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
3. _Multiple character of the wounds._--The same conditions responsible
for the length and directness of the tracks, account for the frequently
multiple character of the wounds implicating either the limbs or
viscera--thus, lung, stomach, liver; neck, thorax, abdomen; abdomen,
pelvis, thigh. Also for the frequent infliction of two or more separate
tracks by the same bullet--thus, arm and forearm with the elbow in the
flexed position; both lower extremities; both lower extremities, penis
or scrotum; leg, thigh, and abdomen, with a flexed knee; upper extremity
and trunk, and more rarely one upper and one lower extremity. Again, it
was remarkable how often the same bullet would inflict injuries on two
or more separate men, not unfrequently dealing lightly with the first
and inflicting a fatal injury on the second, or vice versa. The small
calibre of the bullet, moreover, allows of the neatest and most exact
multiple injuries. Thus in a patient who was crawling up a kopje on all
fours, the flexed middle digit of the hand was struck. The bullet
entered at the base of the nail, first emerged at the distal
interphalangeal flexor fold, re-entered the metacarpo-phalangeal fold,
and finally emerged from the back of the hand between the third and
fourth metacarpal bones.
4. _Small 'bore' of the tracks, and tendency of the injury to be
localised to individual structures of importance._--Here we meet with
the most striking characteristic of the injuries, and evidence that
reduction of calibre affects more strongly the nature of the lesion than
does any other element in the structure of the modern rifle. The
diameter of the track slightly exceeds that of the external apertures,
probably as a result of the more ready separability of the elements of
the structures perforated than exists in the skin. The calibre,
moreover, tends to be fairly even throughout when soft structures only
are implicated, though local enlargements result wherever increased
resistance is met with. Thus a strong fascia may offer such resistance
as to increase locally the bore of the track, and in this particular the
state of tension of the fascia when struck will affect the degree of the
enlargement. The most striking instances of local enlargement of the
track are of course seen when a bone lies in the course of the bullet,
but we must here bear in mind the introduction of a new element--the
propulsion of comminuted fragments together with the bullet itself. In
cases of fracture the distal portion of the track is in consequence many
times larger than the proximal. The most striking examples of small even
tracks are seen, on the other hand, in punctures of the elastic and
practically homogeneous lung tissue, where the wounds are extremely
small.
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