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

CONTENTS

PAGE
CHAPTER I
INTRODUCTORY
ItineraryLinen Holdall with surgical instrumentsSurgical outfit—Personal transport—General health of the troops—Climate—Consideration of the number of men killed and wounded—Transport of the wounded—Vehicles—Trains—Ships—Hospitals 1
CHAPTER II
MODERN MILITARY RIFLES AND THEIR ACTION
General type—Calibre, length, and weight of bullet—Velocity—Trajectory—Revolution—Varieties of rifle in common use by the Boers—Penetration—Comparison of bullets—Use of wax—Comparative efficiency of different types 40
CHAPTER III
GENERAL CHARACTERS OF WOUNDS INFLICTED BY BULLETS OF SMALL CALIBRE
Type wounds—Nature of external apertures—Direct course of wound track—Multiple wounds—Small bore and sharp localisation of tracks—Clinical course—Mode of healing—Suppuration—Wounds of irregular type—Ricochet—Mauser bullet—Lee-Metford bullet—Expanding bullets—Altered bullets—Large sporting bullets—Symptoms—Psychical disturbance and shock—Local shock—Pain—HÆmorrhage—Diagnosis—Prognosis—Treatment 55
CHAPTER IV
INJURIES TO THE BLOOD VESSELS
Nature of lesions; contusion, laceration, perforation—Results of injuries—Primary hÆmorrhage—Recurrent hÆmorrhage—Secondary hÆmorrhage—Treatment of hÆmorrhage—Traumatic aneurisms—Arterial hÆmatoma—True traumatic aneurism—Aneurismal varix and varicose aneurism—Conditions affecting development—Effects of aneurismal varix or varicose aneurism on the general circulation—Prognosis and treatment of aneurismal varix—Prognosis and treatment of varicose aneurism—Gangrene after ligation of arteries 112
CHAPTER V
INJURIES TO THE BONES OF THE LIMBS
Nature of wounds—Explosive wounds—Types of fracture of shafts of long bones—Stellate, wedge, notch, oblique, transverse, perforating—Fractures by old types of bullet—Lesions of the short and flat bones—Special character of the symptoms in gunshot fracture, and of the course of healing—Prognosis—Treatment—Special fractures—Upper extremity—Pelvis—Lower extremity154
CHAPTER VI
INJURIES TO THE JOINTS
General character—Vibration synovitis—Wounds of joints—Classification—Course and symptoms—General treatment—Special joints225
CHAPTER VII
INJURIES TO THE HEAD AND NECK
Anatomical lesions—Scalp wounds—Fracture of the skull without evidence of gross lesion of the brain—Fractures with concurrent brain injury—Classification—General injuries—Effect of ricochet—Vertical or coronal wounds in frontal region—Glancing or oblique wounds 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 and parietal injuries—Occipital injuries—Forms of hemianopsia—Abscess of the brain—General diagnosis—General prognosis—Traumatic epilepsy—General treatment—Wounds of the head not involving the brain—Mastoid process—Orbit—Globe of the eye—Nose—Malar bone—Upper jaw—Mandible—Wounds of the neck—Wounds of the pharynx, larynx, and trachea 241
CHAPTER VIII
INJURIES TO THE VERTEBRAL 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 cord—Effects of high velocity—Concussion, slight, severe—Contusion—HÆmorrhage, extra-medullary, hÆmatomyelia—Symptoms of injury to the spinal cord—Concussion—HÆmorrhage—Total transverse lesion—Diagnosis of form of lesion—Prognosis—Treatment314
CHAPTER IX
INJURIES TO THE PERIPHERAL NERVES
Anatomical lesions—Concussion—Contusion—Division or laceration—Secondary implication of the nerve—Symptoms of nerve injury—Traumatic neuritis—Scar implication—Ascending neuritis—Traumatic neurosis—Injuries to special nerves—Cranial nerves—Cervical, brachial, lumbar, and sacral plexuses—Cases of nerve injury—General prognosis and treatment 341
CHAPTER X
INJURIES TO THE CHEST
Non-penetrating wounds of the chest wall—Penetrating wounds, special characters of entrance and exit apertures—Fracture of the ribs, symptoms, treatment—Wounds of the diaphragm—Wounds of the heart—Wounds of the lung, symptoms—Pneumothorax—HÆmothorax— Empyema—Diagnosis, prognosis, and treatment of hÆmothorax—Cases of hÆmothorax374
CHAPTER XI
INJURIES TO THE ABDOMEN
Introductory remarks—Wounds of the abdominal wall—Penetration of the intestinal area without definite evidence of visceral injury—Wounds of explosive character—Anatomical characters of intestinal wounds—Wounds of the mesentery—-Wounds of the omentum—Results of intestinal wounds, fÆcal extravasation, peritoneal infection, septicÆmia—Reasons for the escape of severe injury in wounds traversing the abdomen—Wounds of the stomach—Wounds of the small intestine—Wounds of the large intestine—Prognosis in intestinal injuries—Treatment of intestinal injuries—Wounds of the urinary bladder—Wounds of the kidney—Wounds of the liver—Wounds of the spleen—General remarks on the prognosis in abdominal injuries—Wounds of the external genital organs—Wounds of the urethra 407
CHAPTER XII
ON SHELL WOUNDS
Varieties of shells employed—Large shells—Wounds produced by different varieties—Pom-Pom shells—Wounds produced by fragments and fuses—Shrapnel— Boer segment shells—Leaden shrapnel bullets—Treatment of shell wounds474
Index of Contents487

