CONTENTS

PAGE CHAPTER I

INTRODUCTORY

ItineraryLinen 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—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 extremity154

CHAPTER VI

INJURIES TO THE JOINTS

General character—Vibration synovitis—Wounds of joints—Classification—Course and symptoms—General treatment—Special joints225

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—Treatment314

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 hæmothorax374

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 wounds474

Index of Contents487

Varieties of Ammunition collected at LadysmithFrontispiece

1. Section of Mauser Aperture of Entry To face p. 73

2. Section of Mauser Aperture of Exit 76

3. Punctured Fracture of Clavicle162

4. Comminuted Fracture of Shaft of Humerus180

5. Comminuted Fracture of Humerus accompanied by an Explosive Exit182

6. Comminuted Fracture of Humerus due to Oblique Impact184

7. Same Fracture healed186

8. Low Velocity Fracture of Humerus With Retained Bullet188

9. Localised Fracture of Humerus Showing Fragmentation of the Bullet190

10. Wedge-shaped Fracture of the Radius192

11. Fracture of the Metacarpus, showing Fragmentation of the Bullet194

12. Finely Comminuted Fracture of the Femur196

13. The same Fracture Healed198

14. Stellate 'Butterfly' Fracture of the Femur200

15. Lateral Impact of Bullet, with Comminution of the Femur202

16. Rectangular Impact of Bullet, with highly Oblique Line of Fracture of the Femur204

17. Punctured Fracture of the Femur with Exit Bone-flap206

18. Fractured Patella208

19. Oblique Comminuted Fracture of the Tibia210

20. Transverse Fracture of the Tibia212

21. Puncture of the Tibia, with an Oblique Fissure214

22. Notched Fracture of the Tibia216

23. Punctured Fracture of the Fibula218

24. The same Fracture, Lateral View 220

25. Vickers-Maxim Fracture of the Humerus 482

FIG. PAGE 1. Linen Hold-all with Instruments4

2. Instrument Hold-all Rolled for Packing5

3. Tin Water-bottle for Emergency Operations6

4. Buggy on the Veldt7

5. McCormack-Brook Wheeled Stretcher Carriage19

6. Indian Tonga20

7. Service Ambulance Wagon21

8. Buck-wagon Loaded with Wounded Men22

9. Interior of a Wagon of No. 2 Hospital Train24

10. P. & O. Hospital Ship 'Simla'25

11. Type of General Hospital 32

12. Type of Tortoise Tent Hospital 33

13. Single Tortoise Hospital Tent 35

14. Five Types of Cartridge in Common Use During the War47

15. Sections of Four Bullets To Show Relative Thickness of Mantles51

16. Entry and Exit Mauser Wounds56

17. Gutter Wound of Shoulder56

18. Oblique Gutter Exit Wound 57

19. Oval Entry, Starred Exit Wounds58

20. Circular Entry, Slit Exit Wounds59

21. Circular Entry, Starred Exit Wounds59

22. Entry and Exit Wounds in Six Successive Spots made by same Bullet61

23. Four Successive Entry and Exit Wounds of same Bullet62

24. Superficial Abdomino-thoracic Track64

25. Superficial Linear Ecchymosis of Thigh65

25a. Sections of Mauser Entry and Exit Wounds74

25b. Prolapsed Omentum77

26. Sections of Four Bullets82

27. Normal Mauser Bullet83

28. Four Mauser Ricochets 84

29. Mauser Ricochet, Disc Form 85

30. Fissured Mauser Mantle 86

31. Mausers Deformed by Impact on Femur 86

32. Apical Mauser Ricochet 87

33. Spiral Ricochet88

34. Normal Lee-Metford Bullet89

35. Apical Lee-Metford Ricochets90

36. " " " 91

37. Four Types of Soft-nosed Bullets92

38. 'Set-up' Soft-nosed Lee-Metford Bullets92

39. Flattened, Solid-based Mantle From Ricochet93

40. Mauser Bullet, Jeffreys-Tweedie Modification94

41. Section of Mark IV. and Soft-nosed Mauser94

42. Tampered Bullets95

43. Large Leaden Sporting Bullets98

44. Explosive Wound of Back100

45. Dead Men on Field of Battle102

46. Flattened Leaden Cores from Mantled Bullets105

47. Explosive Exit Wound over Fractured Ulna156

48. Explosive Exit Wound over Fractured Humerus158

49. Explosive Exit and Entry Wounds of Legs159

50. Types of Gunshot Fracture161

51. Lower End of Fractured Femur164

52. Oblique Perforation of Femur, Separation of Fragment at Exit Aperture in Bone169

53. Gutter Fracture of Head of Humerus178

53a. Diagram of 'Butterfly' Type180

54. Wire Gauze Splint 187

55. Gutter Fracture of Pelvis 191

55a. Diagram of 'Butterfly' Type 200

56. Cane Field Splint for Lower Extremity 209

57. Tunnel Fracture at Surface of Tibia 219

58. Cane Field Splint for Leg 222

59. Skiagram of Injury to Interphalangeal Joint 237

60. Skiagram of Bullet in Nasal Fossa 244

61. Diagram of Aperture of Entry into Cranium 245

62. Aperture of Entry into Frontal Bone 252

63. Fragment of Inner Table Displaced from Opening seen in Fig. 62 253

64. Gutter Fracture of First Degree in Parietal Bone 255

65. Diagram of Gutter Fractures 256

66. Gutter Fracture of Second Degree in Parietal Bone 257

67. Diagrams of Gutter Fractures 258

68. Superficial Perforating Fracture of Parietal Region 259

69. Diagram of Superficial Perforating Fracture 260

70. Fragment Forming Floor of Temporal Gutter Fracture 260

71. Scale of External Table in Low Velocity Injury of Frontal Bone 261

72. Frontal Perforation, Aperture of Exit 261

73. Visual Field in Occipital Injury 279

74. " " " 279

75. " " " 281

76. " " " 281

77. " " " 283

78. " " " 283

79. Contused Spinal Cord 333

80. Divided Spinal Cord 334

81. Superficial Track in Anterior Body-wall 377

82. Spirally Grooved Bullet 381

83. Ecchymosis in Fractured Ribs with Hæmothorax392

84. Subcutaneous Division of Abdominal Muscles409

85. Lateral Incomplete Wound of Small Intestine. Slit Form416

86. Lateral Perforation of Small Intestine. Gutter Form417

87. Entry and Exit Wounds in a Transverse Perforation of Intestine418

88. Inner Aspect of Piece of Intestine Shown in Fig. 87419

89. Impaction of Omentum in Exit Wound of Abdominal Wall421

90. Fragments of Large Shells 475

91. Fragments of Percussion and Time Fuses 477

92. Complete 1-lb. Pom-pom Shell 479

93. Fragments of Exploded Pom-pom Shells 480

94. Percussion Fuse From 1-lb. Pom-pom Shell481

95. Fragments of Boer Segment Shells 483

96. Normal and Deformed Leaden Shrapnel Bullets 485