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About Omaha daily bee. (Omaha [Neb.]) 187?-1922 | View Entire Issue (Sept. 9, 1917)
THE OMAHA SUNDAY BEE: SEPTEMBER 9, 1917. 5 D AK-SAR-BEN GREETERS Men who extend the glad hand to visitors for the kin?. These are (left to right) : Front Row F. W. Fitch, George H. Dodds, M. E. Larsen, H. T. Cutler, H. K. Burket, Dr. H. A. Foster, H. C. Hartry. Center A. A. Alwine, Lou E. Adams, R. L. Manzey, J. T. Dysart. Back -N. L. Sjolin, H. G. Moran. r-b . K r ryt 1 . ' f, Tti JZ&s 'fVH .ii i . ,IM , i, . -p. , , . i ' .t ii. iii- i n iU , ii I,, " Pr.fTT.iT pn , i. i. ... ..-r TELLS U.S. DOCTORS OF WAR PRACTICE Swiss Surgeon Reviews Three Years Work at Front for Benefit of Medics Go ing Abroad. In order tjiat physicians and sur geons in the United States who ex pect to serve at the various European fronts may know just what practice at these fronts is, Dr. Charles Green Cumston of Geneva, Switzerland, pri-yai-docent at the University of Ge neva, etc., has written for the Medical Record as follows under the title "Some Reflections on the Surgery of War, Viewed After Three Years. "The following desultory remarks are offered to the men who are to take the field and have so far re mained in the United States, far from the centers of action. It will be evi dent that what is to follow is merely a very incomplete summary of the present surgical situation, but it may in a few words give a general idea of practice at the front. "The surgery of warfare so greatly differs from what surgeons have been used to that it was at first a surprise to all to encounter so great a number of cases that civil practice had insuffi ciently known. Unquestionably, . the great surgical principles remained un changed, but the very nature of the wounds of warfare, the 'reactions of the injured, and the surroundings in general created absolutely new con ditions for which adaptation was nec essary. But this requisite adaptation rapidly took place, and a new war surgery has resulted, doing away with all the theories of gunshot wounds formulated as a' consequence of the Russo-Japanese and Balkan wars. New War Surgery. , "The first fact which has been ac quired is that most wounds or injuries are due to rifle bullets, grenades, bursting shells, etc., and that bayonet wounds are very rare; In some of my lecture notes published in the Boston Medical and Surgical Journal and in the New York Medical Journal at the beginning of the war I at that time prognosticated that such would be the case, because that fighting, with bayonets in hand-to-Tiand struggles would be limited in extent, and also because a bayonet wound would be more likely to be driven home in the abdomen or thorax, thus wounding the important structures .and blood vessels particularly, with instantly fatal results, and such has been the rtse, with, of course, some few excep tions, particularly so far as the limbs are concerned.' "Another point to which attention should be called is the almost invaria ble infection of wounds. Every wound, with the exception of a 'seton shot,' must be looked upon as infected torn the start. A rise in temperature vill be present within a few hours ifter the injury, the index of a com mencing septic process. The etiologi cal factors of wound iifection in war are legion, but injuries resulting from a spent bullet or bursting shell are invariably soilef'. with earth and bits of clothing, the latter containing in its meshes numbers of. anaerobic bac teria, the former containing the te tanus bacillus. "Very frequently the medical post on the firing line is so incumbered during action that only sumrrtary at tention can be given to many injuries, while the transport of the injured in such great numbers often under the most adverse conditions, is among the multiple but unfortunately unavoid able causes favoring infection. 1 Value of Rest and Calm. . '"Within a few days, not infre quently within twenty-four hours of proper treatment at a hospital or am bulance at the rear, a rapid improve ment becomes visible in . many severely injured. After a few days of rest and calm the temperature reaches the normal and for this reason it is incumbent for the surgeons at the frOnt to get their wounded to the rear . in all cases where the patient will 'be able to bear the transportation. fit may be said in a general way that wounds in warfare suppurate un til their complete cicatrization, re gardless of the most minute aseptic and antiseptic treatment. The causes are the very nature of the injury, in the first place. The entrance and exit openings of a bullet which has gone through a limb have a decided tendency to close, often within a day or two after receipt of the injury, while the tract still contains foreign bodies of all sorts, particularly bits of clothing. If the bone has been in jured, splinters will be present in the traumatic focus, and those detached from the periosteum will act as for eign bodies and increase the progress of infection. "Bullets and pieces of shell or shrapnel shot frequently become en cysted without producing any disor ders if they do not involve a nerve trunk or large blood vessel But with the exception of bullets these foreign bodies practically always carry dirt and bits of clothing into the wound, and these cannot be diagnosed, but it must be taken