Portal de Periódicos da CAPES

THE TREATMENT OF WOUNDS IN WAR

1915; BMJ; Volume: 2; Issue: 2856 Linguagem: Inglês

10.1136/bmj.2.2856.465

0959-8138

Elizabeth G. Kennedy,

Disaster Response and Management

Description of Specimen;'The specimen removed shows a large sac-even now, after shrinkage' in preservative, fully 1l in. in diameter-which pro- jects into and distends the sterno-mastoid muscle on the one hand, and on the other comes'to within a quarter of an inch from the skin surface.The portion of the aneurysm in the muscle presents a distinct sac wall, composed of the dilated coats of the vessels, while that which projects toward the skinl surface has no true wall, and is occupied by a dark red thrombus.In this case, as in tlle last, wllil'e there is a perfectly distinct' history of wounding, no metal was found, either by x-ray examination or at the operation.Thle presump.tion is, tbe'refore, that the penetrating fragment was a very small one, and so was overlooked.It is possible, however, that it penetrated quite beyond the area examin'ed.The complex nature of the aneurysm will be noted, that part whiclh projected into the sterno- mastoid muscle lhaving a true sac wall derived from the coats of the damaged and distended ve'ssels, while thle portion whichi projected toward the skin was of tlle purely traumatic type, there being no true sac wall.It is remarkable that this rnan should hbave suffered sucl grave injury to his carotid artery, internal jugular vein, and vagus nerve, and yet lhave complained only of hleadache due to the thlrobbing of the aneurysm.So far as he is aware, he never lost consciousness.It is significant of the changes in methods of warfare that 'while the two cases-reported above were caused by shrapnel, the -patient in Case iii was wounded by a rifle bullet.CASE III.-Traumatic Femoral Aneurysm.T. B., a Boer, was shot on February.8th, 1900,the bullet, pre- sumably a Lee Metford, entering the thigh at the junction of the middle and lower thirds of the femur, in the line of the femoral artery, and coming out about 6 in.higher up, on the outside of the thigh.The wounds of entrance and exit were alike in appearance.The patient was brought to the Military Stationary Elospital, Orange River, where I was stationed as a civil surgeon, on April 8th, 1900, and placed under mny care.The history given was that he had been supposed to be suffering from fracture of the femur, with great throwing out of callus, and that he had been treated by massage without effect.