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

Mr. Watson Cheyne[19] published a very remarkable instance of one of the dangers of an injury from a spent bullet, in which, in spite of non-penetration of the abdominal cavity, the small intestine was ruptured in two places.

I believe the majority of the wounds designated as explosive were the result of the passage of large leaden bullets, either of the Martini-Henry or Express type. The small opportunity of observing such injuries in the hospitals of course depended on the fact that the majority were rapidly fatal.

Nature of the anatomical lesion in wounds of the intestine.—The openings in the parietal peritoneum tended to assume the slit or star forms, probably on account of the elasticity of the membrane. A diagram of one of these forms is appended to fig. 89. In this instance the opening in the peritoneum was made from the abdominal aspect, prior to the escape of the bullet from the cavity, and on the impact of the tip, the long axis of the bullet was oblique to the surface of the abdominal wall.

In the intestinal wall the openings varied in character according to the mode of impact.

In some cases the gut was merely contused by lateral contact of the passing bullet. The result of this was evidenced later by the presence of localised oval patches of ecchymosis. These were identical in appearance with the patches shown surrounding the wounds in fig. 87.

Fig. 85.

Lateral Slit in Small Intestine produced by passage of bullet. Slit somewhat obscured by deposition of inflammatory lymph. (St. Thomas's Hospital Museum)

More forcible lateral impact produced a split of the peritoneum, or of this together with the muscular coat. Such a lateral slit is shown in fig. 85, although the clearness of outline is somewhat impaired by the presence of a considerable amount of inflammatory lymph.

Fig. 86 exhibits a lateral injury of a more pronounced form. The bullet here struck the most prominent portion of the under surface of the bowel, and produced a circular perforation not very unlike one produced by rectangular impact, except in the lesser degree of eversion of the mucous membrane. Here again the appearance is somewhat altered by the presence of a considerable amount of lymph, but this is of less importance in this figure because the lymph is localised to the portion of the bowel in the immediate neighbourhood of the opening which had suffered contusion and erasion.