NOTES OF SURGICAL CASES UNDER TREATMENT AT THE GOALUNDO DISPENSARY. By Yincent Richards, Civil Medical Officer of Goalundo. CASE I.?SEVERE FRACTURE OF THE TIBIA AND FIBULA: RECOVERY. Nassau Sheik, aged 25 years, a khalassi in the employ of the Eastern Bengal Railway Company, was admitted into hospital with fracture of the tibia and fibula, on the 16th of October 1874. He had been injured by the breaking of a very thick hawser while working on board one of the Company's The steamers, the night previous to admission into hospital. right leg was bound up with very rough splints, and tied tightly with rope, on removing which a severe contused wound was found below the tuberosity of the tibia, and the leg was covered with blisters, the result of the tight bandaging. The tibia and fibula were both fractured in three places in their upper half. The superior fracture ran obliquely downwards and outwards. There was also a lacerated wound, but it did not communicate with either of the fractures. The leg was simply laid on a Liston's splint, and light dressing was applied to the wound. On the 17th the leg became extremely swollen, and gave rise to a good deal of fever. The wound subsequently sloughed, but assumed a healthy appearance by the 29th. By the 20th of January the fractures had united, but there was a good deal of stiffening and pain in knee-joint. Discharged with but slight shortening on the 16th of February. CASE II ?LACERATED -WOUND OF THE FOOT; SYME'S AMPUTATION AT THE ANKLE; SLOUGHING OF THE FLAP: RECOVERY.
Dasi, aged 25 years, a cooly in the employ of the Eastern Bengal Railway Company, was run over by the engine, while shunting," on the 6th of February. He was brought to hospital a short time after the accident. The muscles and tendons of the right foot were much lacerated, and most of the tarsal and metatarsal bones were crushed to pieces. The patient was put under chloroform, and Syme's amputation at the ankle-joint was performed. Every care was taken to avoid a too large and irregular flap and button-holing, but the flap partially sloughed. The stump, however, shewed healthy granulations after some time, but an ulcer of the size of an eight anna pieca remained for a long time, and resisted all treatment. He is now nearly well. "
CASE III.?PUNCTURED WOUND OF THE CHEST: WOUND OF THE LUNG: RECOVERY.
Luchman, aged 22 years, a Hindu servant, had a quarrel with shoe-maker, on the 25th March. The shoemaker was working at the time with a sheni, an instrument to cut leather with, and he stabbed the patient with it, an inch and a half below a
and to the left of the left nipple. I saw the man soon after, and the spot where the occurrence took place, there was a large quantity of blood on the ground, and the patient was
near
t/
THE INDIAN MEDICAL GAZETTE.
214
state of complete collapse ; the pulse being scarcely and the body covered with a cold clammy perspiration. The wound, which was about an inch wide, was then bleeding but slightly. The intercostal artery was wounded, and although he had lost a good deal of blood, the symptoms of collapse were out of all proportion to the amount lost. Reaction occurred during the night, and in the morning he was removed to the hospital. On admission bis temperature was high and his pulse rapid; there was no cough, but urgent dyspnoea. On the 28th, fever had increased; the left side was emphysematous; there was cough, but no haemoptysis. By the 30th, the fever had greatly subsided; there was. however, a great deal of pain on the affected side ; the side was not emphysematous but pneumothorax existed ; there was abnormal resonance on percussion on the affected side, almost amounting to a tympanitic sound; there was amphoric resonance, and the respiratory From the 1st April murmur could be heard with difficulty. to the 10th. he had slight symptoms of pleurisy, but from that date he gradually recovered, and was discharged cured on the 24th of April. Wounds of the nature above described are naturally regarded in England as very serious, but in India they are by no means so serious. I think, if I remember rightly, Dr. Ilarvey points " Indian Medical this fact out in the May number of the Gazettewhich I have unfortunately mislaid.
almost in
a
perceptible,
CASE IV -EXTENSIVE SCALP WOUNDS; LACERATION AND FliACTURE OF BOTH FOUE-ARUS; AMl'UTATION OF BOTH FORE-ARMS: RECOVER*.
