ration of the
wound in the soft parts occurred, however, the remarks made as to the
injuries classed under the third heading also apply here in a lesser
degree.
With regard to the retention of the bullet, in the case of bullets of
small calibre this was a distinctly rare occurrence. I never happened to
see an instance of retention of either a Mauser or Lee-Metford bullet in
an articulation. It is only possible with bullets practically spent, or
travelling at a very low rate of velocity and making irregular impact.
The influence of both volume and velocity of flight was well illustrated
by my own small experience of retained bullets. In one case a
Martini-Henry was found impacted between the femoral condyles, having
slipped in beneath the margin of the patella. It caused a semiflexed
position to be assumed by the joint, and was removed by Mr. Brown in No.
1 General Hospital at Wynberg. The second instance I saw in the Portland
Hospital at Bloemfontein in a patient of Mr. Bowlby's. The bullet was a
Guedes, a form which has been already described as possessing low
velocity and deficient power of penetration; beyond this, in the
particular instance irregular impact was evidenced by the presence of a
large irregular contused wound of entry over the tuberosity of the
tibia.
The presence of the bullet in the knee-joint was later determined by the
X-rays, and Mr. Bowlby removed it successfully. Seven months later the
range of movement was nearly normal.
I may add that I saw several instances of large leaden bullets lodging
in the popliteal space, and a comparatively insignificant number of
bullets of small calibre in the same situation. This was very striking,
in view of the immense relative frequency of use of the latter forms.
There is no doubt, moreover, that small bullets rarely lodge even in the
neighbourhood of joints, unless at the distal end of a long track. To
take the extreme example of large bullets, those employed as shrapnel,
in comparison with the frequency with which wounds were produced by
them, bullets lying at the bottom of short tracks in the neighbourhood
of joints were not uncommon. Thus I saw one lying over the hip-joint,
and another in close proximity to the shoulder capsule.
Wounds of the third class, where the bones had been superficially
grooved, were in some respects the most serious. This was especially so
in the knee and ankle joints, and some cases will be quoted later under
the heading
|