Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small CalibreMakins, George Henry
History
Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small Calibre
Makins, George Henry
Gunshot wounds; South African War, 1899-1902; Surgery, Military
_False traumatic aneurism or arterial haematoma._--This condition was met
with comparatively frequently, and bears a very close relation to that
already described under the heading of interstitial haemorrhages. The
latter might almost have been included here, since the difference
between the two conditions depended merely on the size of the vessels
implicated. The exact correspondence in the period of development of
some of the arterial haematomata, and of the occurrence of the aseptic
form of secondary haemorrhage, also explains the pathology of the two
conditions as identical; except that in the former the effused blood is
retained in the tissues, while in the latter it escapes externally. The
history of these cases was uniform and characteristic. A wound of the
soft parts, or sometimes a fracture, was accompanied by a certain degree
of primary interstitial haemorrhage, which might or might not have been
associated with external bleeding. A haematoma resulted in connection
with the wounded vessel, the general tendency in the effusion being to
coagulation at the margins and subsequent contraction. Meanwhile the
opening in the artery became more or less securely closed by the
development of thrombus, and possibly by retraction of the inner and
middle coats of the vessel. With the return of full circulatory force as
shock passed off, or with the resumption of activity and consequent
freer movement of the limb, the temporary thrombus became washed away.
The newly formed wall of soft clot bounding the effusion proved
insufficient to withstand the full force of the blood pressure, and
extension of the cavity resulted. In the more rapidly developing
haematomata, temporary pressure by the effused blood on the bleeding
vessels was also, no doubt, a common explanation of temporary cessation
of increase in size.
A diffuse soft fluctuating swelling, sometimes accompanied by pulsation,
but oftener without, developed, and not uncommonly diffusion was
accompanied by some discoloration of the surface and elevation of the
general temperature. Such arterial haematomata commonly developed from
ten days to three weeks after the original wound. A few examples will
suffice.
(1) A patient wounded at Elandslaagte was sent down to Wynberg.
The antero-posterior wound in the upper third of the arm was
healed, but a month after the injury a large fluctuating
arterial haematoma developed in the axilla and upper third of
the arm. This was incised (Colonel Stevenson) and a wound of
the axillary artery in its third part discovered, and the
vessel ligatured. The patient made an excellent recovery.
Public-domain text, read in full here on John Shaqi.
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