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
[Illustration: FIG. 23.--Wound of both Thighs. First and second entry
typical circular wounds. First exit a small circular wound; the bullet
'set up' on contact with the femur without causing solution of
continuity of the bone, and second exit is irregular and large.
This diagram is of considerable interest when compared with fig. 22. I
believe the comparative regularity in the wounds to have been due to a
higher degree of velocity of flight on the part of the bullet]
Lastly, vertical or transverse slits may be looked for with considerable
confidence in situations in which transverse oblique or vertical folds
or creases normally exist in the skin, and depend on the lines of
tension maintained by the connection of the skin in these situations to
the underlying fascia. Thus I saw well-marked transverse and vertical
slits in the forehead corresponding with the creases normally found
there, and in this situation I noted some slit entries. Transverse
slits were common in the folds of the neck, the flexures of the joints
(fig. 20), and the anterior abdominal wall either in the mid line or in
creases like those stretching across from the anterior superior iliac
spines. Again they were seen in the palms and soles, but here more
readily tended to assume the stellate forms. Vertical slits are less
common; they occurred with the greatest frequency in the posterior
axillary folds.
Oval apertures of exit are far less common than those of entry, since
the most common factor for the production of an oval opening, bony
support, is never present. In long subcutaneous tracks, or very
superficial wounds, they are however sometimes met with and may
terminate in a pointed gutter (see figs. 18 and 24).
The greatest modifications in the appearance and nature of the apertures
of entry are dependent on previous deformation of the bullet, when all
special characteristics are lost, and it becomes impossible to form any
opinion as to the type of bullet concerned. These modifications are
naturally far more common in the aperture of exit, since the bullet so
often acquires deformity in the body as the result of impact with the
bones. Further remarks on this subject will be found with the
description and comparison of the various bullets on p. 81.
[Illustration: FIG. 24. Superficial Thoracico-abdominal Track. Small
entry: discoloration of surface over costal margin from deep injury to
skin; well-marked 'flame' gutter exit (see fig. 18)]
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