A Surgeon in Belgium | Page 9

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
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