Grand Forks herald. [volume] (Grand Forks, N.D.) 1916-1955, 1919-01-23
WAR SURGERY
ADDS MUCH
TO SCIENCE
Complete Revision of Text
books Necessitated by
War Experiences.

the war has brought about it looks as
IL one Of the most important would
be a complete revision Of our present
text books for army surgeons, and the
introduction of new methods of treat.
ing ragged wounds, whether in mill.
tary or domestic life. '
Doctors at the front have found
that the engines of modern warfare,
asphyxiating gases, flame projectors,
tear shells and the incessant crash of
artillery fire, produce conditions in the
wounded never before known. Shock,
exhaltation, Juror and decentralization
n such abnormal symptoms fire.
Quently make the employment Of any
anesthetic dangerous.
DIR. b. Sherwood-Dunn, who vas
himself wounded at the front, relates
the case of an officer who was brought
into the front line hospital with a
slight fracture of the forehead but
suffering from profound shock. He
was put to bed with a first aid dressing
without administering any a~nesthetic.
Later, when he was anaesthized, he
developed a state of extreme exhalta-
ton, calling upon his men to charge,
and urging them on with cries Of en-
couragen1ent and patriotic fervor."
Gas Gangrenc Developed.
Almost without exception, all the
doctors who were sent to the front
line hospitals at the beginning Of the
war had been taught that their func-
ton was to douche all wounds with
iodine solution, apply a first dressing
and send thA patient to a. base hos
pital for any operation that might be
necessary. As the journey. with re-
peated transfers, frequently took ten
6aVc m. fwn yDoakS tho 1,S11ol Voo,r1f
was the development of countless
cases of gaseous gangrene, tetanus
n fatal infections. Thousands Of
men lost their lives or limbs through
ignorance of the proper treatment.
During the early stages of the war
it was the universal opinion of army
surgeons that operations could not be
performed in the war zone If the
= standard text books and records of
past wars are consulted it will be
found they prescribe that no operating
shall be done in field hospitals. This
ruling was based or the fact hat the
majority of the wounds in past wars
were made by bullets.
In this war rifle fire has been almost
entirely replaced by shells, and almost
all the wounds are from shell splinters
or objects forced into the body by
shell explosions. In former wars a
bullet wound was usually a clean cut
track, seldom contaminated. Under
modern warfare the nature Of the
wounds has completely changed, both
not only demand immediate treatment
but treatment lever dreamed of in
field hospitals of former wars.
Instead Of the smooth path Of a
bullet the surgeon has to deal with
fragments of shells, grenades, tor
pedoes and shrapnel. Each Of these
carries into the wound bits of cloth
ing, which is always dirty; particles
of earth, hair, splinters and even small
pebbles, which are almost certain to
set up immediate infection.
The necessity for immediate treat
ment lies chiefly in the form Of the
wounds. A shell fragment bruises
and mansles the flesh, causing what
rapidly becomes dead tissue and form
ing a nest for infection. To apply a
rough temporary dressing to a cavity
filled with torn and ragged tissue,
foreign matter, dirt. metal splinters
and c%oagulated blood is absolutely
useless.
No matter how literally the wound
ed man may be douched with iodine it
cannot penetrate all the recesses of
such a wound, and the inevitable re-
suit is infection, which it may take
months to eradicate if the patient sur
wives.
New Way q Real Revolution.
The modern surgeon proceeds upon
the theory that he is as much of a
soldier as the man with. the gun and
that whether he is in a front line hos
pital or fifty miles back of the firing
line his duty is to do his best. He has
thrown antiseptics to the dogs. Dur
ing the early stages of the war they
were in universal use; now they are
studiously avoided. In 1914 every
wound was douched with every va
riety Of antiseptic liquid; now all
wounds are kept as dry as possible
n the gauZe drain has supplanted all
others.
The idea that there L. not time OF
that the surgeon has not the nerve to
operate under fire is exploded. He
starts upon the assumption that every
wound which is not made by the clean
cut track Of a rife or machine gun
bullet is contaminated, and the first
thing he does is to open it up SO COM
pletely as to expose, the entire cavity.
Every. particle of. foreign matter Is
removed n any tissue that looks az
if it might die and slough away is cut
out.
The old method of treating the en-
trance and exit of a p%rojectile by en-
larging them as little as possible and
passing a drain through is obsolete.
Instead of that the surgeon makes
liberal incision, long and wide enough
to search the recess and traumatism
thoroughly.
The greatest departure from the
old text books lies in the recommen-
dation for the front line surgeon to do
his, work thoroughly and to lay open
the wound rather too much than too
little. This insures the patient against
injection in case it should be ten day.
Or two. weeks before he arrives at the
l.. II his wounds have not been sub
1ected to a careful and thorough
cleaning by the front line & BY
the time he arrives at a fixed hospital
infection may have progressed to a
degree that will entail months OF
treatment.
But If his wounds have been prop.
erly opened and cleaned out, the sur
face thoroughly gone over with tam
pons and soaked in hydrogen peroxide
the cavity being then carefully packed
with gauze and bandaged to with
stand the demands, of rough travel,
he will usually arrive at his final des.
tination in condition for the beEinnina
: OF healthy granulation.
It has been found that any wound