The Black Hills union. [volume] (Rapid City, Pennington County, Dakota [S.D.]) 1889-1904, 1898-07-29

"
modern weapons Of war should cause
great mortality were they not treated
antiseptically. The extent to which
tissues are impaired in certain cases,
the violent phenomena Of reaction fol-
lowing unon traumatism, the unavoid-
able contagion due to numerous infec-
tiOus agencies to which the tissues are
subjected, impose upon the army sur
geon the duty Of being most uncom-
promising in the matter of antisepsy
and elimination of all morbid germs
from the wounded region.
Every effort should be made by the
surgeon to completely disinfect wounds.
Such has been the constant aim of
every army surgeon since the era Of
antiseptics, M although occasions
have not been very numerous in which
the new discovery could be applied,
there has been ample opportunity for
demonstrating it's usefulness in the bat
tie field. A few figures will suffice for
an appreciation of the antiseptic meth
cd In army surgery. Bergman and
Reyher, who operated on Roumanian
battle fields, give eloquent results.
Out of ffty-seven knee wounds treat
ed several hours after the engagement,
but strongly disinfected, Bergman re-
cords IS per cent Of r%ecoveries and As
per cent of deaths, whereas Hantzel
gives 61.5 per cent of deaths for cases
treated by the conservative method
without antisepsy. In other tables, out
of fifteen cases of fractured knee, Berg
mann states h a fourteen of the
wounded. survived, two after amputa-
ton. Only n died.. e., a mortality
Of sc per cent.
The tables presented by Reyher, who
also operated in the Roumanian field
hospitals, are still more encouraging.
Thirteen flesh wounds, principally in
the thigh, primarily treated by the an
tiseptic method, resulted in one death,
or a mortality of 7.6 per cent, whereas
that mortality was 21.4 per cent, or six
deaths out of twenty-eight cases treat
ed secondarily by the antiseptic meth
cd. Similarly, out Of forty-six cases of
gunshot wound in the knee primarily
treated with antiseptics, there were
six deaths. or a mortality Of 13 per
cent, whereas 70 cases treated Sec
ondarily resulted in forty-eight deaths.
or a mortality of 61.5 per cent. Again.
fractures caused by projectiles, treated
primarily by the antiseptic method,
were followed by four deaths, or a
mortality Of 1871 per cent, whereas,
the proportion vas 1873 per cent, with
tWenty-three deaths out Of sixty-five
cases where the antiseptic method was
applied secondarily.
These figures prove the Importance
of immediate application of antisepsy,
seeing that in the cases treated anti
septically, but more or less after the
event, the mortality was 61.5 per cent,
or nearly the same as in cases where
the method was not applied (62 per
final, as every day experience shows
that the judicious use of antisepsy may
yield good results even long after the
inf1ictiOn of a wound.
Reyher's tables are more encouraging
when considered from the point of view
of mortality by infection. Deaths from
pyaemia, or septic phlegmon, are dis
tributed as follows: Out of II cases of
articular resection antiseptically treat
ed from the outset, there was l death,
or so per cent; out of Is cases of SIM
pie amputation, l death, or 7.6 per
cent; out of % cases of gunshot frac-
ture, 2 deaths, 8 per cent; out of 81
cases Of articular gunshot wounds, l
death, 81 per cent. Average mortality,
81 per cent.
The results for cases treated anti
septically in the secondary period are:
Out Of 65 cases of gunshot fracture
there were 10 deaths, or 20 per cent;
out of IS cases of articular gunshot
wounds there were 33 deaths-that is,
41.3 per cent, Or an average mortality
of 32.1 per cent.
Lastly, for flesh wounds, the same
surgeon found IL cases treated antisep-
tically from the start all recovered, and
% cases treated secondarily resulted in
6 deaths, or a mortality of 21.4 per cent.
These results speak for themselves
They are all the more conclusive since
they were obtained at a time VIE
antisepsy had not been properly de-
veloped and medical equipments in
this respect were deficient.
The above examples sufficiently prove
the value of the antiseptic method on
the battlefield. Now m the ques-
tion-What is the limit of delay in
dressing a wound by this method with
reasonable prospects Of success? The
figures quoted above show the great
difference between it's primary and Sec
ondary application. Is there a period
which must not be exceeded? Volkmann
and Koenig declare hat twelve hours
is the limit; Koehler goes up to twen-
ty-four hours. These limits are GER
tainly too narrow. 1t must not be
forgotten that If a wound is contain
mated from the outset the contamina-
ton remains localized for a long time.
Even in 1870 Bilroth, with rare sagacity,
demonstrated in his surgical letters on
the hospitals Of Mannheim and Wis
semburg that septic complications Of
wounds received in war do not occur
till a certain time after the event.
Without knowing Machnikoff's the
DRY, he said that the Inflammation set
up in the blood vessels played a con-
siderable part in this preservation. And
this, in fact, must be 80. From the
very outset the irritation caused by
traumatism brings out the white cor
puscles, which prevent the invasion of
the system by %virulent germs. The
oscha 10 calnso6 nv fraumatfSm are also
a barrier to infection. This will take
place only when the white corpuscles,
called phagosytes, are exhausted to the
point Of being unable any longer to de-
stroy infectious germs, and when the
eschars. becoming prematurely detach-