War Surgery and Medicine
First World War
First World War
In the 1914–18 War, during the fighting in Europe, anaerobic infection was very common and was responsible for many amputations and deaths. The technique of the primary excision of the wound was developed largely to combat this infection. The radical removal of damaged and avascular muscle was determined because of the ready growth of the anaerobic organisms in this tissue. The priority as regards operation was commonly arranged not by the extent of the wound, but by the presence of anaerobic infection, which was generally rapidly detected by the characteristic smell and often by the discoloration of the skin. General signs of toxaemia with rapid, thready pulse and anaemia were present, and locally the limb was swollen and gas was present in the tissues, giving a feeling of crepitation on examination and showing up in X-ray examination.
The anaerobic infection was accentuated by the wet and dirty condition of the clothing brought about by the nature of trench warfare at that time in Flanders and Northern France. Treatment consisted in the radical excision of all traumatised tissue, especially avascular muscle, and the removal of any retained pieces of clothing or foreign bodies. The wound was freely enlarged and left wide open and treated by antiseptics. The continuous irrigation with the hypochlorites by the Carrel-Dakin method was of great value. Intravenous injection of sodium bicarbonate solution was utilised as well as saline and glucose. Some blood transfusion was also given. X-ray was used as treatment, and some success claimed.
The results of treatment were good as regards prevention and in localised infection. Removal of whole muscle and muscle groups often proved entirely successful in preventing the spread of the infection and amputation of the limb often saved life.
In the fulminating cases associated with generalised infection death normally occurred. Gas infection can be said to have been the main anxiety of the forward surgeon in France in the First World War.