Anti-Shock

Every surgeon dreads, and watches for, post-operative shock. So precise is the body's harmony that even a slight disarrangement of tissues, a two-degree drop in temperature, and the loss of a cupful of blood may be enough to bog down heart and brain and produce a coma, prelude to death. Shock may also follow severe burns, wounds, lacerations, even blows in the solar plexus. Usually shock does not occur until several hours after injury. Standard treatment: warmth, blood transfusion, oxygen, water injections. But these measures often fail.

Among the mechanisms that maintain the body's fluid balance are the small adrenal glands, capping the kidneys. These glands secrete several substances; one of them raises blood pressure, regulates circulation. In 1937 the adrenal hormone, known as cortin, was produced synthetically, given the bristling title desoxycorticosterone acetate. Young Pathologist David Perla of Manhattan's Montefiore Hospital decided to try it as a shock preventive. Last week, in the Proceedings of the Society for Experimental Biology and Medicine, Dr. Perla reported "excellent results."

At Montefiore, world's largest private hospital for chronic diseases, Dr. Perla and co-workers collected 30 of the worst operative risks they could find--patients with advanced tuberculosis, cancer of the colon and rectum, glandular tumors. For five or six days before operation he gave them diets rich in protein and vitamins, plenty of salt and water, and injections of desoxycorticosterone. Injections were continued for two weeks after operation.

"All the patients so prepared," said Dr. Perla last week, "... [showed] little or no evidence of shock. . . . Operative recovery was more rapid than usual and in many instances the patient gave the impression that he had not experienced a major operation." Traumatic shock, he concluded, such as occurs after wounds and accidents, "may respond readily" to large amounts of the natural hormone injected directly into the bloodstream.

At Manhattan's Presbyterian Hospital, Dr. John Scudder has tried an extract of the adrenal cortex (eschatin) to save patients already in shock after operations and severe burns. In a newly published text (Shock--Lippincott--$5.50) he reported that cortical extract snatched 14 persons from death after transfusions and oxygen had failed.

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