ere no symptoms of nerve injury. On the
thirteenth day an Esmarch's bandage was applied and Major
Lougheed laid the tumour open opposite the opening in the
adductor magnus. Much clot was removed, and both artery and
vein, which were found divided in the adductor canal, were
ligatured.

The foot remained very cold for the first twenty-four hours,
but otherwise progress was satisfactory, the wound healing by
first intention. No pulsation was palpable in the tibials at
the end of a month.

For the last two cases I am very much indebted to Major Lougheed. I am
glad to include them, as they illustrate one or two points of special
importance. No. 3 shows the tendency to variation in the tension and
firmness of the tumours, the tendency to primary contraction of the sac,
followed by diffusion, and the rise of temperature often accompanying
the latter occurrence. This is of great interest in relation to the
similar rise of temperature seen with the increase of haemorrhage in
cases of haemothorax. For purposes of comparison, the progress may well
be considered alongside of that in the case related on p. 119, in which
the wounded vessel was probably also the main trunk itself.

No. 4 differs from any of the others in depending on a complete division
of a large artery and vein. The development of the haematoma was
consequently more rapid and continuous. Another point of interest was
the maintenance of pulsation in the tibial vessels, in spite of complete
solution of continuity in the parent trunk. That this was independent of
the collateral circulation seems evident from its complete disappearance
and slowness of return after ligation of the wounded vessels.

_Prognosis and treatment._--The treatment in these cases is sufficiently
obvious, and consists in direct incision and ligature of the wounded
vessels. The cases related show the success with which this procedure
was attended, since uniformly good results were obtained. When possible,
an Esmarch's tourniquet should be applied in the case of the lower limb.
In the upper, compression of the subclavian is necessary during
interference with axillary haematomata, combined with direct pressure on
the bleeding spot after the clot has been removed. In the case of the
arm, digital compression is always to be preferred, in view of the
well-known danger of damage to the brachial nerves from the tourniquet.

Proximal ligature is always to