August 1,
A MIEEOR OE
1873.]
HOSPITAL PEACTICE.
CASES AND OBSERVATIONS.
By Surgeon-Major
J. W, Johnston, M.D.
(Continued from
page
186.^
/
LIGHTNING STHOKE.
V
Sepoy Shib Pershad, aged 25, of 6 years and 18 inches, with a days' service, weight 120lbs., height 5 feet chest circumference of 34 inches, was struck by lightning on clouds the were almost touch25th May during a terrific storm; ing the earth, and practically there was no interval between the when the adjusting regimental peal and flash. On 4th April, medical history sheets, I examined and recorded him as a healthy, 84 and a regular pulse running muscular man, with respirations 17 per minute. His previous sickness consisted of variola in one of and of acute attacks ague (a), hepatitis, youth; two No. 20S1,
since his enlistment. On 25th May he left the regimental hospital, where he was on duty; at 2 p.m. dined in the lines, and visited the latrine field. A comrade returning thence, picked him up at 3 p.m., lying He was at once conveyed to hospital, on his face quite dead. where, at 3-30 p.m., I found him lying on his back with drooping eye-lids, widely dilated pupils, and the chin sufficiently relaxed to expose the dorsum of tongue, on which a quid of half-chewed tobacco rested; the neck was twisted to the left side, with the thumb of right ring and little finger of left hand firmly bent on palm. He was in undress, and wore, when killed, a puggery, choga, salooka dhootie, and Punjabee shoes. The clothing, choga excepted, was all of cotton cloth. On unrolling the puggery, a distinctive odour of singling was perceivable, and each successive turn revealed a charred and burned surface; the superior side of left scalp was freely scorched, the hair along lateral aspect of left neck, including ear, was singed, while one dark ruddy band, a quarter inch broad, circled round to right ear, and another, half an inch broad, scorched the lower aspect of left neck, crossed the clavicle to the manubrium of sternum, and opposite the button of salooka spread out over a circular area, 2 inches in diameter, where the skin was severely cauterized. It continued as a straight band down chest and abdomen to the right of left nipple and linea alba across pubes, singing the pubic hair; thence along the anterior aspect of right thigh, streaking it to within one inch of knee-joint, where it terminated in two lacerated wounds. The temperature, half an hour after death, was in mouth 79? I\, in axilla 82-2? F. An autopsy was made at 4 p.m. The scars of discrete variola, and the ruddy bands above noted, were the only cuticular abnor-
malities.
On cutting through scalp it bled copiously ; the section occupying superior aspect of left parietal bone was scarcely burned, and the corresponding calvarium generally darkened; the meninges of cerebrum were apparently uninjured, but the constituent veins were gorged with blood. About one-thii'd of the grey matter of posterior cerebral lobe of left side was scorched, softened, and discolored, through its entire depth. The choroid plexus was distended with blood; the remainder
of the brain mass appeared normal. The left heart was empty, the right replete with liquid blood ; the anterior surface of left lower lung lobe was occupied by a cicatrix (phthisical ?). The liver was enlarged, other abdominal organs healthy, the
full, bladder empty. The weight of the viscera
213
The very decided scorching of cineritious cerebral matter, and the escape of cerebral membranes, are noteworthy. The query naturally arises?Is there any ostensible cause to explain why this man was " struck ?" The metallic button on his " salooka," according to Arago, would not determine the discharge. Water, for the deceased's clothes were saturated, although an excellent conductor of electricity, and generally commensurate to the task of discharging it harmlessly over the body, in this instance signally failed, so that the recommendation one continually finds in popular text-books, founded on the acknowledged fact that Dr. Franklin could not destroy a wet rat, although he could a dry one, by artificially accumulated electricity ; that the best thing one can do iii a thunder-storm is to get thoroughly drenched, when we hare a natural lightning conductor encircling our bodies is not always to be impli-
citly trusted.
