ADVANCES IN SURGERY DURING THE WAR 321 



of surgical hospitals with competent and trained surgical per- 

 sonnel to operate these special cases far forward, has resulted 

 in getting the wounded to surgical aid quickly, within a few 

 hours after the receipt of the wound. Under such conditions 

 operation on these cases is indicated; the sooner the operation 

 is done the better the chance of success. So that now, as has 

 long obtained in civil surgery, in war surgery, too, these cases 

 are no longer treated expectantly, but are operated when seen 

 early and the mortality in such cases has thereby been very 

 materially reduced. 



In chest wounds a distinct advance has been made in one 

 direction. It has been discovered that opening the chest cavity 

 and thereby allowing air to get in is no longer to be feared for 

 its dire results as formerly. Such fear of air in the chest 

 cavity (pneumothorax) has been found to be largely mythical. 

 Now bruised, devitalized and potentially infected lung tissue is 

 excised, hemorrhage in the chest is stopped, and lung tissue is 

 sutured as is the soft tissue anywhere in the body. In other 

 words, wounds of the lung are debrided or excised and 

 treated as are other wounds of the soft tissues. In the old 

 cases of pus in the pleura, pyothorax or empyema, in which 

 the pleura is greatly thickened or leathery and no longer elastic, 

 imprisoning the lung and preventing it from expanding, the 

 earlier method was to excise the chest wall and allow it to 

 collapse, thus filling the cavity in the pleura so that it will no 

 longer discharge pus. According to present methods, such 

 amounts of the ribs as may be necessary to permit a free access 

 to the affected part of the pleura are resected, care being exer- 

 cised that the periosteum or membranous covering of the 

 ribs is preserved, this thickened pleura is then excised, peeled 

 off of the chest wall and of the lung, permitting the lung to 

 expand and function again. The soft parts are closed, the 

 membranous covering of the portions of the ribs taken out is 

 left in place, the ribs soon grow back, and the old deformities 

 of a collapsed chest wall and drooping shoulder are no longer 

 evident. 



