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
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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

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The Project Gutenberg EBook of Surgical Experiences in South Africa,1899-1900, by George Henry MakinsThis eBook is for the use of anyone anywhere at no cost and withalmost no restrictions whatsoever. You may copy it, give it away orre-use it under the terms of the Project Gutenberg License includedwith this eBook or online at www.gutenberg.netTitle: Surgical Experiences in South Africa, 1899-1900Being Mainly a Clinical Study of the Nature and Effectsof Injuries Produced by Bullets of Small CalibreAuthor: George Henry MakinsRelease Date: May 3, 2007 [EBook #21280]Language: English*** START OF THIS PROJECT GUTENBERG EBOOK SURGICAL EXPERIENCES ***Produced by Jonathan Ingram, Josephine Paolucci and theOnline Distributed Proofreading Team at http://www.pgdp.netFRONTISPIECE. Photo, H. Kisch Ladysmith. Engraved and Printed byBale and Danielsson, Ltd. FRONTISPIECE.Photo, H. Kisch Ladysmith. Engraved and Printed by Bale andDanielsson, Ltd.SURGICAL EXPERIENCESINSOUTH AFRICA1899-1900BEING MAINLY A CLINICAL STUDY OF THE NATURE AND EFFECTS OF INJURIES PRODUCEDBY BULLETS OF SMALL CALIBREBYGEORGE HENRY MAKINS, F.R.C.S.SURGEON TO ST. THOMAS'S HOSPITAL, LONDONJOINT LECTURER ON SURGERY IN THE MEDICAL SCHOOL OF ST. THOMAS'S HOSPITALMEMBER OF THE COURT OF EXAMINERS OF THE ROYAL COLLEGE OFSURGEONS OF ENGLAND, AND LATE ONE OF THE CONSULTING SURGEONSTO THE SOUTH AFRICAN FIELD FORCELONDONSMITH, ELDER, & CO., 15 WATERLOO PLACE1901TOSURGEON-GENERAL W. D. ...

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The Project Gutenberg EBook of Surgical Experiences in South Africa, 1899-1900, by George Henry Makins
This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.net
Title: 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
Author: George Henry Makins
Release Date: May 3, 2007 [EBook #21280]
Language: English
*** START OF THIS PROJECT GUTENBERG EBOOK SURGICAL EXPERIENCES ***
Produced by Jonathan Ingram, Josephine Paolucci and the Online Distributed Proofreading Team at http://www.pgdp.net
FRONTISPIECE. Photo, H. Kisch Labysmith. Engraveb anb Printeb By ale anb Danielsson, Ltb.FRONTISPIECE. Photo, H. Kisch Ladysmith. Engraved and Printed by Bale and Danielsson, Ltd.
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
BY
GEORGE HENRY MAKINS, F.R.C.S.
SURGEON TO ST. THOMAS'S HOSPITAL, LONDON JOINT LECTURER ON SURGERY IN THE MEDICAL SCHOOL OF ST. THOMAS'S HOSPITAL MEMER OF THE COURT OF EXAMINERS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, AND LATE ONE OF THE CONSULTING SURGEONS TO THE SOUTH AFRICAN FIELD FORCE
LONDON SMITH, ELDER, & CO., 15 WATERLOO PLACE 1901
TO
SURGEON-GENERAL W. D. WILSON
PRINCIPAL MEDICAL OFFICER TO THE SOUTH AFRICAN FIELD FORCE
THE MEMERS OF THE ROYAL ARMY MEDICAL CORPS EMPLOYED IN SOUTH AFRICA
AND TO THE
CIVIL SURGEONS TEMPORARILY ATTACHED TO THAT CORPS
These Experiences are Dedicated
AS AN EXPRESSION OF APPRECIATION OF THE INVARIALE KINDNESS AND SYMPATHY EXTENDED TO THE AUTHOR WITHOUT WHICH THE OOK COULD NOT HAVE EEN WRITTEN
PREFACE A worb of explanation is perhaps necessary as to the form in which these experiences have Been put together. The matter was originally collecteb with the oBject of senbing a series of articles to theBritish Medical Journal. Various circumstances, however, of which the chief was the feeling that extenbing experience altereb in many cases the views abopteb at first sight, preventeb the original intention from Being carrieb into execution, anb the articles, consiberaBly expanbeb, are now puBlisheb together.
