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
In a few cases bullets lodged in the neighbourhood of joints in such
positions as to limit movement by mechanical impact with the bones. Thus
I saw one case in which a bullet lay between the radius and ulna just
below the lesser sigmoid cavity; in another the bullet lay in front of
the ankle-joint, and limited the possibility of flexion; and in a case
related to me by Mr. Bowlby, a bullet was removed by him from the wall
of the acetabulum where it was tightly fixed in the substance of the
bone. In two other cases I saw bullets lying deeply on the anterior
surface of the hip capsule and so limiting flexion. In all such cases
the indication for removal of the bullet was sufficiently strongly
marked.
WOUNDS OF THE JOINTS
These may be divided into several classes, varying much in comparative
severity, and in prognostic importance.
1. The comparatively rare instances in which a wound implicated a joint
cavity, without accompanying lesion of any bone.
2. Perforating wounds in which the bullet was retained within the
articular cavity. These were also rare.
3. Wounds of the joints accompanied by grooving of the articular
extremities of the bones.
4. Complete perforating tracks through the articular ends of the bones,
crossing the joint cavity in various directions.
5. Comminuted fractures of the terminal parts of the diaphyses extending
into joints.
Of these several classes, the first was of the least prognostic
importance. In the absence of bone injury the wounds usually healed
without any obvious ill effect beyond the transient effusion into the
joints of a mixture of blood and synovial fluid. When suppuration of the
wound in the soft parts occurred, however, the remarks made as to the
injuries classed under the third heading also apply here in a lesser
degree.
With regard to the retention of the bullet, in the case of bullets of
small calibre this was a distinctly rare occurrence. I never happened to
see an instance of retention of either a Mauser or Lee-Metford bullet in
an articulation. It is only possible with bullets practically spent, or
travelling at a very low rate of velocity and making irregular impact.
The influence of both volume and velocity of flight was well illustrated
by my own small experience of retained bullets. In one case a
Martini-Henry was found impacted between the femoral condyles, having
slipped in beneath the margin of the patella. It caused a semiflexed
position to be assumed by the joint, and was removed by Mr. Brown in No.
1 General Hospital at Wynberg. The second instance I saw in the Portland
Hospital at Bloemfontein in a patient of Mr. Bowlby's. The bullet was a
Guedes, a form which has been already described as possessing low
velocity and deficient power of penetration; beyond this, in the
particular instance irregular impact was evidenced by the presence of a
large irregular contused wound of entry over the tuberosity of the
tibia.
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