A Surgeon in Belgium | Page 8

of spinal anaesthesia, which we used largely for the difficult abdominal cases. With the injection of a minute quantity of fluid into the spine all sensation disappears up to the level of the arms, and, provided he cannot see what is going on, any operation below that level can be carried out without the patient knowing anything about it at all. It is rather uncanny at first to see a patient lying smoking a cigarette and reading the paper whilst on the other side of a screen a big operation is in progress. But for many cases this method is unsuitable, and without chloroform we should indeed have been at a loss. The Belgians are an abstemious race, and they took it beautifully. I am afraid they were a striking contrast to their brothers on this side of the water. Chloroform does not mix well with alcohol in the human body, and the British working man is rather fond of demonstrating the fact.
With surgery on rather bold lines it was extraordinary how much could be done, especially in the way of saving limbs. During the whole of our stay in Antwerp we never once had to resort to an amputation. We were dealing with healthy and vigorous men, and once they had got over the shock of injury they had wonderful powers of recovery. We very soon found that we were dealing with cases to which the ordinary rules of surgery did not apply. The fundamental principles of the art must always be the same, but here the conditions of their application were essentially different from those of civil practice. Two of these conditions were of general interest: the great destruction of the tissues in most wounds, and the infection of the wounds, which was almost universal.
Where a wound has been produced by a large fragment of shell, one expects to see considerable damage; in fact, a whole limb may be torn off, or death may be instant from some terrible injury to the body. But where the object of the enemy is the injury of individuals, and not the destruction of buildings, they often use shrapnel, and the resulting wounds resemble those from the old smooth-bore guns of our ancestors. Shrapnel consists of a large number of bullets about half an inch in diameter packed together in a case, which carries also a charge of explosive timed to burst at the moment when it reaches its object. The balls are small and round, and if they go straight through soft tissues they do not do much damage. If, however, they strike a bone, they are so soft that their shape becomes irregular, and the injury they can produce in their further course is almost without limit. On the whole, they do not as a rule produce great damage, for in many cases they are nearly spent when they reach their mark. Pieces of the case will, of course, have much the same effect as an ordinary shell.
The effects of rifle-fire, particularly at short ranges, have led to a great deal of discussion, and each side has accused the other of using dum-dum bullets. The ordinary bullet consists of a lead core with a casing of nickel, since the soft lead would soon choke rifling. Such a bullet under ordinary circumstances makes a clean perforation, piercing the soft tissues, and sometimes the bones, with very little damage. In a dum-dum bullet the casing at the tip is cut or removed, with the result that, on striking, the casing spreads out and forms a rough, irregular missile, which does terrific damage. Such bullets were forbidden by the Geneva Convention. But the German bullet is much more subtle than this. It is short and pointed, and when it strikes it turns completely over and goes through backwards. The base of the bullet has no cover, and consequently spreads in a manner precisely similar to that in a dum-dum, with equally deadly results. There could be no greater contrast than that between the wounds with which we had to deal in South Africa, produced by ordinary bullets, and those which our soldiers are now receiving from German rifles. The former were often so slight that it was quite a common occurrence for a soldier to discover accidentally that he had been wounded some time previously. In the present war rifle wounds have been amongst the most deadly with which we have had to deal.
It will thus be seen that in most cases the wounds were anything but clean-cut; with very few exceptions, they were never surgically clean. By surgically clean we mean that no bacteria are present which can interfere with the healing of the tissues, and only those who are familiar with surgical work can realize the importance of this condition. Its