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Surgery during World War I

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BerichtGeplaatst: 03 Jan 2010 18:51    Onderwerp: Surgery during World War I Reageer met quote

Surgery during World War I

World War I Surgery
World War I was one of the World's most gruesome event in history, were about 37 million: 16 million deaths and 21 million wounded. The total number of deaths includes 9.7 million military personnel and about 6.8 million civilians. The Allies lost 5.7 million soldiers and the Central Powers about 4 million. It really astound the modern people of the world now! But does the numbers above is based on death from the tour of duty alone? or most likely from the hospitals? Lets find out!

We all know that the surgery way back in 1910 is a hell suicide for most patient, you can't you can survive, although there were great doctors at that time who created breakthrough to the field medicine and for the survival of the thousand of soldiers suffered from the war.

Here's a part from an article: "First Red Cross Mission to Serbia during World War I"

Patients came to the dressing-tables or were carried there. If they did not come again we presumed they had died. For every day as we went into No. 1 Hospital we could see ten to twenty bodies laid out on stretchers, each wrapped in a blanket with a candle burning at his head. They were men from Northern Serbia with no one to mourn them, simply numbers on a casualty list.

" The pressure of work was so great we hardly had time to think. Once I opened a huge abscess in a man's armpit, but in doing so, unfortunately, I also opened an arteriovenous aneurysm behind it which spurted blood violently in my face. I plugged the big cavity hastily with iodoform gauze, stopped the haemorrhage, bandaged the man up, sent him away on his stretcher and started on the next case. Next day he was not brought again, so I was quite sure he had died. A fortnight later he was once more brought to the table. No dressing had been done in the interval. I loosened the stinking bandages very, very gingerly."

According to that article, they do have the best hospital in the town, but the number of wounded and the less number of medical people with experience in surgery foremost is the reason they could not give sufficient medical attention to the patients.

Are the medical Team back that time had greater knowledge in surgery? Here's what the article is telling us:

"It was mainly amputations for septic compound fractures, and ligaturing arteries for secondary haemorrhage. I never thought when I was doing operative surgery for the Fellowship that I should have to use any of the set operations except on the rarest occasions. For the surgery we were doing was the surgery of the Napoleonic Wars. We were ligaturing subclavians or brachials or femorals, popliteals or posterior tibial arteries, or doing the classical amputations we had learnt out of books."

For a simple wound that could be done without amputation, in World War I it means removing something. That's how scary if you are wounded my friend. That is why a simple gunshot wound in the thigh could lost you a leg. When we look at many pictures of World War I survivors most of them lost a leg or an arm. Or simply lost both!

Immediate amputation is, so to speak, never indicated in traumatisms through bullets. It is only admissible in cases of confirmed gangrene.

In the most comminuted fractures, neither very extensive damage of the soft parts, nor an extreme condition of comminution of the diaphyses, nor supposed nor evident lesions of the large vessels, nor injury to important nerves, can be looked upon as indications for amputation.

Very great disturbances of the soft parts can be repaired; it is possible to obtain union in the bones, even when a fracture is comminuted; lesions of the large vessels are not always followed by gangrene, and we cannot be absolutely precise in laying down the exact nature of wounds of important nerves by bullets.

Immediate and atypical amputation can only be called for in cases of complete smashing or of almost total tearing off of a limb by a big projectile or by a big fragment.

Later on, amputation may be necessitated by:

1. Confirmed traumatic gangrene.

2. Rapid extension of emphysematous gangrene, which is almost generalized in one limb.

3. Conditionally, by an enormous diffuse aneurysm, which threatens to rupture if the surgeon does not feel himself qualified to put on a direct ligature.

4. By very grave complications through suppuration, especially osteomyelitis.

Amputation must not be carried out during the period of shock, by reason of its extreme gravity. It should be carried out as soon as the indications for its performance are absolutely confirmed. The incisions should be made as low as possible.

Disarticulation is preferable to amputation when removal of the limb is rendered necessary by medullary lesions.

The circular method in cases of gangrene; in other cases the circular method and the method with square flaps should be preferred.

When there is danger of infection of the stump, the wound should be left open.

Wounds of the Nerves
Treatment, which not long ago were reduced in symptomatic indications, that are Enriched at the end of the recent war by improving adapted from the procedures of daily operations. To appreciate their full value that we return to what we said in recent topic before the Academy of Medicine (February 24, 1914) .* Report on a work by Professor Laurent of Brussels, Aneurysms and wounds of nerves in War Surgery. 0. C.

This technique, we first want to point out, concern about the special task of Surgeons rear. Before any intervention to counter-indicated, it is only on account of the agony of the evaluation, the complexity of a fraudulent and excessive symptomatology, which takes time elucidated; so before we should be content ourselves with dressing the wound and avoiding all the irritation.

This is all the more indicated to make use of this technique at the rear, due to surgery nerve was not urgent about during the intervention as surgery of arteries, and since the hospital behind the surgeon may conduct operations without rush, during which he choose, and under the best conditions closely. One of the conditions for successful operation in this case is very strict asepsis.

We should surely hesitate to place sutures in the wounds threatened infection. It is far better to wait for their recovery before interval.

On the other hand, the large nerves are almost always injured at the same time the arteries, where they are satellites and the surgeon was naturally drawn his attention to their injuries only to a period when consecutive He runs the aneurysm, the treatment of clearly occupy more important than the area of nerve injury.

"The lesions presented by nerves injured by projectiles is, we remarked, at the same time less favorable for the successful operation and better for spontaneous recovery than the wounds we see the day day training. At last the nervous trunks may almost always be divided by instrument or by something sharp; they are not experienced absence of substance, but if healing is place with formation of a neuroma , its excision is not an addition to the loss of elements resulting from primary traumatism. The consideration, which up to now has not been insisted on, should not lose sight of by People who want to form an appreciation of the indications, the level of usefulness, and the results of existing interference.

