In a certain proportion of the injuries the peritoneal cavity was no doubt perforated without the infliction of any further visceral injury, and in these also the doubt as to the occurrence of penetration was never solved.
(158) Wound of belly wall.—Wounded at Modder River. Entry (Mauser), 2 inches below the centre of the left iliac crest; exit, 1½ inch above and internal to the left anterior superior iliac spine. The patient was on horseback at the time of the injury and did not fall; he got down, however, and lay on the field an hour, whence he was removed to hospital. Probably the track pierced the ilium, and remained confined to the abdominal wall. There were no signs of visceral injury.
(159) Cape Boy. Wounded at Modder River. Entry (Lee-Metford), immediately above and outside right anterior superior spine; exit, 1½ inch below and to right of umbilicus. A well-marked swelling corresponded with division of the fibres of the oblique muscles and of the rectus, and on palpation a hollow corresponding with the track was felt. The abdominal muscles were exceptionally well developed (fig. 84).
(160) Wounded at Magersfontein while lying prone. Entry, irregular, oblique, and somewhat contused, over the eighth left rib, in the anterior axillary line; exit, a slit wound immediately above and to the left of the umbilicus. The bullet struck a small circular metal looking-glass before entering, hence the irregularity of the wound. The patient developed a hæmothorax, but no abdominal signs; the former was probably parietal in origin, secondary to the fractured rib, and the whole wound non-penetrating as far as the abdominal cavity was concerned.
(161) Wounded at Magersfontein. Entry (Mauser), 1½ inch external to and 1/2 inch below the left posterior superior iliac spine; exit, 1 inch internal horizontally to the left anterior superior spine.
No signs of intra-peritoneal injury were noted, but free suppuration occurred in left loin; the ilium was tunnelled.
The same patient was wounded by a Jeffrey bullet in the hand; the third metacarpal was pulverised, although the bullet, which was longitudinally flanged, was retained.
(162) Wounded outside Heilbron. Entry, below the eighth right costal cartilage; exit, below the eighth cartilage of the left side. The wound of entry was slightly oval; that of exit continued out as a 'flame'-like groove for 2 inches. A week later the wound track could be palpated as an evident hard continuous cord.
Penetration of the intestinal area without definite evidence of visceral injury.—This accident occurred with a sufficient degree of frequency to obtain the greatest importance, both from the point of view of diagnosis and prognosis, and as affecting the question of operative interference. Amongst the cases reported below a number occurred in which it was impossible to settle the question whether injury to the bowel had occurred or not, and I will here shortly give what explanation I can for the apparent escape of the intestine from serious injury.