William Maddock Bayliss's therapy for wound shock

Abstract

During World War I, military surgeons discovered that patients die from wound shock because their blood pressure falls catastrophically. William Maddock Bayliss produced experimental shock by bleeding anaesthetized cats, which lowers their blood pressure. He restored pressure by infusing salt solution containing enough gum acacia to generate the colloid osmotic pressure ordinarily contributed by the plasma proteins. Ernest Henry Starling had demonstrated that as plasma flows through the capillaries the colloid osmotic pressure of its proteins retains water. From 1917 to 1919 Bayliss and Starling served on the Special Investigation Committee on Surgical Shock and Allied Conditions of the Medical Research Committee. Both gum-saline and blood transfusions were used successfully on wound-shocked soldiers, but we do not know how many were treated, and the effectiveness of whole blood in comparison with gum-saline was not ascertained. Today the colloid osmotic pressure in transfusion solutions is usually provided by dextran or human albumin. Vast quantities are used, but Bayliss's role in the development of this clever biophysical therapy has been almost forgotten.

Advances in the Diagnosis of Shock, Its Assessment and Resuscitation during the Great War

“…This was known as secondary shock. Some shocked men recovered in time and their blood pressure returned to normal, but in others, the blood pressure continued to decline; if they fell to 50-60 mmHg the men died because their pressure was too low to drive enough blood into the coronary circulation to sustain the heart 3,4 .…”

“…The results were later reproduced by Captains Fraser and Cowell in patients at their Casualty Clearing Stations (see figure 1). It should be noted that relatively small volumes (less than one liter in a severely shocked patient) were used which might explain why saline was thought to be ineffective in shocked patients 3 .…”

“…His method of measuring systolic and diastolic blood pressure by means of auscultation took several years to reach Western health practitioners. By 1910, following translation from the papers in German, auscultation for Korotkoff's sounds was beginning to replace palpation of the pulse in western countries 3 .…”

“…Blood pressure measurements by Captain Fraser and Captain Cowell: (a) Private C.M., with a severe shell wound, infused with NaCl solution. The increase in blood pressure is transitory; (b) Case 27, with an abdominal shell wound, apparently moribund on admission; during an operation to suture six intestinal perforations, 887 ml of 6% gum acacia in 0.9% NaCl was infused3 .…”

Fluid Resuscitation for Trauma Patients: Crystalloids Versus Colloids

“…Concurrently, the English physiologist Bayliss had conducted a series of experiments in animal models of ''wound shock,'' which he remedied by sparingly administering a solution of gum arabic, a derivative of Acacia senegalis tree sap, in saline to supplement intravascular oncotic pressure [22]. A related solution was implemented at forward camps during the final months of World War I, thus marking the first widespread use of resuscitation with colloids [23]. Ultimately, the adoption of gelatin was delayed owing to issues with preparation and storage, and gum arabic was abandoned secondary to its hepatotoxicity and antigenicity [24,25].…”