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
(64) _Parietal injury: retained bullet._--Wounded at
Paardeberg. Aperture of _entry_ (Mauser), 1 inch diagonally
below and anterior to left parietal eminence. No exit. The
patient was trephined by the surgeons of the German ambulance
at Jacobsdal.
Sixteen days later he arrived at the Base. A circular pulsating
trephine opening was then to be felt beneath the flap, but no
information was forthcoming as to the bullet. The patient
could speak, but lost words and the gist of sentences; he
could remember nothing as to himself since the day of the
injury. There was right facial weakness; he could not close the
right eye or whistle, but there was little apparent want of
symmetry; there was weakness in the grip of both hands, more
marked on the right side; both lower extremities could be
moved. The reflexes were normal, although the left limb was
slightly rigid. The pupils were equal, reflex normal; slight
nystagmus. Pulse 72, small and regular. Temperature normal.
Rapid improvement followed.
During the fourth week the temperature rose to 103 deg., and
remained elevated for six days, but no local or general signs
appeared; at the end of five weeks there was little evidence of
the paralysis remaining. The patient was discharged from the
service on his return home.
In the upper part of the occipital region glancing or superficial
injuries were comparatively favourable; those near the base, especially
if perforating, were very dangerous. Two such cases are referred to
elsewhere. Case 69 is included as the only example of cerebellar injury
I happened to see who lived any appreciable time after the accident.
The main interest in these cases centres in the defects produced in the
area of the visual field. I am extremely indebted to my colleague, Mr.
J. H. Fisher, who has kindly determined this for me in three of the
following cases. It will be noted that in two instances the injury was
to the left occipital lobe. In these the resulting hemianopsia was of
the pure lateral homonymous character, and in both the visual symptoms
were accompanied by a certain degree of amnesic aphasia (65 and 68).
In 65 the injury was definitely unilateral, and at the time of the
operation I decided that at least an inch and a half of the posterior
extremity of the left occipital lobe was totally destroyed.
In 68 the lesion was probably confined to the left lobe, but it is
impossible to exclude slight injury to the right lobe also. In this
instance amnesic aphasia was a far more marked symptom than in 65, and
the position of the lesion suggested damage both to the visual and
auditory word centres.
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