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of the dorsal spinous processes although there was some paralysis of the lower limbs after the injury, the patient rapidly recovered from the results of his accident (falling down a ship's hold). There were only three dislocations treated during the year, all of the shoulder. In one case the victim was the "boy" of a well known resident in the Colony and when he came to Hospital he was wearing one of his master's silk singlets. By a curious coincidence the master had mentioned the previous evening to me and others his suspicion that his "boy" was pilfering. When the youth left Hospital he was accompanied by an attendant with a note which led to an interesting scene between master and servant, the upshot being that the latter got two months at a pound and a half of oakum per diem. with a turn at the crank occasionally to give him an appetite. This calm method of Chinese "boys" and washermen using European clothing is much more of a nuisance than most residents are aware of, as I am perfectly sure that much skin disease is propagated by it.
I regret that the list of operations performed during the year is rather incomplete principally owing to our being short-handed during the greater portion of the time. Many minor operations such as paracentesis thoracis or abdominis, excisions of buboes, circumcisions, dilation of strictures, excisions of small tumours, opening abscesses and removal of necrosed bone have not been recorded for that reason.
Nine deaths took place after operation. In the case of a Chinaman who had his thigh amputated and re-amputated for necrosis of lower end of the femur the patient one morning announced his determination to die and persistently refused to take food. Notwithstanding that he was fed by stomach tube he gradually wasted and died, the operation wound being practically healed. A post mortem examination revealed nothing which could definitely be laid down as the cause of death. After an amputation at the elbow joint in a machinery accident a Chinese patient never rallied and died in about forty-eight hours. He had internal injuries as well, but a post mortem examination was not allowed. A gunshot wound of the abdomen proved fatal to a coolie during the coolie riots in April. He was walking along Queen's Road just below the Hospital when a member of an opposite clan faction walked up to him and shot the unsuspecting coolie in the abdomen. The coolie walked up to the Hospital and lay down in the waiting room collapsed. The bullet had entered about two inches to the right and one inch above the umbilicus, whilst the wound of exit was about one inch below the last floating rib and 24 inches from middle line. With Dr. AYRES arriving opportunely at the moment he was put on the table and his abdomen opened in the hope of being able to stop the hæmorrhage, which was already apparent by percussion and palpation. The peritoneum was full of blood, and although by grasping and pressure on the spot where the blood seemed to well from (in the region of the portal vein) it appeared to lessen, still the hæmorrhage went on and it was impos- sible to stop the rush of blood; consequently the abdomen was reluctantly closed and the man died within quarter of an hour. At the post mortem examination it was found the bullet had perforated the large intestine, the stomach (full of rice), and had then torn through the portal vein as well as the hepatic artery. Unfortunately the ruffian who shot him was not captured.
In the Wing Lok Street murder a most interesting surgical case was produced which is put on record as an instance of what injury the heart can suffer and yet the patient live for a considerable time after its production. Whilst arresting an arined burglar there P. C. AMEER SINGH was shot through the right arm and in the chest. The bullet which injured the arm was extracted from the carpus. The second bullet first hit a metal button on the man's tunic which deflected it slightly to the right (the patient's left). It then entered the patient's body in the third interspace about one inch and a quarter to the left of the middle line. On slightly enlarging the opening the track could be felt and a groove in the heart could be distinctly made out by the small finger. The bullet could not be felt so the wound was dressed with iodoform, and no more surgical interference at that time was attempted. The patient was a man of magnificent physique and somewhat inclined to adiposity. On the following day, 23rd December, he had some hæmoptysis and his heart had improved in action as his pulse could now be easily felt compared with the previous evening when it was imperceptible. He was put on small doses of morphia during the day. At 10.15 p.m. his respirations were 72 per minute, pulse 116, not moved about for examination. On the 24th December pneumothorax on left side was diagnosed and there was some fullness in the left axilla which on the 25th was cut down on and the bullet extracted in the line of the posterior fold of the axilla. There was some pericardial friction to be made out on this day and pneumo-thorax diagnosed with fluid of some description in the pleura. After the bullet was extracted a very great amount of sero-sanguineous fluid was discharged by the new opening and hopes were entertained that he might now recover. On the 26th and 27th December the discharge was very copious and the pulse kept fairly good. The front wound had healed and the pericardial rub had almost cleared away-at least could not be noted-but no breath sounds were to be heard over the left lung. On the 28th December, however, towards noon his pulse became very bad and he rapidly sank in spite of stimulants, &c., and died at three o'clock the same afternoon. The following post mortem notes give the state of affairs found the following morning. The bullet entered skin in line of nipples one inch and quarter from median line. It then passed through the third interspace and entered the pericardium bruising and indenting the heart about two inches from the base of the pulmonary artery just over the interventricular septum. It then passed out of the pericardium and entered the left lung about one inch and a quarter from the free edge of the lung, travelled through the lung and passed out in the sixth interspace in the mid-axillary line,