The undeformed ball caused the fracture of the phalanx and metacarpal of the thumb; the deformed ball fractured the neck of the third metacarpal; a ball which escaped from the wound and touched the base of the first phalanx of the middle finger and fractured the first phalanx of the little finger; and another ball, which glanced along the anterior surface of the lower end of the shaft of the radius and left a deposit of metal to mark its course, also escaped from the ulnar border of the forearm at a point indicated in the plate. Four balls were concerned with this wound; two of them have lodged with some damage and two others have escaped, after inflicting a slight injury. Multiple shrapnel wounds are common. It may be said that the greater the number of balls lodged in a given area the less the distance of the plane from the apex of the cone of dispersion of a shrapnel discharge. Several shrapnel balls, lodged in a small area without causing much damage or exhibiting much power of penetration, indicate low velocity at close range of shrapnel balls on discharge from the shrapnel envelope. In a personal case, eight shrapnel balls were removed from a forearm. [Illustration: Plate 110.] SHRAPNEL--PLATE 110. CHEST. Gunshot Wound of the Chest, with Lodgment of the Missile in the Lung. The posterior chest wall is next to the plate, as the posterior rib shadows are much more distinct and much smaller than the shadows of the anterior ribs. The shadow of the ball is blurred, which shows that it moved with respiration and is, therefore, probably in the lung. The shadow is only slightly enlarged and is fairly dense, which indicates it to be not far from the ribs and, therefore, in the posterior portion of the lung. The treatment of such cases is conservative; infection is not common; hæmothorax pleurisy, empyema, pneumonia, and pulmonary abscess are most frequent complications, named in the order of frequency. Pulmonary abscess is very rare. Pneumonia was seen in a personal case. [Illustration: Plate 111.] SHRAPNEL--PLATE 111. CHEST. Gunshot Wound of Chest, with Lodgment of the Missile Superficially. While the missile is not a shrapnel ball, it presents similar conditions and does not need to be separately classified. The vertebral border of the scapula is distinctly shown in light shadow, indicating its position near the plate. The outline of the missile is so distinct and the shadow so dense that it must lie near the plate, and is located superficially in the infraspinatus fossa. [Illustration: Plate 112.] SHRAPNEL--PLATE 112. CHEST. Gunshot Wound of the Chest, with Fractured Rib and Lodgment of the Missile in the Axilla. The back of the patient lay on the plate, as is indicated by the normal size of the ribs behind and the exaggerated outline in front.