s diplopia, and the vision of the right eye
is much impaired; the man can see persons, but cannot count
fingers with certainty, although he sees the hand. Putting on
one side the loss of free movement, there is no obvious
external appearance of injury to the eye.

Mr. J. H. Fisher reported as follows:

Ophthalmoscopic examination shows the left eye and fundus to be
normal. The right disc is not atrophied, but the whole of the
lower half of the fundus is coated with masses of black retinal
pigment. There is atrophy in spots of the capillary layer of
the choroid, and the larger vessels of the deeper layer are
exposed between the interstices of the pigment masses. There is
no definite choroidal rupture. The lesion encroaches upon and
implicates the macular region.

The injury is a concussion one, not necessarily resulting from
contact, and certainly not due to a perforation. The loss of
movement and faulty position are the result of injury to the
muscles, and not to nerve implication.

The man complained that when he blew his nose the left eye
filled with water and air came out. The left nasal duct was
however shown to be intact, as water injected by the
canaliculus passed freely into the nose.

Intra-orbital bleeding, subconjunctival haemorrhage with proptosis and
ecchymosis of the lids were usually well marked. The latter was
sometimes extreme.

Injury to the nerves was naturally of a very mixed character. In many
instances the branches of the first two divisions of the fifth nerve
were obviously implicated and regional anaesthesia was common. This was
often transitory when the result of vibratory concussion, contusion, or
pressure from haemorrhage. In other cases it was more prolonged as a
result of actual division of the nerve. As is usually the case, when a
small area of distribution only was affected, sensation was rapidly
regained from vicarious sources, even when section had been complete.

As individual injuries, those to the optic nerve were the most
frequently diagnosed. I am sorry to be unable to attempt a
discrimination of injuries to the nerve alone from those in which both
nerve and globe suffered, but the globe can rarely have escaped injury,
either direct or indirect, when the bullet actually traversed the
orbital cavity. (A few further remarks concerning injuries to the optic
nerve will be found in