Omaha daily bee., 1919-02-13
Revolution IN War Surgery
New York Sun.


has brought about it looks as if 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 military or do
nestle life.
Doctors at the front have found that the
engines of modern warfare, asphyxiating gases,
fame projectors, tear shells and the incessant
crash of artillery fire produce conditions in the
wounded never before known. Shock, exalta-
II ton, Juror and decentralization and such abnor-
NAL symptoms frequently make the employ
rnent of any anesthetic dangerous.
DR. B. Sherwood-Dunn, who was himself
wounded at the front, relates the case of an
officer who was brought into the front line hos
pital with slight fracture of the forehead but
suffering from profound shock He was put to
bed with hrst-ad dressing without administer
ing any anesthetc. Later, when he was an
isthized, he developed a state of extreme ex-
altation, calling up his men to charge and
urging them on with cries of encouragement
and patriotic fervor"
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
function was to douche all wounds with iodine
solution, apply a first dressing and send the pa
tent to a base hospital for any operation that
might be necessary. AS the journey with re-
peated transfers, frequently took 10 days or
two weeks the usual result was the develop
ment of countless cases of gaseous gangrene,
tetanus and 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 on the
TACT that the majority of the wounds in past
wars were made by bullets.
In this war rife fire has been almost entirely
replaced by shells, and almost all the wounds
are from she'll splnters or objects forced into
the body by she'll explosions. In former wars
bullet wound was usually clean-cut track
seldom contaminated. Under modern warfare
the nature of the wounds has completely
changed both in their aspect and gravity, and
they not only demand immediate treatment, but
treatment never 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, torpedoes and shrapnel. Each of
these carries into the wound bits of clothing,
which is always dirty; particles of EARTH hair |
splinters and even small pebbles, which are al
most certain to set up immediate Infection
The necessity for immediate treatment lies
chiefly in the form of the wounds. A she'll
fragment bruises and mangles the flesh, causing
what rapidly becomes dead tissue and forming
a nest Tor infection. TO apply a rough temper
airy dressing to- cavity filled with torn and
ragged tissue foreign matter dirt metal splin- |
tiers and coagulated blood is absolutely useless.
No matter how literally the wounded man
may be douched with iodine it cannot penetrate |
all the recesses of such a wound, and the inev-
liable result is infection, which it may take |
months to eradicate if the patient survives.
The modem surgeon proceeds upon the
theory that he is as much of soldier as the |
man with the gun and that whether he is in
front line hospital or so miles back of the firing |
line his duty is to do his best. He has thrown |
antiseptics to the dogs. During the early stag |
es OF the war they were in universal use, now |
they are studously avoided. In 1914 every
wound was douched with every variety of anti /
septic liquid; now all wounds are kept as dry |
as possible and the gauze drain has supplanted /
all others.
The idea that there is not time or 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 I
clean-cut track of rife or machine gun bullet
is contaminated, and the first thing he does is
to open It up so completely as to expose the
entire cavity. Every particle of foreign matter
IS then removed and any tissue that looks as if
1t might die and slough away is cut off
The old method of treating the entrance and
exit OF projectile by charging them as little
as possible and passing drain through is OBJ
solete Instead of that the surgeon makes lib
erai inclson, long and wide enough to search
the recess and traumatism thoroughly
The greatest departure from the old text
books lies in the recommendation for the front
line surgeon to do his work thoroughly and to
lay. open the wound rather too much than too
ittle This insures. the patient against infec-
ton in case it should be 10 days or two weeks
before he arrives at the base hospital
II his wounds have not been subjected to
careful and thorough cleaning by the front line
surgeon by the time he arrives at a fixed hos
pital infection may have progressed to a degree
that will entail months of treatment.
Rut II bic f,szrn H. |
opened and cleaned out, the surface Thoroughly
gone over with tampons and soaked in hydrogen
peroxide the cavity being then carefully packed
with gauze and bandaged to withstand the de-
niands of rough travel, he will usually arrive at
his final destination in condition for the begin
ming Of healthy granulation
1t has been found that any wound which
has been properly cleaned and packed should
remain untouched for at least a week unless
there is some sign of infection or a rise in tenn
perature. Redressng healthy wound too fire.
quently has now been found to retard its re-
covery.