Case 2.?A severe mound
A FEW CASES FROM UPPER ASSAM. By S. O. Medical
I
.
/
Bishop, M.R.C.S.E., L.R.C.P., Superintendent, Koomtai, Badulipar
and
other Tea, Estates. The following cases having come under my notice during the last few months, I thought perhaps they might be interesting to some of your readers. Case 1.?Struck or not struck by lightning. This case is one of peculiar interest, as the damage sustained was so slight. Case.?It happened as follows : A young lady, during a thunderstorm was standing in the verandah of her bungalow with her brother, who was stooping down putting some earth into some flower pots ; all at once there was a flash followed by a terrific peal of thunder. The brother was knocked down but did not lose his senses ; on trying to get on fire, and as up he could not at first, and felt as if his leg was soon as he recovered himself a little, shouted for water, and when this was poured on his leg he was able to get up ; on doing so he found his sister lying on the floor and looking with cold as if she was dead ; however after a little time water, &c., she recovered. I was at once sent off for, but was so my friend, Mr. some miles away on another journey, Charles Peterson, attended and rendered every assistance ; lie said he found them both in a very nervous state and he prescribed suitable remedies, and the next day very wisely removed them a few miles away to his own bungalow for a
change.
shock to the nerfew cays, sustained no injuries except a bruise on the right shoulder and right ankle, and this I am inclined to think was due to the fall. The brother's leg turned black and blue, and exhibited more, the character of a bruise than anything else, and he felt it sore for days afterwards. Lead and opium lotion was at first prescribed and then stimulating liniments. Bungalon?This was not set on fire, but the servants state that the roof was smoking ; as rain was falling heavily at the time, this must have put it out. Tea bushes 30 yards away were scorched, but if from this particular flash no one is able to tell. The interior of the bungalow presented the appearance as if something had stripped the plastering from the wall in places, but it was not burnt or blackened. In two rooms the plastering was taken off and a great rent shown ; in the verandah where they stood and behind them a piece of wood 4 feet long and an inch broad had been torn out of the wooden floor, and for some time a smell of sulphur pervaded the bungalow. The brother described the middle room as if one had just fired a gun off in it. Remarks.?I saw them both a few days afterwards, the sister says she recollected nothing further than the flash when she fell down. The brother states that he recollects being knocked down, and then felt as if his leg was on fire, and on trying to get up found he could not rise, but was able to do so after he had had cold water poured on the leg. 1 don't for a moment think either were struck by the lightning, but it was a very miraculous escape ; had they been in the inner room it must have been fatal. They must have been thrown down by the shock and close proximity of the electric fluid, which seems to have entered the roof and gone down the wall of the room that separates the centre room from the bed-rooms. Another lucky thing is, that they had just left the breakfast table to go and look at the storm; it happened about 9 A. m.
Injuries.?The sister, beyond
vous
a
system and loss of smell for
severe a
from
a
hear.
The following case is of some interest. A dakwallah was attacked by a bear, and before he was driven off he inflicted severe injuries. The man was carried into Diffloo Hospital and attended by the native doctor ; as I did not see the case for some time, in fact till he was fairly on the road to recovery, all the credit for putting him through is due to the native doctor. He states that when the man was brought into the hospital some hours after the accident he was sensible though Yery weak from loss of blood. Injuries.?The whole of the scalp on the right side was torj off from about 2 inches above the right orbit to the half of the occipital bone, the whole of the scalp and periosteum was torn away likewise from the right parietal bone. Between the intra scapular space there was a deep lacerated wound ; the scalp was hanging posteriorly by a small flap. The Baboo cleaned the scalp and applied sutures; there had been considerable hemorrhage, but this had ceased. The wounds were dressed with Carbolic oil and stimulants freely given with opiates at night. The whole of the injured scalp sloughed away and left the bones bare and exposed. "When I saw the case some time afterwards the wound in The head presented the following the back had healed. appearance ; the right parietal bone was quite bare, denuded of everything and polished and white, part of the occipital and frontal bones the same, but healthy. Granulations are springing up and extending daily, and doubtless in a little time the whole will be covered. Treatment is Carbolic oil dressing and warm water syringing. The patient is looking well under the circumstances, and the only thing that seems to trouble him is, will the hair grow on that side again ? A splendid chance for Allen's Hair Kestorer. Case
3.?Amputation of
the
Leg for
a
Gangrenous Ulcer.
