The Project Gutenberg eBook ofSurgical Experiences in South Africa, 1899-1900This ebook is for the use of anyone anywhere in the United States and most other parts of the world 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 atwww.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.Title: Surgical Experiences in South Africa, 1899-1900Author: George Henry MakinsRelease date: May 3, 2007 [eBook #21280]Most recently updated: January 2, 2021Language: EnglishCredits: Produced by Jonathan Ingram, Josephine Paolucci and theOnline Distributed Proofreading Team at https://www.pgdp.net*** START OF THE PROJECT GUTENBERG EBOOK SURGICAL EXPERIENCES IN SOUTH AFRICA, 1899-1900 ***
This ebook is for the use of anyone anywhere in the United States and most other parts of the world 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 atwww.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.
Title: Surgical Experiences in South Africa, 1899-1900Author: George Henry MakinsRelease date: May 3, 2007 [eBook #21280]Most recently updated: January 2, 2021Language: EnglishCredits: Produced by Jonathan Ingram, Josephine Paolucci and theOnline Distributed Proofreading Team at https://www.pgdp.net
Title: Surgical Experiences in South Africa, 1899-1900
Author: George Henry Makins
Author: George Henry Makins
Release date: May 3, 2007 [eBook #21280]Most recently updated: January 2, 2021
Language: English
Credits: Produced by Jonathan Ingram, Josephine Paolucci and theOnline Distributed Proofreading Team at https://www.pgdp.net
*** START OF THE PROJECT GUTENBERG EBOOK SURGICAL EXPERIENCES IN SOUTH AFRICA, 1899-1900 ***
FRONTISPIECE. Photo, H. Kisch Ladysmith. Engraved and Printed by Bale and Danielsson, Ltd.FRONTISPIECE.Photo, H. Kisch Ladysmith. Engraved and Printed by Bale and Danielsson, Ltd.
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 PLACE1901
TOSURGEON-GENERAL W. D. WILSONPRINCIPAL MEDICAL OFFICER TO THE SOUTH AFRICAN FIELD FORCETHE MEMBERS OF THE ROYAL ARMY MEDICAL CORPSEMPLOYED IN SOUTH AFRICAAND TO THECIVIL SURGEONS TEMPORARILY ATTACHED TO THAT CORPSThese Experiences are DedicatedAS AN EXPRESSION OF APPRECIATIONOF THE INVARIABLE KINDNESS AND SYMPATHY EXTENDEDTO THE AUTHORWITHOUT WHICH THE BOOK COULD NOTHAVE BEEN WRITTEN
A word of explanation is perhaps necessary as to the form in which these experiences have been put together. The matter was originally collected with the object of sending a series of articles to theBritish Medical Journal. Various circumstances, however, of which the chief was the feeling that extending experience altered in many cases the views adopted at first sight, prevented the original intention from being carried into execution, and the articles, considerably expanded, are now published together.
As to the illustrative cases introduced in support of various statements made in the text, only those have been chosen from my notes which were under my own observation for a considerable time, and many of these have been brought up to date since my return to England. I have, as a rule, avoided the inclusion of cases seen cursorily, and few simple ones have been quoted since their character is sufficiently indicated in the text. These remarks seem necessary since the mode of selection has resulted in the inclusion of a number of cases of exceptional severity, and any attempt to draw statistical conclusions from them would be most misleading.
The first two chapters have been added with a view to affording some information, first, as to the conditions under which a great part of the surgical work was done, and, secondly, as to the mechanism and causation of the injuries, which would not readily be at hand in the case of the general surgical reader. For much of the information contained in Chapter II. I must express my indebtedness to the work of MM. Nimier and Laval, so frequently quoted.
The only other object of this Preface is to express my thanks to the many who have aided me in the task of amplifying the observations on which the articles are founded, and I think no writer ever received more sympathetic and kindly help in such particulars than the author.
My first thanks, those due to the Members of the Royal Army Medical Corps, I endeavour to express by the dedication of this volume. Any attempt to make individual acknowledgment to either the Members of the Service, or to the Civil Surgeons temporarily attached, would be impossible. I have, however, tried to associate the names of many of those in charge of cases in the recital of histories and treatment throughout.