On the 7th May, Hari. aged 22 years, a Hindu Kalashi, in the the Eastern Bengal Railway Company, when attempt>p into the Break-Van, while the train was in motion, fell, and the carriage passed over botli forearms crushing them I reached the station Rajbaree? to pieces up to the elbows. 7 miles from Goalundo in less than an hour after the accident happened, and found the man lying on the floor of a godown of the station. He had bled freely, and although slightly drowsy, Besides these injuries he had a scalp was perfectly sensible. wound on the front of his head, fully 3? inches long, and another extending right across the back of his head; both wounds involved the entire thickness of the scalp. I amputated both arms at their middle thirds; the elastic band having been used were applied to the anterior very little blood was lost; sutures wound of the scalp, and plaister and bandages to the posterior him into to lift the one. "When about train, the head was accidentally too much raised, and he had a convulsive fit. However, when the fit passed off, which it did in a couple of minutes, he He was carefully put into the train, his head being kept low. was admitted into the hospital at Goalundo, and never had a bad symptom, and was perfectly well by the 30th. He was kept in hospital for some time pending a reference to the Railway authorities regarding his pension.
employ of ing to ju
[August 2,
1875.
Dasi, aged 25 years, a cooly in the employ of the Eastern Bengal Railway Company, was run over by the engine, while shunting," on the 6th of February. He was brought to hospital a short time after the accident. The muscles and tendons of the right foot were much lacerated, and most of the tarsal and metatarsal bones were crushed to pieces. The patient was put under chloroform, and Syme's amputation at the ankle-joint was performed. Every care was taken to avoid a too large and irregular flap and button-holing, but the flap partially sloughed. The stump, however, shewed healthy granulations after some time, but an ulcer of the size of an eight anna pieca remained for a long time, and resisted all treatment. He is now nearly well. "
CASE III.?PUNCTURED WOUND OF THE CHEST: WOUND OF THE LUNG: RECOVERY.
Luchman, aged 22 years, a Hindu servant, had a quarrel with shoe-maker, on the 25th March. The shoemaker was working at the time with a sheni, an instrument to cut leather with, and he stabbed the patient with it, an inch and a half below a
and to the left of the left nipple. I saw the man soon after, and the spot where the occurrence took place, there was a large quantity of blood on the ground, and the patient was
near
t/
THE INDIAN MEDICAL GAZETTE.
214
state of complete collapse ; the pulse being scarcely and the body covered with a cold clammy perspiration. The wound, which was about an inch wide, was then bleeding but slightly. The intercostal artery was wounded, and although he had lost a good deal of blood, the symptoms of collapse were out of all proportion to the amount lost. Reaction occurred during the night, and in the morning he was removed to the hospital. On admission bis temperature was high and his pulse rapid; there was no cough, but urgent dyspnoea. On the 28th, fever had increased; the left side was emphysematous; there was cough, but no haemoptysis. By the 30th, the fever had greatly subsided; there was. however, a great deal of pain on the affected side ; the side was not emphysematous but pneumothorax existed ; there was abnormal resonance on percussion on the affected side, almost amounting to a tympanitic sound; there was amphoric resonance, and the respiratory From the 1st April murmur could be heard with difficulty. to the 10th. he had slight symptoms of pleurisy, but from that date he gradually recovered, and was discharged cured on the 24th of April. Wounds of the nature above described are naturally regarded in England as very serious, but in India they are by no means so serious. I think, if I remember rightly, Dr. Ilarvey points " Indian Medical this fact out in the May number of the Gazettewhich I have unfortunately mislaid.
almost in
a
perceptible,
CASE IV -EXTENSIVE SCALP WOUNDS; LACERATION AND FliACTURE OF BOTH FOUE-ARUS; AMl'UTATION OF BOTH FORE-ARMS: RECOVER*.
On the 7th May, Hari. aged 22 years, a Hindu Kalashi, in the the Eastern Bengal Railway Company, when attempt>p into the Break-Van, while the train was in motion, fell, and the carriage passed over botli forearms crushing them I reached the station Rajbaree? to pieces up to the elbows. 7 miles from Goalundo in less than an hour after the accident happened, and found the man lying on the floor of a godown of the station. He had bled freely, and although slightly drowsy, Besides these injuries he had a scalp was perfectly sensible. wound on the front of his head, fully 3? inches long, and another extending right across the back of his head; both wounds involved the entire thickness of the scalp. I amputated both arms at their middle thirds; the elastic band having been used were applied to the anterior very little blood was lost; sutures wound of the scalp, and plaister and bandages to the posterior him into to lift the one. "When about train, the head was accidentally too much raised, and he had a convulsive fit. However, when the fit passed off, which it did in a couple of minutes, he He was carefully put into the train, his head being kept low. was admitted into the hospital at Goalundo, and never had a bad symptom, and was perfectly well by the 30th. He was kept in hospital for some time pending a reference to the Railway authorities regarding his pension.
employ of ing to ju
[August 2,
1875.
