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
(43) In a man wounded at Paardeberg the bullet entered the leg
to the inner side of the crest of the tibia, about 3 inches
below the tubercle; thence it coursed upwards to emerge about 2
inches above the cleft of the knee-joint on the outer side.
Regulation dressings were applied, and a week later the man
arrived at the Base, with little apparent mischief in the
knee-joint. He was placed in bed and warned against movement;
on the second day, however, he got up and walked to the
latrine. When bending his knee to sit down he was seized with
agonising pain in the joint, and had to call out for help; he
was then carried back to bed in a more or less collapsed
condition. The knee commenced to swell; there was rise of
temperature and great pain, together with extreme restlessness.
I was asked to see him two days later, and after a
consultation, Major Burton, R.A.M.C., freely incised the
knee-joint bi-laterally. One opening was closed, the second
plugged for drainage, as there was a large quantity of pus. No
improvement followed, and a week later Major Burton amputated
through the thigh. An attack of secondary haemorrhage a few days
later, combined with the degree of septic infection, ended the
man's life. On examination of the joint, a groove forming
three-fourths of a tunnel was found in the external tuberosity
of the tibia, leading into the knee-joint beneath the external
semilunar cartilage. The bullet had then passed upwards over
the outer border of the cartilage, bruised the margin of the
external condyle of the femur in such a manner as to depress
the outer compact layer, and finally escaped from the joint
near the upper reflection of the synovial membrane. The
synovial membrane was granular in appearance and reddened, but
there was no suppuration outside the confines of the joint,
except in a cavity corresponding to 2 inches of the track
before it actually perforated the tibia. A localised abscess
had evidently formed here and been diffused into the joint by
the movement of flexion already described.
(44) A man wounded during General Hamilton's advance on
Heilbron was struck on the outer aspect of the heel. An oval
opening of some size led down to a track in the os calcis; the
bullet was retained. The foot was dressed, and put up later in
a plaster-of-Paris splint. On the tenth day the splint was
removed to see to the wound, which looked satisfactory and was
re-dressed.
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