child was in the school at the time of the attack, I struggled to make sense of the tragedy. I decided to conduct research into the experience as a way to learn lessons that might help others exposed to community-wide trauma in the future. Through modified oral history interviews of other Columbine parents in combination with other qualitative research strategies, I collected and studied stories of the events of that day and the years following. An unexpected by-product emerged from the study, for it seemed that I was not only learning about crisis response and trauma care but also offering a means for parents to gain comfort in reflecting on their own experience. This paper describes the distinct approach that I employed to create a gateway to understanding this experience. It does not explicate the findings of the Columbine study but instead explores the potential for positive outcomes for those who, by giving voice to their stories, can connect to a deeper appreciation for their own experience.

Oral history and Hurricane Katrina: reflections on shouts and silences.

In the immediate aftermath of Hurricane Katrina in August 2005, many oral historians throughout the nation began to consider the role their methodology could serve in documenting the storm and its aftermath. Interviewing so soon after such a traumatic event creates new considerations for oral history as an approach to recording experience. The problems and possibilities of oral history as such a moment initiated a vibrant discussion on H-Oralhist and at professional meetings in the fall of 2005. This article reflects on many of the topics raised in that dialogue, including issues of historical distance, objectivity, reflection, and emotional trauma. The piece also offers an early review of the work of the Center for Oral History and Cultural Heritage at the University of Southern Mississippi to document the impact of Hurricane Katrina in Mississippi.