d from the venter ilii by effused blood. There was no
perforation of the abdominal cavity.

[Illustration: PLATE IX.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson, Ltd.

(28) LOCALISED COMMINUTED FRACTURE OF THE HUMERUS

Range '100 yards.'

The entry and exit wounds were on the front and back aspects of the arm,
about 3 inches above the elbow.

Fragmentation of the mantle of the bullet has occurred. It will be noted
that the fragments are lodged in both the proximal and distal segments
of the track. This may indicate that the bullet was damaged prior to
entry, or the recoil of fragments. I incline to the latter view. The
skiagram was taken a fortnight after the injury.

The large median fragment carried forwards, and the small degree of
comminution, suggest the decrease of resistance and prolongation of
impact by carriage back of the arm when struck.

The fracture is one of the nearest approaches to a transverse cleft that
I met with.

The plate may well be compared with No. XII., where the effect of
increased resistance in augmenting the degree of comminution is seen.]

Lesser degrees of the same kind of injury amounting to grooving of the
surface or notching of the crest of the ilium were not uncommon, and the
occasional large character of exit openings in buttock wounds pointed to
contact of travelling bullets with other parts of the external pelvic
wall.

[Illustration: FIG. 55.--Clean Gutter Fracture of the Ilium (range
placed by patient at 300 yards. Highland Brigade, Magersfontein). The
gutter was clean cut, and admitted the forefinger. The inner and outer
tables of the bone were in part blown out of a large irregularly
circular exit opening about 1-1/2 in. above the crest of the ilium. The
cancellous tissue was probably entirely blown out. Plates of the outer
and inner tables still remained connected by their periosteum to the
deep aspects of the iliacus and gluteus medius muscles. The peritoneal
cavity was not opened. The patient did well. Compare with the gutter
fractures of the skull shown in figs. 64, 66.]

Certain portions of the pelvis were subject to more severe comminution;
thus in one case in which the bladder was wounded, a very much
comminuted fracture of the horizontal ramus of the pubes was produced by
a bullet which subsequently lodged in the thigh behind the femoral
vessels. In this case the track was so oblique as to have necessitated
almost pure lateral i