MARVELS OF SURGERY.

Pukekohe & Waiuku Times, Volume 6, Issue 245, 26 January 1917, Page 3 (Supplement)

MARVELS OF SURGERY.

MARVELS OF SURGERY

STORIES OF WONDERFUL AY ORE

"HOPELESS" CASES OF RECOVERY (From the Manchester Guardian.)

The public can have no adequate conception of the great debt we owe in this war to modern surgery. Some of us may have entertained a thought that the sur-•-gical and medical treatment of the soldier has not kept pace with the horrible mutilations caused by modern scientific aids to destruction. But all that one needs to correct any mistaken view is to visit the military hospitals and to follow the surgeon in his work from the operating theatre to the convalescent wards. We expresse our admiration of the soldier for his consummate bravery and cheerful disposition in the face of the enemy, and his patience under suffering. Our soldiers, in turn, express their unbounded admiration for our surgeons, who, by their extraordinary skill, are carrying on this great work of human renovation. An efficient medical service has a great influence on the morale of an army. A soldier has to make great sacrifices, and the knowledge that behind the guns is mobilised a highly-skilled army of surgeons and nurses encourages him greatly. The mind cannot conceive what the horrors of war would be in the absence of our surgeons.. Ambrose Pare, one of the greatest military surgeons France ever produced—he is the father of military surgery—in his description of the conditions after a battle in the campaign of Turin (1536), mentions that he went into a stable where some wounded men were sheltered. "As I was looking at them in pity there came an old soldier, who asked if there was any way to cure them. I said No. And then he went up to them and cut their throats, gently, and without malice. And when I upraided him, he answered and prayed God that when he should be in such a plight someone would do the same for him, that he should not linger in misery." There is real comfort for us all in the knowledge of what surgical skill can accomplish nowadays.

WORK IN MANCHESTER. Since the beginning of the war above three thousand operations have been performed in the Second Western General (Manchester) Military Hospital, iWhitworth Street. Some of these have been nothing less than surgical triumphs. Limbs which the patients were confident had been lost to them have been saved; cripples who to the lay mind were cripples for life have had the full use of the defective limb restored; shattered jaws have been made whole; faces shockingly torn by shell have, as it were been remodelled,, leaving in some cases only a faint trace of the wound, and in those cases where amputation was the only alternative if the life of the soldier was to be saved (the Manchester surgeons will not remove a limb if they can possibly save it) excellent artificial limbs have been provided.

The war has given -ise to numerous cases of complicated compound fractures, nerve injuries, and muscular paralysis which have called for a high degree of surgical skill in their treatment, and some of the most striking work of the hospital has been in the treatment of injuries of the skull, brain, and spinal cord and nerves. It is a point of some interest to note that the Franco-German war of 1870 was practically the starting point of modern brain surgery. Although previous to that date it was known that human beings might survive injuries to the brain, there was much obscurity as to the function of the cortex to the brain, and the accidents of warfare embracing severe injuries to the head, frequently with considerable portions of the brain exposed, led two of the German army surgeons, Fritsch and Hitzig, to make certain observations in the course of their work, and to prove that the cortex of the brain could be excited by electrical stimuli, whereby definite movements of various parts of the body could be produced. In turn this led to the work of Sir David Ferrier in the localisation of function to the cerebal cortex, and later to some of the valuable researches of the late Sir Victor Horsley in the domain of brain surgery. In the Franco-German War it was seen that even with larke areas of the brain exposed it was possible for a man to live, but the defect in the skull was a difficult matter to deal with satisfactorily, and various methods have been employed since 1870 to protect 4 he damaged area. The skull bone docs not rapidly repair—a gap in the bone is liable to persist—and fractures of tho cranium with loss of bone are amongst .some of the most serious injuries inflicted in the present war. Where the underlying brain is both exposed and lacerated, the damage must be regarded as permanent to some extent, and in some parts of the brain some amount of paralysis will result and will be permanent. But some very remarkable cases have occurred in the Manchester Hospital, where (there being a defect in the cranium from loss of bone, but without paralysis) the gap has been treated by a delicate operation with immense benefit to the soldier towhom has been, given a feeling of well justified security as regards the portion of the brain previously unprotected by bone.

