SURGERY FINDS.

Northern Advocate, 8 May 1915, Page 7

SURGERY FINDS .

SAILORS RESIST WOUNDS BET TER THAN DO SOLDIERS.

Physicians and surgeons in the countries not at war have been very much interested to know the details of the care of the wounded, of whom there have been so many in the last few months, and. the authentic information finally is available.. It proves to be quite as interesting for the general public in many ways as for the medical profession. Until now the surgeons most occupied in the war have been too busy. to write much, but mw they are settling down to the routine of their work and, recognising that their experience may be a benefit to others, are taking pains to give it publicity. Besides, inspectors' re ports have been made available as regards hospital conditions an-.i the general state of the wounded, and these give a vivid picture of the medical history of the most interesting war that has ever taken place.

Probably the most striking feature in the information now at hand is the. great difference between the healing of the wounds of sailors and of soldiers. Though the severest wounds from which both classes of fighting men suffer are the same— that is, are inflicted by shells and therefore are likely to be large, lacerated wounds —wounded sailors recover almost without -complica tions, while wounded soldiers are vlmost without exception suffering from some of the severest kinds of infections, and, therefore, have a long drawn out convalescence. Many of the wounded sailors have been immersed for a time in cold salt water before their wounds were dressed, but though the cold has lowered their resistive vitality their wounds have healed promptly and usually without complication. The sailors have suffered as a rule surprisingly little from shock, and even very large lacerated wounds of muscles simply can be stitched up, and they heal by first intention.

FREE FROM EARTH DUST

The reason for this notable different in the two classes of patients is almost obvious to the physicians. The sailors are not exposed to having their wounds contaminated by earth dust, and that is the serious element for wounded complications. In spite of all the care that has been exercised in preventing sepsis the mode of the present war has utterlyupset all the calculations. The fighting has been in trenches. The men have literally dug themselves in. It is almost impossible that the wounded men should not get earthy materials, and especially those from just below the surface of the ground, into their wounds. This has "been the serious factor. Bacteria, so far as we know anything about them, are little plants, and they grow luxuriantly in the soil, and therefore are particularly prevalent in the trenches. They are especially rife in cultivated ground, and not a little of the fighting has been done in the ploughed fields of North France.

In the notes on naval and military surgery in the current number of the "British Journal of Surgery," which is the representative surgical periodical of Great Britain, a surgeon who has had the opportunity to inspect a number of the military hospitals in France as well as in England declares that the present war has been almost literally "an orgy of sepsis."

The large lacerated wounds caused by shell fire, or by bullets striking compact bones and bursting out of the tissues, are almost invariably contaminated with septic material. The reasons for this are the presence of metal fragments in the wound, pieces of cloth carried in, and then, above all, earth dirt from the neighbouring soil. .Even with all these disadvantages sepsis would be much less serious but for the length of time which elapses between the receipt of the wound and the first thorough dressing.

BACTERIA IN SOIL.

The soil contains particularly the anaerobic bacteria, as they are | called —that is, the microbes which J grow out of the presence of the air and will not grow wherever free oxygen is present; hence the fondness for the soil above for rich loam., The tetanus bacillus is one of these, and another is the bacillus which causes gangrene with gas formation. Wherever soldiers have been wounded in ploughed fields or in areas that had been under cultivation a great many of th e wounded have suffered these severe complications. If not properly treated these are always fatal. Experience everywhere apartfrom war is that wounds made in farmyards and especially by rakes aud forks and other implements used in handling hay and plants are very likely to b e complicated by tetanus. This has happened then In the present war, and iv the neighbourhood of vineyards the gas producing bacillus which causes gangrene has I been particularly prevalent.

The soldiers after their long stay in the trenches, with lack of sleep, irregular food, and the disturbing alarms of night and early morning attacks, have been in no condition to resist such infections. Sailors have not been exposed to these particular bacteria, but then, besides, the sailors, living an open-air life in the free, pure air of the sea, fed regularly and with regular hours of sleep, they have been in excellent condition to resist infections of all kinds. No wonder then that a distinguished surgical authority who has had much experience with sailors declares that it is astonishing how mild the infection of sailors' wounds has been. The excellent physique of the men is a great factor in the rapid recovery which takes place, and it also accounts for the striking absence of shock and the readiness with which the patients rally under treatment from such shock as may be present. The sailor is an excellent surgical risk.

DEATH-RATE LESSENED

The development of treatment, however, has done much to 1 help the soldier, and the death-rate among the wounded is already greatly lessened over what it was at the beginning of the war. In all cases where wounds are received in cultivated ground preventive inoculations of tetanus serum are given, and the number of cases of subsequent tetanus Is thus greatly reduced. Por the gas-producing bacillus and the consequent gangrene injections of hydrogen peroxide have been found almost completely curative even in extremely bad cases. These bacilli will not grow in the presence of free oxygen, - and hydrogen peroxide has an extra atom of oxygen in its make-up which it gives off readily and which very soon chokes off the growth of the gas-producing bacillus. When the peroxide injections are made Just above the advancing process of gan-

grene in tissues that are healthy the progress of the affection stops at once and there is a prompt reaction which makes the wound heal without delay, though, of course, all the gangrenous material has to be thrown off by natural processes.

The antiseptic that has been found most valuable is simple tincture of iodine. This has proved much better than much more dangerous antiseptics. It has far outdistanced carbolic acid and other more poisonous materials in its usefulness in preventing infection. The mercurial antiseptics so deadly in civil life have been little used. The Engish surgeons declare they would like to have had every wound freely treated at its first dressing with simple tincture of iodine. In spite of its application to large open wound surfaces it has produced no serious results and been followed by no complications.. It is rather severe as an application for the moment, but, considering the conditions, the wounded men do not mind this. WOUNDED ARE STOICAL. It can readily be understood that on the firing line itself and usually for the first aid dressing, ansesthetics can be employed only to a very limited extent. The wounded have to stand so much, and knowing that tl-ey must do so, are bearing their sufferings with such stoical fortitude that the slight sting of the iodine when it guarantees to a great extent against septic complications is readily borne. The use of hydrogen peroxide early where there is liability to infection with a gas-pro-ducing bacillus, is just beginning to have good results in prevention similar to those obtained from the use of iodine. Considering the extent of the wounds and the serious injuries of bones and joints, there is much less amputation than would probably be expected. The watchword of the surgeons is conservatism —that i?, preserve every possible portion of the tissues that can be saved in any way. It has proved to be much better to have even a serously crippled limb of one's own than the most interesting and apparently useful artificial limb with the nicest of mechanical contrivances. It is surprising how much tissue that used to be sacrificed can now be saved. Convalescence is longer, but in the end the result is ever so much more satisfactory.