wrist-joint, and was at him. The fired shot first the produced by bullet had entered at the root of the thumb between the radial artery and the median nerve, and external to the pisiform bone which was exposed in the large lacerated wound of entrance; and came out half an inch external to the styloid process of the ulna and just over the wrist-joint apparently between the radius and ulna. The wound of exit was small, round, and everted, and both wounds bled freely ; but there was no arterial spouting, nor could any vessel requiring The wounds were all a ligature be detected. warm 1 in 5,000 with washed out carefully perchloride of mercury solution, syringed with a warm solution of tincture of iodine (3i, tinct. iodi to 1 pint warm water), and after all foreign particles had been removed and all haemorrhage had ceased, the dressings were applied. Powdered iodoform was plentifully dusted into and over the wounds and covered with lint dipped in 1 in 2,000 perchloride of mercury solution and cottonwool, a splint and bandages were applied. The chest wounds were not probed, but carefully examined (by the finger previously rendered aseptic) for bleeding points, and damaged ribs or foreign bodies, then syringed with the iodine solution, and dressed with powdered iodoform perchloride of mercury, lint, cotton-wool, bandages, wound had traversed the left

PERFORATING GUNSHOT WOUNDS OF THE CHEST AND OF THE WRIST-JOINT, BOTH IN THE SAME PATIENT AND FOLLOWED BY RECOVERY. Br Surgeon1 Geo. S.

[Published by The

patient,

i.m.s.

Permission of the

Medical Officer, Her "

THOMSON',

the

Principal

Majesty's Forces, Bombay.] Native Adjutant of the 1st

Bombay Lancers, was admitted into the Regimental Hospital on the 25th November 1889, on account of a perforating gunshot wound of the chest, and another of the left wrist-joint.

This Native Officer was shot by a Sowar in the who had already shot Colonel Heyland and another Native Officer by firing self-made Cartridges with his Martini-Henry carbine. I first saw the patient at 8-30 A.Zl. on the 25th of November, or about two hours after he had been wounded. He was then suffering from partial shock, with pallor of the face, cold surface of the body, and frequent small pulse, due to loss of blood from the injuries iufiicted on him by the two shots fired at him. One bullet had entered the chest on the left side behind at the level of the 9th rib, below the angle of the scapula and th ree inches from the spinal column ; and having traversed the chest made its exit one inch below the left clavicle and three inches from the extraclavicular notch. There was an indented skindeep wound one inch above and internal to the wound of entrance produced by the wad used in loading the cartridge and consisting of a circular plate of lead. Air bubbled from the wound of exit anteriorly (traumatopnoea) during the movements of respiration with a hissing sound; and slight pain and difficulty of breathing were complained of. No ha;moptysis, emphysema, or external was present; and the patient ielt at ease except for a sense of oppression in the chest and a slight

lines,

haemorrhage

.ll.nt

f

lorn

pain during swallowing !^auubrium sterni, probably reflex in

origin injury to some nerve fibres connected with the recurrent nerve. The second bullet

and strapping. Perfect rest was enjoined in a separate ward, and the following was given at once : &?

Hydrargyri Subchloridi Pulv. Jalapse co

...

...

grs. 3Sg>

v.

20 minims liquor opii sedativus in a and the patient was ordered to be fed chicken soup, mutton broth, and sago

followed by

draught; on

milk,

conjee.

At 4 P.M. the

his temperature he got grs. v. of antifebrin in an ounce of braudy, and this was repeated iu four hours and brought the temperature down to lOO^F. that evening. When I examined him at 5 p.m., I fouud bronchial breathing and duluess over the middle portion ol the lelt luug iu front and behind. No hajmoptysis at any time, and the sputum was quite free from the slightest tinge of blood. He complains of pain in the chest at the seat of the wounds and difficulty in swallowing, and pain in the wrist-joint and hand. On the 26th November the temperature was only slightly over 100?F. in the morning (100'8?F. at 8 a.m.,) aud reached 101*6?F. at 12 noon when antifebrine grs. v. in one ounce ot braudy was given, aud the temperature fell to 99?F. at 3 p.m., and never again rose to 101?F. during the remainder of the time the patient was in the hospital. On the 29th November I examined the hand and found it considerably swollen from the webs

rose

to

same

103'4?F, when

evening

Sept.