A female coolie received a slight injury over the tibia from a tea bush ; she went to work as usual, and the case did not come under my notice for a fortnight when I saw it. The wound had developed into a large sloughing ulcer which was rapidly spreading, it was situated on the anterior surface about the middle of the leg. Nitric acid was applied and charcoal poultices with extra diet and a mixture of Bark, Quinine and Nitric acid given ; but it went on from bad to worse, and the woman was getting weaker every day, till finally it became gangrenous and slight hemorrhage took place from time to time, so I determined to amputate. Assisted by Mr. Charles Peterson and Sarut Chundra Chuckerbutty, native doctor, both of whom rendered valuable assistance, I amputated as high up as possible by the modified circular ; very little blood was lost, and the patient made an excellent recovery, and I am getting a leg for her as the stump is short. She will be able to walk on her knee in a rest.
Remarks.?This
was
a
new
importation,
a
weakly
woman
about 35 years of age, spare and thin ; there is no doubt that she had very little recuperative power ; doubtless operation was called for, here we have a patient getting weaker daily and fatal hemorrhage might at any time have set in, and the ulcer was gangrenous and bones exposed. The patient has gained flesh, and is hearty and well now. Case
4.?Amputation at Shoulderjointfor
severe
injuries.
Death. One afternoon I received a note from the Manager of a large requesting me to come over at once, as one of his coolies had met with a severe accident and had had his arm torn off by catching it in a belt in some machinery. Host no time in going over, but it was getting dark when I arrived. On examination I found the arm had been torn off just below the elbow, and both ulna and radius were protruding ; I found the humerus was fractured and comminuted in two portions, one just above the elbow and the other very high up. Hemorrhage had ceased when I saw him, but I was told that considerable bleeding had taken place at the time of the accident; this is curious, as in cases of torn wounds The patient was as a rule not much hemorrhage is noticed. very weak and evidently suffering from collapse and loss of blood. As it was now dark I decided the patient would better bear the operation early in the morning. A tourniquet was applied lightly and a native doctor was told off to stay with him all night. He had stimulants and nourishment and afterwards an opiate ; he slept for several hours. In the morning I found him weak but pretty free from pain. I determined to operate at once, and assisted by Mr. Charles Peterson and the native
factory,
November 1,
1882.]
A MIRROR OF HOSPITAL PRACTICE.
doctor, I amputated at the shoulder joint
; compression was made over the subclavian against the 1st rib, and a posterior flap was cut, it was seized together with the axillary artery ; not much blood was lost, and the whole operation from first giving chloroform to completion was just 15 minutes. He was just recovering from the chloroform and I was putting the last stitches in the flaps, when he collapsed, and could not be brought round, though we tried every means.
297
A FEW CASES FROM UPPER ASSAM. By S. O. Medical
I
.
/
Bishop, M.R.C.S.E., L.R.C.P., Superintendent, Koomtai, Badulipar
and
other Tea, Estates. The following cases having come under my notice during the last few months, I thought perhaps they might be interesting to some of your readers. Case 1.?Struck or not struck by lightning. This case is one of peculiar interest, as the damage sustained was so slight. Case.?It happened as follows : A young lady, during a thunderstorm was standing in the verandah of her bungalow with her brother, who was stooping down putting some earth into some flower pots ; all at once there was a flash followed by a terrific peal of thunder. The brother was knocked down but did not lose his senses ; on trying to get on fire, and as up he could not at first, and felt as if his leg was soon as he recovered himself a little, shouted for water, and when this was poured on his leg he was able to get up ; on doing so he found his sister lying on the floor and looking with cold as if she was dead ; however after a little time water, &c., she recovered. I was at once sent off for, but was so my friend, Mr. some miles away on another journey, Charles Peterson, attended and rendered every assistance ; lie said he found them both in a very nervous state and he prescribed suitable remedies, and the next day very wisely removed them a few miles away to his own bungalow for a
change.
shock to the nerfew cays, sustained no injuries except a bruise on the right shoulder and right ankle, and this I am inclined to think was due to the fall. The brother's leg turned black and blue, and exhibited more, the character of a bruise than anything else, and he felt it sore for days afterwards. Lead and opium lotion was at first prescribed and then stimulating liniments. Bungalon?This was not set on fire, but the servants state that the roof was smoking ; as rain was falling heavily at the time, this must have put it out. Tea bushes 30 yards away were scorched, but if from this particular flash no one is able to tell. The interior of the bungalow presented the appearance as if something had stripped the plastering from the wall in places, but it was not burnt or blackened. In two rooms the plastering was taken off and a great rent shown ; in the verandah where they stood and behind them a piece of wood 4 feet long and an inch broad had been torn out of the wooden floor, and for some time a smell of sulphur pervaded the bungalow. The brother described the middle room as if one had just fired a gun off in it. Remarks.?I saw them both a few days afterwards, the sister says she recollected nothing further than the flash when she fell down. The brother states that he recollects being knocked down, and then felt as if his leg was on fire, and on trying to get up found he could not rise, but was able to do so after he had had cold water poured on the leg. 1 don't for a moment think either were struck by the lightning, but it was a very miraculous escape ; had they been in the inner room it must have been fatal. They must have been thrown down by the shock and close proximity of the electric fluid, which seems to have entered the roof and gone down the wall of the room that separates the centre room from the bed-rooms. Another lucky thing is, that they had just left the breakfast table to go and look at the storm; it happened about 9 A. m.
