THE EFFECTS OF SMALL CALIBRE BULLETS AS USED IN MILITARY ARMS.
By GWILYM G. DAVIS, M.D., M.R.C.S. (ENG.),

OF PHILADELPHIA,

SURGEON TO THE GERMAN HOSPITAL.
SINCE France, in i886, adopted the small calibre of 8 millimetres as its military arm various nations have followed its example, and replaced their larger calibres of 10.75 millimetres to I2.50 millimetres with those ranging from the 8 millimetres of Austria, France, and Denmark down to the smallest, that of the United States naval rifle, of 6 millimetres, recently adopted. The causes which led to this reduction in the size of the bullets did not relate to the different effects produced by the smaller-sized missile, but solely to the increased ballistic properties and convenience of the new charge. During the ten years which have intervened since the introduction of the small calibre arms, the character of the wounds produced by them have been much studied and contrasted with those inflicted by the larger calibres. These studies have been largely of an experimental character, as there has been no great war in which the effects of the small calibred bullet could exhibit its true properties on such an extensive scale as to determine its value as a weapon of warfare, and furnish sufficient data to afford a proper comparison with its larger, old time rival. Our civil war was fought with weapons ranging in calibre from a.50 to.58 inch, or 12.50 to 14.50 millimetres, and in our medical and surgical history of that war will be found ample records of the effects they produced. The results of the small calibres have been shown in a limited
EFFECTS OF SMALL CALIBRE BULLETS.
way in the fighting in the civil war in Chili, in which the 7.6 millimetres Mannlicher rifle was used; in some of the contests of the English troops with the half savage occupants of their Eastern possessions, in which the 7.7 millimetres Lee-Metford was used; in the Japanese-Chinese war, in which the former used the Murata rifle of about 8 millimetres (.3I5 inch); in the Abyssinian campaign, in which the Italians used the 6.5 millimetres Mannlicher-Careano rifle; in the present Cuban rebellion in which the Spanish soldiers are armed with the 7 millimetres Mauser rifle, and, finally, in a certain number of more or less minor isolated instances. The conclusions arrived at from a survey of these practical tests have not been as satisfactory towards the establishment of the efficiency of the new arm as were the experimental effects derived by governmental commissions. The question which is now raised is whether the experimental results produced on dead bodies can be accepted as exemplifying the wounds which surgeons will be called to treat in future wars ? Are they as severe on the living body as it has been shown they are on the dead? and how will they compare with the wounds received in previous wars ? Colonel Stiles,' in discussing the question of the efficiency of the new arm, says he thinks it may be answered in the affirmative, yet he concludes by saying that the wounds it produces offer the surgeon an extremely favorable field for his labors, while materially lightening them. Thus practically stating that the new bullet does not produce such severe wounds as the old. Before discussing the relative disabling power of the new and old arms, let us briefly review the facts discovered concerning the principles of gunshot wounds in general, and also the properties of the small calibres. The United States has adopted two calibres. The larger,.30 inch or 7.62 millimetres, for the army and.236 inch or 6 millimetres for the navy. The experiments made have been principally with the larger calibre, which is also vtery near those adopted by most foreign powers. The bullet has a length of

Journal of the Military Service Institution, November, I894.

G WZL YM G. DA VIS.

four diameters or thirty millimetres and is composed of a compressed lead interior and German-silver jacket. A gunshot wound is produced practically by two forces, one, penetrative, in the axis of flight, and the other, lateral, or transverse to the axis of flight. This lateral effect when it exists in any considerable degree has been termed explosive. Therefore we can define explosive effect as a marked destruction of the tissues surrounding the track of the bullet. Inasmuch as the missiles usually used are projected from rifled arms, they have a third effect due to the rotation which is thereby given to them. In many gunshot wounds there are no appreciable effects due to this rotary force. This is evidenced by the fact that at its start the bullet only makes one rotation on its axis for every nine inches of its flight, and as its velocity decreases so does the rapidity of its rotation. When a bullet perforates a part it often remains in it too short a time for its rotary action to manifest itself. When, however, a bullet is arrested in a part and expends all its energy on it then there are rotary effects produced. Evidences of this was shown in the spiral markings obtained by Henrad and the twisted markings in clay obtained by Horsley. The tendency of a rotary motion of the projectile is towards a lateral effect on the tissues, therefore increasing its explosive action. Kocher from his experiments considered that it exerted so little influence on the character of the wounds that he did not consider it appreciable, and described the explosive action as being independent of it. Horsley, also from his experiments, states that as far as the brain is concerned little destructive action is to be ascribed to it, while Lagarde apparently did not think it important enough to take into consideration at all. This leaves the two forces, penetrative and lateral, alone to e considered. Every gunshot wound is the resultant of these two. In some the penetrative predominates, in others the lateral. The primary or initial force is an onward, propulsive, or penetrative one, and it is only when resistance is encountered that a part of it is transformed into a lateral one. The whole of

