| OCR Text |
Show X-Rays the Light of the World in Modem War Surgery By Minnie Goodnow ' Doric in France) The X-ray is Indispensable In war, even more than In peace. Fractures of bones are located by its means of which more later. Since virtually all wounds are made by some sort of a missile, there is always a likelihood that all or part of the missiles may still be in the man's body. The X-ray is in constant use to locate them. These foreign bodies (noted as "f.b." on the surgeons' charts) are found fSre you least expect them. A bullet bul-let rShave struck a bone at an angle and glanced off inan unheard-of direc-! direc-! tion. Shrapnel may be in any location loca-tion and in any sized pieces. In the welter of blood which accompanies operation, the surgeon's eyes or fingers fin-gers may easily miss rather large pieces; but the X-ray locates them unfailingly. un-failingly. How It Is Done. In order to get the exact location of the foreign body, two views are always taken. If one's first picture happens to be taken directly in front of the object, one cannot tell how deeply it lies;. one must get a side view as well. Or. one may get an edgewise view at first and think the Piece of metal very small, when another an-other picture shows it to be of quite a size. If the wound Involves important tissues, even three pictures may be teken; by their means the foreign body I may be located with such exactness 'hat the operating knife may find it v-'ith the greatest possible accuracy ! anl tiie least possible damage. Removal of Shrapnel. In the begin-r'i!ig begin-r'i!ig only the largest or most important impor-tant pieces are sought. Small bits, Imbedded in unimportant places, one does not trouble about. They can be Amoved at some other time. At the s:art, life or future health are made oie chief considerations; mere comfort cmes later. Still, any, piece which 'ouid interfere with the healing of a Wr-ur.d must be taken out. itimes a bit of shrapnel will ork up toward the surface of a ' wound and appear of itself. Pieces of Nothing also do the same thing, and r;s-7s aftf- the man is admitted to their Invaluable in' Peace They Are Indispensable in the War Hospitals of France Uncanny Predictions by Surgeons as to When Wounds Will Heal pick out of the wounds shreds of British Brit-ish khaki or French "horizon blue" 05 tiny scraps of metal, as the case maybe. may-be. If the scattered bits inadvertently-left inadvertently-left behind are near the surface, the soldier himself often locates them. A little cocaine is injected and they are quickly removed. The t'se of the Vibreur. When the foreign body lies deep, even with good X-ray pictures to locate it, It is easily missed in attempting a removal. To help out the situation, an instrument called the vibreur has been devised. It is a large electric magnet, made of a bundle of rods, hung so as to be freely manipulated. The surgeon protects pro-tects himself with rubber gloves, his assisting nurse wTaps the magnet in a sterile towel, the current is turned on and the vibreur is placed in the wound, in contact - with it. The magnetic force pulls the foreign body which is of metal and therefore attracted by It toward the vibreur. The surgeon ' with the fingers of his free hand feels for it, finds the hard lump which is trying to make its' way out. gets Its exact location: he swings the magnet out of the way, takes his scalpel, and lol the thing is in his hand. A second trial may be necessary, where the wound is deep or difficult-to difficult-to get at; but the method is a very exact one. If the case is especially difficult the vibreur Is applied before the man is anesthetized, so that he may help in locating the foreign body. The Germs Which Infect Wounds. As has been said, all war wounds are infected. Bacteria, or germs, belong to the vegetable kingdom. iThey are not "bugs." though even doctors and nurses sometimes call them that.) They require for their growth exactly the same things that plants do,, warmth, moisture and a suitable soil. In the human body warmth and moisture are always present, and the soil is usually suitable. Some kinds of bacteria prefer better in muscular tissue. The streptococcus strep-tococcus and the staphylococcus (the common pus-producing bacteria), the bacillus of malignant edema, the tetanus teta-nus germ, the microbe of gas gangrene, gan-grene, etc., all find an ordinary flesh wound the best of soil. It is these which the surgeon has to' combat. Antiseptic vs. Aseptic Surgery. Aseptic means free from germs. Antiseptic Anti-septic means combating germs. Most of our modern surgery has been aseptic; asep-tic; that is, done with sterile hands and materials in a sterile field. War surgery has gone back to the days of Lister, the father of modern surgery, who used antiseptics in a field already infected. The First Treatment of a wound ls to remove all foreign matter that may be present in it. This is done by operation, oper-ation, by sponging, by Irrigation. At the same time the wound is thoroughly-opened, thoroughly-opened, so that it may drain, that all discharges may come away freely, that there be no