ing extensive surgical operations and in the victims of war wounds, burns, industrial accidents, and automobile injuries. It was a common and deadly combination in soldiers during World War I, and caused more deaths than any other single condition.
The term shock was originally applied to this condition when it occurred immediately after an injury. Later, the word came to include states of low blood pressure which might appear some hours after the injury. We now speak of primary and secondary shock. Primary shock generally follows soon after pain or injury. It resembles fainting. It is not due to hemorrhage. Secondary shock develops, insidiously, some hours after injury, burns, or hemorrhage. Its outstanding feature is low blood pressure. It has been found that practically every man injured during battle is in a state of shock, either real or potential. The condition is influenced or caused by hemorrhage, tissue destruction, mental trauma, fatigue, and many other factors. Shock must receive the first attention after hemorrhage is controlled.
Fortunately, today we can afford to wait and let shock be relieved before operating. I remember during World War I, when I was commanding officer of the Naval Hospital at Brest, we used to make every effort to operate on our surgical cases as soon as they were brought in to us; if possible, within the "golden period" of six hours after the injury. We believed, as the profession did then, that after that period infection was practically certain to set in, cutting down the chances of recovery. Today the sulfa drugs have extended the traditional "golden period" from six hours to from three to four days. The first time this miracle-working new drug was tested severely in a vast number of cases during conditions of war was at Pearl Harbor. "The experience," Captain Hayden said, "completely demonstrated that the free local use of sulfanilamide powder in wounds permits us safely to select the best time to operate on these patients."
All severely wounded patients also received sulfanilamide by mouth, in routine dosage, for from several days to a week after
