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
If, however, a wound crosses from side to side a region such as the
thigh where well-marked differences exist in the subjacent support,
thickness, and elasticity of the skin implicated in the apertures, the
wound of entry, if in the thick skin of the outer aspect, was usually
circular, while the exit in the thin elastic skin of the inner aspect
was either slit-like or starred. The difficulty in laying down any
general rule as to the occurrence of circular or slit apertures of exit
in any definite region is, however, great, as may be seen by reference
to the accompanying diagrams taken from two patients wounded at
Paardeberg (figs. 22 and 23).
In fig. 22 the bullet entered the outer and posterior aspect of the left
buttock, crossed the limb behind the femur, and emerged at the inner
aspect by a vertical slit: the bullet then entered the scrotum by a
vertical slit, and emerged by a typical circular aperture; re-entered
the right thigh by a transverse slit aperture, and, striking the femur
in its further course, underwent deformation, and finally escaped by an
irregular aperture 3/4 of an inch in diameter. The occurrence of exit
slits in the adductor region is common, and to be explained by the
tendency of the comparatively thin elastic skin to be carried before the
bullet; the slit entry in this position must, I suppose, be explained by
the comparatively slight support afforded by the underlying structures,
which are often in a condition of hollow tension. The scrotal wounds are
perhaps more difficult to account for, but in this case the fact of the
distal aperture being directly supported by the right thigh is a ready
explanation of the circular exit, while the skin corresponding to the
slit entry was no doubt carried before the bullet, and finally gave way
in the line of a normal crease.
[Illustration: FIG. 22.--Entry and Exit Wounds in both thighs and
scrotum. From right to left: 1. Circular entry in left buttock behind
trochanter. 2. Vertical slit exit in adductor region. 3. Slit entry in
scrotum (probably inverted before bullet broke the surface, and then a
slit occurred in a normal crease). 4. Circular exit in scrotum (here
supported by surface of right thigh). 5. Transverse slit entry in right
adductor region. 6. Irregular 'explosive' exit, the bullet having set up
on contact with the front surface of the femur, but without having
caused solution of continuity of the bone.]
In fig. 23 all the wounds are circular except the final exit, which was
irregular as a result of the bullet in this case also having struck the
femur in the second thigh. Considerable variation also exists in the
size of the circular apertures; this illustrates the secondary
enlargement often occurring in such wounds, and most marked at the
apertures of entry, as the more contused. Both diagrams were made from
patients eight days after the reception of the wounds.
Public-domain text, read in full here on John Shaqi.
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