in a mass, the number which are scattered around the wound and become lodged in the tissues, and the extent of surface over which they are scattered, will all vary as the distance is varied.

So long as there is a large and complete open wound bearing a resemblance to a bullet wound, the explanation is to be found in the fact that it is not inflicted by a single layer of shot, as it were, but by successive layers. Shot behind closely follow those in front, so that not only are openings made by the shot which first strike, but any tissues that may have remained to connect these openings are broken up and other openings produced by the shot which follow. The whole of the tissues of the part thus rained upon are completely destroyed, and an open blank remains. When the shot have diverged to a certain extent, all the shot travel in different paths, and they then strike singly, and as a rule, unless a shot happens to strike an important part, as the eye, without any serious results.

Charge of shot fired beyond five yards' distance.-Beyond a range of five yards there will probably not be any central wound, but still, if the fire-arm be not far removed from this distance, a proportion of the shot will be more closely congregated at a spot corresponding with the line of fire than elsewhere. The rest of the shot will be scattered, sometimes two or three together, but generally at increasing distances from each other as the distance from the centre of collision is increased, and from the slanting direction in which they strike and pierce the surface and underlying parts, will almost invariably remain lodged. The distance to which they penetrate will of course depend on the force retained by the shot, the nature of the tissues penetrated, and the resistance, always relatively great, made to the progress of each of the small, obtuse, and usually flattened shot concerned.

Charge of shot fired from about fifty yards. -At a distance of fifty yards some shot will still retain sufficient energy to enable them to penetrate the surface, but they will usually not sink beneath the fascia. They are commonly found imbedded in the subcutaneous areolar tissue, whence they can generally be extracted without difficulty immediately after the infliction of the wound. If not extracted, under the circumstances named, simple shot rarely give rise to local irritation: the opening through which it entered soon becomes closed, and the shot remains quiescent. It probably becomes encysted.

Effects of small shot on blood-vessels, nerves, and some other organs.-The divergent laceration caused by small shot within short ranges has an important bearing when the shot passes through structures in which vessels and nerves of large size are contained. A vessel which might possibly escape division by yielding to the pressure of a bullet passing through the adjoining tissues has scarcely any chance of avoiding laceration or

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fired close at hand traverses superficially some part of the surface of the body, the integuments and some of the muscular structures beneath will be excavated and carried away, and a lacerated and contused wound with much surrounding ecchymosis will be presented to view. Some of the shot are generally caught and imbedded in or near the surface of the wound. The integument bounding the gap effected by the shot is torn irregularly, separated to some extent from the subjacent tissues, blackened, and hangs about, showing that it is deprived of its usual elasticity, and to some extent of vitality. If nerves and arteries have happened to be in the way of the shot, they also are torn, and generally in part shot away. The effects of a rasing charge of shot, such as that just described, necessarily become modified as the distance of the point of discharge is increased, in the same way as has been described with regard to point-blank wounds.

When part of a charge of shot fired from a considerable distance has penetrated the surface slantingly, it may still be expected that some of them will travel to long distances from the wounds of entrance. The shot cleave their way very readily through the connective tissue which binds the muscles or other organs together. The readiness with which this happens is one reason why these slanting wounds so often give rise to troublesome complications and require prolonged treatment.

Effects of small shot on parts covered with clothing. When a charge of small shot enters a part of the body which is covered by clothing, the shot generally carry some fragments of cloth in with them. They do this, indeed, more commonly and more extensively, in proportion to their size, than larger projectiles, such as rifle bullets.

A spherical or cylindro-conoidal bullet, when it penetrates a part of the body covered with clothing, especially when the clothing has been put upon the stretch, as happens with a sleeve of his tunic when a soldier's arm is bent in front of him, or with the upper part of his trouser when he is kneeling, usually punches out a portion nearly corresponding in shape and size with its own circumference. But if the velocity of the spherical projectile be lessened, or if the clothing which covers the part it happens to impinge upon be free and loose, or if the bullet be one with a narrow diameter and tapering front, the accident of a portion of the clothing being detached and carried onward by the projectile is frequently avoided. The cloth or linen is pushed forward by the projectile for a certain distance, when its fibres yield, an opening is made, and through it the bullet pursues its course.

With small spherical shot the case is different. The shot, being fired in close contact, often lose their round form and become more or less flattened against one another, in consequence of the character of the force impressed upon them at the time of

their discharge from the fowling-piece. Their penetrative energy is thus lessened. The shot de net severally pierce the covering, or punch out a portion corresponding in size to themselves, but each presses before it and tears away a small portion rather larger than itself of the woven material opposed to its passage; or, when two or more shot strike very near each other, they carry away not only portions directly opposite to them, but also some of the intervening cloth by which these portions were connected.

The amount of the covering carried away, however, will depend upon the kind of clothing, whether it be of a texture that parts asunder read: y, or whether it be tough and elastic. A charge of shot passing through the upper leather of a boot and through a stocking vite the foot may not carry any of the leather into the wound, arless it is fired close to the foot, so that the shot enters in a du. «h, as the expression is, but it will almost ceray ay fragments of the stocking into it. This happened in the cause of the shot wound of the foot referred to on page 192. The seller had a Wellington boot on when he was hit, and the cha.ye cntered through it. Some of his cotton stocking was osried me the wound, but none of the leather. The back of the

s was not out: the portion of the charge which passed comese through the foot was found mixed with coagulated blood and boot itself. In a case which fell under my care in which a ola ge of very small shot, such as is specially used for killing basis or natural history collections, was accidentally fired close so the foot, the muzzle of the gun being probably only two or ta.ee mchos from it, a circular piece of the comparatively soft upper leather of the boot, as well as a fragment of the sock, were ged into the foot. The chief part of the remaining force seemed to do expended upon one of the metatarsal bones, which was fractured for none of the shot passed out through the sole of the foot. They were concentrated in greatest number around the seat of fracture; but others were dispersed in all directions among the lacerated soft textures of the foot.

SECTION IV

ON THE PRIMARY SYMPTOMS AND COMPLICATIONS OF GUNSHOT INJURIES

Introductory remarks.--In the preceding section the local physical effects of the strokes of projectiles have been described; in the present section the primary symptoms or early phenomena which usually attend the production of these effects, and certain complications with which they are liable to be accompanied, will be particularly noticed.

The symptoms which frequently attend gunshot injuries are (A) pain, (B) shock, and (C) primary hæmorrhage. (D) Thirst so generally exists in an intense degree among men suffering from gunshot wounds on fields of battle, that it may also be regarded as one among the other symptoms of such injuries. The primary complications of gunshot wounds which will be described. are (E) lodgment of foreign bodies, (F) burns, and (G) multiplicity of wounds.

CHAPTER I

(A.) ON PAIN AS A PRIMARY SYMPTOM OF GUNSHOT INJURIES

Causes which modify this symptom.-The amount of primary pain which accompanies the infliction of a gunshot wound, more particularly one by a bullet, varies very greatly in degree according to the kind and situation of the injury, together with the condition of mind and the state of constitution of a soldier at the time of being hit. It is not, as a general rule, a symptom which affords any reliable indication of the nature or degree of gravity of the wound which has been inflicted. In very severe wounds from projectiles of considerable size, pain is usually deadened either by annihilation of function and sensation of the parts wounded, or by the state of stupor into which the shock of the injury has at once thrown the patient. In occasional cases of nerve injuries, pain is extremely intense from the first, and continues so unless relief be afforded, so that this symptom