the integuments by adhesions of old standing. So much is this the case, that the mucous membrane and skin have become quite continuous, the intestine has also contracted firm adhesions to the adjacent peritoneum on the inner side. A quill is inserted into the upper part of the gut, which is of the usual caliber, and the mucous membrane is healthy. The bowle below the wound is very much contracted from want of use, but pervious. The faces were voided through the preternatural opening.

The following preparation of a perforating gunshot wound through several folds of the small intestine, followed by recovery, is, as far as I am aware, quite unique. No. 1271. (See Plate V.)-Two pieces of the small intestine; jejunum showing the results of injury by gunshot wound. The larger piece of intestine exhibits three constrictions of that gut, two of which have been laid open to show the interior, and the third one remains entire. In the inside these contractions present much the appearance of a cicatrix, being totally devoid of the normal villous character of mucous membrane of the intestine; above and below it is bounded by a sharp and well-defined line of the natural lining of the intestine. Externally these constricted points are covered by a layer of old granular lymph; they were of a darker hue and more vascular than other portions of the small intestine, which, however, presented throughout the arborescent vascularity and soddened state constantly observed in rapidly fatal cases of blue spasmodic cholera. The smaller piece of intestine exhibits a fourth constriction of the gut, capable of admitting only a good-sized quill.—Donor, J. R. Taylor, Surgeon 80th Regiment. This preparation is from Private Paul Massey, 80th Regiment, who was shot in the abdomen at the battle of Ferozeshah, December 22nd, 1845. The symptoms consequent immediately upon the wound appear to have been so inconsiderable that it is recorded by Dr. MacDonald (then surgeon of the regiment), that it was his opinion that the ball had coursed round the abdomen, and not penetrated or passed through that region. The patient, however, shortly before his death, stated he had passed blood by stool after the receipt of the injury. Recovery followed slowly, but appeared to be perfect. The soldier, how

ever, became subject to attacks of bowel complaint, gradually becoming more frequent, and for the last twelve months of his life he was nearly constantly under treatment for symptoms of dysentery of the land scorbutic type. Whilst in hospital on account of this disease, he was seized, on the 13th May, 1851, with blue spasmodic cholera, terminating fatally the same day. Death five and a half years after being wounded. Cholera was then prevalent in the neighbourhood, and became epidemic in the regiment in the following month. Post-mortem appearance, an hour and a half after death.Externally. Livid; but less so than during life; not much emaciated; cicatrix of a wound in left linea semilunaries, about four inches above the crista ilii, and on the same plane posteriorly, another cicatrix, an inch to the left of the spine.-Head. General livid appearance of meninges and cerebral substance, some milky opacity on the upper surfaces of the hemispheres, slight serous effusion under arachnoid. — Thorax. Adhesions on the right side; lungs partially collapsed; structure healthy; heart normal; fluid blood in left ventricle.-Abdomen. Omentum firmly adherent to the internal surface of anterior cicatrix, and gathered into a knot at that point. The intestines neither there nor elsewhere morbidly adherent, but the fold of intestines immediately opposed to the cicatrix presented a line of contraction, as if a ligature had been tied round the gut. The fold of intestine immediately above presented the same appearance, and on the first fold, four inches from the first noticed contraction, and situated in a line below the umbilicus, was another similar appearance. The mucous surface of the small intestine generally was pale-pinkish in colour; no ulceration of large intestine; upper part of colon attenuated and contracted in situ; rectum thickened; stomach pale; liver small, congested; gall-bladder half filled with dark viscid bile; spleen small; kidneys healthy. (See Plate V.)

It is curious to remark, on post-mortem examination of a case of direct gunshot perforation of the abdomen, that the intestine is wounded in many places considerably removed from the direct course of the ball. Is this removal of wounded portions of intestine from the line of the ball due solely to the natural peristaltic action, or to something more than this, as the

result of the injury? Probably the latter influence is considerable; as it has been remarked, and I believe truly, that under perforation of the intestines by ulceration there is not only contraction in caliber, but marked shortening of the intestinal canal. This action beyond the peristaltic may be expected, and really appears to follow equally perforations by injury and disease, thus explaining the withdrawal of the wounded points of intestine from the line of the ball, as indicated by the orifices of entrance and exit.