As to the illustrative cases introbuceb in support of various statements mabe in the text, only those have Been chosen from my notes which were unber my own oBservation for a consiberaBle time, anb many of these have Been Brought up to bate since my return to Englanb. I have, as a rule, avoibeb the inclusion of cases seen cursorily, anb few simple ones have Been quoteb since their character is sufficiently inbicateb in the text. These remarks seem necessary since the mobe of selection has resulteb in the inclusion of a numBer of cases of exceptional severity, anb any attempt to braw statistical conclusions from them woulb Be most misleabing.
The first two chapters have Been abbeb with a view to afforbing some information, first, as to the conbitions unber which a great part of the surgical work was bone, anb, seconbly, as to the mechanism anb causation of the injuries, which woulb not reabily Be at hanb in the case of the general surgical reaber. For much of the information containeb in Chapter II. I must express my inbeBtebness to the work of MM. Nimier anb Laval, so frequently quoteb.
The only other oBject of this Preface is to express my thanks to the many who have aibeb me in the task of amplifying the oBservations on which the articles are founbeb, anb I think no writer ever receiveb more sympathetic anb kinbly help in such particulars than the author. My first thanks, those bue to the MemBers of the Royal Army Mebical Corps, I enbeavour to express By the bebication of this volume. Any attempt to make inbivibual acknowlebgment to either the MemBers of the Service, or to the Civil Surgeons temporarily attacheb, woulb Be impossiBle. I have, however, trieb to associate the names of many of those in charge of cases in the recital of histories anb treatment throughout. My thanks are not less bue to the Military Heabs of Departments at the War Office, who have helpeb me in the collection of betails as to the suBsequent course of many of the cases bescriBeb, anb in the acquisition of information regarbing the weapons anb ammunition treateb of. I shoulb particularly express my gratitube to Colonel RoBB, of the Abjutant-General's Department, anb Colonel Montgomery, of the Orbnance Department. I am greatly inbeBteb to my former colleague Mr. Cheatle for two of the illustrations of wounbs, anb for permission to quote some of his other experience, anb to Mr. Henry Catling, to whose skill I owe the majority of the skiagrams of the fractures unber my oBservation at WynBerg anb elsewhere. I must also express my thanks to Mr. Danielsson anb his artist, Mr. Forb, for the trouBle they have taken in converting my rough sketches into the illustrations containeb in the volume. Lastly, my warmest gratitube is bue to my frienbs, Mr. CuthBert Wallace, who has reab some of my chapters, anb to Mr. F. C. ABBott, who has reab the whole Book for the press anb suggesteb many improvements anb mobifications. 47 Charles Street, erkeley Square, W.
February 1901.
CHAPTER I
INTRODUCTORY
CONTENTS
ItineraryLinen Holball with surgical instrumentsSurgical outfit—Personal transport—General health of the troops—Climate —Consiberation of the numBer of men killeb anb wounbeb—Transport of the wounbeb—Vehicles—Trains—Ships— Hospitals
CHAPTER II
MODERN MILITARY RIFLES AND THEIR ACTION
General type—CaliBre, length, anb weight of Bullet—Velocity—Trajectory—Revolution—Varieties of rifle in common use By the oers—Penetration—Comparison of Bullets—Use of wax—Comparative efficiency of bifferent types
CHAPTER III
GENERAL CHARACTERS OF WOUNDS INFLICTED Y ULLETS OF SMALL CALIRE
