es in diameter a mass of brain debris, bone fragments and particles
of dura-mater, skin, and hair, bound together by coagulated blood,
protruded as a primary hernia cerebri if the patient survived the first
few hours after the injury. In other cases of the same class the actual
opening was smaller, but the whole scalp was swollen and oedematous,
sometimes crackling when touched from the presence of extravasated blood
in the cellular tissue, while firm palpation often gave the impression
that the head consisted of a bag of bones over a considerable area.

Gutter fractures of the scalp were sometimes situated beneath an open
furrow, gaping from loss of substance, or beneath a bridge of skin; in
the latter case they were usually palpable. Simple punctures were also
usually palpable, but the smallness of the openings sometimes rendered
their detection more difficult than might be assumed.

I never saw a case in which the skull escaped injury when the bullet
struck the scalp at right angles, but the frequency with which Mauser
bullets were found within the helmets of men would suggest that this
must have sometimes occurred. A case of injury to the external table
alone has been described (p. 243). An illustration of the next degree of
injury is afforded by the following:--A bullet lodged in the centre of
the forehead, the point lying within the cranial cavity, while the base
projected from the surface: this patient suffered but slight immediate
trouble, so little, indeed, that he merely asked his officer to remove
the bullet for him, as it was inconvenient. The bullet was subsequently
removed in the Field hospital.

In a few cases the bullet entered the skull and was retained, when only
a single wound was found. Such cases are described in Nos. 54 and 68,
where the position of the bullet was determined by palpable fractures
beneath the skin. With regard to the retention of bullets, however, in
small-calibre wounds, it was always necessary to examine the other parts
of the body with great care, and to ascertain, if possible, the
direction from which the wound was received, as an exit was often found
some distance down the neck or trunk. Again the possibility of the
opening having been produced by glancing contact had to be considered.

In cases which survived the injury on the field, free haemorrhage, as in
wounds of other regions, was rare, and although general evidence of loss
of blood was often noted in patients brought i