BOOK REVIEW

FIELD SURGERY IN TOrAL WAR. By DOUGLAS W. JOLLY, M.B., Ch.B.N.Z., Late

Major, Spanish Republican Army Medical Service; with a Foreword by SURGEON REAR-
ADMIRAL G. GORDON-TAYLOR, O.B.E., M.A., F.R.C.A., F.R.A.C.A. Published by Paul
B. Hoeber, New York City.
THIS BOOK, written by a late major in the Spanish Republican Army Medical Serv-
ice, bears the impress of experience, for the casualties which passed through his hands
were the gravest type of injury and embraced the treatment of some s,ooo wounded
men. No British surgeon before the author of this book, and probably no surgeon at
any rate, has ever personally operated upon almost I,ooo gunshot wounds of the abdomen.
It is for these reasons, which have been expressed by Surgeon Rear-Admiral G.
Gordon-Taylor, that we offer this review at this critical time, for it would seem that
the Medical Corps Field Service School would do well to study this work carefully,
with the object of modifying our present organization. Jolly comments on the sur-
geon who uses Dakin's solution as a "I9I4-I,I8 model," so in a way is the operation of
our own evacuation system outdated.
A criticism of the "Three Point System" may be the question of whether it is
possible to normally keep patients in these advanced stations for eight or ten days
before evacuating them. However, the success of the plan in Spain was marked, and
a lesson that certainly might be well taken by our Army is the location of the echelons
of evacuation with the five-hour, ten-hour and i8-hour lag-periods, following the re-
ceipt of a wound, rather than by the fixed distance of miles. The lag-period between the
sustaining of the wound and the surgical inztervention, from Jolly's experience, is the
crux of the organization of the Medical Corps of the Army in the field.
Another feature, which Jolly seems to demonstrate, is the importance of the Classi-
fication Hospital, with routings to the Hospital for Immediate Operations (called the
No. I), or to Hospitals for Intermediate Priority and Special Attention (the No. 2),
and finally the more trivial cases needing hospitalization being directed immediately to
the Evacuation Hospital.
Among the outstanding contributions of this experience of Jolly there may be men-
tioned the following:
(I) The well-controlled use of glucose and saline in the treatment of shock.
(2) The general use of blood, which in our more "expensive" war, may be sup-
plemented by plasma or serum, frozeti or dry.
(3) Instructions to litter bearers in the handling of the suspected spine injury-
abdominal cases to place them in the prone position, and in hyperextension aided by
the sag of the stretcher canvas.
(4) The use of plaster extension cases to transport fractures of the extremities
and spine.
(5) The more generous use of brachial plexus block for injuries of the upper
extremities.
(6) Two-thirds of all war wounds involve bones; hence the temptation of primary
closure of these wounds in the advance station. Apparently, this has been abandoned in
this war. However, the primary excision of these wounds, encasing them in plaster and
holding them for 24 hours before evacuating to the rear, seems to be safe.
The chapter on Abdominal Wounds is one of the highlights in war surgery at the
present time. His description of the manner of organization, the simple and yet com-
plete instructions he has given in the handling of many conditions are arresting. The
prognosis charts of Schmieden and Abadie are sections worth while.
JAMES B. MASON,
Major, Medical Corps, U.S.A.

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