New Zealand Medical Services in Middle East and Italy
Surgery at 1 General Hospital
Surgery at 1 General Hospital
For the first month from the date of its opening at Senigallia at the beginning of September, 1 General Hospital performed surgery of the type usually done at the CCS, many wounds having their first surgical treatment there. Most of the wounded arrived in very good condition after their treatment at the field units and their journey back along the fairly smooth coast road, exceptions being men with compound fractures of the femur where infection had not been controlled by penicillin. Two of these had to have above-knee amputations following secondary haemorrhage from the popliteal artery.
Six cases of gas gangrene were encountered in September, one of the septicaemic type being the only death. The others recovered following excision of the muscle groups involved. Gas gangrene had been more commonly met with during the campaign in Italy and occasional severe cases arose, especially in late cases. Penicillin proved to be very useful when combined with adequate surgical excision. A much higher proportion of wounds was subjected to primary surgical treatment, partly as a precautionary measure against gas gangrene and partly to ensure success when subjected to delayed primary suture.
Delayed primary suture was performed for many wounds, use being made of either calcium penicillin, sulphanilamide powder, or proflavine powder. Results were good but there was often slight infection of the stitch holes. It was found that the third or fourth day was the optimum time for suture. Whenever possible the deep fascia was closed by means of figure-of-eight sutures, including the page 630 skin and the fascia. Where this was possible healing was more satisfactory and the scars less adherent.
Two cases of rectal wounds which had not been detected in the forward units were seen, colostomy and drainage of the pelvic cellular tissues being carried out. Both had severe accompanying wounds and neither had intra-peritoneal involvement.
The notable feature of the September casualties was the infrequency of grossly infected wounds and, consequently, diminished toxaemia.
A feature of the later casualties was the large number of leg and thigh amputations, mainly the result of mine wounds, a considerable number of traumatic amputations having been sustained. A small number of cases of gas gangrene, but none of tetanus, was seen. In the larger wounds, including fracture cases, parenteral penicillin was given for some days to ensure the control of infection. All types of cases were dealt with except fractures of the femur, which were evacuated as soon as possible to 3 General Hospital at Bari for definitive treatment. In October 200 operations out of a total of 500 were performed for suture of wounds.
Intramuscular penicillin was being used freely by this time for severe bone and joint cases and in chests. There were remarkably few deaths at this period. The two unit surgeons, Lieutenant-Colonel Bridge and Major A. W. Douglas, carried the heavy load of surgery in the hospital at this time, though for a period a surgeon from 2 General Hospital was attached to the unit and gave valued assistance. Some diphtheritic infection of wounds occurred and proved a serious complication.