Lieut. R W Haybittle’s Clinical Record


N0.485 .1917

32 BGH Amara Diagnosis: GSW IX.1  R Thigh – severe

_medical-case-notes-01-haybittle21.12.17 Admitted with a GSW of entry in R Thigh some two to three inches below the middle one third Pouparts ligament and to the outer side the line of vessels.

No wound of exit, bullet retained.  No bowel or bladder symptoms, complaining much of severe intermittent pain along the course of the obturator nerve as far as the inner side of the right knee.  Wounded 5.12.17, in hospital Bagdhad 11 to 16th.

23.12.17 X rays show presence of a rifle bullet in the upper part of the thigh probably lying somewhere in the obturator foramen amongst the muscles.

24.12.17 Temp. rising rapidly to 103 F, some pussey discharge from the wound.  First Operation Col.Davis Colley: Wound of entry explored with finger, no foreign body felt, track passes downwards and inwards behind the main vessels with a large portion of the psoas muscle intervening.  Counter incision made on inner aspect of the thigh as high up as possible, muscle planes separated and bullet searched for.

During search a small abscess cavity communicating with the wound of entry was opened and evacuated of pus.  A thorough search failed to find the foreign body so both wounds were left open and tubes inserted.

27.12.17 Temp. shows signs of falling at once after the operation and the obdurator pain has not returned.  Temp. normal this morning.  Both wounds draining well, more particularly the anterior one.

3.1.18 Temp. has been remittent and swinging since last operation and a tender swelling has gradually developed in the right buttock just outside the right sacral margin, definite fluctuations today.  Is also having occasional loose motions without blood or slime , stools very green and foul.  Note: there is considerable tenderness but no swelling over the capsule of the right shoulder joint.

Second operation.  Col Davis Colley.  :  Abscess in right buttock drained by two incisions.  The pus seemed to be beneath the gluteal muscles  tracking round the Ischium, but no definite track leading forward to the other incisions in the thigh could be found.  Note: of these last incisions the one on the inner side of the thigh leads up to the inner side of the Ischial Tuberosity which can be felt at the bottom of it.

A further search was made for the bullet but it was not found.  There was no induration of the tissues in the ischio-rectal fosse over the pelvic cellular tissue.  Buttock abscess drained with two tubes.  Tube omitted from anterior wound in thigh to encourage closing of this wound if possible. 

6.1.18 Temp. fell for 24 hours after the above operation and there was much oedema of buttock which subsided in 24 hours.  Temp. however rose rapidly and pulse rate also, accompanied by much pain, tenderness and some swelling of right shoulder joint.  Exploration of this with needle 24 hours ago showed pus in the joint.

Third Operation.  Col. Davis Colley.  R shoulder joint opened from behind and a moderate quantity of pus evacuated.  Interior of joint as far as could be ascertained appeared to be quite smooth.  Large tube inserted down to incision in the capsule, no splint applied.  Both thigh and buttock wounds are discharging pus very freely, has no pain and is taking feeds extremely well.

7.1.18 Fourth Operation: Capt. R J McNeill Love.  Counter incision made in front of R. Shoulder Joint as drainage from posterior incision above was poor.

  6.15 pm There has just been a brisk secondary haemorrhage from a large muscular branch to the Deltoid.  Controlled by pressure, very collapsed and shocked.

  9.0 pm Some further haemorrhage again occurred from the counter incision in front of R Shoulder.  Wound opened up to its full extent, bleeding point found and ligatured.  Pulse and general condition very poor.  Usual restorative measures applied.

8.1.18 Condition steadily got worse all night, pulse very weak and rapid, died at 5.0 am, no further haemorrhage having occurred.

POST MORTEM  R. Hip region examined, hip joint full of pus, cartilage eroded.  Small fracture of head of bone and adjacent cotyloid margin.  Much old haemorrhage and bruising in adductor muscles in right thigh.  Bullet found just to inner side ascending ramus pubic bone.  No pus around it, hip joint evidently source of septicaemic infection.

A Coombs, Capt. RAMC, Mo i/c of Case.