A Surgeon in Belgium | Page 8

never know, of his existence. They
go to sleep in a quiet anteroom, and they waken up in the ward. Of the
operation and all its difficulties they know no more than their friends at
home. Perhaps even more wonderful is the newer method 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