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
_Abscess of the brain._--Local abscesses formed in a considerable
proportion of the cases where serious damage to the brain had occurred,
in whatever region this happened to be. I never saw one develop in cases
where primary union had taken place, even when bone fragments had not
been removed; neither did I ever see an abscess situated at a distance
from the original injury. I take it that the latter is to be explained
by the early date of the suppuration, and the fact that in the great
majority of small-calibre wounds the exit opening exists in the
situation of the contre-coup damages of civil practice.
The main feature in the symptoms when abscesses developed was the
insidious mode of their appearance, usually at the end of fourteen to
twenty-one days, and their comparative mildness.
Very slight evidences of compression were observed; thus, varying
degrees of headache, drowsiness, irritability of temper or depression,
twitchings, or in some cases Jacksonian seizures, combined with slow
pulse and slight rises of temperature. I never happened to see complete
unconsciousness. The slight evidence of compression was perhaps
explained in most cases by the large bony defect in the skull, which
acted as a kind of safety-valve. Again the firm nature of the
cicatricial tissue which formed at the periphery of the injury and
extended up to the skull and there formed a more or less firm
attachment, also preserved the actual brain tissue to some degree from
either pressure or direct irritation. After evacuation of the pus, the
usual difficulty was experienced in ensuring free drainage, and
definitive healing and closure of the cavities was very slow. The
following two cases will illustrate the character of the cases of
cerebral abscess we met with:--
(70) _Fronto-parietal abscess._--Wounded at Magersfontein
(Mauser). _Entry_, 1-3/4 inch above the line from the lower
margin of the orbit to the external auditory meatus, and 1-3/4
inch behind the external angular process; _exit_, a little
posterior to the left parietal eminence. There was right
hemiplegia. The wounds were explored, and a large number of
fragments of bone and pulped brain were removed, especially
from the anterior wound. No great improvement followed, and the
patient was sent to the Base. At this time there was a large
hernia cerebri at the anterior wound which was suppurating.
A further operation was here performed (Mr. J. J. Day). The
hernia cerebri was removed, also several fragments of bone
which were found deeply imbedded in the brain. The patient then
improved, but a month later his temperature rose, and on
exploration an abscess was discovered in the frontal lobe and
drained.
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