ng evidence of the aseptic nature of the wounds, and the harmless
character of the projectile as a possible infecting agent, than that
offered by the general course of these injuries in this campaign, is to
be found in the whole range of military surgery.

The aseptic nature of the wounds, and the slight and localised character
of the bone lesions, have in fact justified the opinion previously
expressed by Von Coler, that these injuries in the future would be less
feared than fractures of the diaphyses of the bones.

Not less important than the localised character of the bone lesion
itself is the fact that the accompanying wounds of the soft parts retain
the small or type forms. Thus I occasionally observed more troublesome
results from minor shell wounds in the neighbourhood of joints, but not
implicating the synovial cavity, than in actual perforating injuries
produced by bullets of small calibre.

_Vibration synovitis._--Before proceeding to the consideration of wounds
of the joints, a short account is necessary of a condition of some
importance which is, I believe, more or less special to injuries from
bullets of small calibre travelling at high rates of velocity. This
condition, if not novel, at any rate excited little comment in the
descriptions of the older forms of injury, although this may have
depended on the more serious nature of the primary local lesions
accompanying wounds from the larger bullets, among which it formed a
comparatively unimportant element.

The condition referred to was the occurrence of considerable synovial
effusion into the joints of limbs in which the articulation itself was
primarily untouched. These effusions sometimes occurred even when the
soft parts alone were perforated, especially when the wounds were
situated above or below the knee-joint. They were apparently the direct
result of vibratory concussion of the entire limb dependent on the blow
received from the bullet.

The effusions were most strongly marked in cases of fractures of the
diaphyses, although this was more noticeable in some situations than
others. Thus with fractures of the shaft of the femur anywhere below the
junction of the upper and middle thirds of the bone, and in some cases
even higher, effusion into the knee-joint was very common, and sometimes
extreme. On the other hand, similar effusions into the hip-joint were
less marked, since I failed to determine their existence in the majority
of cases. I am in