A historical account of the "wet lung of trauma" and the introduction of intermittent positive-pressure oxygen therapy in world war II.

During World War II, my associates and I observed for the first time in medical history that casualties with severe brain, thoracic, abdominal, and extremity trauma, who had persistent "wet" respiration (wet lung of trauma), were most difficult to resuscitate, withstood operation poorly, and had the highest mortality. The etiology appeared to be ineffectual cough and persistent bronchopulmonary fluid from hemorrhage, pulmonary transudates resulting from anoxia, airway obstruction, and unknown causes secondary to trauma, some of which have been discovered since then. Our treatment consisted of assisting cough, transnasal tracheobronchial aspiration and oxygenation, bronchoscopy, and tracheostomy. To treat the advanced form, pulmonary edema, I devised an effectual hand-operated intermittent positive-pressure oxygen machine, which has been supplanted by elegant automatic volume- and pressure-regulated devices. Through the use of the intermittent positive-pressure breathing machines, most hospitals have developed thriving departments of respiratory therapy. Better physiological monitoring and use of intermittent mandatory ventilation and positive end-expiratory pressure have improved the care, but our basic principles of treatment are still the standards of respiratory therapy.