WOUNDS WORSE THAN EXPECTED.

Waikato Times, Volume 87, Issue 13275, 2 September 1916, Page 3 (Supplement)

WOUNDS WORSE THAN EXPECTED.

An enormously higher proportion i.i wounds in the present European War have become infected than in any former contest. It- was formerly regarded by military surgeons that bullet-wounds are generally clean and become infected only by neglect or carelessness alter infliction. Even as late as the Russo-

Japanese and the Balkan wars, severe wound-infection was rare. avc. are informed by Dr Herman Matti, of Berne, in an article contributed to the Deutsche Medizinische Woclienschrift (Vienna, December 2). In the present conflict, therefore, the enormous numbers ol wounds presenting .severe infection came as a great surprise. The cause is now clear, we are told by Dr Matti. It- may be partly due in the first weeks of the war to lack of first aid and insufficiency in transport, but the main reason lies in the great increase in the number of artillery wounds. Says the writer:

"In no other conflict lias the use of artillery attained such tactic significance as ;n the present, and tor that reason the wounds caused by artillery-fire play so important a part in war-surgery. It is not possible at the moment to give definite data, but it can be said that while artillery-wounds during former Avars averaged from 10 to per cent, of all the injuries, according to Friedrich, in some of the battles along the Eastern front to-day wounds of this character constitute 70 per cent. . . . "Shrapnel-wound* show a higher degree of infection than rifle-injuries, been use the larger shot of the former produces a larger area of injury and more extensive contusions. Payr states that from 70 to 80 per cent of all shrapnelwounds become infected. Tile case is still more difficult with explosive-shell wounds, which early in the war had acquired a bad reputation. According to Gari'e, fivefil'ths of all the severe infections found in Champagne are due to this source; and in from DO to 95 per cent of the fractures' produced by grenade splinters there is wound-infection The cause for this is apparent. Gren-ade-splinters for the most part hit indirectly and carry with them gross contamination. such as is contained in masse,; of earth. Owing to their irregular, pointed shape, they tear away fragments of clothing and leather, and carry these and other foreign bodies into the wound. In addition to the heavy load of infectious material conveyed by the : nlosive missile, the prognosis of theswounds is made serious because of the extraordinarily high degree of mechanical lesion produced in the surrounding tissues and the creation of eonditinos which are morphologically unfavorable to healing. We get deep, radiating, cavern-like wounds, in which decomposing fragments of bone-splinter, muscle, and other tissues are to be I'oiukL Along the edges of the extensive contusions we find severely injured, lifeless tissue. These wounds have the appearance often, of having been boiled. In addition, through the powerful dynamic effect of the exploding splinter, there is extensive injury done to the adjoining

tissues "Injuries caused by small-calibre shot also exhibit a bad outlook during the present war. There are, of course, many eases of healing without complications. where the bullet has made a clean-cut passage, but severely infected fractures are also common. Here also the fatal influences of unfavorable circumstances, such as severe mechanical injuries, is pronounced. It is a mistake to suppose that the size of the wound is directly related to its prospect of healing. For instance, from the beginning of the war, the clinical outlook in thighfractures has been serious. Infections ot the severest type have resulted from the. masses of splintered bone and destroyed tissue lying beyond the small opening mad? by the bullet." The German small-calibre bullet, Di Matti points out. has an initial velocity of nearly a, half-mile per second, ant' that used by the French has a speed not much less. The modern bullet is therefore, capable of causing from lonr distances effects much more severe than those of the old-fashioned large-calibre bullet. As a result there are marked explosive effects, such as extensive bonesplintering. A tiny hole made by a bullet at entry may end in an area at its exit as large as a saucer. Although these bullets may carry little infectious material, therefore, this is largely'offset by their tendency to mechanical injury. We road further: '•The uncleanliness which is unavoidable. in long-continued trench warfare and climatic conditions of dampness and cold "ire other important factors in wound infection, and the significance of such hygenic measures as adequate bathing'facilities and frequent changes of clothing can not be over-estimated.