As the battle opens the sight of blood is the first object lesson to the alert surgeon. For lack of prompt and efficient treatment of hemorrhage many a soldier has yielded up a noble life. The control of hemorrhage has been carried out along the lines of the civil surgeon. Momberg's method of controlling hemorrhage, for amputation at the hip-joint, does not seem to have met with any great ad vance, and the number of operations done are comparatively few. The use of the tourniquet in some form has been applied by fearless as sistants and the stretcher-bearers in so intelli gent a manner that many lives have been saved. Wyeth's method has been of service.
Surgery of the heart has presented some very striking illustrations of progress, in keep ing with the advances of the past few years in civil life, regarding the operations done in this direction. Especially is this true in bayonet and stab wounds, and here an excellent oppor tunity is offered for securing an estimate of the final results. There are so many more cases to he studied than in civil practice. Much re search work has resulted and more operations were performed than could possibly have oc curred in civil life for decades.
It is interesting to note the treatment of such large vessels as the inferior vena cava and others that have been reached when operating upon wounds of the abdomen. Injuries to the arteries and veins have developed a large num ber of traumatic and arterio-venous changes. Apparently nothing has escaped the military surgeon of to-day. Surgery of the blood ves sels, in the form of traumatic aneurisms, as well as like surgical procedures, will, when the concensus of opinion has been reached, show that great skill has been exercised from time to time in doing this work.
Possibly there is no part of the body that will show such marked advance in immediate operative interventions as that of gunshot and stab wounds of the lungs, together with more or less fracture of the thorax and in the lodg ment of foreign bodies within the cavity of the pleura. This is well illustrated by the en trance of a portion of shrapnel within the cav ity of the lung. An immediate operation is done, at the nearest place to the receipt of the injury, with safety to the operator and as sistants, the wound enlarged, portions of frac tured ribs removed, if required, hemorrhage controlled as promptly as possible, the lung ex posed, the foreign substance searched for and removed, then thoroughly aseptic work accom plished, the wound closed, with or without drainage, and a very large proportion of these patients make a prompt recovery, without sup puration. The employment of air bags, sacks
or balloons to fill space, and for the lungs to press against — removing them gradually— ap parently has proven of value. No such splen did work as this has been accomplished in the history of any of our previous wars.
This same prompt operative intervention also applies to wounds within the abdominal cavity. There was a marked contrast in the his tory of surgery during the first year of the World War, and that of the last, regarding the advances made in the treatment of these wounds. In the first period many surgeons were of the impression that non-operative in terference in a penetrating wound of the ab domen led to more successful results, but, gradually, in the study of these cases, they be came more practical, and, as a result of their observations, surgery was pushed to a point of careful inspection and operative work, where "the sooner the better)) it was discovered. So soon as the patient could reach a place of safety, and proper appliances, an operation was done at once, consisting of opening up the ab dominal cavity, if necessary resetting the in testines, or properly closing all wounds or lacerations within the cavity of its contents, controlling hemorrhage, and then carefully closing the wound. It has been shown that many of these cases die of hemorrhage if not operated upon at once. Only in such cases as seemed absolutely necessary was drainage made use of, and the percentage of recoveries has been most marked. In these wounds, and which also applies to the cavity of the cranium, the same bold successful surgery was done in enlarging the opening in the skull, trephining as called for, placing the patient in as comfort able a position as possible for transportation— which applies to all wounds in any portion of the body — not handling any more than can be avoided, the dressing watched carefully, not to be disturbed, if all goes well, and when reaching the base hospital keeping them ab solutely quiet.