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War Surgery and Medicine
PENSIONS REVIEW OF PENETRATING CHEST WOUNDS
PENSIONS REVIEW OF PENETRATING CHEST WOUNDS
In 1952 Dr. D. Macdonald Wilson, of the War Pensions Department, examined the files of all ex-servicemen who had applied for pension on account of war wounds of the chest. There were 307 cases with intra-thoracic injury, of whom 299 were gunshot wound cases penetrating the thorax due to missiles of various types. The remaining 8 cases consisted of 5 cases of page 220 haetnothorax due to bomb blast injuries, 2 cases of accidental trauma of chest wall with associated haemothorax, and 1 case of a foreign body in the lung which will be described in detail later.
Of the 299 gunshot wound cases, 295 occurred in the Army in the Middle East, 3 in the Pacific, and 1 in Japan (J Force).
The vast majority of cases from the Middle East arrived back in New Zealand with the wounds of the chest healed and not requiring further treatment. Indeed, there appear to have been only 4 cases which required treatment on return to New Zealand for discharging sinuses in the chest. Unless there were other disabilities requiring treatment, these chest cases on return to New Zealand were fit to return to civil life. If followed up for a year or two it was found they had not sought treatment. Few complained of any severe disablement. Occasional stabbing pains in chest, shortness of breath on exertion, or slight cough were common complaints upon inquiry. Cases which had suffered from haemothorax or infected pleural effusions with displaced mediastina showed no evidence of any cardiac displacement. X-ray examinations in the main revealed only some slightly thickened pleura but few changes in the parenchyma. Even where a metal foreign body was retained within the thorax (77 cases), only in one or two cases was any parenchymatous change shown round the foreign body. Haemoptysis occurring since return of the patient to civil life had been rare. Cases with unusual complications are referred to below.
All 307 cases, except 1 who died of another unrelated disability and 5 other cases, were employed in 1952. None of these unemployed was prevented from working by any chest wound disability. The types of employment in which these men were engaged were farming (20.5 per cent), labouring (14.5 per cent), truck driving (6 per cent), various trades (28 per cent), clerical and professional (20 per cent), and employed but details unknown (11 per cent). While 13 per cent of these cases suffered no disablement in 1952 warranting any pension, 75 per cent received pensions for disablement varying from 10 per cent to 25 per cent, and only 12 per cent of the cases received pensions at a higher rate. Thirty-eight per cent of all cases received a pension assessed at 20 per cent disablement.
Of the 299 cases of gunshot wound of the chest, 77 had metal foreign bodies retained within the thorax, usually within the lung. There was no evidence at that stage (1952) that the presence of a foreign body in the lung substance caused any increase in disablement. All these 77 cases were then employed, 11 per cent not receiving any pension, 80 per cent on pensions varying from 10 per cent to 25 per cent, and only 9 per cent receiving pension for page 221 a higher assessment of disablement. Forty per cent of these 77 cases received a pension for disablement assessed at 20 per cent. Three cases with retained metal foreign bodies suffered from haemoptysis up till the year 1948, 1 case leading to bronchiectasis and lobectomy in 1948. This last case was wounded in 1943 and the other 2 in 1944 and 1945 respectively.
Thirty-eight of the 299 cases suffered an intra-abdominal injury associated with the gunshot wound of the chest. Of these, 6 were associated with liver injury and there were retained metal foreign bodies within the liver in 2 cases. Six suffered splenectomy, 3 had had colostomy for lacerated bowel, and 2 then had a ventral hernia and 1 a diaphragmatic hernia with large gut in the thorax.
Two cases originally suffered symptoms of associated brachial plexus nerve injury, but one case had made a complete recovery while the other still suffered from ‘winged scapula’. One case suffered an arterio-venous aneurysm of the left subclavian vessels, while another had the subclavian vein ligated through a divided clavicle.
After return to New Zealand 4 cases suffered from slight bronchitis, while in 2 cases (1 with retained metal foreign body) bronchiectasis developed and lobectomy had been successfully employed. In 1 case any chest symptoms were then masked by those of Addison's Disease. Four cases (including one of bomb blast injury only of lungs) had developed pulmonary tuberculosis.
The following case deserves special attention:
A soldier was wounded in 1941 in Greece while leaping from a truck which had come under machine-gun fire. The wound was in the upper part of the right thigh and bled profusely. He was taken prisoner and was not repatriated until 1945. He did not remember much about the first twenty-four hours after being wounded; except that he bled profusely and that a few days later there was some blood in his sputum. At no time was he wounded in the chest, and there was no exit wound in thigh. On return to New Zealand in 1945 at routine chest X-ray examination a metal foreign body was revealed lying in the right lower lobe. This foreign body resembled the top of a metal screw. He had no recollection of ever inhaling a foreign body. Subsequently he developed a bronchiectasis and the lobe of lung was resected. The foreign body proved to be the top of a screw. It is thought that this man was wounded in the thigh by this piece of metal from the truck splintered by gunfire. The screw top entered the femoral vein, was subsequently carried to the right side of the heart, and thence to the lungs. Years later it ulcerated through a bronchial wall.
page 222| penetrating wounds— | |
| With haemothorax | 96 |
| With haemo-pneumothorax | 11 |
| With retained FB in chest | 24 |
| With haemothorax and retained FB | 15 |
| With removal FB from chest | 2 |
| With haemothorax and retained FB in heart | 2 |
| With retained FB in pericardium | 2 |
| With pericardial effusion | 1 |
| With pneumothorax | 4 |
| With other | 7 |
| Undefined | 71 |
| Chest wall | 18 |
| —— | |
| 253 |
| accidental injuries invalided to nz— | |
| Penetrating injuries with— | |
| Retained FB | 3 |
| Haemothorax | 1 |
| Haemo-pneumothorax | 2 |
| Pyopneumothorax | 3 |
| Fracture rib and haemothorax | 1 |
| infected— | |
| Haemothorax and empyema | 13 |
| Empyema | 2 |
| Haernothorax and abscess lung | 2 |
| Pyopneumothorax | 9 |
| Abscess chest wall | 1 |
| thoraco-abdomina l— | |
| With haemothorax | 1 |
| With empyema | 3 |
| Other | 2 |
| admissions to hospital, 2 nzef, july 1941 to july1945— | |
| Penetrating chest | 467 |
| Perforating chest | 95 |
| Haemothorax | 160 |
| Pneumothorax | 29 |
| Pyopneumothorax | 7 |
| Empyema | 8 |
| Fracture ribs | 71 |
| Injury to lung | 73 |
| Contusions, etc., chest wall | 480 |
| Contusions, chest, undefined | 143 |
| —— | |
| 1533 |