soft parts, and was possibly less than when
larger bullets were the rule, and again it was often remarkably slight
after the infliction of serious visceral injury. Still shock was
observed in a considerable proportion of the patients, and its
occurrence appeared to vary under very much the same conditions as
obtain in civil practice. Grades of severity depended on individual
idiosyncrasy, on the degree of excitement or preoccupation at the moment
of injury, and to a certain degree on the range of fire at which the
injury was received.

[Illustration: FIG. 45.--Note position of head, neck, and forearms in
upper figure]

The last is the only special factor, and as far as my observation went
it was one of considerable importance. When the soft parts only were
affected, even high velocity did not produce much effect; but when to a
flesh wound a severe bone fracture or injury to any part of the nervous
system was added, shock might be severe or profound. The question of
shock dependent on visceral injury will be considered in succeeding
chapters, but it may be well to state here that the most severe shock
appeared to follow injuries to the central nervous system especially to
the spinal cord, fracture of the larger bones, and wounds of the
abdominal and thoracic viscera, the latter especially when the cardiac
neighbourhood was encroached upon: hence the severity depended almost
solely on the importance of the part injured and the degree of damage
inflicted. I never observed instances of entire absence of shock in
visceral injuries, unless the range of fire had been an especially long
one.

To these remarks on constitutional shock I should add a few on the
'local shock' exhibited by the actual part of the body struck. The
phenomena were of a severity I was quite unacquainted with in civil
practice, and apparently were attributable to the local vibration
transmitted to the whole structure of a limb or part of the trunk. In
many fractures, and in some wounds of the soft parts alone, without the
direct implication of any large nerve trunk, the loss of functional
capacity of the limb was complete, and this condition persisted for
hours or even days.

2. _Pain._--As an initial symptom the occurrence of pain varied greatly
with the idiosyncrasy of the patient, and according to the circumstances
under which the wound was received. Some individuals are remarkably
insensitive, and in these the fact of a wound being a gunshot inju