SOME SURGICAL CASES Treated Sambiitr Nath Pandit By D. G. CR

in the

Hospital, Calcutta.

WVF03D, M.B.,

MAJOR, I.M.S.,

O/ficiatiiiij Gioil Surgeon. IV-Parganas, (Continued from page 14.) The wound on Sahadut's left thumb was also received in trying to ward off the knife. Only one knife was found, and, according to both men's stories, only one knife was Not much inference could be drawn used. situati on or direction of the wounds; the from fact that the largest of the three the though sligh t wounds on Inait's throat was deepest on the right, and tailed off to the left, rather against its having been selfwas

probably

inflicted. The

case

against Sahadut

was

dismissed.

committed for trial to the Session, where he was convicted of causing grievous hurt, and sentenced to five years' rigorous imprisonment. I saw both men at the Sessions Court Inait was perfectly well; on 21st November. Sahadut's voice was still rather husky. Case No. 7. Wound of throat.?Ramzan Mehter, Hindu male, .30, was brought to hospital about 10 A.M. on 24th October by a constable, who stated that ho had cut his throat, when recovering from the effects of liquor that morning about 5 a.m. I was in the hospital when he arrived, and attended to him at once. There was a wound, 5 inches long, gaping 2i inches wide, across the front of the throat. The left sternomastoid muscle was exposed, but not injured. The larynx was completely divided, except for a very narrow strip posteriorly, about

Inait

was

pK1,

1899

]

SURGICAL OASES-CRAWFORD.

49

Remarks.?When first 1 saw this case, 1 was little or no chance of half an inch above the lower border of the thought thyroid man'sthat there As regards the treatment recovery. and cartilage. There was blood on his dhoti, the it be two other cloths had been saturated with blood. pursued, may questioned whether putting a into the part of the larynx, tube a of tracheotomy Only very slight oozing blood was taking before stitching up the wound, was the proper place on admission. Two small oozing points course to were tied. pursue. It would, of course, have been more satisfactory if the wound in the Under chloroform the divided edges of much the larynx had been sewn up throughout its entire thyroid cartilage were brought together with three and had united without trouble. Judgon stitches length, each side, a tracheotomy tube catgut from the after-history of the case, ing, inserted in however, the The middle line in front. being rest of the wound on each side was stitched I do not think there would have been any up chance of such a favourable sequence of events. with horse-hair sutures. On recovering from As the chloroform he vomited about an ounce of it was, with first a tracheotomy tube, and then an opening in the front of the larynx, he blood clot. The pulse was quiet and of fair suffered from severe dyspnoea on more than one strength. occasion. Had there been no opening into the He had fever up to the 29th, the temj highest the probability is that either it would of perature reached being 102'2 on the eveninglarynx, have been necessary to re-open the whole wound the 25th. From 30th October his temperature to enable him to breathe, or the patient would remained normal. have been suffocated. For six days he was unable to swallow anything, and attempts to pass a nasal tube failed,In all the above cases the greater part of the of the cases were taken by Assistantthe tube coming back into the mouth, instead notes of De and Nripendra Nath Surgeons down the going oesophagus. He was therefore whoSotish Chunder Basu, nourished entirely by nutrient enemata. He successively held the post of Resident had absolutely no nourishment Surgeon of the Sumbhu Nath Pandit Hospital. by the mouth I cannot from the night of the 23rd, before he cut his speak too highly of the care and attention throat, till the evening of the 29th, when he given to the cases in hospital by both these officers. swallowed some milk for the first time. He ate solid food for the first time on 5th Novem- [Note.?The subsequent history of this case was not so satisfactory as appeared probable when these notes were ber. written. On the 26th November, eleven days after his He was at first much troubled transfer to Alipur Jail, by which time the wound in the by mucus collarynx had almost closed, he again had an attack of severe lecting in the tracheotomy tube, the inner part dyspnoea ; and the wound was enlarged, and the tracheoof which had to be constantly removed andtomy tube again inserted. Up to 19th December he was cleaned. Respiration was noisy and stridorous still in the Jail Hospital, and still wearing the tube, for several days, though no affection of the lungsthough otherwise in good health]. could be detected. On the 30th October the Case No 8, Injury to back.?Bhaglu, Hindu tube was removed for the first time; in themale, 35, admitted on the 1st October lb98, states evening the aperture became blocked by somethat between 8 and 9 a.m., a heavy plank fell on thick dry mucus, after which the tube wasthe lower part of his back, since when he had reinserted for the It was finally removedbeen unable to move. A gap in the spine could night. on the 31st. The aperture was again nearlybe felt below the 10th dorsal vertebra, but no blocked by similar thick dry mucus on 6th crepitus could be detected. Sensation in the November; and again on 9th November, causinglower limbs was unimpaired, but he could only move his legs with much dyspnoea for a time. difficulty, and was He was unable to speak for the first nineteen unable to stand or even sit up. He was unable days after admission, though he could answer to pass water, which had to be drawn off by a questions by nodding or shaking his head. He catheter. His temperature on admission was was able to speak in a hoarse whisper, for the 100 6; it rose to 102 2 on the evening of the 4th, first time, on 12th November. but fell to normal on the morning of the 6th, The wound in the and did not again rise above normal. He united cartilage thyroid well. By 2nd November the edges appeared to passed water for the first time without the aid have united, except for the of a catheter on the evening of the 4th October; gap in the middle where the tube had been inserted, from that date to the 19th, the catheter had tracheotomy fhe horse-hair stitches were removed on that to be used occasionally; after the 19th he passed ?lay from the rest of the wound, which had water naturally. At first he complained of severe failed to unite by first intention. pain over the seat of injury on the back, but this On 15th November he was considered to be gradually passed off; the gap which could be felt in the spine had filled up by the 11th, but well enough for transfer to the Alipur Jail Hospital. There was then an opening into the the spot was still very tender to the touch. By 'a,'3"nx, ? inch long from side to side, ? inch the 4th November he was able to sit up in bed )road from above downwards. The rest of the without help, but still raised his legs with diffiwound in the neck was

