The presence of a metallic foreign body having been determined and its position localised by means of the X-rays, all devitalised and contaminated tissue is excised, the foreign material, e.g., a missile, fragments of clothing, gravel and blood-clot, removed, the wound purified with antiseptics and closed or drained according to circumstances.

#Pistol-shot Wounds.#—­Wounds inflicted by pistols, revolvers, and small air-guns are of frequent occurrence in civil practice, the weapon being discharged usually by accident, but frequently with suicidal, and sometimes with homicidal intent.

With all calibres and at all ranges, except actual contact, the wound of entrance is smaller than the bullet.  If the weapon is discharged within a foot of the body, the skin surrounding the wound is usually stained with powder and burned, and the hair singed.  At ranges varying from six inches to thirty feet, grains of powder may be found embedded in the skin or lying loose on the surface, the greater the range the wider being the area of spread.  When black powder is used, the embedded grains usually leave a permanent bluish-black tattooing of the skin.  When the weapon is placed in contact with the skin, the subcutaneous tissues are lacerated over an area of two or three inches around the opening made by the bullet and smoke and powder-staining and scorching are more marked than at longer ranges.

When the bullet perforates, the exit wound is usually larger and more extensively lacerated than the wound of entrance.  Its margins are as a rule everted, and it shows no marks of flame, smoke, or powder.  These features are common to all perforations caused by bullets.

Pistol wounds only produce dangerous effects when fired at close range, and when the cavities of the skull, the thorax, or the abdomen are implicated.  In the abdomen a lethal injury may readily be caused even by pistols of the “toy” order.  These injuries will be described with regional surgery.

Pistol-shot wounds of joints and soft parts are seldom of serious import apart from the risk of haemorrhage and of infection.

Treatment.—­The treatment of wounds of the soft parts consists in purifying the wounds of entrance and exit and the surrounding skin, and in providing for drainage if this is indicated.

There being no urgency for the removal of the bullet, time should be taken to have it localised by the X-rays, preferably by stereoscopic plates.  In some cases it is not necessary to remove the bullet.

#Wounds by Sporting Guns.#—­In the common sporting or scatter gun, with which accidents so commonly occur during the shooting season, the charge of small shot or pellets leave the muzzle of the gun as a solid mass which makes a single ragged wound having much the appearance of that caused by a single bullet.  At a distance of from four to five feet from the muzzle the pellets begin to disperse so that there are separate