1 Dakin, Presse Medicale, loco citato.
2 Carrel, Dakin, Daufresne, Dehelly, and Dumas, Presse Medicale, Oct. 11, 1915.
3 Carrel, Archives de Midecine et de Pharmacie Militaires, May, 1916.
4 Pozzi, Academie de Midecine et Sociki de Chirurgie, 1915 and 1916.
On May 23rd, M. Quenu demonstrated at the Societe de Chirurgie the results obtained by MM. Hornus and Perrin in one of the field hospitals under the charge of M. Uffoltz. These surgeons had treated 121 wounds in their wards. In 44 cases they had been able to suture, and the other 77 cases were ready to be sutured at the moment of M. Quenu's visit. At the same meeting M. Tuffier read a paper by MM. Dehelly and Dumas on the sterilisation and closure of wounds in war. In 31 out of 33 cases, union by first intention had been obtained after secondary closure.
1 Tuffier, Societe de Chirurgie, 1915 and 1916.
2 Uffoltz, Archives de Medecine et de Pharmacie Militaires, Jan. 1916.
Although these results showed, in an unmistakable manner, that infected wounds could be sterilised and sutured, yet even when more than a year had elapsed since the technique had been made known, the chemical sterilisation of wounds was still an exceptional occurrence. It was only at the hospital at Compiegne, at M. Depage's hospital at Panne, and in two or three territorial hospitals that the method was employed in its integrity.
Nevertheless, the employment of this method was steadily extending, thanks to M. Pozzi, M. Tuffier, M. Regaud, and a few surgeons of other nationalities. In Belgium M. Depage,1 from the beginning of 1916, succeeded in accomplishing the sterilisation and secondary closure of a large number of wounds, some of which were accompanied by fracture. In Paris Senor Chutro, of Buenos Ayres, succeeded in sterilising and healing old infections of the bones and articulations. In New York Mr. Gibson and Mr. Lyle began to apply the method of chemical sterilisation in ordinary surgical practice.
At the close of 1916 Mr. Sherman,2 principal surgeon to the United States Steel Corporation, demonstrated that the chemical sterilisation of wounds constitutes a considerable improvement in the treatment of industrial casualties.
The possibility of maintaining wounds in a sterile condition enables us to study the laws of cicatrisation with an exactness hitherto unknown. A comparison of the curves of sterilisation and of cicatrisation shows us in an exact manner how the various procedures employed in the treatment of wounds act upon those wounds. Similar technical methods were employed by Professor Halsteed in the ingenious experiments which were carried out under his supervision at the John Hopkins Hospital.
1 Depage, C. R. Societe de Chirurgie, 1916, p. 1987, and Feb. 1917. 2 Sherman, Surgery, Gynecology and Obstetrics, January, 1917.
In the treatment of mastoiditis M. Mahu1 systematically sterilised the wound immediately after operation, reducing the duration of the treatment to one-third of what it was previously. MM. Tuffier and Depage2 treated purulent pleurisies by sterilising the pleural cavity and suturing the opening. They thus succeeded in very greatly diminishing the duration of the treatment.
From September, 1916, we investigated more particularly the application of the method to the wounds of men already infected when they reached the hospitals in the rear. These researches were undertaken by MM. Guillot and Woimant, in the Compiegne hospital. They demonstrated the fact that suppurating wounds and old fractures can be rendered sterile, and that complications resulting in the death of the patient or the amputation of the limb may be almost entirely avoided.
Suppuration might have been suppressed in the hospitals as early as September, 1915. But our methods encountered such opposition on the part of certain gentlemen who were at the head of the medical profession in France, that they were scarcely anywhere applied. A perusal of the reports of the Societe de Chirurgie and the Academie de Medecine shows with what culpable frivolity a method which might have saved the lives and limbs of large numbers of wounded men was rejected.1 Those who criticised us so severely2 had not taken the trouble either to examine our technical methods or to check our results. They knew nothing whatever of the methods which they were criticising.3 Their responsibility is all the greater inas-
1 Mahu, Presse Mtdicale, 1917.
2 Tuffier et Depage, C.R., Societe de Chirurgie, 1917.
1 ". . . et nous apporter cela d'Amerique, laissez-moi rire. . . ." M. Broca, professeur a la Faculte de Medecine de Paris, Jan. 5th, 1916. Bulletin et Memoires de la Sociiti de Chirurgie de Paris, vol. xlii. pp. 104 and 105.
2 Especially should be noticed the communications made in 1915 and 1916 to the Societe de Chirurgie de Paris or at the Reunion chirurgicale de la IVe Armee, by MM. Delbet, Hartmann, Broca, Potherat, Chapm, etc. Bulletin et Memoires de la Societe' de Chirurgie and Presse Medicale, 1915-1916.
3 With regard to the attitude of the Societe de Chirurgie, note M. Pozzi's communication to the meeting of May 17, 1916.
". . . . In any case, one should see for oneself at Compiegne - only two hours from Paris - the condition of the wounded treated by the new method. This is what I have already done myself, on two occasions, when I took part in the memorable discussions which took place at the meetings of our Society, the 5th and 26th of January; and at the Academie de Medecine, the 11th of January last. And it is what I have begged my colleagues to do, at once. I am glad that, at last, M. Quenu has followed my advice. The time has come at last to repair the real injustice committed towards a method which for long months past had displayed in vain evidence of its value, which is certainly destined to save, in the future (as it has already done in the immediate past), a great number of wounded men, and to lessen, in almost every case, the gravity of mutilations and infirmities.
"In fact, after the sentence, almost of reproof, pronounced against it here, and at the Academie de Medecine in the month of January last, there was brought about amongst the young surgeons at the front a sudden hesitation to apply the new method, which at first they had received with marked approval. This was emphatically to be regretted. Further - may I be allowed to say in all sincerity? - it is not only the wounded to whom much as their position in the University of France and the hospitals of Paris lent weight to their verdict.
The aim of this book is to show how surgical sterilisation of the greater number of infected wounds may be obtained. In the following pages we shall describe the principles which allow a given antiseptic to act in an efficient manner. The application of these principles constitutes a "method," that is to say, an entity, no portion of which should be altered at random. The deplorable results obtained in several hospitals by surgeons who believed they were using our methods, but who, in reality, were altering them according to their fancy, make clear the necessity for observing exactly the directions which will be laid down in the following pages. The best way to learn the method is to see it applied. Hence this book is especially intended to recall essential details of the technique to those who already know something of its application.
this attitude of our great learned Societies risks doing harm, but it is the Societies themselves, who, a priori, and without relying upon an investigation easy to carry out (l'hopital Carrel being at Compiegne), have publicly refused to the treatment newly instituted the merit of originality and of progress . . . ."