October 5th 1914

One of the first Old Dragons to cross over to Belgium was not in fact a soldier, but a surgeon: Henry Souttar. He has been appointed Surgeon-in-chief at a Belgian field hospital at Antwerp. Here he has had to deal with the casualties of war for the first time. Many have been wounded by shrapnel.

“The balls are small and round, and if they go straight through soft tissues they do not do much damage, If, however, they strike a bone, they are so soft that their shape becomes irregular, and the injury they can produce in their further course is almost without limit. On the whole, they do not as a rule produce great damage, for in many cases they are nearly spent when they reach their mark…”  

Henry Souttar is also dealing with the problems of wounds caused by bullets, where infection has been a major problem for him and his team.

“…In most cases the wounds were anything but clean-cut; with very few exceptions, they were never surgically clean… When we say, then, that every wound with which we had to deal was infected with bacteria, it will be realised how different were the problems which we had to face compared with those of work at home…

Now there is one way in which all such infections may be defeated – by plenty of fresh air, or, better still, by oxygen. We had some very striking proofs of this, for in several cases the wounds were so horribly foul that it was impossible to tolerate their presence in the wards; and in these cases we made it a practice to put the patient in the open air, of course suitably protected, and to leave the wound exposed to the winds of heaven, with only a thin piece of gauze to protect it. The results were almost magical, for in two or three days the wounds lost their odour and began to look clean, whilst the patients lost all signs of the poisoning which had been so marked before.”

Bullet wounds are of course very common. Surprisingly, Henry does not appear always to be in favour of removing bullets from the body.

“If a bullet is doing any harm, pressing on some nerve, interfering with a joint, or in any way causing pain or inconvenience, by all means let it be removed…. But the mere presence of a bullet inside the body will of itself do no harm at all. The old idea that it will cause infection died long ago. It may have brought infection with it; but the removal of the bullet will not remove the infection, but rather in most cases make it fire up.

We now know that, provided they are clean, we can introduce steel plates, silver wires, silver nets, into the body without causing any trouble at all, and a bullet is no worse than any of these…. It may be a mark of a Scotch ancestry, but if I ever get a bullet in my own anatomy, I shall keep it.”

The greatest advance for the surgeon and of course the patients, compared with previous generations, is the availability of anaesthetics. Sometimes a soldier can be operated on whilst still conscious and yet feel no pain.

“With the injection of a minute quantity of fluid into the spine all sensation disappears up to the level of the arms, and, provided he cannot see what is going on, any operation below that level can be carried out without the patient knowing anything about it at all. It is rather uncanny at first to see a patient lying smoking a cigarette and reading the paper whilst on the other side of the screen a big operation is in progress.”

However, in many cases chloroform is needed for a general anaesthetic. This seems to suit the Belgians better than the British.

“The Belgians are an abstemious race, and they took it beautifully. I am afraid they were a striking contrast to their brothers on this side of the water. Chloroform does not mix well with alcohol in the human body, and the British working man is rather fond of demonstrating the fact.”

 

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