Читать книгу Surgical Experiences in South Africa, 1899-1900 - George Henry Makins - Страница 11

Fig. 1.—Linen Holdall with surgical instruments

My departure for the seat of war was rather hurried, hence my surgical equipment was not of an extensive nature. It may be of interest, however, to shortly recount what it consisted in, since it proved an ample one, and yet was carried in a small satchel. The plan of selection adopted consisted in carefully going through the equipment of the British Field Hospital, and then adding such other instruments as seemed to me likely to be useful. With few exceptions, therefore, designed to meet emergencies, my set of instruments formed a supplement to the actual necessities carried by the Service hospitals, and was as follows:—4 trephines, Horsley's elevator, brain knife and seeker. 2 pairs of Hoffman's and 1 pair of Lane's fulcrum gouge forceps, 3 bone gouges, 1 pair straight 1 curved necrosis forceps, 1 pair bone forceps. 1 Wood's 1 Horsley's skull saws, 18 Gigli's saws with an extra handle, and two Podrez' directors for the same. 1 set Lane's bone drills, broaches, screw-drivers, and counter-sink with eight ounces of screws: silver patella wire, and 1 pair Peter's bone forceps. 2 aneurism needles, 1 bullet probe, 1 pair Egyptian Army pattern bullet forceps. 4 Lane's and 3 pairs Makins's bowel clamps, Nos. 3 4 and 5 Laplace's bowel forceps, 6 Murphy's buttons, 1 pair Morris's retractors, 6 dozen intestine needles, 2 Macphail's needle-holders, Nos. 4 5 6 Thomas's slot-eyed needles, 1 mouth gag, 1 Durham's double raspatory, 3 strong plated raspatories, 1 pair tongue forceps, 1 tracheal dilator, 1 pair hernia needles, 1 hernia and 1 ordinary steel director, 1 transfusion set with metal funnel, and a stock of Messrs. Burroughes and Wellcome's compound saline infusion soloids. 1 antitoxin syringe. 6 scalpels, 2 blunt-pointed curved bistouries, 6 forcipressure forceps, 1 pair Jordan Lloyd's retractors, 1 pair ordinary retractors, 2 pairs of forceps, 3 pairs of Scissors, 1 skin-grafting razor and roll of perforated tin foil, 1 metal pocket case, and 1 hypodermic syringe with tabloids. A stock of silkworm gut, horsehair and silk ligatures, the latter prepared and sterilised for me by Miss Taylor, the Theatre Sister at St. Thomas's Hospital. Some pairs of McBurney's india-rubber, and cotton-thread operating gloves.

Fig. 2.—Instrument Holdall rolled

The instruments were packed in sets in small linen holdalls suggested and made by Messrs. Down Bros., who also devised my satchel. In the light of the experience gained I should have preferred a tin case to the satchel, as it never needed to be carried on horseback.

For dressings I trusted entirely to the Royal Army Medical Corps, and at my request Colonel Gubbins, R.A.M.C., sent out to the Cape a quantity of sterilised sponges and pads made by Messrs. Robinson & Co. Ltd. of Chesterfield, which fully met all requirements in this direction.

Fig. 3.—Tin Water-bottle for the march (Military Equipment Company)

This equipment was superfluous at the Base hospitals, but when in the field with the troops proved very useful. In the early part of the campaign I was able to do all my travelling by train, but later I travelled by road only. I received the greatest kindness and help in this particular. General Sir William Nicholson, Chief Director of Transport, provided me with a buggy, a pair of horses, and a driver, and Prince Francis of Teck, the Chief Remount Officer, selected a pony suitable to my equestrian powers. The buggy proved a very great success; the box seat carried my instruments and dressings, the front a 4-gallon tin water-bottle for emergency operations, and the rear shelf my personal belongings. The water-bottle was lent to me by the Portland Hospital. (Fig. 3.)

The cart was able to cross any drifts or dongas, and when an engagement was in progress was able to accompany the Ambulance wagons, so that I had all my necessaries on the spot, even at the first dressing station. In point of fact when with the Highland Brigade, on some occasions, we did all necessary operations on the spot during the progress of fighting; a most useful performance, since fighting on several days did not cease till dark, and the evenings were much too cold to allow of operations being done with safety to the patients. The great advantage of the buggy was its lightness and smallness. On one occasion it accompanied me between 500 and 600 miles without a single accident, beyond the fact that one night I was relieved of both my horses by some troopers whose own were worn out.