pockets for infection to hide in, no odd corners for bacteria. If the wound is deep, narrow and likely to heal over on the surface before be-fore it fills in with healthy tissue at the bottom, it is kept open by some sort of a drain. This may be a tube, a strip of folded gauze, a bit of rubber tissue or whatever the surgeon may-find may-find appropriate. The Dressings. The wound or.ee o"pened and drained, the chief thing is to keep it dressed with an antiseptic which shall help to destroy the existing exist-ing germs or at any rate to prevent their growth. This antiseptic treatment treat-ment must be continued for days or weeks. since even a slight infection is sometimes very persistent. Since the first year of the war wet dressings have been used. Wounds are filled or covered with gauze wet in an antiseptic solution. This is renewed dally, or in serious cases twice a day. While w-e have changed the technic the approved one. and in its simplest form is still used for small, open w-ounds. For more extensive wounds, the Carrel treatment is employed, of which a description will be given later. New Antiseptics. It was speedily found, at the begining of the war, that the antiseptics which were efficient in ordinary- practice, such as bichloride of mercury, carbolic acid, lysol, etc., were very unsatisfactory. They took care of only the surface infection, while virulent bacteria grew undisturbed in the depths of the wounds, and the men died from the absorption of their poisons. poi-sons. New solutions had to be found. One of the best is a solution of hypho-chlorite hypho-chlorite of soda (prepared by a rather elaborate formula) which has come to be called Dakin's solution, from Da-kin, Da-kin, one of England's greatest surgeons, sur-geons, who introduced it. It is neutral in reaction, i. e.. neither acid nor alkaline, al-kaline, and penetrating to a marked degree. de-gree. It not only kills bacteria, but virtually "eats 'em alive." It is still the antiseptic of choice for most surgeons sur-geons in the war zone. It sometimes proves slightly irritating to the skin, out this is overcome by the simple expedient of anointing the edges ot the wound with common yellow vaseline. vase-line. Other solutions have also been successfully suc-cessfully used. Eau de javelle, a preparation prep-aration with which the French laundress laun-dress is familiar, has been employed with good results. It is similar in chemical composition to Dakin's solution, solu-tion, and is sometimes less irritating. Eusol. also similar to Dakin's. is much used in Eritish hospitals. Salt solution, solu-tion, made somewhat stronger than the well-known "normal salt solution" of our home hospitals, has been the accepted treatment of several famous surgeons, notably Sir Almoth Wright. Dr. Joseph A. Blake, formerly of New York, who is doing a large amount of research in his great Fa-is lutions. One is soda bicarbonate (the common baking soda), an alkali; for other cases he employs acetic acid, an opposite treatment; a quinine solution is used in others. Sometimes he alternates al-ternates an acid and an alkali, dressing dress-ing a wound with one for a day or two, then changing to the other, fie gets excellent results with all of them. They are used according to the sort of bacteria present in any particular wound. ' Microbe Charts. Doctor Carrel, in his hospital at Compiegne, was probably- the first to make and use "microbe "mi-crobe charts." De Page, of La Panne, in Belgium, and Turner, of Paris, are among his enthusiastic followers. These charts are graphic records of the number of bacteria (of all sorts) found in the wounds during the process of healing. At the time that dressings are changed, every day or alternato days, a specimen of the discharge from the wound is taken, and the bacteria bac-teria in it are counted. By this means a surgeon can know with absolute exactness ex-actness whether or not his line of treatment is proving effective. If the number of bacteria remains the same, or if it increases, it is certain that the wound will not heal. If, on the other hand, the number grows less with each count, one may be sure of a good result. Healing According to Prophecy. Lofcg use of these microbe charts, and their constant checking tip of progress, prog-ress, has, in the hands of surgeons using exact methods, enabled them to prophesy just when a certain wound will be healed. When the microbes disappear from the discharge, the wound is "sterilized." -vhich means germ-free, andr is ready to be sewed up, strapped together with adhesive plaster, plas-ter, or otherwise closed, with a certainty certain-ty of the trouble being ended. With Doctor Carrel's own patients, the pre-dictions pre-dictions are positively uncanny. At Compiegne they will tell you, weeks ahead, just the day when each wound will be healed, and the results invariably invari-ably tally with the prophecies. The sine qua r.on of the prophecy is that one has followed a specified line of treatment. Unless the treatment is appropriate and carefully done. Infection In-fection may persist and healing be p-o.-cTitoil for q vorv tons' Tln,o |
