24 THE ACTION OF THE LIVING CELL 



removal of the damaged tissues must be accomplished 

 before autolysis has progressed to any appreciable ex- 

 tent. 



Objectively, but without understanding the under- 

 lying reason for the procedure, this fact was recog- 

 nized by Duboys, who served with the French troops 

 in this country during the Revolution. He states that 

 "American surgeons amputated at once and lost but 

 few, but the French delayed and lost many." The 

 recognition of the value of such treatment was per- 

 haps due to Benjamin Rush, the surgeon-general of 

 our army during that period. Similarly, Larrey, a 

 French surgeon who early advocated the "debride- 

 ment" of wounds and thereby saved numerous lives 

 during the Napoleonic Wars, remarked, "The effects 

 of commotion (shock), far from being aggravated, 

 diminish and disappear insensibly after the opera- 

 tion." 



The question may arise in the reader's mind: Why 

 does not the tissue damage which inevitably results 

 from simple cuts, burns, and bruises cause shock? 

 Simply because such injuries are not sufficiently ex- 

 tensive. Obviously when the area of tissue damaged 

 is but small, the toxins liberated are inadequate in 

 quantity to elicit serious consequences. Nevertheless 

 since the state of shock is but the culmination of a 

 series of physiological changes, we may well expect 

 the liberation of the shock toxin even in small amounts 

 to manifest some physiological activity. 



This indeed is the case, and the writer's experiments 

 have, he feels, placed this substance in a unique posi- 

 tion in the internal environment of the animal : that is, 

 as a substance capable of modifying to a considerable 



