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
Cervical injuries, owing to the comparatively sheltered position of the
more deeply sunk spines, and from the fact that the head was usually
under cover of a stone or ant-heap, were less common; in one instance
hyperaesthesia was noted in one upper extremity as the result of a
crossing bullet having struck the fourth cervical spine. In a man
wounded at Paardeberg Drift the bullet entered at the centre of the
buttock, traversed the bones of the pelvis, and, leaving that cavity
above the crest of the ilium, crossed the spine to emerge in the
opposite loin. Suppuration occurred, and when the wound was laid open
the third and fourth lumbar spinous processes were found to be loosened,
but still connected to the surrounding soft parts. There were no nerve
symptoms in this case; these would not have been expected, since by the
time that the bullet had traversed the bones of the pelvis its velocity
must have been considerably lessened, even if high at the moment of
primary impact. In another case a dorsal spine, together with its
lamina, was separated and moveable; the only nerve symptoms were slight
pain and a crop of herpes on the line of distribution of the
corresponding intercostal nerve, the bullet having probably struck the
nerve in passing across the intercostal space. In one instance of a
retained bullet lying beneath the skin of the back, its passage between
two contiguous dorsal spines without fracture of either was determined
during an extraction operation.
When the prone position was assumed by the men, more or less
longitudinal wounds in the course of the spine were naturally liable to
occur. These tracks assumed somewhat greater importance than the
transverse ones, because the injury to bone was more often multiple, and
the laminae were frequently implicated. The relative importance of such
injuries was dependent on the velocity of the bullet and the depth at
which it travelled. As an instance of a more serious character the
following may be given:--
(95) In a Highlander wounded at Magersfontein, probably at a
range within 1,000 yards, the bullet entered at the right side
of the sixth cervical vertebra; tracking downwards, it loosened
the laminae of the fifth and sixth dorsal vertebrae from the
pedicles, and separated the tip of the seventh spine. The
bullet was extracted from beneath the skin at the latter spot,
its force having been no doubt exhausted by the resistance of
the firm neural arches supported by the weight of the man's
body. Symptoms of total transverse lesion of the cord followed,
and the patient died at the end of fifty-four days. The bone
had not apparently been sufficiently depressed to exert
continuous pressure, but the cord was diffluent and actually
destroyed over an area corresponding with the fourth, fifth,
sixth, and seventh dorsal segments.
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