WAR WOUNDS. The wounds described will be those peculiar to the war of 1914-18. Indeed, they have special characteristics, cording to the objects producing them, and cannot be compared with the wounds of ceding wars. In the wars of the last tury, 80 per cent were produced by bullets. In the war of 1914-18 80 per cent were caused by pieces of shell, grenades, bombs and does. We are also confronted with injunes resulting from new chemical compounds, like gas and burns from liquid flatne. Wounds by bayrmet, sword or lance are rare, whHe the two most common types of injury-inflicting agents are the bullet and pieces of shell. But besides these, we find other foreign bodies in the wounds. For instance, the projectile may carry a fragment of wood which was in the vicinity of the soldier into the body, or a shell may explode in a group of men, the bones of one man entering the body of another. These projectiles often carry with them pieces of clothing covered with mud and containing many bacteria. The presence of such foreign bodies is characteristic of shell wounds.
It sometimes happens that a bullet takes alcmg with it a button, or a coin or a metallic piece of a suspender, but this is exceptional. It may happen, also, when the form of the bullet has become changed, by ricochetting, that it will carry with it bits of clothing. But where it strikes directly, it perforates the cloth, piercing its way between the fibres of the tissue, and in this way does not carry along any of the clothing. On the contrary, a piece of shell, always irregular and jagged, cuts the cloth into pieces, which it carries to the bottom of the wound. This cloth is the conveyor of the bacteria into the wound. It can thus readily be seen why a bullet wound is generally unin fected, while that produced by shell is usually infected.
Aside from the element of foreign bodies carried into the wound, there is a big difference between the injury produced by a bullet and that resulting from a piece of shell. The bul let causes only slight damage to the soft tis sues, because it advances insumatingly, pushing the fibres aside without tearing them. The piece of shell tunnels its way through the body, its ragged edges cutting and tearing, pro ducing in this way a kind of pulp out of the contused muscles and cellular tissues tom and detached from the walls of the track. This pulp proves a very good culture mediutn for the bacteria. The :hell fragments are thus not only sources of infection, but are also the purveyors of food for the bacteria which they carry into the wound along with clothing and other foreign bodies.
Upon the bony structure of the body, the bullet inflicts generally more serious injury than does the piece of shell. This is due to the greater velocity of the bullet, which pro duces considerable pressure in the bone into which it is penetrating, this pressure causing bursting of the bone. The lesser speed with which a piece of shell enters usually prevents bursting of the bone, but it increases the seriousness of the compound fracture by carry ing more bacteria.
In present-day warfare every kind of in jury can be seen, from a tiny scratch to com plete tissue disintegrationt but the variety of wounds is less characteristic than their number. The plentiful supply of artillery, with its greater precision, multiplies the injuries. The wounded are numerous and each usually has several wounds: generally not less than two or three, often 10 or 15, sotnetimes as many as 40 to 70, and even 90. The number of the wounded esnphasizes the fact that the injured can no longer be considered by the general staff as a negligible waste, of which little care need be talcen, but that it is important to treat them quickly in order to preserve them for a continuance of the struggle.
The characteristic of the clinical evolution of shell wounds is the element of infection. Every disease-producing bacterium may be the agent of this infection. The most dangerous are the tetanus bacillus, gas or Welch bacillus, and the streptococcus. Tetanus was very fre quent at the beginning of the late war because of the lack of antitoxin. Later every wounded man was injected with antitoxin and no more tetanus was observed. Gas gangrene is a very serious complication, which manifests itself by the necrosis of the walls of a wound, spreading quickly into the rest of the limb; by the pro duction of gas which distends the tissues and by general poisoning of the injured. Treat ment for it is wide opening of the wound, to expose the bacteria to the oxygen of the air, which prevents their development, and the in jection of an antitoxin prepared by Bull and Pritchett of the Rockefeller Institute, or by Weinberg in France, Streptococcus is the bacterium of erysipelas. It is one of the most resistant bacteria, and causes serious local and general infection. We have not as yet any specific treatment against it.