plied, to say nothing of the danger from loss of
blood.

Beyond these more or less pure perforations, long slits or gutters were
occasionally cut. I saw instances of these in the case of the ascending
colon, and in the small curvature of the stomach. The comparative fixity
of the portion of bowel struck is a matter of great importance in the
production of this form of injury.

[Illustration: FIG. 88.--The same piece of Intestine as that shown in
fig. 87, laid open to show the ecchymosis on the inner aspect of the
Bowel. The two indicating lines lead to the openings, which appear
slit-like, and are sunk at the bottom of folds. (St. Thomas's Hospital
Museum)]

It may be well to add that, although the figures inserted are all taken
from small-intestine wounds, the nature of the wounds of the
peritoneum-clad part of the large intestine in no way differed from
them, except in so far as fixity of the bowel exposed it to a more
extensive wound when the bullet took a parallel course to its long axis.

A more important point in the injuries to the large intestine was the
possibility of an extra-peritoneal wound. I saw several such lesions of
the colon, every one of which ended fatally. I became still more fully
convinced of the greater seriousness of extra- to intra-peritoneal
rupture of this portion of the gut than I was when I expressed a similar
opinion in a former paper.[20] It will be seen later that the results of
intra- and extra-peritoneal wounds of the bladder fully confirm this
view, as all extra-peritoneal injuries died, while many intra-peritoneal
perforations recovered spontaneously.

_Wounds of the mesentery._--I had little experience of this injury; in
fact, case 169, on which I operated, was my sole observation. It stands
to reason, however, that injuries to the mesentery would be much more
frequent proportionately to wounds of the gut than is the case in the
ruptures seen in civil practice, since the whole area of the mesentery
is equally open to injury. Viewing the extreme danger of haemorrhage into
the peritoneal cavity in these injuries, I should be inclined to expect
that a considerable proportion of those deaths from abdominal wounds
which took place on the field of battle were due to this source.

_Wounds of the omentum._--Here, again, I am unable to express any
opinion, although the supposition that haemorrhage from this source took
place is natural.

Prolapse of omentum was comparatively rare, ex