312 THE NEW WORLD OF SCIENCE 



infection is controlled, after which a freshening of the edges 

 of the wound can be done and a secondary closure, perhaps 

 after two or three weeks, be successfully performed. The suc- 

 cess of early closure of wounds depends, then, on getting the 

 wounded man to a surgical formation as soon after being 

 wounded as possible ; for the earlier a wound has surgical treat- 

 ment, the greater the chance of success in immediate closure, 

 when the wound, after thorough excision of the injured tissues, 

 behaves as does a clean wound made by a surgeon in ordinary 

 civil operating, healing taking place without any complicating 

 suppuration. This necessity of early surgical treatment was 

 met by improved methods of evacuating the wounded from the 

 battlefield and by moving the surgical hospitals and operating 

 teams as far forward as safety of the wounded permitted, in 

 order to shorten the haul to the place where surgical aid was 

 available. Constant improvement along these lines resulted 

 in the reception of the wounded and operation upon them within 

 an average time, in the majority of cases, of six to eight hours 

 after the receipt of the wound. 



It had been hoped that the incidence of infection of war 

 wounds would be less than had occurred in former wars, due 

 to the use of the so-called '* humane/' small caliber, high 

 velocity bullet of the modern military rifle. But, as a matter 

 of fact, such did not prove the case since, especially as the war 

 progressed, the number of those wounded by the small bullet 

 was a small percentage only. The great majority in the later 

 stages of the war showed wounds from shell fragments of the 

 high explosive shell, which was used more and more as the 

 number of field guns and long range cannon increased, and such 

 wounds were invariably potentially infected. Wounds from 

 shell fragments are torn, jagged and lacerated, and the mass 

 of macerated, devitalized tissue surrounding the track of the 

 projectile is increased. Hence debridement or total excision of 

 this injured tissue is rendered more difficult, and requires much 

 patience and painstaking care to insure 'that all of the bruised 

 and infected tissue is entirely removed, for this is essential to 



