TREATMENT OF SHOCK

Press, Volume LXXXIX, Issue 27193, 10 November 1953, Page 13

TREATMENT OF SHOCK

NEW TECHNIQUES OF “HIBERNATION” COLD INSTEAD OF HEAT USED (From a Reuter Correspondent.) PARIS. A new French medical discovery—“freezing” patients into a long sleep after they have drunk a. medical cocktail—has cut battle deaths in Indo China by more than one-third. Some French experts believe that it may revolutionise surgical practice generally. The discovery is called artificial hibernation. Pioneered by Dr« Henri Laborit and other French sui> geons during the last few years, it has now become common medical practice in this country for serious operations. It is also used in treating serious burns, severe shock and a number of grave diseases. Artificial hibernation uses the principle of an old and well-known natural defence mechanism of the body—the long winter sleep common to certain trees, plants and animals. It combines the use of .certain drugs which are non-toxic, but which deaden the nervous system with actual re-frigeration-putting the patient bn icq It has been used on patients ranging from infancy to 85 year# old. Dr. Laborit first began thinking about the idea after watching patients who were inja state of shock as s result of serious accidents, wounds burns or infectious diseases.’ He decided that shock ought to be treated in a diametrically’ opposite way Iron the methods used previously. Theusua: method has been to stimulate thf body’s defence reactions, by heating applying stimulants and administering tonics. Dr. Laborit reasoned that since the- organism was using its last re. serves of energy, it might be more reasonable to help anybody in shock or about to enter it—as, for example in an operation—by slowing down al living functions until the body reachec a condition bordering upon inertia. Working in Paris with researci teams at the Central Laboratory o Physiology and in surgical depart ment of the Vaugirard Hospital, he developed a so-called “lytic cocktail’ which Would put the entire automata nervous system at rest. Then, bi applying cold, he slowed down vita functions, restraining oxygen con sumption and organic combustion ii the cells. Specially-built refrigerator; and ice containers were used. Technique Described Surgery was only the first and mos spectacular success of artificial hiber nation, especially when it usee with patients too weak or old t<

undergo necessary major operations. This is how the system is applied now in France. A seriously injured man is rushed to a hospital operating theatre suffering from shock. A few years ago, everything would have been done to warm the body and stimulate the defence reactions. He would have been buried under a pile of blankets, given warm drinks and heart stimulants. Today, the treatment is just the opposite. The first step is an injection of “‘medical cocktail,” including largactU, and supplemented, depending on the case, by phenergan, pethidine, diparsol, procaine and vitamins. This is repeated every quarter of an hour. Within half an hour of the first “cocktail,” the injured man is sleepy and rests quietly on his bed. He ■no longer feels pain and does not appear to be disturbed. Then refrigeration is applied by placing six or eight ice gacks at vital nervous points such as the stomach, heart, armpits, groin and the top of the spine. The man’s temperature drops to between 33 and 35 degrees centigrade (91.5 to 95 degrees fahrenheit) and kept there. The surgeon begins to operate. The patient is practically unconscious. When it is all over, the hibernated patient is put’ to bed either without coverings or with only a light sheet over him. The room is kept cool, and he “hibernates” for between 48 hours and three days. To prevent trembling or shivering, he gets daily “coektails.” In some cases, French patients have hibernated successfully for 10 days. The after-effects are reported to be far better than with the previouslyused anaesthetics. There is no pain or vomiting and the patient is calm or indifferent. body reheats itself slowly as the cocktails are reduced. Hibernation has been used with patients whose physical resistance is low, such as old people, advanced cancer cases and weakened tubercular cases. Out of a total of 67 “terminal patients,” the majority of them suffering from cancer, who underwent major surgical operations last year, Dr. Labdrit said, more than two-thirds survived, thanks to artificial hibernation. 1

Use In Big Operations The system has been used for prolonged operations involving heavy loss of blood such as neuro-surgery, removal of brain tumours and in pulmonary critical or multiple fractures, crushed limbs and stomach wounds. Some French- medical authorities predict that the system will become standard medical practice for victims of road accidents, explosions, major firps, and air or railway catastrophes. It has even been used successfully in the care of premature infants, to help mothers through complicated deliveries and in psychiatry. Instead of placing premature babies in incubators at constant warm temperatures and giving them oxygen, French obstetricians and pediatricians have been giving them doses of largactil cocktails and putting them into hibernation as long as seven days and in a few cases up to 12 days. Professor Maurice Lacomme, Professor of. Obstetrics at the Faculty of Medicine in Paris and director of one of France’s largest maternity centres, believes that this method of therpay overcomes the state of shock in which many premature babies are born. , But 'it is in Indo-Chiha that the most spectacular results have been achieved. Dr. Laborit trained units of physicians, anaesthetists and nurses to

use the system in the Indo Chinese war area, where jungles, insects, heat and difficult transport and hygienic conditions made every wound a hazard. The system was first used there 14 months ago. Dr. Laborit has just returned after a tour o> the war front to survey the results. Dr. Laborit, who is only 38 years old, served in 1939-40 as a ship’s doctor aboard the famous French destroyer Sirocco. When his ship was sunk off Dunkirk, he served in the Naval Medical Corps in North Africa, returning to France with the liberating Allied Forces. After the war, he worked in the Naval Hospital at Toulon and then in the Military Medical Centre at the Vai De Grace Hospital in Paris. Artificial hibernation, which is in wide use in France today thanks to Dr. Laborit, is also being fksed in the United States, Britain, Germany, the Scandinavian courvti-fißs, Canada, Argentina and Brazil.