Medicine: War Wounds

Military surgeons work by one rule of thumb: patch up and move on. At frontline dressing stations neither time nor sentiment is wasted on the hopelessly injured. A seriously wounded man has to survive the long stretcher trip through collecting station, hospital station, evacuation hospital to base hospital, some 30 or 40 miles behind the lines, before he is permitted the medical luxuries of thoroughgoing surgical care.

Though overworked army surgeons in World War I had to work thus, with a lick & a promise, great were the medical lessons they learned. Brilliant U. S. Neurologist Harvey Gushing, confronted with crowding thousands of head wounds such as he had never seen before, devised a dozen new brain operations by the light of a kerosene lamp in French front-line operating shacks. Tetanus, great killer in all previous wars, was practically eliminated by routine injections of anti-tetanic serum to all wounded soldiers. Fatalities from black gas gangrene were greatly reduced by immediate injections of vaccine, a treatment developed by famed U. S. Pathologist William H. Welch. The late Spanish war taught doctors a rapid, efficient blood-transfusion technique. But military surgery remains essentially a problem in organization, and doctors aim primarily to sort and shift casualties, to move them on like “factory goods on a conveyor belt.” Experts claim that eight operating teams, of nine men each (including anesthetists and nurses), can handle 120 serious surgical cases in ten hours.*

Most U. S. casualties in World War I were caused by gunshot, shrapnel, shell and rifle wounds. Most frequently injured organs were spinal columns. In decreasing order: abdomens, chests, heads. Exactly how casualties will line up in World War II, no one can yet predict, for new weapons cause new types of wounds. For every known type, army physicians are prepared. Many British surgeons carry an up-to-date handbook on war surgery, newly published by Drs. Philip Henry Mitchiner and Ernest Marshall Cowell.†

Penetration v. Laceration. Battlefield wounds are of two main types: penetrating, lacerating. Penetrating wounds are caused by bomb fragments and bullets, lacerating wounds by high explosive bombs. “Secondary bodies” may also act as missiles. “Thus the contents of a victim’s pockets,” say Drs. Mitchiner and Cowell, “may be peppered by the force of the burst bomb, and such things as … penknives, coins and pencils may be found distributed in the body, and occasionally outside objects such as pebbles, bits of masonry, and even the bones and soft tissues of a nearby victim may cause wounds.” Grease, dirt and bits of clothing are driven into wounds. It is a military axiom that “every wound is infected.”

When a man is perforated by a bullet, the bullet does not always go into or through him in a straight track, even when the holes where the bullet came in and ‘went out are in a straight line. A sharp-nosed bullet is easily deflected by ribs or tough muscles. A surgeon must explore the internal track of all penetrating bullets, no matter how tiny the entering wounds may seem. If he meets an abdominal wound, for instance, he must first cut off all jagged infected surface tissue. Without damaging important nerves, veins, arteries, he must then pull out the intestines “foot by foot,” looking for bullet perforations, and stitching them up. Although he may find as many as eight or ten perforations, the entire operation should not take more than 20 minutes. If he neglects the exploration, his patient is almost certain to die from hemorrhage or peritonitis. (Patients suffering from hemorrhage should have an H marked on their foreheads.to insure prompt treatment.)

Lacerating wounds usually rip out huge chunks of a victim’s body. “The only way to save the lives of most of these patients is prompt amputation.” When they are partly eviscerated, as they often are, nothing much can be done.

Wound Shock. The bane of medical officers in France during World War I. “wound shock” is a condition of “lowered vitality” which follows wounds, even trivial ones. Unchecked, it causes death. Wound shock comes from pain, loss of body heat, bleeding and toxemia. Lack of water balance, due to excessive sweating and short water rations, makes soldiers ready victims. The loss of fluid thickens their blood, produces a high concentration of poisonous urea. Best treatment for wound shock, discovered in the last year of World War I: 1) small doses of morphine for relief of pain; 2) an abundance of blankets and hot water bottles to prevent chill; 3) plenty of warm, sweet tea to restore a proper water balance; 4) blood transfusion to avoid blood poisoning; 5) operation as soon as the patient comes out of shock.

Anesthesia and Antiseptics. Small amounts of morphine are used to dull pain. For deep anesthesia, gas and oxygen are considered safest. Oxygen tanks should be stored underground, where they cannot be exploded by bombs or shellfire.

All instruments and dressings are of course sterilized. But Drs. Mitchiner and Cowell do not believe in the use of antiseptics for wound surgery. Powerful antiseptics, they hold, “cause more damage to the tissue cells than to the micro-organisms and thus encourage the spread of infection.” Iodine they mention only to “condemn.”

Burns. Standard treatment for burns, whether caused by incendiary bombs, mustard gas or lewisite, is application of tannic-acid dressings. Where tannic acid is not available, strong, lukewarm tea is a good substitute. Tannic-acid compresses must be left undisturbed for two or three weeks, until new skin forms. Victims of mustard gas must have their clothes carefully removed, must be “decontaminated” with soap, clean water and sodium bicarbonate, rubbed with a paste of bleaching powder and water, successful antidote for the oily gas. Then routine tannic-acid treatment follows. Mustard gas can remain on the skin for ten minutes before burns occur; lewisite burns immediately. But treatment for both is the same.

*In Paris last week, 400 U. S. veterans and 100 U. S. women registered at American Legion Headquarters for service in the Legion’s volunteer ambulance corps. Soon to reach the Western Front, the corps consists of three ambulances, a portable garage, 20 stretchers, twelve drivers. Chief organizer: burly Dr. James V. Sparks of Indianapolis, veteran of the Lafayette Escadrille.

† MEDICAL ORGANISATION AND SURGICAL PRACTICE IN AIR RAIDS—J. and A. Churchill ($2.75).