s usually been rapid and
continuous; hence a fresh haemorrhage is always probable when the local
pressure has been removed. Tapping therefore should not necessarily mean
complete evacuation, and should be followed by careful firm binding up
of the chest, the administration of opium, and the most stringent
precautions for rest.

(iii) Tapping may be needed as a diagnostic aid, and in such
circumstances as much fluid as can be removed should be evacuated with
the same precautions as mentioned in the last paragraph.

(iv) Tapping may be indicated for the evacuation of serum expressed from
the blood-clot, or due to pleural effusion, on the same lines as in any
other collection of fluid in the pleural cavity.

(v) Early free incision is, as a rule, to be steadfastly avoided. Some
cases already quoted fully illustrate its disadvantages.

(vi) Cases in which an incision and the ligature of a parietal artery
are indicated are very rare. I never saw such a one myself.

(vii) If a haemothorax suppurates, it must be treated on the ordinary
lines of an empyema. In view of the constant formation of adhesions and
difficulty in drainage, a portion of a rib should always be resected in
order to ensure sufficient space for after-treatment. The cavities, as a
rule, are better irrigated, the usual precautions being taken where
there is any reason to fear that the lung is still in communication with
the cavity.

Care in carrying out asepsis in tapping, which should be performed with
an aspirator, need hardly be more than mentioned. It will be noted that
in some of the cases quoted suppuration followed tapping, but it must be
remembered that in these the two primary wounds already existed as
possible channels of infection.

Retained bullets of small calibre in the thoracic cavity were not
common, unless the lodgment had occurred in the bodies of the vertebrae.
I saw very few. Shrapnel bullets and fragments of shells, however, were,
in proportion to the frequency of wounds from such projectiles, more
commonly retained. The rules to be followed in such cases do not
materially deviate from those to be observed in the body generally.

When the bullet is causing no trouble, and is lodged in either the bone
of the spine or the lung substance, no interference is advisable. When,
on the other hand, the bullet as viewed by the X-rays is seen to be in
the pleural cavity, and any symptoms of its presence exist, it may be
justifiable to remove