TRENCH SURGERY.

Auckland Star, Volume XLIX, Issue 11, 12 January 1918, Page 13

TRENCH SURGERY.

NEW METHODS FOR NEW WAYS OF WARFARE. SAMPLES OF THE EXPERIENCE or SURGEONS. (By WOODS HUTCHINSON, M.D.) Trench surgery is just as different from earlier war surgery as trench flght,ing is from the former art and science of war. For twenty years past Army 'surgeons have been priding themselves jon the fact that war surgery was coming i nearer and nearer the standard of cleanliness, and certainty of results of peacetime surgery. I j Clean wounds and quick healing are coming to be the rule in canvas-covered 'field hospitals as well as in the whitetiled, glass-roofed temples of healing at lhome. And when this war broke out we 'prepared our operating kits in full and blissful confidence that his onward and upward course would be continued and jeven brought nearer the goal of complete I asepsis and no puß or visible scare. I But a bitter awakening was in store for us; within three .weeks of mud and 'shell-fire we had slumped back thirty iyears in our surgical methods and projblems, and had to begin all over again, almost from where Lister did. l And the fierce ancient battle between asepsis and anti-sepsis broke out afresh, and raged with fury. Almost the whole trend of develop[ment in modern weapons and armament [seemed to be heading towards making the I wounds inflicted more and more nearly germ-free or asptic. THE HIGH VELOCITY BULLET. The high velocity rifle bullete, for instance, were driven through the grooves of the rifle barrel at such enormous pressure and friction that their surfaces were literally sterilised by heat, and unless they happened to strike the ground first and "richochet," entered the body almost as clean and osceptic as a surgeon's knife in the operating, theatre. Further than this, instead of being round or domeIshaped, they were pencil-shaped and [pointed, and their nose or tip so sharp and smooth and polished that it vvas almost impossible for it to catch threads or scraps of the clothing and carry them into the wound with it, which was a very serious form of deep infection in the days of round bullets, or even . of sword and sabre cuts. So important indeed was it that soldiers were required to take a bath and put on clean underwear the night, or morning before going into action, so that if any scraps of clothing were carried into the wounds they would be as clean and free from germs as possiblo. I saw two cases in French hospitals, in which one single pocket of a huge shell wound kept on obstinately discharging and refusing to heal for weeks after the rest of the wound was closed. Finally a radical operation was decided upon, and a free incision made right down from the surface, laying open the pocket, and in one case a scrap of cloth from the patient's tunic was discovered, and in the other a larger rag, with a button still stitched to it. Furthermore, these high velocity bullets at average ranges were still whirling swiftly -when they struck and literally drilled their way through the tissues so cleanly and smoothly that unless they struck a bone or penetrated the heart or a big blood-vessel or the brain or spinal cord, they did astonishingly little damage, and the wounds healed surprisingly quickly and kindly. In fact, cold-blooded military experts were actually advising against the use of high velocity or pencil-shaped bullets in wars against savage or barbarous tribes, becauses they simply would not stop a

rush. A charging Zulu or Somali warrior, for instance, might be drilled through with half a dozen bullets without stopping him or even checking his onrush, unless on of-them.happened to strike a big vessel or the spinal cord. .While the shock of the old-fashioned leaden or soft-nosed bullet, which would spread and mushroom the moment it struck a bone or even a tough tendon, j would usually knock him down and put 'him out of Hub fight at once, even if it did not kill him. Bullet .wounds, whether rifle or machine gun, in this war, are regarded almost as a trifle providing that they have not struck a bone or an artery or a nerve trunk, or perforated the intestines. Time and again, when watching tbe dressing of some hideous, still gaping shell wound, I have noticed little circular brownish scabs, about the size of a dime, with a reddish ring round them, on the arm, shoulder, hip, or leg of the patient. » These puzzled mc at first, because they did not look just like surface wounds or burns of any sort, and they were evidently not boils—until I inquired and discovered that they were the scars of bullet .wounds which had drilled right through the limb or the fleshy part of the shoulder or hip, and were now practically healed and dry, five, seven, nine days after they had been inflicted. In that sense, as also in the sense that less than 15 per cent of the wounds of this war are bullet wounds, and twothirds of them from machine guns, the rifle has almost ceased to bo a deadly weapon. SWORD AND BAYONET WOUNDS. As for the sword-wounds and bayonetwounds, well, swords have become pretty nearly parlour ornaments in modern war, and bayonet wounds, while dangerous on account of their depth and their narrowness, which prevents through drainage, are not very likely to be infected, because, as recent tests have shown, germs of any sort cannot thrive or live long upon polished metal surfaces. Besides, for some singular reason bayonet-wounds have become the rarest surgical curiosities in this war. "One surgeon inspector-general, in charge of three armies, with whom I was visiting the field hospitals, told mc that he had seen exactly four cases of bayonet wounds since the war began, and he had been in it from the Battle of the Marne. And one of those coses was a spy, who had suddenly been discovered in the fighting line in a French uniform, and who had been promptly perforated like a pincushion, "and'yet he did live," said tho inspector, with a smile and a shrug. Another division surgeon, of two years' experience, told mc that he had only seen four, and that one of these was in the leg of an officer who, leading a charge and leaping down into an tfnemy front line trench, spiked himself on the point of a rifle with fixed bayonet, which had been left standing the wall of the trench. And these are samples of the experience of surgeons in both armies on the •western front. Tlie scarcity of bayonet wounds is almost incredible, even after allowing for the fact that this is so overwhelmingly a war of artillery, and especially as both newspapers and "official communiques" have reported quite a considerable amount of fighting at close quarters, clearing trenches with the bayonet and so forth.