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
Injury to the brain more than corresponded in extent to the fractures of
the bone. Pulping of its tissue existed over a wide area both at the
points of entrance and of exit. In the former position the amount of
damage was the less, the gross changes roughly corresponding with the
tissue directly implicated by the bullet itself, and the fragments of
bone carried forward by it. The degree of splintering of the skull
therefore in great part determined the severity of the lesion. At the
exit aperture much more widespread destruction existed, while masses of
brain tissue, small shreds of the membranes, fragments of bone, and
_debris_ from the scalp were found occasionally bound together by
coagulated blood and protruding from an exit opening of some size. The
largest masses of such _debris_ were most often seen in instances in
which the bullet had entered by the base to escape at the vertex of the
skull.
The brain in the line of injury suffered comparatively slightly, but
small parenchymatous haemorrhages into its tissue indicated in lesser
degree the same type of injury undergone by the mass of brain pulp and
small blood-clots found at the external limits of the wound. Beyond this
extensive haemorrhages at the base of the skull were common.
With regard to the extensive character of the brain destruction in the
region of the aperture of exit, it must be borne in mind that this
lesion corresponds in position with one which would exist even if the
injury were of a non-penetrating degree. A large proportion of the
contusion and destruction is therefore explained by violent impact of
the projected brain with the skull prior to the passage of the bullet,
and not to the direct action of the bullet on the tissues.
These cases of 'general injury' afford a marked example of the lesions
to which the term 'explosive' has been applied, and as such have an
important bearing on the theories held as to the mode of production of
explosive effect. The increased area of tissue damage at the aperture of
exit favours the theory of direct transmission of a part of the force
with which the bullet is endowed, to the molecules of tissue bounding
the track made by the projectile. Thus the area of destruction
corresponds with the cone-like figure which one would expect to be built
up by the vibrations spreading from the primary point of impact. The
exit region of the skull is subjected not alone to the force of the
travelling bullet, but also to that exerted over a much wider area by
the tissue to which secondary vibrations have been communicated. The
brain itself is, in fact, dashed with such violence against the bone as
to cause a great part of the injury.
Public-domain text, read in full here on John Shaqi.
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