class of the whole series of trunk or visceral injuries. Cases of wound
of the heart and great vessels afforded the only exceptions to an almost
universally favourable course, both as regards life and the
non-occurrence of serious after-effects.

This was mainly explicable on two grounds: first, the sharply localised
character of the lesion produced by the bullet of small calibre; and,
secondly, the fact that the lung, the most frequently injured organ, is
not materially affected by the grade of velocity with which the bullet
strikes. In point of fact, wounds of this organ probably afford an
instance in which high grades of velocity are distinctly favourable to
the nature of the injury, and this is possibly true in the case of
wounds of the chest-wall also.

The significance of the calibre of the bullet in wounds of the chest is
evident. The late Mr. Archibald Forbes, in one of his letters from the
seat of the Franco-German war, remarked that in crossing a battlefield
it was easy to recognise the patients who had suffered a wound of the
lung from the fact that the whistle of the air entering and leaving the
chest was plainly audible. This was, indeed, not uncommonly the case in
wounds produced by the older bullets of large calibre, but with the
employment of the smaller projectile it has become an experience of the
past. Some evidence as to the comparative severity of wounds produced by
the larger forms of bullet was, moreover, afforded by the present
campaign, since Martini-Henry wounds were occasionally met with. Of some
instances observed by myself, in one, external haemorrhage was a
prominent symptom; in another, a piece of lung was prolapsed from a
wound in the back, and twice I observed pneumothorax, an uncommon
sequela to wounds from bullets of small calibre.

It may be remarked, however, that all these more serious injuries were
recovered from, also that when we consider that the patients were
comparatively young and healthy subjects, the favourable prognosis was
what might have reasonably been expected. When, as occasionally
happened, a patient of more mature years, with enlarged facial
capillaries, received a wound of the lung, the course was in no way so
favourable as that witnessed in the case of the younger men.

In support of this opinion I may add that wounds from shrapnel and
fragments of shell also did remarkably well, although they sometimes
gave rise to more troublesome symptoms than did wounds pr