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
In connection with the subject of wobbling, reference should be made to
the form suggested by Nimier and Laval, in which the wobble, as the
result of resistance to the apex of the revolving bullet, assumes the
form of movement seen when the spin of a top is failing. This would
explain a peculiarity in some wounds of entry over the skull first
pointed out to me by Mr. J. J. Day. When such wounds were explored, as
well as the presence of brain in the entry aperture, a number of
fragments of the external table of the skull were found everted and
fixed in the tissues of the scalp. As already suggested, this may be
mere evidence of splash, but it may be equally well explained by a
process of wobble around the axis of revolution of the bullet. This
might, no doubt, also be invoked to explain the displacement of some of
the fragments in fractures of the long bones, where considerable
resistance to the passage of the bullet is offered.
II. _Vertical or coronal wounds in the frontal region._--These injuries
were common, and offered some of the most interesting illustrations of
the variations in symptoms and effects following apparently exactly
identical lesions, judging from the condition of the external soft parts
alone; since the latter sometimes gave little indication of the force
(dependent on the rate of velocity) which had been applied.
With the lower degrees of velocity simple punctured fractures of the
skull resulted, without extensive lesion of the frontal lobes as
evidenced by immediate symptoms. The nature of the fractures differed in
no way from the punctured fractures we are familiar with in civil
practice. The openings of entry in the bone were irregularly rounded,
corresponding in size to the particular calibre of the bullet concerned.
The margin consisted of outer table alone, while the inner table was
either considerably comminuted, or a large piece was depressed, wounding
the dura-mater and projecting into the brain substance (see fig. 63).
The aperture of exit presented exactly the opposite characters, the
splintering comminution or separation of a large fragment affecting the
outer table, while the inner presented a simple perforation. The latter
condition is represented in figs. 71 and 72, and I will here give short
notes of four illustrative cases, as being the shortest and most
satisfactory method of conveying a correct idea of the nature of such
injuries.
[Illustration: FIG. 62--Aperture of Entry in Frontal Bone. Case No. 50.
1/2]
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