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beyond the reach of the hypochlorite but it makes it possible to close the solution; or the germicide may not be point of drainage at the desired moment applied according to the prescribed tech without fear of a distressing aftermath nique.
Be the reason what it may, of any sort. the charts constitute unmistakable In many instances of appendicitis the warnings. Not only that, but each problem is complicated by pustulent graph is, after a fashion, a check on the abscesses which may provoke peritonitis other.
or lead to other septic and inflammatory Doctor Dehelly, who has now joined conditions. These are ordinarily very the instructional staff of the War Dem- hard to combat and may enforce long onstration Hospital, spent some months periods of pain, if nothing worse. Adapin Rumania, arriving there just when tations of the Carrel-Dakin method of typhus fever was rampant. "Well-nigh dealing with infected wounds, in conall of the patients that came under his junction with surgery, have wrought asobservation were sadly debilitated by tonishing cures in cases of this character. lack of proper nourishment, and because The measure of suffering that can thus of their rundown condition most of them be prevented is inestimable. developed abscesses, which added just The ever-menacing bacilli streptothat much more to the acuteness of cocci, which add to the gravity of scarlet their suffering and the aggravation of fever and diphtheria, are certainly contheir condition. In treating typhus it is tributive to the seriousness of puerperal the practice to give hypodermic injec- sepsis, all too common in maternity tions of camphor. Almost invariably cases. Infection, once established, is the tiny wound of the needle became in ordinarily an insidious foe which the a short while an abscess, simply because physician finds difficult to fight successthe prick brought to a focus, by secon- fully. The odds, however, are now in dary infection, the streptococcus bac- his favor, thanks to the means of attack teria present. This localized the septic put in his hands by Carrel and those state of the fever-stricken patient. Doc who have worked valiantly with him. tor Dehelly found that these suppurat- Thus are tempered the hazards of the ing sores were readily responsive to the women that
down into the very ValCarrel-Dakin treatment; and by this ley of the Shadow of Death that the cleansing process convalescence was
Such is one of the speeded up
paradoxical reflexes of the battle-fields In cases of mastoiditis, one of the where millions of men have died. most painful of inflammatory diseases Years ago Pasteur classed microrecovery is often retarded by rather organisms in two general divisions: those prolonged suppuration, and the peril of living in the presence of air he called a serious relapse is thus encouraged. "aërobic,” and those living remote from However, it has lately been established such contact he named "anaërobic.” that final healing and a return to normal The bacillus of tuberculosis is of the can be greatly hastened by sterilizing aërobic variety and flourishes best when the surgical wound with hypochlorite of exposed to an abundant supply of oxysoda applied agreeably to the Carrel gen. What is technically termed surgimethod. Again, there is the malady of cal tuberculosis is that permitting the empyema, as suppuration of the pleural curative use of the knife, such, for incavity incasing the lungs is called. The stance, as of the joints, bones, glands, usual treatment consists in providing an In surgical tuberculosis the parts artificial drain for the pus, but because of the body affected are generally exof the lingering nature of the infection cluded from the air; oxygen reaches the relieving wound more often than them only through the circulation of the otherwise becomes a rather persistent blood. By keeping a tubercular knee, fistula. This is very apt to invite serious for example, in a plaster cast and quiet consequences.
The Carrel system of for months, a cure may be accomplished sterilization works wonderfully well in without recourse to the scalpel, if the combating empyema. It not only ef- general physical state be improved the fectually sterilizes the infected pleura, while.
