CASUALTIES IN ACTION IN TIBET.

xJ By C. N. C. WIMBERLEY,

MAJOR,

Comdg. No. 71, Native Field Hospital.

During ths last few months, while serving with the Tibet Mission Force, a certain number of casualties occurring in action have passed through my hands. As the variety of wounds has been somewhat curious, owing to the varied

nature of the arms in the hands of the Tibetans, some details of a few cases may be interesting.

I should state that all the wounds were re-

cent, being first attended to by me at a dressing station, and afterwards taken back to the Field

Hospital for treatment. In all 83 cases have passed through my

hands, which may be tabulated as follows .?? Killed in action 15 Wounded 68 Died of wounds 7

Of the 15 killed

f 13 were due to gunshot / f?,ea(i 1 1 Abdomen t

Of the 68 wound ed

1 was due to multiple sword-cuts, 1 was due to fracture of skull from a stone.

^51 were due to gunshot J J? dangerous wnnnds 1

24 severe vvounas 121 slight 10 were due to sword-cuts { f s?-v<Lr5 lb slight

, 7 were due to stones hurled f 2 severe I by the enemy \ 5 slight

Of the 7 who died, all were cases of gun-shot wounds? Of the Abdomen 2

,, ? Chest 2

? ? Shoulder 2

,, ..Thigh 1

Detail of Casks.?Case I.?A European re- ceived numerous sword-cuts at the action of Hot

Springs on the 31st March. On the field all that could be done was to stop haemorrhage, including severe bleeding from the temporal artery, and cover up the wounds with temporary dressings. Next day under chloroform it was found necessary to disarticulate the left hand at the wrist joint, as the tendons and all the metacarpals had been severed by a sword- cut on the back of the hand, a>id the hand at the same time cleft in two nearly down to the wrist joint by a second sword cut, which entered between the ring and middle fingers. A third cut had divided most of the extensor

endons on the back of the right hand without

ijuring the bones. These were carefully

sutured, though some of the tendon ends which c

had retracted could not be found, the distal^ end of the extensor indices tendon having to be', united to a slip separated from the extensor tendon of the middle finger. A wound of the scalp and of the leg were

also sutured, the latter cutting deeply into the head of the left fibula. The whole operation was carried out in a tent in a severe sand-storm, which was not conducive to asepsis. The

patient was sent back down the line. All the wounds healed kindly except in the case of the stump of the left hand, where some trouble occurred, apparently due to a small spicule of enamel from the reservoir of an irrigator used during the operation having been left in the wound. This had subsequently to be removed. He has since rejoined the Force in robust health, with a perfectly useful right hand, in which the

movements of the fingers are as good as ever. Case II.?A Sepoy of the 32nd Pioneers was

wounded at the Zaindang Gorge on the 10th of April, being shot in the left forearm by a matchlock at a few yards' range. The bullet had almost an explosive effect. There was a

small wound of entrance near the middle of the shaft of the left radius, but the ulna was shattered and splintered for some three inches, and a large flesh wound of exit, four inches long, was found on the ulnar side of the forearm, through which muscles and tendons bulged. Many detached splinters of the ulna had to be

removed, and the wound very slowly filled by granulations, numerous sloughs of tendons

having to be snipped off from time to time. He was eventually, at the end of May, sent back to India with a small sinus remaining, and a mass of callus round the damaged ulna.

Case III.?A Sepoy of the 32nd Pioneers was wounded in the chest at the Karo-la on the 6th

May, the bullet, apparently a rifle one, passing clean through the right side of the chest from

before backwards about the level of the fourth rib. After being hit he lay out on the hill- side in a snow-storm for some hours. When

brought in he was much collapsed, but rallied next morning. Unfortunately on that same

day he had to start back in a doolie towards

Gyantse, to which place the Force was returning He did well, however, all that day, but on being taken out of his doolie at 4 p.m. on the next

day at the end of a long march of 20 miles, he was found collapsed, pale and breathless, and died shortly afterwards,apparently from internal haemorrhage. I cannot help thinking that if lie could have been kept quiet, he would have done well. But such are the exigencies of war.