for granted that they are there. Therefore, every wound must be freely opened, exposed, and all foreign bodies removed. "Besides projectiles, one often finds other foreign bodies in the wound, such as buttons; and I know of a case of a large abscess on the thigh from which, after incision, the remains f the soldier's watch was removed. "Given these septic lesions, it is evident that antisepsis is to be relied upon much more than in civil practice. Carbolic acid is an excellent antisep s " ..." . tic, but has now been given up, very largely on account of poisoning, which which was largely noted by tnglish and Canadian surgeons. Dakins so lution is of value and should be em ployed in spite of much adverse criti cism to which it has, and, I think most unjustly, been subjected. Use of Antiseptics. "I am of the opinion that ether is a very superior antiseptic, and its use in peritonitis and large injuries to the joints and limbs, I can confidently recommend. It is indicated in vast cavities which are not easily drained, such, for example, as compound frac tures of the thigh. Space doe's not permit me to consider many other ex cellent antiseptics, but I would partic ularly mention irrigation with a 1 :200, 000 silver nitrate solution according to the method of Denyze, when disin fection combined with stimulating ac tion is required. "Correct statistics can only be made after the war is over, but certain facts are nevertheless striking. Unques tionably vast fracture wounds are the most common, and it is also evident that since the use of Adrien's metal helmet injuries oi the skull and brain have decreased quite notably. "In order of frequency fractures of the thigh come first, after which come those of the leg and humerus. I am also of the opinion that fractures of the leg more frequently escape .the ef fects of conservative treatment and necessitate amputation, and after them come fractures of the thigh. Fractures of the humerus seem gen erally to consolidate quickly after proper immobilization has been ob tained. ' . "Open fracture of the femur al ways seem the most serious at first, because the vast wound is usually ac companied by a focus difficult to drain, but if muscular contraction is over come and carefully guarded against the prognoses in many cases will pot prove to be as bad as when the case was first seen. On the whole, ampu tations of the thigh have not been considerable during the war. .""After free exposure of the wound focus and removal of the bone splin ters and foreign bodies, if the sup puration is free and the fracture easy to keep reduced, some simple splint may be all that is required in some cases, but the best results areunques-. tionably obtained by extension ap paratuses. Oi course, when the wound needs frequent daily dressings the plaster of paris collar splints, With galvanized tin joining brackets, are the only type to be employed. The Question of Amputation. "When the suppuration continues, and shows no inclination to diminish in infected cases, with a progressive decline of the patient's general health from sepsis, the question of amputa tion comes up for consideration. It is better to be conservative in regard to removing a limb, and it is better to temporize within the limits of safety, because we have all seen cases m which amputation was judged neces sary by some, but the patients recov ered with their limbs, although not in perfect condition, still with a con solidation that was quite acceptable. "Wounds of the thorax and abdo men, naturally penetrating ones, re quire more space than I can give, but I may say that, contrary to what was thought at the beginning of this war, most surgeons are now convinced that when one can operate in proper sur roundings a laparotomy (opening the abdomen) should be done at once, even in an ambulance behind the line, ant results have justified this conclu sion. Penetrating wounds of the thorax involving the heart or lung constitutes a subject too long to be discussed, but I would say that at the ambulance, after cleaning the sur rounding skin, a very tight binder should be applied, morphine given to ease the. dyspnea, (shortness xof breath), and the case then watched for further developments. "It is astonishing how well a large percentage of thoracic wounds do. Empvema (abcess of the lung) is very prone to occur, but resection of one or two ribs and pleurotomy have usually mastered the situation, even when it appeared desperate." Persistent Advertising is the Road to Success. Victor Motor Co. . Takes New Business Announcement was made last week to the effect that the Victor Motor Car company will lake over the busi ness of the McShane Motor company, which has had the Hupmobile and Mercer. 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Thus hangers and fasteners are unnecessary.. In dozens of scien tific ways Marmon construction is simplified and weight reduced. , So comes this big light car that gives between 50 and 7 per cent more gasoline mileage and 40 to 50 per cent more service from tires. Moreover, the Marmon excels heavier cars in readability. Low center of gravity, minimum un sprung weight, long wheelbase and almost perfect balance combine to produce riding qualities that cars of old-style build cannot match regardless of weight.' 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