Enuresis in the Army
Authors: P. L. Backus, G. S. Mansell
Journal: BMJ (1944)

The type generally used at this time was the encasing of the limb in plaster, with slits for the traction strapping and fixation of the limb to the Thomas splint with plaster bandages.The plasters were always padded and split.Details, with dates and simple diagrams, were well marked on the plaster, and proved most useful.For the upper extremity the " U " plaster, from the nape of the neck and including the forearm, was mostly used, and proved satisfactory.The immobilization of extensive soft-tissue wounds had been advised, but was perhaps not carried out as often as it might have been.Traction for wounds of the knee-joint was occasionally found to have been omitted.The usual faults in plaster work appeared from time to time: carrying the plaster beyond the proximal crease *of the palm, so that stiffness of the metacarpo-phalangeal joints and fingers results; lack of instruction to the patients to move the fingers and toes continually; faulty position of the ankle and foot.These faults always seem to be cropping up, and need constant attention.The results are very difficult to correct.Abdomeni.-Thetreatment evolved in the Middle East was amply confirmed: suture, when possible, rather than resection; exteriorization and colostomy for wounds of the colon and rectum; gastric suction and intravenous therapy as a routine; and retention of cases for a minimum of ten days.Chest.-Conservative surgery (wound excision and closure of the open pneumothorax), with early aspiration, was the rule, and proved satisfactory.Great relief of dyspnoea was noted after the early aspiration of haemothorax fluid.Many breathless shocked patients were greatly relieved by being propped up, and these cases travel better in ambulances and trains when so positioned.The advantage of treating the shock by the completely recumbent position does not compensate for the serious respiratory embarrassment caused.In only a few cases was full thoracotomy indicated in the forward area.Head.-At the beginning there was some difference of opinion between the F.S.U.surgeons-and the neurosurgeons as to whether the general surgeons should deal with these cases.It was pointed out that in the forward units the general surgeon had no special equipment for this type of work: diathermy was not available; x-ray examination was not always possible; and at the time there was only improvised suction.It was therefore accepted that it was better to get patients back to the neurosurgical unit with 48 hours if this was possible, for operation there.The sulphonamides-sulpha- diazine when available-were always used.Maxillo-facial Wounds.-Aslittle as possible was done in the F.S.U.s and C.C.S.s beyond cleaning up, the arrest of haemorrhage, and fixation of the jaw, when necessary, by the dental officer.These cases were then transferred to the maxillo-facial unit.Biuriis.-All coagulation treatment was forbidden as first aid.The routine was sulphanilamide and vaselined-gauze dressing.It was confirmed that cases of severe burns travel badly during the first five or six days after injury.Septic Sores.-During the hot weather there was much man- wastage from sores on the exposed areas of the knee, elbow, and forearm regions.Often quite trivial in origin, they became chronic and resistant to treatment if neglected, and frequently meant weeks in hospital.There seemed to be no panacea for them.Unit medical officers were asked to get men with even minor skin abrasions, thorn-pricks, etc., to report sick at once so that they could obtain early treatment.Whitlows.-It was found necessary to issue an instruction that only the most minor conditions should be treated by unit medical officers.Much time and many bad results are saved by early admission to hospital.Too many midline and inadequate incisions under ethyl chloride were seen in the early stages of the campaign.Chemotherapy.-It was impressed on all that the sulphonamides are not a substitute for early surgery.These drugs were used prophylactically and therapeutically.To begin with, oral doses at four-hourly intervals had been advised for all wounded.In practice this broke down on the long lines of communication, and the Middle East sulphanilamide label, with the two doses at 8 a.m. and 6 p.m., was adopted.Owing to the universal use of these drugs, both orally and locally, it was impossible to evaluate their effect.The general impression was that they were of value in retarding the onsets of infection.Also, as compared with the last war, the appearance and general condition of the men in the base hospitals seemed better.Although many wounds were infected the patients did not look so toxic and ill.Sulphanilamide, sulphathiazole, and sulphapyridine were the forms mainly in use for surgical cases.Some sulphadiazine was obtained latterly.Penicillin was not available in this campaign.The Penicillin Unit arrived in North Africa in May, 1943, and began investigations in one of the Algiers hospitals.Anaerobic Infections.-Tetanus:Up to May, 1943, one case of generalized tetanus occurred in a German prisoner-of-war and one