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Joel C. Swanson, M.D.
JAMA. 1931;96(17):1382. doi:10.1001/jama.1931.27220430003009b.
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W. O., a youth, aged 18, was admitted to St. Luke's Hospital, July 4, 1929. He was brought to the emergency room, sitting in a wheel chair, an air pump plunger rod through his head. He was cold and clammy, his pulse slow and weak, with the appearance of severe shock, not unconscious, but unable to respond to questions.

Immediate antishock treatment was started. The protruding shaft was cleansed with iodine and withdrawn, the patient was put to bed, and tetanus antitoxin was given. The pump shaft was five-sixteenths inch in diameter and 18 inches long. It had entered the skull through the medial and upper angle of the right orbit, without injury to the eyeball, and had protruded 6 inches in the midline at about the parietal and occipital articulations.

The patient's mother stated that the young man had been placing lighted firecrackers in the pump barrel and holding


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