VICTIMS OF NEW HOLLAND TORNADO, WITH

REPORT OF SIX SPECIAL CASES.

BY DRS. J. H. DOWNEY AND H. L. RUDOLPH, GAINESVILLE

Mr. President and Members of the Georgia Medical Association:

It was thought by the authors of this paper that it would be of interest to the members of this Association to hear a presentation of a few cases treated at the New Holland Hospital following the terrible calamity which was visited upon our section June 1, 1903. So in order to be as concise as possible we have selected six cases of special interest which we present in as complete a form as our time limit permits.

The New Holland Hospital was opened for the reception of patients on June 3, 1903, and a total of thirty-two tornado sufferers were received as bed patients and treated by the physicians in charge. The hospital was closed on July 16, 1903, a few convalescents being removed to their homes. on that date.

Case 1. The first case which we will consider is that of Mrs. J. F. McGill, white, female, aged twenty-two years; entered hospital on June 3, 1903.

Diagnosis. Compound, comminuted fracture of all the bones of the face, with the exception of the left nasal vomer, two lachrymal, and two molar bones. Also a lacerated wound traversing the face obliquely from above downwards, extending from a point one inch below external canthus of right eye to the lower border of the

interior maxilla to a point one inch to the left of the mental process. Also a laceration of the left side of body beginning at the angle of the eighth rib behind, and extending forward to the mammary line to a point two inches below left breast. Cause of wound unknown.

This patient was found by Dr. Downey with face crushed almost beyond recognition and the wounds full of san l and splinters. Patient was hurriedly stimulated and about six or eight hours after injury she was anesthetized and operation was performed by Dr. F. W. McRae assisted by Drs. Downey, Dorsey, Collier and Amster. Inferior maxilla was found to be fractured once on right and twice on left side and the other bones of the face were fractured and displaced beyond description.

The oblique laceration above referred to extended from right to left across face, dividing the upper lip, crushing in superior maxilla, knocking out two incisors, eye and first bicuspid teeth on right side and also dividing the lower lip. After cleaning off dirt, etc., these lacerations were closed with subcutaneous silkworm-gut sutures. The bones of the face were placed in position as nearly as possible and a stiff dressing of cardboard, etc., applied. The body laceration was closed with interrupted silk sutures and a dry dressing applied.

On entering the hospital on June 3d, the face was greatly swollen and the discharge of pus from both nostrils was profuse and of bad odor. Right eye was closed. Temperature was 102 degrees F., pulse 115. Treatment was as follows: Cold applications of a weak boric acid solution on gauze to right eye every hour. Mouth and nostrils cleansed with saturated solution of boric acid every two hours. Strychnin sulphate (grains 1-30)—by mouth t. i. d. Lapactic pills when necessary. Pain eased and sleep produced by papine and codeia when necessary. Nourishment,

sweet milk and meat broths. The lower jaw was placed in a folding cardboard splint. Wounds of face and body dressed twice daily with gauze wrung out of weak carbolic solution until about twelfth day when sutures were removed from face and back, union being good. Temperature never over 101 degrees F. Dry dressings for a few days longer, the cardboard splints being kept on face for one month, Small particles of bone worked out beneath lower jaw for five weeks. Lower jaw-bone now firm. Lower front teeth one-half inch posterior to upper front teeth. Right nostril almost closed, the left nostril being free. Small particles of bone worked out just above the right eye at end of sixth week. Eight weeks after injury the patient was taken to Atlanta and examined by Drs. McRae and Creighton and the latter removed sufficient of the right inferior turbinated. bone to make right nostril free. At end of two and one-half months, recovery complete, with a fairly presentable countenance and patient able to masticate food.

Case 2.-The second case is that of Miss Adelaide Robinson, white, female, age eighteen years. Entered hospital June 3, 1903.

