Show MonERN SURGERY IN TflFWR Wounds Through Head and Heart Not FatalEffect 0 Mauser Bullets Special Correspondence j New Yorkug 19Dr William M Gray of the hospital ship Relief found time the other day to talk of the part that surgery has playedin the present war and the influence of new scientific I ap lances us tested bj practical experience ex-perience In making the lot of the wcunded men easier Dr Gray is the 1irosopist at the medical museum at Washington and was detailed by this I iLsttuton for surgIcal work in war with secia reference to the diagnosis of gunshot wounds by the Roentgen rays rysOne thing this war has taught he I toms ana one very remarleaDe case where a bullet entered the left chest passed through the body and out of the abdomen went through the air for a foot or so and landed in the right thigh about half way to the knee WOUND IN TH HEAT NOT FATAL Another case whicb caused some discussion dis-cussion among the surgeons was that of a man shot through the breast on the left side the bullet entering about a quarter of an inch below the nipple and passing out at the back shattering shatter-ing the shoulder bade The point of exit showed that the bullet took an upward up-ward course which made i certain that it passed yer close to the point of the heart Indeed it is an open I question whether It did not actually pas through the heart The doctors are aJeed that i nassed throuch the I pericardium or covering of the heart i I and Major George H Torney the surgeon I sur-geon In command of the Belief is in I I dined to belIeve that the heart itself was penetrated I I I is conceivable he mid that a man may live as this one did even though a bullet has gone through his heart We must suppose that the bullet bul-let struck the heart just as I was drawn hard together in its closest contraction con-traction I Is very likply that if the same bullet had come when the heart I was on the other beat and therefor I distended and softer it would h vet ve-t S t I f e been so badly torn that death would have ensued Dr Gray explained that most of the operations were performed at night as the days were crowded full receiving the wounded Even so we were not rushed he said On the average we had three or four operatons each night sometimes as many as six You sec the emergency emer-gency work was done on the field be sore we received the wounded We had plenty of time to work carefully Did you use ether No chloroform I is better on shipboard as it Is not so Inflammable and takes up less space We had no h1 I 7j fj ittfL H 1 jj 4 I SKIAGBAPK TAKEN ABOARD THE PELTEF SHOWflG TEE SKIGRAH TAN A0AD T RELT SHOWG T COURSE OFA BULLE1 FTNALLY LODGING I T ARM said is that the probe in alit forms has gone out of use No more searching search-Ing blindly In a mans body for the bullet no more danger of blood poisoning I pois-oning from the Introduction into the I wound of inrruments of search The fluoroscope tells us InstantlY where I the projectile has imbedded Itself and I we have only to cut it out as if it were thre before our eyes The ingenious I electric proce and all similar devIces I have seen their day In all future bat I t s experts in sldagaply will be attached at-tached of necessity to the medical I corps and the work of the surgeons I wi be materially assisted by their I precise indications We took out bullets bul-lets by the pint on board the Relief I and almost without exception they were located by the Xrays The surgeon exhibited the apparatus for producing the Xras and the operating table ilere the skiagahs are made These stand amidships in I an open space ranged about wth hospital I hos-pital cots Dr Gray explained that I excellent a the result have been so far they will be better in the future I since the Relief starts on her new cruise with much improve Xry appliances ap-pliances In the developing room he showed a number of Xray plates such as were prepared for the surgeons gUidarce these cannot fail to furnish interesting data for the surgical history his-tory of the war I seemed that valuable time might be lost in making these pictures and the doctor was asked about i I is all done In a few moments he said five seconds for a wound m the hand thirty seconds for one in the foot and not over ten or fifteen min utes for a wound through the thick pelvis The patent is stretched out here the Xray bulb adjusted over the wound like this see illustration the plate put under the limb or part where the wound Is and the thing is done The plates are developed almost instantly In many cases we save hours of vain searching not infrequently infre-quently we save the soldiers life Then he went on to tel of a re I markable case where a man was I wounded in the right shoulder by a Iauser bullet which plowed its way I on around the chest walls under the deep muscles and lodged in the left arm shattering the humerus Hee was an odd cOditon a wound in the I right shoulder but no bullet the hone of the left arm broken hut no wound Hnw4ong do you suppose would have I taken to find that bullet by probing It did not take us one minute to find It I with the Xrays Here i is in this I I picture you sue it there quite plainly I He handed over a sldagaph reproduced repro-duced herewith that shows the fractured I I frac-tured humerus and the imbedded bullet bul-let as if the arm were transparent I I was simply n matter of a few cuts and I II the bullet was outDid I out-DId the bullet do nb harm doctor in going through the body i Apparently not the man made lit I J tie complaint and Is doing nicely We have had more remarkable cases than that of Mauser bullets passing through the body and doing no harm One man wa shot through from side to side with both lungs traversed but he had no symptoms not even any bleeding There was just a small red spot where the bullet went in and a small red pot where i came out I his leg had not been cracked bj another shot he would not have been in the hospital We I had two cases on the ship shot through i the Intestines but showing no symptoms j symp-toms one case of a man shot through the liver and kidneys with n symp I deaths from the anaesthetc Did you have to operate in bad weather No we were fortunate in having a smooth sea I would be impossible to operate in a storm the patents would have to wait WOMEN NURSES How may nurses had you onboard on-board About 3010 men and 20 women We shall have a