Prolapse of Lung Following an Injury

Srib-Assist ant Surgeon, In-Charge, Dispensary, Hujra, Montgomery District On 29th October, 1932, Bahawal, a Mohammadan male, aged 35 years, was brought to the dispensary with the following injuries :? (1) An incised wound 5 inches by 14 inches on the right side of the chest in the mammary region; the third, fourth, fifth and sixth ribs were severed and a large portion of the right lung was prolapsed through the wound. (2) An incised wound 3 inches long just above the left wrist, both bones of the forearm were completely cut, the hand was only hanging by the skin and flexor tendons. Besides the above injuries he had others as well. At the time of admission he was in a moribund conditio11 with severe symptoms of shock, but he was conscious. The injuries had occurred about twelve hours previously and the parts were wrapped in dirty rags. Treatment.?Under chloroform, the prolapsed lnn? was washed with normal saline and was replaced in the chest. The pleural cavity was cleared of blood clots. Bleeding points in the chest wall were secured and the wound was stitched in layers without any drainage. His left forearm wound was cleaned thoroughly water and saline lotions, and dabbed with acriflavine lotion 1?1,500. The bones were approximated and the wound was stitched without drainage and the arm waS fixed in an antero-posterior splint. All his remaining injuries were similarly treated and were stitched. All the wounds united by first intension. On the seventh day all stitches were removed, the left side 0 the chest was strapped as some of the ribs were fractured. _ During all this time he complained of pain in the le1 side of chest and was running a temperature; gradually he developed signs of effusion on this side, On 17th November his chest was explored and fluid ^vaf detected. On 23rd November one pint of blood-stain^ fluid was removed from the left side of his chest, th first portion of the fluid containing some pus. The