tebra, and escaped below the twelfth right rib. The
track suppurated where it crossed the back, but the man did well until
the twentieth day, when a swelling developed in the left iliac fossa and
the general temperature rose to 102 deg.. An abscess was at once suspected
and the swelling incised by Major Lougheed, R.A.M.C. A large
subperitoneal haematoma only was discovered, and evacuated. The
temperature at once fell and the after progress was uneventful, the
wound healing by primary union.

TREATMENT OF HAEMORRHAGE

_Primary._--No deviation from the ordinary rules of surgery should be
necessary in the majority of cases, but in a certain number the
conditions are so unusual that the special considerations must be taken
into account. The natural tendency to spontaneous cessation of primary
haemorrhage in small-calibre wounds is the first of these. Experience has
shown that often mere dressing, or at any rate slight pressure, suffices
to efficiently stanch immediate bleeding. Although, however, immediate
control is to be obtained by such means, the cases of traumatic aneurism
of every variety related in the next section show that the ultimate
result is in many such cases by no means satisfactory.

Under these circumstances it may be said that the classical rule of
ligation at the point of injury should never be disregarded. Against
this, however, certain objections may be at once raised; thus in many
cases both artery and vein need ligature, a consideration of much
importance in the case of such vessels as the carotid and femoral
arteries. Again in many of the injuries to the popliteal artery the
wound directly communicated with the knee joint, a complication which,
while it may be disregarded in civil practice, must take a much more
important place in the circumstances under which many operations in
military surgery are performed.

On the whole, it seems clear that the military surgeon must be guided by
circumstances, since it may be far better to risk the chances of
recurrent haemorrhage, or the development of an aneurism or varix, all of
which are amenable to successful treatment later, than those of gangrene
of a limb or softening of the brain. As a general rule, therefore, on
the field or in a Field hospital, primary ligature of the great vessels
is best reserved for those cases only in which haemorrhage persists,
while in those in which spontaneous cessation has occurred, or in which
bleeding is readily contro