There is no fracture of the bones, although a shrapnel ball has passed transversely through the foot, striking the heads of the second and third metatarsals with only slight injury and leaving a few metal particles at points of contact. [Illustration: Plate 156.] SHRAPNEL--PLATE 156. LOWER EXTREMITY. Gunshot Wound of the Left Foot by Multiple Missiles, Fracture of the Metatarsus, and Lodgment of the Missile. The sole of the foot lay next to the plate. The normal outline of the shadow of the shrapnel ball shows it to lie near the plate or at least beneath the plantar surface of the first metatarsal. The fragments of metal lying near the fourth and fifth metatarsals lie either in the same relation or on the plantar side of the metatarsus. The metallic track leads to the wound of exit of shrapnel ball, other than the one lodged. Even though the missile has escaped, its identity can be creditably established by the one remaining, which, it is morally certain, was the escaped missile’s companion. These shrapnel particles again demonstrate that the metal deposits seen in other wounds can be identified as particles of lead scraped off from shrapnel balls in the contact of the latter with bones. [Illustration: Plate 157.] OPERATIVE INTERFERENCE IN GUNSHOT WOUNDS. In the 1,500 radiograph plates from which this collection was selected, only four were found showing operative interference for the repair of fractures. While no data are available from which to determine accurately the ratio of these operations to the entire number of fracture cases under treatment, and as, most certainly, there were some formal amputations, excisions, immediate immobilization of fractures, and other operative procedures which were not submitted to radiography, it may nevertheless be justly inferred from this radiographic evidence that very few such operations were performed. OPERATIONS--PLATE 157. Gunshot Fracture of the Humerus. This plate shows an attempt to wire a fracture of the humerus, which, very probably, would have recovered as favorably without interference. [Illustration: Plate 158.] OPERATIONS--PLATE 158. Gunshot Fracture of the Ulna. This plate shows an attempt to wire the ulna in a clean wound. [Illustration: Plate 159.] OPERATIONS--PLATE 159. Gunshot Fracture of the Radius and Ulna. This plate shows an attempt to wire the radius and ulna where the indications were rather doubtful. [Illustration: Plate 160.] OPERATIONS--PLATE 160. Gunshot Fracture of the Tibia and Fibula. This plate shows an attempt at immediate immobilization of the fragments of the tibia which has failed to meet the mechanical indications for maintaining correct position. [Illustration: Plate 161.] OPERATIONS--PLATE 161. Amputation at the Knee Joint. This plate shows a satisfactory result of a secondary amputation at the knee, after the method of Gritti, following a severe naval shell wound of the leg. [Illustration: Plate 162.]