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 danger of overlooking injuries to the bone was of special importance
in the short subcutaneous tracks occasionally met with at the points at
which the surface of the skull makes sharp bends. In all such wounds it
was a safe rule to assume a fracture of the skull until this was
excluded by direct examination. In some of the gutter wounds and
subcutaneous tracks crossing the forehead and sides of the head, signs
of intracranial disturbance were occasionally observed in the absence of
external fracture, such as transient muscular weakness, unsteadiness in
movements, giddiness, diplopia, or loss of memory and intellectual
clearness. In connection with such symptoms the classical injury of
splintering of the internal table of the skull, the external remaining
intact, had to be borne in mind, but I observed no proven instance of
this accident. I am of opinion, moreover, that its occurrence with small
bullets travelling at a high degree of velocity must be very rare, since
little deflection is probable unless the contact has been sufficiently
decided to fracture the external table; while in the cases of spent
bullets the injury is unlikely, as requiring a considerable degree of
force.
_Injuries to the cranial bones, without evidence of gross lesion to the
brain._--It may be premised that these were of the rarest occurrence,
and they may be most readily described by shortly recounting the
conditions observed in a few cases I noted at the time. The injuries
resulted from blows with spent bullets, from bullets barely striking the
skull directly, or those striking over the region of the frontal
sinuses. Wounds of the mastoid process will not be considered in this
connection as being of a special nature (see p. 299).
I saw only one case of escape of the internal, with depressed fracture
of the external, table of the skull.
(45) In marching on Heilbron a man in the advance guard was
struck by a bullet at right angles just within the margin of
the hairy scalp. The regiment was at the time to all intents
and purposes outside the range of rifle fire, and the patient
was the only individual struck among its number. When brought
into the Highland Brigade Field Hospital, a single typical
entry wound was discovered; examination with the probe gave
evidence of a slight depression in the external table of the
frontal bone just above the temporal ridge. Although no
perforation was detectible by the probe, and this was
positively excluded on the raising of a flap (Major Murray,
R.A.M.C.), it was considered advisable to remove a 1/4-inch
trephine crown, the pin of the instrument being applied to the
margin of the depression. No depression or splintering of the
internal table was discovered, nor any injury to the dura, nor
blood upon the surface of that membrane. The man made an
uninterrupted recovery.
Public-domain text, read in full here on John Shaqi.
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