ANNEXURE

MEDICAL AND SURGICAL EXPERIENCES IN THE FIRST WORLD WAR AND SOME STATISTICS AND MEDICAL MEASURES OF GREATEST VALUE TO ALL ARMY MEDICAL CORPS

E. Petrie HOYLE, M.D.

One has to work, at top speed, on clinical knowledge, plus using the medicaments on hand during a war.

Our Calendula off. is so important that it will pay to sow some seeds of this easily grown plant, which is the common Scotch marigold.  Sow it round wherever you have base hospital.  A very few half opened buds or freshly opened flowers, together with the “gummy” (sticky) terminal shoots, form the part of the plant used to make a large supply of the mother tincture (strongest tincture)of this vulnerary.  To make same, pound up the parts named above and macerate same in 50% alcohol.  Don’t use stronger alcohol, or you will coagulate out the valuable “balsams” which nature has incorporated in the plant for its cures.  Place this material in some bottles.  Shake several times daily for up to three weeks to thoroughly extract all values.  Filter off the clear liquid and cork well for your stock supply. 

Calendula officinalis is a“germ inhibitor” of the highest order, as microbes do not develop in the presence of Calendula solution.  To each pint of as clean water as can be obtained add one teaspoonful of the Calendula tincture.  This is for wet-dressings on any sort of wound, meaning even if wounds are known to be infected, which every war wound surely is.  If the wound is deep, syringe with this dilution and very lightly pack with medicated gauze to prevent sudden closing, then cover the wound with some waterproof material, N.B.  Don’t keep a wound too warm. Dress twice daily, if possible, though once daily dressings have carried thousands through to perfect cure.  I never saw a gangrene in a Calendula dressed wound. 

By close observation, one may at times consider that a wound  suddenly seems to go “sluggish” and that the healing process is really halting. My experiences have taught me that if I see any such partial arrest of progress, I must at once change the Calenduladressing for an intercurrent use of normal saline dressing for two to three days.

When you consider that a wound has granulated up sufficiently so that there will not be too great a tissue depression, and when you consider it may still take months to skin over, I used the  “ambirine wax” treatment, first introduced into France for mustard gas burns. When applied to these gas burns, the first thing noted was the instant cessation of all pain a few minutes after application, which places it in the first rank of value. It is generally accepted that skin grows only from the edges of any open wound, but underambrine wax treatment on the third or fourth day one sees tiny white spots appearing all over the denuded area. These tiny white spots, termed islands, increase daily in size and number, so that one finds scores of such islands of true skin, rapidly enlarging until they meet, without a vestige of cicatricial scars.

WAR WOUNDS-RELAPSING OR RECRUDESCENCESS OF SUPPURATION

I have seen war wounds all healed over, suddenly swell up and take on a shiny pink around old wound areas. All such cases had been x-rayed before received and so ticketed as free from fragments of bone or shell. However, I now know that no x-ray will show a tiny fragment or shred of garment carried that the cause of such relapses is due, or is most likely due, to the smallest shred of cloth. Rush at the front clearing station is a good excuse. The obvious thing to do is to dissect to the bottom of things, using some adrenalin to clear the field of oozing blood, find your garment shred, drain and use antiphlogistine, if procurable.

Keep open, drain well and use Calendula after a few days of antiphlogistine.

INTERNAL MEDICATION TO HELP WAR AND CIVILIAN WOUNDS TO HEAL

Symphytum Officinale: “Symphytum Officinale is a “old cell proliferant” is as valuable in tissue repair as for callus hardening. It is a good adjuvant to the Calendula wet-dressings.

Hypericum is to the nerves what Arnica is to the muscles and tendons. It soothes pains due to nerve injuries, whether by surgery or war, hence its field of usefulness after operations. In case of nerve shock from near-by explosions without any wounds, it often puts soldiers to sleep so quickly that they think they have had a narcotic dose.

      Dr.John H. Clarke summed up its sphere; Nerve shock, fright, and wound shock. These three points are inseparably bound up in war.

Gelsemium sempervirens: The sphere of the shock is on the fright side. The purely nerve shock case is often excited and talkative. The traumatic shock will exhibit the three great key-notes of the drug, and he will be “dull, drowsy and dizzy,” the three classical “D’s”! I feel sure that I have seen two distinct spheres of Gelsemium shock, as above outlined, but all will exhibit trembling and especially goose-flesh (horripilation), Some want to know all about their troubles and are very excitedly talkative, and I will quote you one such case. 

Arnica Montana: I will give you a typical Arnica case.  At Furnes, Belgium, in November or December, 1914, I had a Commandant Harfeld (name not certified after all these years).  He has been  thrown, they said 30-odd meters by an exploding shell which killed all the officers he was grouped with.  He came in stunned and helpless and turning black, green, and blue, all over.  He had no wound.  He received Arnica Ø or 1x. in water, given quite often at first, and he mended extremely fast.  The Queen of the Belgians who came to our hospital several times weekly seeing him, hastened to his bed, saying, “Commandant, you promised me that you would not expose yourself to open danger.  Your brains are too valuable to poor Belgium.”  As he was convalescing nicely, she took him to the royal cottage by the sea at La Panne to complete his recovery, I giving him a bottle of Arnica 3x. medicated pills to take with him.  Here is a bit of side history.  Whilst in bed with us I taught him some Homœopathy, as he was intrigued by his rapid recovery which astonished him.

Silica: Silica is of more use in cases when there is extensive suppuration and sloughing.  Like Symphytum, this Silica aids bone repair and the greater the callus deposit the better is the Silica indicated, as it often comes in the later stages of recovery.  Silica is also to be preferred when there is much suppuration.  Equisetum often contains as much as 18% to the fresh plant.  The strength of straw and bamboo is due to Silica, therefore you may believe in the necessity of Silica in healthy bone repair. It was Dr. J.ComptonBURNETT (see his Curability of Tumors, pp. 46, 72) who emphasized that cartilage (read callus) is bone minus silex (Silica), for which, in enchondromata he prescribed Silica.

     Silica is valuable in high potencies (12x. upwards) in all suppurative cases and including boils, carbuncles, etc.  In the latter case think of a dose of Anthracinum, 30^th to 200^th.