Lettsomian Lectures ON JAUNDICE: WITH SPECIAL REFERENCE TO TYPES OCCURRING DURING THE WAR
Authors: W. H. Willcox
Journal: BMJ (1919)

1 ~~~~~~~~~~~~~~~~~~~~~~~MEZDICAL JOUIRNAL, to return to his battalion is remarkable without reckoning his recovery from an attack of trench fever, and from a gunshot fracture of the thigh.Private C. (Australian infantry), aged 20, was wounded in the neck by a fragment of shell on April 28th, 1917, and was admitted to the 3rd Australian Casualty Clearinig Station on the same day.He remembered nothing after being wounlded with the exception that he had a slight recollectionl of being in a motor ambulance until he became coniscious after operation.'The wound of entry was on the left side, over the horizontal ramus of the lower jaw, which was splintered, but without 0Oiution of continuity.'Thetrack then extenided inferiorly and posteriorly to a large clot surrounding a wound of the left internal jugular vein, which was almost completelysevered immediately below thelevel of tie superior borderof the thyroid cartilage.The left common carotid artery, immediately below the bifurcation, was'slightly lacerated and contused, but the iintima was not severed.The artery was 'thrombosed at this level, and the thrombhb.eextendedinto the proximal portions of the external and internal carotid arteries.The proximal and distal ends of the dividod internal jugular vein were ligatured.I,Aigatured the lefttcommon, external aind internal carotid arteries immediately beyond the limits of the inijury and tfirombus,' and the intervening thrombosed portions of these vessels were removed.The left vagus nerve was found com- pletely severed.The track was then followed to the fissured Iransverse process of .acervical vertebra (sixth), and from this position the shell fragment was removed.The vagus nerve was sutured with catgut and the wound sutured, free drainage anterior and posterior to the sterno- mastoid being provided.The patient was in the casualty clearing station for six days; he could only whisper; there was no hemiplegia; the pLilse rate was 140.The remainder of the history I obtained for the most part from' the patient.He wvas admitted to No. 5 General Hospital on May 5th, 1917.The pulse was still 140, aud this rate was maintained for about two weeks after the date of being wounded.The sutures were removed on May 12th, 1917.The wound had healed on May 16th, and he arrived in England on May 17th, 1917.There was weakness of the left arm (inability to abduct) for six weeks after being wounded.By the end of June, 1917, lie could walk at a slow pace.He noticed that the left armpit and left side of the chest perspired very freely from about May 16th to June 16th, 1917.Improvement of voice was noticed by the end of June, 1917; the pulse rate was then about 100.A niote made on the medical history sheet previous to August 5th, 1917, states "slight paresis deltoid and biceps."He was admitted to the command d6p6t on that day.Any sudden severe exertion made him feel giddy, and he was unable to do physical drill on account of coughing and severe vomiting.No (liscomfort was caused by marching at the ordinary rate.Between August 5th and November 10th, 1917, he was classified four times, and on each occasion the medical officer remarked oin his rapid pulse.He rejoined his battalion on November 10th, 1917, and was evailuated, suffering from trench fever, on February 2nd, 1918.The temperature remained high for one week; the pulse reached 120, and remained rapid till the blginning of Apri,, 1918.He again rejoined his battalion iln June, 1918.On September 2n'd, 1918, he was evacuated for slhell wound of the right thigh (compound fracture of femur), which became septic.The highest temperature recorded in his notes was 1030, and the highest pulse rate 120.He last vomited in November, 1918.Qn January 16th, 1919, he was admitted to the 1st Australian GCeneral Hospital.The femur was firmly united in good posi- tion.On'February 28th, 1919, he couldl wheel hiimself about in atNheel chair.Thiere Nwas slight hoarseiness, but no dysphagia, antdthe appetite was good.The average pulse rate since ^4i.Wission while resting lhas varied between 80 and 90.After wjyjeeeling himself at a rapid rate for 200 yards in a wheel chair, file pulse rate rose to 144; after five minutes it fell to 108, and in fifteen minutes to6'96.Physical examiniation revealed no abnormality.X-ray exami,ation after a bismuith meal showed that the stomach was normal in shape, position, and time of emptying.X-ray examination showed no abnormality of the transverse processes of the cervical vertebrae of the left side.T'he right vocal cord was natural, and moved freely; the left was perfectly white, but only moved very slightly.Speech was accomplished by compensation, the right vocal cord coming across to the left.No pulsation could be detected in the left superficial temporal artery.