missile has had before entering, and, therefore, the direction it has probably taken after having penetrated the body, the probable site of its lodgment if it should not have passed out, and other similar matters which may require settlement. Evidence of the sort may appear trifling in itself, but nothing is really unimportant that helps to prevent unnecessary interference with a wound, or that serves to render the diagnosis of it more accurate and complete. In any case of gunshot wound, it is most important to determine as exactly as possible the course a missile has taken; and any observations, however slight, which are capable of assisting a surgeon in acquiring this necessary information early are valuable.

Arrest of projectiles by clothing without or with wounds.After an action, the protection which has been afforded in particular instances by clothes or other articles carried by soldiers has always formed a subject of remark. Bullets have been repeatedly found in the folds of rolled great-coats which have been worn across the shoulders or folded up on the back, in the padding of tunics, in the folds of handkerchiefs, in knapsacks, and other articles of accoutrement. I have elsewhere mentioned the case of a mounted officer who was saved from a wound of the thigh by the bullet being stopped in the leaves of a book which he was carrying in one of his pistol-holsters.

These coverings and articles, however, are not always so favourably situated, or, from other causes, especially the amount of velocity possessed by the projectile, they do not always present sufficient resistance to arrest its progress completely, though they may stop it sufficiently to prevent it from inflicting any but a comparatively superficial wound. So it occasionally happens that a projectile will have sufficient force to penetrate the body to a limited distance, at the same time carrying a portion of the wounded man's shirt before it, while, owing to the yielding nature of the material, it fails to tear a piece out of it. The missile will then lie, as it were, at the bottom of a prolongation or pouch of the shirt, like the finger of a glove; and when the shirt is taken off, it will be brought away with it. The presence of the foreign body will of course be observed, if due care be taken to look for it shortly after the wound has been inflicted; but very often it is not possible to accomplish this, and in a field hospital, in the hurry of the moment, under the pressure of many patients urgently needing attention, it is very liable to slip away and escape without either the patient's or surgeon's knowledge. Or the projectile and its covering may not have entered so deeply as to be retained in the wound if the patient has been subjected to a variety of movements. This must have happened in the case of Captain M., who was wounded in a boat attack on Namtow, in the Canton river, by a large gingal bullet fired from the wall

of the town, on the 11th of August 1857. He died in the year 1876, near Netley, from the effects of stricture of the colon. During this long interval he had lived under a depressing conviction that the ball was lodged in his chest, and occasional attacks of pain, probably in reality connected with adhesions, led him to believe that it was lying near his heart. The surgeon, a very accomplished medical officer, who had attended him on the hospitalship, was also fully persuaded that the bullet had remained in his chest. But the opportunity of an examination after death being afforded, a very careful search was made at Netley, and no bullet was found. The projectile had not even penetrated the chest, but it had struck the walls of the cavity with sufficient violence to fracture two ribs, and the sharp edge of one of them had grazed the lung superficially. Hæmothorax, and some other symptoms of wound of the lung had taken place as a consequence, and these indications had, not unreasonably under the circumstances, been misinterpreted. Thirty hours had elapsed before the wounded officer was received on the hospital-ship after his injury, and in the meantime the gingal ball had dropped away and been lost. Had the officer's shirt been examined in this instance, in all probability the true facts of the case would have been so far ascertained, that the patient would have been spared years of groundless anxiety. The fact of the shirt worn over a wounded part being untorn must of course be a sufficient proof that the wounding missile cannot have lodged in the man's body, even although it may not be found. In the same way a bullet may strike a soldier's boot and inflict a wound in the foot, without perforating the leather, or it may penetrate the leather, but fail to pass through the sock. In either case an inspection of these coverings will show that the bullet has not passed into the wound, and the forethought of making the examination may be the means of preventing an unnecessary exploration. It has happened that a bullet has passed through a boot on one side and through the foot, but has been prevented by the leather from passing out on the other side. In such a case the missile will of course be found in the boot if it be taken off with due precaution.

Mr. Guthrie relates that he saw an officer just after he had been wounded at the battle of Vimiera, into whose wound the shirt had gone with the ball, without any injury to the linen. On Mr. Guthrie pulling at the shirt, it came out from a depth of four inches a perfect cul-de-sac, having the ball at the bottom of it.' As the wound is described as having been received in the thigh,' it would be a portion of the free end of the shirt which had entered with the bullet, and this may explain its having been carried to so great a depth without being torn. Hennen refers to the wound of an officer who had several folds of a silk pocket

handkerchief carried into the pectoral muscles by a bullet. On withdrawing the silk from the wound the bullet came away imbedded in its folds. The unfettered condition of the folds of the handkerchief doubtless assisted in causing the occurrence. Dr. Jobert saw a case in which a bullet, the force of which had been partly spent, failed to make a hole in the wounded man's shirt, but yet penetrated the cavity of the abdomen. On drawing the shirt out of the wound the bullet came too, and though a protrusion of intestine followed, it was reduced, and the patient quickly recovered. In this case the accident of the shirt not being rent open prevented the lodgment of the bullet in the peritoneal cavity, and saved the patient's life.1

It is evident from the examples above quoted that it is not sufficient for a surgeon to examine only the uniform clothing worn by a patient. A bullet may perforate a soldier's great-coat, tunic, or some of his accoutrements from which it has encountered more or less resistance, but yet it may fail to pass through the shirt, or some article of underclothing which is more free to yield to the pressure. The garment that happens to have been next to the skin of the part wounded is therefore that to which attention in all such cases should be particularly directed.

