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
In closing these remarks reference must be made to the occasional
occurrence of paraplegic symptoms of an apparently purely functional
nature. I saw these on one or two occasions, of which the following is
a fair example. A man was wounded in the lower extremity and fell. When
brought into the hospital he complained of loss of power in the legs and
inability to straighten his back. No very definite evidence was present
of serious impairment either of motor or sensory nerves, and the man was
got up and walked with crutches. While moving about the hospital camp,
another man pushed him down, and the patient then became completely
paraplegic. He was placed in bed, and the next day moved his limbs
without any difficulty, and gave rise to no further anxiety.
_Prognosis._--In slight concussion the importance of prognosis is as to
remote effects, and upon this no opinion can be given at the present
time. The same may be said concerning cases in which transient symptoms
followed the slighter degrees of surface and medullary haemorrhage. In
the case of the latter, however, I think it would be rash to give a too
confident opinion as to the future non-occurrence of secondary changes.
Severe concussion is probably irrecoverable.
Meningeal haemorrhage of either form is one of the slighter lesions, and
less dangerous, both as an immediate condition and as to the
probabilities of after trouble. None the less the possibilities of
secondary chronic meningitis, or chronic trouble from adhesions, must be
kept in mind.
Cases of medullary haemorrhage with incomplete signs are favourable in
prognosis, as far as life is concerned; as to complete recovery,
however, this is hardly possible; in many cases serious functional
deficiency at any rate will remain, while in others the healing of the
lacerated tissue and subsequent contraction can scarcely fail to
influence unfavourably an already imperfect recovery.
I think it must be a rare occurrence for pressure from bone fragments to
be able to be regarded as a favourable prognostic condition, since in
the very large majority of cases the velocity of the bullet causing the
injury will have been such as to inflict irreparable damage on the cord.
Still, cases may occasionally be met with where the velocity has been
sufficiently low, or contact with the bone slight enough, to allow of
the comparative escape of the cord. In this relation cases in which the
bullet is retained, especially if the symptoms of transverse lesion are
incomplete, may be regarded as relatively favourable.
Cervical and high dorsal injuries, as in civil practice, offered the
worst prognosis. In cases in which symptoms of total transverse lesion
were present, as far as my experience went, it was, however, only a
matter of importance as to the prolongation of a miserable existence.
All the patients eventually died; those with higher lesions at the end
of a few days; the lower ones, at the completion on an average of six
weeks of suffering.
Public-domain text, read in full here on John Shaqi.
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