The hand lies with its ulnar side next to the plate, as is indicated by the sharp outline of the swollen hypothenar eminence, nearer the plate than the thumb, with the enlarged, poorly defined, and rarefied shadow of its metacarpal and phalanges. As the normal size of the balls and the clear outline of the metal fragments must place them almost in contact with the plate, the ball is located near the fifth metacarpal. As this is the same case as is shown in plate 106, the conclusions drawn from each plate are confirmed by the other. The wound is infected, as indicated by the swelling of the palm. The treatment is removal of the missile, with management of the infection. [Illustration: Plate 108.] SHRAPNEL--PLATE 108. UPPER EXTREMITY. Gunshot Wound of the Left Hand, with Lodgment of the Missile. The shadow of the hand is shown with the palm next to the plate, as indicated by the small, well-defined outline of the first metacarpal lying within the outline of the larger and less-defined shadow of the second metacarpal. The third finger is flexed at the first phalangeal joint, and the end of the second phalanx is outlined in deeper shadow, with its long axis vertical to the plate. The position raises the first finger from the plate and very slightly enlarges the size of the shadow of the bullet, although it retains its sharp outline. The shadow of the ball being very nearly the normal size, the ball lies on the palmar side of the third metacarpo-phalangeal joint. It entered the hand on the outer border of the base of the first finger, and left a fragment of metal on its slight contact with the bone. The ball was deformed by ricochet before striking the hand, with almost completely spent velocity. The wound is infected. The treatment is the management of infection. [Illustration: Plate 109.] SHRAPNEL--PLATE 109. UPPER EXTREMITY. Multiple Gunshot Wounds of the Right Hand and Forearm, with Fracture of the Metacarpus and Phalanges and Lodgment of the Missile. The hand lay with the palmar surface next to the plate. The distinct outline of the small metal fragments and the natural size of the shadow of the undeformed shrapnel ball show that they lay on the anterior side of the metacarpus. The arrangements of the metal particles and bone fragments and the indication of the point of entrance of one wound on the outer border of the metacarpal of the thumb indicate the course of the balls to have been from the radial to the ulna side of the palm. The undeformed ball, then, lies, most probably, in front of the second metacarpal. The deformed ball shows, in its enlarged shadow and not so distinct in outline as the normal ball, that it is on the dorsal surface of the third and fourth metacarpals.