Case IV.?A sepoy of the 32nd Pioneers was wounded in both legs at the Karo-la on the 6th

May, apparently by a " Lhasa Martini" bullet of

about *550 bore. The bullet passed through the muscles of the calf of the left leg, disorgan- ising them a good deal, and, entering the right leg, shattered the tibia in its lower third exten-

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414 THE INDIAN MEDICAL GAZETTE. [Nov. 1904.

ively. He was brought back three marches to jhe Hospital at Gyantse and housed in a Tibetan building, where the Hospital had to be located to be safe from jingal tire from the jong. The wounds became putrid, stinking most offensively, and large bullte formed over the right foot and

ankle. The best treatment would have been immersion in a bath of weak antiseptic lotion, but there were no appliances for this at hand. In default, the limbs were kept wrapped in lint soaked with corrosive sublimate solution 1?5000, and covered with guttapercha tissue, the dress-

ings being frequently changed. By this means, and with the help of a liberal diet, lie eventually did well, and when sent back to India had

merely a sinus leading down to some carious bone in the right tibia.

Case V.?A private servant, while standing at the Hospital door at Gyantse, on the 8th May, was struck in the left hip by a large jingal bullet, weighing about 3 lbs. The head of the left

femur, and probably the acetabulum and pelvis were smashed to atoms, and he never recovered from the initial shock but died in a few hours.

Case VI.?A sepoy of the 32nd Pioneers was hit in the post at Gyantse, on the 12th May, by a dropping jingal bullet. The bullet entered in the

right supra scapular region, passed down under the skin, and was removed through an incision made just below the angle of the right scapula. It weighed about 8 ounces. A few days later the patient exhibited a large tender swelling in the right loin, sharply bounded by the crest of the right ilium. A lu"ematoma had formed from blood which had gravitated down under the fascia. It was slowly absorbed.

Cases VII & Vlll.?Two men of the 8th Gurkhas were wounded at the taking of the "Gurkha Picquet" at Gyantse on the 19th May. They were both struck by stones hurled on their heads by the defenders, and not wearing pagris, each received a very nasty lacerated con- fused scalp-wound. However, the skull, though bared, was not fractured in either case, and

they both did well and recovered quickl}7. Case IX.?A mountsd-infantry man of the

23rd Pioneers, who was with others carrying the d&k, was wounded on the 19th May some three miles from Gyantse. He received a gunshot wound of the right hand, which necessitated the removal of parts of the thumb and two fingers, which were extensively damaged. He also had a second gunshot wound in the region of the bend of the left forearm. Here the bullet had not emerged, so the wound was enlarged, and a small match-lock bulletj not much larger than a slug, but wrapped round and round with dirty tow to make it fit the bore of the

weapon, removed. The wound was well washed out with carbolic lotion, but two days later the whole surface of the wound was found covered with a layer of a yellow unctuous looking material, evidently a pure culture of some

microrganism, possibly the staphylococcus

aureus. No microscope was available to

corroborate this. Some sj'mptoms of grave septic absorption set in. On the 25th, a sudden severe hemorrhage occurred from the wound in the bend of the elbow, and before I could arrive, he had lost apparently about two pints of blood. A tourniquet was at once put in, the man got under chloroform, and the left, brachial. tied in the middle of the upper arm. At the same

time the wound at the elbow was again cleaned and scrubbed, and all clots turned out. A few days later a second slight haemorrhage

occurred from the same place, but was controlled by a tourniquet above the elbow. But as these

slight haemorrhages recurred several times, he was, on May 30th, for the third time put under

chloroform, the wound at the bend of the elbow opened up, and every bleeding point that could be found tied, the wound being swabbed with a solution of chloride of zinc.

Thereafter he slowly recovered, but not

without all the finger stumps breaking down and several abscesses forming in various parts of the body, which had to be opened and drained. Eventually his temperature fell to

normal, the various wounds became clean and

began to heal, and when I left Gyantse in the middle of July he was walking about, a shadow of his former self, but convalescent. I should mention that he too had to be housed in a Tibetan building, where a short time before

many very severe septic burn cases had been treated?the result of a gun-ponder explosion.

Case X.?Another sepoy of the 23rd Pioneers was wounded at the same time in the left foot. There was a small wound of entrance, about 1 inch below and 1 inch in front of the left internal malleolus. This was also cut down on, but

though an extensive search was made in and between the tarsal bones the bullet could not be found. In this, as in several other cases, a

portable X-ray apparatus was badly needed. He was sent back with the bullet still lodged.

Case XI.?A man of the Bengal Sappeis and Miners was shot right through the Tieck at

.

