Surgical Experiences in South Africa, 1899-1900

CHAPTER III

GENERAL CHARACTERS OF WOUNDS INFLICTED BY BULLETS OF SMALL CALIBRE

Type wounds--Nature of external apertures--Direct course of wound track--Multiple wounds--Small bore and sharp localisation of tracks--Clinical course--Mode of healing--Suppuration--Wounds of irregular type--Ricochet--Mauser bullet--Lee-Metford bullet--Expanding bullets--Altered bullets--Large sporting bullets--Symptoms--Psychical disturbance and shock--Local shock--Pain--Haemorrhage--Diagnosis--Prognosis--Treatment 55

CHAPTER IV. Injuries to the Blood Vessels

INJURIES TO THE BLOOD VESSELS

Nature of lesions; contusion, laceration, perforation--Results of injuries--Primary haemorrhage--Recurrent haemorrhage--Secondary haemorrhage--Treatment of haemorrhage--Traumatic aneurisms--Arterial haematoma--True traumatic aneurism--Aneurismal varix and varicose aneurism--Conditions affecting development--Effects of aneurismal varix or varicose aneurism on the general circulation--Prognosis and treatment of aneurismal varix--Prognosis and treatment of varicose aneurism--Gangrene after ligation of arteries 112

CHAPTER V. Injuries to the Bones of the Limbs

INJURIES TO THE BONES OF THE LIMBS

Nature of wounds--Explosive wounds--Types of fracture of shafts of long bones--Stellate, wedge, notch, oblique, transverse, perforating--Fractures by old types of bullet--Lesions of the short and flat bones--Special character of the symptoms in gunshot fracture, and of the course of healing--Prognosis--Treatment--Special fractures--Upper extremity--Pelvis--Lower extremity 154

CHAPTER VI. Injuries to the Joints

INJURIES TO THE JOINTS

General character--Vibration synovitis--Wounds of joints--Classification--Course and symptoms--General treatment--Special joints 225

CHAPTER VII. Injuries to the Head and Neck

INJURIES TO THE HEAD AND NECK

Anatomical lesions--Scalp wounds--Fracture of the skull without evidence of gross lesion of the brain--Fractures with concurrent brain injury--Classification--General injuries--Effect of ricochet--Vertical or coronal wounds in frontal region--Glancing or oblique wounds of any region--Gutter fractures--Superficial perforating fractures--Fractures of the base--Symptoms of fracture of the skull, with concurrent injury to the brain--Concussion--Compression--Irritation--Frontal injuries--Fronto-parietal and parietal injuries--Occipital injuries--Forms of hemianopsia--Abscess of the brain--General diagnosis--General prognosis--Traumatic epilepsy--General treatment--Wounds of the head not involving the brain--Mastoid process--Orbit--Globe of the eye--Nose--Malar bone--Upper jaw--Mandible--Wounds of the neck--Wounds of the pharynx, larynx, and trachea 241

CHAPTER VIII. Injuries to the Vertebral Column and Spinal Cord

INJURIES TO THE VERTEBRAL COLUMN AND SPINAL CORD

Fractures in their relation to nerve injury--Transverse processes--Spinous processes--Centra--Signs of fracture of the vertebra--Injuries to the spinal cord--Effects of high velocity--Concussion, slight, severe--Contusion--Haemorrhage, extra-medullary, haematomyelia--Symptoms of injury to the spinal cord--Concussion--Haemorrhage--Total transverse lesion--Diagnosis of form of lesion--Prognosis--Treatment 314

CHAPTER IX. Injuries to the Peripheral Nerves

INJURIES TO THE PERIPHERAL NERVES

Anatomical lesions--Concussion--Contusion--Division or laceration--Secondary implication of the nerve--Symptoms of nerve injury--Traumatic neuritis--Scar implication--Ascending neuritis--Traumatic neurosis--Injuries to special nerves--Cranial nerves--Cervical, brachial, lumbar, and sacral plexuses--Cases of nerve injury--General prognosis and treatment 341

