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.

  • Makins, George Henry, Sir, 1853-
Date:
1901
Catalogue details

Licence: In copyright

Credit: 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. Source: Wellcome Collection.

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    of the bullet was particularly well marked. The exit wounds w^ere often smaller than those of entry, especially if the bullet emerged by an intercostal space; even when the ribs were comminuted, the fragments were, as a rule, too small to occasion more than a slightly enlarged and irregular aper- ture. Taken as a class, however, and putting aside explosive exit wounds, wounds of the chest afforded more numerous examples of irregular outline and variation in size than were met with in any other region of the body. When the tracks penetrated the broad upper intercostal spaces, an interesting feature, due to the tense and rigid nature of the muscles closing the intervals, and their large admixture of fibrous tissue, was sometimes noticed. The bullet, especi- ally if passing obliquely, was apt to cut a slit in the muscles far exceeding in size the opening in the overlying integument, with the result of leaving a palpable subcutaneous defect. Under these circumstances the yielding spot was often noticed to rise and fall with the movements of respiration, external palpation met with an absence of normal resis- tance, and there was impulse on coughing. Fractures of the ribs.—These injuries were produced in either transverse or longitudinal coursing tracks, their special feature being a sharp localisation of the lesion of the bone. In tracks crossing the chest transversely the injury to the ribs might consist m notching, perforation, or complete solution of continuity, sometimes with fine comminution. In the incomplete injuries some importance attached to the localisation of the lesion to the upper or lower border of the rib, in so far as the intercostal arteiy was concerned. Comminution at the wound of entry was, as a rule, not so ex- tensive as at the aperture of exit, and hi any case was less apparent, since the fragments were driven inward. The wider comminution at the exit aperture depends on the lesser degree of support afforded by the thoracic coverings to the convex outer surface of the rib, and on the fact that the velocity of the bullet has been lowered by its passage through the opposite rib and the chest cavity. The splinters of comminuted ribs are small, and wide-