evidence offered above, certain pathological
observations support the view that the intestine escapes perforation by
displacement. Most of my knowledge on this subject was derived from the
limited number of abdominal sections I performed on cases of injury to
the small intestine, and may be summed up as follows.

The small intestine may present evidence of lateral contusion in the
shape of elongated ecchymoses, either parallel, oblique, or transverse
to its long axis. These ecchymoses resemble in extent and outline those
which ordinarily surround a wound of the intestinal wall produced by a
bullet (see fig. 87, p. 418).

The wall of the small intestine may be wounded to an extent short of
perforation, either the peritoneal coat alone being split, or the wound
implicating the muscular coat and producing an appearance similar to
that seen when the intestine is dragged upon during an operation, but
without so much gaping of the edges (see fig. 85, p. 416).

I met with these conditions in association with co-existing complete
perforations of the small intestine, and in one case of intra-peritoneal
haemorrhage in which no complete perforation was discoverable (No. 169,
p. 432).

The implication and perforation of the small intestine are to some
extent influenced by the direction of the wound. A striking case is
included below, No. 201, in which a bullet passed from the loin to the
iliac fossa on each side of the body, approximately parallel to the
course of the inner margin of the colon, and I also saw some other
wounds in this direction in which no evidence of injury to the small
intestine was detected, and which got well. Again wounds from flank to
flank were, as a rule, very fatal; but I saw more than one instance
where these wounds were situated immediately below the crest of the
ilium, in which the intestine escaped injury (see case 171). A very
striking observation was made by Mr. Cheatle in such a wound. The
patient died as a result of a double perforation of both caecum and
sigmoid flexure; none the less the bullet had crossed the small
intestine area without inflicting any injury.

The sum of my experience, in fact, was to encourage the belief that,
unless the intestine was struck in such a direction as to render lateral
displacement an impossibility, the gut often escaped perforation.

As a rule, the wounds of the abdomen which from their position proved
the most dangerous to the intestine were--

1. Wounds