granulating.

50

THE INDIAN MEDICAL GAZETTE.

the toes hanging down. At this time he could walk a little with another man's support, but could not stand without support. By the 18th November he could walk fairly with the help of a stick. He was discharged from hospital that day at his own request, being entered

culty,

as

discharged relieved.

Injury to head and neck.? male, 30, admitted on the 1st OctoJhutai, Hindu, ber 1898, suffering from the effects of the same Case No. 9.

accident as the preceding case; the same plank having fallen on the back of his head and neck, stunning him. On admission lie was semi-conscious, speaking with some difficulty. There was a large ecchymosis over the right temporal region;the neck was rigid,and very tender behind; the right pupil was dilated; the movements of the left arm were impaired; the pulse was slow, 58 per minute. The temperature on admission was 99'8 ; it rose to 1002 on the evenings of the 3rd and 4th October, and to 99-8 on the evening of the 5th; after which it fell to and remained at normal. The tongue when protruded was deflected to the right. Vision in the right eye was much impaired ; he was unable to count fingers. On October 3rd he vomited thrice ; otherwise the case proceeded favourably, except for severe pain in the head and neck, which he described as starting in the right frontal lobe and shooting down the neck. The dilatation of the right pupil had disappeared by the 26th October, but vision was still somewhat impaired, and remained so till he left hospital. He was discharged cured on the 18th November, by which time he was free from pain, and well, except for the diminished vision in the right eye. Remarks.?In both the above cases the injuries at first sight seemed more severe than they really were. In both cases a favourable prognosis was given, and the treatment adopted was

entirely expectant.

[Feb.

189D.

Surgical Cases: Treated in the Sambhu Nath Pandit Hospital, Calcutta.

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