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
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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
The small extent of skin actually destroyed is an important element in
the rapid contraction often seen in these wounds when they progress
favourably. Thus the large wound portrayed in fig. 48 contracted to
one-fourth its original size ten days after the diagram and measurements
were made. The large mass of protruded tissue was often most striking
when a muscle such as the biceps in fig. 48 had been divided; but the
herniae were more persistent when the mass projected in regions where
tendons formed a large integral constituent, as at the wrist or lower
third of the forearm. The protruding tissues naturally consisted of many
varieties, according to what lay in the track of any particular wound.
It should be added that for 'explosive' features to reach their
strongest development, it is necessary that the bone affected should lie
near the surface of the body; hence the most characteristic explosive
wounds were met with in the forearm or leg, over the metacarpus or
metatarsus, or in the arm. In the thigh, on the other hand, where the
femur in a great part of its course not only lies deeply, but is also
protected by particularly strong and resistent skin and fascia, another
type of wound was met with. The explosive exit aperture, although large,
was still only moderate in extent, sometimes, as in the front of the
lower third, exposing a somewhat angular large track walled by the
divided quadriceps extensor cruris. In other cases, on introducing the
finger through a moderate exit opening on the inner aspect of the thigh,
a large cavity, sometimes 4 or 5 inches in diameter, was discovered,
full of clot and shreds of destroyed tissue and lined by a layer of
similar material. In either of these latter cases the fractured bone
ends were situated too deeply to take part in the actual laceration of
the skin, while the force transmitted to the bone fragments, although
sufficient to cause them to widely destroy the first soft tissues met
with, did not suffice to cause them to burst or lacerate the skin
widely.
[Illustration: FIG. 48.--(22) 'Explosive' Exit Wound of front of Arm.
Wound actual size eight days after its infliction. The prominences in
the upper and lower parts correspond with the lacerated biceps. The dark
crater led down to the fracture. In another week the wound had
contracted to half the size. The entry aperture was a normal circular
one. The arm a year later was used in the patient's employment as a
hammer-man.]
With regard to the theories of the production of these phenomena, that
of the transmission of a part of the force of the bullet to the
comminuted fragments, which thus themselves acquire the characters of
secondary projectiles, seems quite adequate.[18] Examination of any of
the skiagrams in which considerable comminution has taken place, shows
that the fragments are carried forward and perforate the tissues distal
to the fracture.
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