"Let us talk about their own, first in cases of slight contusions. Although they show the original sensori-motor disturbances that may put us on the wrong scent about their real threat, the continuation of obscenity is not interrupted at this time.

"With extensive contusions brusqueness greatly injured; is forced back myeline often gives rise to the immediate formation of a small neuroma over the point of injury. Here again, however, continued the vulgarity is not interrupted. Why, then, should we work? Again, if we intervene a little time after the traumatism, to what extent we carry the loss of substance necessi tated a refreshing end of the nerve before suturing?

"In the midst of Abrasions, some partially, and involve only very small area around the trunk nervous. Could we but clinically identify them, no one will dream of meddling with them. Some, however , was complete or nearly complete, and the forcing back of myeline added to the loss of substance. At a time when one might think the operation, one should look forward to having to treat a pretty extensive loss substance joined a nervous deterioration, which itself is rather large, and is undefined limits. Sutures can be difficult to obtain, and their success problematical. These lesions, but less circumscribed, is especially that dangerous when nerve was injured in a projectile by having a good velocity - that is to say, this one fired from a short distance.

"With Perforations, any immediate intervention is inexplicable. Freyer, front with the three injured men showing such lesions, abstained from all surgical interference. Really, one can not see what other courses he followed.

"This may be gathered from statements that it is somewhat difficult to suggest that nowadays any active treatment for the wounds of nerves by projectiles within a short time from the occurrence of traumatism, yet 't in cases where the nerve was pierced by a stick, it being discovered in the course of surgical intervention for some other reason.

"In such cases as these last, we consider the better to allow Nature to undertake any repair, or to show evidence of his incapacity to do so. On the other hand, having the injury is, every-thing must be tried to help Nature. surgical therapeutics, the results of which are not full enough as factory, offer some way for us to use, such as removing , suturing the distance by Assaky plan, implantations, and strong and grafting.

"A nerve compressed by a fibrous band or by a process of callus formation should be liberated and Transposed; Partial excisions of neuromata be done, followed by direct suturing; total excisions of neuromata, also followed by direct suturing; a stick which pierced a nerve must be removed; when there is absence of substance, we should have recourse to the end-to-end anastomosis. "

To create a canal for protecting important elements of repair, we can, the following examples of Professor Laurent of Brussels, creating a sheath for the nerve in a strip of Fascia. The surgeon was largely his strips taken from the extensive aponeurosis of Fascia cans. It detaches from falsehood, to form a government, a square piece of 3-4 centimetres, he sutures with silk or catgut all round the whole end of the nerve.

The method of forming a sheath is only an invitation to the method of Van den - is called tubulization. The surgeon made each extremity of the divided nerve penetrate a tube of decalcified bone.

Foratimi (1904) making the proposed use of arterial or venous fragments taken from a freshly killed calf, and pieces were treated by immersion in formol and clean with alcohol.
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Laatst aangepast door Yvonne op 03 Jan 2010 18:53, in totaal 1 keer bewerkt
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BerichtGeplaatst: 03 Jan 2010 18:53    Onderwerp: Reageer met quote

With the First Red Cross Mission to Serbia

At the beginning of the war, Mr James Johnston Abraham was an experienced General Surgeon. He was born in Ulster, Northern Ireland in August 1876 but qualified in Dublin and practised as a General Surgeon in London. He applied to join the RAMC in 1914.
The following extract from his autobiography, "Surgeon's Journey" describes how he was refused by the RAMC, as being too senior, but was readily accepted for the Red Cross Mission by the famous surgeon, Sir Frederick Treves.
He served in Serbia in charge of The First British Red Cross Serbian Mission in 1915 and graphically describes the inadequate medical facilities in that poor country and how these few medical facilities were swamped by the great Typhus Epidemic of 1915. [The description of his journey from England to Serbia has been edited as it was mainly concerned with non-medical descriptions of his journey through Malta, Greece and Salonika by sea and by rail to Serbia where he was posted to Skopjlie (Uskub).]
At that time medical services for Serbia were almost non-existent. The overcrowded insanitary conditions in this country produced fertile breeding grounds for louse infection and led to the great Typhus Epidemic of 1915 that killed tens of thousands of Serbian and Austrian soldiers and civilians.
In 1915, the cause of Typhus was unknown, although the louse as a vector was suspected. It was not until 1921 that the Rickettsia group of organisms were identified as the causative factor. During WW1 there was no known cure and the mortality approached 15 - 20%. It was recognised that the mortality was higher in older patients and in patients over the age of 50 -60 it approached 50%; that is why Mr Abraham warned Dr. R. 0. Moon against offering his services to treat Typhus.
The onset of Typhus is rapid with high fever, vomiting and headache and pains in the back and limbs. A typical rash appeared on the 4th or 5th day as rose-red spots on the trunk, spreading to the limbs. Apathy and drowsiness may lead to delirium which can be noisy and violent. Diarrhoea can lead to dehydration. Bedsores occurred when the nursing arrangements were poor, as they were in Serbia, and this led to considerable disability. Lung complications of broncho-pneumonia were common and frequently led to death.

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BerichtGeplaatst: 23 Sep 2010 20:13    Onderwerp: Reageer met quote

Wellicht niet de juiste plek om de vraag te stellen, maar toch.
Ik kom net van Sanquin alias de Bloedbank. Bestond dit fenomeen ook al in WO1?
"if nothing else works, a total pig-headed unwillingness to look facts in the face will see us through"- General Sir Anthony Hogmanay Melchett
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