e bullet
travelled the more extensive was the comminution. In some cases nearly
the whole length of the bone superficial to the track would be raised;
in fact, the bullet having once entered, the force is applied from
within in exactly the same way that it operates on the inner table in
the gutter fractures. A corresponding injury is met with in the case of
the bones of the extremities (see fig. 57 of the tibia), and again the
resemblance between these injuries of the skull and such perforations of
the long bones as are illustrated by skiagrams Nos. III. and XXIII. of
the clavicle and fibula is a close one.

[Illustration: FIG. 68.--Superficial Perforating Fracture. Illustrating
lifting of roof at both entry and exit openings]

I will add here a case of coexistent gutter fracture and perforating
wound of the skull, the conditions of the bone in which will illustrate
the behaviour of the outer and inner tables respectively, when struck
with moderate force.

[Illustration: FIG. 69.--Diagrammatic longitudinal section of Fracture
shown in fig. 68]

[Illustration: FIG. 70.--Fragment forming the main part of the floor of
Gutter Fracture in the squamous portion of the temporal bone. (Low
velocity, hard bone)]

(54) Wounded at Thaba-nchu. Guedes bullet. _Entry_ behind left
ear, just above posterior root of zygoma; gutter fracture;
bullet retained within skull. Above and corresponding to right
frontal eminence there was a haematoma, beneath which a loose
fragment of bone was readily palpable. When brought into the
Field hospital, twenty-four hours after the injury, the man
appeared to understand when spoken to, but made no answers to
questions. The urine was passed unconsciously, the bowels were
confined.

He was drowsy, the pupils widely dilated, the pulse 68, of good
strength, and the temperature 104 deg.. He slept well the following
night and midday there was little change, except that the
pupils acted to light, and the pulse had risen to 88, becoming
dicrotic and small. The temperature was 103 deg., the tongue furred
and dry, but he was lying with the mouth wide open.

At 2 P.M. the wound was explored. The entry led down to a
typical gutter fracture in the squamous portion of the temporal
bone, at the point of junction of the vertical with the
horizontal part; the floor of the gutter had been displaced
inwards as a s