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When a man is perforated by a bullet, the bullet does not always go into or through him in a straight track, even when the holes where the bullet came in and 'went out are in a straight line. A sharp-nosed bullet is easily deflected by ribs or tough muscles. A surgeon must explore the internal track of all penetrating bullets, no matter how tiny the entering wounds may seem. If he meets an abdominal wound, for instance, he must first cut off all jagged infected surface tissue. Without damaging important nerves, veins, arteries, he must then pull out the intestines "foot by foot," looking for bullet perforations, and stitching them up. Although he may find as many as eight or ten perforations, the entire operation should not take more than 20 minutes. If he neglects the exploration, his patient is almost certain to die from hemorrhage or peritonitis. (Patients suffering from hemorrhage should have an H marked on their foreheads.to insure prompt treatment.)
Lacerating wounds usually rip out huge chunks of a victim's body. "The only way to save the lives of most of these patients is prompt amputation." When they are partly eviscerated, as they often are, nothing much can be done.
Wound Shock. The bane of medical officers in France during World War I. "wound shock" is a condition of "lowered vitality" which follows wounds, even trivial ones. Unchecked, it causes death. Wound shock comes from pain, loss of body heat, bleeding and toxemia. Lack of water balance, due to excessive sweating and short water rations, makes soldiers ready victims. The loss of fluid thickens their blood, produces a high concentration of poisonous urea. Best treatment for wound shock, discovered in the last year of World War I: 1) small doses of morphine for relief of pain; 2) an abundance of blankets and hot water bottles to prevent chill; 3) plenty of warm, sweet tea to restore a proper water balance; 4) blood transfusion to avoid blood poisoning; 5) operation as soon as the patient comes out of shock.
Anesthesia and Antiseptics. Small amounts of morphine are used to dull pain. For deep anesthesia, gas and oxygen are considered safest. Oxygen tanks should be stored underground, where they cannot be exploded by bombs or shellfire.
All instruments and dressings are of course sterilized. But Drs. Mitchiner and Cowell do not believe in the use of antiseptics for wound surgery. Powerful antiseptics, they hold, "cause more damage to the tissue cells than to the micro-organisms and thus encourage the spread of infection." Iodine they mention only to "condemn."
Burns. Standard treatment for burns, whether caused by incendiary bombs, mustard gas or lewisite, is application of tannic-acid dressings. Where tannic acid is not available, strong, lukewarm tea is a good substitute. Tannic-acid compresses must be left undisturbed for two or three weeks, until new skin forms. Victims of mustard gas must have their clothes carefully removed, must be "decontaminated" with soap, clean water and sodium bicarbonate, rubbed with a paste of bleaching powder and water, successful antidote for the oily gas. Then routine tannic-acid treatment follows. Mustard gas can remain on the skin for ten minutes before burns occur; lewisite burns immediately. But treatment for both is the same.