My thanks are not less due to the Military Heads of Departments at the War Office, who have helped me in the collection of details as to the subsequent course of many of the cases described, and in the acquisition of information regarding the weapons and ammunition treated of. I should particularly express my gratitude to Colonel Robb, of the Adjutant-General's Department, and Colonel Montgomery, of the Ordnance Department.
I am greatly indebted to my former colleague Mr. Cheatle for two of the illustrations of wounds, and for permission to quote some of his other experience, and to Mr. Henry Catling, to whose skill I owe the majority of the skiagrams 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.
47Charles Street, Berkeley Square, W.February 1901.
PAGECHAPTER IINTRODUCTORYItineraryLinen 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—Hospitals1CHAPTER IIMODERN MILITARY RIFLES AND THEIR ACTIONGeneral 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 types40CHAPTER IIIGENERAL CHARACTERS OF WOUNDS INFLICTED BY BULLETS OF SMALL CALIBREType 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—Localshock—Pain—Hæmorrhage—Diagnosis—Prognosis—Treatment55CHAPTER IVINJURIES TO THE BLOOD VESSELSNature 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 arteries112CHAPTER VINJURIES TO THE BONES OF THE LIMBSNature 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 extremity154CHAPTER VIINJURIES TO THE JOINTSGeneral character—Vibration synovitis—Wounds of joints—Classification—Course and symptoms—General treatment—Special joints225CHAPTER VIIINJURIES TO THE HEAD AND NECKAnatomical 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—Generaldiagnosis—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 trachea241CHAPTER VIIIINJURIES TO THE VERTEBRAL COLUMN AND SPINAL CORDFractures 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—Treatment314CHAPTER IXINJURIES TO THE PERIPHERAL NERVESAnatomical 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 treatment341CHAPTER XINJURIES TO THE CHESTNon-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 hæmothorax374CHAPTER XIINJURIES TO THE ABDOMENIntroductory 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 intestinalwounds, 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 urethra407CHAPTER XIION SHELL WOUNDSVarieties 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 wounds474Index of Contents487
PLATES
Varieties of Ammunition collected at LadysmithFrontispiece1.Section of Mauser Aperture of EntryTo face p.732.Section of Mauser Aperture of Exit763.Punctured Fracture of Clavicle1624.Comminuted Fracture of Shaft of Humerus1805.Comminuted Fracture of Humerus accompanied by an Explosive Exit1826.Comminuted Fracture of Humerus due to Oblique Impact1847.Same Fracture healed1868.Low Velocity Fracture of Humerus With Retained Bullet1889.Localised Fracture of Humerus Showing Fragmentation of the Bullet19010.Wedge-shaped Fracture of the Radius19211.Fracture of the Metacarpus, showing Fragmentation of the Bullet19412.Finely Comminuted Fracture of the Femur19613.The same Fracture Healed19814.Stellate 'Butterfly' Fracture of the Femur20015.Lateral Impact of Bullet, with Comminution of the Femur20216.Rectangular Impact of Bullet, with highly Oblique Line of Fracture of the Femur20417.Punctured Fracture of the Femur with Exit Bone-flap20618.Fractured Patella20819.Oblique Comminuted Fracture of the Tibia21020.Transverse Fracture of the Tibia21221.Puncture of the Tibia, with an Oblique Fissure21422.Notched Fracture of the Tibia21623.Punctured Fracture of the Fibula21824.The same Fracture, Lateral View22025.Vickers-Maxim Fracture of the Humerus482
FIG.PAGE1.Linen Hold-all with Instruments42.Instrument Hold-all Rolled for Packing53.Tin Water-bottle for Emergency Operations64.Buggy on the Veldt75.McCormack-Brook Wheeled Stretcher Carriage196.Indian Tonga207.Service Ambulance Wagon218.Buck-wagon Loaded with Wounded Men229.Interior of a Wagon of No. 2 Hospital Train2410.P. & O. Hospital Ship 'Simla'2511.Type of General Hospital3212.Type of Tortoise Tent Hospital3313.Single Tortoise Hospital Tent3514.Five Types of Cartridge in Common Use During the War4715.Sections of Four Bullets To Show Relative Thickness of Mantles5116.Entry and Exit Mauser Wounds5617.Gutter Wound of Shoulder5618.Oblique Gutter Exit Wound5719.Oval Entry, Starred Exit Wounds5820.Circular Entry, Slit