Wonders of War Surgery

[The New York Times/Current History, February 1917]

In every one of the belligerent countries there is now a new army, the army of maimed and crippled men. So great is their number they are to be counted by hundreds of thousands and so serious is the loss to the efficiency of the respective nations that it is realized that nothing less than heroic measures can minimize the evil both to the community and to the individual sufferer.

While the war goes on the first consideration in dealing with the men who appear in the casualty lists under the heading of "wounded" is to get as many as possible fit again for the firing line. This exclusively military standpoint has had a tendency to leave the man incapacitated for further fighting to shift for himself or rely upon charity. The army authorities, finding that a wounded soldier could not be patched up, have lost interest in him, given him his discharge and a pension, and forgotten other national needs. It has, however, become increasingly evident that, while a man may have ceased to be of further militaryvalue, it would be disastrous to let him become a useless member of society, a source of expense to the State and a burden to himself.

A man may have lost a limb or his eye-sight, and yet, given the opportunity, he may be fitted for some new useful occupation. Accordingly, in Germany and France, and to some extent in Great Britain, the foundations are being laid for a system of "re-education," that is, a system of vocational training that will enable wounded men to begin a new career of usefulness. In this way it is hoped to alleviate somewhat the horror of the human wreckage and reduce the waste of industrial man power.

One of the striking features of the war has been the rapid progress in surgery consequent upon the necessity of saving life and limb. Surgeons have performed operations that were hardly thought possible before the war. New methods have been discovered, new appliances invented, and, indeed, an entirely new chapter has been written in the history of surgery. Soldiers, whose fighting days seemed at an end, have been remade and sent back to the front as fit and strong as when they first joined the colors.

In the old days, as any one who has read history knows, the practice was to amputate as a matter of course. Now every effort is made not to amputate, for surgery in its progress has become conservative in the best sense of the word. Thus, at the Herbert Hospital, Shooter's Hill, London, there have been between three and four thousand operations on wounded soldiers, but of these only about twenty-five have been primary amputations.

Extraordinary operations are being performed every day in cases of bone, muscle, and nerve fracture. The surgeons, discovering that the human body has greater powers of recuperation than they thought, do not hesitate to take a piece of bone from one part of a patient's anatomy and utilize it to repair another that has been destroyed or removed. At another military hospital in London there was, for example, a case of severe injury to the jaw. The surgeon removed a piece of bone about 2½ inches long from the tibia (the large shinbone) of the patient and fixed it in the jaw. The man's leg has healed up, and the jaw has improved so much that eating is now a far less painful process. In very many cases a broken bone is rejoined by a steel splint screwed to the bone just as a carpenter screws together two pieces of wood. The steel plate, which is sometimes an inch wide and four or five inches long, remains permanently in the wound, together with the steel screws, without pain or inconvenience. One of the surgeons who has performed many of these operations believes that in time the steel will become dissipated in the system and disappear altogether. As iron is one of the constitutents of the blood, the splint does not become a source of danger.

Wonderful successes have also been achieved with injured nerves. At the Hammersmith General Hospital, London, for example, six useless muscles were taken from one side of a patient's wrist and transferred to the other, with the result that the hand, previously paralyzed, could once more be used. In another case the surgeon found four inches of a nerve in the arm gone. He telephoned round to the other London hospitals to inquire whether an amputation was in prospect and learned that a man was to have a leg off that afternoon. He asked that the severed limb should be put at once in a saline bath and brought to him in a taxicab. The patient was already under an anaesthetic when the leg, still bloodwarm, arrived. The surgeon promptly transferred four inches of nerve from the amputated leg to the arm of the patient with a perfectly successful result.

But perhaps the most wonderful surgical triumph was that in the case of a man with a shrapnel wound. A piece of metal, about the size of a twenty-five-cent piece and much thicker, had entered the breast and lodged in the region of the heart. It was actually touching the heart and impeding its action. When the opening was made the surgeon thrust his hand right in and pulled out the piece of metal. The soldier made a complete recovery. The triumphs of British, French, and German practitioners would fill volumes.

The bacteriologist has also played an important part in the war. In the earlier period of the war tetanus was playing havoc among the troops, and great work was done in combating its ravages by the famous French physician, Doyen, since dead. More recently an important discovery has been made by Miss Mary Davies, bacteriologist for the Robert Walton Goelet Research Fund, as the result of experiments at a hospital in France. One of the chief causes of infection has been pieces of uniform shot into the body. Miss Davies, who had alreadygained distinction by inoculating herself with gangrene bacilli to prove the efficacy of Taylor's specific, set to work to discover how soldiers' uniforms could be rendered aseptic. She finally devised a treatment based upon a combination of cresol and soft soap with which the clothing is to be periodically impregnated.

