"TRENCH BACK" TREATED BY SODIUM SALICYLATE IONIZATION
Authors: J. D. Sandes
Journal: BMJ (1915)

19I51 " TRENCH BACK." [ I 5DICALJOUBAL 2I5upper part of right rectus, viscera adherent round a collection of dirty grey fluid and gas, which issued from a hole deep down in the inflamed lining of the cavity.This hole could not be closed.Drainage through the wound of entry; closure of the operation wound.Vomiting and pain ceased at once; the next morning the patient was reading the paper.Discharge free, reddening the surrounding skin; no faecal smell.The patient was trans- ferred to the base six days later.While there the discharge diminished and ceased to be irritating, but he gradually sanl and died.CASE III.-Wound of Dutodenumn or Beginnin)g or Jejunulll77lLocalized Collection of lF'lutidl: Drainage: Deat/i ini Five Days.Lieutenaint C., 2nd Leicesters.Slhrapnel wound left loin two andl a half days before.No symptoms till the night before admissionl, then vomitinig, pulse 120, hiccough, and pain re- ferred to testes.Operation May 24th: Incision splitting left rectus.On opening the peritoneum a dirty fluid, fetid though the odour was not faecal, issued under pressure from a, cavity formed by adherenit viscera.The hole in the intestine could not be demonstrated but lay apparently in the duodeno-jejunal flexure.A shrapnel bullet was found lying in the mesetitery of the jejunum close to the bowel which was here intact.Closure in layers with a lumbar drain.May 25th.The discharge is practically pure bile.This fluid, later oni, reddened and excoriated the surrounding skin; the patient vomited a good deal, grew weaker, and died May 29th.CASE Iv.-Injntry to a Coil of Intestinie wchich, Retracted fromt the Wfoun7ld anid wa(ts Mlisse( at Operation : Death from Haenmorrhage.Private M., 2nid Leicesters.Woun(d in left iliac fossa; pulse 120.Operation May 17th: Vertical inicision over the wound, large collections of clot inside and outside the peritoneum, that insidle smells slightly faecal.Colon intact, two small punctures in the adjacent small intestine closed with sutures.Casing of ricochet bullet found loose.The patient died on May 19th.Post mortemn: Abdomen full of blood, wound of omentum.In the umbilical regionl, at some distance from the wound, lay a coil of jejunum completely wrapped in omentum, with four biggish holes.No escape of contents, no general peritonitis.The injured coil and the bowel above it muclh distenided, the ilntestine below empty and shruinken.CASE v.-Resectiont of 2tft. of Small Inttestinie: Dysentery Recovery.Corporal M., R.Y.R. Shell wound through right ilium thirty- six hours before in direction of pelvis.Slight abdominal distension; no pain on vomiting.Urine normal.Operation March 18th: Incision in the middle line.Three woun(ds found in a coil of ileum; the coil adherent all rounid.No escape of conitents.The missile, a square piece of shell about I in.across, lay in the lumen of the gut.Two and a half feet of intestine resected, end-to-end suture, suprapubic drain.Two days later the bowels were moved with calomel, eniemas, and pituitrin.A week after operation he developed (liarrhoea, which later became a definite dysenterv, witlh passage of blood and mucus.Treated with mag.sulph.hourly.Recovery.Transferred to base April 9th, three weeks after operation.CASE Vi.-JWounds of Smnall Intestine: