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GUNSHOT WOUND OF RIGHT ORBIT AND MAXILLA;
1217
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL.
HONORARY
SURGEON
OF
THE
COVENTRY
AND
WARWICKSHIRE
HOSPITAL; AND
GUNSHOT WOUND OF RIGHT ORBIT AND
MAXILLA;
E. W. G. MASTERMAN, M.D. DURH., F.R.C.S. ENG.,
D.P.H., SENIOR HOUSE
.:It MUCH DESTRUCTION OF BONE AND SOFT PARTS ; ADAPTATION OF ARTIFICIAL EYE AND CHEEK.
BY SIR WILLIAM J. COLLINS, K.C.V.O.,
M.S., M.D.,
B.SC.LOND., F.R.C.S.ENG., OPHTHALMIC SURGEON TO THE KING GEORGE
TWO CASES OF STRANGULATED UMBILICAL HERNIA. BY F. L. HARMAN BROWN, M.B., C.M.EDIN.,
HOSPITAL,
ETC.
SURGEON, COVENTRY AND WARWICKSHIRE HOSPITAL. -
THE two following cases appear to us worthy of record on account of their peculiar difficulty and successful issue. The patients were both unusually fat, middle-aged women, both were operated on within three days, and both left the
hospital on the same day. They suffered from chronic emphysema, asthma, and albuminuria. Private --, aged 32, was severely wounded on the rightt CASE 1.-The aged 55, was admitted to hospital on side of the face by a bullet at Ypres on Oct. 30th, 1914. He March 2nd, 1916,patient, with a history that she had had complete was taken prisoner by the Germans, but while in hospital intestinal obstruction for three days and had been vomiting was placed under the care of two French surgeons, also) all she took. The patient vomited in the ward soon after admission. She was an immensely stout woman, and was prisoners-viz., Dr. Bettremieux and Dr. Ballenghien, both1 said to have weighed 18 st. before this illness (she weighed of Roubaix. From notes made by the latter, which I have! 16 st. 9 lb. when discharged). She had had an umbilical seen, it appears that on Nov. 9th, 1914, the patient had an hernia for several years. On admission the patient was in enormous wound of the right side of the face, extending fromI pain, and she had a large, nodular, irreducible and very the ear to the nose, the soft parts including the right globe, great tender mass half buried in the thick deposit of fat over the and portions of the eyelids were destroyed and there wereabdominal muscles. Temperature, 97° F. ; pulse, 104. The fractures of the right malar, superior maxillary, lacrymal condition of the patient was very unfavourable. She had and nasal bones causing a large opening between the nose chronic bronchitis and emphysema, and her face was and the right orbit. Seven operations were performed chronically cyanosed ; there was a considerable quantity of between Nov. 12th, 1914, and March 4th, 1915, at first for albumin as well as some blood and pus in the urine. In of these conditions the operation was done the removal of the remains of the globe and of sloughs, and consequence under local anaesthesia, codranine being used. later of a plastic nature with a view to restore the cheek. entirely The herniated mass was dissected out of the subcutaneous Deafness of the right ear having supervened paracentesis of fat and the narrow opening in the abdominal fascia was the tympanum was performed. enlarged. On opening the sac the contents were found to The patient was admitted under my care at the King consist largely of omentum, much of which was deeply George Hospital on June 29th, 1915, and I performed two congested, and partly of large intestine. All the sac further plastic operations, suturing together the palpebral contents were adherent to each other and to the peritoneal The omentum was ligatured and removed along margins and also closing the sinus into the nose. I covering. with a great part of the coverings of the hernia, and the the aid of art then be more usefully felt that might remainder of the peritoneal covering adherent at the neck called in rather than attempt any further effort at blepharo- being carefully divided it was returned together with the plasty. I accordingly designed an artificial cheek of painted intestine and the stump of the omentum to the abdominal
Reproductions of photographs illustrating Sir William Collins’s case of gunshot wound of right orbit and maxilla. and moulded copper-plate, with eye attached, set in a pair cavity. The wound was then sewn up in layers. The patient of spectacles, similar to a contrivance I had previously bore the operation well. The vomiting ceased at once and she passed flatus a few hours later. On account of the employed in a case where I had removed an eye and superior condition of the chest she had to be propped up in a sitting maxilla for sarcoma.l Mr. Eastgate, of Messrs. Sillis, posture from the first, and her cough and asthmatic breathing Strudwick, and Co., took great pains in constructing this were very troublesome for the next fortnight. She had an apparatus, and his mechanical and artistic skill have, as the enema with successful result on the 6th and the 9th, and her series of accompanying photographs serve to show, achieved bowels were open naturally on the llth. The wound healed a highly satisfactory result. by first intention and, after being fitted with a proper belt, The first photograph shows the condition of the wound in the patient left the hospital in good condition on April 8th. the early days, the second after the kindly and skilful work CASE 2.-The patient, aged 47, was admitted on March 5th, of Dr. Ballenghien, the third represents the state on leaving 1916. She was very fat (weight on leaving 13 st. 7i lb.), but the King George Hospital, and the fourth the appearance not like the previous case. She had had an umbilical hernia for 16 years, gradually growing larger. She had had several with the artificial cheek and eye applied. attacks of semi-obstruction, and three months before a Albert-terrace, Regent’s Park, N.W. severe one which was thought to be commencing strangula1 See THE LANCET, tion. She had never worn any belt or truss. On March 3rd Sept. 29th. 1894, p. 736. .