Exit Wounds5921.Circular Entry, Starred Exit Wounds5922.Entry and Exit Wounds in Six Successive Spots made by same Bullet6123.Four Successive Entry and Exit Wounds of same Bullet6224.Superficial Abdomino-thoracic Track6425.Superficial Linear Ecchymosis of Thigh6525a.Sections of Mauser Entry and Exit Wounds7425b.Prolapsed Omentum7726.Sections of Four Bullets8227.Normal Mauser Bullet8328.Four Mauser Ricochets8429.Mauser Ricochet, Disc Form8530.Fissured Mauser Mantle8631.Mausers Deformed by Impact on Femur8632.Apical Mauser Ricochet8733.Spiral Ricochet8834.Normal Lee-Metford Bullet8935.Apical Lee-Metford Ricochets9036. " " "9137.Four Types of Soft-nosed Bullets9238.'Set-up' Soft-nosed Lee-Metford Bullets9239.Flattened, Solid-based Mantle From Ricochet9340.Mauser Bullet, Jeffreys-Tweedie Modification9441.Section of Mark IV. and Soft-nosed Mauser9442.Tampered Bullets9543.Large Leaden Sporting Bullets9844.Explosive Wound of Back10045.Dead Men on Field of Battle10246.Flattened Leaden Cores from Mantled Bullets10547.Explosive Exit Wound over Fractured Ulna15648.Explosive Exit Wound over Fractured Humerus15849.Explosive Exit and Entry Wounds of Legs15950.Types of Gunshot Fracture16151.Lower End of Fractured Femur16452.Oblique Perforation of Femur, Separation of Fragment at Exit Aperture in Bone16953.Gutter Fracture of Head of Humerus17853a.Diagram of 'Butterfly' Type18054.Wire Gauze Splint18755.Gutter Fracture of Pelvis19155a.Diagram of 'Butterfly' Type20056.Cane Field Splint for Lower Extremity20957.Tunnel Fracture at Surface of Tibia21958.Cane Field Splint for Leg22259.Skiagram of Injury to Interphalangeal Joint23760.Skiagram of Bullet in Nasal Fossa24461.Diagram of Aperture of Entry into Cranium24562.Aperture of Entry into Frontal Bone25263.Fragment of Inner Table Displaced from Opening seen in Fig. 6225364.Gutter Fracture of First Degree in Parietal Bone25565.Diagram of Gutter Fractures25666.Gutter Fracture of Second Degree in Parietal Bone25767.Diagrams of Gutter Fractures25868.Superficial Perforating Fracture of Parietal Region25969.Diagram of Superficial Perforating Fracture26070.Fragment Forming Floor of Temporal Gutter Fracture26071.Scale of External Table in Low Velocity Injury of Frontal Bone26172.Frontal Perforation, Aperture of Exit26173.Visual Field in Occipital Injury27974. " " "27975. " " "28176. " " "28177. " " "28378. " " "28379.Contused Spinal Cord33380.Divided Spinal Cord33481.Superficial Track in Anterior Body-wall37782.Spirally Grooved Bullet38183.Ecchymosis in Fractured Ribs with Hæmothorax39284.Subcutaneous Division of Abdominal Muscles40985.Lateral Incomplete Wound of Small Intestine. Slit Form41686.Lateral Perforation of Small Intestine. Gutter Form41787.Entry and Exit Wounds in a Transverse Perforation of Intestine41888.Inner Aspect of Piece of Intestine Shown in Fig. 8741989.Impaction of Omentum in Exit Wound of Abdominal Wall42190.Fragments of Large Shells47591.Fragments of Percussion and Time Fuses47792.Complete 1-lb. Pom-pom Shell47993.Fragments of Exploded Pom-pom Shells48094.Percussion Fuse From 1-lb. Pom-pom Shell48195.Fragments of Boer Segment Shells48396.Normal and Deformed Leaden Shrapnel Bullets485
1.Case of Axillary Hæmatoma, Blood Temperature1192.Case of Hæmothorax with Recurrent Hæmorrhages3953.Primary and Secondary Rises of Temperature in Hæmothorax, Recovering Spontaneously4024.Secondary Rise of Temperature in Hæmothorax4035.Falls of Temperature in Hæmothorax following Paracentesis4046.Secondary Hæmothorax, Spontaneous Fall of Temperature405
The following pages are intended to give an account of personal experience of the gunshot wounds observed during the South African campaign in 1899 and 1900. For this reason few cases are quoted beyond those coming under my own immediate observation, and in the few instances where others are made use of the source of quotation is indicated. It will be noted that my experience was almost entirely confined to bullet wounds, and in this respect it no doubt differs from that of surgeons employed in Natal, where shell injuries were more numerous. This is, however, of the less moment for my purpose as there is probably little to add regarding shell injuries to what is already known, while, on the other hand, the opportunity of observing large numbers of injuries from rifle bullets of small calibre has not previously been afforded to British surgeons.
