COMBINED PREVENTIVE INOCULATION AGAINST TYPHOID AND PARATYPHOID FEVER AND BACILLARY DYSENTERY
Authors: J. P. Johnson, A. J. Milne
Journal: BMJ (1916)

Of the 7 cases treatecd with cliloramine, 5 were corln- poundl fractures of the jaw and 2 were fleslh wounds involvinig tlhe miioitlh.The following are clinical notes of these cases; CASE I. P. C.. woundledI att Aizac on October 6tlh, was operated on nine htours later uinder ai anaestlhetic for a rifle-bullet wound of the uipper jaw.The bullet lhad entered the right cheek just below and ini front of the mialar promiinence, shattering the right supraimaxilla, ploughing up the soft palate, removing scum1 teeth of the left upper jaw, and then passing through the left -leek, leaving a large ragged vound.The woun(ds and surrounding) skfin were cleansed with hypoellorite solution, the ragged edgcs cu7t away, and many small fragments of bone veino eil.A tube wass inserted through the exit wound into the lialate region andi auother through the mouith; the latter was kept in position b)y a safety-pin through the bandage.The mloultlh w-as irrigated ever-two hours withl chloramine alnd the xvounods (IressedI twice dailv.He was fed every four hours throughl the tube.Six (davs later lhe was able to gargle for himself and drink fItids.Onl October 18th he was dischlarged to H.M.H.S. A(qnIitoni )ia.The wvounds had remained clean, and there had at.)no tinme been any puruleint discharge or offensive smell fronm the miiontl.I am; informied that ten days later he was landed in England with the wvounds almiost healed and the mouth conliitioti satisfactorv.CASE II.J. L. sustained a shrapnel wound of the right upper jaw on October 13th at Helles.He was received on board twentyf)urhloturs later suffering from miiarked dyspnoea.Under chloroform he was fouild to haive a compound fracture of the right tupper jav and laceration of the palate.The wounds were cleansed, and a slhrapnel bullet and a tooth were removed frrOm.the posterior plharyngeal wall.No tubes were inserted.Thie patient was able to gargle frequiently with chloramine and to drinkli fluiid.Oni October 18ti hle Nwas discharged to H.M.H.S. ,quitania.D)nring this period the brpath remained inoffensi've and the tongiue clealn.CASE TII.W. G. T. was wvounded at Anzac by shrapnel on October 27th.Tlwo days later he wNas received oln board, and examined under anii anaoesthetic.lIe was fouind to have extelsive flesh wounds of the riJght arm, anid a compour d fractuire of the right lower law; all wounds.were very septic and the breath fetid.The woulnds Were irrigated and dressed with hypochlorite, and a *hlor'-tlinme mouthl waslh ordered to be used every two hours.Ont N'o-ember 2nd, w-henl the patient was discharged to hos- pital at Malta, the external iaw wouiond halid cleaned up consider- abiv, all in-trroundllng inflhaimnation had subsided, and onlya srlig junelentli.ei-harge remnained; the mouth had become tlite clean, and tihe breath inoffensive.CASE IV. 'r.0. x-as wounded at S;uvla on November 8th.An operationi was performed sixteen houirs later for a penetratinig rifle bullet vouilnd; the entrance was at the riglit miastoid process, anId the t.xit through left clheek; it lhad injured the base of the skiull, the hainl lalate.anid th;e left supramaxilla.The right ear was clea,useil -ith livpochlorite and plugged with gauze.The wo¢ud 'of enltranice, through whicih cerebro-spinal fluid was lealing, wvas clean1sed and dressed, and a tube inserted throtugh hI-e Cexit wvoullld inito the palate.Daily dressing aind hourly ir igation with ehloramine Nwas used.oni Novem-eiber 13tlhle was dlischarged to hospital at Alexan- di.i, .tlie \wo;nl;ds cleai).;nd the miouth being illoffensive.