But this measure of inaction is not that surgical tuberculosis indicates a always practicable, and the tubercular general tubercular condition of the paaffection may work out to the surface tient, and that the affected part is and become a suppurating sore. This merely a focus of the disease. Accordlast stage is commonly complicated by ingly it is not logical to expect systesecondary infection-i.e., by the im matic relief or cure by the amelioration planting of other septic microbes. In of a purely local manifestation of the a large majority of tubercular joints, bodily prevalence of the malady. Howetc., the malady reaches the distressing ever, this application of Carrel's revival climax just described, and it is nearly of antisepsis is a long stride forward, hopeless to deal with the tubercular con because it obviates piecemeal surgery dition, per se, so long as the open wound which, sooner or later, involves amputais otherwise infected. Doctors who have tion of the whole or better part of the specialized in this field of surgery have affected limb. Not only that, but by frankly admitted that, no matter how reducing the septic and debilitating repainstaking their efforts, it was only sults of suppuration, it makes it possible rarely they succeeded in completely to bring into play curative agencies closing the wound after treatment. The which may finally restore the sufferer to practice of some of them, in order to health and strength. prevent reinfection through stitching, These benefits should not appear has been to use grafts of healthy tissue speculative, because we know now what laid in the excised areas and bound the Carrel method has achieved in dealdown or held in place by bandages oring with injuries of extreme gravity adhesive plaster until union was ef among the battle-stricken in Europe. fected.
It has made cures possible despite the However, while union has been fact that the virulence of infection durbrought about in this way to a degree, ing the present conflict has surpassed nearly perfect in numerous instances, anything recorded of previous wars. secondary infection has balked ultimate Why, then, should we be skeptical of
Sooner or later abscesses ap the results when applied to the problems peared, and all because the surgeon, by of the civil and industrial surgeon? It his unaided eye, could not make sure has been reported by Doctor Tuffier, as that he had removed every trace of the a result of wide experience with war troublesome microbial colony. At the wounded, that something like 70 per War Demonstration Hospital, cases of cent. of the operations demanded were tuberculosis of the hip and the knee required because of the inroads of infechave responded to the treatment prac tion and not because of the anatomical tised there after other efforts to deal damage done by battle agencies! In the with them have failed. The abscesses or earlier stages of the conflict, when the sores are opened so that the sterilizing antiseptic method as devised by Carrel hypochlorite of soda can do its cleansing was not employed, fractures of the hip work and search out the intrenched were closed successfully in only 14 per microbes. In this manner the secondary cent. of the cases—the other 86 per cent. infection is dealt a death blow and dis- remained suppurating. To-day, so it posed of, and the wound thereafter is seems, thanks to the genius of this man reduced to a condition which allows the who has contributed in many ways to surgeon to treat unhampered the tuber- the wonders of modern surgery, 94 per cular area. Again, the microscope and cent. of the hip fractures heal perfectly, the bacterial smears guide him in deter and only a modest 6 per cent. are obstimining the sterility of the wound. With nate and continue open! this established, it is practicable to pro The layman is prone to judge by receed to close the opening entirely. sults only, quite forgetting that the cir
Doctor Dehelly, who has charge of cumstances leading up to such a climax cases of this nature, is very hopeful of are anything but unimportant to the the ultimate benefits of this new treat sufferer lying abed. It is said authoriment and its probable widespread ap- tatively that, “There is a profound difplication. Just the same, he recognizes ference between the facial appearance
of a patient whose wounds are in a fair soda we have another germicidal agent way for sterilization, even if he still has in chloramine paste. For fresh surface some fever, and the 'look' of a man wounds this sterilizing medium is adwhose wounds, treated aseptically, are mirable, and its bactericidal potency is still suppurating.” The latter does not of a high order. It can be packed in sleep; his appetite is gone; he is apt to collapsible tubes just like vaseline and be agitated and depressed; and his state other pharmaceutical preparations, and is aggravated by pain. Sterilization
first-aid kit is far more effects a transformation: pain vanishes; desirable than caustic iodine which has the appetite is lively; and hopefulness figured so commonly in the soldier's outis the dominant mood. No wonder, fit in the past three years. Chloramine then, that cheerfulness prevails in the paste is benign in its action upon raw wards of the War Demonstration Hos and living tissues, and therefore differs pital in New York city. This is a happy radically from iodine, carbolic acid, and augury of what we may find commonly bichloride of mercury. Accordingly, it in the future when antiseptic surgery lends itself to general use and to the comes into its own.
