ed if the nature of
the wound and the virulence of the sepsis would of themselves justify
removal of the limb. Every surgeon can recall cases in which a timely
amputation has been the means of saving life.

The _counteraction of the toxaemia_ and the _treatment of the bloodless
state_, are carried out on the usual lines.

#Haemorrhage of Toxic Origin.#--Mention must also be made of haemorrhages
which depend upon infective or toxic conditions and in which no gross
lesion of the vessels can be discovered. The bleeding occurs as an
oozing, which may be comparatively slight and unimportant, or by its
persistence may become serious. It takes place into the superficial
layers of the skin, from mucous membranes, and into the substance of
such organs as the pancreas. Haemorrhage from the stomach and intestine,
attended with a brown or black discoloration of the vomit and of the
stools, is one of the best known examples: it is not uncommonly met with
in infective conditions originating in the appendix, intestine,
gall-bladder, and other abdominal organs. Haemorrhage from the mucous
membrane of the stomach after abdominal operations--apparently also due
to toxic causes and not to the operation--gives rise to the so-called
_post-operative haematemesis_.

#Constitutional Effects of Haemorrhage.#--The severity of the symptoms
resulting from haemorrhage depends as much on the rapidity with which the
bleeding takes place as on the amount of blood lost. The sudden loss of
a large quantity, whether from an open wound or into a serous
cavity--for example, after rupture of the liver or spleen--is attended
with marked pallor of the surface of the body and coldness of the skin,
especially of the face, feet, and hands. The skin is moist with a cold,
clammy sweat, and beads of perspiration stand out on the forehead. The
pulse becomes feeble, soft, and rapid, and the patient is dull and
listless, and complains of extreme thirst. The temperature is usually
sub-normal; and the respiration rapid, shallow, and sighing in
character. Abnormal visual sensations, in the form of flashes of light
or spots before the eyes; and rushing, buzzing, or ringing sounds in the
ears, are often complained of.

In extreme cases, phenomena which have been aptly described as those of
"air-hunger" ensue. On account of the small quantity of blood
circulating through the body, and the diminished haemoglobin content of
the blood, the tissues are imperfectly oxygenate