The suppression of suppuration and infection in the majority of wounds has important consequences for the patient, since it diminishes to a very large extent the local and general complications of wounds, and consequently the length of treatment and the degree of final incapacity.
The rapid sterilisation of wounds nearly always protects patients from those complications which lead to death. From the month of December, 1915, to October 1, 1916, 303 cases of wounded coming directly from advanced dressing posts were treated at the hospital for research at Compiegne. Thirteen died after a stay in the hospital of more than twenty-four hours. In eight cases death was due to extensive anatomical damage to brain, contents of mediastinum, or abdominal organs. In three cases it followed multiple wounds of the two lower limbs, thorax and upper limb. Twice only was it due to septicaemia. One officer, who had a fracture of the thigh with great smashing-up of the bone developed rapid gas-producing septicaemia which in spite of amputation resulted in death. In the second case, staphylococcal septicaemia developed in the train of a fracture implicating almost the whole length of the femoral diaphysis. This case also terminated by death. In all the other cases it was possible to avert serious general infection. It is probable that the improvements which experience has enabled us to make in our methods would allow us to-day to obtain recovery from lesions similar to those which determined the two fatal septicaemias. Lowering of the rate of mortality from infection has been observed by other surgeons who have applied the method in its entirety.
The general condition of the cases whose wounds are in a fair way to become sterilised is habitually good, even when the temperature is more or less elevated.
This phenomenon was exhibited in a striking manner by those cases which were brought to hospital with injuries of long standing and freely suppurating. Immediately the suppuration disappeared clinically, the general aspect of the patient changed. The first effect of the cleansing of wounds was always marked improvement in the general condition.
The suppression of infection has permitted us to escape the lymphangitis, abscesses, and purulent tracks which usually accompany infected fractures and joint-injuries. In a year we have only seen three abscesses. One was the result of a lymphangitis which existed before treatment. The two others developed in the neighbourhood of a fracture of the humerus and of an infected knee. These abscesses were opened, sterilised, and closed in three or four days. In cases where the extent and complexity of the lesions do not permit rapid sterilisation, the destruction of the greater quantity of the microbes and gangrenous tissue immediately produced considerable local amelioration. From this resulted the possibility of preserving limbs which presented very extensive lesions, or of performing conservative operations instead of carrying out radical treatment In nearly every case where resection of the elbow or shoulder was indicated, we were content with an arthrotomy and disinfection of the articulation. It was the same, to a certain extent, with the knee. In the case of fractures, operations for the removal of splinters have been reduced to a minimum, and thus have been avoided those cases of marked shortening and the pseudarthroses which are so often seen after large removal of bony fragments.
Amputations have been able to be reduced to the cases in which the crushing of almost the whole of the portion of the skeleton concerned, or the destruction of the vasculo-nervous supply, rendered impossible the conservation of the limb. Between December 1, 1915, and October 1, 1916, we performed twenty-three amputations. These amputations were necessitated in four cases by crushing-up of the bones, accompanied by section of vascular trunks. In sixteen cases it was a matter of limbs being partially or completely torn away by shells, or more especially bombs. The operation consisted in either completing the amputation with scissors, or in amputating a little higher up where the bone became normal. As a general rule, amputation was practised directly through the contused seat of fracture, which the application of numerous instillation tubes allowed to be sterilised in a few days. In only three cases was amputation determined by infection. Two were the cases of septicaemia of which we have already spoken. The third case was a fracture of the upper part of the forearm with extensive vascular lesions and a considerable diminution of the circulation of the limb. This case had been operated on previously in a field-hospital. After a few days the skin became mottled with bluish patches, at the same time signs of septicaemia appeared. Amputation was done, and the patient recovered. Similar results were observed in the field-hospital at V- by M. Perret, who, out of one hundred cases, only amputated once. The sterilisation of wounds, therefore, permits of 1 the preservation of nearly all limbs which are not rendered useless by the extent of destruction of osseous, vascular, or nervous elements.
Similar, and even more striking results were observed in the case of wounds which were, roughly speaking, from two to forty days old. In the series of a hundred already infected subjects of which we have already made mention, MM. Guillot and Woimant were not obliged to perform a single amputation.
The possibility of disinfecting injuries lessens the number of amputations in a very great proportion, since this operation to-day in 70 per cent. of the cases is caused by septic sequelae.
The length of time treatment has to be carried on has been lessened because wounds have been rapidly closed, and because repair of bone, muscle, and nerve has been effected at an early stage.