The times., 1898-06-27
NEW ARMY SURGERY.
improvements in Methods Greatly
Decrease Mortality.

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''The many injuries resulting from
modern weapons of war should cause
great mortality were they not treated
antiseptically. The extent to which tis-
sues are impaired in certain cases, the
violent phenomena of reaction following
upon trautmatsm, the unavoidable con-
tagion due to numerous infectious
agencies to which the tissues are sub
jected, impose upon the army surgeon
the duty of being most uncompromising
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,
and although occasions have not been
very numerous in which the new discov-
cry could be applied there has been
ample opportunity for demonstrating it's
usefulness in the battlefield A few fig
ures will suffice for an appreciation of
the antiseptic method in army surgery.
Bergman and Reyher, who operated on
Roumanian battlefields, gives eloquent
results.
''Out of ffty-seven knee wounds treated
several hours after the engagement but
strongly disinfected, Bergman records
80 per cent of recoveries and 10 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, Bergman states that
fourteen of the wounded survived. two
after amputation. Only one died-i. e..
a mortality of 6.6 per cent.
THE tables presented by Reyher. who
also operated in the Roumanian field hos
pitfalls, are still more encouraging. Thir-
teen flesh wounds principally in the
thigh, primarily treated by the antisep-
tic method resulted in one death, or a
mortality of 76 per cent. whereas that
mortality was PA per cent. or six deaths
out of twenty eight cases treated second
arily by the antiseptic method. Similar
ly out of foIty-siX cases of gunshot
wounds in the knee primarily treated with
antiseptics, there were six deaths. or a
mortality of l3 Per cent, whereas seventy
eight cases treated secondarily resulted
in foIty-eight deaths. or a mortality of
pl-O per cent. again, fractures caused by
projeCtileS. treated primarily by the an
tiseptic method, were followed by four
deaths, a mortality of Isl per cent,
with twenty-three deaths out of sixty
hve cases where the antiseptic method
was applied secondarily.
These figures prove the Importance of
immediate application OF antisepsy. see
ing that III the cases treated antisepti-
cally, but more or less after the event
~. -4.I.4 ga
the same as in cases where the method
was not applied (62 per cent?. This YER
diet is not. however, final, as every day
experience shows that the judicious use
of antisepsy may yield good results even
long after the infiiction of a wound
Reyher's tables are more encouraging
when considered from the point of view
of mortality of infection. Deaths from
pyaemia, septic phiegmon. are distri-
buted as follows: Out of II cases of ar
ocular resection antisepticalIy treated
from the outset. there was ! death, or 81
per cent: out Of I3 cases of simple ampu-
tation, death or 7.6 per cent: out OF y
cases of gunshOt fracture Deaths per
cent out of q cases of articular gunshot
wounds. l death. 81 per cent. Average
mortality. 6.1 per cent.
The results for cases treated antiSep-
ticaIIy in the secondary period are: out
VI VI NtiStS bL SuISi!pL fracture lUtIG
Were l3 deaths. or 20 per cent; out OF IS
cases of articular gunshot wounds there
were deaths-that is Il per cent, or an
average mortality of 321 per cent.
Lastly. for flesh wounds. the same sur
geOn found j cases treated antisepticaIly
from the start all recovered. and 25
cases treated secondariIy resulted in 3
deaths or a mortality of PA per cent.
These results speak for themselves.
oil he 81,
they were obtained al a time when an
tisepsy had not been properly developed
and medical equipments in this reSpec-
were deficient.
The above examples sufficiently prove
the value OF the antiseptIc method on
the battlefield. Now comes this question:
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
its primary and secondary application
Is there a period, which must not be ex-
+ ceeded? Yolkmann and KoeniS declare
that twelve hours is the limit: Koehler
goes up to twenty-fOur hours These linn
its are certainly too narrow. II must
not be forgotten that if d wound is CON
taminated from the outset the contami-
nation remains localized for a long time.
Even in 1870 Rilroth. with rare sagacity.
demonstrated in his surgical letters on
the hospitals of Mannheim and Wissem-
| burg that septic complications of wounds
received in war do not occur till a certain
| time after the event.
without knowing Mechnikoff's theory.
he said that the Inflammation set up in
| the blood vessels played a considerable
| part in this preservation. And this, in
fact, must be so. From the very outset
the irritation caused by traumatism
brings out the white corpuscles, which
| prevent the invasion of the system by
| virulent germs. The eschars caused by
| traumatism are also a barrier to infec-
ton. This will take place only when the
white corpuscles, called phagosytes, are
| exhausted 10 the point of being unable
| any longer 10 destroy infectious germs,
and when the eschars, becoming prema-
| turely detached, leave the door open to
| the irruption of virulent agents into the
| circulation.
Such are the arguments which speak
! in behalf of the success of the antiseptiQ
! method. even after an extended period
! has elapsed since the infiiction of a
| wound. 1t is certain in such a case that
| if by washings and careful disinfection
| the number and virulence of the germs
| are diminished, there is a good chance
of avoiding infection.
These views are confirmed by the
| OPINIONS of many army surgeons. Won
! Hahn in particular, who was able to save
| the wounded of Plevna and Ralowa from
| septicaemia and erysipelas after three to
five days transport by carefully irrigat-
| ing their wounds with a solution of phe-
! nic acid. Other Prussian army surgeons
! claim 10 have obtained the same results
| by cauterization with nitric acid These
| assertions must not be generaliZed to the
| extent of believing that all wounds will
| escape infection. Although secondary
/ antisepsy is not to be neglected, it is