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
The degree of fissuring is probably affected by the resistance offered
by the particular skull, or the special region struck, but as a rule the
elasticity and capacity for alteration in shape possessed by the bony
capsule, is opposed to the production of the extreme radial starring
observed in the long bones or a fixed sheet of glass. Corroborative
evidence of the influence of elasticity in the prevention of starring is
seen in the limited nature of the comminution of the ribs in cases of
perforating wounds of the thorax.
In the most severe cases we can only speak of the 'aperture' of exit in
a limited sense in so far as the opening in the scalp is concerned; this
was often comparatively small, not exceeding 3/4 of an inch in diameter.
Beneath this limited opening in the soft parts, the bone of the skull
was smashed in a most extensive manner. The portion exactly
corresponding to the point of exit of the bullet was carried altogether
away, but around this point a number of large irregularly shaped
fragments of bone, from 3/4 to 1 inch in diameter, were found loose, and
often so displaced as to expose a considerable area of the dura-mater.
Beyond the area of these loose fragments, fissures extended into the
base and vertex, in the latter case often being limited in their extent
by the nearest suture.
Over extensive fractures of this nature general oedema and
infiltration of the scalp, due to extravasation of blood, were present.
When the exit was situated in the frontal region ecchymosis often
extended to the eyelids and down the face, while in the occipital region
similar ecchymosis was often seen at the back of the neck.
The opening in the dura mater at the aperture of entry was either
slitlike, or more often irregular from laceration by the fragments of
bone driven in by the bullet. At the point of exit a similar limited
opening corresponded with the spot at which the bullet had passed, while
separate rents of larger size were often seen at some little distance.
The latter were the result of laceration of the outer surface of the
membrane by the margins of the large loose fragments of bone above
described.
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