the propulsive force is never transformed into a lateral or explosive one, a part of it is always consumed in penetration. When it is expended on penetration the bullet leaves a clean track through the tissues, but when it is expended laterally there then is tearing and disintegration of the tissues extending far beyond the track of the ball. There are several factors which cause a wound to assume either a penetrative or explosive character. As a rule, penetrative effects are directly proportional to,(i) The hardness of the projectile (non-deforming). (2) The softness (elasticity and compressibility) of the tissues. (3) The velocity of the bullet. (4) The small size (frontage) of the bullet. (5) The weight of the bullet. The hardness of the bullet prevents its being deformed on striking the tissues; therefore, the energy which would be disseminated by this deforming of the bullet is preserved and aids it in penetrating deeper. This is seen in the relative penetration of bullets as shown by Lagarde. A.30 inch calibre Germansilver jacketed projectile penetrated five and three-tenths inches of solid oak, while the harder steel-jacketed one of the same calibre and velocity penetrated nineteen and a half inches. The.45-inch calibre lead projectile at a somewhat lower velocity only penetrated three and one-fifth inches. The softness or compressibility and elasticity of the tissues also aids a bullet in its flight by being easily penetrated or displaced instead of resisting progress, as does bone, for example. It is evident that increased velocity should produce an increased penetration, but this is only so to a certain extent, because the resistance to the entrance and passage of a bullet increases as the velocity increases, and it does so in a more rapid ratio than does the penetration, so that a point is soon reached beyond which any additional velocity is simply expended laterally on the tissues instead of producing an increased amount of penetration. With the same amount of initial energy imparted to bullets of the same weight but different diameters, the penetration of the bullet of less diameter would be the greater. This is on account of the less frontage presented by the ball, and consequently the less resistance offered to its entrance.

G WIL YM G. DA VIS.

The greater the weight of the bullet the greater is its inertia. It requires more energy to start its flight, and consequently greater resistance to stop its progress. Therefore, a wound by a small, hard projectile impelled through soft tissues at a suitable velocity would present the characters of a simple perforation without any marked injury to the structures adjoining its track. Such wounds occur quite commonly and are the least dangerous. The lateral effect, which when marked is termed explosive, of a projectile is proportional. (I) To the softness of the bullet,-easily deformed. (2) To the hardness and non-compressibility of the tissues. (3) To the velocity of the bullet. (4) To its large size (frontage). (5) To its weight. (6) In a slight degree to the rapidity of rotation on its axis as. imparted by the rifling. The softness of a bullet favors lateral action by spreading out sideways instead of penetrating onward. On this account lead bullets at certain ranges produce greater destruction of tissue than do the metal-jacketed ones. So well known is this, that for hunting purposes soft lead-nosed bullets are especially made. The parting of the hard metal jacket from the leaden core also increases the destructive action. Lagarde estimates it to occur in io per cent., but others regard this as being somewhat too high; it probably varies considerably. The harder and less compressible the tissues are into which the bullet penetrates, the more is its penetration checked, and therefore the greater is the lateral expenditure of its energy. A bullet may enter a bone only a short distance, yet it will split it for a considerable distance. Water is practically incompressible, therefore tissues containing it transmit the force imparted by the bullet to a very nrarked degree. The explosive action of bullets is seen to be much greater in the bladder, stomach, brain, liver, and spleen than it is in the muscles, lungs, or intestines. The lateral effect increases rapidly with the increase of velocity. The injured tissues, so to speak, have not time to be pushed aside to make way for the bullet, but are torn to pieces and carried onward and thrust latterly with great destruction of the surrounding parts. A flying bullet striking a bone shatters