Injuries.?The sister, beyond
vous
a
system and loss of smell for
severe a
from
a
hear.
The following case is of some interest. A dakwallah was attacked by a bear, and before he was driven off he inflicted severe injuries. The man was carried into Diffloo Hospital and attended by the native doctor ; as I did not see the case for some time, in fact till he was fairly on the road to recovery, all the credit for putting him through is due to the native doctor. He states that when the man was brought into the hospital some hours after the accident he was sensible though Yery weak from loss of blood. Injuries.?The whole of the scalp on the right side was torj off from about 2 inches above the right orbit to the half of the occipital bone, the whole of the scalp and periosteum was torn away likewise from the right parietal bone. Between the intra scapular space there was a deep lacerated wound ; the scalp was hanging posteriorly by a small flap. The Baboo cleaned the scalp and applied sutures; there had been considerable hemorrhage, but this had ceased. The wounds were dressed with Carbolic oil and stimulants freely given with opiates at night. The whole of the injured scalp sloughed away and left the bones bare and exposed. "When I saw the case some time afterwards the wound in The head presented the following the back had healed. appearance ; the right parietal bone was quite bare, denuded of everything and polished and white, part of the occipital and frontal bones the same, but healthy. Granulations are springing up and extending daily, and doubtless in a little time the whole will be covered. Treatment is Carbolic oil dressing and warm water syringing. The patient is looking well under the circumstances, and the only thing that seems to trouble him is, will the hair grow on that side again ? A splendid chance for Allen's Hair Kestorer. Case
3.?Amputation of
the
Leg for
a
Gangrenous Ulcer.
A female coolie received a slight injury over the tibia from a tea bush ; she went to work as usual, and the case did not come under my notice for a fortnight when I saw it. The wound had developed into a large sloughing ulcer which was rapidly spreading, it was situated on the anterior surface about the middle of the leg. Nitric acid was applied and charcoal poultices with extra diet and a mixture of Bark, Quinine and Nitric acid given ; but it went on from bad to worse, and the woman was getting weaker every day, till finally it became gangrenous and slight hemorrhage took place from time to time, so I determined to amputate. Assisted by Mr. Charles Peterson and Sarut Chundra Chuckerbutty, native doctor, both of whom rendered valuable assistance, I amputated as high up as possible by the modified circular ; very little blood was lost, and the patient made an excellent recovery, and I am getting a leg for her as the stump is short. She will be able to walk on her knee in a rest.
Remarks.?This
was
a
new
importation,
a
weakly
woman
about 35 years of age, spare and thin ; there is no doubt that she had very little recuperative power ; doubtless operation was called for, here we have a patient getting weaker daily and fatal hemorrhage might at any time have set in, and the ulcer was gangrenous and bones exposed. The patient has gained flesh, and is hearty and well now. Case
4.?Amputation at Shoulderjointfor
severe
injuries.
Death. One afternoon I received a note from the Manager of a large requesting me to come over at once, as one of his coolies had met with a severe accident and had had his arm torn off by catching it in a belt in some machinery. Host no time in going over, but it was getting dark when I arrived. On examination I found the arm had been torn off just below the elbow, and both ulna and radius were protruding ; I found the humerus was fractured and comminuted in two portions, one just above the elbow and the other very high up. Hemorrhage had ceased when I saw him, but I was told that considerable bleeding had taken place at the time of the accident; this is curious, as in cases of torn wounds The patient was as a rule not much hemorrhage is noticed. very weak and evidently suffering from collapse and loss of blood. As it was now dark I decided the patient would better bear the operation early in the morning. A tourniquet was applied lightly and a native doctor was told off to stay with him all night. He had stimulants and nourishment and afterwards an opiate ; he slept for several hours. In the morning I found him weak but pretty free from pain. I determined to operate at once, and assisted by Mr. Charles Peterson and the native
factory,
November 1,
1882.]
A MIRROR OF HOSPITAL PRACTICE.
doctor, I amputated at the shoulder joint
; compression was made over the subclavian against the 1st rib, and a posterior flap was cut, it was seized together with the axillary artery ; not much blood was lost, and the whole operation from first giving chloroform to completion was just 15 minutes. He was just recovering from the chloroform and I was putting the last stitches in the flaps, when he collapsed, and could not be brought round, though we tried every means.
297
