The ball struck the sixth rib behind and caused a fracture at the angle. It then continued its course to the axilla. The normal size of the shadow of the ball indicates that it lies superficially behind the head of the humerus. The wound of the rib was infected superficially, and the secretion of the wound carried away the most of the metal particles which the ball in striking deposited on impact. [Illustration: Plate 113.] SHRAPNEL--PLATE 113. CHEST. Gunshot Wound of the Chest, with Lodgment of the Missile in the Axilla. There is no wound of the bone. The ball lies in the axilla, behind, not close to, the plate, because the density of the shadow is not very great and the size is slightly enlarged. The distance from the plate is probably that of the mid-axillary line. The wound is not infected. Pain and impaired movement of the arm suggested localization of the missile and indicate removal in the subsequent course of treatment. [Illustration: Plate 114.] SHRAPNEL--PLATE 114. CHEST. Gunshot Wound of the Chest, with the Lodgment of the Missile in the Axilla. The posterior chest wall lay next to the plate. The almost normal size of the shadow of the ball indicates that it lies near the plate, and the blurred outline shows that it has moved with the chest in respiration. The ball lies, therefore, in the posterior axilla near the middle of the outer border of the scapula, imbedded in the thoracic muscles. The treatment is expectant. Such wounds are rarely infected. Pain or impairment of function only would indicate removal of the missile from a clean wound. [Illustration: Plate 115.] SHRAPNEL--PLATE 115. PELVIS. Gunshot Fracture of the Crest of the Right Ilium, with Lodgment of the Missile. As the wound was received while the soldier was lying prone, the course of the missile in the body was from above downward, striking the crest of the ilium, on which it was fragmented, and trailing its fragments as far down as the great trochanter. The injury to the ilium was a crushing fracture, with the displacement of small fragments from the antero-superior spine. As the sacrum was next to the photographic plate, the missile, judging from its indistinct shadow, lies farther from the plate and in front of the bone. The relative distinctness of the large fragment seen on the wing of the ilium indicates its probable position to be on the outside of the ilium. The trail of the smaller metal fragments lies between the antero-superior spine and the great trochanter, anterior to the plane of the femur. The treatment in such cases is always conservative. [Illustration: Plate 116.] SHRAPNEL--PLATE 116. LOWER EXTREMITY. Gunshot Wound of the Thigh, with Lodgment of the Missile.