it and sends the pieces into the surrounding tissues, and not infrequently tears a great hole through the part as it emerges. The soft'but incompressible tissues of the liver, spleen, and brain, when entered by a bullet at high velocity, are apt to be reduced to a disorganized, pulpy mass. The greater the size or frontage of the bullet, the greater will be the amount of tissue which it displaces in its passage and the more resistance will it encounter. Small bullets will frequently slip through. a part without injuring it, but a large bullet will tear the surrounding tissues severely. Bullet wounds from the small-calibred revolvers are often not serious, but those of the' large-calibred weapons will almost always be of a dangerous character. So true is this that if a disabling effect is desired a big frontage is obtained either by using a large-sized bullet or so preparing it as to cause its expansion on striking the object. An increase in the weight of the bullet is accompanied by a marked increase in its lateral action. This is due to its greater inertia. It is a well known fact to hunters that small game shot with a round, light ball is not mutilated nearly so much as when shot with the heavier conical projectile when moving at the same velocity. The influence of the rotation of the projectile on its axis, as shown in wounds inflicted by it, is slight. It exhibits its characteristics by the irregularity of the injury inflicted in the surrounding parts. We have defined explosive effect as a marked destruction of the tissues surrounding the track of the bullet, and have endeavored to show that it is nothing more than the lateral transmission of a considerable proportion of its initial energy. According to Horsley, Hugier, in I848, first pointed out that the marked disturbance (or explosive effect) produced in the soft organs was due to a dispersion in a hydrodynamic manner of the water contained in these organs; 1 also that Kocher had gone over the same ground, and that Kramer and himself had fully confirmed the experiments, and that the effect is really a hydrodynamic one. To attribute explosive action to a single

I Sir William MacCormac credits William Busch with this suggestion, Lancet, August 3, 1895.
cause is, however, hardly correct. Explosive action is simply a marked degree of lateral action, and lateral action, as detailed above, is shown to be the resultant of at least six different conditions, which, being combined or present in different degrees, produce the lateral destruction of the tissues. Sir William MacCormac1 also states that the pressure is not strictly a hydraulic one. Horsley himself shows that in gunshot wounds of the skull and brain the explosive effect is most marked on the side of entrance. When muscular tissue alone is traversed by the ball the explosive effect is almost nil, but if a bone is traversed, then from that point it is marked. This is due not to any special hydrodynamic action, but to the hard bony splinters which are detached and driven onward by the force of impact. This is so true that Lagarde and others considered a large wound of exit in the extremities as being indicative of extensive bone lesion. Delorme2 claims, and Stevenson 3 agrees with him, that too much importance has been attached to the hydraulic theory. Coming now from theory to fact, let us see the application of the above general principles to the special wounds produced by the recently introduced jecketed missiles of small calibre and high velocity. Owing to the fact that the recently invented firearms are used for war purposes, the wounds they produce have been studied by a large number of individual experimenters and government experts. Space will allow of allusion to only a few. The missile adopted by the United States for use in the army is an average type. It is cylindro-conoidal in shape, weighing 220 grains, 7.62 millimetres or.30 inch in diameter, four diameters in length, and composed of a leaden core surrounded by a Germansilver mantle or cover. It is impressed with a muzzle velocity of 2000 feet per second. The discarded arm used a compressed leaden ball I I.25 millimetres or.45 inch in diameter, weighing 500 grains, with a velocity of 1300 feet. The following results are deduced from experiments on dead bodies and other inanimate objects by the more recent experi1 Lancet, August 3, 1896. 2 Chirurgie de Guerre, Vol. XI, p. 996. 3 Lancet, March 9, I895, p. 6io.
menters, Bruns, Von Beck, Von Bardeleben, Reger, and Von Koler and Schjerning (the German Commission), of Germany; Delorme, Nimier, and others, of France; Habart, of Austria; Demosthene, of Bucharest; Kocher, of Switzerland; Horsley, of England; and Lagarde and Griffith, of our own country. When the earlier experiments were made, the opinion, as voiced by Bruns, was more or less general that the new arm was more humane in regard to the wounds it produced than the older weapons. Later experimenters, as Demosthene, held that it was more destructive. Lieutenant Stiles, United States army, in a careful review, considered it less humane than had been claimed. Major Halley regarded the small calibre as the more deadly. Griffith 1 evidently considered it extremely destructive. He states that at distances up to IOOO yards the explosive quality of the missile is terrific. Major A. C. Girard, in commenting on the results obtained by Kocher and the German Commission, stated that it is evident from both series of observations that the more humane effects are a myth. The vulnerating effect of the United States army gun of 7.62 millimetres or.30-inch calibre was considered so firmly established that when, a couple of years later, the government wished to rearm the navy, the calibre was still further reduced, and one 6 millimetres or.23 inch was adopted. The results of experiments by the 7.62 millimetres or.3o-Ach calibre alone are here considered. The skin-wound of exit of the.45 inch or large calibre is larger than the wound of entrance, while of the small calibre there is not much difference unless a bone is struck, when it also is much larger. Greater hemorrhage was expected from the small calibre, but this has not yet been positively determined. Muscles.-Explosive action on the muscles is not marked unless the bone is injured. It is less marked than on the liver and spleen. At short ranges there is a perforation about the size of the bullet or a little larger, and at longer ranges somewhat smaller. Bones.-On these a somewhat different effect is produced 1 Paper read before the Association of Military Surgeons, x895.

