A case of burning and slight poisoning by methyl bromide

Abstract

91his survey he states that no specific case was, reported by Sir Cuthbert Wallace in his review of the abdominal injuries i n the last war, but he mentions one case in the last war and two in this where the duct might possibly have been injured. In his case the duct was found to be divided at a n opemion performed nineteen hours after the injury. The proximal end could not be found and the wound was drained. The patient later developed obstructive jaundice and cholangitis. At a second operation, nearly four months after the injury, a n end-to-end suture of the duct was performed with a successful result. CASE REPORTThe present case is that of a young soldier (G. W. S., aged 20) who was in his camp in Southern England on June 29 when a Aying bomb fell 20 ft. from where he was standing. He was admitted to a military hospital under the care of Lieut.-Col. F. N. Foster, to whose detailed and careful notes I am indebted for the: following resume. He showed multiple dirty w0und.s and was very shocked, but he improved with resuscitation treatment. The radiographs showed multiple foreiign bodies in the chest wall, with blast changes in both lungs and several foreign bodies in the right side of thl: abdomen, the right knee, and the left arm.At operation a penetrating wound of the sole of the right foot was found, with large wounds of the right thigh involving the whole depth of the quadriceps? an extensive wound of the left thigh with a large retained foreign body, and numerous wounds of the back, both arms, and forearms. All wounds were surgically cleaned and dressed. Subsequently his condition was, for a time, very poor, but the notes showed that he was given the most meticulous care and attention. hi & B and sera were administered, frequent cultures of the wound were taken, and, under their control, treaxrnent with penicillin instituted. Soon after the operation he began to vomit and on the second day there was tenderness and discomfort over the liver area. On the ninrlh day the wounds were clean, but he developed diarrhaea. On the thirteenth day there was more vomiting, with fullness in the right flank and upper quadrant of the abdomen. On the sixteenth day a right upper paramed:ian incision was made and a large collection of bile found with many adhesions. Drains were inserted into the r:ight kidney pouch and above the pubes into the pelvis. A further study of the radiographs revealed a small fragment of metal in the region of the common duct.On July 21 the paramedian incision was healed,.as were many of the wounds on the limbs, some of which had been treated by secondary suture, but a:U his bile was draining through the suprapubic wound. On Sept. 12 jaundice was noticed for the first time.On Sept. 18 Lieu.-Col. Foster was pos1:ed abroad, and by the kind offices of Brigadier Donald, who was consultant to the S.E. Command, the patient was transferred to me at the London Hospital. Elxamination showed a small rather poorly developed man who was in a good state of general health with all his wounds nearly healed. There ...