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_), B (plate II.) represents a section of an infected exit
aperture from a patient who died seven and a half days after its
infliction. Two main points of interest are at once apparent: 1. The
carrying forwards of the subcutaneous fat into the lips of the skin
wound by the bullet. This illustrates the manner in which lightly
supported structures are carried forward by the bullet, and throws some
light on the mode by which vessels and nerves may escape by a process of
displacement. This figure may be compared with fig. 25 (_b_) which shows
a tag of omentum similarly carried forward by a bullet crossing the
abdominal cavity and plugging the exit wound. 2. The second feature of
interest is the amount of haemorrhage into the subcutaneous tissue. In
this respect the contrast between the exit and entry apertures is
marked, since in the latter haemorrhage is scarcely apparent. The
presence of such haemorrhages is explained by the same dragging action as
the extrusion of the fat, and is of course dependent on consequent
rupture of small vessels. It is of importance as predisposing the exit
wound to more easy infection, and it accounts for the persisting
subcutaneous induration more often detected beneath healed exit than
entry apertures. Again, it suggests that the presence of blood in the
deeper parts of the tracks may be the determining cause of the indurated
cords often replacing them.
[Illustration: PLATE II.
Engraved and Printed by Bale and Danielsson, Ltd.
G. L. CHEATLE.
Mauser Wound of Exit, 7-1/2 days after infliction. Healing delayed by
Infection. About 12/1.
Section of the exit segment of a Mauser wound, removed seven and a half
days after infliction. Magnified twelve diameters.
The healing process has been delayed by infection.
There is no attempt at closure by a layer of epidermis, and the margins
are not depressed.
The wound track is narrower than that seen in the entry wound plate I.,
and completely occluded by a plug of the subcutaneous fat which has been
carried forward by the bullet in its passage. A small wedge-shaped plug
of lymph indicates the position of the actual track at its termination.
Dragging on the surrounding tissue consequent on the extrusion of the
plug of fat has ruptured some capillaries, and given rise to
considerable extravasation of blood, which is seen as a darker layer in
the deepest portion of the wound.
Comparison of this plate with the exit wound depicted in fig. 16, p. 56,
explains the nature of the tags of tissue there seen to protrude from
the convex opening.
Range 800 yards. Seat of wound, abdominal wall below 9th costal
cartilage.]
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