MARVELS OF WARSURGERY.

Mount Ida Chronicle, Volume XLV, Issue XLV, 15 November 1918, Page 1

MARVELS OF WARSURGERY.

Surgery has made rapid progress under war conditions. It has been estimatod that in this colossal struggle over 20,000,000 mon -have been wounded, apart from those who have died from wounds. More than 50 per cent, 'of the wounds have been slight, and among the 20,000,000 are men who have, been wounded more thaa. once—some of them four or five times. Each time a man is,wounded seriously enough to need attention at a dressing station or a field hospital he is classed as a casualty, and every time he is wounded his name helps to swell 'the casualty lists. No estimate" can be formed of the exact number of men who have been wounded—counting each wounded man as a unit, no matter how often he has been wounded—but the number is colossal, though below 20,000,000. With such a vast quantity of human material to work on, surgery has naturally developed. A few months of war service have given the general practitioners among the Army -medical Corps more surgical experience than the great specialists of the profession acquired in many years of work in peace time. Wonderful operations have been performed which a few years ago would have beeu regarded as impossible, and would not have been attempted. In some cases bullets or pieces of shrapnel splinters have been removed from the brain and even from the heart. Army surgeons have had to* work rapidly, owing to the great call on their services after each big battle. For this reason there is a reverse side of the shield to be taken into consideration: Many a wounded man .has had an arm or leg amputated not because it was impossible to save it, but because it would liuve been impossible to give him the weeks of close proiessional attention neces-sary to save it. Without tli.s constant attention blood-poisoning might set in, and thus the wounded man might iose his liie instead of saving his limb. ( Owing to the value of man power in thia j war of exhaustion, surgery his had to aim at rapid cures in order to res Lore a wounded

man to the lighting line... as quickly as possible. This lias necessitated the abandon-

ment of the old leisurely methods of treatment. In dealing with this aspect of the quostioa Colonel Herbert A. Bruce, a distinguished Canadian doctor, who has had a great deal of experience among tlio British wounded in France, states: " Surgery s greatest triumph during this war has come through a repudiation or medical decoctions. It has come through the elimination of disinfectant processes in tre.-iting septic wounds, and the substitution of the kmie. Practically all wounds are intecied. We have passed through various stages in the treatment of such woimds, and I think I may say that now a new technique has developed. This method consists ot the thorouga mechanical cleansing of the wound, the excision of all infected and damaged tissues, and the primary closure of the wounds in cases operated on soon after the injury is inflicted. When conditions do not permit of primary closure in the casualty clearing stations, then either the delayed primary closure or a secondary closure takes place at the base hospital. " When I use the term ' mechanical cleansing,' I mean using the knife instead of a disinfectant. After Joseph Lister made known the value of antiseptics in operations if-iistorism became popular, and carbolic sprays were set up in the operating room. Then the pendulum swung back, with the' realisation that, the better method was to prevent any germs from getting into the wound. But when this war began disinfectants still were- used in treating wounds, practically all of which are contaminated. The treatment required six or eight months, sometimes longer. There was always the danger of sepsis, necessitating the amputation of a limb. Aside from the fact that tho wounded man was kept all this time out of service, so that another man must replace him, there was the expense involved of hospital accommodation, nursing, vast quantities of bandages, and surgical attention. Nowadays, instead of using disinfectants, the contaminated tissue, muscle, even bone, is cut away. Whatever the condition, tho excision "is such as to remove all the infection: and then, unless the man has been for an unusual length of time without treatment, or some other condition makes closure inadvisable, the wound is closed. That is a matter of surgical technique. It. may be necessary to work in muscle or fat if the excision is large, but almost invariably the closure can bs made. Under this treatment the wound heals, as a. rule, in two weeks. This means an enormous saving in time, in lives, in man-power, iu bandages, nursing, and surgical attention, to say nothing of money. To my mind, it is the most important thing we have learned during this war. From 85 to 90 pei : cent, of tho wounded recover and are returned to the firing line."