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

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--H?morrhage--Diagnosis--Prognosis--Treatment 55
CHAPTER IV
INJURIES TO THE BLOOD VESSELS
Nature of lesions; contusion, laceration, perforation--Results of injuries--Primary h?morrhage--Recurrent h?morrhage--Secondary h?morrhage--Treatment of h?morrhage--Traumatic aneurisms--Arterial h?matoma--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--H?morrhage, extra-medullary, h?matomyelia--Symptoms of injury to the spinal cord--Concussion--H?morrhage--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--H?mothorax-- Empyema--Diagnosis, prognosis, and treatment of h?mothorax--Cases of h?mothorax 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, f?cal extravasation, peritoneal infection, septic?mia--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 OF BULLET, WITH COMMINUTION OF THE FEMUR 202
16. RECTANGULAR IMPACT OF BULLET, WITH HIGHLY OBLIQUE LINE OF FRACTURE OF THE FEMUR 204
17. PUNCTURED FRACTURE OF THE FEMUR WITH EXIT BONE-FLAP 206
18. FRACTURED PATELLA 208
19. OBLIQUE COMMINUTED FRACTURE OF THE TIBIA 210
20. TRANSVERSE FRACTURE OF THE TIBIA 212
21. PUNCTURE OF THE TIBIA, WITH AN OBLIQUE FISSURE 214
22. NOTCHED FRACTURE OF THE TIBIA 216
23. PUNCTURED FRACTURE OF THE FIBULA 218
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 INSTRUMENTS 4
2. INSTRUMENT HOLD-ALL ROLLED FOR PACKING 5
3. TIN WATER-BOTTLE