Remarks ON THE TREATMENT OF WOUNDS IN WAR, Made in opening a Discussion at the Medical Society of London on November 16th, 1914
Authors: W. W. Cheyne
Journal: BMJ (1914)

MuR. PRESIDENT AND GENTLEMEN,-I propose to-niglht to liniit my share in thle discussion on surgical experiences in thie present war to tlle treatment of injuries sustained.fromiy missiles.Time treatment of these injuries naturally falls under two hleadings:1.The treatment of the wound itself; and 2. The treatment of the various injuries whiclh miiay be done to the structures or organs througlh which the missile passes.It seems to me that at this stage of the war tlle most urgent and profitable heading to discuss is the first- nlamiiely, tlle treatmnent of the wound as a wound, apart from the otlher injuries whliicl may be present.As regaLrds the latter, we can as yet only speak of individual cases, wlhiel, however interesting to the surgeon hiimself, are not sufficiently numerous or advanced to enable us to make any freslh generalizations apart from those whlich hlave already been made in connexion with other wars.CHARACTER OF, WOUNDS IN TIIIS WVAR.Naval wounds are, p)ractically enitirely, caused by frag- menits of shiell or portionls of tlhe sliip itself broken up by time sl) lls, and tllese produce large, ragged, lacerated wounds wvIiich canniot scab over, and where bones are ilijured tlhey are very mnuchl broken up.;We llave lnot had fromn otur ships a sinigle instance of a bullet wound, but wev lad somiie builet and also some shrapnel'wounds atoniig the miarines from Anltwerp.A considlerable number of the wounds havel also been coinplicatecl with burns, wlhile in m-aniy cases therme have becik burns without any-wound, as the result of the explosion of tlhe enemy's slhells or of our own.e In tlle case..of the arfmy, a large.proportion of the wounds ar:-due -to tll6 slharp-pointed, -uarrow bullets, many of which -pass throtu4ll the tissues and leave only sniall apertures of entrance amid exit, whidc.scabover and seldom require-any troatment for thle.wound itself.Occasionally,-however, for various reasons, the wound of exit uay be large, in wlicll case sepsis may occur.tlhere.The roLtud shrapnel-Ibullets make larger orifices oLentrance and exit than tile rifle bullets, a'nd do not -so ofbei -scab over, wlhile if they fracture bones the injuiries, are much more severe.The wounds ,with portions of shell resemble those nlet with in naval warfare.* TIE-PREVALENCE OF SEPSIS.-Now the firet thing whichbstrikes every -one wlho is actively engaged at the present time in the treatment of the wounded, whlether.on land or sea, is the great pre- valence of sepsis.Givi.ng my.:owx' experience of naval cases, all the sovoulds: which-I have as yet come across have, been septic, some of them verybadly so.I hear also that those wlho are wvorking at tlhe army hospitals are having a large amount of sepsis in shell and shrapnel wounds, and in addition, at any rate while our army was towards the centre of tlle linie, were having a good many cases of tetanus and acute spreading gangrene.So far, we have not had tetanus in the naval wounded, and that is, of course, natural, for, seeina that the tetanus bacillus reaches wounds from tlie soil, it is only those wounded on land wlho would get their wounds contam-inated witlh thlis oraanisml.And, probably for the same reason, I have not m'et with a ease of acute spreading gangrene.It is a very serious matter that all the larger wounds wlhiclh arrive at the base are septic.It is true that in somiie tlhe.sepsis is not so severe as to threaten the life of the patient, but it is no light thing for a wound to become septic.Once get sepsis into a wound, especially a com- pound fracture or a wound of a joint, and you have no r Tir.