a
consultation, Major Burton, R.A.M.C., freely incised the
knee-joint bi-laterally. One opening was closed, the second
plugged for drainage, as there was a large quantity of pus. No
improvement followed, and a week later Major Burton amputated
through the thigh. An attack of secondary haemorrhage a few days
later, combined with the degree of septic infection, ended the
man's life. On examination of the joint, a groove forming
three-fourths of a tunnel was found in the external tuberosity
of the tibia, leading into the knee-joint beneath the external
semilunar cartilage. The bullet had then passed upwards over
the outer border of the cartilage, bruised the margin of the
external condyle of the femur in such a manner as to depress
the outer compact layer, and finally escaped from the joint
near the upper reflection of the synovial membrane. The
synovial membrane was granular in appearance and reddened, but
there was no suppuration outside the confines of the joint,
except in a cavity corresponding to 2 inches of the track
before it actually perforated the tibia. A localised abscess
had evidently formed here and been diffused into the joint by
the movement of flexion already described.

(44) A man wounded during General Hamilton's advance on
Heilbron was struck on the outer aspect of the heel. An oval
opening of some size led down to a track in the os calcis; the
bullet was retained. The foot was dressed, and put up later in
a plaster-of-Paris splint. On the tenth day the splint was
removed to see to the wound, which looked satisfactory and was
re-dressed.

A few hours later the man was seized with very severe pain in
the ankle, and a day later I was asked to see him by Mr.
Alexander. The man was anaesthetised, and I examined the wound
with care, and also removed the retained bullet from the inner
margin of the leg. The bullet was reversed, having no doubt
suffered ricochet, hence the large aperture of entry, but it
was in no way deformed. I could not certainly determine the
presence of any fluid in the ankle-joint, and as the pain was
apparently localised to the distribution of the
musculo-cutaneous nerve, I decided not to freely open the
joint. In this, however, I erred, and two days later, after
consultation, the joint was f