ened up from behind,
and some fragments of bone removed by Mr. Hanwell. On the 26th day this
joint was doing well, and considerable flexion and extension were
possible without pain. There was a somewhat abundant discharge of bloody
synovia during the first few days after the operation.

[Illustration: FIG. 59.--Illustrates the very neat and limited injury to
the Phalanges over the dorsal aspect of the first inter-phalangeal joint
of the Middle Finger, accompanying a gutter wound received by the
patient while holding a rifle.]

I never saw any troublesome results from perforations of the _carpus_.
The joints of the _fingers_ also offered little special interest,
except in so far as they afforded astonishing examples of the extreme
neatness of the injuries which a small-calibre bullet can produce. Fig.
59 is a good example of such an injury.

_Hip-joint._--I can only repeat with regard to this joint what I have
already said as to the injuries to the head of the femur. I had
practically no experience of small-calibre bullet injuries to the
femoral constituent, and beyond the single case of injury to the
acetabular margin mentioned on p. 193 I saw no obvious wounds of the
joint at all.

_The knee_, as usual, proved itself _par excellence_ the joint most
commonly injured, no doubt as a result of its size, the extent of its
capsule anteriorly, and its exposed position. In spite, however, of the
frequency with which it suffered injury, and the opportunities it
afforded for observation of the progress of the effusions towards
absorption, the injuries to the joint gave less anxiety and attained a
more favourable prognostic character than is the case in civil practice.
This depended on the very favourable course observed in the frequent
pure perforations following a direct line. These occurred in every
direction, the accompanying haemarthrosis usually disappearing completely
in an average period of little over a month. The extremes can be fairly
placed at a fortnight and six weeks. Limitation of movement was slight
or non-existent in many cases; in others it was of a very moderate
character, and I only remember to have seen one case in which a really
serious anchylosis developed. In this the man was struck from a distance
of 300 yards, and a considerable amount of bone dust from the femur was
found in the lips of the exit aperture. The wounds healed _per primam_,
but when I saw the man two months later anchylosis in the strai