BULLETIN

Page 57 | Bulletin 93 | September 2015
AsWeWere
by Dr David Zuck, History of Anaesthesia Society
... we have seen more of war in these few weeks than has fallen to the lot of many an old campaigner. It was our great regret
that we had so little time in which to see the work of the Antwerp hospitals. Those we saw were magnificent buildings,
equipped in a way which filled us with envy. The show part was the suite of operating theatres, which certainly eclipsed those
of the London Hospital. Each theatre had its own anaesthetizing room, its own surgeon’s room, and its own sterilizing rooms
and stores, all furnished with a lavishness beyond the financial capacity of any hospital in London.
Our own hospital occupied one of the largest houses in the Boulevard Leopold, a magnificent avenue. It had previously been
used as a school, and was well adapted to our needs. We had in all 150 beds, and a staff of about 50, including 8 doctors and
20 nurses. When a rush came the scenes in any part of the hospital required steady nerves, but the centre of interest was the
theatre. Here all the worst cases were brought - men with ghastly injuries from which the most hardened might turn away in
horror. With all these we had to deal as rapidly and completely as possible, reducing each case to a form which it would be
practicable to nurse, where the patient would be free from unnecessary pain, and where he would have the greatest chance
of ultimate recovery. Of course all this was done under anaesthesia. What a field hospital must have been before the days of
anaesthesia is too horrible to contemplate.
It is not so many years since a famous surgeon who was fond of walking back from his work at the London Hospital along the
Whitechapel Road used to be pointed to with horror by the Whitechapel butchers. But now all that is changed. The surgeon
can be human again, and except when he goes round his wards his patients may never know of his existence. They go to
sleep in a quiet ante-room, and they waken up in the ward. Of the operation and its difficulties they know no more than their
friends at home. Perhaps even more wonderful is the newer method of spinal anaesthesia, which we used for the difficult
abdominal cases. With the injection of a minute quantity of fluid into the spine all sensation disappears up to the level of
the arms. It is rather uncanny at first to see a patient smoking a cigarette and reading the paper whilst on the other side of
a screen a big operation is in progress. But for many cases this method is unsuitable, and without chloroform we should
indeed have been at a loss. The Belgians are an abstemious race, and they took it beautifully. I am afraid they were a striking
contrast to their brothers on this side of the water, who were fond of demonstrating that chloroform does not mix well with
alcohol in the human body.
With surgery on rather bold lines it was extraordinary how much could be done, especially in the way of saving limbs. During
the whole of our stay in Antwerp we never once had to resort to an amputation, although anything more awkward to manage
than a thigh with six inches of bone missing is difficult to imagine. Splints presented insuperable difficulties, so after some
hesitation we attempted the method of fixation by means of steel plates introduced by Sir Arbuthnot Lane. The missing
piece of bone is replaced by a long steel plate screwed to the remaining portions. The result was a brilliant success. Not only
could the limb be handled as if there were no fracture at all, to the infinite comfort of the patient, but the wounds themselves
cleared up with great rapidity. There were none of the prophesied disasters, sepsis, or breakages, and one of our most
indignant critics returned to his own hospital after a visit, with his pockets full of plates.
It is one of my chief regrets that we never kept a visitors book. Twice a week the Queen of the Belgians came round our
wards. She came quite simply, with one of her ladies, and no one could have taken a deeper interest in the patients. One
of our distinguished and most welcome visitors was Madame Curie, the discoverer of radium. She brought her large X-ray
equipment, and stayed with us for a week. One of our store rooms was rapidly fitted up as an impromptu radiographic
department, and electric current was obtained from a dynamo bolted to the step of a car standing in the courtyard, and
driven by a belt from the flywheel of the engine. Madame Curie was an indefatigable worker, and in a very short time had
taken radiographs of all the cases we placed at her disposal, Considering its obvious utility it has always been a source of
wonder to me that there is no such thing as a car designed with a view to radiology. It would place X-ray equipment at the
disposal of every cottage hospital.
And this brings me to a subject on which I feel very strongly, the folly of removing bullets. If a bullet is doing any harm,
interfering with a joint, or in any way causing pain or inconvenience, by all means let it be removed. But the mere presence
of a bullet inside the body will of itself do no harm at all. We now know that, provided they are clean, we can introduce steel
plates, silver wire, silver nets, into the body without causing any trouble, and a bullet is no worse than any of these. It is a
matter in which the public is largely to blame, for they consider that unless the bullet is removed the surgeon has not done
his job. It may be the mark of a Scottish ancestry, but if I ever get a bullet in my own anatomy, I shall keep it.
*****
Extracted from H.S. Souttar, A Surgeon in Belgium. London, Arnold, 1915. (Reprinted by The Naval and Military Press
Ltd.) This wonderfully interesting book is also available to e-readers as a free download from the web site of the Gutenberg
Project. Sir Henry Souttar (1875-1964), was a mechanic, a mathematician, and a surgeon. On 16 May 1925 at the
London Hospital he performed the first open heart operation, in an attempt to dilate what was thought to be a stenosed
mitral valve. He had an illustrious career, and according to Plarr’s Lives was instrumental in founding the Faculty of
Anaesthetists, of which he was elected an honorary fellow.