Pahla, on the 26th May, by some small high velocity projectile, apparently from a mauser

pistol. So far as could be made out the bullet must have passed between the pharynx and the vertebral column. A first field dressing was applied on the spot. When removed, onljr a

small scab was found on either side, and the man was discharged to duty about a week

later, complaining only of slight stiffness in the neck. This was a case which illustrates the wonderful way in which a modern projectile will pass through vit?I parts without doing any damage. It also shows how well such wounds do when ths first original dressing is left alone. But let me add a note of experience with regard to these first field dressings. It is this. Throw-

away all the guttapercha ivaterproof tissue

supplied. The drier such wounds are kept the better.

Nov. 1904.] ABDOMINAL PREGNANCY, OPERATION, RECOVERY. 415

Case XII.?A Lance-Naik of the 32nd

Pioneers was shot in the region of the left

shoulder joint on the 26th Ma}r. The head of

the humerus was shattered, but the vessels and

nerves had escaped. His arm was strapped to

his side with the hand on the opposite shoulder

after the wound had been dressed. He com-

plained of much pain, for which morphia was (riven, but otherwise seemed to be doing well. On the 28th May I was out the whole day on a military expedition, and on my return

in the evening was astonished to hear that he

had died suddenly that morning, and that his corpse had already been burnt. I am quite unable to speculate as to the cause of death.

Case XIII.?A man of the 8th Gurkhas, who was running through a number of rifles lying on the ground on the 26th May, tripped over one, which went off, and was thus accidentally shot by one of our own Lee -Metford bullets. The bullet took an extraordinary course. It went right through the muscles of the left calf, entered again at the inner part of the left thigh suspiciously near the femoral artery, emerged at the front of the left thigh in its upper third, entered again just below the spine of the left ilium, and after a track of 3 inches under the

skin, finally emerged at the back of the left loin. The skin at this last part broke down, leaving a long shallow ulcer, which granulated, The other wounds healed quickly.

Case XIV.?A Havildar of the Bengal Sappers and Miners was sitting cooking his food in the Gyantse Post, with his back to a substantial

protective traverse made of logs and stones. A large jingal bullet weighing 41bs.?a "

Big William" as it was generally known in

Gyantse?passed through the traverse, grazed the inner side of his left forearm and adductor surface of his left thigh, and finall}? buried itself in the ground just between his legs. The skin showed extensive bruising, and finally a large area on the inside of the thigh sloughed, leaving a large shallow ulcer. The above show in some degree the variety of

cases we have been called on to treat. I may add a few words about a couple of cases of in- terest, which have since occurred, though not

cases of wounds in action.

On the 2na of August, a Sepoy of the 32nd

Pioneers, was asleep in a tent on picquet duty with several others. He was awaked at about

2 A.M. by a comrade for his turn of sentry-go, and just as he was turning round, preparatory to risino-, in some unaccountable manner a Lee- Enfield?'rifle lying on the ground abotit 8?10

inches from him went off. The bullet entered

by a small hole in the back of the left carpus and emerged in the left forearm above the wrist. At. the wcurtd of exit was a long triangular clean cut tear of the skin, some 3 inches long. It seemed as if the bullet had simply burst

out through the elastic skin, tearing it over this

extensive area. The muscles or tendons were

not damaged. Another interesting point is that although the rifle was discharged at this short distance from the bare skin of the back of his

hand, there was no sign of singeing or of

particles of powder near the wound. It would have been impossible to say from an examination of the wound that the rifle had not been dis-

charged at a distance of 100 yards. Lastly, the case of a Tibetan interpreter with

the Force, who went into Lhasa contrary to

orders the other night, on a private enterprise from our camp here. News was brought in next day that he was

lying cut to pieces in a Tibetan house in the

city. A doolie with an escort was sent for him and he was brought back to camp in the after- noon. He had been lying in a filthy Tibetan house for over 16 hours after he had been

wounded, covered with dirty blankets, and with his wounds bound up with nondescript Tibetan rags. He was found to have received no less than

10 sword cuts, most of them very severe, and must have lost pints of blood. Of two long scalp wounds, both grooving the skull deeply,one had divided the left temporal, which started

spouting when the wounds were being cleaned and had to be tied, another cut went clean

through the left radial, another opened the

right wrist joint and so on. And yet now a

week later, nearly all the wounds have healed

by first intention, and he is walking about

quite cheerful.