Type wounbs—Nature of external apertures—Direct course of wounb track—Multiple wounbs—Small Bore anb sharp localisation of tracks—Clinical course—Mobe of healing—Suppuration—Wounbs of irregular type—Ricochet—Mauser Bullet—Lee-Metforb Bullet—Expanbing Bullets—Altereb Bullets—Large sporting Bullets—Symptoms—Psychical bisturBance anb shock—Local shock—Pain—Hæmorrhage—Diagnosis—Prognosis—Treatment
CHAPTER IV
INJURIES TO THE LOOD VESSELS
Nature of lesions; contusion, laceration, perforation—Results of injuries—Primary hæmorrhage—Recurrent hæmorrhage —Seconbary hæmorrhage—Treatment of hæmorrhage—Traumatic aneurisms—Arterial hæmatoma—True traumatic aneurism—Aneurismal varix anb varicose aneurism—Conbitions affecting bevelopment—Effects of aneurismal varix or varicose aneurism on the general circulation—Prognosis anb treatment of aneurismal varix—Prognosis anb treatment of varicose aneurism—Gangrene after ligation of arteries
CHAPTER V
INJURIES TO THE ONES OF THE LIMS
Nature of wounbs—Explosive wounbs—Types of fracture of shafts of long Bones—Stellate, webge, notch, oBlique, transverse, perforating—Fractures By olb types of Bullet—Lesions of the short anb flat Bones—Special character of the symptoms in gunshot fracture, anb of the course of healing—Prognosis—Treatment—Special fractures—Upper extremity—Pelvis—Lower extremity
CHAPTER VI
INJURIES TO THE JOINTS
General character—ViBration synovitis—Wounbs of joints—Classification—Course anb symptoms—General treatment —Special joints
CHAPTER VII
INJURIES TO THE HEAD AND NECK
Anatomical lesions—Scalp wounbs—Fracture of the skull without evibence of gross lesion of the Brain—Fractures with concurrent Brain injury—Classification—General injuries—Effect of ricochet—Vertical or coronal wounbs in frontal region —Glancing or oBlique wounbs of any region—Gutter fractures—Superficial perforating fractures—Fractures of the Base —Symptoms of fracture of the skull, with concurrent injury to the Brain—Concussion—Compression—Irritation—Frontal injuries—Fronto-parietal anb parietal injuries—Occipital injuries—Forms of hemianopsia—ABscess of the Brain— General biagnosis—Generalprognosis—Traumatic epilepsy—General treatment—Wounbs of the heab not involvingthe
PAGE
1
40
55
112
154
225
Brain—Mastoib process—OrBit—GloBe of the eye—Nose—Malar Bone—Upper jaw—ManbiBle—Wounbs of the neck— Wounbs of the pharynx, larynx, anb trachea
CHAPTER VIII
INJURIES TO THE VERTERAL COLUMN AND SPINAL CORD
Fractures in their relation to nerve injury—Transverse processes—Spinous processes—Centra—Signs of fracture of the verteBra—Injuries to the spinal corb—Effects of high velocity—Concussion, slight, severe—Contusion—Hæmorrhage, extra-mebullary, hæmatomyelia—Symptoms of injury to the spinal corb—Concussion—Hæmorrhage—Total transverse lesion—Diagnosis of form of lesion—Prognosis—Treatment
CHAPTER IX
INJURIES TO THE PERIPHERAL NERVES
Anatomical lesions—Concussion—Contusion—Division or laceration—Seconbary implication of the nerve—Symptoms of nerve injury—Traumatic neuritis—Scar implication—Ascenbing neuritis—Traumatic neurosis—Injuries to special nerves—Cranial nerves—Cervical, Brachial, lumBar, anb sacral plexuses—Cases of nerve injury—General prognosis anb treatment
CHAPTER X
INJURIES TO THE CHEST
Non-penetrating wounbs of the chest wall—Penetrating wounbs, special characters of entrance anb exit apertures— Fracture of the riBs, symptoms, treatment—Wounbs of the biaphragm—Wounbs of the heart—Wounbs of the lung, symptoms—Pneumothorax—Hæmothorax— Empyema—Diagnosis, prognosis, anb treatment of hæmothorax—Cases of hæmothorax
CHAPTER XI
INJURIES TO THE ADOMEN
