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
Complete motor and sensory paralysis below ensiform cartilage,
with well-marked hyperaesthetic zone around trunk. All reflexes
absent. Retention of urine. Incontinence of faeces. Bed-sores in
sacral region developed during the first two days, and
seventeen days later well-developed serpiginous trophic sores
developed on the outer side of each leg and continued to
increase slowly until death. The paralysis remained of the
absolutely flaccid variety. Great emaciation occurred,
accompanied by hectic fever, the temperature ranging from
normal to 102.5 deg.. During the third week double pleurisy
developed.
At the _post-mortem_ no bone injury could be detected. The cord
and dura-mater were adherent over an area corresponding to the
fifth to the eighth dorsal vertebrae, and opposite the seventh
the cord was soft and of the consistence of butter. A small
intra-dural haemorrhage was still evident below the main lesion,
not extensive enough to give rise to serious compression.
General adhesions in each pleura. Cystitis.
[Illustration: FIG. 79.--Appearance of Spinal Cord enclosed in membranes
in case 103 after removal from the canal. When the membranes were opened
a white custard-like substance took the place of the cord. Slight
evidence of extra-dural haemorrhage existed]
(104) _Dorsal region; section of cord; retained bullet._--Wound
of _entry_ (Mauser), in seventh right intercostal space, 4-1/2
inches from the dorsal spinous processes, oval in outline;
bullet retained.
Complete motor and sensory paralysis, with absence of reflexes
below umbilicus. Retention of urine, incontinence of faeces.
Large sacral bed-sore developed rapidly. Right haemothorax.
The patient emaciated rapidly, and for the last fourteen days
the temperature ranged to 104 deg., the bed-sore steadily
increasing in size. Death occurred on the forty-second day.
At the _post-mortem_ a Mauser bullet was found embedded in the
centrum of the twelfth dorsal vertebra. The bullet was slightly
curved; its anterior extremity had passed across the spinal
canal, and wounding the dura posteriorly rested against the
left lamina. The plating of the mantle of the bullet was
stripped from half the area of the tip. The dura was not
adherent, and the cord was softened for half an inch above the
point of section; above this it was normal, the vessels
coursing normally to the softened spot. Below the point of
section the cord was blanched, but offered no other macroscopic
evidence of disease. No evidence of either intra- or
extra-dural haemorrhage was detectible.
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