AN EXTRAORDINARY CASE. One soldier operated upon in Manchester (this is typical case of many) had a large part of his skull blown away. The ca.se seemed to he almost hopeless except to the surgeon to whom the patient was entrusted. One need not go into details; tliey are too terrible.. It will he sufficient to sav that the most difficult and delicate part of the operation was to provide a permanent protective covering for the brain. This was done by implanting a plate of silver in the top part of the skull and making it secure. This silver phite. about the thickness of an ordinary visiting card, is perforated to provide a means of drainage from one tissue to another, and to permit the formation of adhesions, which make most efficient and permanent "anchors." XrXIiOLOGK'AL HOSPITAL. The surgery of the nerves in a military hospital is particularly interesting. Where it. is quite clear that recovery without operation is impossible or very unlikely lone branch hospital of tlu principal Manchester military hospital i- set aside for the special study and treatment of nerve cases, and i- known a-, the Neurological Hospital 1 ), the patient ha~ the damaged nerve dealt with according a.- it belongs to one or other class of e.i'-es. In one case the nerve i-. not divided, but compressed bv surrounding >car tissues, fibrous in character, or due to the formation of a excessive amount of callus (bony material) after union of a. fractured bone. In this tvpe of case the netve trunks are expo ed bv operation, freed from the .surrounding '■car tissue, found to be practically of normal size, and after wrapping a special animal membrane round the freed nerve so as to prevent further adhesion to surrounding scar tissue the wound is clo-cd. A case in ■this group recovers within two or three months.

In another group, although the nerve has not been divided oy the bullet or shell wound, 6car tissue has grown round the nerve in such a way as to make a definite constriction. It is as though a ligature had been tied about the nerve. Here the damage to the nerve is more severe—degeneration may have set in—and possibly the small area of comp'-essed nerve must be cut out, and tne divided ends of the nerve stitched together with fine silk. Recovery in this case is much slower, but is likely to be complete after a few months, the time depending chiefly upon the length of nerve between the point of injury and the termination of that nerve in the limb.

In another group of cases the nerve has been divided, partially or completely, by the bullet or foreign body, or by the sharp end of a fractured bone. Here there is absolutely no prospect of recovery in the damaged nerve unless the divided ends are found, freshened so as to oppose nerve fibres to nerve fibres, and sutures (stitching by threads of silk) applied to hold the ends together. Some of these cases present special difficulties, and various ingenious plans arc adopted to deal with iudividual cases. YYhere the divided ends of the nerve can be brought to gether without much tension, simple stitching with fine silk gives excellent results. But sometimes there is a gap between the ends of the nerve, and for this various methods have been adopted. Occasionally the main bone of the limb is shortened so as to allow the two ends of the nerve to meet, or the nerve is diverted at a point and in such manner as to give a more direct course to its ultimate distribution. In other cases there is no alter, native but to take a piece of other nervo from the same patient or from a fresh and quite healthy portion of an amputated limb to complete the circuit and restore continuity to the nervous system.

Results on the whole are good, but a considerable time must elapse to secure complete restoration of function, which is greatly aided by massage and electricity. Here one must pay a tribute to the devoted band of masseuses whose skilled services have been placed at the disposal of our soldier patients. Not only in these nerve cases, but in the numerous stiff joints following injury, massage is proving of the greatest service. SKIN AND BONE GRAFTING. The transplantation of living tissuesnerve, tendon, bone, and skin—is quite a common operation in Manchester, and many operations of orthopaedic surgery for the correction of deformities testify to the thoroughness of the work, and make clear the fact that nothing is left undone to restore the injured soldier so as to lit him to resume his place in the ranks of the army, or to return him almost unimpaired to his former work as a civilian.

The transplanting of bone and tendons, the supply of new elbow joints, skin grafting, and the giving of new life to partially paralysed muscles are among the other remarkable achievements in our Manchester hospitals. Some marvellously successful skin-graft-ing operations have been performed with a view to removing all traces of scars on the face or bauds. The skin is usually shaved from the patient's thigh. It might be from 2in to 6in long and -Jin to ljin wide, and about the thickness of very thin paper. If a bone has been shattered and more boue is required to fill a cavity which has completely destroyed the contour of the face, the surgeon takes a piece of bone from the tibia, or shin bone, to fill up the gap and to correct the malformation. Broken bones are sometimes joined up by screwing a plate over the disconnected parts, and it is not an uncommon thing to bore holes through the bones and secure the detached parts by threads of silver. Boiled white of and a piece of sponge are successfully employed to fill up bone cavities. One might specially mention the operations that are performed for the absolutely stiff elbow, where, as the result of a carefully planned surgical procedure, a wonderfully reconstructed elbow joint is obtained, with a range and variety of movement equal to the normal. Shrapnel wounds have n«»t been particularly septic, the reason being that when the fragments of shrapnel have entered the body they have been tot enough to cauterise the woands made. In connection with nearly all the shrapnel wounds the superficial tissues have been seared as though with a hot iron. Wounds of the largo blood vessels often lead to the formation of varieties of aneurism, and a large number of these have been treated in Manchester with conspicuous success. One of tie primary difficulties in treating the wounded soldier, when he arrives in Manchester, is that all the wounds ore septic, and the 6oldier is suffering in greater or less degree from bWd-p->w >:iing or infection. This, of con *'., greatly complicates the course <f the injury and sometimes ends fata'.lv.