CHAPTER X. Injuries to the Chest

INJURIES TO THE CHEST

Non-penetrating wounds of the chest wall--Penetrating wounds, special characters of entrance and exit apertures--Fracture of the ribs, symptoms, treatment--Wounds of the diaphragm--Wounds of the heart--Wounds of the lung, symptoms--Pneumothorax--Haemothorax-- Empyema--Diagnosis, prognosis, and treatment of haemothorax--Cases of haemothorax 374

CHAPTER XI. Injuries to the Abdomen

INJURIES TO THE ABDOMEN

Introductory remarks--Wounds of the abdominal wall--Penetration of the intestinal area without definite evidence of visceral injury--Wounds of explosive character--Anatomical characters of intestinal wounds--Wounds of the mesentery---Wounds of the omentum--Results of intestinal wounds, faecal extravasation, peritoneal infection, septicaemia--Reasons for the escape of severe injury in wounds traversing the abdomen--Wounds of the stomach--Wounds of the small intestine--Wounds of the large intestine--Prognosis in intestinal injuries--Treatment of intestinal injuries--Wounds of the urinary bladder--Wounds of the kidney--Wounds of the liver--Wounds of the spleen--General remarks on the prognosis in abdominal injuries--Wounds of the external genital organs--Wounds of the urethra 407

CHAPTER XII. On Shell Wounds

ON SHELL WOUNDS

Varieties of shells employed--Large shells--Wounds produced by different varieties--Pom-Pom shells--Wounds produced by fragments and fuses--Shrapnel--Boer segment shells--Leaden shrapnel bullets--Treatment of shell wounds 474

