tance in this figure because the lymph is localised to the portion
of the bowel in the immediate neighbourhood of the opening which had
suffered contusion and erasion.

[Illustration: FIG. 86.--Gutter Wound of Small Intestine caused by
lateral impact. Position of shallow portion of gutter indicated by
deposition of inflammatory lymph. Circular perforation. (St. Thomas's
Hospital Museum)]

Fig. 87, A B, illustrates a symmetrical perforation of the small
intestine; the aperture of entry (A) is roughly circular, and a ring of
mucous membrane protrudes and partially closes the opening. The aperture
of exit is a curved slit, again partially occluded by the mucous
membrane. The same amount of difference between the two apertures did
not always exist; in many cases both were circular, and apparently
symmetrical. Beyond this I have seen three apertures in close proximity,
two lying on the same aspect of the bowel, and the first of these was no
doubt an opening due to lateral impact similar to that seen in fig. 86.
In the recent condition little difference existed between the three
apertures.

The localised ecchymosis surrounding the apertures is quite
characteristic of this form of injury, and is a valuable aid to finding
the openings during an operation.

Fig. 88 shows the interior of the same segment of bowel, as fig. 87. It
shows the localised ecchymosis as seen from the inner surface, here
rather more extensive from the fact that the blood spreads more readily
in the submucous tissue.

[Illustration: FIG. 87.--Perforating Wounds of Small Intestine. A.
Entry; note circular outline and eversion of mucous membrane. B. Wound
of exit; curved slit-like character, eversion of mucous membrane. Note
the localised ecchymosis, more abundant round exit aperture. (St.
Thomas's Hospital Museum)]

It will be noted that the main feature of the form of injury is the
regular outline and the small size of the wounds. Another feature not
illustrated by the figures should also be mentioned. In the ruptures of
intestine with which we are acquainted in civil practice the wound in
the gut is almost without exception situated at the free border of the
bowel, but in these injuries it was just as frequently at the mesenteric
margin. The importance of this factor is considerable, since wounds
near the mesenteric edge are much more likely to be accompanied by
haemorrhage, and thus the opportunity for diffusion of infection is
considerably multi