Host Resistance in Hemorrhagic Shock. IX. Demonstration of Circulating Lethal Toxin in Hemorrhagic Shock.

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Abstract
I. Normal dogs tolerate an infusion of blood from dogs dying of advanced hemorrhagic shock without noticeable harm. Dogs in hemorrhagic shock recover rapidly and without signs of illness if transfused after 2 hours with normal donor blood, or with their own shed blood. But about 70% of such dogs die if the transfused blood is from dogs dying of prolonged hemorrhagic shock. Most of the recipients that survive, as well as all those that die, are prostrated, unable to stand, drink or take fluid after the transfusion, and display a bloody diarrhea until recovery or death. Only 37% of the 2 hour shock recipients of blood from dogs in prolonged shock die if the latter have been vigorously pretreated with non-absorbable antibiotics given orally and by rectum. The survivors, moreover, recover rapidly and disclose no signs of illness. Hence the blood of dogs in prolonged hemorrhagic shock contains a lethal toxin, which, for the reasons given, is considered to be an exogenous toxin derived from the intestinal flora. By the same token endogenous toxins, whether present or not, are not responsible for irreversibility to transfusion or death. II. The same findings are also true for the rabbit: The mortality rate of recipients of blood from untreated donors was 91%, while the mortality rate of recipients of blood from pretreated donors was only 7%. The greater tolerance to prolonged shock of animals pretreated with non-absorbable antibiotics appears to be due to the elimination of bacterial endotoxins by the antibiotics. III. The hemorrhagic lesion in the gut of shocked animals is produced by the toxin and not by the shock itself.