services of those not familiar with the Knowing, as we do, that micro-organ- limitations and the drawbacks of the isms multiply rapidly, and after half a other germicides mentioned. Here is day of neglect may seriously infect an another helpful heritage of the present injury, the question may be reasonably conflict. asked, What can be done to deal with Doctor Carrel started out to save the these germs, particularly in wounds of lives of stricken soldiers and likewise to moderate extent, in the absence of an preserve, as far as his skill permitted, the apparatus for the application of hypo- bodily integrity of his patients. In chlorite of soda? Syringes have been other words, his object was twofolddevised to take the place temporarily of vital and physical conservation. He the more elaborate equipment already knew how important to France was the described; and in one of our great in maintenance of her man power fit for dustrial plants it is the practice to spray the battle-lines and, falling short of this the "walking cases” with Dakin's solu- standard, to return the wounded back to tion and supplement this by a bottle of civil life in a condition that would enable the antiseptic which the patient applies them to be self-supporting in one way or himself before returning to the com another and not public charges or burpany's physician for the next dressing. dens upon their loved ones. As a precautionary measure, all injuries, What he has done in behalf of the involving breaking of the skin, are con fighting forces becomes equally applicasidered infected wounds at the start. By ble to industrial armies—not to mention thus anticipating septic developments, the vast civil populace in its multiple a great deal of pain and suffering is walks of life. Infection is not discrimprevented; and it seems that new in inatory; it is not balked by social conjuries when treated promptly with the ditions; and those best qualified to know solution heal by first intention, while admit its omnipresence and its ceaseless others, manifestly infected at the start, menace. Doctor Carrel has shown what clear up in an astonishing manner under science, the microscope, and common the influence of the germicide. To sense, in collaboration, may bring forth; be more specific, instances are men and of this triad he personally lays a tioned, at the plant in question, of great deal of stress upon the last. By lacerated fingers and of compound fract reason of Carrel's amazing successes the ures of the bone, in which, by the use of pioneer work of Lister shines in a Dakin's solution, the partly severed brighter light; and, as the Psalmist of members, held only by the slightest old sang, "The stone which the builders piece of integument, have been saved! refused is become the head stone of the
As an evolution of the hypochlorite of corner.”
BY R. G. BEEDE
ONDER where the boss him or go to the devil. A sudden fury got the kid?”
possessed him. “Damn him!” he whis“Looks pretty white
white- pered, his nails clawing the palms of his livered."
hands. “He thought I'd starve. He “Don't look like thought I'd be back begging for mercy. much of a carpenter." But I won't. I won't. I won't! I'll
“Where'd he go?" make a man of myself, or-or“Up in the loft. Guess he'd had sup The men were coming up. Most per in town."
seemed not to notice the kid. He “Did he have his tools?”
watched them as intently as the rapidly “I dunno."
darkening shadows of the long summer “Well, he can't be much worse than day permitted. At length one addressed Louisiana.'
as “Dad” turned to the boy. “Hell!”—Louisiana rose from his keg “Well, kid, where'd yah come from?” -"I nevér pretended to be a carpenter." “North Dakota." He spat disgustedly. "He asked me if "North Dakota? Whew! You're a I could saw straight, and I told him, long ways from home.” ‘Hanged if I know; I never tried."" "Yes. "If you hadn't 'a' had that bottle, “Come out tah take
land?” though, you'd 'a' got the sack, believe
"I may–when I'm old enough.” me. We sure was a dry bunch that "Well, well; ain't you eighteen?” morning.'
“No-not quite.' "Well, I think I'll turn in. That is “Where'd yah put your bed?" Don't none of yah want a game?” “Over there."
"Got many blankets?” "I'll play awhile."
“One." “So 'll l.”
“Only one? Best come in with me, “What 'll it be! Black-jack?" then. I hain't got but two, and it gets “Suits me; I'm near broke."
mighty cold ’long toward morning.' The kid felt sick, deathly sick. There Summer in northern Alberta outdoes were so many things the matter. And herself. Nature seems never to sleep. now he was afraid -- afraid of those Almost before the last rays of twilight men. If he could only sleep! Then he'd have disappeared from the west, the forget.
brightening east betokens another day. In the stable below, the men were pass- Yet, even so, the same sun awakes a ing coarse jokes. And he was a sissy, a world entirely refreshed, a world surgcontemptible, milk-and-water-sissy! He ing, teeming, exulting with life. But knew it. He'd fought against it, but it nature's parasites are a .