on the diaphysis and epiphysis. At short ranges the explosive action is very marked, splintering and comminuting the bone for great distances from the track of the ball. As the distance increases beyond about 400 yards (Kocher, 350 Girard) the splinters are not so extensive nor so completely detached from the periosteum and surrounding parts. Simple perforation of the shaft of long bones is comparatively rare at any range. On the epiphyses, however, perforations occur sometimes even at short range, and are the rule at long ranges. The comparative effect of the two calibres on the bones at distances from 500 to I 200 yards is well summed up by Stiles, who says, " There is none of the splintering, comminution, and scattering of fragments always caused by the old ball at these ranges." Lagarde states that beyond the explosive zone, which he limits to 350 yards, the small hard bullet almost invariably perforates or gutters the epiphysis, and that the lesions to the joint are never severe. The flat bones are commonly perforated without extensive crushing and fracturing. The smaller-sized long bones are badly broken iii the region of impact. Griffith found the clavicle comminuted for one inch at IOOO yards, and the ulna one and a half inches at 600 yards. Skull.-It is on the skull and brain that the small calibre bullet produces its worst effects. At almost all distances, certainly up to IOOO tards, it fractures the bone extensively and disorganizes the brain. According to Kocher, explosive effect is shown even up to I IOO metres' distance, and at longer distances perforations. The disorganization at short ranges is terrific. Chest.-Tearing of the lung only occurs when a rib has been fractured and the pieces driven onward. Tendons. -Griffith found that at 6oo yards the tendons were not injured, but pushed aside. At greater velocities they would be torn. Abdomen.-The abdomen is perforated at almost the extreme range of the bullet,.-over 3000 yards. There are usually from three to eight wounds when the intestines are involved (German Commission). On the liver and spleen particularly explosive action is marked. On the kidney to a less extent.
45 Liver.-Kocher found pulpification of the liver up to 700 metres, while the German Commission found it present up to 2000 metres. Spleen is injured to the same extent as the liver. Griffith found it almost split in half at 500 yards. Kidney badly torn, but hardly to same extent as the spleen and liver. General Considerations.-Prom the results of the earlier experimenters, particularly Bruns, it was thought that the wounds of the small calibre bullet would be less severe than those made by the larger, slower, and softer one. Then came Demosthene and Habart, who -claimed that the 6.5 milliietre Mannlicher inflicted worse wounds than the old arm. Tht were supported by Brunner,1 and to a certain extent by Von Koler and Schjerning, of the German Commission, who seemed to get more severe results from the small calibre than others. Kocher and Major Lagarde, on the contrary, did not consider the effects worse. Major Griffith concludes that the explosive effects up to I000 yards are terrific. The German Commission and Griffith experimented by shooting at bodies at the actual distances, therefore the severe results obtained by them, as pointed out by Girard, may be due to the bullet being more easily deflected,-i.e., not keeping end on, but turning to a certain extent either before or after entering the tissues. Kocher and Lagarde experimented at a distance of twenty-eight to thirty yards with charges reduced to give the proper velocities. Turning now from the theoretical to the actual, from experiments on dead bodies to an observation of effects on living ones, some very interesting facts are developed. It is found that living tissue does act differently from dead tissue. The armament of most of the large nations was decided on before the small calibres were given any thorough trial in actual service. An opportunity was afforded the English to observe the effect of their new Lee-Metford rifle, 7.7 millimetres, in the Chitral campaign. Surgeon-Lieutenant Gould2 collected twenty-five or thirty