larger proportion of women wo-men nurse on the next cruise It seemed to be the general opinion among the doctors that the wounded can get no care bike that which women give gve But the doctors are equally positive in declaring women out of place on the field of battle They ant stand the horrors of i said Major Torney they are too sensitive One of the surprises of this war to I the surgeons has beep he failure of the fauser bullet to dorsuch work of I bone shattering and general destruction I destruc-tion a had been prophesied for it The result of many experiments made before I be-fore the war had been to satisfy experts that this small bullet with Its velocity would do more damage to the human body than had ever ben done by any I other bullet Mauser bullets had been fred into bags of sana and cans of water and cadavers f such a splashing splash-ing and plowing and splintering a to I cause them to be looked upon a mot formidable engnes of carnage And yet f in real warfare when practically tested I upon the bodies of our men these bul lets have by no means shown the vI I ciousness expected of them I MAUSER BULLETS You know they told us said Dr I I Gray that the Mauser bullets would make a small hoH where they entered the body but would come out through a hole big enough to put your fist in I Well nothing of the sort has happened I In cases under our obseraton On the I contrary the hole of exit has often been I I I que as small a the hole of entry i Take that case I mentioned of the man i shot through from side to side there was vo difference In the size of the two holes and both were very small Then they told us and seemed to prove it bj experiment that the impact im-pact of a Iauser bullet against large bones or against the skull would cause I a frightful splnteing oe the bone or cranium I remember a case where a doctor for sake of experiment fired I Mauser bullets Into a human leg only I a few minutes after its amputation and the bullets did bulets certainly shatter I the bones in a most alarming way But I in practIce under SpanIsh r the rauser bullets have shown less shat tering power than our on KrgJO 1 gensen bullets Mauser bullets fred into the skulls of cadaver splintered them into fragments but Mauser bullets bul-lets fred into the skulls of live Amen cans in many cases made only two clean holes And did the men live shot through the brain In one or two cases they dId but most of them died from the poisoning of foreign mater brought into the bran with the bullets As far as the bone shattering went they might have I recovered Have you any theory doctor to account I ac-count for this difference between what was expected of the Mauser bullets and I what was actual done by them 1 1 Ca only sugqest that the trouble < < n may have been with defective ammunition ammuni-tion used by the Spaniards Perhaps the bullets were not really drIven against us as hari as is supposed You see Mauser bullets are counted upon to kill at 3500 yards and mot 01 our men were wounded at distances varying between tween 500 and 1000 yards Very few were wounded under 500 yards for the simple reason that when we got a close a that the Spaniards ran I is rather odd but true tat Spaniards wounded under the same conditions a our men usually show worse woundf This Is one of the puzzles of the war that experts will have to work out EFFECT OF BULLETS Lieutenant Colonel Senn chief of operating staff with the army in the field has been with the Relief and sails with her again Dr 8enn ex plans the fact that so large a proportion propor-tion of bullets a 10 per cent remained in the bodies of the wounded on the assumption that may of these bullets before striking the bodies in which they lodged had ben impeded or deflected i In their course by stones trees underbrush I brush etc on the field This would I seem to be IndIcted by the bent or flattened condition of may bullets found embedded in soft tissues D Semi sees no reason to doubt that the modem elongated bullet will Jecome moder elongate bulet wi t cme encysted in the body a readi perhaps per-haps more so than the oldfahIon leaden bullet All patients treated by him for gunshot wound in the spine where the spinal cord was seriously damaged have died or will die in the near future As to chest wounds he found an astonishing number where the sufferers lived long enough to reach a hospital or the coast and what is still more surprising he says that barring bar-ring severe hemorrhage the patients symptoms were mild some of them being confined to bed for only a few days All of these chest wound cases were treated on the expectant plan that is by dressing the external wound I or wounds in no instance was the pleural cavity opened for the purpose of arresting the hemorrhage It is well known said Dr Senn that fiuinintr the war of the rebellion lijea had a better chance for life when a bullet passed through the chest than when the chest was opened and the ball remained The sante remains true hOW although not to the same extent as the small calibre bullet is less likely to carry with it into the chest clothing or other infectious material No further doubt remains In regard to the difference in the mortality from gunshot wounds inflicted with large and small calibre bullets The cases treated on board the Relief appear to prove that the danger incident to gunshot gun-shot wounds in the chest made b small projectiles consist in complicating complicat-ing Injuries involving the heart and large blood vessels and that in the absence of such injuries the progress Is favorable Another conviction that has been strengthened In me by our recent cx perience in Cuba is that not infrequently infre-quently cases of penetrating gunshot wounds in the abdomen will recover without active surgical interference For years I have maintained as the result of clinical experience and ex peniments on the cadaver that a huh let may pass through the abdomen on a level with and above the umbilicus without producing visceral injuries demanding active operation On the other hand if a bullet traverses the small intestine area it is probable that from one to 14 perforatIons will be found In this case death is almost certain to ensue and did ensue in every such instance In our Cuban experience despite surgical operations CLEVELAND MOFFETT ii fii i Jill I I llIli4 I5 2 JL i t S LOZAPI BULLETS BY X4AYSONBOARD THE RELIEF |