_Fractures of the patella._--Punctured fractures of the patella were common with direct impact of the bullet; these were often difficult to palpate, and were only to be certainly diagnosed by attention to the direction of the track, and the development of haemarthrosis. I saw at least three or four in which the bullet, in addition to traversing the knee-joint, injured the popliteal vessels. I have notes of one case in which a bullet traversed the soft parts from above downwards and scored a vertical groove on the surface of the patella; this was readily palpable, but produced no solution of continuity. In several cases the margin of the patella was notched by a passing bullet. I never saw a case of stellate fracture, and by this my experience in the case of the ilium was confirmed. On two occasions I saw pure transverse fractures of the bone; in each the wound was produced by a Lee-Metford bullet. This is of some interest as denoting that the greater volume and weight, in conjunction with the blunter tip, of the Lee-Metford may produce more severe injury to the bones than the Mauser. I believe this to be the case, given an equal degree of velocity on the part of the bullet at the moment of impact; but it is probable that the position of the patella with regard to the condyles of the femur when struck is of far greater importance in relation to the production of transverse fractures. The skiagram represented in plate XVIII. shows an obliquely transverse fracture, which in this instance resulted from a crossing bullet, which grooved the surface of the bone. With regard to the two cases of transverse fracture above referred to, I may add that one occurred in a youth under twenty, and a good result was obtained by treatment with splints, and later by massage. In the second the patient was a man over fifty, who had received other injuries. The wound over the patella healed and some union had occurred, when the patient fell and burst both the bone union and the skin cicatrix. Secondary suppuration of the knee-joint, necessitating an amputation of the thigh, followed, but the patient made a good recovery. The third case also did well. [Illustration: PLATE XXII. Skiagram by H. CATLING. Engraved and Printed by Bale and Danielsson, Ltd. (40) NOTCH FRACTURE OF THE CREST OF THE TIBIA Range 'short.' The raising of the margins of the notch suggests a perforation. Compare with figs. 51 and 57 in the text.]