d out a wedge, and becoming slightly
deflected, cut a vertical groove to the base of the mandible;
_exit_, in left submaxillary triangle. The bullet subsequently
re-entered the chest wall just below the clavicle, and escaped
at the anterior axillary fold. The appearance of these second
wounds suggested only slight setting up of the bullet; the
original impact was no doubt of an oblique or lateral
character.

The injury was followed by free haemorrhage and remarkably
abundant salivation (I was inclined to think that the latter
symptom was particularly well marked in gunshot fractures of
the body of the mandible), and very great swelling of the floor
of the mouth.

The patient could not bear any form of apparatus, but was
assiduous in washing out his mouth, and made a good recovery,
the fragments being in good apposition.

(83) _Entry_ (Mauser), over the right malar eminence; the
bullet carried away all the right upper and lower molars,
fractured the mandible, and was retained in the neck.

A fortnight later an abscess formed in the lower part of the
neck, which was opened (Mr. Pooley), and portions of the mantle
and leaden core, together with numerous fragments of the teeth,
were removed. The bullet had undergone fragmentation on impact,
probably on the last one (teeth of mandible), and still
retained sufficient force to enter the neck.

This case affords an interesting example of transmission of force from
the bullet to the teeth, and bears on the theory of explosive action.

In the treatment of fractures of the upper jaw, interference was rarely
needed. In the case of the mandible, a remark has already been made as
to the advisability of removing fragments when the neck of the condyle
has suffered comminution. The removal of loose fragments is necessary in
all cases in which the buccal cavity is involved. Experience in fracture
of the limbs has shown a tendency to quiet necrosis when comminution was
severe, in spite of primary union. This is no doubt dependent on the
very free separation of fragments on the entry and exit aspects from
their enveloping periosteum. In the case of the mandible, considerable
necrosis is inevitable, and much time is saved by the primary removal of
all actually loose fragments.

A splint of the ordinary chin-cap type with a four-tailed bandage meets
all further req