SH06 WITTGENSTEIN AND THE CONCEPT OF “WOUND SHOCK”

Ludwig Wittgenstein was one of the most influential and controversial philosophers of the 20th century. His ideas concerning the foundations of mathematics and the role of language remain of essential importance in these fields, while his eccentricities still warrant popular examination. During World War II, having relinquished his chair in philosophy at Cambridge University, he worked as dispensary porter and as laboratory assistant. In these roles and in association with the MRC Research Unit, initially at Guy’s Hospital, London and latter at the Royal Victoria Infirmary, Newcastle‐on Tyne, he was involved in investigations of what was then termed “wound shock”. These studies were carried out on air‐raid and latter industrial accident victims, under the leadership of Grant and Reeves, latter E.G, Bywater. Today, we would recognise the poorly defined clinical syndrome of “wound shock” as manifestations of hypovolaemia. This entity had been recognised since the trench warfare of the First World War, but it is amazing to realise that as recently as the mid decades of the last century, the understanding of the physiology of injury was so rudimentary that this relationship was not recognised. It is instructive to examine Wittgenstein’s role in discussion of the semantics of the term “shock”, which persists in causing confusion in the popular mind, as well as his experimental efforts. The development of understanding concerning hypovolaemic shock and crush injuries following the London Blitz shows how recently some of the most basic concepts on which we manage patients have become evident.