MEDICAL SCIENCE AND THE WORLD WAR. Army medical departments everywhere had, before the war, prepared for the treatment of surgically clean wounds made by modern fire-arms in distance engagements. The soldiers °First Aid° kit, with its sterilized dressings sealed from contamination, was ex pected to maintain this freedom of wounds frominfection almost without exception. Aseptic wounds assure prompt and uncompli cated recovery. Serious injuries of important organs would still often be fatal, but all others, as a rule, would be followed by convalescence without delay or complication. These anticipa tions were sadly disappointed by the immediate recourse to trench warfare as almost the sole mode of conflict. In trenches recently dug in fields which had been under cultivation for hun dreds of years, bacteria abounded and infec tions inevitably occurred. Two extremely fatal forms of infection, tetanus and gas gangrene, raged among the troops. Both of these were often fatal and the gas bacillus caused long illness and often extensive mutilation, even when recovery took place. Tetanus, after the early sad war experience, was prevented by injections of anti-tetanus serum as soon as the wounded came under observation, the injections being repeated at regular intervals if convales cence from the wound was prolonged, for it was found that delayed infections occurred. The gas bacillus proved a much more difficult problem because of the utter unfamiliarity with tt at first. It was unknown in Great Britain before the war, was not seen during our Civil War, and is very rare in civil life. Some 70 per cent of the wounds received in the trenches during the first year of the war were infected by it. It was never noted in wounds of the face or neck where the blood supply is abund ant and the tissues well oxygenated, for the bacillus of it, discovered by Welch at Johns Hopkins, like the tetanus bacillus, is anerobic, that is, grows best out of the presence of the air. The successful methods of treatment in cluded thorough opening up of wounds, the use of hydrogen peroxide, so as to provide addi tional oxygen for the tissues, and after careful investigation, the use of serums for curative and prophylactic purposes, elaborated by vari ous agencies.
The large number of badly infected wounds to come under treatment proved very discour aging to the surgeons at first and iodine was found so valuable that it was used in large quantities until it was suggested that this would be known in medical history as the Iodine War.° The noteworthy difference be tween the healing of the wounds of soldiers and sailors led to an important development in the treatment of large shell wounds and penetrat ing wounds of various kinds in which foreign particles were carried deeply into the tissues Soldiers thus wounded in the trenches suffered almost invariably from septic developments, often fatal and always with a protracted con valescence. Months after a bad shell wound,
a soldier, if he recovered, would only be past the border line of danger, while sailors with similar wounds would usually be entirely well at the end of a month. The sailors had often been subjected to exposure to cold sea water, sometimes for an hour or more after the re ception of their wounds. The influence of salt water as an application to the surfaces of large wounds was studied and it was found that when of about the specific gravity of sea water, it caused a pouring out of serum and a conse quent cleansing of the wound by the discharges Besides, the blood serum was dictinctly bac tericidal and the outward current set up car ried off septic materials which would have been serious if allowed to remain. Mainly through the observations of Sir Almroth Wright, salt water was used extensively as a dressing for wounds, with some excellent results, and the principle is evidently to be of service after the war.
The important development in the treatment of wounds came when Dr. Alexis Carrel of the Rockefeller Institute was put in charge of a French hospital in Compiegne during the sec ond year of the war. He set about the prac tical application of Lister's principles. Ordi nary surgical antiseptics were too poisonous to be used for the out of large wounds A solution of hypochlorites proved to be bac tericidal, yet non-toxic and non-corrosive to tissues. After experiment, Dakin's fluid, so called from the inventor of it who had been the director of the Herter Chemical Institute, New York, was found the most efficient solution of the hypochlorites. The important part of this treatment was the bacteriological control After removal of all foreign particles and all injured tissues, wounds were thoroughly flushed with Dakin's fluid many times a day, until it was found by careful microscopic examination that the secretions contained very few bacteria and none to be feared. The wound was then closed up and permitted to heal without further interference. The results were excellent Healing took place rapidly as a rule, convale% cence was brief and absorption of septic mate rial so as to produce constitutional disturbance rare and without danger. The after result was better than that produced by any other method and the hospitals where it was employed took on a new aspect from that which had been seen in the war hospitals before.