e. The aperture of entry was cleansed by Major Harris,
R.A.M.C., who determined the fact that penetration of the
peritoneal cavity had occurred, and removed the fuse (see fig.
94) by a separate incision. The patient made an uneventful and
uninterrupted recovery, the wound healing by granulation and
leaving little weakness of the abdominal wall. He returned to
England at the end of five weeks.

In a second case the fuse, together with a fragment of the iron case,
entered the buttock by a ragged opening. The fragment of iron escaped by
an exit aperture of about the same size. When the patient arrived at the
Base some days after the injury, a hard body was felt in the wound, and
on exploration the fuse was found and removed.

In a third case the fuse struck the side of the foot below the outer
malleolus and comminuted the astragalus, and then passing forwards
lodged beneath the extensor tendons of the toes. The wound was explored
at the time of the injury and some fragments of bone removed;
considerable cellulitis supervened, and the fuse was only discovered
some days later when the patient came under the care of Sir W. Thomson
in the Irish Hospital in Pretoria. It was there removed, together with
some more fragments of bone, and the wound slowly granulated. The
patient then returned to England, when the wound rapidly healed after
the removal of some further necrosed fragments of cancellous tissue. The
astragalus had been reduced to a mere shell of compact tissue, and the
convexity of the articular surface was altogether lost. The deformity,
together with the formation of adhesions in the ankle-joint, led to the
development of a firm anchylosis.

[Illustration: FIG. 94.--Pom-pom Percussion Fuse, exact size]

My friend Mr. Abbott removed a similar fuse from the substance of the
lung after the lapse of nine months, the patient having developed an
empyema, and a chronic fistula, which rapidly closed after the removal
of the foreign body.

[Illustration: PLATE XXV

OBLIQUE FRACTURE OF THE HUMERUS CAUSED BY A FRAGMENT OF A VICKERS-MAXIM
OR POM-POM SHELL

The entire absence of comminution is very striking]

I will add one further case, that illustrated by plate XXV. In this a
fragment of a pom-pom shell entered the outer aspect of the right
shoulder to escape on the inner aspect of the arm, just below the
confines of the axilla. An oblique, non-comminuted fracture of the
humerus resulted,