Sessional_Paper_1893 — Page 349

345

distance of three inches or so in the turnip. Taking all-together the conclusion I came to was that the rifle had been held quite close to or practically touching the boy's clothes and the absence of charring was due to the above fact and probably also to the copious hemorrhage which took place immediately. If the rifle had been further away there would have been charring and greater laceration in the clothing and also a larger, more superficial wound in the boy's groin.

Another case of a boy shot at Kowloon came in early in the year. He was one of the crowd of boys who hover round the targets hunting for lead. Whether the boy was hit direct or by a deflected bullet is not known, but he was admitted to Hospital with a wound over the great trochanter of the left femur. The upper third of the bone was found to be smashed into three large pieces and several smaller ones. The smaller pieces were removed and a drainage tube was inserted. The bullet could not be found in spite of careful search, although a track existed running down between the gluteal muscles. The boy's condition otherwise than the local injury was satisfactory. During the following week in spite of antiseptic precautions the wound got dirty with copious suppuration and it was resolved to cut down on the joint and, if thought necessary, excise it. This was done and after it he recovered without a bad symptom. The bullet was again looked for during the second operation but could not be found. However, a fortnight later a hard swelling formed in the buttock and on cutting into this the bullet was found evidently a Martini-Henry bullet considerably flattened. The boy was discharged with only 24 inches shortening; a very good result seeing that practically the upper third of the femur had been removed.

A third interesting case was that of P. C. GODFREY who went out to hunt the "Tytam tiger." While scrambling through the bush his carbine went off and the bullet entered his right arm in front of the wrist and emerged two inches below the elbow on the extensor surface of the forearm, smashing about 2 inches of the radius on its way. The shattered piece of radius was removed in about thirty-five pieces and a drainage tube put along the track of the wound. As is frequently the case in gunshot wounds there was a considerable amount of inflammation afterwards, but thanks to the patient's pluck the armi has been saved and is improving day by day. The flexor tendons are adherent to the anterior cicatrix but it is possible that by an operation to try and free then he may yet have a very useful hand and arm.

A CASE OF SEVERE INJURIES.

Severe injuries to a Chinaman had a peculiar causation. He was working on the Praya and fell a distance of about 16 feet landing on his face on the edge of an iron tank. When brought to Hospital at 3 p.m. he was a horrid sight-his lower jaw bone being smashed to pieces and the lower half of his face was lying on his chest. Almost all the blood vessels in the neck were divided except the carotids. Some projecting substance had passed through the neck and caused a wound at the back of the neck about an inch from the middle line at the level of the second and third cervical vertebræ. All visible torn vessels were tied and the large face wound closed up, several drainage tubes being left in the wounds. There was some more hemorrhage (after he had rallied slightly) which soaked the dressing. A fresh dressing was applied and, as his pulse had improved, it was resolved to tie the left common carotid should it continue. This was not necessary however. Owing to the lower jaw having disappeared with the exception of part of the two rami, it was necessary to keep the tongue pulled well forward. The following morning at 6.30 a.m. as I found him seriously collapsed I transfused him, injecting nineteen ounces of neutral saline solution. His condition improved wonderfully but he again sank two hours later. He was again transfused at 10 a.m., twelve ounces of fluid being injected and he again improved. At noon as his breathing was very laboured tracheotomy was performed by Dr. ATKINSON but he never rallied again and died at 2.30 p.m. A post mortem examination was not allowed. Query.-Had he a fractured skull or severe abdominal injury as well? It was naturally difficult to get any information from him, but he complained of pain in the abdomen. The collapse, of course, night have been due solely to the hemorrhage from the wound; but the marvellous way in which he rallied after transfusion and the rapid sinking pointed to some further loss of blood. Improvement after transfusion, I am aware, is often transitory but although the injuries and external hemorrhage in this case were severe they were scarcely sufficient to account for death in such a strong and otherwise healthy man.

TRACHEOTOMIES.

The

The European death was from diphtheria, the first case recorded in the Hospital for years. patient was sent in on 3rd July, at 3 p.m., by Dr. BELL. He had well-marked diphtheritic exudation on his tonsils and pharynx. As far as I can make out he must have been infected in Singapore. At 10.30 p.m. he was much worse with symptom of asphyxiation. Tracheotomy was quickly performed, but although he improved somewhat after it he died about 2 a.m. following morning. Post mortem diphtheritic membrane was found to extend half way down the trachea whilst the inflammation extended down to the bronchi. Another of the cases where this operation was necessary the patient had tried an original method of suicide. He had first cut through the superficial structures with a razor and then he systematically proceeded to stab his trachea with a pair of scissors. When admitted there had evidently been a considerable amount of hemorrhage as coarse rales could be heard all over