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
History
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
(62) _Fronto-parietal perforating fracture._--Wounded at
Magersfontein. _Entry_, within the margin of the hairy scalp;
_exit_, behind and below the left parietal eminence, the track
crossing about the centre of the fissure of Rolando. Right
hemiplegia, the lower half of the face only being involved. The
wounds were explored and a large number of fragments of bone
and a quantity of pulped cerebral matter removed. Six days
later the hemiplegia persisted, speech was slow, headache was
troublesome and the pulse not above 45. After this, gradual
improvement took place, and a month later the lower extremity
and face had regained good power. The upper extremity remained
flaccid and paralysed, except for some slight power of movement
of the shoulder.
(63) _Fronto-parietal perforating fracture._--Wounded at
Magersfontein. _Entry_ (Mauser), 2-1/2 inches from the median
line, 3-1/2 inches from the occipital protuberance; _exit_, 3/4
of an inch from the median line, 4-1/2 inches from the
glabella; sanious fluid escaped from both ears. There was left
facial paralysis, complete paralysis of the left upper
extremity, and partial paralysis of the left lower extremity.
The patient was deaf, drowsy, and the pulse 45.
Exploration showed the entry wound to be in the parietal, the
exit to involve both parietal and frontal bones. The openings
were enlarged, and a number of fragments of bone, together with
pulped cerebral matter and blood-clot, were removed. The wound
healed, except at the front part, where a small prominence
suggested a hernia cerebri.
The patient improved slowly; fourteen days after the operation
he could hear well, and the flow from the ears had ceased. The
facial weakness was slight, the upper extremity was still
powerless, but he could move the lower and draw it up in bed.
At the end of six weeks the wound had healed, and he was got up
and dressed.
At the end of two months he was well enough to be sent home;
there was only a trace of facial weakness; the right upper
extremity, however, was powerless and slightly rigid,
occasional twitchings occurring in it. Considerable power had
been regained in the lower extremity, so that the patient could
walk with help, but foot-drop persisted; the gait was spastic
in character, the reflexes were much exaggerated, and there was
marked clonus. The patient was sensible, but his manner
suggested some mental weakness. Both the openings in the skull
were closed by very firm material, apparently bony.
This patient became a Commissionaire some ten months later. His
mental condition is normal, and loss of memory seems confined
to the events immediately following the injury. The lower
extremity has improved, but the upper is useless.
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