no doubt could exist as to the perforation of the lung. As a rule, a
considerable quantity of blood might be coughed up shortly after the
injury; but I never knew this to be sufficient in amount to give rise
to any misgivings as to danger from the haemorrhage. After the first
evacuation of blood from the wounded lung, the sign varied much; in the
majority of instances the patients continued to expectorate small
quantities of blood mixed with mucus, for some three or four days, the
blood gradually assuming a coagulated condition. Sometimes only the
primary haemoptysis was noted, and still more rarely the expectoration of
clots was continued for a week, or even longer. This probably depended
partly on personal idiosyncrasy, partly on the size of the vessels which
had been implicated in the track.

Cough was not commonly the troublesome symptom noted in the contused
wounds of the lung seen in civil practice accompanying fracture of the
ribs. Moist sounds were usually audible on auscultation, but in many
cases over a very limited area and only on the first few days.

Cellular emphysema was distinctly rare, and usually limited in extent:
thus I saw it in the posterior triangle of the neck alone in an apical
wound; over about a third of the upper part of the thorax in another
wound through the second intercostal space, and in this case oddly
enough the emphysema was the only sign of injury to the lung; and very
occasionally widely distributed--in the latter case there were also
usually multiple fractures of the ribs. Neither issue of air from the
external wound nor frothy blood was ever seen with small-calibre wounds,
but I saw one instance in a case of Martini-Henry wound.

_Pneumothorax_ was also rare. I saw pneumothorax three times out of
about half a dozen Martini-Henry wounds, but I do not think it occurred
as often in 100 small-calibre wounds. The Martini-Henry wounds all
recovered; but convalescence was very prolonged, and the same remark to
a less degree holds good in the small-calibre cases.

That the slow recovery in cases of pneumothorax in the Martini-Henry
wounds was due mainly to the size of the opening in the thoracic
parietes was, I think, proved by the fact that in the small-calibre
bullet wounds, followed by the development of pneumothorax, the external
wounds were usually large and irregular in type; also, that in the only
pneumothorax which I saw produced during an extraction operation, the
air was very