WOUNDS IN MODERN WAR

¹ Surgical Consultant to the Canadian Active Service Force

In conclusion, there are certain main principles, of the soundness of which the author is convinced at the present time.

1. In mobile warfare it becomes a matter of the greatest importance either to evacuate the wounded by air or, failing this, to bring the facilities for early surgery to the patient.

2. The advantages of the closed-plaster treatment are paramount. It allows for safe transportation over long distances without the necessity for dressing during the journey. As already noted in reports from the East, "those who have been subjected to débridement and plaster fixation traveled well and looked fit on arrival". Furthermore, continued closed-plaster treatment at the base hospital would seem to be the method of choice. Our experience in Canadian hospitals after eighteen months encourages us to adopt the method as routine treatment.

3. It is clear from our experience in England, also from reports in Libya, that war wounds should not be sutured.

4. The use of sulphanilamide as a prophylactic measure is not on sufficiently firm ground to warrant the impression which is held by some surgeons that it will constantly prevent gas gangrene and other infection if applied to a contaminated wound. The author knows of no prophylactic against gas-forming organisms other than the early removal of devitalized muscle. When such débridement has been carried out and local chemotherapy used, we have been unable to see evidence of increased healing or lessening of infection when compared with those cases in which similar surgical treatment without chemotherapy has been instituted. On the other hand, sulphonamides given by mouth as soon as possible after injury may cut down the incidence of severe streptococcus infection, particularly when such cases are delayed in reaching an organized operating center. The application of sulphonamides to superficial wounds, particularly burns, is of undoubted value, but such routine use on the deeper penetrating wounds does not lessen the urgency for surgical treatment.

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