In a case that came under the observation of Deputy InspectorGeneral T. Alexander, C.B., the small intestines were found to have been wounded sixteen times;* and in preparation No. 1272 the small intestines are perforated four times and the mesentery twice.

No. 1272.-Gunshot wound of the small intestines and mesentery, the former wounded in three places, and the latter in one. Death twenty-four hours after the accident.

No. 1125.-A gunshot wound of the large curvature of the stomach. The man lived eight hours after the accident.

* Mr. Guthrie's Commentaries,' p. 576.

CHAPTER IX.

GUNSHOT WOUNDS OF THE BACK AND SPINE.

GUNSHOT Wounds with fracture of the vertebra without lesion of the spinal cord are in general very tedious and slow to cure; sinuses form along the spine and are very troublesome; the spinous or transverse processes become carious; balls and pieces of cloth are sometimes lodged, and require free incision for their removal.

Ten have been admitted: six have been discharged to duty, and four invalided; all were the result of musket balls; one was a case of fracture of the ilium and spinous process of the lumbar vertebræ, with the wounds still unhealed. One with fracture of the spinous process of the dorsal vertebræ; wounds still open.

Two cases of wounds of the sacrum; in one of them the wound was still open, and a probe could be passed right across from the one aperture to the other. The last was a wound of the spinous process of the lumbar vertebræ, also still unhealed. The two following cases are examples of this description of wound.

93rd Regiment.-Sergeant James Munro; wounded at Lucknow by a musket ball through the loins; the ball entered a little behind and below the crest of the left ilium, and passed a little upwards and backwards, nearly across the back, and made its exit immediately above the crest of the right ilium; numerous pieces of bone came away from both apertures. Shortly after the injury the urine was tinged with blood, and it is doubtful whether the two last vertebræ are injured. 12th July.The aperture of exit of ball has closed; that of entrance is still open and discharging, and the probe can be introduced for a considerable distance, but bare bone is not detected; he is

unable to sit upright, and he has lost considerable power over the limbs; has incontinence of urine. Invalided 29th September, 1858.

24th.-Private Patrick Farrell, æt. 30, wounded 7th July, 1857, by a musket ball, which entered on the right side of the third lumbar vertebra, two inches from the spinous processes, passed across the back, and made its exit a little below the centre of the crest of the left ilium; several pieces of bone came away from the aperture of exit. August 2nd.-Aperture of entrance is healed; that of exit is still discharging, leading down to diseased bone. There is some thickening over the spinous processes of the lumbar vertebræ. Undisposed of.

Pelvis.-Balls sometimes pass across from one side of the pelvis to the other, without entering the cavity. When a ball is allowed to remain in any of the bones of the pelvis, it is the source of great annoyance, and gives rise to disease of the bones, profuse discharge, and probable death. When a ball lodges or is impacted in the flat bones, incisions ought at once to be made through the muscular substance for its removal.

LESION OF THE SPINAL CORD.

When the spinal cord is injured, either by gunshot, dislocation, or fracture, there is, in general, partial or general paralysis in some of the parts below the seat of the injury. The ball should, if possible, be removed. The patient should be placed on an air or water-bed, and kept scrupulously clean and quiet, the urine drawn off by the catheter, and every means taken to prevent sloughing of the back and nates.

None were admitted from India; but the following cases from preparations in the Museum illustrate this injury.

No. 2912.-Dorsal portion of the spine, showing a bullet lodged in the canal. The ball appears to have entered exactly through the centre of the arch, which, with the spinous process, is partly broken away. From a sergeant of the 5th Dragoons, who was shot by a private of the regiment.

No. 2913.-Is from Private R. Greive, 3rd Light Dragoons, who was wounded at Rhamnuggur, November 21st, 1849, by a