in extent,
and such rises were often seen when the patient had been moved or taken
a journey. Again, the temperature often fell to normal after
paracentesis and removal of the blood, to rise again with a fresh
accumulation, which was not uncommon. I have already mentioned the large
proportional incidence of haemothorax observed in the patients who had
to travel down from Paardeberg, and I might instance another case
related to me by Dr. Flockemann of the German ambulance, which was very
striking. A Boer, wounded at Colesberg, developed a haemothorax which
quieted down, and he was removed to Bloemfontein; on arrival at the
latter place the temperature rose, and other signs of fever suggested
the development of an empyema; an exploring needle, however, only
brought blood to light. After a short stay at Bloemfontein the symptoms
entirely subsided, and the man was sent to Kroonstadt, when an exactly
similar attack resulted, again quieting down with rest.

Similar recurrent attacks of haemorrhage and fever occurred, however, in
patients confined to their beds without moving after the first journey.
Some temperature charts, in illustration of this point, are added to the
cases quoted later. The explanation of the recurrent haemorrhages is, I
think, to be found in the reduction of the intra-thoracic pressure with
coagulation and shrinkage of the clot in the pleura in the patients kept
quiet in bed, while in the patients who had to travel it was probably
the result of direct mechanical disturbance.

In many of these cases a pleural rub was audible at the upper margin of
the dulness with the development of the fresh symptoms. Whether this was
due to actual pleurisy or to the rubbing of surfaces rough from the
breaking down of slight recent adhesions which had formed a barrier to
the effusion, I am unable to say, but the signs were fairly constant. In
some instances the increase in the amount of fluid was, no doubt, due to
pleural effusion resulting from irritation from the presence of
blood-clot, or perhaps the shifting of the latter; in these the
secondary rise of temperature may well be ascribed to the development of
pleurisy.

I am inclined to believe, however, that the primary rise of temperature
was similar to that seen when blood accumulates in the peritoneal cavity
as the result of trauma, and the secondary rises in most cases to those
which we saw so frequently accompanying the interstitial secondary
haemorrhages spok