ILLUSTRATIONS

PLATES

Varieties of Ammunition collected at LadysmithFrontispiece
1. Section of Mauser Aperture of Entry To face p. 73
2. Section of Mauser Aperture of Exit 76
3. Punctured Fracture of Clavicle162
4. Comminuted Fracture of Shaft of Humerus180
5. Comminuted Fracture of Humerus accompanied by an Explosive Exit182
6. Comminuted Fracture of Humerus due to Oblique Impact184
7. Same Fracture healed186
8. Low Velocity Fracture of Humerus With Retained Bullet188
9. Localised Fracture of Humerus Showing Fragmentation of the Bullet190
10. Wedge-shaped Fracture of the Radius192
11. Fracture of the Metacarpus, showing Fragmentation of the Bullet194
12. Finely Comminuted Fracture of the Femur196
13. The same Fracture Healed198
14. Stellate 'Butterfly' Fracture of the Femur200
15. Lateral Impact of Bullet, with Comminution of the Femur202
16. Rectangular Impact of Bullet, with highly Oblique Line of Fracture of the Femur204
17. Punctured Fracture of the Femur with Exit Bone-flap206
18. Fractured Patella208
19. Oblique Comminuted Fracture of the Tibia210
20. Transverse Fracture of the Tibia212
21. Puncture of the Tibia, with an Oblique Fissure214
22. Notched Fracture of the Tibia216
23. Punctured Fracture of the Fibula218
24. The same Fracture, Lateral View 220
25. Vickers-Maxim Fracture of the Humerus 482

IN THE TEXT

FIG. PAGE
1. Linen Hold-all with Instruments4
2. Instrument Hold-all Rolled for Packing5
3. Tin Water-bottle for Emergency Operations6
4. Buggy on the Veldt7
5. McCormack-Brook Wheeled Stretcher Carriage19
6. Indian Tonga20
7. Service Ambulance Wagon21
8. Buck-wagon Loaded with Wounded Men22
9. Interior of a Wagon of No. 2 Hospital Train24
10. P. & O. Hospital Ship 'Simla'25
11. Type of General Hospital 32
12. Type of Tortoise Tent Hospital 33
13. Single Tortoise Hospital Tent 35
14. Five Types of Cartridge in Common Use During the War47
15. Sections of Four Bullets To Show Relative Thickness of Mantles51
16. Entry and Exit Mauser Wounds56
17. Gutter Wound of Shoulder56
18. Oblique Gutter Exit Wound 57
19. Oval Entry, Starred Exit Wounds58
20. Circular Entry, Slit Exit Wounds59
21. Circular Entry, Starred Exit Wounds59
22. Entry and Exit Wounds in Six Successive Spots made by same Bullet61
23. Four Successive Entry and Exit Wounds of same Bullet62
24. Superficial Abdomino-thoracic Track64
25. Superficial Linear Ecchymosis of Thigh65
25a. Sections of Mauser Entry and Exit Wounds74
25b. Prolapsed Omentum77
26. Sections of Four Bullets82
27. Normal Mauser Bullet83
28. Four Mauser Ricochets 84
29. Mauser Ricochet, Disc Form 85
30. Fissured Mauser Mantle 86
31. Mausers Deformed by Impact on Femur 86
32. Apical Mauser Ricochet 87
33. Spiral Ricochet88

