SURGERY AND THE SOLDIER

New Zealand Herald, Volume LV, Issue 16895, 6 July 1918, Page 1 (Supplement)

SURGERY AND THE SOLDIER

BY HILDA KEANE.

MODERN MIRACLES.

This war has produced many wonderful and unforeseen results; but none are more marvellous than the triumphs over disablement that have been performed by the surgeons who ore putting their whole thought forward to secure the best means of giving to wounded men the power of using, more or less efficiently, their injured limbs. Very briefly, we may quote a number of thoso.

i " A common typo is a fractured thigh, with 3in, 4in, or 6in of shortening; and, in addition, a lateral or backward deflection, which gives rise to almost complete loss of the function of tho limb in walking. The orthopaedic surgeon considers first of all the best and safest way of lengthening the limb, taking care to see that the log is placed in such a position that whon the patient is ablo to walk the incidence of body-weight bears a correct relationship to the joints. . . . The muscles are then developed by intensive methods, including special forms of electricity, massage, and exercise, tho patient being kept under supervision until the functions are as nearly normal as art can make them. . . . Another man has a stiff wrist and a stiff elbow, with 3in of ono of tho forearm bones blown away. The joints are first mado mobile, then a . piece of the shin-bone is demoved and placed in the arm. ... Or a nerve is shot through— the arm is paralysed. In an orthopaedic mobilisation of tlio joints can be quickly secured, and the surgeon will reunite the nerve. But ho will keep the patient in hospital to consider tho position of tho muscles during recovery and to constantly supervise them during their re-education." Again a nerve- may be so torn that sewing together is impossible. The surgeon " will cut at their insertion certain muscles that can bo spared, and will transplant them. ... A nerve whose function it is to supply the muscles which open tho fingers and lift tho wrist is hope. lessly destroyed . above the elbow—the hand is flail and helpless. Certain muscles can bo spared from the front of the forearm; they are placed into the paralysed tendons, and in three months the patient can raise his hand."

In certain cases the surgeon has to consider which to give—"a strong stiff elbow or a weak niovablo one," according to the man's future occupation. " A soldier, who was a milkman, pointed out that with his elbow at a right angle, ho could not reach the cow's udder; the elbow was therefore set at 135 degrees. In the case of a former big-game hunter,' the patient insisted that his elbow be stiffened iu a position to which he could take up a gun easily. The soldier is, in such cases, consulted as to the most desirable setting with regard to tho calling which ho will take up after recovery."

The Constructive Instinct. The surgeon who gives this information, writes delightfully ol the steady development of the orthopaedic centres. It was advisable, he remarks, that tho " surgeons to do the work" should be young, with sufficiently flexible minds to keep pace with, and improve upon modern methods. The choice was limited, for many of our young surgeons with orthopcedic training were with tho overseas armies, and our senior men already held important appointments. He found that establishments kept apart for massage, electro-therapy, and for manual exercises, invariably took "a wrong perspective of their powers. Frequently no attention was paid to tho posture of the muscles, nor to tho fact that paralysis existed which could not be affected by treatment until the ruptured nerve was sutured." . . . Surgeons had to be found, trained to do tho most delicate operative work, but also trained to recognise the possibilities of recovery without orthopedic training might seo a still wrist and deformed fingers and say : " This arm will never be any good. He is better with an artificial one."

The orthopajdist knows that in spite of looking so hopeless, the "wrist which is flexed and stiff, may be replaced in a position in which it is useful. Two stiff lingers with potentialities of recovery aro patiently restored to function; the remaining two lingers, for which there is no hope of recovery, are placod and permanently fixed by operation in a position useful to the patient in his particular trade." .... He found many young surgeons with true constructive instincts. ".Some weeks ago," ho writes "I met such a type, and havo captured him for orthopedic work. A soldier had lost his right thumb from his wrist. He was willing to havo a finger from the other hand transplanted in order to form a now thumb. The stump of the thumb was dissected, and the ends of the tendons found, The ring finger of the left hand was half amputated, and its tendons attached to the

thumb. Tho finger was attached' and stitched to the stump, so that half of it was supplied with blood from the right arm and half from the left. As the borrowed circulation began to feed the new thumb, it was, stage by stage, separated from its original site. ' When 1 saw it, the transplanted finger was moving just in tho same way as the original thumb, and now it is completely detached from the other hand to assume the moro important function of a thumb." After Discharge From Hospital. From a close study of the cases cited, six months is about the shortest tune for treatment ; many cases require further continued attention, without residence at the hospital. Our authority suggests the establishment of hostels where men from

a distance may stay for treatment or training. While repeatedly urging the value of occupation, lie advocates that in tho cities "every use should bo made of the Technical Schools as curative workshops—and very useful work and training ran be given by private firms. All this is easy in big centres. For the remote areas, local committees will contralise in their particular areas, and establish hostels, round which can be grouped the means of treatment and training." Country doctors should "be encouraged to undergo an intensive training by periodic visits to tho nearest orthopedic centre. They should also receive visits from inspectors with orthopedic knowledge, who, from time to time, would report the progress being made. For instance, a sutured nerve may take two years for recovery. The careful mapping out of the return of sensation, and the progress of muscular recovery, must be accurately recorded from time to time. Tho Pensions Ministry should encourage and pay tlie expenses of the soldier for these visits. Refusal to do this may mean great hardship, 'for a radical change of treatment, such as an 1 operation, may bo needed. If tho surgeons should at any time require their cases to return, every facility should be given. If a discharged soldier is driven from pillar to post we lose our hold on him, we forfeit his trust, and we deprive the nation of a valuable asset." j An article full of information is concluded by the orthopaedist's appeal for what be calls "permanent memorials" of tho war. Ho condemns stone and brass as cold, dead things. And, so they are, when compared with a nation's wealth in contented, efficiently working men. The surgeons of to-day are bringing all their science and skill to bear upon | the question of war's wounds and disablements; such men as Pearson are nobly trying to give a second sight to blinded men; and there is a large body of neurasthenics, to say nothing of those unfortunate and not sufficiently pitied men who are slightly deaf. That the nation, from the highest to the lowest, should concentrate upon the matter of first healing and then finding lucrative and pleasurable employment for the men who nave saved their kin and ours from the terrors of Germanism, is the only lasting memorial. They were our best men; their fitness was sacrificed in a nation's cause. The national memorial of their work should bo an individual obligation on each of us to see them living happy, useful lives.