Wound Shock: A History of Its Study and Treatment by Military Surgeons

Abstract

The treatment of wounds has received considerable attention from the time of the Trojan War. However, it was not until the American Civil War that shock was described as an entity distinct from the wounds themselves and that efforts were directed at more than just treatment of the wound. The need for fluid resuscitation in the treatment of hemorrhagic shock was first recognized in the Spanish American War, as was the association of sepsis with shock. World War I showed the need for blood in the treatment of "wound shock," a lesson that had to be relearned in World War II through bitter experience. Studies in the Korean War described the concept of disseminated intravascular coagulation and multiple organ failure, and the existence of disseminated intravascular coagulation was confirmed by studies in Vietnam. The treatment of hemorrhagic shock is now very effective, but the treatment of traumatic and septic shock remains unsatisfactory.

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

“…Improvements in the surgical management of wounds led to the gradual disappearance of clostridium-associated gas gangrene through the first half of the 20th century. In World War I, the incidence of gas gangrene was 5% with a 28% mortality rate; in World War II, incidence was 1.5% with 15% mortality; and in the Korean War, 0.08% with no mortality [23].…”

Treatment of War Wounds: A Historical Review

“…Although the British had entered the war with large quantities of blood and plasma and Charles Drew of the American Red Cross had developed an international blood collection and distribution system for the Blood for Britain campaign of 1940 [50], the US Army had no blood banks, and when blood was given, it was only in small amounts (100-150 mL) [59]. After heavy losses in North Africa, military surgeons recommended a blood bank be instituted.…”

“…After heavy losses in North Africa, military surgeons recommended a blood bank be instituted. However, the Surgeon General's office balked, citing logistic concerns and stating plasma was adequate [59]. Under the leadership of US Surgeon General Kirk, an organized system to provide whole blood transfusions instead was developed by army field hospitals in 1943 and 1944.…”

“…Mortality rates decreased with the use of antiseptic dressings in the field and antiseptic/aseptic surgical techniques in hospitals, although sterile technique had not developed to the point that gloves and masks were used [34,36]. Surgeons began to associate wound shock with sepsis and administered a saline solution subcutaneously or rectally to hydrate their patients [59]. These innovations almost halved the mortality rates (compared with the Civil War) to 7.4% of the 1320 patients treated for gunshot wounds, with only 29 cases treated by amputation [22].…”

History of Infections Associated With Combat-Related Injuries

“…At the dawn of the modern microbiology era, it was recognized that wounds were infected with the anaerobic bacteria, Bacillus aerogenes capsulatus (other names used in the literature for the next 50 years included Bacillus welchii, Clostridium welchii, and Clostridium perfringens), resulting in gas gangrene. 16 …”