of its position
when the erect attitude was assumed. The latter fact was of much
importance with regard to the nature of the injury sustained by the
bones, as under these circumstances the mode of impact was irregular,
and consequently comminution was often produced.

The behaviour of the different bones of the tarsus varied somewhat. On
the whole the prognosis in cases of injury to the os calcis was the
best, since the injury was more often individual and did not implicate
any joint, and also because of the comparatively regular architecture of
the bone. In the smaller bones concurrent injury to a joint was more
frequent. In the astragalus the central hard core extending upwards from
the interosseous groove, as increasing resistance, I think accounted for
the fact that comminution was more marked in this bone than in any
other. The effect of wound of bones of the tarsus in producing a certain
degree of laxity in the mediotarsal joint resulting in a slightly flexed
position of the fore part of the foot and some projection of the head of
the astragalus did not seem to me easy of explanation, but it occurred
with some regularity.

The injuries to the _metatarsus_ corresponded so nearly to those already
spoken of in the case of the metacarpus that they need no further
mention. They were less common, however, and I am under the impression
that fragmentation of the bullet was not such a marked feature, probably
on account of the lower degree of density of the bones, and their
greater fixity of position.

FOOTNOTES:

[18] Col. W. F. Stevenson. _Loc. cit._ p. 69.

CHAPTER VI

INJURIES TO THE JOINTS

Until recent times gunshot injuries of the joints formed a class
entailing the gravest anxiety to the surgeon, both in regard to the
selection of primary measures of treatment and in the conduct of the
after progress of the cases. The external wounds were severe,
comminution of the bones was great, and retention of the bullet within
the articulation was not uncommon. Operative surgery therefore found a
large field in the extraction of bullets, removal of bone fragments,
excision of the joints, or even amputation of the limbs.

The introduction of bullets of small calibre has robbed these injuries
of much of the importance they possessed in earlier days and during the
present campaign direct clean wounds of the joints were little more to
be dreaded than uncomplicated wounds of the soft parts alone. No more
striki