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
It will be, of course, appreciated that the coarse brain lesions under
the third heading differed in localisation and in extent alone, and in
no wise in nature, from those observed in the two preceding classes. The
damage consisted in direct superficial laceration and contusion, and
beyond the limits of the area of actual destruction, abundant
parenchymatous haemorrhages more or less broke up the structure of the
brain, such haemorrhages decreasing both in size and number as
macroscopically uninjured tissue was reached. No opportunity was ever
afforded of examining a simple wound track in a case in which no obvious
cerebral symptoms had been present.
IV. _Fractures of the base._--In addition to the above classes, a few
words ought to be added regarding the gunshot fractures of the base of
the skull. These possessed some striking peculiarities; first in the
fact that they might occur in any position, and hence differed from the
typically coursing 'bursting' fractures we are accustomed to in civil
life as the consequence of blows and falls, and consequently were often
present without any of the classical symptoms by which we are accustomed
to locate such fissures. Secondly, the peculiar form was not uncommon in
which extensive mischief was produced from within by direct contact of a
passing bullet.
As far as could be judged from clinical symptoms, indirect fractures of
the base such as we are accustomed to meet in civil practice in
connection with fractures of the vault were decidedly rare, and, as has
already been mentioned, ocular evidence of extensive fissures extending
from perforating wounds of the vertex was wanting, except in the extreme
cases classed under heading I. For these reasons I am inclined to regard
them as uncommon.
Direct fractures of the base, on the other hand, were of common
occurrence, especially in the anterior fossa of the skull. These might
be produced either from within, the most characteristic form of gunshot
injury, or from without. The fractures from within were often simple
punctures of the roof of the orbit or nose.
Punctured fractures of the roof of the orbit caused little trouble as
far as the cranium was concerned, but the orbital structures often
suffered severely. I saw one or two very severe comminutions of the roof
of the orbit caused by bullets which had crossed the interior of the
skull; in one case the whole roof was in small fragments, while the
damage in others was not greater than chipping off some portion of the
lesser wing of the sphenoid. The roof of the orbit again was sometimes
very severely damaged by bullets which first traversed that cavity
itself; thus in one case which recovered, the bullet passed
transversely, smashing both globes, and fracturing the roof of both
orbits and the cribriform plate so severely as to lacerate both
dura-mater and brain, portions of the latter being found in the orbit on
removal of the damaged eyes.
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