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
The lesion is one of the left occipital cortex in the cuneate
lobe and the neighbourhood of the calcarine fissure. The speech
suggests a slight degree of aphasia.
(66) _Injury to occipital lobes._--Wounded at Magersfontein
while in prone position. Distance, 500 yards. He says he was
never unconscious, but for two days was absolutely blind. His
eyesight gradually improved, but headache was very severe, and
sleeplessness nearly absolute. On the eighth day the wound,
which was situated over the right posterior superior angle of
the parietal bone, was opened up, and a number of fragments of
bone and a quantity of pulped brain removed from a depressed
punctured fracture, surrounded by an annular fissure,
completely encircling it, 1-1/2 inch from the opening. The
portion of brain destroyed was probably a considerable portion
of the cuneate and precuneate lobules of both sides, as well as
a portion of the first occipital convolution, and the superior
parietal lobule of the right side. There was no evidence of
injury to the superior longitudinal sinus in the way of
haemorrhage.
After the operation the patient slept better, but still
complained of headache, and when he arrived at the Base, the
flap became oedematous, and the stitch holes and also the
central part of the wound suppurated. The temperature rose to
101 deg.. The wound was therefore re-opened, and a number of
additional fragments of bone, some as deeply situated as 2
inches from the surface, were removed. Steady improvement
followed, and at the end of a further three weeks the wound was
healed, the headache had ceased, and there were no abnormal
symptoms, except that light was unpleasant to the right eye,
and the field of vision was manifestly contracted (Mr. Pooley).
A year later the man was employed as a letter-carrier. He
complains of headache at times, and on six occasions has had
'fainting fits.' He says that the latter commence with tremor,
that his legs then give way and he falls. In a quarter of an
hour he gets up, and feels no further inconvenience. Speech is
perfect, there is no deafness. The bone defect is very nearly
completely closed.
Mr. Fisher reports as follows as to the vision. There is a high
degree of hypermetropia in each eye, the R. has nearly 6.0 D
and the L. about 5.0 D. With correction he gets practically
full direct vision with each.
[Illustration: FIG. 75.--Right Visual Field, in case 66. Injury to both
occipital lobes. Field for white. Test spot 10 mm. Good artificial
light. Defect in field complicated by functional symptoms]
[Illustration: FIG. 76.--Left Visual Field, in case 66. Defect in lower
half of field]
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