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
_Olfactory._--I observed temporary loss of smell on three occasions. In
two instances this accompanied transverse wounds of the bones of the
face in which the upper third of the nasal cavities was crossed; in the
third a track passing obliquely downwards from the frontal region passed
through the inner wall of the orbit, and crossed the nose at a lower
level. In view of the small area of the olfactory distribution which was
directly implicated, I was at first inclined to regard the loss of smell
as dependent on the presence of dried blood on the surface of the mucous
membrane, or on obstruction of the cavities from the same cause. Further
observation, however, appeared to show that it was due to concussion of
the branches of the olfactory nerve, since the loss of function
persisted when the cavities were manifestly clear.
In all these cases we were confronted with the same difficulty which was
experienced both in lesions of sight and hearing, the determination as
to whether the concussion was of the branches or of the olfactory bulb.
When the symptom was the accompaniment of a fracture of the roof of the
orbit, the possibility of concussion of the olfactory lobe was manifest.
In all, again, it was difficult to say what part the accompanying
concussion of the branches of the fifth nerve took in the production of
the symptom. In all three cases mentioned the return of function was
gradual, but apparently fairly complete at the end of three weeks. In
one it was noted that at first the patient was conscious of an odour
before he was able to discriminate its actual nature; later he could
determine the latter readily.
_Optic._--Some remarks concerning lesions of the optic nerve have
already been made under the heading of wounds of the orbit. Concussion
and contusion of the nerve both occurred, but I was unable to
differentiate between the effects of these on the nerve itself, apart
from the effects on the globe of the eye, which usually accompanied
wounds of the orbit.
In some cases the nerve was directly divided in orbital wounds, and
either pressure on or division of the nerve in the intra-cranial portion
of its course, or as it traversed the optic foramen, was not uncommon.
_Auditory._--Loss of hearing was also not infrequent; thus it
accompanied all three wounds of the mastoid process quoted under the
heading of the seventh nerve, also two cases of fracture of the
occipital bone near the ear quoted on p. 278. In all these instances it
was impossible to attribute the deafness to lesion of the nerve alone,
as the causative injury equally affected the internal ear, and in at
least two the bullet implicated the tympanum as well in its course. The
deafness was absolute in each case, and in none had any improvement
occurred at the end of nine months. Deafness was a symptom in a certain
number of the more severe cerebral injuries in which the course of the
bullet was not so near to the internal ear: probably some of these were
central in origin.
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