The founders, Dr William Hawes
(1736-1808) and Dr Thomas Cogan (1736-1818), originally positioned
attendants at intervals along the banks of the river Thames and
paid them 2 guineas toattempt resuscitation to anyone who had
drowned (provided their attempts lasted longer than 2 hours!).
Prior to this it was generally felt that the best thing you could
do to a drowned man was pick his pockets.
At this time the function of the
lungs was unknown. Oxygen had not yet been discovered (Priestley
1776) and Galen's idea that the function of the lungs was to cool
the heart was widely accepted. The standard resuscitation regimen
at the time was to dry and warm the body by applying friction
to the skin, and to administer tobacco smoke enemas.
There were recent clues as
to the lung's function however. William Harvey had described the
circulation of the blood in 1628, and it had been noted that dark
venous blood exposed to the air became bright red. Additionally
there were reports of successful resuscitation of drowned men
(and dogs) with bellows. Paracelsus (1493-1541), an alchemist
and perhaps the greatest physician of his age, was said to have
attempted the resuscitation of a corpse using bellows, a trick
he perhaps picked up from Arabic medical writings. And Andreas
Vesalius (1514-1564), the father of modern anatomy, reported successfully
using bellows to resuscitate asphyxiated dogs. By the 1740s, several
cases of successful mouth-to-mouth resuscitation had been reported,
the most famous of which was Tossach's 1744 report of the resuscitation
of a clinically dead coal miner who had been suddenly overcome
after descending into a burned-out mine.
Marshall Hall
In 'Asphyxia, its rationale and its remedy' Hall put forward that
the restoration of warmth without preventing the victim's tongue
from blocking his airway or providing immediate ventilation was
detrimental. Hall correctly added airway and breathing to the
initial steps in resuscitation.
'In World War I, there was a real
appreciation of the time factor between wounding and adequate
shock treatment. If the patient was treated within one hour, the
mortality was 10 percent. This increased markedly with time, so
that after eight hours, the mortality rate was 75 percent.'
Time from injury |
Mortality |
1 hr |
10 % |
2 hr |
11 % |
3 hr |
12 % |
4 hr |
33 % |
5 hr |
36 % |
6 hr |
41 % |
8 hr |
75 % |
10 hr |
75 % |
This data was subsequently used
by R. Adams Cowley in his 'Golden Hour' concept.
Santy, P. Marquis Moulinier, Da
Shock Tramatique dans les blessures de Guerre, Analysis d'observations.
Bull. Med. Soc. Chir., 1918, 44:205
WB Cannon pubishes on the preventive
treatment of wound shock and shows poor outcome with intravenous
fluid resuscitation. Remains largely forgotten until renewed interest
in late 1980's & early 1990's.

Cannon W, Fraser J, Cowell E. The
Preventative Treatment of Wound Shock. JAMA 1918:618-621
More
permissive hypotension references
Prospective, randomized pre-hospital
trial had 598 patients with penetrating torso trauma and systolic
BP < 90. The study comparing Standard resuscitation vs Limited
resuscitation (until surgical intervention). Limited resuscitation
gave ~ 375 ml IV fluids - 30% mortality and 23% complication rate
Standard Resuscitation averaged 2,480 mls IV fluid - 38% mortality
(p=0.04) and 30% complication rate - Higher than ‘limited
fluid’ group.
Bickell WH, Wall MH, Pepe PE, Martin
RR, Ginger VF, Allen MK, Mattox KL, 'Immediate versus delayed
fluid resuscitation for Hypotensive patients with penetrating
torso injuries' N Engl J Med 1994 Oct 27; 331:1105-9
Department of Emergency Services, Saint Francis Hospital, Tulsa,
Oklahoma, USA
More
permissive hypotension references