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These cases and a severe chest wound case with massive surgical emphy
sema which recovered and many other cases speak volumes for the skill of the
Nursing Services who were taken to assist with the cases and then left under
trying hot weather conditions to complete the results of surgery.
Large numbers of fractures treated successfully with no case of invaliding
from this cause were recorded at Kohat and special comment is made on the
reliable work of trained I. H. C. orderlies in this theatre.
At Lucknow a B. O. R. with compound fracture of tibia and fibula deve
- l o p e d g a s g a n g r e n e , t w o d a y s a f t e r s u c c e s s f u l e x c i s i o n o f t h e w o u n d . G a n g r e n e
developed to the level of the knee with marked gas formation and amputation
was performed to the lower 1/2 of the thigh. He made an uninterrupted re
- c o v e r y .
From Ranikhet a case of excision of the head of the radius for comminuted
fracture is reported. Two operations were performed and patient returned
to full duty with very slight limitation of movements.
The value of portable X-ray sets is emphasised in the case of fractures
and of gunshot wounds.
(ii) Gunshot wounds.—Gunshot wounds were in evidence in Waziristan
. In Razmak 19 B. O. Rs. and 2 officers were operated upon for wounds, all re
- c o v e r e d e x c e p t a v e r y s e v e r e a b d o m i n a l c a s e .
A case of gunshot wound below Pouparts left ligament with the bullet
lying in the extra peritoneal tissues behind the rectum, having damaged the
meso-colon, sigmoid-colon and rectum. Each portion was repaired and the
left superior haemorrhoidal veins ligatured. The patient made an uninter
- r u p t e d r e c o v e r y .
A bullet wound which passed from the left thigh, mid-posterior aspect,
to emerge above the right Pouparts ligament. Orchidectomy was necessary.
Patient made an uninterrupted recovery.
A case of comminuted, compound fracture of the elbow from G. S. W.
which required ligature of the brachial artery 4 days after successful toilet
of the wound had been performed and plaster splinting had been applied.
There was no sepsis, but the arterial bleeding came from the interosseous
artery.
Gas gangrene.—The incidence has been surprisingly low. In over 300
cases of G. S. W. seen by the Surgeon at Razmak during 3 years there has been
only 1 frank case of infection and 2 others where it was suspected in which
excision of the wound was carried out. Sulphonilamide drugs were given in
large doses to these three.
He also considers that anaerobic infection, though not proved bacterio
- l o g i c a l l y , m a y a c c o u n t f o r c e r t a i n c a s e s o f s e v e r e s h o c k w h e n t h e i n j u r y i t s e l f
did not seem to account for the amount of shock.
(iii) Other Surgical Cases. From Madras.— A soldier with multiple
enchondromata of the metacarpals of the left hand. The shaft of the 2nd
metacarpal which was painful and swollen was excised and a bone graft from
the tibia successfully put in. The result was satisfactory.
From Rawalpindi.—A lady with acute haemorrhagic pancreatitis was
operated upon, the pancreas being incised and drained, the gall-bladder was
full of stones and emptied and bile passages drained; she was in extremis but
recovered; then became acutely ill with a thrombosed splenic vein but re
- c o v e r e d f r o m t h i s ; t h e n d e v e l o p e dd
i a b e t e s
and finally recovered from every
-thing.
K2