C'.U'T.*lS 1%. jV. I'AYE, R.A.3I.C.
'l'iii~si< notes give a Ilricf T C W I K ~ of certain points of pathological importaricc that have 1w.m o1)servcd a t various autopsies which were niade in ordcr t o asccrtain the cailse of cleatli in earli casc, a n d so to throw light iipon future qucstions of diagnosis and trcatnicrit. 'l'lie cnsrialty clearing station in France, a t which this work was pcrforniedt was sitr~ated a t :I distance of less than tcn niiles froin the front. It therefore rcceived casualties with very severe woiintls which. in the worst C I I S ~S , might be fatal within thc first twenty-foiir horirs after their infliction. It is for the Iattcr reason especially that tlie facts recorded i n these notes are of interest, because the lcsions which provr fatal at. this early tinie present a differcnt appearance from those that have bccn described elsewlicrc in pathological ot)ser~atioris iiiadc on wounds that provcd fatal at a later date.
WOUNDS OF THE CHEST ONLY.
The cases cxaniined were 14 in number, 3 having been caused by high-velocity bullcts,
The wscs fall into two main groups, iianiely :-I . l'rn who died within twenty-four hoiirs after the wound from the immediate el'fcrts of the injury.
' 1. Four who survived this stage, but succuni1)ed t o later septic coinplications o n the lirfh, ninth, and twelfth davs.
..I Ii;t*rnotlioras was found in each of the 14 cases, and in no one of those who dird in the firr;t twcnty-four hours was thew evidence of the prcsence of air together with t h e hloorl in t h e plciiral cavity. Thc blood in thesc early cases (Group 1) was fluid, and practictnlly frec from clot. I t s quantity varied greatly : but the lower measurements arc of little valucl I)cctuise they were often spoiled by the free leakage of fluid throrigli tlic extcrn:il worind in thc chrst. The maximum volunir found on one side was pints : from 1 t o 2 pints w a s found in sevcral cases.
1Iic Iring was forind to be wounded iii 12 out of thc entirc 1 4 cases : hiit thc tyi'e o f t11i.j woiintl varied in proportion :IS tlw clirst wall was niore or less laceratcd by the entcring missile. \Yhcn t h e entry wound in the chest wall was a tiny track through :in interc:ost:11 space, a similar track through the lung sribstancr would be found : but cven in tlirse simplcst of wounds, the lung around this narrow lumen was found t o have been infiltrated with clotted blood ovcr a n area of about one inch in diameter. \'ith severer woiintls t h a t had caused coniininutcd fracturcs of the ribs, tlic sribjacent lung was found t o pwsent a11 irregular lacerated wound: often containing splintcred portions of rib, clotliing, ;tnd dirt. while the wholc of the wounded lol,e w:is infiltrated with extravasated blood, ant1 looked arid felt firm and solid.
'J'l~cre were 3 cases of bilateral hxniothorax, and in each of these the missile (in 1 case :I i)ullet and in the 2 otlicr cases R piece of shell) had passed throrigh tlic bodies of the Ttli, s t ) ) , or 9th thoracic vrrtebrz without c:rusinp any injury t o thc spinal canal. and withorit p > d ~i e i i i g a n y clinical phenomena indicative of damage t o the cord.
,v~ptic ~~~e , e , i o l h o r n ~. ~-' ~l i e outstanding feature of all the four w s e s in Group ' 1 was the l : q e size of tlie empyeina cavity, which was practically coterminous with that of the pleiiral a i d the rcniaining 11 either by shell-fragments or shrapnel. r .