ACIDOSIS AND THE NITROGEN PARTITION IN PREGNANCY
Authors: H. L. Murray
Journal: BMJ (1915)

aseptic state of the urinie.Tlhe operation was performedl about sixteen and a lhalf hoturs from the time the man w%vas hiit. CASE XXII.The seconid bladder wouind was that of a mani shot through the right buttock transverselv; also by a shrapnel ball.Ad- mitted witht extenisive extravasation of blood anid urine ar;ounld( the perinieum aDd both buttocks.Opened up area of extravasa- tion by miultiple incisions.When incising over the left ischiorectal fossa fotind the l)ullet, which practically dropped inito onie's hand.Owinlg to the man's state, wlicih was very bad, nio attempt wvas ma(le to lhtunt for thle wouind of the bladder.The bladdler was opened suprapuibically anid drained.He was kept in hospital six days after operationi; the perineum was then (iry anid (loing Nvell.Perlaps this man should have been operated upon thlroughi the perineum by an external urethrotomy higlh up, but it was thouight at the time that the supraptubic drain -was the safest.BAYONET WOUNDS.Onily onie bayon1et woLund was admitted to this hospital.rrliis seemns very surprising, as bayonet attacks were reported to be occuitrring frequently and one would hiave expected serious wounids.CA(SE XXIII.Private P. (Royal Fusiliers).Brought in urgently bym-otor ambulance for treatment for severe haemorrhage from nmouthl and eye.The bayonet had entered at the inner cantlhus of the left eye and peenetrated thlrough the left maxillary aiutruim.He w%#as bleeding freely from vessel round palatal and maxillary regions.IUnder ether the antrum was opened throtgh the caniine fossa, and the opening was rapidly enlarged.It was fotund full of blood clot.It was washed ouit and packed in gauize soaked in hydrogen peroxide.Packing lhad to be very firmi in order to stop the smart bleedinlg.The eyeball had escapect injury, evidently putshe( asside by the bayonet. WVOUNDS OF TI10RAX.A considerable nuinber of officers and meniei were admiitted with perforatinig 'wouLnds of the thorax.Wotunds of the uipper part of the chest invariably did well; wotunds of the lower part were serious and often fatal.A short hiistory of one case will illustrate the others.CASE XXIV.Captaiii S., B. X.M.C., attached to the -Regiment, was Shot thlrOUgfh both lungs by a bullet whlile gallantly atteindiing to woulnde(d men uinder a heavy fire.For this act he has beeim aWvarded the Military-Cross.He was stooping forward at the time with both arms extended away from the body.The bullet struck him about the lower part of the right axilla and emerge(d aboit the posterior axillary line of the left side.He wvas adumitted with severe shock and dyspnoea.He had frequent cough, wlhich he tried to prevent owing to the paini it produced.WVhen puit to bed and heroin A grain placed under the tonguie he 'became easier and the shock gradually disappeared.The cough eased off anid respiratory excursionis became more marked; temperature normal, pulse rapidl.There was m--arked dullness over the right lung base.The breath souinds were vesicular but distant.The patient said lbe felt so well that lhe wished to get up.In fact he did get up once or twice when the watchful French nursing sister was out of the ward.'At the end of the third day the temperature ran up to 103°F.Dyspnoea'became marked, and pain in breathing so severe that abhypodermic of morphine was given; the pain was all over the right base.Briefly, the course of events was: pleurisy of riglt base, pneumonia over the course of bullet wound throulgh right lulng, expectoration of old blood clots, high temperatture.'rhe left lung, curiously enough,' escaped, although-there was (lulluess duie to haem-othorax of left base.The after-history was a slow recovery.