INDEX OF CONTENTS 487

ILLUSTRATIONS

PLATES

VARIETIES OF AMMUNITION COLLECTED AT LADYSMITH Frontispiece

1. SECTION OF MAUSER APERTURE OF ENTRY To face p. 73

2. SECTION OF MAUSER APERTURE OF EXIT 76

3. PUNCTURED FRACTURE OF CLAVICLE 162

4. COMMINUTED FRACTURE OF SHAFT OF HUMERUS 180

5. COMMINUTED FRACTURE OF HUMERUS ACCOMPANIED BY AN EXPLOSIVE EXIT 182

6. COMMINUTED FRACTURE OF HUMERUS DUE TO OBLIQUE IMPACT 184

7. SAME FRACTURE HEALED 186

8. LOW VELOCITY FRACTURE OF HUMERUS WITH RETAINED BULLET 188

9. LOCALISED FRACTURE OF HUMERUS SHOWING FRAGMENTATION OF THE BULLET 190

10. WEDGE-SHAPED FRACTURE OF THE RADIUS 192

11. FRACTURE OF THE METACARPUS, SHOWING FRAGMENTATION OF THE BULLET 194

12. FINELY COMMINUTED FRACTURE OF THE FEMUR 196

13. THE SAME FRACTURE HEALED 198

14. STELLATE 'BUTTERFLY' FRACTURE OF THE FEMUR 200

15. LATERAL IMPACT OF BULLET, WITH COMMINUTION OF THE FEMUR 202

16. RECTANGULAR IMPACT OF BULLET, WITH HIGHLY OBLIQUE LINE OF FRACTURE OF THE FEMUR 204

17. PUNCTURED FRACTURE OF THE FEMUR WITH EXIT BONE-FLAP 206

18. FRACTURED PATELLA 208

19. OBLIQUE COMMINUTED FRACTURE OF THE TIBIA 210

20. TRANSVERSE FRACTURE OF THE TIBIA 212

21. PUNCTURE OF THE TIBIA, WITH AN OBLIQUE FISSURE 214

22. NOTCHED FRACTURE OF THE TIBIA 216

23. PUNCTURED FRACTURE OF THE FIBULA 218

24. THE SAME FRACTURE, LATERAL VIEW 220

25. VICKERS-MAXIM FRACTURE OF THE HUMERUS 482

IN THE TEXT

FIG. PAGE 1. LINEN HOLD-ALL WITH INSTRUMENTS 4

2. INSTRUMENT HOLD-ALL ROLLED FOR PACKING 5

3. TIN WATER-BOTTLE FOR EMERGENCY OPERATIONS 6

4. BUGGY ON THE VELDT 7

5. MCCORMACK-BROOK WHEELED STRETCHER CARRIAGE 19

6. INDIAN TONGA 20

7. SERVICE AMBULANCE WAGON 21

8. BUCK-WAGON LOADED WITH WOUNDED MEN 22

9. INTERIOR OF A WAGON OF NO. 2 HOSPITAL TRAIN 24

10. P. & O. HOSPITAL SHIP 'SIMLA' 25

11. TYPE OF GENERAL HOSPITAL 32

12. TYPE OF TORTOISE TENT HOSPITAL 33

13. SINGLE TORTOISE HOSPITAL TENT 35

14. FIVE TYPES OF CARTRIDGE IN COMMON USE DURING THE WAR 47

15. SECTIONS OF FOUR BULLETS TO SHOW RELATIVE THICKNESS OF MANTLES 51

16. ENTRY AND EXIT MAUSER WOUNDS 56

17. GUTTER WOUND OF SHOULDER 56

18. OBLIQUE GUTTER EXIT WOUND 57

19. OVAL ENTRY, STARRED EXIT WOUNDS 58

20. CIRCULAR ENTRY, SLIT EXIT WOUNDS 59

21. CIRCULAR ENTRY, STARRED EXIT WOUNDS 59

22. ENTRY AND EXIT WOUNDS IN SIX SUCCESSIVE SPOTS MADE BY SAME BULLET 61

23. FOUR SUCCESSIVE ENTRY AND EXIT WOUNDS OF SAME BULLET 62

24. SUPERFICIAL ABDOMINO-THORACIC TRACK 64

25. SUPERFICIAL LINEAR ECCHYMOSIS OF THIGH 65

25a. SECTIONS OF MAUSER ENTRY AND EXIT WOUNDS 74

25b. PROLAPSED OMENTUM 77

26. SECTIONS OF FOUR BULLETS 82

27. NORMAL MAUSER BULLET 83

28. FOUR MAUSER RICOCHETS 84

29. MAUSER RICOCHET, DISC FORM 85

30. FISSURED MAUSER MANTLE 86

31. MAUSERS DEFORMED BY IMPACT ON FEMUR 86

32. APICAL MAUSER RICOCHET 87

33. SPIRAL RICOCHET 88

34. NORMAL LEE-METFORD BULLET 89

35. APICAL LEE-METFORD RICOCHETS 90

36. " " " 91

37. FOUR TYPES OF SOFT-NOSED BULLETS 92

38. 'SET-UP' SOFT-NOSED LEE-METFORD BULLETS 92

39. FLATTENED, SOLID-BASED MANTLE FROM RICOCHET 93

