Surgery of violence. V. Missile wounds of the head and spine.

The patient with a cerebral gunshot wound has a very unstable condition. In Belfast emphasis has been laid on rapid evacuation and on starting resuscitation within a few minutes of injury. Early and adequate transfusion combats shock; controlled ventilation helps limit the rise in intracranial pressure. Intracranial haematomata should be sought by early operation. Operation seldom improves neurological function in missile wounds of the spine.     

Report on injuries sustained by patients treated at the Birmingham General Hospital following the recent bomb explosions.

As a result of recent bomb explosions a total of 82 patients were treated at the Birmingham General Hospital, 61 with minor injuries. Bomb injuries may be divided into three main groups due to the blast effect (such as blast lung and ruptured tympanic membranes), the flash (such as burns to the exposed part of the body), and shrapnel (which may cause a wide variety of injuries). The amount of warning of such explosions is usually minimal, and so the prepared accident schemes of most hospitals are inappropriate. If the disaster occurs outside normal working hours much responsibility initially falls on the resident staff. This report gives some idea of the type of injuries they are likely to see.     

Cranial injuries as evidence of violence in prehistoric southern California

Crania from the Channel Island area of southern California were examined for evidence of traumatic injuries. Well-healed depressed fractures in the outer table of the cranial vault are common in skeletal remains from the northern Channel Islands (18.56% n = 598) but rare in those from the mainland coast (7.5% n = 146). This prevalence of traumatic injuries among the islanders may be a result of intense competition over resources in a geographically circumscribed environment. The frequency of cranial injuries increases significantly between the early and late prehistoric periods on the Channel Islands. This temporal variation appears to reflect changes in patterns of violence associated with population growth and environmental instability.     

The Tower of London bomb explosion.

After the detonation of a bomb in the Tower of London 37 people were brought to St. Bartholomew''s Hospital. The explosion caused numerous severe injuries of a type rarely seen in peacetime.     

Hyperparathyroidism among atomic bomb survivors in Hiroshima.

To determine the effect of exposure to atomic bomb radiation on the occurrence of hyperparathyroidism, the prevalence was determined among a population of 3,948 atomic bomb survivors and their controls in Hiroshima. The diagnosis of hyperparathyroidism was based upon histopathological findings or the presence of consistent hypercalcemia and elevated levels of serum parathyroid hormone. Primary hyperparathyroidism was diagnosed in 19 persons (3 males, 16 females). Females had approximately a threefold higher overall prevalence of hyperparathyroidism than males (P less than 0.05). The prevalence rates of hyperparathyroidism increased with radiation dose (chi2(1) = 12, P less than 0.001) after adjusting for sex and age at the time of the bombing. The estimated relative risk was 4.1 at 1 Gy (95% confidence limits 1.7 to 14). There was some evidence that the effect of radiation was greater for individuals who were younger at the time of the bombing. In conclusion, exposure to atomic bomb radiation affected the occurrence of hyperparathyroidism, suggesting that doses of radiation lower than those used in radiotherapy may also induce this disorder.