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
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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
On transverse section of the track the gross amount of actual tissue
destruction occupies a lesser area than that corresponding to the
diameter of the bullet. The destructive action of the projectile is in
fact exerted mainly on the tissues directly lying in its course, the
track being opened up during the rush of the passage of the bullet,
partly as a result of its wedge-like shape and partly as a result of the
throwing off of the tissues forming the walls of the track by a
diversion of a portion of the force in the form of spiral vibrations
dependent on the revolution of the bullet. Again, the opening out of the
tissues may be aided by the direction taken by the first and strongest
as well as the simplest series of vibrations transmitted, which would
assume the shape of a cone of which the point of impact forms the apex.
The escape from actual destruction by structures lying in the immediate
neighbourhood of the track is indeed often surprising, but not perhaps
so astonishing as the perforation of long narrow structures such as the
peripheral nerves and vessels, without irreparable damage to the parts
remaining, and this although the structures themselves may be of a
diameter not exceeding that of the bullet itself. The capacity of these
projectiles to split such structures as tendons was already well known
before our experience in this campaign, but the injuries to the nerves
and vessels of the same character came as a surprise to most of us. The
lateral displacement of tissues seems to bear a strong resemblance to
what is seen on the passage of an express train, when solid bodies of
considerable weight are displaced by the draught created without ever
coming into contact with the train itself. The tendency to lateral
displacement is still more strongly exhibited when dense hard structures
such as bone are implicated. Here the fragments at the actual points of
impact on the proximal and distal surfaces of a shaft are driven
forwards, while the lateral walls of the track in the bone are simply
comminuted and pushed on one side without loss of continuity with their
covering periosteum.
The extension of this form of displacement to a degree amounting to a
so-called explosive character in the case of the soft tissues, even when
the bullet passed at the highest degrees of velocity, was, however,
never witnessed by me, and I very much doubt the existence of a
so-called 'explosive zone' so far as wounds of the soft parts are
concerned. On the contrary, I am inclined to believe that the highest
degrees of velocity are favourable to clean-cut neat injuries of the
soft tissues. I saw a large number of type wounds of entry and exit
inflicted at a range of under fifty yards.
Public-domain text, read in full here on John Shaqi.
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