Word: ascroft
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Dates: during 1943-1943
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During two years of fighting in the Middle East, Major Peter Byers Ascroft, a surgeon with the Eighth Army, and his Scottish surgical unit handled 516 head-wound cases. Last summer Major Ascroft summarized the clinical results of this experience in the British medical journal, The Lancet. Last week the New England Journal of Medicine declared Major Ascroft's article required reading for every U.S. military and civilian surgeon. Reasons: 1) "the conclusions differ so fundamentally from those previously authorized for publication by the [U.S.] War Department, which were largely reached shortly after World War I"; 2) the article...
Most important point in Major Ascroft's paper: "We believe it is better not to operate in forward areas [on patients with head wounds], provided that the patient can reach a fully equipped base hospital within 48 to 72 hours of injury." This agrees with the late, great Dr. Harvey Cushing's World War I finding that "incomplete operations were more dangerous than a few more hours of delay." But Major Ascroft points out that "in this war most casualties have not reached a base hospital under 48 hours or more...
...Major Ascroft's chief reason for operating at a base hospital: there the surgeon can use 1) the X-ray (which is not always available in forward zones); 2) a suction apparatus to remove injured brain tissues and debris and an electric cautery to stop bleeding. Neither device is obtainable near a swiftly moving front...
Wide-Open Wounds. Major Ascroft finds only three valid reasons for treating head-wound cases at the front: 1) severe shock (but "shock is seldom severe in head wounds"), which makes it impossible to move a patient at once; 2) need for immediate surgery to relieve pressure on the brain; 3) no possibility of reaching a base hospital in 72 hours. For such cases he recommends "an operation of expedience"-a cleanup after which the wound is left wide-open, protected only by a plaster-of-paris bandage. A diagram of the wound may be drawn on the bandage...
...Other Ascroft ideas...