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Prologue

Contents

Prologue

The principle that underlies all surgical management of battle fractures and wounds of major joints was relearned in the field in North Africa and Italy. When Serjeant-Chirurgeon Richard Wiseman who attended Charles II in his wanderings on the continent of Europe in the 17th century wrote on the ''Cure of Gunshot-Wounds, he turned to a Latin version of Hippocrates. Omne quod contusum, necesse est ut putrescat, & in pus vertatur, it was written. ''What is Contused must necessarily putrefie, and be turned into matter. This is the ancient principle that surgeons reared under the aseptic mantle spread by Lister must come to know when they are called upon to deal with the soiled and torn flesh of gunshot wounds.

''But, said the young surgeon, ''I cannot take responsibility for opening a knee joint in a tent with a dirt floor! ''Why not, is the reply, ''when the joint already contains devitalized cartilage and mud from a foxhole?

A distorted version of Trueta's teaching which omitted his emphasis on the careful excision of dead tissue was a false starting point, but facts disclosed by experience soon replaced unsound ideas. Skeletal pins fixed in plaster do not withstand transport. Packing the wound with vaseline gauze causes necrosis and macerated flesh. Splinting for transport is a different art from splinting for the maintenance of reduction. Unpadded plasters abrade the skin. An evil smell and gas bubbles do not necessarily spell clostridial myositis. These and many more detailed lessons emerged as the product of grim experience and came rapidly to the surgeons of the Mediterranean theater. They are set forth in this volume dealing with gunshot wounds of the extremities.

EDWARD D. CHURCHILL, M. D.