Notes from a Field Hospital

Two days ago I came across A Surgeon in Belgium at gutenberg.org. It was written by Dr. Henry S. Souttar about his work at a Belgian hospital as the German army invaded in 1914, and evidently published before the end of the war. Its tone is oddly light at times -- e.g. "The wards were full when we arrived, and I had a wonderful opportunity of studying the effects of rifle and shell fire." -- and the descriptions of Antwerp and its history feel out of place. The ugliness and seriousness of the war have clearly not sunk in yet, and he still seems to find a thrill in it. But he is passionate when he describes the burned-out Belgian villages and shelled churches and fleeing peasants -- also when he theorizes about the Teutonic character with predictably unflattering conclusions and predicts the triumph of the British side in the emotional and dogmatic jargon that I already know from the fiction of the time. What interested me most, since I find medicine fascinating, were his medical observations:

- In the Antwerp hospital where he worked, many soldiers arrived whose wounds were infected by the filth of the fields where they had been fighting. But the bacteria to which they were exposed in the countryside were less dangerous than those in the city. The medical staff dressed the wounds fairly lightly and treated them with solutions of oxygen, and in the worst cases wheeled the patients out into the fresh air. Even gangrenous injuries healed satisfactorily, because the oxygen was so effective. And there were no cases of tetanus.

- Among the most problematic injuries were those where bones were severely broken and even blown away. But a new approach that worked reasonably well was to replace the bone with steel plates. Concerns that the screws which fixed the plates to the bones might come loose did not seem justified. [N.B. Opapa had trouble with such a screw, though, I think, and had to have it operated out.]

- Apparently there is no need to extract bullets from a body -- unless they are pinching a nerve or causing other discomfort, and then preferably only when the wound has healed -- because, if any infection exists, it is only exacerbated when the bullets are removed. [I don't understand how bullets can be infectious, since the act of firing presumably makes them hot enough to sterilize them. On the other hand, since they might do damage if they get into the bloodstream, it seems best to me to remove them routinely as soon as the wound has healed.]

- A practice of which the two sides in World War I accused each other was removing the hard nickel tips of bullets to make "dum-dum bullets." Without the casing tip, the bullet spreads out when it hits its target, and causes severe damage where it would otherwise make a fairly clean perforation.

- A person who has alcohol in his bloodstream does not take chloroform very well.

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Last February I also read Notes on Nursing (1860) by Florence Nightingale, the pioneer of modern nursing and hospital sanitation. In her book, which is not a training manual but a guide for the general public, she explains her ideas about nursing and tries to dispel the myths. She stresses hygiene above everything; a sick-room must be scrupulously well-dusted, well-aired, neat and clean. As a part of this, she refutes the idea that night air is harmful, by pointing out that the day air in cities is a polluted brew upon which the night air is a decided improvement; therefore it is good for patients, provided that they are properly tucked in so that the cold does not affect them.

Her model nurse is stereotypically efficient; she must be clear and firm in her voice and step, inform the patient accurately about her comings and goings so that he can trust her, keep good records so that someone else can take her place at any time, observe well, and report facts and not opinions to the doctor. But she should also be considerate . . .

. . . as well-meaning visitors often are not. Florence Nightingale lists rather awful instances of common thoughtlessness: plunking down on the patient's bed without thinking that it can jar him, bringing flowers with overpowering scents, speaking from angles at which it's difficult for the patient to see one properly, lecturing the invalid about his illness and airing conspiracy theories or raising false hopes, etc. It's exaggerated, of course -- clearly not all visitors are so insensitive, and all patients so sensitive -- but I'm sure that almost everyone does one or two things that prove, on reflection, to be thoughtless and perhaps unkind.

An underlying idea to Florence Nightingale's rules is that the nurse should devote considerable time and thought to each patient, and not be content with superficial observation. For example, a patient may appear to have eaten food when he has really scraped it politely into the garbage. And, if he refuses to eat the food, he does not necessarily have no appetite, but maybe the food came at a bad time or wasn't prepared properly. Besides, she argues against hastily assessing a patient's well-being; redness or paleness have many causes, for instance, and she recommends that decisions about a patient's state of mind be made only after the nurse has had a lively discussion with him for an hour or more, and preferably also after the following night's sleep. I don't know if nurses have the time and energy to take all that trouble, but it makes sense.

Her view of the patient is quite respectful. She points out that a patient can know his own body better than the nurse. For instance, some patients ask for food (fruit, pickles, jams, gingerbread, bacon or ham, cheese, butter or milk, etc.) which it doesn't seem wise to eat but which has no bad effects after all. The times when the invalid wants to sleep, and when he wants to eat, must be accommodated; and even apparently trivial annoyances, whether the cause is a colour or a noise or something else, should be treated considerately.

Finally, she made a reflection that is as relevant today as ever: medicine should not be expected to take the place of letting the body do its work, or of proper diet and care.

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. . . and a non sequitur at the end:

“The truth which makes men free is for the most part the truth which men prefer not to hear.”

-- Herbert Agar (American journalist, 1897-1980), A Time for Greatness
(Quoted in Oxford Dictionary of Quotations, rev. 4th ed.)