Work of 1 General Hospital Surgical Team

This team was attached to 1 Mobile CCS for the Cassino battles, and the OC reported that ‘the team is strongly aware of the great advantages of X-ray, a laboratory and a wealth of skilled nurses.’ The team expressed a strong preference for working in tents rather than buildings.

In abdominal operation X-ray was considered to be of great assistance in planning the approach. Adequate nursing facilities at the CCS following operation were held to outweigh the advantages of operation two to three hours earlier at the MDS. This is a very significant commentary from a team with such long experience of work at the MDS.

In chest cases a more radical operative treatment was adopted and rib ends were trimmed and accessible foreign bodies removed. Inter-costal nerve block was utilised and thought to be effective.

During the period 1 December 1943 to 31 March 1944, 279 operations were performed with 31 deaths. There were 60 abdominal cases, with 24 deaths, and 6 gas-gangrene cases, with 2 deaths. The influence of cold and exposure was demonstrated by the death of 9 abdominal cases out of 12 operated on at Castelfrentano, on the Sangro front, after difficult evacuation after heavy snowfall.

page 548

An analysis of the deaths according to the period following operation is of considerable interest:

Within 24 hours:	Shock 14
	Shock and brain injury 2
	Shock and blast 1
	Pulmonary oedema 1
	Peritonitis (3 days wounded) 1
24–48 hours:	Shock 2
	Mesenteric thrombosis 1
	Haemothorax 1
3 days:	Gas gangrene 2
4 days:	Peritonitis 1
7 days:	Cerebral embolus and thrombo-phlebitis 1
	Secondary haemorrhage from sutured perforations of jejunum 1
8 days:	Peritonitis 1
12 days:	Biliary obstruction from divided common bile duct 1
30 days:	Pericarditis 1