ADVANCES IN SURGERY DURING THE WAR 317 



prevents the formation of this film of lymph and invites the 

 flow of lymph from the tissues, causing what Wright terms 

 " lymph lavage." This lymph is one of the protective fluids 

 of the body, and the constant outgoing stream of it through 

 the infected tissues serves to carry away with it the bacteria 

 which are growing on the surface and to prevent their deeper 

 penetration. 



The above have been the most successful methods of treating 

 infections which have already become established and of pre- 

 venting serious infection in wounds in which surgical cleanli- 

 ness could not be obtained. 



Brief mention should be made of the treatment of shock. No 

 specific treatment has been discovered; it is still symptomatic. 

 Cannon did valuable work in this field. While nothing new in 

 treatment has been added, methods of treatment were rendered 

 available and efficient, which had not been so formerly in the 

 field with armies. So-called " shock teams " were organized, 

 consisting of personnel specially trained in the handling of 

 shock cases, and these teams worked in the hospitals in the 

 advance zone. The evacuation and mobile surgical hospitals 

 had wards set aside for the treatment of these cases, and the 

 personnel to carry out the treatment. Field hospitals and 

 triages had litters so arranged as to warm up quickly and to 

 keep warm any patients received in a state of shock, and ambu- 

 lances heated from the exhaust were used to transport them. 

 The warming and keeping warm of a patient in shock is still 

 a great necessity. Acidosis, an acid condition of the blood, 

 which is normally alkaline, is present in shock, and Cannon 

 combats this with success by giving sodium bicarbonate by the 

 mouth, and a 4 per cent, solution of it intravenously, intro- 

 duced very slowly, about an ounce a minute. The menace of 

 low blood pressure is met by position, prone, or head lowered, 

 except in cranial and chest wounds, as little movement and 

 handling as possible, and many advocate the use of 6-10 per 

 cent, glucose and 5-7 per cent, gum arabic solutions in the veins, 

 either alone, or with glucose added, and perhaps a small per- 



