IN THIS paper I shall present new evidence in the support of the hypothesis that a bacterial factor is responsible for the refractory state of traumatic shock. This new evidence warrants reshaping the hypothesis as follows: the refractory state of shock is the result of ischemic damage to the reticuloendothelial system (RES) in liver and spleen, and this injury allows a neurotoxin of bacterial origin to produce fatal collapse of the peripheral circulation. The evidence will include data showing that perfusion of the arterial blood for less than one hour through a freshly excised donor spleen eliminates the toxin and thereby effects recovery from the state of shock.
Report of Cases
I shall begin with a recent clinical experience. A man of 70 left the hospital in good order a week after surgical repair of an obstructing duodenal ulcer. Five days later, when he returned for inspection of his wound,