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
When the bullet impinges at a right angle the wound is circular, with
more or less depressed margins, and of a diameter, corresponding to the
size of the bullet occasioning it, from a quarter to a third of an inch.
The description 'punched out' has been sometimes applied to it, but it
would be more correct to reverse the term to 'punched in,' since the
appearance is really most nearly simulated by a hole resulting from the
driving of a solid punch into a soft structure enveloped in a denser
covering. The loss of substance, moreover, in the primary stage is not
actually so great as appears to be the case, fragments of contused
tissue from the margin being turned into the opening of the wound track.
The true margin therefore is not sharp cut, and the nature of the line
differs somewhat according to the structure of the skin in the locality
impinged upon. Thus the granular scalp and the comparatively homogeneous
skin of the anterior abdominal wall will furnish good examples of the
nature of the slight difference in appearance. From the first the margin
is also often somewhat discoloured by a metallic stain, similar to that
seen when a bullet is fired through a paper book. This ring is, however,
narrow, and not likely to be noticeable when the bullet has passed
through the clothing. In any case it is subsequently obscured by the
development of a narrow ring of discoloration due to the contusion. This
latter varies in width, and still later a halo of ecchymosis half an
inch or more in diameter surrounds the original wound.
[Illustration: FIG. 18.--Oblique Exit Gutter. Diagram enlarged to actual
size from case shown in fig. 24, p. 64.]
With increasing degrees of obliquity of impact more and more pronounced
oval openings of entry result, culminating in an actual gutter such as
is seen in fig. 17.
In all oval openings the loss of substance is more pronounced at the
proximal margin, while the wound is liable to undergo secondary
enlargement at the distal margin, since in the former the epidermis is
mainly affected, while in the latter the epidermis is spared as an
ill-nourished bridge, the deeper layers of the skin suffering the more
severely. When the wound occurs in regions, such as the chest-wall or
over the sacrum, where the skin is firmly supported, the oval openings
are often very considerable in size, reaching a diameter at least double
that of the circular ones. In the case of the oval openings the
depression of the margins is not such a well-marked feature as in wounds
resulting from rectangular impact of the bullet, since the distal margin
is really lifted.
[Illustration: FIG. 19.--Oval Entry Wound over third sacral vertebra.
Exit wound, anterior abdominal wall. Slightly starred variety. Diagram
made on second day]
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