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
(100) _Cervico-dorsal region. Total transverse lesion._--Wound
of _entry_ (Mauser), to the right of the sixth cervical
vertebra: the bullet was removed on the field from the left of
the seventh dorsal spinous process, which was somewhat
prominent. Complete motor and sensory paralysis extended
upwards to the third intercostal space; the breathing was
almost entirely diaphragmatic. Retention of urine. Entire
abolition of reflexes in lower limbs and trunk. Hyperaesthesia
was present in both upper extremities, with a zone of
hyperaesthesia around the chest. The patient suffered greatly
for some weeks from pain in the hyperaesthetic area, he
developed severe cystitis and later incontinence of urine. A
large trophic sacral bed-sore steadily increased in depth and
size.
About ten days before death, which occurred on the fifty-third
day from exhaustion and septicaemia, the patient complained of
pains in his legs; but there was no return of sensation,
motion, or reflexes.
At the _post-mortem_, the seventh dorsal spinous process was
found to be loose and the laminae of the fifth, sixth, and
seventh vertebrae were separated from the pedicles, and somewhat
depressed on the left side. These laminae were adherent to the
dura, as were also a few small separated bony spiculae. There
was no sign of old haemorrhage. The spinal cord was practically
gone between the levels of the fourth and seventh dorsal
vertebrae, and diffluent from myelitis up to the third cervical.
(101) _Dorsal region; total transverse lesion._--Wound of
_entry_ (Mauser), in the left supra-spinous fossa of the
scapula; _exit_, between the eleventh and twelfth ribs of the
right side. Complete motor and sensory paralysis, with absence
of reflexes from mid-dorsal region downwards. Upper
intercostals working. Retention of urine, penis turgid.
Sensation perfect to lower extremity of sternum. Early trophic
sacral bed-sores developed and steadily increased in depth and
extent, slighter ones developed on the heels. The paralysis was
flaccid throughout. The patient gradually emaciated with fever,
and died on the seventy-eighth day.
At the _post-mortem_ the wound proved not to have penetrated
the thorax, and both the vertebral spines and laminae were
intact, no trace of bony injury being discoverable. Opposite
the sixth dorsal vertebra, for a distance of 1-1/2 inch, the
cord and dura were adherent, and over the same area the cord
was represented by soft custard-like material. There was no
sign of old haemorrhage.
(102) _Dorsal region; total transverse lesion; slight
extra-dural haemorrhage._--Wound of _entry_ (Mauser), at the
posterior aspect of the right shoulder; _exit_, 2 inches to the
left of the spine below the ninth rib.
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