MILITARY SURGERY.

Sun (Christchurch), Volume III, Issue 864, 16 November 1916, Page 11

MILITARY SURGERY.

DISFIGURED FACES RESTORED. HOW NOSES ARE MADE. In an earlier article I referred to the triumphs of the surgeon's art hi the Manchester hospitals in connection with the brain and nerves. I purpose in this article to deal with the great surgical work which is daily performed in Manchester's Jaw Hospital—one of the special departments of Manchester's excellent hospital administration, writes a contributor in the "Manchester Guardian." The medical men of Manchester will not be satisfied with anything short of the highest efficiency in the treatment of our battered and mutilated soldiers, and for this reason the organisation of special departments for certain well-defined injuries offering the best surgical and nursing treatment—a scheme strongly urged by Sir Alfred Keogh—has been arranged. What was formerly a Manchester school is now fitted up and equipped as a hospital for the treatment by surgeons and dental surgeons of jaw fractures. Almost every kind of fracture is represented, both simple and compound. The latter are, of course, the more serious. In the compound fracture an open wound is produced through which the bone sometimes protrudes. A fracture is comminuted when the bone is shattered in several places; it is complicated when important adjacent structures are injured, and impacted when one part is driven into the other.

In order to discover the exact nature of the injury and to locate the shrapnel splinters or bullets which have caused the mischief, each case is submitted to the X rays, and sometimes the assistance of the plastic surgeon is sought. The X-ray photographs give the surgeon practically all the information he needs. From them he gets an accurate estimate of the damage done, he can trace the existence of foreign substances, and form an idea of the work necessary to restore the "fabric." No matter how great the damage, how hopeless the case presented, or how great the difficulties to be overcome (there are hardly two cases alike), the work of restoration is proceeded with. Some Typical Cases.

One of the worst cases at the hospital is that of a young soldier whose face and jaw had been badly mutilated by shrapnel. There was an ugly hole in the left side of his face — so large that any attempt to feed him in the ordinary way was impossible. When admitted to the care of the surgeons he was standing upon the drawbridge of life and death. By the insertion of tubes he was fed, and when in a fit condition to be placed under an anaesthetic he was operated upon. When 1 visited the hospital the wound was healing and the general work of restoration was going on to the satisfaction of the surgical statf. This soldier when he reached Manchester had little hope of recovery. Another soldier at this Manchester hospital had a terrible experience on the battlefield. He was hit in the face by a piece of shrapnel, and when the shock of the blow had passed he found that the side of his face and lower lip were hanging. He held the torn flesh in position, and lay in a trench for nearly twenty-four hours before he was rescued. He was conscious all the time, and when assistance came he had become completely exhausted through loss of blood. His wound was dressed at the dressing-station, and then he was brought to Manchester. The appearance of the injured parts to-day give only a faint clue to the gravity of the original wounds. Jaw Splints.

Some of the fractures are so serious as to separate the two rows of teeth considerably, the lower jaw falling away to the side of the fracture. The problem is how to get the jaw back to its original position and to secure the occlusion of the teeth. The surgeons, with splints in the form of what; to all appearance, is a double set of artificial teeth, are gradually drawing the broken jaw back into its natural position. To each splint (or set of teeth) some hooks are attached, and by means of short bands of elastic the jaw is held in position. To complete the cure these elastic bands are periodically shortened until the fractured jaw has been made to correspond with the other and the teeth are reunited.

". The savagery of modern war was revealed in the face of another soldier who had been the victim of shell fire. His jaw had been fractured, his face badly torn, and immediately under his left eye was a large and unsightly excrescence from a wound which had almost destroyed his sight. This soldier was being treated by an ophthalmic surgeon, a denial surgeon, and a plasticsurgeon, and although the disfigurement was very had the members of the hospital stair are confidenl that before he leaves them they will be able to remove the unsightliness, leaving only the trace of honourable war marks of a comparatively faint kind. Wounds in the mouth are very septic, and the frequent use of antiseptic solutions to remove the discharges is imperatively necessary. For this purpose irrigators are used, and also an "atomiser" (an instrument for reducing liquids to line spray), which searches and cleanses the wound in every part. It is hardly necessary, perhaps, to add that to the devoted ministries of the sisters and nursing staffs no inconsiderable share of the "successes" at: this and other of the Manchester hospitals is due. Grafting. Tlie loss of hone in cases of fracture is often very considerable, and bone grafting is done. The success of this experiment largely depends on the skill of the surgeon. Rone is lo some extent interchangeable, and so is muscle and skin, li' a large piece of hone is needed to fill up a cavity in the jaw, the surgeon cuts it from the shin bone, where it can best be spared, and the damaged framework is built up with it. Likewise (he flap of skin is shaved oil' jthe inner surface of the arm or thigh and grafted on the lace, where it | serves lo hide a conspicuous scar. Rhinoplasty, or the plastic surgery

of the nose, is also practised in Manchester. When an artificial nose is to be supplied the surgeon gets one oi the latest photographs of the patient before the injury was received, and a model is made by Lieutenant Derwent Wood, the sculptor. ■ The masked nose is made of silvered copper, and is coloured to match the surrounding complexion. These artificial parts are remarkably well done, and cannot he detected except at night, when the colouring has been known to be unsuitable. To obviate the danger of detection in cither natural or artificial light it is sometimes thought advisable to have two noses made, each with a different shade of colouring, the one for day use and the other for night-time. In cases where the nose has been knocked out of shape or the bridge has been brdken it is made shapely again by a comparatively simple operation. No one is more surprised than the soldiers to find what remarkable results are attending the work of our surgeons. "Nothing is too dillicult for them," said a former patient of one of Manchester's hospitals, "When nise myself. 1 was stricken with horror when I happened one day hi catch a glimpse of my injuries. I said to myself 'I am done for. No surgeon living can put me right again.' I was a pessimist then; lam an optimist now."