in any
portion of the cranium._--These injuries were the most common, the most
highly characteristic of small-calibre bullet wounds, the most
interesting from the point of view of diagnosis, prognosis, and
treatment, and beyond this they formed the variety most unlike any that
we meet with in civil practice.

They were met with in every region of the cranium, and in every degree
of depth and severity. The lesser are best designated as gutter
fractures, the deeper are perforating and gradually approximate
themselves to the type of injury described as class 1.

When the bullet struck a prominent or angular spot on the skull a
considerable oval-shaped fragment was occasionally carried away, leaving
an exposed surface of the diploe (case 60, p. 274). Under these
circumstances the apparent lesion on raising a flap was slight, but
exploration often showed extensive intra-cranial mischief. Thus in the
case referred to both dura and brain were wounded, and continuing
haemorrhage led to the development of progressive paralysis, relieved
only by operation.

From the more deeply passing bullets a more or less oval opening
resulted, in which both tables were freely comminuted and displaced.
These cases differed from the typical gutter fracture only in length and
outline, and the nature of the accompanying intra-cranial lesion was
identical, while in the latter particular they differed much from
fractures in which the impact of the bullet was direct, in spite of a
near resemblance in the appearances in the osseous defect.

I saw one instance in which a circular fissure about 1-1/2 inch from
the actual opening of entry surrounded the latter, the area of bone
within the circle being somewhat depressed, though radial fissures were
absent.

In several of these cases fragments of lead were either found on the
fractured surface of the bone or within the cranial cavity, showing that
the bullets had undergone fissuring of the mantle, or had actually
broken up on impact.

_Gutter fractures._--The nature of the injury to the bones in these is
best illustrated by a series of diagrams of sections such as are shown
below.

[Illustration: FIG. 64.--Gutter Fracture of first degree. The drawing
does not show well the small fragments of bone usually carried from the
margins of the depression by the bullet.]

In the most superficial injuries the outer table was grooved and
depressed, usually with loss of substance from small fragments dire