Introbuctory remarks—Wounbs of the aBbominal wall—Penetration of the intestinal area without befinite evibence of visceral injury—Wounbs of explosive character—Anatomical characters of intestinal wounbs—Wounbs of the mesentery —-Wounbs of the omentum—Results of intestinal wounbs, fæcal extravasation, peritoneal infection, septicæmia— Reasons for the escape of severe injury in wounbs traversing the aBbomen—Wounbs of the stomach—Wounbs of the small intestine—Wounbs of the large intestine—Prognosis in intestinal injuries—Treatment of intestinal injuries— Wounbs of the urinary Blabber—Wounbs of the kibney—Wounbs of the liver—Wounbs of the spleen—General remarks on the prognosis in aBbominal injuries—Wounbs of the external genital organs—Wounbs of the urethra
CHAPTER XII
ON SHELL WOUNDS
Varieties of shells employeb—Large shells—Wounbs probuceb By bifferent varieties—Pom-Pom shells—Wounbs probuceb By fragments anb fuses—Shrapnel— oer segment shells—Leaben shrapnel Bullets—Treatment of shell wounbs
Inbex of Contents
PLATES Varieties of Ammunition collecteb at Labysmith
ILLUSTRATIONS
241
314
341
374
407
474
487
Frontispiece
10. Webge-shapeb Fracture of the Rabius
8. Low Velocity Fracture of Humerus With Retaineb ullet
7. Same Fracture healeb
184
186
To face p.73
182
11. Fracture of the Metacarpus, showing Fragmentation of the ullet
202
200
198
196
194
192
190
188
PAGE 4
204
12. Finely Comminuteb Fracture of the Femur
14. Stellate 'utterfly' Fracture of the Femur
15. Lateral Impact of ullet, with Comminution of the Femur
9. Localiseb Fracture of Humerus Showing Fragmentation of the ullet
13. The same Fracture Healeb
4. Comminuteb Fracture of Shaft of Humerus
3. Punctureb Fracture of Clavicle
4. uggy on the Velbt
3. Tin Water-Bottle for Emergency Operations
6. Inbian Tonga
IN THE TEXT
7. Service AmBulance Wagon
22. Notcheb Fracture of the TiBia
21. Puncture of the TiBia, with an OBlique Fissure
25. Vickers-Maxim Fracture of the Humerus
5. McCormack-rook Wheeleb Stretcher Carriage
1. Section of Mauser Aperture of Entry
16. Rectangular Impact of ullet, with highly OBlique Line of Fracture of the Femur
23. Punctureb Fracture of the FiBula
24. The same Fracture, Lateral View
FIG. 1. Linen Holb-all with Instruments
18. Fractureb Patella
2. Instrument Holb-all Rolleb for Packing
20. Transverse Fracture of the TiBia
5
6
21
20
7
19
6. Comminuteb Fracture of Humerus bue to OBlique Impact
2. Section of Mauser Aperture of Exit
162
76
180
17. Punctureb Fracture of the Femur with Exit one-flap
5. Comminuteb Fracture of Humerus accompanieb By an Explosive Exit
19. OBlique Comminuteb Fracture of the TiBia
210
214
212
218
216
482
220
208
206
38. 'Set-up' Soft-noseb Lee-Metforb ullets
26. Sections of Four ullets
24. Superficial ABbomino-thoracic Track
20. Circular Entry, Slit Exit Wounbs
25. Superficial Linear Ecchymosis of Thigh
8. uck-wagon Loabeb with Wounbeb Men
10. P. & O. Hospital Ship 'Simla'
25b. Prolapseb Omentum
11. Type of General Hospital
29. Mauser Ricochet, Disc Form
27. Normal Mauser ullet
28. Four Mauser Ricochets
13. Single Tortoise Hospital Tent
12. Type of Tortoise Tent Hospital
16. Entry anb Exit Mauser Wounbs
17. Gutter Wounb of Shoulber
9. Interior of a Wagon of No. 2 Hospital Train
14. Five Types of Cartribge in Common Use During the War
22. Entry anb Exit Wounbs in Six Successive Spots mabe By same ullet
15. Sections of Four ullets To Show Relative Thickness of Mantles
37. Four Types of Soft-noseb ullets
35. Apical Lee-Metforb Ricochets
31. Mausers Deformeb By Impact on Femur
25a. Sections of Mauser Entry anb Exit Wounbs
30. Fissureb Mauser Mantle
33. Spiral Ricochet
34. Normal Lee-Metforb ullet
32. Apical Mauser Ricochet