Diagnosis. A deep penetrating wound beginning an inch to the right of the spinal column, opposite the fourth dorsal vertebra, extending downward and outwards to a little below the inferior angle of the right scapula just posterior to the right axillary line, penetrating the chest between the sixth and seventh ribs. Also a compound fracture of the left radius, two and one half inches below elbow-joint. Chest wound was caused by the entrance of a long splinter, which was removed before patient entered hospital. A ragged wound was left, which would admit a probe for four and one-half inches.

On entering the hospital temperature was 101 degrees F., pulse weak and 115, respiration 24. Much pain in back and left arm. The left arm had been placed in plas ter cast with elbow at right angles and the wound dresse

through a window cut in cast. The treatment was as follows: Strychnin sulph. grain 1-60 in essence of pepsin, one half drachms every three hours. Normal liquid aconite 1-2 drop, fluid extract of gelsemium one drop every three hours. Codeia sulph. grain 1-2, every three hours when in pain. The wound in back was dressed twice daily, sponged out and gauze drainage inserted with a moist corbolic gauze dressing covered by rubber tissue applied. About 1-2 drachm of pus was discharged from wound per day. On June 6th the discharge became very foul, but less in amount and the patient showed symptoms of a pneumonia in right lung. Temperature 103 1-2 degrees F., pulse 120, respiration labored and at 40. Aconite and gelsemium increased to two hours. Whiskey one-half ounce every four hours. Turpentine and lard flannel on right chest. Lower end of wound opened under cocaine and better drainage from wound established. Patient's condition unchanged for two days except her more septic appearance and sweating suggested empyema. Aspiration at first obtained no pus from chest but a second attemp was successful, pus being obtained. The patient's mother was consulted in regard to an operation, but her consent was not forthcoming. This was on June 10th. At this time patient developed a little cystitis probably from catheterization. Hot towels to perineum and internal administration of calomel and soda and elixir buchu, one drachm every four hours, soon relieved this trouble.

Patient gradually grew worse, temperature 102 to 105 degrees F., pulse. 140-160, respiration 40-60. Whole right side of chest flat and we could not obtain permission for operation. Finally, on Wednesday, June 17th, the mother agreed and patient was prepared for operation. Strychnin, grain 1-30 Hyd. and whiskey used one-half ounce three hours before operation, but pulse very feeble and at 160, just before opera

tion.

an

Right side incision

Anesthetic by Dr. G. T. Canning. rendered as aseptic as possible and five inches long made over wound in back. The tissue between the sixth and seventh ribs was SO pliable that it yielded to slight pressure of the little finger and the chest was found full of pus of a terrible odor. One half gallon was allowed to escape and two rubber drainage-tubes inserted. Did not cut ribs as the lung expanded pretty well and good drainage was established.

Dressings applied and patient returned to bed just eighteen minutes after anesthetic commenced. Patient gave no promise of recovery. Pulse rate beyond 180. Recovered from anesthetic in one hour. Respiration very labored. Afternoon, temperature 106, under right axilla. Pulse indistinct. Norwood's tincture of veratrum viride given one gtt. lq. two hours. Pulse became better and temperature at 10 P м. 104 per axilla. Patient gradually improved, the chest being washed out with hot normal salt solution twice daily for four weeks, sterile wet dressings with rubber tissue being applied over wound. Diet of milk, soups, toast, eggs, etc. Norwood's tincture replaced by aconite and gelsemium on second day after operation. Patient's strength gradually improved and she was removed from hospital on July 16th, with wound in chest still discharg ing foul pus but in small amount. Tubes removed on July 20th; chest was washed out with warm water for three or four weeks and wound finally healed. Left arm did well also. Patient has been well since recovery last August.

Case 3.-Leila Solesbee, white female, aged six years, entered hospital June 3, 1903.

Diagnosis. A deeply lacerated wound beginning at the lower border of the ribs three inches to the left of the spinal column extending downward and inward to the crest of the ilium, one inch from spinal column, severing the left ureter, necessitating removal of left kidney; also compound