it. I saw this done in one case for the removal of
a shrapnel bullet from the lower reflexion of the pleura on account of
fixed pain and tenderness complained of by the patient. The bullet, a
shrapnel, had perforated the arm, which the patient was sure was by his
side at the moment of injury, and the X-rays showed it to lie at the
bottom of the pleural cavity, where we assumed it had fallen. When,
however, the bullet was removed by Mr. Watson, he found that the fixed
pain and tenderness had been the result of a fracture of a rib from the
inner side, not involving loss of continuity; hence the actual
indication for the operation had been a delusive one, since the bullet
had not fallen, but expended its last force in injuring the rib. The
patient made an excellent recovery, and rejoined his regiment at the end
of six weeks. I saw several cases in which the bullet was lodged in
either the lung or bones of the spine do well with no interference. The
great disadvantage of primary removal in inducing an artificial
pneumo-thorax and in laying open a haemothorax is obvious.

In case of lodgment of the bullet in the lung, bearing in mind the
infrequency of untoward symptoms, the latter should be watched for prior
to interference.

The following cases illustrate some typical instances of wound of chest
accompanied by the development of haemothorax:--

[Illustration: TEMPERATURE CHART 3.--Primary Haemothorax, with rise of
temperature. Secondary rise, with fresh effusion and pneumonia.
Spontaneous recovery. Case No. 154]

(154) _Severe haemothorax. Spontaneous recovery._--Wounded at
Modder River at a distance of 30 yards. _Entry_, at the
junction of the left anterior axillary fold with the
chest-wall; _exit_, immediately to the left of the seventh
dorsal spinous process. The patient arrived at the Base with
signs of an extensive haemothorax, accompanied by a temperature
which reached 102 deg. on the fourth day, and on the evening of the
tenth 103 deg.. The man was very ill, and an exploring needle was
inserted, by which about an ounce of blood was evacuated. The
signs of fluid in the left pleura were accompanied by those of
consolidation over the lower fourth of the right lung, and the
sputa were rusty. Evidence of perforation of the left axillary
artery existed in feebleness of the radial pulse; and there was
musculo-spiral paralysis.

After the prel