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
No doubt the brain in its reaction to the bullet forms as near an
approach to a fluid as any solid tissue in the human body, and
experimental observation has shown how greatly its presence or absence
in the skull affects the degree of comminution on the exit side; hence
the fondness for the so-called hydraulic theory that has been always
exhibited in the case of these injuries. The localisation of the injury
in its highest degree to the neighbourhood of the exit aperture,
however, shows that in any case the main wave takes a definite direction
in a course corresponding to that of the bullet.
The real importance of the presence of the brain within the skull in
increasing the amount of damage at the exit end of the track, is as a
medium for the ready transmission of forcible vibrations. That the
latter are to some extent conveyed as by a fluid is evidenced by the
occasional presence of brain matter and fragments of bone in the
aperture of entry, which suggests recoil or splash such as would be
expected from a fluid wave.
Experience of the character of the lesions observed after severe
concussion by the ordinarily somewhat coarser forms of violence common
to civil life, fully explains the severity of the damage to the brain
tissue met with in injuries due to bullets of small calibre. Viewing the
elaborate arrangements which exist for the preservation of the central
nervous system from the moderate vibration incidental to ordinary
existence, it is easy to appreciate the harmfulness of such exquisite
vibratory force as that transmitted by a bullet of small calibre
travelling at a high rate of velocity.
_Effect of ricochet in the production of severe forms of injury._--In
connection with the lesions above described mention must be made of
cases in which the aperture of entry reaches a large size, or a portion
of the skull is actually blown away.
Examples of the former class were not uncommon; I will briefly relate
one.
(48) A Highlander while lying in the prone position at
Rooipoort, was struck by a bullet probably at a distance of
about 1,000 yards. A large entry wound in the scalp was
produced, while the defect in the skull was coarsely comminuted
and was capable of admitting three fingers into a mass of
pulped brain. Both brain matter and fragments of bone were
found in the external wound, which was situated just anterior
to the right parietal eminence. The bullet passed onwards
through the base of the skull, crossing the external auditory
meatus, fracturing the zygoma and probably the condyle of the
mandible, and eventually lodged beneath the masseter muscle.
Blood and brain matter escaped from the external auditory
meatus.
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