MARVELS OF WAR SURGERY

Manawatu Standard, Volume XLIII, Issue 1388, 21 November 1918, Page 8

MARVELS OF WAR SURGERY

Surgery Ims made rapid progress under •v.ir conditions. ii has been tstimated that in (his colossal struggle over 20,000,000 nun 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 than once —some of them four or live times, Each time a man is wounded seriously enough to need attention at a dressing station or a field hospital he is classed as casually, and every time he is wounded his name helps to swell Iho casualty list. 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—hut 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 mouths of war service have given the general practitioners among the Army .Medical dorps more surgical experience than the great specialists of the profession acquired in many years of work ill peace time. Wonderful operations have, been pel formed which a few years ago \vould have been 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 oven from the heart. Army surgeons have,had to work rapidly, owing to the great call or. their services after each big battle. For this reason there is a reverse side of the shield to he 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 have been impossible to give him (lie weeks of close professional attention necessary to save it. Without this constant. attention blood-poisoning might set in, and thus the wounded man might lose his life instead of saving his limb. Owing to the value of man-power in this war of exhaustion, surgery has had to aim at rapid cures in order to restore a wounded man to the fighting line as quickly as possible. This has necessitated the abandonment of the old leisurely methods of treatment. In dealing with this aspect of the question, Colonel Herbert A. Bruce, a distinguished Canadian doctor, who has had a great deal of experience among the.British wounded in France, states: “Surgery s great triumph during this war has come through a repudiation of medical decoctions. It has come through the elimination of disinfectant processes in treating septic wounds, and the substitution of the knife. Practically all wounds are infected. We have passed through various stages in the treatment of such wounds, and I think J may say that now a new technique has developed. This method consists of the thorough mechanical cleansing of the wound, tlie 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 Listeii.-:m became popular, and carbolic sprays were set tip in the operating room. Then the pendulum swung hack, with the realisation that the better method w*» 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 wore 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 the 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, oven bone, is cut away. Whatever the condition. the incision is such as to remove all the infection; and then, unless the man has been for an ususual 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 he necessary to work in muscle or fat, if the excision is large, but almost invariably the enclosure can bo 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, in bandages, nursing, and surgical attention, to say nothing of money. To my mind, it is the most important thing wo have learned during this war. From 85 to 90 per cent, of the wounded recover and arc returned to the firing lines’