I think the general trend of the observations goes to show that the employment of bullets of small calibre is all to the advantage of the men wounded, except in so far as the increased possibilities of the range of fire may augment the number of individuals hit; also that such variations as exist between wounds inflicted by bullets of the Martini-Henry and Mauser types respectively, depend rather on the form and bulk of the projectile than on any inherent difference in the nature of the injuries. Thus in the chapter devoted to the general characters of the wounds, it will be seen that most of the older typesof entry and exit aperture are produced in miniature by the small modern bullet, and that the main peculiarity of the deeper injuries is the frequent strict localisation of the direct damage to an area of no greater width than that crossed by narrow structures of importance such as arteries or nerves.
It is to be regretted that I am unable to furnish any important statistical details, but incomplete numbers, such as are at my disposal, would be of little value. In view, however, of the considerable interval which must elapse before the Royal Army Medical Corps is able to arrange and publish the large material which will have accumulated, it has seemed unwise to defer publication until the completion of a report which will deal with such matters thoroughly.
It may be of interest to premise the opportunities which I enjoyed of gaining experience during the campaign. I arrived in South Africa on November 19, 1899; two days later I proceeded to Orange River with Surgeon-General Wilson, and on the day three weeks after leaving home performed some operations in the field hospitals on patients from the battle of Belmont. I remained at Orange River during the three next engagements, Graspan, Enslin, and Modder River, and on the day of Magersfontein I went forward to the Field hospitals at Modder River, arriving during the bringing in of the patients from the field of battle. I returned to Orange River with the patients and remained there a further period of three weeks, during which time the patients were gradually transferred to the Base hospitals at Wynberg. At Christmas I followed the patients down to the base, and thus was able to observe the course of the cases from their commencement to convalescence. I remained at Wynberg six weeks, during which time a number of cases from the neighbourhood of Rensburg and some from Natal were received. On February 7, I left Wynberg, following Lord Roberts up to my old quarters at Modder River, where I saw a few wounded men brought in from the engagements at Koodoosberg Drift. On Lord Roberts's departure for Bloemfontein he requested me to return to Wynberg to await the wounded who might be sent down from the fighting which might occur during his advance. I therefore had the disappointment of seeing the start of thearmy, and then returning to Wynberg, where I remained for another six weeks in attendance at Nos. 1 and 2 General Hospitals.
During this period a very large number of the wounded from Paardeberg Drift and other battles were sent down and treated, after which surgical work began to flag.
On April 14, I was recalled to the front and journeyed to Bloemfontein, where I stayed three weeks, making one journey out to the Bearer Company of the IX. Division at the Waterworks.
On May 4, I left Bloemfontein with Lord Roberts's army, and shortly after joined the IX. Division, with which I journeyed until the commencement of June, seeing a good deal of scattered work in the field and Field hospitals, and in the small temporary improvised hospitals in the towns of Winberg, Lindley, and Heilbron. Early in June I left Heilbron with Lord Methuen's division, and spent the next four weeks with this division in the field. Thence I journeyed to Pretoria and Johannesburg, seeing a small number of wounded in each town, and on July 10, with Lord Roberts's consent, I started for home, visiting a number of the hospitals in the Orange River Colony and Natal on my way down to Cape Town. During the movements briefly recorded above, which absorbed a period of nine months, my time was fairly evenly divided between Field, Stationary, and Base hospitals; hence I had opportunities of observing the patients in every stage of their illnesses, and in all some thousands of men came under my notice.