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

George Henry Makins

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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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• Publié le: 08 décembre 2010
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• Langue: English

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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

89

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

187

191

159

161

164

169

237

244

245

252

200

209

219

222

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

258

257

256

255

253

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