A MIRROR OF HOSPITAL PRACTICE.

1890,J

He

?71

flex find extend his and use his hand in riding, but says he finds it becomes more easily tired than his painted : R. hand. The scar of the wound of uninjured Argenti Nitratis grs.xx.entrance at, the root of the thumb is slightly 3j;t Sp. iEtheris Nitrosi tender 011 .firm pressure over it, and there is Aquae Distillate and the following iron mixture was prescribed.?occasionally a burning sensation in the ring R. finger of the left hand which finger cannot be Extracti Ciiscarae .Sagradse Liq. moved with as great freedom as the others in 51'v. Tincfc Ferri Perchloridi 3jv. flexion. Massage, electricity, and dumb-bell and Magnesii Sulphatis ^iss. gymnastic exercises are now being used to the Extracti Glycyrrhiza Liq. 5|v. Sp. Chloroformi \ 5;;. hand, and under this treatment the wrist-joint has become more supple and the sense of power ~v;. Aq. Camphorse add Hiin the hand has increased. Tlie patient is able Half an ounce every 4 hours until the bowelsto all as a his duties Native Officer and perforin are freely moved. [before.attends all parades with his troop, to the charge The wounds of hand and chest dressed asofj which he has recently been promoted, and is 3rd December 1889.?Again looked at bothin every respect fit for service. wounds and found exit wound of chest almost Remarks.?In this case none of the usual and healed. No pus coming from it or discharge ofwhat are commonly regarded as the pathognomoThe swelling of the hand had com-nic of -a,ny kind. sigus wound.of the lung were atfirst present, pletely subsided, and the wounds of [the wrist-except escape of air (traumatopnea) from the joint were granulating healthily. The skin-deepwound of exit and pain at the seat of the injuposterior wound discharged a little matter due tories. The value of the conservative treatment dead Subcutaneous tissue, which was sloughingof gunshot wounds of joints, is worthy of notice, and had to be gradually removed with dressingtogether with the success of the dry method of forceps and scissors. Syringed both wounds withtreating wounds antiseptically. the iodine solution, and dressed as before. Deesa, 25th July 1890. 5th December 1889.?All wounds healingwell, especially those of the chest, and the hand wounds of the

up to the wrist-joint, and it with the following solution

fingers

? was

?

wrist-joint,

...

...

^

...

_

t

,

... "

...

...

>m

#

...

...

...

...

|

granulating satisfactorily.

Patient

eats

and

and is free from pain and fever. No chest symptoms present, but he is weak and still complains of difficulty in swallowing. To get tonics and stimulants. 8th December 1889.?From this date the patient went out daily for a ride in the statipnhospital cart, and continued to mend rapidly, and made such satisfactory progress that he was able to go on six months' sick leave to his native country 011 the 3rd January 1890. His condition 011 departure was that the chest wounds were perfectly healed, and no symptoms of any antecedent injury to the lungs or thoracic viscera could be detected by careful physical examination, and lie felt nothing abnormal in the

sleeps well,

chest. The hand wounds were almost completely healed, excepting a small space at the root of the thumb, about half an inch in area, which had not yet been covered in by skin. The wrist-joint movements were fair, giving of flexion and extension. The some degree hand is slightly adducted when at rest, and all the movements of all the fingers and of the and sensations are normal in thumb are

perfect,

all parts of the wounded Present

The

-

extremity.

from leave, 18th himself as expresses patient and looks healthy and strong. free from pain, and all sympindicate the serious nature of

condition

July 1890: feeling quite well, The chest is quite toms which might the injury inflicted

on

on

it.

return

can

adduct, abduct,

Perforating Gunshot Wounds of the Chest and of the Wrist Joint, Both in the Same Patient and Followed by Recovery.

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