e abdominal
cavity had not occurred. In other instances a definite subcutaneous
gutter could be traced, and often in these a well-marked cord in the
abdominal wall corresponding to the track could be felt at a later date.
Again, limitation to the abdominal wall was sometimes proved by the
position of the retained bullet, or sometimes by the presence in the
track of foreign bodies carried in with the projectile. See case 160.

Fig. 84 illustrates an example where the limitation to the abdominal
wall was evident on inspection. Here the division of the thick muscles
of the abdominal wall had led to the formation of a swelling exactly
similar to that seen after the subcutaneous rupture of a muscle, and two
soft fluctuating tumours bounded by contracted muscle existed in the
substance of the oblique and rectus muscles.

[Illustration: FIG. 84.--Wound of Abdominal Wall (Lee-Metford). Division
of fibres of external oblique and rectus abdominis muscles. Case 159]

The cases which presented the most serious diagnostic difficulty in this
relation were those in which the wound was situated in the thicker
muscular portions of the lower part of the abdominal and pelvic walls.
Such a case is illustrated in the chapter on fractures (see fig. 55, p.
191). I saw one or two such instances, in which only the exploration
necessary for treatment of the fracture decided the point. In many of
the wounds affecting the lateral portion of the abdominal wall the
question of penetration could never be definitely cleared up, as wounds
of the colon sometimes gave rise to absolutely no symptoms.

In a certain proportion of the injuries the peritoneal cavity was no
doubt perforated without the infliction of any further visceral injury,
and in these also the doubt as to the occurrence of penetration was
never solved.

(158) _Wound of belly wall._--Wounded at Modder River. _Entry_
(Mauser), 2 inches below the centre of the left iliac crest;
_exit_, 1-1/2 inch above and internal to the left anterior
superior iliac spine. The patient was on horseback at the time
of the injury and did not fall; he got down, however, and lay
on the field an hour, whence he was removed to hospital.
Probably the track pierced the ilium, and remained confined to
the abdominal wall. There were no signs of visceral injury.

(159) Cape Boy. Wounded at Modder River. _Entry_ (Lee-Metford),
immediately above and outside right a