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
_Prognosis._--The question of general mortality amongst the wounded has
already been considered (Chapter I. p. 11), and it has been shown,
putting aside those dying at once on the field, or during the first
twenty-four hours, that the mortality was a low one. Some other points
specially dependent on the nature of the injury are, however, worthy of
mention in this place. First, it has been shown, with a slight
reservation as to when a wound can be considered definitely sound, that
if suppuration did not occur, healing was rapid, and that many men with
slight wounds were back with their regiments in the course of a very few
days. Again, that suppuration when it did occur tended to be local in
character; none the less, if it was at all extensive, it often proved
very prolonged and difficult of treatment, while residual abscesses
after apparent healing were not uncommon. In connection with this
subject I may quote from Colonel Stevenson[12] an observation that limbs
the subject of marked local shock are especially liable to furnish
septic discharges. Parts the subject of local shock when infected show a
lesser degree of vitality and power of resistance to the spread of
infection than do normal ones, and if infected do badly. I think I
convinced myself of this on many occasions, and also of the fact that
cases of fracture in which this condition was marked were slow in
consolidating. Again I am inclined to think that the bad results which
sometimes followed the tying of the limb arteries were also consequent
on lowered vitality, and possibly vaso-motor disturbance due to the
effects of the exquisite vibratory force to which the nerves had been
subjected. On this account I was never anxious to hurry operations in
such cases, unless obviously necessary at the moment.
The larger question of general nervous breakdown as the result of
injuries from bullets of small calibre is at present hardly capable of
an answer, and is so complicated by the co-existence of concurrent
mental anxiety, exposure, &c., that a definite answer will always be
difficult. I think there is already sufficient evidence, however, to
suggest that the remote effects of many of these injuries may be far
more serious than we expected at the moment, especially in the direction
of sclerotic changes in the nervous system.
_Treatment_.--In view of the remarks on the treatment of special
injuries contained in succeeding chapters, I shall confine myself here
to the question of the treatment of wounds of the soft parts alone.
Public-domain text, read in full here on John Shaqi.
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