He couldn't harden to the Already the day had lost its freshness, raillery of such as they, couldn't stomach had grown dry and stale, when the hired their dissipations, couldn't brave their man sat up with a start, dug under his horse-play.
coat for his "watch, muttered He finished spreading his blanket on curse, and reached for his shoes. the bare haymow floor and moved over The kid, sleeping near, awoke, and for to the open window. He was here; he a long time after lay still and stiff, hardly must make the best of it. Perhaps, daring to undertake the task of relating after all But what hopes were there? himself to his surroundings. Surely, His father had said he could come with surely it must be a dream. All this last
was no use.
month was nothing but a dream. He But no one, now he had awakened, might awake any minute and laugh at gave him any more attention. the impossible things that now seemed The boy hurried and was able to climb actualities. He just couldn't be here; down the ladder just behind Dad. Outit was too—too unthinkable. But the side, but one man was left at the pump. boy was unused to such early hours; his “I guess we're kinda late, kid. Better eyes closed, and he fell back again into wash after breakfast,” Dad advised. his troubled dreams.
But the kid hastened to the pump. In one vivid dream it seemed that He wanted to plunge his head into the the old bearded man was angry; he cold water. Perhaps then that song was telling him to go. It didn't bother which was still ringing in his ears would him, though; he'd never liked to herd stop: sheep. He'd much rather lie under a The cold water fully awoke him. He tree and watch the squirrels, the birds, straightened. He was alone now; all the grass,
the flowers. But the old man the others were inside. But the singing was very angry; he must get away. He —yes, the singing was real! Some one grew afraid. He must run, run, run, as was actually singing! The realization fast as he could; so he ran, ran, ran; un thrilled him. He felt the uprush of new til he was so tired he'd lost all sense of life. It was morning; it was summer; direction, of distance, of speed—there and he was young-and decidedly hunwas such a roaring in his ears and burn gry. ing under his tongue. Finally he felt himself falling. He resisted it for a long The kid's tools had already given him time, still trying to run. At last he had away. He had got them in Calgary, on to give in. But-yes-some one had lower eight, leaving in return a halfcaught him! Some one was holding dozen scarf-pins and a cheap watch. him! His head was close, close against The square was rusty and bent. The a warm, pulsing breast. It was she; saw-even Louisiana shivered when he somehow he recognized her; he knew sighted down it. Only the hammer was her. It was all right, then; he could good for tacks. sleep now. He snuggled his head closer “Hey, kid, we want to top-plate that and she began to sing. Every weary, sill. Start there." The foreman winked tense muscle relaxed to bathe in the to the others. lulling flood of that song. It was the The kid, his face coloring, walked to song the flowers sang,
the place evidently designated and breathed, the wind sighed; only until looked hopelessly around. What—where now his mind, not his ears, could appre was the sill? He looked at the other ciate it.
men; they were presumably all busy.
The man nearest him was nailing pieces “Come on, you North-Dakota-ite! of "two-by-four” to a heavy plank. What dah yah think this is? Rest-cure The kid watched a moment and then for invalids? Kick him, Ole."
tried clumsily to imitate. The men, It was a terrible wrench to wake thus. all the while, seemed to pay him no And even then the boy could hardly heed. A number, though, coughed conrouse himself. He saw the men-most siderably. After he had pounded and of them were waiting turn at the ladder, banged away for what seemed hours, trythough a few were still clustered, grin- ing to nail a "two-by-four" to the plank, ning, around him; but the song-that he was suddenly conscious that the forewas what confused him—the
song still man had come up from behind and was re-echoed in his ears.
watching him. It made him even more “Guess you'll have to hunt your baby nervous. Still, it was some time before his bottle, Dad. He don't seem tah the foreman spoke; he must have been have the strength tah rise, so kinda enjoying it. fagged, don't yah know."
“Say, yah little fool, what yah doin' The kid shuddered and rose. “Gee! with that studdin'? Can't yah obey I guess I-I must have been pretty tired. orders?” - What time is it?"
“Did-didn't you tell me to do this?"