WOUNDED IN BATTLE

Dominion, Volume 8, Issue 2274, 7 October 1914, Page 5

WOUNDED IN BATTLE

INSTRUCTIONS TO FRENCH SURGEONS ; „ The French Wax Office recently circulated to all the surgeons with the French troops a digest of a paper Toad a few days ago by'M. Edniond Delonne, the Medical Inspector-General of the Army; before the Academie des Sciences I on the treatment of wounds caused by ' modern projectiles. In his paper Dr. Delorme emphasises especially two points, firstly, the little gravity of tho wounds produced by the small bullets ■used to-day, and secondly, the principle that surgery as practised in war-time should be essentially conservative—rthat is, that the surgeon should only have recourse to operations in very exceptional cases. Dr. Delormo states that life is now seldom threatened, and the surgeon should therefore concentrate his eftorts on getting a cure with the fewest possible bad after-effects. Simple_ methods' must be the- chief characteristics of the field hospitals owing to the mass of tho wounded that have to be dealt with, and because they all have to be treated simultaneously. The wounds in the soft' parts of tho body caused by the sharpnosed German bullets are generally very small. Tho wound is, usually not contaminated by scraps of clothing, and healing should be complete in a few days or weeks. The-first-aid bandages that the soldiers carry should suffice for their treatment in tho firing line. Effects of Shrapnel. Wounds caused by ricochets or by shrapnerare larger, and are often com-, plicated by »the presence of foreign bodies, such as splinters and scraps of clothing. Such wounds are not serious, but they fend to suppurate, require antiseptic treatment, and take.longer" to heal. The treatment of fractured bones is one of the chief problems for the army surgeon. They'"are nearly always infected. In every instance conservative surgery should bo practised, no matter what the limb affected or what the ox-' tent of the injury. Amputation is only justified if the large vessels and large nerves are involved. Foreign metallic bodies should not be looked for. Immobilisation in special' apparatus is in most case sufficient treatment, and, in,the case of serious wounds, the disinfection of the area involved. When the large vessels are involved in bullet wounds haemorrhage is less fre-. quent than formerly, but aneurisms are commoner. Their treatment should be left to the more experienced surgeons. Injured nerves require no' immediate intervention, nor is there anything special about .their later treatment. Injuries to Vital Organs. In wounds of. the head and brain the disinfection of the wound and the removal of splinters are advised. . Deepseated projectiles should not be looked for, and it should be reln'embered that such cases should not be moved. Wounds in the lungs, if large vessels &ro not involved, heal more readily than formerly, and complications arc rare. Tho chest should be immobilised and the wound closed _ aseptically. Wounds in the abdomen involving the intestines are very common in war, and require all the caro that can be given them by the surgeons at the i front. These wounds are always serious, but recent methods havo considerably reduced their gravity. While the surgeon in times of peaco considers the advisability of laparotomy, recourse should certainly not be had to it immediately in time of war. _ Tho wars in the Transvaal, Manchuria, and the Balkans have proved its harmfulness. In the Transvaal 'War especially the cleverest intervention gavo worso results, than the policy of non-operation. When tho wound is clean tho smallness of the hole and-tlio absence of contamination indicates the old-fashioned treatmont. absolute rest, dieting, the lion- , removal of tho patient, and injections of serum. If tho intestinal wound is large, as when caused by shrapnel striking the abdomen obliquely,, and scraps of clothing have < been carried in, peritoneal infection is inevitable. Even in such cases Dr. Delorme is opposed to laparotomy as occupying too much of the surgeon's time in view of the demand made on him by other wounded, and recommends the simplest operation, known as tho Murphy incision, by means of which the peritoneal cavity, can bo disinfooted.