34. Normal Lee-Metford Bullet89
35. Apical Lee-Metford Ricochets90
36. " " " 91
37. Four Types of Soft-nosed Bullets92
38. 'Set-up' Soft-nosed Lee-Metford Bullets92
39. Flattened, Solid-based Mantle From Ricochet93
40. Mauser Bullet, Jeffreys-Tweedie Modification94
41. Section of Mark IV. and Soft-nosed Mauser94
42. Tampered Bullets95
43. Large Leaden Sporting Bullets98
44. Explosive Wound of Back100
45. Dead Men on Field of Battle102
46. Flattened Leaden Cores from Mantled Bullets105
47. Explosive Exit Wound over Fractured Ulna156
48. Explosive Exit Wound over Fractured Humerus158
49. Explosive Exit and Entry Wounds of Legs159
50. Types of Gunshot Fracture161
51. Lower End of Fractured Femur164
52. Oblique Perforation of Femur, Separation of Fragment at Exit Aperture in Bone169
53. Gutter Fracture of Head of Humerus178
53a. Diagram of 'Butterfly' Type180
54. Wire Gauze Splint 187
55. Gutter Fracture of Pelvis 191
55a. Diagram of 'Butterfly' Type 200
56. Cane Field Splint for Lower Extremity 209
57. Tunnel Fracture at Surface of Tibia 219
58. Cane Field Splint for Leg 222
59. Skiagram of Injury to Interphalangeal Joint 237
60. Skiagram of Bullet in Nasal Fossa 244
61. Diagram of Aperture of Entry into Cranium 245
62. Aperture of Entry into Frontal Bone 252
63. Fragment of Inner Table Displaced from Opening seen in Fig. 62 253
64. Gutter Fracture of First Degree in Parietal Bone 255
65. Diagram of Gutter Fractures 256
66. Gutter Fracture of Second Degree in Parietal Bone 257
67. Diagrams of Gutter Fractures 258
68. Superficial Perforating Fracture of Parietal Region 259
69. Diagram of Superficial Perforating Fracture 260
70. Fragment Forming Floor of Temporal Gutter Fracture 260

71. Scale of External Table in Low Velocity Injury of Frontal Bone 261
72. Frontal Perforation, Aperture of Exit 261
73. Visual Field in Occipital Injury 279
74. " " " 279
75. " " " 281
76. " " " 281
77. " " " 283
78. " " " 283
79. Contused Spinal Cord 333
80. Divided Spinal Cord 334
81. Superficial Track in Anterior Body-wall 377
82. Spirally Grooved Bullet 381
83. Ecchymosis in Fractured Ribs with HÆmothorax392
84. Subcutaneous Division of Abdominal Muscles409
85. Lateral Incomplete Wound of Small Intestine. Slit Form416
86. Lateral Perforation of Small Intestine. Gutter Form417
87. Entry and Exit Wounds in a Transverse Perforation of Intestine418
88. Inner Aspect of Piece of Intestine Shown in Fig. 87419
89. Impaction of Omentum in Exit Wound of Abdominal Wall421
90. Fragments of Large Shells 475
91. Fragments of Percussion and Time Fuses 477
92. Complete 1-lb. Pom-pom Shell 479
93. Fragments of Exploded Pom-pom Shells 480
94. Percussion Fuse From 1-lb. Pom-pom Shell481
95. Fragments of Boer Segment Shells 483
96. Normal and Deformed Leaden Shrapnel Bullets 485

TEMPERATURE CHARTS

1. Case of Axillary HÆmatoma, Blood Temperature 119
2. Case of HÆmothorax with Recurrent HÆmorrhages 395
3. Primary and Secondary Rises of Temperature in HÆmothorax, Recovering Spontaneously 402
4. Secondary Rise of Temperature in HÆmothorax 403
5. Falls of Temperature in HÆmothorax following Paracentesis 404
6. Secondary HÆmothorax, Spontaneous Fall of Temperature 405

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