Correspondenzblatt fir Schweizer Aerzte. ' British Medical Journal, July 20, I895.
cases and reports twenty of them in detail. He did not know, however, at what distances the wounds were received, nor did he have an opportunity to examine the dead. He says," There can be little doubt that. from a humanitarian point of view the Lee-Metford rifle is a perfect weapon. The bullet obviously inflicts very little damage on the soft tissues, and on the bones its action is apparently not very severe, preferring rather to go through a bone than to badly fracture it." Again, " From the little experience I have had in injury to bone tissue by the Lee-Metford bullet, I certainly think it causes but slight shock, and doubt its capacity of putting a man out of action." One man was shot through the sacrum and in three weeks was ready to fight alin; another was shot through the olecranon and upper part of the shaft of the ulna; rapid recovery took place with good movemeint of the elbow. Another was shot through the lower portion of the radius; the wound healed rapidly with fair movement of the wrist and fingers which was improving daily. Compare the course of these wounds to what they would have been with our old.45-calibre arm? Another was shot through the face, the bullet enitering below the right malar bone and coming out below the centre of the lower border of the left zygomatic arch,-of this patient it is said he had no severe symptoms, nor pyrexia during treatment, and will soon be well and none the worse for being shot. The wounds pursued an extremely favorable course, the healing being very rapid. Major Girard' saw the case of a convict who was shot through the head at short range with the new United States Krig-Jorgensen rifle. The explosive effect was marked, the skull being shattered and the brain disorganized. He states, "When the first experiments with the small calibre gun were made, it was found that occasionally the epiphysis of a bone showed an almost clean perforation, and the rash conclusion was drawn that the new class of weapons, instead of shattering the bones and tearing the flesh, would make almost a punctured wound; therein they would be more humane." This he characterizes as a fallacy, and adduces the foregoing case in proof I Journal of the American Medical Association, October I9, I895.

