MEDICENE, WARFARE, AND HISTORY — FULTON 433 



surgery, and they are rapidly being adopted in our surgical clinics, 

 largely through the influence of the younger medical officers returning 

 from active service, 



A second important result of the use of penicillin and the sulfon- 

 amides has been the avoidance of umiecessary amputations and un- 

 necessary removal of potentially viable tissue. With the greater con- 

 fidence that these drugs are bringing to the surgeon he is able to oper- 

 ate much less radically. Formerly it was taught that all contused 

 tissue should be removed from an injured area, but a contused muscle 

 may still have an active circulation and therefore be capable of regain- 

 ing its normal function. When the thigh muscle or the calf has been 

 injured by a high- velocity missile, the muscle is generally contused 

 over a large area, and a surgeon of the old school would in most such 

 instances amputate rather than risk secondary infection. During 

 the last 2 years of World War II and during the Korean campaign 

 countless extremities injured in this manner have been saved by com- 

 bining penicillin therapy with conservative surgery. One of the burn- 

 ing arguments, however, that one still encounters in surgical amphi- 

 theaters turns on the criterion of tissue viability : how can a surgeon 

 be certain that a contused muscle will recover its function ? The old 

 adage ran, "Wlien in doubt, remove it" ; a newer epigram might be, 

 "If it bleeds, it can recover," and "Wlien in doubt, leave it." 



BLOOD FRACTIONATION 



Surgery has also been influenced by wartime studies on human blood 

 and the blood plasma fractions that have become available in pure 

 form, again as a direct result of wartime medical research. At the 

 beginning of the war, much effort was devoted to the preparation of 

 blood fractions suitable for transfusion. Blood plasma (whole blood 

 minus the red blood cells) was made available, but since many un- 

 toward reactions occurred from the transfusion of incompatible plas- 

 mas, and since under war conditions blood typing was often difficult 

 or impossible, the plasma proteins were fractionated and the globulin 

 fraction that carries the allergic potentialities of the blood was elim- 

 inated, leaving the albumins and fibrinogen. Albumin was then pre- 

 pared in pure form and was thus made available for immediate trans- 

 fusion without fear of complications. 



It soon became obvious, and this should have been clear from our 

 experience in World War I, that when men have sustained severe 

 hemorrhage whole blood is needed for transfusion, not merely plasma 

 or albumin, since many weeks are required for the body to regenerate 

 its red blood cells. The British had attempted to collect and store 

 whole blood in 1939, but their efforts were largely unsuccessful because 

 of difficulties in preservation. In 1943 an effective preservative was 



