Surgical Experiences in South Africa, 1899-1900 | Page 2

of the fractures under my observation at

Wynberg and elsewhere.
I must also express my thanks to Mr. Danielsson and his artist, Mr.
Ford, for the trouble they have taken in converting my rough sketches
into the illustrations contained in the volume.
Lastly, my warmest gratitude is due to my friends, Mr. Cuthbert
Wallace, who has read some of my chapters, and to Mr. F. C. Abbott,
who has read the whole book for the press and suggested many
improvements and modifications.
47 CHARLES STREET, BERKELEY SQUARE, W.
February 1901.

CONTENTS
PAGE
CHAPTER I
INTRODUCTORY
Itinerary--Surgical 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 extremity 154

CHAPTER VI
INJURIES TO THE JOINTS
General character--Vibration synovitis--Wounds of
joints--Classification--Course and symptoms--General
treatment--Special joints 225
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--Treatment 314

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 hæmothorax 374
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 wounds 474
INDEX OF CONTENTS 487

ILLUSTRATIONS
PLATES
VARIETIES OF AMMUNITION COLLECTED AT LADYSMITH
Frontispiece
1. SECTION OF MAUSER APERTURE OF ENTRY To face p. 73
2. SECTION OF MAUSER APERTURE OF EXIT 76
3. PUNCTURED FRACTURE OF CLAVICLE 162
4. COMMINUTED FRACTURE OF SHAFT OF HUMERUS 180
5. COMMINUTED FRACTURE OF HUMERUS ACCOMPANIED
BY AN EXPLOSIVE EXIT 182
6. COMMINUTED FRACTURE OF HUMERUS DUE TO OBLIQUE
IMPACT 184
7. SAME FRACTURE HEALED 186

8. LOW VELOCITY FRACTURE OF HUMERUS WITH RETAINED
BULLET 188
9. LOCALISED FRACTURE OF HUMERUS SHOWING
FRAGMENTATION OF THE BULLET 190
10. WEDGE-SHAPED FRACTURE OF THE RADIUS 192
11. FRACTURE OF THE METACARPUS, SHOWING
FRAGMENTATION OF THE BULLET 194
12. FINELY COMMINUTED FRACTURE OF THE FEMUR 196
13. THE SAME FRACTURE HEALED 198
14. STELLATE 'BUTTERFLY' FRACTURE OF THE FEMUR 200
15. LATERAL IMPACT