bone is
struck. By removing the covering from the point of the bullet, as is
done in the Dum-Dum bullet, or by splitting the end, the bullet is made
to expand or "mushroom" when it strikes the body, and its stopping power
is thereby greatly increased, the resulting wound being much more
severe. These "soft-nosed" expanding bullets are to be distinguished
from "explosive" bullets which contain substances which detonate on
impact. High velocity bullets are unlikely to lodge in the body unless
spent, or pulled up by a sandbag, or metal buckle on a belt, or a book
in the pocket, or the core and the case separating--"stripping" of the
bullet. Spent shot may merely cause bruising of the surface, or they may
pass through the skin and lodge in the subcutaneous tissue, or may even
damage some deeper structure such as a nerve trunk.

A blank cartridge fired at close range may cause a severe wound, and, if
charged with black powder, may leave a permanent bluish-black
pigmentation of the skin.

The lesions of individual tissues--bones, nerves, blood vessels--are
considered with these.

#Treatment of Gunshot Wounds under War Conditions.#--It is only
necessary to indicate briefly the method of dealing with gunshot wounds
in warfare as practised in the European War.

1. _On the Field._--Haemorrhage is arrested in the limbs by an improvised
tourniquet; in the head by a pad and bandage; in the thorax or abdomen
by packing if necessary, but this should be avoided if possible, as it
favours septic infection. If a limb is all but detached it should be
completely severed. A full dose of morphin is given hypodermically. The
ampoule of iodine carried by the wounded man is broken, and its contents
are poured over and around the wound, after which the field dressing is
applied. In extensive wounds, the "shell-dressing" carried by the
stretcher bearers is preferred. All bandages are applied loosely to
allow for subsequent swelling. The fragments of fractured bones are
immobilised by some form of emergency splint.

2. _At the Advanced Dressing Station_, after the patient has had a
liberal allowance of warm fluid nourishment, such as soup or tea, a full
dose of anti-tetanic serum is injected. The tourniquet is removed and
the wound inspected. Urgent amputations are performed. Moribund patients
are detained lest they die _en route_.

3. _In the Field Ambulance or Casualty Clearing Station_ further
measures are employed for the relief of sho