M.T. Pepper Jenkins introduces Ringer's lactate to treat shock

Abstract

M.T. Pepper Jenkins was one of the team that introduced balanced salt solutions (in those days, Ringer's Lactate) to the resuscitation of traumatic shock. The revolutionary proposal is one of the most important innovations in the modern care of the surgical patient. Before 1950, surgeons and physiologists felt that salt solutions were contraindicated in surgical patients because they did not excrete a sodium load. Anesthetized patients were given small amounts of D5W, and if blood loss was excessive, they were given transfusions of whole blood. The turning point came in 1950 when Jenkins reported a series of critical patients in hemorrhagic shock, who received D5W and whole blood for resuscitation. They developed high hematocrits, stiff lungs and pulmonary failure, called “congestive atelectasis.” Jenkins theorized that congestive atelectasis could be prevented if Ringer's Lactate was given with the blood. Over the next 30 years, Shires demonstrated the deficit of extracellular fluid, which occurs in hemorrhagic shock in dogs and humans, and the acute sequestered edema space that results from trauma. This work established the efficacy for the use of balanced salt solutions in shock. Salt solutions were not contraindicated, rather they are indicated and, in fact, life saving. Salt solutions are now used all over the world for the treatment of shock and have saved millions of lives. Our understanding of surgical fluid therapy has changed forever; and Jenkins could be compared to Copernicus who suggested that the earth and other planets rotate around the sun, changing the way we think about the universe.