The only reliable rationale is, that as the deceased was running against a full g&le, he left a rarefied track behind him, which the lightning would more willingly affect. Hence the axiom,?during the progress of a thunder-storm travel with the wind.
TYPHUS
FEVER,
No. 2409, Sepoy Kalifa Khuttack, Pathan, service 2 years, age 21, height 5 feet 9i inches, chest circumference 33f inches, weight 1401bs, normal; pulse 84 ; has been vaccinated. During his service he lias suffered from dysentery, diarrhoea, and laryngitis, spending 12| days per annum in hospital. He is stout, hardy, and muscular. On 4th July, when on cut cherry guard, he felt so ailing that he came to hospital complaining of constipation, headache, loss of appetite, feebleness: his pulse was excited ; his tongue large He had a saline diaphoretic every two hours. and pale. On 5th I found he had passed a restless night; his tongue there was no tympanitis or was furred, and he felt weak ; diarrhoea ; the headache was more severe, and the pupils slightly contracted. On 6th the symptoms were in no way improved: his tongue darker and more foul ; sordes had formed on teeth; the pulse ran 108 per minute, and was feeble and jerky; the skin was harsh and dry. An injection of two quarts of water, holding an ounce of salt in solution, was administered, which determined profuse diaphoresis. As this subsided, a 15-grain dose of quinine was given. In the evening the symptoms were not abated, and there was marked splenic dulness. Ordered syrup of nitro-muriatic acid " in full doses every second hour, and the cold pack." On 7th I found a very abundant dusky rash had appeared overnight, accompanied by general abatement of constitutional symptoms; muscular weakness was marked; the tongue dry, cracked, and fissured; and the pupils keenly contracted. The rash occupied the trunk, face, and extremities. It was slightly elevated, and distinctly maculate in character. For the first two days it paled or disappeared on pressure ; afterwards it was unaffected by it, and became flush with skin. The acid draught was continued every three hours, and his mouth sponged out frequently with glycerine and vinegar. From this date to 18th, when the rash disappeared, the symptoms were of a mild character, as witnessed by appended memoranda of pulse and temperature :? Pulse.
Temperature..
stomach
was?
Dates.
Avoirdupois, lbs.
Brain Cerebellum Heart
Right lungb
Left Liver
?
Spleen
...
...
...
...
Eight kidney
Left
???
...
?
???
^
8
???
0
???
0
3J
?
-.
???
...
...
...
ozs.
...
???
7 ^ 1 2 4.0 0 0 6 1 64 *
Remarks.?The lightning, presumably, discharged over the superior aspect of left parietal bone, and there bifurcated, one fork passing through the neural centres and producing instantaneous death, the other running along the superficies of the body.
June 7th 8th ? 9th ? 10th ? ? ? ? ? ? ? ?
Ut? 12th 13th 14th loth 16th 17th
108 108 108 120'
108 91 84 75 64 64 64
108 108 108 108 96 90 84 75 64 64 61
108 108 108 108
103? 103? 103? 100?
99?
100? 99?
60
102? 102? 102? 103? 103? 100? 99? 99?
64 64 64
98? 97?
98o 97o
97? 97? 97?
80 84
103? 103?
103? 103? 103? 103? 101?
214
THE INDIAN MEDICAL GrAZETTE.
On 30th June the temperature marked 98? F. and pulse 68. The former continued steadily at 98? F. until he was discharged on 11th July, while the pulse beat 70 on 2nd, 75 on 4th, 80 on 6th, and 84 on 9th and lltli. Remarks.?The case was one of undoubted spotted typhus. During convalescence the appetite was voracious. I cannot account for this solitary attack. "While at Kohat, as many as nine instances of typhus were discovered in one Khuttack village, and both in 4rh and 1st Punjab Infantry cases ?were treated. This sepoy, however, had not recently visited his home. Carbolic acid oil was freely anointed ; the teeth and month frequently brushed with Condy's fluid; the attendants protected ; and quarantine rigidly enforced.
[August 1,
1873.
