A Surgeon in Belgium | Page 9

maintenance is implied in the term "aseptic surgery," and upon this depends the whole distinction between the surgery of the present and the surgery of the past. Without it the great advances of modern surgery would be entirely impossible. When we say, then, that every wound with which we had to deal was infected with bacteria, it will be realized how different were the problems which we had to face compared with those of work at home. But the difference was even more striking, for the bacteria which had infected the wounds were not those commonly met with in England. These wounds were for the most part received in the open country, and they were soiled by earth, manure, fragments of cloth covered with mud. They were therefore infected by the organisms which flourish on such soil, and not by the far more deadly denizens of our great cities. It is true that in soil one may meet with tetanus and other virulent bacteria, but in our experience these were rare. Now, there is one way in which all such infections may be defeated--by plenty of fresh air, or, better still, by oxygen. We had some very striking proofs of this, for in several cases the wounds were so horribly foul that it was impossible to tolerate their presence in the wards; and in these cases we made it a practice to put the patient in the open air, of course suitably protected, and to leave the wound exposed to the winds of heaven, with only a thin piece of gauze to protect it. The results were almost magical, for in two or three days the wounds lost their odour and began to look clean, whilst the patients lost all signs of the poisoning which had been so marked before. It may be partly to this that we owe the fact that we never had a case of tetanus. In all cases we treated our wounds with solutions of oxygen, and we avoided covering them up with heavy dressings; and we found that this plan was successful as well as economical.
Though any detailed description of surgical treatment would be out of place, there was one which in these surroundings was novel, and which was perhaps of general interest. Amongst all the cases which came to us, certainly the most awkward were the fractured thighs. It was not a question of a broken leg in the ordinary sense of the term. In every case there was a large infected wound to deal with, and as a rule several inches of the bone had been blown clean away. At first we regarded these cases with horror, for anything more hopeless than a thigh with 6 inches missing it is difficult to imagine. Splints presented almost insuperable difficulties, for the wounds had to be dressed two or three times, and however skilfully the splint was arranged, the least movement meant for the patient unendurable agony. After some hesitation we attempted the method of fixation by means of steel plates, which was introduced with such success by Sir Arbuthnot Lane in the case of simple fractures. The missing portion of the bone is replaced by a long steel plate, screwed by means of small steel screws to the portions which remain, "demonstrating," as a colleague put it, "the triumph of mind over the absence of matter." The result was a brilliant success, for not only could the limb now be handled as if there were no fracture at all, to the infinite comfort of the patient, but the wounds themselves cleared up with great rapidity. We were told that the plates would break loose, that the screws would come out, that the patient would come to a bad end through the violent sepsis induced by the presence of a "foreign body" in the shape of the steel plate. But none of these disasters happened, the cases did extremely well, and one of our most indignant critics returned to his own hospital after seeing them with his pockets full of plates. The only difficulty with some of them was to induce them to stop in bed, and it is a fact that on the night of our bombardment I met one of them walking downstairs, leaning on a dresser's arm, ten days after the operation.
And this brings me to a subject on which I feel very strongly, the folly of removing bullets. If a bullet is doing any harm, pressing on some nerve, interfering with a joint, or in any way causing pain or inconvenience, by all means let it be removed, though even then it should in most cases never be touched until the wound is completely healed. But the mere presence of a bullet inside the body will of itself do no harm