of his position. He appears not to take into consideration the facts that the distance was only ninety feet, or thirty yards, and that the injury was inflicted on a part of the body which shows most markedly the destructive action of the small-calibred missile. Almost any arm would probably have produced just as severe effects under similar circumstances, and the.45-calibre probably greater. During the late Chinese-Japanese war the Chinese soldiers used mostly old arms, but the Japanese had some troops armed with the Murata rifle of 8 millimetres, although the bulk of the troops'were armed with a heavier calibre. According to the Pioneer,' reports received from China showed that the Murata rifle inflicted wounds like the Lee-Metford (both being about the same calibre). It says " the Chinese soldiers wounded in action experienced no difficulty in getting away, even after being hit by two or more bullets. They had to trust to kindly nature to heal their wounds. This she did in a most marvellous fashion in many cases, and China must now contain many hundreds of socalled soldiers who owed their lives to the invention of the smallbore rifle. In the decisive actions it was a rifle that carried a much heavier bullet that did the real execution." Sir William MacCormac 2 states that in the Chitral Expedition, according to Surgeon-Lieutenant H. Burden, who was present at three actions, as far as he could see and hear from others, the wounds through the soft tissues, at both long and short ranges, were clean and incised, with very little or no bruising, and that they quic'kly healed. Through the bones clean, punched-out holes were made with little splintering, and he said in no case was there any explosive action. The damage caused by the large-bore bullets of the enemy was much more severe. Also Surgeon-Lieutenant Evans reports that these cases healed rapidly and well, notwithstanding the use of dressings very far from aseptic applied by the men themselves. The natives, however, said in reply to questions, that " all the men who had suffered fracture of long bones were dead."
Journal of the Military Service Institution, November, I895.
2 Lancet, August 3, I895.
As throwing some light on this point, an examination of the twenty cases already alluded to, reported in detail by SurgeonLieutenant Jay Gould, shows, that the following long bones were hit without very serious fracture: Ulna, 2; humerus, 2; radius, 3; fibula, i; tibia, 2; femur, i. Seydel gives the details of fifteen cases treated by himself. In two cases the soft parts alone were affected and healed without pus. In two the phalanges were shot through. They recovered with pseudarthroses (without the loss of the finger). Of three abdominal wounds, two were shot through the liver and died, while the third recovered with a facal fistula. Two shot through the lungs recovered without difficulty, while six shot through the head or skull died. When there was any chance at all for recovery it took place rapidly, General Lowe, who commanded the leading column in the Chitral campaign, is quoted by the Washington Post as saying, "Often prisoners were brought in with two or three bullet-holes through them that seemed to cause the wounded men but little inconvenience, for they had been marched six and seven miles before they reached our bivouac. These prisoners accounted for the extraordinary absence of the dead enemy on the field by saying that unless a man was shot througlh the head or bowels he did not die, and nothing but a wound in the joints of the lower limbs disabled him. I am clearly of the opinion that for fighting savages the old.45-calibre arm should be used. The Chitralis had a.45-calibre rifle, and they disabled or killed a man whenever they hit." As evidence of the correctness of this latter statement, our own chief of ordnance, General Flagler,2 says that for close range the.45-calibre is superior to the new.30 calibre. Quoting General Lowe again, he says, " We had to execute a spy. The firing party, with eight rifles loaded with bulleted cartridges and four with blanks, fired on him at fifteen paces. The prisoner was hit six times, three shots piercing his chest. He, on being unbound, started and ran a quarter of a mile before

1 Minchener medicinische Wochenschrift, February II, I896. 2 Army and Navy Journal, August 8, I896.
he was overtaken by a mounted Sikh, who cut his head nearly off at a single blow with his sabre." The same paper states that a German murderer received the fire of nearly an entire platoon and tried to escape. The sergeant at the head of the firing party shot the wretched man through the head, but did not kill him. He reloaded his piece, and while the wounded man was lying on the ground begging for his life the sergeant placed his rifle behind the prisoner's ear and killed him. He had received nine wounds before he died. It is interesting to recall, in this connection, that in Brigadier-General Griffith's experiments, one of the bullets entered to the left of the sternum, in the second intercostal space, one-half inch to the left of the median line passed through the sternum to the left of the trachea and above the arch of the aorta, and made its exit one-half inch to the right of the second dorsal vertebra. There were no fractured bones nor damage to the vital parts or organs. Imagine the effect of a.45 calibre bullet pursuing a similar course ? A field officer, writing in the Morning Post' (Calcutta), is quoted as saying that " the effect of a bullet, particularly a light one, fired at a high initial velocity, is far greater on dead than on living flesh and bone. In the latter there would really appear to be some resistin'g quality, for which we must confess ourselves unable to account, not possessed by dead flesh and bone. An express bullet usually forms a crater in the flesh of a dead animal, and breaks up the-bones; whereas in a living one it seems to be turned aside by the least obstruction and merely passes through the body." He also states that he has shot a large quantity of game in India, chiefly with a.36express, but has never seen in the animal shot while living the terrible wounds made by the same rifle on a dead carcass. The lack of disabling power by the new small calibre arms has attracted the attention of the military authorities both of this country and abroad. The United States authorities examined into the question at Springfield and decided to retain the present small calibre German-silver jacketed projectile on account of its superior ballistic properties and power of dislodging troops be1 Journal of the Military Service Institution, September, I895.
hind breast-works, etc. In the recent fighting in South Africa, the British troops were unable, by their rifles alone, to stop the onward rush of the natives, and it was only the opportune assistance of the machine-guns that saved them from being overcome by the savages. The Italians in their campaign against the Abyssinians were not so fortunate. The disabling effect of the MannlicherCarcano rifle of 6.5 millimetres, with which they were armed, were so slight that it was thought that the ammunition might have been tampered with. The natives overcame the Italians with most frightful slaughter. To conclude, I would submit,(i) That the initial force of a bullet is an onward or penetrative one. (2) That when penetration is impeded, the onward force becomes transformed into a lateral one. (3) That explosive effect is only another name for lateral action,-i.e., outside of the track of the bullet. (4) That lateral action is most marked in hard bones (the fragments being carried onward) and in organs containing water (bladder, brain, liver etc.). (5) That practically the rotation of the bullet on its axis does not materially affect the character of the injury. (6) That the effect of gunshot-wounds is not so severe on the living body as on the dead. (7) That the destructive power of the small calibre arm has been over-estimated. (8) That its stopping or disabling power is less than that of larger calibres. (g) That wounds in future conflicts will be, as a rule, less severe and healing more rapid, with fewer complications than has been the case in the past. (Io) That less radical treatment will be required and conservatism will be followed by most brilliant results.

