TO-DAY I have been asked to talk about what one would do in the event of an air raid, where one would be meeting all sorts of casualties, and I do not quite know how to tackle it, because you will have the ordinary injuries to deal with and, in addition, there will be a large fear-element, and it is going to be very difficult to give you anything more than an outline of what you may be up against and how you are going to tackle it. As far as I can see the only way one could approach the subject would be to imagine an air raid–go to the movies and see what it is like–and then try and picture what sort of injuries it would produce; or find out from the Spanish medical men what sort of injuries they met with, and see what sort of drugs you would require to use for them. But it is going to be very sketchy and theoretical, and I do not know whether it will be of much value.
The other thing people are very much exercised in their minds about is what they are going to do for gas cases should they have to deal with them.
Well, as regards the ordinary injuries, it depends very largely on the type of bombs that are used. If they are using the small bombs, such as they used mainly in Spain, we shall get any amount of small puncture wounds with a great deal of destruction of the soft tissues underneath. The splinters from the small bombs are very small, they are just like little pieces of tin really, they make quite a small hole in the skin but lacerate the soft tissues underneath to an enormous extent. They are the kind of case which is the ideal breeding ground for gas gangrene.
And for a case of that sort, an injury of that sort, there are two drugs which you will have to consider; and it will be very difficult until we see the cases to know which drug is going to be the most useful. It is exactly the picture one is accustomed to associate with Arnica.
But I am not sure that from the point of view of considering the danger of gas gangrene, we would not be much better using Ledum for these cases rather than Arnica. Ledum has a definite prophylactic effect on gas gangrene ; but where gas gangrene has actually developed you get much more effect from one of the drugs like Crotalus horridus, which has much more the appearance of a gas gangrene wound with its typical horrible black look and the complete liquifaction of the tissues.
So once you have got a gas gangrene I think you will want Crotalus rather than Ledum ; but as a prophylactic I think Ledum will be more helpful. If, as one hopes. Arnica will greatly minimize the effusion of blood from the area underneath, then it will also minimize the nidus for your gas gangrene to grow in, and it is quite possible that Arnica will be a most useful prophylactic; but personally I think Ledum will be more hopeful; and if gas gangrene develops, one of the snake poisons will be most useful of all.
Then again, these small, irregular fragments do set up a frightfully painful wound, which makes one wonder if Hypericum is not going to come into the picture too, because it produces the horribly septic, spreading type of infection and much more acutely, violently, painful injuries than either Ledum and Arnica. Ledum and Arnica, have much more the dull pain, and Hypericum the flaring, stabbing pains which you are likely to get from these rough, small fragments. And Hypericum, again, is a powerful prophylactic in the way of sepsis developing in a small wound.
So these are the three drugs on which I think you will have to ring the changes in the immediate stage.
Then, as far as the other types of injuries are concerned, where you have got definite dislocations or fractures. Here I think the simplest way is to take the question up in degrees of severity.