SURGICAL PROGRESS IN WAR-TIME.

New Zealand Herald, Volume LII, Issue 16020, 11 September 1915, Page 5 (Supplement)

SURGICAL PROGRESS IN WAR-TIME.

- t., ""' —♦—i NEWtreatment OF INFECTED WOUNDS. . ' lifc'i/' '■?.-. ■ ■ ;:' --■ "■:■'; . '■"'';■[ f'. Os many startling statements made about tie present war few are more- surprising than "that which has gained a wide currency, to the effect that, as a'result of* ;;. experiences gained with wounded men', '• Listerism has gone "by the board, says the : , \ Morning Post. Like most popular (/generalisations, the statement is funds- £ , mentally inexact, while it contains a truth 4* that has obtruded itself forcibly on the fr.V minds of the surgeons who have had to -"-" deal with the wounded. n ordinary i,: times of peace the surgeon rarely sees a ;A; wound that is infected—a, state of affairs I that has given birth to the axiom that in ■i modern surgery antisepsis has been re--6 placed by asepsis. In the present war . ■; more so than in the South African War, .: > owing to the changed character of the %-.- missiles, whose effects recall those inflicted by'the "Brown Bess" in the old days, 3^.the wounds received have been of so ter--7 ribly severe an order that infection on a J j. large scale becomes inevitable, and, further, in almost every instance scraps of \infected clothing or other infected • material have been driven into the wound, ;" with the result that the severely wounded "/tissues have become infected on a scale ( ; that is without precedent. While this .experience was novel, the majority of the •*J surgeons practising in France relied.on a ;-,- more stringent application of recognised ./-'methods. ■' Tissues were deluged with &?. powerful antiseptics, strong carbolic acid r;-.even, being employed. The success obW tained was, however, trifling, and a new :': t - system, based on one of the most beauti- | ful discoveries in physiological physics, > has heen substituted for the older method. >: It is a common-place of modern discovery ;<-jkthat if a vessel is divided into two com- » " partments by an animal membrane and ;- ' the solutions on the two sides of the mem- > s brane are at different concentrations, ■; * liquid will pass from the weaker to the . stronger solution until ultimately both are ;v at the same strength. y ~ Success of the. New System.

Experience at the base hospitals has . . shown that this system of treating severe .'.'wounds is more effective than any vain \ attempt at subduing the infection by antiseptics, and the method now being followed with success is thoroughly to cleanse the -wound, to provide an effective system of drainage, and also to have in , the wound a liquid (a mixture of sodium citrate and sodium chloride is usually employed} at av.considerably greater -'concentration than that in the serum of * the • Wood. Under the influence of -the liquid the serum of the blood, has Strong antiseptic properties, is poured-out from the body into the wound, tending both; to - cleanse it and to destroy the bacteria.- * that are present. Clearly the system has . the : great advantage that, \if .it is -used . with discretion, the tissues are left nnininred by the fluids used for the destruc- , tion of the bacteria, and the full recog- -. nition ;of its '■ efficiency , in . the case of severely infected wounds must be regarded ■,' as one-of the most important advances made in' surgery as a result of the war, tie chief exponent and originator of the 1 new method being Sir Almroth Wright. : Vr-The Nature el Shock. Another "direction; in. which" the fresh experience gained during the-war ; has :re- .*^^..^ ah advance 'of knowledge isi;in connection * with what may" be - described •, ai PSFphical'shockJ The surgeon has long : , be«>n familiar with - the definite shock that V /occurs as' a result of .injury, leaving the : body , less resistant than • normally,. to ■: ;.;disease and giving 'rise to other ; serious '- ' symptoms. . , The effect of the - strain due * to' exposure to explosive fire and -to 4 ,»,<j otter conditions has, however, come es a startling-surprise. In several instances men have developed a degree of neuras- ; thenia so acute as to suggest the existence of physical damage to -the'nerve' cells, and ' • so persistent as to require long periods of j Sfel!?- to bring about a cure - Acaseillus-j ;. trating, the condition and indicating a line of preventive treatment was described • recently in the British Journal of Surgery. $m?.™° seamen 1 went down' in the Cressy and immediately after being rescued were anxious to return to the front. After a , brief; rest of a week they were sent back, * and shortly. afterwards received trivial .wounds.-As a result of the shock they , **d experienced in the sinking of the ship ' the wounds had' the effect on them of r "completely destroying .their nerve; and it 33 now recognised that in cases where men . have-been subjected to such acute nerve >, strain they i should have a : long period of \ rest before, being sent on further active t service. In the air corps it is regarded : asjdesu-able.that a man. who has been en- 1 Jgaged in flying should have as much as .; one month oat of the four away from : the { front.'-' ■ ;' ■':"■'■*' .-...■. .■•"■■ . ■-- - , Fracture and Splints. '•• Much new information has been obtained as a result '-of casualties on the effect of shot striking- bone. Repeatedly .•■•' *].}* found that a large bone, such as the '. thigh bone, :w hen pierced, by a small pro- - jectile, travelling with enormous energy at . a very high velocity is completely shat- '. tered for as much as.three inches of its '. • length. The broken fragments of . bone ' _ spread -out- in a sort of " spindle fihape, and when the injured limb has been set a .large mass of callus is formed that suggests in appearance nothing so much as the swelling .'seen in .the ojchard when a shoot lias been grafted on a tree. . Experience is showing that the facility with which a patient may be able to move his limb and the ..absence of pain give no indication as to " whether it is feasible for the patient to We his limb. The soft callus gives no adequate support, and when weight is Put on it gives way, serious deformation of_ the- bone resulting. Practice in deal- ' "' tog with these cases and others in which there has been serious injury to the bone hag already resulted in several modifications and improvements of the splints generally employed in civil practice. '* In - ~ war time two widely-different purposes - nave to be served by" the splint. In the . first stage of treatment the essential object aimed at is to immobilise the fracture that the patient may enjoy as much com--1 «?*" as is possible in his journey from the . §§ firing h'na to the base, while at the same time the surgeon is called upon carefully -ti consider the after effects of bis treatment.. In the work done at the base it ' J5 being found more and more necessary, . ' in. view of the peculiar character of the - injuries described above, to keep the limb extended, and to meet these two distinct , aims there have been several modifications introduced into previous practice, most of them being designed especially to ensure that in moving the patient the * Weight that with ordinary splints would . probably have come on the injured limbs is borne by other uninjured parts of the V" body, even though it may be necessary to . move the patient in ways that would be Unnecessary in ordinary civilian practice. -A system now followed by some German ' surgeons is to fit collars tightly above and .below the injured part and immobilise tile part by a connecting rod, but this is _•■'■-. not regarded with favour by British surgeons, as being likely to cause both unnecessary pain and 'unduly to interfere : : -With the circulation.