Evidence afforded when projectiles have traversed coverings of the body.-It generally happens, however, that when a missile has had force enough to penetrate the body, it will have previously made an opening in all the clothes or other articles. covering the part of the body penetrated. Sometimes a glance at these openings will at once settle a question as to whether some portions of the substances overlying the wounded part have lodged in the wound. A piece punched completely out of a leathern belt, the loss of a button, a hole in a coat, vest, or shirt, which the flaps or torn edges when replaced toward the centre fail to fill up, will indicate the probability, almost the certainty, of the absent portions being contained in the wound. It has already been mentioned that when cylindro-conoidal rifle bullets were brought into use, they were found, almost equally with those of the old spherical shape, to carry such fragments before them on their first entrance into wounds, and that they would afterwards leave them behind in some part of their track, while they themselves would either escape or remain lodged at some distance from the place of entrance. It is to be expected that such occurrences will scarcely ever be brought to notice when the new narrow projectiles become the common sources of rifle wounds. Their little liability to lose their normal form, and the smallness of the openings left by them in clothing when they pursue a direct course, together with the fact that in many instances the texture of the portion of cloth removed is reduced to minute shreds by the force with which they are armed, cause such fragments, if lodged in wounds, to be

scarcely appreciable, and relatively of trifling importance from a surgical point of view. The effects are very different when the portions of clothing or other coverings are of considerable size, such as are often met with when the missiles concerned consist of fragments of shell, shrapnell shot, or some of the irregularly shaped secondary projectiles which frequently give rise to wounds in warfare.

It is a common occurrence when a fowling-piece has been discharged near to the body, to find a number of detached portions of the various articles comprising the clothing of the part wounded carried into the wound or wounds with the charge of shot. As their lodgment often seriously aggravates the symptoms resulting from the wound, it is well not only to determine the fact of the removal of these substances from the clothes, but also to ascertain the number of the fragments and their sizes. By this means, on some pieces of cloth or linen being extracted, it will be known whether the whole or only part of the lodged foreign substances have been got away. The observation of the torn clothing thus becomes a help in respect to some of the details of treatment. I have previously alluded to a case under my care in which a charge of shot was accidentally fired into the foot at very close distance. In this instance the pieces of the upper leather of the shoe and of the sock which were carried into the foot with the charge of shot were found on extraction to fill up exactly the holes left in the coverings mentioned. It was thus proved that no more fragments of them remained among the lacerated tissues of the foot.

Evidence afforded by clothing as to distance of discharge of fire-arms.—The fact that a weapon has been fired close to a person is frequently more obviously apparent from the state of the clothes than it is from the appearance of the wounded part which was covered by them. If the clothes be woollen, they are usually not only more extensively torn than they would be by a shot fired from a distance, but, if the charge consist of gunpowder, they are blackened by the smoke and particles of powder which they retain in their texture. If the muzzle of the gun happen to have been placed close enough for the flame of the ignited gunpowder to act upon them, they will also be scorched, and if the material be cotton or linen, may even be set on fire.

Dep.-Insp. Genl. Dr. Marshall has related the case of a malingerer in Ceylon who wished to escape from further service in the army. He was brought to hospital with a severe wound in the leg. The soldier, who had been on sentry, declared he had been shot by a Kandyan rebel from the adjoining jungle, and that he had fired at him in return; but the marks of gunpowder and the general state of the man's trouser proved that his musket had been discharged, not toward the jungle, but close to his own leg.2

Sizes and shapes of openings made by projectiles in clothing. As a general rule, the size of the opening in articles of clothing covering a wounded part of the body should not be depended upon for indicating with precision the size of the projectile which has entered. When a bullet happens to penetrate at high speed in a direct line, the diameter of the hole in the cloth or linen covering the wounded part is usually rather smaller than that of the projectile or than that of the entrance opening of the wound itself, perhaps owing to the greater elasticity of the materials, and perhaps also to the fact of the bullet being clear of other things which would help to widen its track. It is occasionally larger when part of the texture adjoining that which was immediately opposite to the bullet has been torn away with it. Neither, as a general rule, should the shape of the opening be regarded as showing the form of the projectile. The form and dimensions of the opening will vary with the angle of incidence of the projectile, and also with the texture of the material through which it passes. A spherical bullet fired through broadcloth makes a round hole, but through an ordinary piece of canvas makes a square hole. This is owing to the different textural arrangements of the two substances. In the broadcloth the woollen fibres are closely mingled together, so as to form almost a uniformly even layer; in the coarse canvas the threads cross each other at right angles, and are readily disconnected. The crossing threads which remain entire in the canvas after the passage of a bullet, and which bound the portion carried away by it, necessarily form a square, while the fringed ends of the threads which have been stretched and then divided recede into the adjoining texture, especially after the canvas has been drawn open or put on the stretch. The opening made by a spherical bullet in a linen article of clothing on a wounded person, when a portion of its substance has been carried away, will sometimes present a rectangular appearance from the same reason, but at other times will be a torn hole of irregular outline, particularly if the texture be fine and close.

Openings of entrance and exit in clothing. In any case, if a projectile make a wound of entrance and another of exit through a part of the body covered by clothes, especially if they are woollen, a careful examination of the clothes will scarcely ever fail to determine which has been the first, and which the second opening. Any missiles of sufficiently obtuse frontage, passing through a part of the body so covered, at a high rate of velocity, punches out, as it were, the part of the cloth which it first meets, and so makes a hole, through which it enters; but, in escaping again, it ordinarily forces its way out by simply tearing the texture of the clothes asunder. Part of the cloth is carried away from the first opening; while, as to the second, the torn edges, on being brought together, generally close it; or, if they do not do so completely, the part