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
One word may be added as to the treatment of shock when severe. Quiet in
the supine position, and the administration of a small amount of
stimulant, was usually all that was required. Hypodermic injections of
strychnine sulph. grs. 1/30 to 1/10 were useful, and in some severe
cases, especially where operations were needed, saline infusions with a
small amount of stimulant were made into the veins, either at the elbow,
or in amputation cases into one of the large veins exposed.
The treatment of haemorrhage is dealt with in Chapter IV.
The after treatment of simple wounds needs little comment, but bearing
in mind what has been said as to the definite healing of the internal
portion of the tracks, it will be obvious that in parts such as the
thigh or calf, care was needed as to not commencing active work at too
early a date. On the other hand, a too long period of absolute rest is
also to be deprecated. The best results were obtained by careful
movement and massage, commenced after the first week or ten days,
according to the appearance presented by the external wound, followed by
a gradual resumption of active movement. It was a striking fact that
some of the patients suffering from such wounds took longer to become
apparently well than many of those who had suffered visceral injuries.
FOOTNOTES:
[9] _Loc. cit._ p. 31.
[10] _Loc. cit._ p. 100.
[11] _Loc. cit._ pp. 54, 55.
[12] _Wounds in War_, p. 83. Longmans & Co. 1897.
[13] A First Field Dressing, _Brit. Med. Jour._ 1900, vol. ii. p. 668.
CHAPTER IV
INJURIES TO THE BLOOD VESSELS
The small calibre of the modern bullet, and its tendency to take a
direct course, naturally favour the occurrence of more or less
uncomplicated wounds of the large vascular trunks, and both the nature
of these wounds and the results which follow them are in some respects
most characteristic.
NATURE OF THE LESIONS
1. _Contusion or laceration without perforation._--(_a_)The vessel may
be struck laterally, the injured portion then forming a part of the
bounding wall of the wound track, or (_b_) one or more layers of the
vessel wall may be destroyed over a limited area. Given primary union,
these conditions are only of importance in so far as subsequent
contraction of the lumen of the vessel may result from implication in
the neighbouring cicatrix. One of the most striking features of the
wounds as a whole was seen in the hair-breadth escapes of the large limb
vessels with no subsequent ill effects, and such injuries were seen in
every situation.
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