jury to the chest was complicated by paraplegia from
spinal injury and septicaemia, and it was possibly pyaemic.

_Diagnosis._--No difficulties special to small-calibre wounds were
experienced, except such as have been already dealt with. The only class
of case which frequently gave rise to difficulty was haemothorax. Here
two points especially needed consideration. (1) _The source of the
haemorrhage as parietal or visceral._ As has been already foreshadowed,
this was mainly to be decided by the amount and persistence of the
haemoptysis, but naturally free haemoptysis did not negative concurrent
parietal bleeding. Then the actual source of the bleeding other than
from the lung had to be considered; in the great majority of cases the
intercostal vessels were responsible, and attention to the course of the
tracks often allowed this to be definitely decided upon.

A case included in the chapter on Injuries to the Blood Vessels (No. 5,
p. 127) is of great interest in this particular; in that instance
feebleness of the radial pulse, together with the position of the wound,
was a valuable indication of injury to the subclavian artery, but
weakened somewhat by the fact of retention of the bullet, and hence
uncertainty as to the exact course that it had taken, and as to whether
the bullet itself was not responsible for pressure on the vessel. Such
indications, however, should make one very chary of interference with a
haemothorax, even with extremely urgent symptoms, in the light of our
present knowledge of the nature of the lesions to the great vessels
produced by small-calibre bullets, and their tendency to be incomplete.

(2) _The imminence of suppuration or its actual occurrence._--In most
cases it sufficed to preserve an expectant attitude, and in the
persistence or increase of symptoms, to have recourse to an exploratory
puncture as the best means of solution of the difficulty.

_Prognosis._--The prognosis both as to life and as to subsequent
ill-effects was remarkably good; in many cases of uncomplicated injury
to the lung the patients rejoined their regiments at the end of a month
or six weeks. In the more serious cases complicated by the collection of
blood in the pleura, convalescence was more prolonged, and an average
time of six to eight weeks often elapsed before the patients could be
safely discharged from hospital. In the more serious a certain amount of
dulness always persisted at this time over the base of th