Mr. Lloyd George, then War Minister in England, on receiving Miss Davies's report, ordered that the British soldiers' clothes should be sterilized with her preparation. In addition to its value in reducing the proportion of highly septic wounds the preparation is also welcome as a destroyer of body lice, one of the greatest discomforts of life in the trenches.

Military considerations have, of course, been so far uppermost in the treatment of wounded men; but it is recognized that steps must be taken to prepare the maimed, crippled, and invalided as effectively as possible for civil life after the war. Germany has in this respect taken the lead. There sixty schools are already in existence for the purpose of training men in new occupations. France has also made a vigorous beginning in the matter of "reducation des mutiles." M. Millerand took the initiative while Minister of War. As a result of the movement then begun, the Ministries of the Interior, of Commerce, and of Agriculture have since joined hands to create a system of training the "mutilated" for new occupations.

At first there was naturally some confusion of method. Men who had lost legs or feet were placed in the same institutions as those who had lost arms or hands, when obviously two such distinct classes of wounded men needed different courses of training. But these early mistakes have been corrected, and the French Government, beginning with the great school established at Bordeaux, has evolved a system which will ultimately classify the "mutilated" according to the limbs or organs they have lost and find appropriate occupations for the different groups. Legless men who can use their hands will learn different crafts from those who are armless, and so on.

Great Britain has moved metre slowly than France or Germany in the task of re-educating her mutilated men. Nevertheless a start has been made, in one instance more through the spontaneous desire of the wounded soldiers to have something to do to pass the time than because of any carefully thought-out plan. At the Military Orthopedic Hospital, Shepherd's Bush, London, a proportion of the 800 inmates have been set to work at a variety of occupations. Workshops have been built, as well as a gymnasium. In one of the shops a number of men are now making surgical boots, and have developed so much skill that their work is as good as that of the lifelong craftsman, while the hospital is getting the articles it requires at practically cost price. Other wounded men are making aluminium splints, steel supports, and leather bandages for their comrades.

One of the most pathetic, and yet curious, sights is to see two men who have each lost a hand combining to do the work of one man. You will see, for example, in the blacksmith's shop attached to the hospital a one-handed soldier pumping the bellows till the steel is red hot. Then he takes it out of the fire and places it on an anvil, where he holds it in position while another one-handed man hammers it into shape. In the carpenter's shop you will see similar teamwork by a couple of men engaged on a skillful piece of joinery for hospital use, one man holding the nail while the other does the hammering. Men who have lost the right arm or hand learn to put the left to new uses, and it is amazing how resourceful a man with only one hand can become.

The British Government, however, is slow in developing a national system of re-education for the disabled, for in this, as in most things, the British way is not to plan beforehand or with much logic, but to improvise and build up as one goes along. John Galsworthy, however, has foreseen the danger that must inevitably arise if the treatment of the wounded and disabled is to be dealt with from the military point of view of salvaging manhood merely for a new lease of life in the trenches.

"If it remains simply an army problem," he has declared, "our towns and countrysides, when the war is over, will be plastered for the next twenty or thirty years with well-nigh useless men. To retain control of the patient, so that his treatment may be coherent and sustained, seems to be of the very essence of what can be done for the future of most of these men. Vital it is that the most huge calamity of this war shall be divested of every consequence which foresight and ingenuity can strip away. Not all discharged men, of course, will need refitting for civil life there are some whom refitting cannot serve; but for the great majority it is essential. The disablement is so various; eighteen categories exist. Think what that means in the diversity of treatment required. Every man who is discharged without being first remade so far as possible goes back to civil life half beaten. The half-beaten man is soon done for altogether, and becomes a ghost to haunt us all."

But these ghosts are already haunting the people. In every town, in every little village, the belligerent countries swarm with the cripples and invalids, the wreckage of the war; and so it will be for a generation to come. It is that which makes the thought of living in those countries after the war a thing of horror. Already in England some of these men who have escaped with their lives but not with bodies intact are being driven to eke out their scanty pensions by such disguised forms of begging as soliciting pennies with the aid of a street organ. Before the war Great Britain had nearly a million persons whose legal status was that of paupers. It is easy to imagine what the condition of the country will be if the poor-law army is allowed to be swelled by thousands of men who have been disabled in the war.

The aggregate of disabled men for all the warring nations runs to millions, and they are practically all Europeans. This immense population, filling the hospitals now as thick as leaves in an Autumn forest, dependent upon public and private benevolence, despite the salvage that will be effected by refitting and re-educating a certain proportion, already means a huge loss to the productive capacity of Europe and the social and intellectual activities upon which economic well-being depends.

© J. Fred MacDonald, 2013

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