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Annotations."Ne quid nimis."

MODERN BULLET-WOUNDS.

THE descriptions which have prevailed hitherto in workson surgery of the lesions inflicted by bullets must be com-pletely rewritten. The remarkable changes of recent yearsin the diameter and velocity of rifle-bullets have been fol-lowed by changes equally remarkable in the wounds pro-duced by them. A few weeks ago we described some veryinteresting experiments which had been performed to deter-mine the comparative effects of modern bullets, and theresults were of great value because the experiments werecomparative. These experimental results had to be tried

on the touchstone of actual experience, and a very interestingletter from Sir William Mac Cormao (which is published inthis number of THE LANCET) shows that the practical resultsfall far short in severity of what might have been expected asa deduction from the experiments to which we have referred.Sir William Mac Cormac is particularly well qualified toexpress an opinion on the severity of bullet-wounds, for hehad excellent opportunities of observing the lesions resultingfrom bullets during the Franco-Prussian War, and he tellsus that in most cases the damage done by the modern bullet,especially by the Mauser, cannot be compared in severitywith that inflicted by the needle-gun or the Chassepot. The

slight severity of the injury has struck him with amaze-ment. The projectile bores a small clean hole right throughthe part and the aperture of exit can hardly, if at all, bedistinguished from that of entrance. The wounds are onthe whole aseptic and heal readily under a simple antisepticdressing. So rapid is the healing in most cases that instanceshave already occurred of men who had recovered from onewound and been discharged being re-admitted later for asecond bullet-wound. When only the soft parts of a

limb are perforated and no important vessels have beentorn the shock at the time of infliction of the injuryis but slight and recovery is rapid and complete. SirWilliam MacCormac cites a case where a Mauser bullettraversed both thighs, passing in front of one femur andbehind the other. There was very little hmmorrhage andthe man was able to run another 800 yards after receivingthis injury. Even when a bone has been hit the bullet maymake a clean hole through it without any splintering, orwith very little. This is naturally more common in thecase of flat bones, such as the scapula, than in the longbones. It has also occurred in the case of the bones of theskull. In many cases even when important structures havebeen in the line of the bullet no harm seems to

have resulted. In one instance a bullet entered on the

right side of the neck immediately behind the sterno-

mastoid and an inch above the clavicle, and its pointof exit was in a similar position on the otherside. Some difficulty in swallowing and speaking fol-

lowed, but this passed off almost completely in a veryshort time. In another case the shot passed through theleft ilium just below the crest and emerged a little morethan an inch below the ensiform cartilage. From thesituation of the apertures of entrance and exit, and remem-bering that a Mauser bullet passes straight from one to theother, turning neither to the right hand nor to the left, weare justified in thinking that the bullet must have piercedthe stomach, but no symptoms of any such injury appeared.The patient took his food from the beginning without anyinconvenience and had a rapid and uneventful convales-cence. In yet another instance, from the situation ofthe wounds and from the fact that a most obstinate

constipation followed the injury, it is almost certainthat the colon was perforated, yet no peritonitisarose. Not the least remarkable of the effects ofthe Mauser bullet is the very slight haemorrhage resultingfrom perforation of the lung. There is generally a littlehaemoptysis which soon ceases and convalescence ensues.Even when a comminuted fracture of a bone of a limb hasbeen produced complete consolidation of the broken bone mayresult, though the fracture was necessarily compound. Astriking case of perforation of a joint shows that only aslight synovitis may follow. This is in marked contrast tothe havoc produced by a large-bore bullet. These resultsmust produce a feeling of hopefulness in the treatment ofmodern bullet-wounds, for they show that in many cases atemporary interference with military service is all that is

produced. To Sir William Mac Cormac the profession owesa deep debt of gratitude for his graphic pictures written fromthe seat of war. While helping his country he is at the

same time making a solid contribution to our scientific

knowledge. ------

MALARIA AND MOSQUITOES.

WE would draw the attention of those of our readers whoare interested in the investigations which have been carriedon by various observers as to the relation alleged to existbetween malaria and mosquitoes to a paper by Dr. G.Bastianelli and Dr. A. Bignami published in this issue. Weowe the translation of this paper into English to Dr.G. Sandison Brock. An excellent réslImé is givenof the present state of the question, which will beunderstood not only by those who have followed theaccounts which have appeared from time to time in medicalliterature of the researches which have been conductedin malarious districts, but also by those who are not

acquainted with the work already accomplished. Due creditis given to other observers. The asstivo-autumnal parasitesare first considered and a sketch is given of th& two life-

cycles which they present, one of which is completed entirelyin man and is the cause of the fever, while the other is onlyinitiated in man and is completed in mosquitoes of the genusanopheles. All three species of malarial parasite, distinguish-able with certainty from each other, adopt as host the samespecies of mosquito, and the authors of the paper proceed todiscuss whether the parasites preserve intact the distinguish-ing characters of their species. An affirmative answer isreturned to this question, relying not merely on morpho-logical data, but also on the results of experiment, and itis shown how even after their passage through the anophelesthe species of malarial parasite remain distinct and do notbecome transformed one into another. Further, it is

affirmed that a single infected mosquito is capable of

inoculating malaria into man, and even more, namely, thata single mosquito by successive bites can infect several

people. It sometimes happens that two species of

parasite may develop in one and the same mosquito-forinstance, an mstival and a tertian parasite-the two remain-ing distinct, so that it can well happen that a singleanopheles may inoculate a mixed infection. The combina-tion of the two fevers is by no means rare in Italy.The knowledge of these facts is of considerable prac-tical importance. It has been suggested that much maybe done to mitigate the prevalence of malaria in a districtby destroying the breeding places of the anopheles, but theabove facts indicate how thoroughly that would have to bedone in order to make any appreciable effect in the occur-rence of the disease. The concluding paragraphs of the

paper are particularly worthy of attention, for they refer tothe measures of prophylaxis which should be taken against

infection. It is insisted that the careful treatment of the

malarial patient constitutes one of the principal tasks of