AIR RAID CASUALTIES


In the compound fractures I think you mostly have much more nerve injury as well, owing to the fact that the ends of the bone come in contact with the cutaneous nerves, and you get much more stabbing pain as well as the bruised condition. And you very often find you want a dose of Hypericum, rather than Arnica, in the first instance, until the fracture has been set, and then you want some Arnica to follow it up with.


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.

If the patient has merely been knocked over and bruised, perhaps with a dislocated shoulder or wrist, then in the first instance you should consider whether the nervous alarm–the fear element–or the actual physical injury is the more important. If you decide that the shock and terror is of greater importance, I think in the first instance you would be very much wiser giving them a dose of Aconite, just for the sudden, terrifying experience they have gone through. Aconite will often steady the nerves, and then you will have to treat the actual traumatic condition.

If the injury is a simple sprain, you come down to the old trinity of Arnica, Rhus tox. and Ruta. The Arnica patient, of course, will want to keep as still as possible, and there will be effusion and a lot of swelling of the injured part. The Rhus patient will have less swelling of the injured part, the affected joint will feel horribly stiff, and the patient will always be wanting to move the injured part just to ease it, it stiffen up so abominably if kept still.

And anatomically Ruta has rather more affinity for a piece of periosteum torn away from bone, or a ligament torn from its attachment, rather than fro the ordinary strain in which a few fibres are split in the course of a tendon. It is when the injury is at the junction of fibrous ligament and bone that Ruta particularly helps you.

Then when you are dealing with a fracture, it depends to a very large extent whether you have got a simple fracture or a compound fracture. I think most simple fractures get their greatest relief from Arnica in the first instance, I mean as the immediate treatment of them.

In the compound fractures I think you mostly have much more nerve injury as well, owing to the fact that the ends of the bone come in contact with the cutaneous nerves, and you get much more stabbing pain as well as the bruised condition. And you very often find you want a dose of Hypericum, rather than Arnica, in the first instance, until the fracture has been set, and then you want some Arnica to follow it up with.

Then there is the question of dressings for wounds. Here it is going to be very difficult, because all these people are automatically going to hospital, and there will be definite instructions issued by the authorities as to what dressings are to be applied, and these instructions will more or less have to be followed. On the other hand, were one free to treat these cases as one wished, personally I would have no hesitation in going away from the ordinary, automatic painting of everything with Iodine, and would apply Calendula dressings to all these wounds without exception. I think they do much better.

If you have a devitalized tissue and apply strong antiseptic dressings you still further devitalize it, and your ultimate result is bad. Whereas if you use a part-antiseptic, part-stimulant like Calendula, you get a very much better result you do no get bad septic wounds if you treat them with Calendula. Supposing you have a shattered stump, and you put in into a Calendula clean wound you get, instead of the septic, sloughing wound you have been accustomed to see. And as regards changing dressings.

If I were dealing with a large, lacerated area I would change the dressing every four hours. If it was quite a simple wound I would change the dressing every twelve hours. But I am afraid we shall not be allowed to treat wounds as we like, and it is not as if we would be able to see the patents through from start to finish, for if there is much air activity we shall not be allowed to keep the patients but will have to clear them all out of this hospital at the end of twenty-four hours.

As regards the question of Anti-tetanus and Anti-gas serums. Again we shall almost certainly be told what we have to do, and as the essence of all these treatments is early administration, and as the case will be going out of homoeopathic hands, I think the only fair thing to do for the patients is to initiate the treatment as soon as possible and give Anti-tetanus. or Anti-gas serum as the case may be. But, even, with the administration of these, I should feel inclined to give the homoeopathic drug as well.

The reason being that where we were dealing with diphtheria cases, which we had to send on to the fever hospital, we found that the administration of the homoeopathic drug plus their serum materially speeded up their recovery and minimized the severity of the attack as compared with treating them by serum alone. So in these casualties I should treat them on homoeopathic lines plus whatever the authorities ordered. I do not think the administration of the serum will interfere with the homoeopathic drug.

Then there is one other useful thing to remember, namely that where you are dealing with a scalp wound Calendula in potency has a peculiar affinity for scalp wounds. You can diminish the probability of sepsis in scalp wounds by giving Calendula in potency as well as applying a local Calendula dressing.

I am perfectly certain you would be astonished at the way these scalp wounds do not go septic after the administration of Calendula, This is the case even when you would normally expect the wounds to go septic–and you know how beastly they are if they go septic, and you get a horrible mess tracking under the tense fascia, so if you can avoid that it is well worth while. So to any casualties with a scalp wound I would certainly give Calendula in potency automatically–three or four doses about an hour apart– and I should expect definitely to minimize the scalp sepsis.

Douglas Borland
Douglas Borland M.D. was a leading British homeopath in the early 1900s. In 1908, he studied with Kent in Chicago, and was known to be one of those from England who brought Kentian homeopathy back to his motherland.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.