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL.
HONORARY
SURGEON
OF
THE
COVENTRY
AND
WARWICKSHIRE
HOSPITAL; AND
GUNSHOT WOUND OF RIGHT ORBIT AND
MAXILLA;
E. W. G. MASTERMAN, M.D. DURH., F.R.C.S. ENG.,
D.P.H., SENIOR HOUSE
.:It MUCH DESTRUCTION OF BONE AND SOFT PARTS ; ADAPTATION OF ARTIFICIAL EYE AND CHEEK.
BY SIR WILLIAM J. COLLINS, K.C.V.O.,
M.S., M.D.,
B.SC.LOND., F.R.C.S.ENG., OPHTHALMIC SURGEON TO THE KING GEORGE
TWO CASES OF STRANGULATED UMBILICAL HERNIA. BY F. L. HARMAN BROWN, M.B., C.M.EDIN.,
HOSPITAL,
ETC.
SURGEON, COVENTRY AND WARWICKSHIRE HOSPITAL. -
THE two following cases appear to us worthy of record on account of their peculiar difficulty and successful issue. The patients were both unusually fat, middle-aged women, both were operated on within three days, and both left the
hospital on the same day. They suffered from chronic emphysema, asthma, and albuminuria. Private --, aged 32, was severely wounded on the rightt CASE 1.-The aged 55, was admitted to hospital on side of the face by a bullet at Ypres on Oct. 30th, 1914. He March 2nd, 1916,patient, with a history that she had had complete was taken prisoner by the Germans, but while in hospital intestinal obstruction for three days and had been vomiting was placed under the care of two French surgeons, also) all she took. The patient vomited in the ward soon after admission. She was an immensely stout woman, and was prisoners-viz., Dr. Bettremieux and Dr. Ballenghien, both1 said to have weighed 18 st. before this illness (she weighed of Roubaix. From notes made by the latter, which I have! 16 st. 9 lb. when discharged). She had had an umbilical seen, it appears that on Nov. 9th, 1914, the patient had an hernia for several years. On admission the patient was in enormous wound of the right side of the face, extending fromI pain, and she had a large, nodular, irreducible and very the ear to the nose, the soft parts including the right globe, great tender mass half buried in the thick deposit of fat over the and portions of the eyelids were destroyed and there wereabdominal muscles. Temperature, 97° F. ; pulse, 104. The fractures of the right malar, superior maxillary, lacrymal condition of the patient was very unfavourable. She had and nasal bones causing a large opening between the nose chronic bronchitis and emphysema, and her face was and the right orbit. Seven operations were performed chronically cyanosed ; there was a considerable quantity of between Nov. 12th, 1914, and March 4th, 1915, at first for albumin as well as some blood and pus in the urine. In of these conditions the operation was done the removal of the remains of the globe and of sloughs, and consequence under local anaesthesia, codranine being used. later of a plastic nature with a view to restore the cheek. entirely The herniated mass was dissected out of the subcutaneous Deafness of the right ear having supervened paracentesis of fat and the narrow opening in the abdominal fascia was the tympanum was performed. enlarged. On opening the sac the contents were found to The patient was admitted under my care at the King consist largely of omentum, much of which was deeply George Hospital on June 29th, 1915, and I performed two congested, and partly of large intestine. All the sac further plastic operations, suturing together the palpebral contents were adherent to each other and to the peritoneal The omentum was ligatured and removed along margins and also closing the sinus into the nose. I covering. with a great part of the coverings of the hernia, and the the aid of art then be more usefully felt that might remainder of the peritoneal covering adherent at the neck called in rather than attempt any further effort at blepharo- being carefully divided it was returned together with the plasty. I accordingly designed an artificial cheek of painted intestine and the stump of the omentum to the abdominal
Reproductions of photographs illustrating Sir William Collins’s case of gunshot wound of right orbit and maxilla. and moulded copper-plate, with eye attached, set in a pair cavity. The wound was then sewn up in layers. The patient of spectacles, similar to a contrivance I had previously bore the operation well. The vomiting ceased at once and she passed flatus a few hours later. On account of the employed in a case where I had removed an eye and superior condition of the chest she had to be propped up in a sitting maxilla for sarcoma.l Mr. Eastgate, of Messrs. Sillis, posture from the first, and her cough and asthmatic breathing Strudwick, and Co., took great pains in constructing this were very troublesome for the next fortnight. She had an apparatus, and his mechanical and artistic skill have, as the enema with successful result on the 6th and the 9th, and her series of accompanying photographs serve to show, achieved bowels were open naturally on the llth. The wound healed a highly satisfactory result. by first intention and, after being fitted with a proper belt, The first photograph shows the condition of the wound in the patient left the hospital in good condition on April 8th. the early days, the second after the kindly and skilful work CASE 2.-The patient, aged 47, was admitted on March 5th, of Dr. Ballenghien, the third represents the state on leaving 1916. She was very fat (weight on leaving 13 st. 7i lb.), but the King George Hospital, and the fourth the appearance not like the previous case. She had had an umbilical hernia for 16 years, gradually growing larger. She had had several with the artificial cheek and eye applied. attacks of semi-obstruction, and three months before a Albert-terrace, Regent’s Park, N.W. severe one which was thought to be commencing strangula1 See THE LANCET, tion. She had never worn any belt or truss. On March 3rd Sept. 29th. 1894, p. 736. .