The nature of irreversible shock: its relationship to intestinal changes

Abstract

The numerous theories conceived over the years to explain the nature of irreversible shock can perhaps be grouped under one or the other of three major headings. First, that prolonged vasoconstriction accompanying shock causes enough cellular damage alone, due to mechanical limitation of blood flow and attendant ischemia, to result in the irreversible state. Malcolm 1905 (1), Bainbridge and Trevan 1917 (2), Erlanger and Gasser 1919 (3), and Cannon 1923 (4) deserve mention as early votaries of this theory, along with Freeman 1933 (5) who gave it new life. Or secondly, that toxic products and/or bacteria are released from tissues such as liver or muscle during shock, and these products and/or bacteria are responsible for the irreversible state. Aub 1944 (6) and Shorr 1945 (7) were early proponents of this idea. More recently, Fine 1954 (8) has revivified this theory with 15 years of continuous research — which points to bacteria and their products (endotoxins) as being responsible for the development of the irreversible state — anchoring his findings by stating that the irreversible state can be prevented by appropriate antibiotic treatment.

What has been is what shall be,

What has gone on is what shall go on,

And there is nothing new under the sun.

Men may say of something, “Ah, this is new!”

But it existed long ago before our time.

The men of that old time are now forgotten,

As men to come shall be forgotten,

By those who follow them.

Ecclesiastes 1, 9–11