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
Fig. 25 (_a_), A (plate I.) represents a section carried across an
aseptic aperture of entry. The specimen was removed by Mr. Cheatle from
a patient who died forty-eight hours after reception of the injury. It
shows well the small amount of gross destruction suffered by the
subcutaneous tissue, and the rapid repair which follows, since
macroscopically the track is scarcely discernible. Reference to plate I.
shows the remarkable fact that even at this early date considerable
progress towards definite healing has occurred, and a thin layer of
stratified epidermis covers the original opening. The question may be
raised whether the origin of this epidermal layer is not in part a
floating up of the margins of the main aperture.
During the course of healing some variation takes place in the
appearance of the apertures, especially that of entry. This, at first
contracted, later becomes somewhat relaxed, while in many cases a small
halo of ecchymosis develops around it. The blood-clot occupying its
centre now contracts, the margins rapidly become approximated
centripetally, and a small circular dark spot only remains, which is
later replaced by a small red cicatrix. The dark central spot under
these circumstances consists of the contused margin of the wound in the
skin, and a small proportion of blood-clot which finally comes away as a
small dry scab. When slight local infection occurs in place of simple
contraction and dry scabbing, the process is prolonged, the contused
margin separates by granulation, the clot in the opening breaks down,
and a small ulcer of somewhat larger proportions than the original wound
remains and takes some days to heal.
[Illustration: FIG. 25 (_a_).--_A._ Wound of entry 48 hours after
reception. _B._ Wound of exit, 7-1/2 days after reception. 1. Skin. 2.
Subcutaneous fat carried into the lips of the wound by the bullet. 3.
Infected blood extravasation in subcutaneous tissue. Exact size. (See
plates I. and II.)]
The aperture of exit in simple wounds of the soft parts sometimes heals
even more rapidly than that of entry, and if of the slit form may be
almost invisible at the end of ten days or a fortnight, actual primary
union having taken place as after a simple small incision. Larger or
irregular exit apertures, however, take a longer period to close than
entry wounds, and this is most often observed when the bullet has
undergone deformation within the body, or bone fragments have been
driven out with the bullet.
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