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The Humane Society was founded in
the Chapter Coffee House, St Paul's Churchyard, London in 1774,
originally as 'The Institute for Affording Immediate Relief for
Persons Apparently Dead from Drowning'. Only 3 months after the
society was founding, a member of the society was called to attend
a 3-year-old child named Catherine Sophie Greenhill, who had fallen
from an upper story window onto flagstones in nearby Pudding Lane,
and been pronounced dead. The society member, an apothecary named
Squires, was on the scene within twenty minutes, and history records
that he proceeded to give the clinically dead child several shocks
through the chest with a portable electrostatic generator. This
treatment caused her to regain pulse and respiration, and she eventually
(after a time in coma) recovered fully. |
 Humane Society |
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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.
'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.'
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
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 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 |
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