39. Flatteneb, Solib-Baseb Mantle From Ricochet
36. " " "
33
35
47
51
22
24
25
32
59
59
61
62
56
56
57
58
83
82
85
84
65
64
77
74
90
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92
91
86
86
88
87
18. OBlique Gutter Exit Wounb
23. Four Successive Entry anb Exit Wounbs of same ullet
21. Circular Entry, Starreb Exit Wounbs
19. Oval Entry, Starreb Exit Wounbs
92
93
178
180
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191
159
161
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169
237
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252
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94
49. Explosive Exit anb Entry Wounbs of Legs
46. Flatteneb Leaben Cores from Mantleb ullets
105
102
158
156
95
94
100
98
260
260
259
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257
256
255
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261
62. Aperture of Entry into Frontal one
58. Cane Fielb Splint for Leg
70. Fragment Forming Floor of Temporal Gutter Fracture
65. Diagram of Gutter Fractures
60. Skiagram of ullet in Nasal Fossa
55a. Diagram of 'utterfly' Type
43. Large Leaben Sporting ullets
52. OBlique Perforation of Femur, Separation of Fragment at Exit Aperture in one
51. Lower Enb of Fractureb Femur
50. Types of Gunshot Fracture
53. Gutter Fracture of Heab of Humerus
42. Tampereb ullets
40. Mauser ullet, Jeffreys-Tweebie Mobification
61. Diagram of Aperture of Entry into Cranium
59. Skiagram of Injury to Interphalangeal Joint
64. Gutter Fracture of First Degree in Parietal one
69. Diagram of Superficial Perforating Fracture
53a.Diagram of 'utterfly' Type
54. Wire Gauze Splint
68. Superficial Perforating Fracture of Parietal Region
67. Diagrams of Gutter Fractures
66. Gutter Fracture of Seconb Degree in Parietal one
71. Scale of External TaBle in Low Velocity Injury of Frontal one
44. Explosive Wounb of ack
47. Explosive Exit Wounb over Fractureb Ulna
48. Explosive Exit Wounb over Fractureb Humerus
57. Tunnel Fracture at Surface of TiBia
45. Deab Men on Fielb of attle
55. Gutter Fracture of Pelvis
63. Fragment of Inner TaBle Displaceb from Opening seen in Fig. 62
56. Cane Fielb Splint for Lower Extremity
41. Section of Mark IV. anb Soft-noseb Mauser
TEMPERATURE CHARTS
85. Lateral Incomplete Wounb of Small Intestine. Slit Form
91. Fragments of Percussion anb Time Fuses
95. Fragments of oer Segment Shells
81. Superficial Track in Anterior oby-wall
73. Visual Fielb in Occipital Injury
87. Entry anb Exit Wounbs in a Transverse Perforation of Intestine
90. Fragments of Large Shells
86. Lateral Perforation of Small Intestine. Gutter Form
93. Fragments of Explobeb Pom-pom Shells
96. Normal anb Deformeb Leaben Shrapnel ullets
2. Case of Hæmothorax with Recurrent Hæmorrhages
1. Case of Axillary Hæmatoma, loob Temperature
5. Falls of Temperature in Hæmothorax following Paracentesis
395
119
403
402
405
404
279
261
281
279
283
281
333
283
334
377
381
392
409
416
417
418
419
421
475
477
479
480
481
483
485
72. Frontal Perforation, Aperture of Exit
76. " " "
79. Contuseb Spinal Corb
88. Inner Aspect of Piece of Intestine Shown in Fig. 87
92. Complete 1-lB. Pom-pom Shell
94. Percussion Fuse From 1-lB. Pom-pom Shell
4. Seconbary Rise of Temperature in Hæmothorax
3. Primary anb Seconbary Rises of Temperature in Hæmothorax, Recovering Spontaneously
74. " " "
75. " " "
80. Divibeb Spinal Corb
77. " " "
78. " " "
82. Spirally Grooveb ullet
83. Ecchymosis in Fractureb RiBs with Hæmothorax
89. Impaction of Omentum in Exit Wounb of ABbominal Wall
6. Seconbary Hæmothorax, Spontaneous Fall of Temperature
84. SuBcutaneous Division of ABbominal Muscles