advisable; but I several times saw good results follow
ligation of the anterior tibial artery for secondary haemorrhage, even
when suppuration existed, and occasional good results after incision
and drainage of joints if the infection was not of the most acute form.

Primary amputation was rarely needed for any case of injury from a
bullet of small calibre, since it was only necessary either in the case
of injury to both main arteries, and this was rare, or in cases of very
extensive injury to the soft parts. I saw many of the latter make fair
results when treated conservatively, even though the condition seemed
almost hopeless at first sight. All the primary amputations that I saw
were either for shell or large bullet injuries. A word may be inserted
here as to the weight that ought to attach to nerve injuries in this
relation. From the experience gained elsewhere it is clear that we
should attach little importance to these unless the divided nerves are
actually in sight, as far as deciding on amputation is concerned. On the
other hand, there is little doubt that the presence of concurrent nerve
injury, be it only concussion or contusion, exerts an important ulterior
influence on the healing of the wound, whether the part be amputated or
not. Amputation flaps in such cases possess a very considerably lowered
degree of vitality.

Secondary amputations were often needed for sepsis, and on the whole did
very well; both for the same cause and for haemorrhage intermediate
amputations had occasionally to be performed; the results of these, as
elsewhere, were bad.

_Fractures of the tarsus._--Wounds of these short bones were as a rule
of slight importance, given fairly direct impact on the part of the
bullet. They then consisted of either simple perforations or surface
grooving. A single bone might be implicated or several might be
tunnelled; in the latter case the implication of the joints very
considerably influenced the prognosis, since the addition of the joint
injury caused much more prolonged weakening of the foot.

Wounds of the foot were common from the fact that when the men lay out
in the prone position, the foot was often the part least protected by
the cover chosen, and particularly the heel. In these circumstances the
os calcis was the bone most frequently implicated, and that by tracks
taking an oblique course downwards from the leg to the sole. Again the
foot was often struck by ricochet bullets, as a result