A MIEEOR OE
1873.]
HOSPITAL PEACTICE.
CASES AND OBSERVATIONS.
By Surgeon-Major
J. W, Johnston, M.D.
(Continued from
page
186.^
/
LIGHTNING STHOKE.
V
Sepoy Shib Pershad, aged 25, of 6 years and 18 inches, with a days' service, weight 120lbs., height 5 feet chest circumference of 34 inches, was struck by lightning on clouds the were almost touch25th May during a terrific storm; ing the earth, and practically there was no interval between the when the adjusting regimental peal and flash. On 4th April, medical history sheets, I examined and recorded him as a healthy, 84 and a regular pulse running muscular man, with respirations 17 per minute. His previous sickness consisted of variola in one of and of acute attacks ague (a), hepatitis, youth; two No. 20S1,
since his enlistment. On 25th May he left the regimental hospital, where he was on duty; at 2 p.m. dined in the lines, and visited the latrine field. A comrade returning thence, picked him up at 3 p.m., lying He was at once conveyed to hospital, on his face quite dead. where, at 3-30 p.m., I found him lying on his back with drooping eye-lids, widely dilated pupils, and the chin sufficiently relaxed to expose the dorsum of tongue, on which a quid of half-chewed tobacco rested; the neck was twisted to the left side, with the thumb of right ring and little finger of left hand firmly bent on palm. He was in undress, and wore, when killed, a puggery, choga, salooka dhootie, and Punjabee shoes. The clothing, choga excepted, was all of cotton cloth. On unrolling the puggery, a distinctive odour of singling was perceivable, and each successive turn revealed a charred and burned surface; the superior side of left scalp was freely scorched, the hair along lateral aspect of left neck, including ear, was singed, while one dark ruddy band, a quarter inch broad, circled round to right ear, and another, half an inch broad, scorched the lower aspect of left neck, crossed the clavicle to the manubrium of sternum, and opposite the button of salooka spread out over a circular area, 2 inches in diameter, where the skin was severely cauterized. It continued as a straight band down chest and abdomen to the right of left nipple and linea alba across pubes, singing the pubic hair; thence along the anterior aspect of right thigh, streaking it to within one inch of knee-joint, where it terminated in two lacerated wounds. The temperature, half an hour after death, was in mouth 79? I\, in axilla 82-2? F. An autopsy was made at 4 p.m. The scars of discrete variola, and the ruddy bands above noted, were the only cuticular abnor-
malities.
On cutting through scalp it bled copiously ; the section occupying superior aspect of left parietal bone was scarcely burned, and the corresponding calvarium generally darkened; the meninges of cerebrum were apparently uninjured, but the constituent veins were gorged with blood. About one-thii'd of the grey matter of posterior cerebral lobe of left side was scorched, softened, and discolored, through its entire depth. The choroid plexus was distended with blood; the remainder
of the brain mass appeared normal. The left heart was empty, the right replete with liquid blood ; the anterior surface of left lower lung lobe was occupied by a cicatrix (phthisical ?). The liver was enlarged, other abdominal organs healthy, the
full, bladder empty. The weight of the viscera
213
The very decided scorching of cineritious cerebral matter, and the escape of cerebral membranes, are noteworthy. The query naturally arises?Is there any ostensible cause to explain why this man was " struck ?" The metallic button on his " salooka," according to Arago, would not determine the discharge. Water, for the deceased's clothes were saturated, although an excellent conductor of electricity, and generally commensurate to the task of discharging it harmlessly over the body, in this instance signally failed, so that the recommendation one continually finds in popular text-books, founded on the acknowledged fact that Dr. Franklin could not destroy a wet rat, although he could a dry one, by artificially accumulated electricity ; that the best thing one can do iii a thunder-storm is to get thoroughly drenched, when we hare a natural lightning conductor encircling our bodies is not always to be impli-
citly trusted.
