XVIII 



ADVANCES IN SURGERY DURING THE WAR 

 JOHN W. HANNER 



WHILE there has been nothing startling or revolutionary 

 in the surgical art as a result of the recent great war, 

 substantial and valuable gains in the surgical field have marked 

 the progress of surgeons of all nationalities through the multi- 

 plicity of conditions met with, and valuable knowledge for 

 future use has been stored up in the literature. 



Perhaps the outstanding and most spectacular achievement, 

 one that shortened the period of disability greatly and resulted 

 in the early return of the soldier to the fighting line, as well as 

 prevented large, mutilating and often disabling scars and con- 

 tractures, was the early closure of wounds, after thorough 

 excision and cleansing of the lacerated, devitalized tissue found 

 in and around the track of the projectile, a procedure called by 

 the French " debridement." 



This excision of tissue and immediate closure of a wound is 

 successful only when it can be done within a short period after 

 the receipt of the wound, usually given as eight to twelve hours. 

 As a rule, when a longer time has intervened, infection of the 

 wound has already gained such headway and has become so 

 widespread, since the organisms have had time to multiply and 

 penetrate into the surrounding tissue, that it is unsafe to close 

 the wound immediately. In such cases, it has been found safer 

 to delay the suture of the wound for two or three days, when 

 in favorable cases it can be closed without fear of future in- 

 fection ; or to employ antiseptics to combat and limit the infec- 

 tion ; or to use simple drainage, as was formerly done, until the 



