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
As to the causation of the 'radiation' symptoms, it is difficult to
discriminate the effects of neighbouring parenchymatous haemorrhages from
those of local vibratory concussion of the nervous tissue. The local
character of the signs seems, however, to point to causation by
molecular disturbance, resulting from the conduction of forcible
mechanical vibration to the brain tissue rather than to upset in the
intra-cranial pressure. Again the limited nature of the paralysis
observed, sharply defines it from the general loss of power accompanying
ordinary cases of concussion of the brain. The similarity of the
phenomena to those described in other parts of the body under the
heading of 'local shock' is sufficiently obvious.
The following instance well exemplifies the condition in question:
(55) Wounded at Spion Kop. A scalp wound 3 inches in length
crossed the left parietal bone nearly transversely, starting
1-1/2 and ending 2 inches from the median line: the centre of
the wound corresponded with the position of the fissure of
Rolando. The patient was struck at a distance of fifty yards
while kneeling; he fell and remained unconscious an hour and a
half. Right hemiplegia without aphasia followed. The wound was
cleansed and sutured, and in three days both arm and leg could
be moved, after which time the man improved rapidly. Three weeks
later when I saw him at Wynberg there was still comparative
weakness of the right side, but beyond some neuralgia of the
scalp, the man considered himself well. No groove could be
detected on the bone on palpation. (This case offers a good
example of the ease with which bone injury may be overlooked.
The man came over to England 'well;' but while on furlough, two
pieces of bone came away spontaneously. He is now again on
active service.)
_Compression._--Equally rare was it for pure symptoms of compression to
be exhibited. This depended on two circumstances: first, the rarity of
injuries giving rise to meningeal haemorrhage; secondly, the fact that in
nearly every case a more or less extensive destructive lesion was
present, at the margins of which less completely destroyed tissue
remained, capable of giving rise to symptoms of irritation. Again, as we
have seen, free haemorrhage into, or from the walls of, the cavities
produced in the brain was not a marked feature, and beyond this the
large defect in the cranial parietes was calculated to render a high
degree of compression impossible.
As the most serious head injuries presented a remarkable similarity in
their symptoms, I will shortly summarise their common features.
Every degree of mental stupor up to complete unconsciousness was met
with, but in some instances where the pulse, respiration, and general
bodily condition pointed to speedy dissolution, the patients answered
rationally often between moans or cries indicative of pain.
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