Fig. 4.—My Buggy on the veldt at Bloemfontein. (Photo by Mr. Bowlby)

With regard to the general health of the troops as subjects of surgical wounds, I suppose a better class of patient could scarcely be found. The men were young, sound, well set and nourished, and hard and fit from exercise in the open air. Beyond this, in spite of the scarcity of vegetables, a certain amount of fruit, rations of jam, and lime juice made any sign of scurvy a rare occurrence—I never saw a case during the whole of my wanderings. The meat was good, especially in the early part of the campaign, when it was for the most part brought from Australia and New Zealand, and we enjoyed the two collateral advantages of getting plenty of the ice which had been used for the preservation of the meat, in the camps, and the still greater one of having no butchers' offal to need destruction or prove a source of danger. When bread was to be got it was fairly good, and the biscuit was at all times excellent. Except on the advance from Modder River to Bloemfontein, as far as I could judge, no large bodies of the men ever really suffered from shortness of food, and then only for a few days. Drink was a more serious problem: in the early days beer was to be got at the canteens, but with the increase of numbers and difficulties of transport this ceased to be the case, and water was the sole fluid available. This was often muddy, and the soldiers would take very little care what they drank unless under constant supervision; hence a great quantity of very undesirable water was drunk. None the less I think the water was more often the cause of sand diarrhœa than of enteric fever. A large quantity of fluid was by no means a necessity if the men would only have exercised some self-control. During the first week I spent at Orange River, I drank lime juice and water all day, but after that time, by a very slight amount of determination, I thoroughly broke myself of the habit, and drank at meal-times only. Most of the men however emptied their water-bottles during the first hour of the march, and the rest of the day endured agony, seizing the first opportunity of drinking any filthy water they met with. When, for instance, we camped near a vlei, and the General took the greatest care that the mules and horses should be watered at one spot only, in order to preserve the cleanliness of the rest of the pool, the men would often go and fill their water-bottles amongst the animals' feet rather than take the trouble to walk the few necessary yards round. In such particulars they needed constant supervision.

The climate on the western side was a great element no doubt both in the general healthiness of the men and in the general good results seen in the healing of wounds. The days were often hot; thus even in November at Orange River the thermometer registered 115°F. in the single bell tents, but on the other hand the nights were cool and refreshing. The air was very pure and exceedingly dry, while the constant sunshine not only kept up the spirits, but also proved the most efficient disinfector of any ground fouled to less than a serious extent. Dust was our principal bugbear; and when a camp had been settled for a few days, flies; both of these evils increasing rapidly as the stay on any one spot was prolonged. My personal experience of rain was small, but I was twice in camp, once at Orange River and once at Bloemfontein, when very heavy rain fell, and this was sufficient to make the camps terribly uncomfortable for a few days.

Under these conditions, as might be expected, until the outbreak of enteric fever the health of the men was remarkably good, minor ailments alone prevailing. One of the most troublesome of these was diarrhœa, which gained the appellation of 'the Modders,' already a classical name as far as South Africa is concerned. This most frequently, I think, depended on errors of diet, combined with the swallowing of a large amount of sand with the food as dust, and in the water drunk. Cases of severe dysentery, however, were also not very uncommon. Rheumatic pains were a common ailment, which, considering the dryness of the atmosphere, would hardly have been expected. Continued fever of a somewhat special type was not uncommon, and was sometimes spoken of under the name of the district, sometimes as veldt fever—of this I will say nothing, as others better fitted to point out its peculiarities will no doubt deal with it. Enteric fever, our chief scourge, I will pass over for the same reason. I might, however, remark from the point of view of one not very experienced in this disease, that in a large number of the fatal cases I happened to see, the actual cause of death seemed to me to be septicæmia from absorption from the mouth. The mouths were unusually bad, even allowing for the often insufficient cleansing that was able to be carried out, and I was inclined to attribute these in some degree to the dryness of the atmosphere, which very quickly and effectively dried up the mucous membrane of the mouth in patients not breathing through the nose, and encouraged the formation of large cracks. Pneumonia was rare, and this was rendered the more striking from the comparatively large number of men who contracted the disease on board ship on the voyage out from England.

As will be gathered from the above, medical disease seldom called for the aid of the surgeon. Abdominal section was occasionally considered in cases of perforation in enteric fever, and was, I believe, a few times performed, but as far as I know without success. It was also proposed to treat some of the severe dysentery cases by colotomy, but I never saw the method tried. As far as I was concerned I never met with a case of either disease I thought suitable for the treatment. I saw one case in which an abscess of the liver had followed an attack of enteric, which had been successfully treated by incision, and a few cases of tropical abscess which probably came into the country were also subjected to operation. Some cases of appendicitis, as would be expected, also needed surgical treatment. In a few instances empyema followed influenza, and a few cases of mastoid suppuration had to be dealt with.

Of surgical diseases the one most special to the campaign, although not of great importance, was the veldt sore. This was a small localised suppuration most common on the hands and neck, but sometimes invading the whole trunk, more particularly the lower extremities however, when the covered parts of the body were attacked. The sores were no doubt the result of local infections; they reminded me most of the sores seen on the hands of plasterers, and I think there is no doubt the dust was responsible for them. I think piles were somewhat more prevalent than they should have been among the men, but this was probably dependent on the strain involved in defæcation in the squatting position, since the soldiers were for the most part regularly attentive to the calls of nature.

I saw a good many cases of lightning stroke, and some were fatal. Sunstroke was not common, and, considering the heat, it was very remarkable how little the men suffered from this condition. This was no doubt in part attributable to the absence of the possibility of getting alcoholic drinks, but it is not common for any one in South Africa to suffer in this way, probably as a result of the continuous nature of the sunshine.

In spite of the labours of hospital surgeons at home, it was rather instructive to see the number of men who suffered with hernia, varicocele, and varicose veins to a sufficient degree to necessitate going to the base. The experience quite sufficed to explain the trouble which is taken to prevent men with these complaints entering the service.