40. MAUSER BULLET, JEFFREYS-TWEEDIE MODIFICATION 94

41. SECTION OF MARK IV. AND SOFT-NOSED MAUSER 94

42. TAMPERED BULLETS 95

43. LARGE LEADEN SPORTING BULLETS 98

44. EXPLOSIVE WOUND OF BACK 100

45. DEAD MEN ON FIELD OF BATTLE 102

46. FLATTENED LEADEN CORES FROM MANTLED BULLETS 105

47. EXPLOSIVE EXIT WOUND OVER FRACTURED ULNA 156

48. EXPLOSIVE EXIT WOUND OVER FRACTURED HUMERUS 158

49. EXPLOSIVE EXIT AND ENTRY WOUNDS OF LEGS 159

50. TYPES OF GUNSHOT FRACTURE 161

51. LOWER END OF FRACTURED FEMUR 164

52. OBLIQUE PERFORATION OF FEMUR, SEPARATION OF FRAGMENT AT EXIT APERTURE IN BONE 169

53. GUTTER FRACTURE OF HEAD OF HUMERUS 178

53a. DIAGRAM OF 'BUTTERFLY' TYPE 180

54. WIRE GAUZE SPLINT 187

55. GUTTER FRACTURE OF PELVIS 191

55a. DIAGRAM OF 'BUTTERFLY' TYPE 200

56. CANE FIELD SPLINT FOR LOWER EXTREMITY 209

57. TUNNEL FRACTURE AT SURFACE OF TIBIA 219

58. CANE FIELD SPLINT FOR LEG 222

59. SKIAGRAM OF INJURY TO INTERPHALANGEAL JOINT 237

60. SKIAGRAM OF BULLET IN NASAL FOSSA 244

61. DIAGRAM OF APERTURE OF ENTRY INTO CRANIUM 245

62. APERTURE OF ENTRY INTO FRONTAL BONE 252

63. FRAGMENT OF INNER TABLE DISPLACED FROM OPENING SEEN IN FIG. 62 253

64. GUTTER FRACTURE OF FIRST DEGREE IN PARIETAL BONE 255

65. DIAGRAM OF GUTTER FRACTURES 256

66. GUTTER FRACTURE OF SECOND DEGREE IN PARIETAL BONE 257

67. DIAGRAMS OF GUTTER FRACTURES 258

68. SUPERFICIAL PERFORATING FRACTURE OF PARIETAL REGION 259

69. DIAGRAM OF SUPERFICIAL PERFORATING FRACTURE 260

70. FRAGMENT FORMING FLOOR OF TEMPORAL GUTTER FRACTURE 260

71. SCALE OF EXTERNAL TABLE IN LOW VELOCITY INJURY OF FRONTAL BONE 261

72. FRONTAL PERFORATION, APERTURE OF EXIT 261

73. VISUAL FIELD IN OCCIPITAL INJURY 279

74. " " " 279

75. " " " 281

76. " " " 281

77. " " " 283

78. " " " 283

79. CONTUSED SPINAL CORD 333

80. DIVIDED SPINAL CORD 334

81. SUPERFICIAL TRACK IN ANTERIOR BODY-WALL 377

82. SPIRALLY GROOVED BULLET 381

83. ECCHYMOSIS IN FRACTURED RIBS WITH HAEMOTHORAX 392

84. SUBCUTANEOUS DIVISION OF ABDOMINAL MUSCLES 409

85. LATERAL INCOMPLETE WOUND OF SMALL INTESTINE. SLIT FORM 416

86. LATERAL PERFORATION OF SMALL INTESTINE. GUTTER FORM 417

87. ENTRY AND EXIT WOUNDS IN A TRANSVERSE PERFORATION OF INTESTINE 418

88. INNER ASPECT OF PIECE OF INTESTINE SHOWN IN FIG. 87 419

89. IMPACTION OF OMENTUM IN EXIT WOUND OF ABDOMINAL WALL 421

90. FRAGMENTS OF LARGE SHELLS 475

91. FRAGMENTS OF PERCUSSION AND TIME FUSES 477

92. COMPLETE 1-LB. POM-POM SHELL 479

93. FRAGMENTS OF EXPLODED POM-POM SHELLS 480

94. PERCUSSION FUSE FROM 1-LB. POM-POM SHELL 481

95. FRAGMENTS OF BOER SEGMENT SHELLS 483

96. NORMAL AND DEFORMED LEADEN SHRAPNEL BULLETS 485

TEMPERATURE CHARTS

1. CASE OF AXILLARY HAEMATOMA, BLOOD TEMPERATURE 119

2. CASE OF HAEMOTHORAX WITH RECURRENT HAEMORRHAGES 395

3. PRIMARY AND SECONDARY RISES OF TEMPERATURE IN HAEMOTHORAX, RECOVERING SPONTANEOUSLY 402

4. SECONDARY RISE OF TEMPERATURE IN HAEMOTHORAX 403

5. FALLS OF TEMPERATURE IN HAEMOTHORAX FOLLOWING PARACENTESIS 404

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