In this month's Archives, Nuytinck and his coinvestigators1 review in depth the autopsy findings in 35 cases of patients who died after severe injury. They point out there is a pathologic accumulation of polymorphonuclear leukocytes and abnormal organ weights in these patients. Although the investigators have exercised a fair amount of restraint in their conclusions, they hypothesize that "ARDS [adult respiratory distress syndrome] See also p 1519. and MOF [multiple organ failure] are the results of a generalized and massive activation of inflammatory mediators." They focus particularly on polymorphonuclear leukocytes and complement. I have no doubt in the validity of the observations made in this particular study; however, one must exercise some caution in assigning cause and effect. One can also learn from earlier observations.
In August 1917, the Medical Research Committee of Great Britain appointed a special investigation committee to undertake the coordination of inquiries into surgical shock