bed to me. In one
the patient muttered 'They have got me this time,' and died quietly; in
a second the patient's face became ghastly pale, he lay on his back with
the knees flexed, clutching the ground, gasping for breath, and died
only after some minutes of evident great agony. The absence of any
_post-mortem_ details as to the condition of the heart in these injuries
is much to be regretted.

(145) _Entry_, in the seventh left intercostal space, in the
posterior axillary line; _exit_, immediately below the ninth
costal cartilage, close to the position of the gall bladder.

This track in all probability involved the diaphragm twice,
both lungs and pleurae, and passed immediately beneath the
heart. The liver was also perforated, but the spleen and
stomach probably escaped as far as could be judged from the
symptoms. The patient afterwards developed a pneumo-haemo-thorax
on the right side. The immediate symptoms were great distress
in breathing and rapid irregular pulse. The difficulty in
respiration was probably in part accounted for by the injuries
to the lung and diaphragm. The pulse remained from 112 to 120
for three days, at first soft and hardly perceptible, later
very irregular, and dropping one every fifth or sixth beat; and
it seemed fair to attribute this to the shock to the nervous
mechanism of the heart. The patient recovered from the chest
injury.

In some other patients in whom the track passed close below the
heart a disturbance of the pulse rate was noted, but this was
in some cases a slowing, not below 48, in others quickening to
100, with irregularity both in force and beat.

(146) _Entry_, in the fourth right interspace, 3 inches from
the middle line; _exit_, in the seventh left interspace, in the
mid-axillary line. This wound was received at a distance of
500-600 yards, but the bullet penetrated both sides of a stout
silver cigarette case and some cigarettes before entering the
body. There were minor signs of pulmonary injury, 'coughing day
and night,' and slight discoloration of the sputum on three or
four occasions. The respirations were quickened to 32, and as
much as ten days after the injury the pulse only beat 48 to the
minute; it then rose to 56, but beat in a very deliberate
manner.

In other cases the signs were almost nil.