REVIEWS OF BOOKS.

M. L. Harris, on the diagnosis of abdominal tumorrs, offers material for an instructive and well illustrated chapter. The mesocolon naturally divides the abdomen into four spaces, he says, and by the inflation of the colon a diagnostic help is secured, of which surgeons make too little use. Chapters upon the detection of calculi by the X-rays and upon the use and abuse of saline solutions add much to the value of the book. The above constitute but an imperfect mention of a few of the features of this work. We have no word of praise too great for its style or for the fine judgment exercised in the selection of its constituent material. JAMES P. WARBASSE.
LES PROJECTILES DES ARMES DE GUERRE: LEUR ACTION VULNERANTE. Par les Drs. H. NIMIER, Medecin Principal de l'Armee, Professeur au Val-de-Grace, et ED. LAVAL, Msedecin Aide-Major de ire Classe. i vol. in 12 avec gravures. FELIX ALCAN, Pditeur. Paris.
In this small hand-book are reproduced the lectures delivered by the author as Professor at Val-de-Grace. The work is divided into two parts,-infantry and artillery projectiles. In succession are considered the physical and dynamic qualities of each, their zones of action and of effect upon the human body as to infantrv projectiles. Greatest interest at the present time naturally attaches to the effects of the small calibre-jacketed projectiles used in the arms now adopted generally in the armies of civilized nations. The conclusion of these French authorities seems to be in accord with American and British experience that wide-spread lacerations, so-called explosive effects, are rarer and less marked in the wounds made by the new projectiles than in those caused by the old-style balls. The conclusion of the authors is expressed thus: "In fact, the difference between the action of the old and
CHEYNE AND BUYHARD, SURGICAL TREATMENT. 747
the new projectiles is due to this, that in the old, owing to the larger surface of impact, their larger normal calibre, and the greater frequency of their accidental deformation, more favorable conditions were created for the extension to the tissues through which they passed of their destructive effects. On the other hand, the notably greater velocity at near distances of the new projectiles is not sufficient to compensate for the inferior wounding power due to their smaller calibre and freedom from deformation." It is now evident, fromi abundant experience, that the surgery of the new projectile is of a simpler and more hopeful character than that which attached to the old, large-calibred, soft projectiles. The changes wrought in military affairs by the new arms are rather of a strategic than of a surgical character. LEWIS S. PILCHER.
A MANUAL OF SURGICAL TREATMENT. By W. WATSON CHEYNE and F. F. BUYHARD. In seven volumes. Vol. III. Pp. 305, with ioo illustrations.
The third volume of this work (see ANNALS OF SURGERY, April, I9oo) is devoted entirely to the surgery of the osseous system,-fractures, diseases of bone, and amputations. This section of the manual is very good, and must prove of great practical value. As in the preceding volumes, there is still some tendency to dwell rather too much on certain old-fashioned apparatus and procedures, while some valuable "modern" methods are either treated too briefly or not at all. Although the X-rays belong properly to a treatise on diagnosis, it is surprising that this adjuvant to treatment fails of mention in this work. The direct fixation of fractures by operative interference is considered very fully. It is rather to be regretted that the methods of pegging, wiring, etc., are so well illustrated and described, as they give the tyro a false impression of the useful-