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Consulting Surgeon to the Forces.THIS communication must be prefaced by the remark that the writer fully appreciates the fact that it deals solely with a certain stage of progress of the lesions described. The circumstances of the present campaigu, which necessitate the rapid evacuation of all patients able to bear transference to England, have prevented not only the opportunity for treatment, but also of prolonged observation. None the less, the material dealt with provides many points of interest for consideration; and if its publication had been further delayed, at least another twelve months must have been allowed to elapse before any reliable permanent results were ready for observation and review. Such results, moreover, may well form a part of a more extensive report when the campaign is ended.The present war has afforded some surprises with regard to gunshot injuries inflicted upon the blood-vessels. Primarily it was expected that the experience gained in the South African and succeeding wars would be merely confirmed; but one of the first observations made was to the effect that isolated injuries either to the vessels or the great nerve cords were vastly less frequent than was the case during the period in which the dome or ogival tipped bullets were in use. It became at once apparent that the instability of flight of the sharply pointed bullet, unless the latter strikes the body at an exact right angle to the surface, is opposed to the production of neat and -limited perforations such as were common with the better balanced earlier forms, and that the injuries t o the blood-vessels as a class are not only more severe in themselves, but also accompanied by more extensive destruction of the surrounding soft tissues. Later experience of the common use of &e high explosive shell, and especially of the various forms of bomb (all of which furnish a large number of small, shkp, ragged fragments), has shown also that these missiles are as frequently the cause of vascular injuries, resulting in one of the various forms of traumatic aneurysm, as rifle bullets, althaugh the wounds are of a somewhat different character. The increased number of wounds caused by missiles of this class has in fact greatly multiplied the number of traumatic aneurysms met with amongst the wounded.Of some interest, though of less common occurrence, are the vascular injuries produced b y the shrapnel ball, since these are practically identical with those caused by the old round ball of 'Brown Bess ' (Pig. 120). An aneurysm resulting from a bayonet wound has not yet come under my observation.

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