rrhage is rather to be ascribed to the
special method of production and the consequent nature of the wound. The
lesions were the result of immense force strictly localised in its
application, which might well induce very complete and rapid contraction
of the vessel wall; while the track in the soft parts was not only
narrow, but also lined by a thin layer of tissue possibly so devitalised
superficially as to specially favour rapid coagulation of the blood.
Beyond this the tracks were often sinuous when the position of the limb
at the time of reception of the injury was replaced by one of rest. The
influence of mere narrowness of the track is illustrated by classical
experience in the development of aneurismal varices after stabs by
knives or bayonets; and in the injuries under consideration the frequent
development of large interstitial haemorrhages into the tissues of the
limbs indicated that blood does not readily travel along the wound
track. It was noteworthy that when haemorrhage did occur it was most free
from, or often limited to, the wound of exit. This is due to the
direction of the active current set up by the rush of the bullet through
the tissues. The mechanical factor is, no doubt, the most important.

Control of primary haemorrhage from a wounded vessel by the impaction of
a foreign body was of much less frequent occurrence than appears to have
been the case with the older bullets. I saw a case in which, on removal
of a fragment of shell (Mr. S. W. F. Richardson), very free haemorrhage
occurred from a wound of one of the circumflex arteries of the thigh,
but not a single one in which a similar result followed the extraction
of a bullet of small calibre. The comparative infrequency of retention
of modern bullets is probably one of the main elements in this relation.
A very curious instance of provisional plugging of a wound in the upper
part of the brachial artery by an inserted loop of the musculo-spiral
nerve was related to me by Mr. Clinton Dent. This instance must, I
think, be regarded as an accident definitely dependent on the size and
outline of the bullet and on the nature of the force transmitted by it
to neighbouring structures.

While, however, deaths from external primary haemorrhage were rare, a
considerable number resulted from primary internal haemorrhage. In some
of these, injury to the largest trunks in the thorax or abdomen led to
an immediately fatal issue; in others wounds of the large vi