The only reliable rationale is, that as the deceased was running against a full g&le, he left a rarefied track behind him, which the lightning would more willingly affect. Hence the axiom,?during the progress of a thunder-storm travel with the wind.
TYPHUS
FEVER,
No. 2409, Sepoy Kalifa Khuttack, Pathan, service 2 years, age 21, height 5 feet 9i inches, chest circumference 33f inches, weight 1401bs, normal; pulse 84 ; has been vaccinated. During his service he lias suffered from dysentery, diarrhoea, and laryngitis, spending 12| days per annum in hospital. He is stout, hardy, and muscular. On 4th July, when on cut cherry guard, he felt so ailing that he came to hospital complaining of constipation, headache, loss of appetite, feebleness: his pulse was excited ; his tongue large He had a saline diaphoretic every two hours. and pale. On 5th I found he had passed a restless night; his tongue there was no tympanitis or was furred, and he felt weak ; diarrhoea ; the headache was more severe, and the pupils slightly contracted. On 6th the symptoms were in no way improved: his tongue darker and more foul ; sordes had formed on teeth; the pulse ran 108 per minute, and was feeble and jerky; the skin was harsh and dry. An injection of two quarts of water, holding an ounce of salt in solution, was administered, which determined profuse diaphoresis. As this subsided, a 15-grain dose of quinine was given. In the evening the symptoms were not abated, and there was marked splenic dulness. Ordered syrup of nitro-muriatic acid " in full doses every second hour, and the cold pack." On 7th I found a very abundant dusky rash had appeared overnight, accompanied by general abatement of constitutional symptoms; muscular weakness was marked; the tongue dry, cracked, and fissured; and the pupils keenly contracted. The rash occupied the trunk, face, and extremities. It was slightly elevated, and distinctly maculate in character. For the first two days it paled or disappeared on pressure ; afterwards it was unaffected by it, and became flush with skin. The acid draught was continued every three hours, and his mouth sponged out frequently with glycerine and vinegar. From this date to 18th, when the rash disappeared, the symptoms were of a mild character, as witnessed by appended memoranda of pulse and temperature :? Pulse.
Temperature..
stomach
was?
Dates.
Avoirdupois, lbs.
Brain Cerebellum Heart
Right lungb
Left Liver
?
Spleen
...
...
...
...
Eight kidney
Left
???
...
?
???
^
8
???
0
???
0
3J
?
-.
???
...
...
...
ozs.
...
???
7 ^ 1 2 4.0 0 0 6 1 64 *
Remarks.?The lightning, presumably, discharged over the superior aspect of left parietal bone, and there bifurcated, one fork passing through the neural centres and producing instantaneous death, the other running along the superficies of the body.
June 7th 8th ? 9th ? 10th ? ? ? ? ? ? ? ?
Ut? 12th 13th 14th loth 16th 17th
108 108 108 120'
108 91 84 75 64 64 64
108 108 108 108 96 90 84 75 64 64 61
108 108 108 108
103? 103? 103? 100?
99?
100? 99?
60
102? 102? 102? 103? 103? 100? 99? 99?
64 64 64
98? 97?
98o 97o
97? 97? 97?
80 84
103? 103?
103? 103? 103? 103? 101?
214
THE INDIAN MEDICAL GrAZETTE.
On 30th June the temperature marked 98? F. and pulse 68. The former continued steadily at 98? F. until he was discharged on 11th July, while the pulse beat 70 on 2nd, 75 on 4th, 80 on 6th, and 84 on 9th and lltli. Remarks.?The case was one of undoubted spotted typhus. During convalescence the appetite was voracious. I cannot account for this solitary attack. "While at Kohat, as many as nine instances of typhus were discovered in one Khuttack village, and both in 4rh and 1st Punjab Infantry cases ?were treated. This sepoy, however, had not recently visited his home. Carbolic acid oil was freely anointed ; the teeth and month frequently brushed with Condy's fluid; the attendants protected ; and quarantine rigidly enforced.
[August 1,
1873.
