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Summary 1 A series of 317 cases is presented, including all cases in the Second New Zealand Expeditionary Force during the Italian campaign. Deaths prior to admittance to medical units are also included. The patients were followed up to evacuation by hospital ship to New Zealand. 2 Approximately half the patients died, and of the deaths only 48 out of 160 took place later than forty-eight hours following injury. 3 Early deaths in the forward areas are due to the severity of the trauma. Later deaths in the forward areas are due partly to the trauma and partly to infection. Deaths at the base are all due to infection. 4 Very few patients were refused operation. At the casualty clearing station level, over 96% of the patients were operated on and only three patients were refused operation in our own casualty clearing station. 5 Of the patients who recovered, only 22 out of 157 were retained as graded men, the others being evacuated to New Zealand. 6 Of all the patients 50% recovered. Of all patients brought in alive to any medical unit 54% recovered. In all cases 61% of patients recovered, other than those who died quite mint for operation. 7 No deaths occurred following exploration yielding negative results, and only three patients had completely negative findings. 8 Particulars are given of the mortality caused by different missiles and the severity of mine wounds is stressed. 9 The relative safety of thoracic exploration in thoracoabdominal injuries is established and the high mortality in severe liver wounds is indicated. 10 Data with regard to the time of admission and of operation, following infliction of a wound are presented. 11 The condition of the patient on admission, immediately before operation and after operation is described. 12 The extent of the injuries sustained has been studied. One-third were hopeless, a third very severe and the other third severe. 13 Anuria was the most common and the most deadly complication. Preventive treatment by early intravenous administration of fluid is suggested. 14 Haemorrhage, both primary and secondary, is discussed. The importance of mesenteric bleeding is stressed. The diagnosis of retroperitoneal haemorrhage is discussed. 15 Sepsis is discussed and it is pointed out that since the institution of parenteral administration of penicillin from the onset at the casualty clearing station there have been no deaths at the base hospitals. 16 Details of the mortality in different injuries and combination of injuries are given. They are similar to other published figures. 17 Opinion is expressed with regard to the location and management of the forward operating units. The casualty clearing station is recommended as the best site for forward abdominal surgery. Staffing is discussed and the need for reliefs stressed. 18 The essentials of resuscitation are stated and post-operative treatment is described. 19 The optimal time for operation is discussed in the light of altered ideas concerning priority. 20 Operation on the different abdominal organs and the difficulty in dealing with the right side of the colon are discussed. 21 Evacuation of casualties to the base is dealt with, as well as the treatment of late infection. |
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