Stench and Guillotines

Two methods in war surgery-one for saving limbs, the other for amputating them-were reported at the A.M.A. meeting last week.

> Standard treatment for wounds in World War II is to trim off all dying flesh, enclose the limb or trunk in an old-fashioned plaster cast, leave the cast undisturbed for many weeks until the wound has healed. This closed plaster method prevents many an amputation, reduces infection to a minimum, allows soldiers to be moved with no ill effects. Only drawback: after a week or so the wounds develop a foul stench. Last week Dr. Allan Dinsmore Wallis and Researcher Margaret J. Dilworth of Philadelphia told how they prevented the smell by simply placing lactose (milk sugar) solution on wounds before enclosing them in plaster. Apparently, said the scientists, the lactose provides food for harmless bacteria in the wounds, prevents them from causing putrefaction.

> Quickest, simplest, safest method of amputation on the battlefield, said Colonel Norman Thomas Kirk of the U.S. Army, is the circular or "flapless guillotine" operation. "The word 'guillotine,'" said Colonel Kirk, "is a misnomer. The circular guillotine amputation is not a 'chop' operation." It consists of cutting around the skin of the limb, waiting a moment for it to draw back, then cutting around the connective tissue, waiting again for withdrawal, cutting through the muscles circularly, and finally sawing the bone. The old practice of covering the bone with flaps of skin has been abandoned; the stump is sprinkled with sulfanilamide, left exposed so that there is no closed pocket for bacteria to breed in. Later on, the skin is pulled down over the bone.

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