e lung, and the
chest was usually somewhat contracted on the injured side, with evidence
in the way of decreased vesicular murmur that the lung was still not
free from compression. With regard to the persistence of dulness on
percussion, it is well to bear in mind that a thin layer of blood
apparently produces as serious impairment of resonance as a much larger
quantity of serum. The signs appeared to favour the view that the space
necessary for the location of the haemorrhage had been obtained at the
expense of the lung rather than by distension of the thoracic parietes,
and also, I think, denoted the presence of adhesions. Possibly they will
entirely disappear with the return of full excursion movements of
respiration, the latter being often still somewhat restricted when the
patients left hospital. All the patients with such signs were liable to
attacks of pain and shortness of breath on actual bodily exertion. I
happened to meet with an officer, the subject of a Lee-Metford wound of
the thorax, sustained five years previously, and he told me that he was
nine months before he could take active exercise without feeling short
of breath.

As to the cases of haemothorax and empyema which needed drainage, all did
well; but expansion of the lung was much less satisfactory than would
have been expected, probably on account of especially firm adhesions.
The importance of concurrent injury I need hardly dwell on; but I might
add that perforation of one or both arms, the most common one, did not
materially affect the general statements above made.

_Treatment._--In the early stages of the pulmonary wounds rest was the
all-important indication, and when this was assured few serious cases of
haemothorax occurred. Beyond simple rest, the administration of opium
with a view to checking internal haemorrhage was used with good effect.
The wounds needed simple dressing only.

The treatment of haemothorax at a later date, however, was of much
interest and difficulty. I think the following lines may be laid down
for guidance in such cases:--

(i) Haemothorax, even of considerable severity, will undergo spontaneous
cure. An early rise of temperature may be disregarded.

(ii) Tapping the chest is indicated when pressure signs on the lung are
sufficiently severe to cause serious symptoms, and the removal of the
blood undoubtedly shortens the period of recovery, as well as relieves
symptoms.

In such cases the collection of blood ha