metimes so
slight as to be scarcely noticeable. This may be said to have been most
common in injuries to the large intestine. Wounds of the caecum,
ascending and descending colon, the sigmoid flexure, or the rectum, were
sometimes followed by no serious symptoms, either local or general.
Again in these portions of the bowel the development of local signs, and
the later formation of an abscess, were by no means uncommon.

In the case of the small intestine I never observed this sequence, and
the same may be said of the transverse colon, which in its anatomical
arrangement and position so nearly approximates to the small bowel. In
suspected wounds of these portions of the bowel either the symptoms were
so slight as to render it doubtful whether a perforation had occurred,
or marked signs of general peritoneal septicaemia developed, and death
resulted.

The condition of the peritoneum in fatal cases varied much. In some a
dry peritonitis, or one in which a considerable quantity of slightly
turbid fluid was effused, was found. In others a rapid suppurative
process, accompanied by the effusion of large quantities of plastic
lymph, was met with. My experience suggested that the latter condition
was the result of free infection from multiple wounds of the gut, the
former the accompaniment of single wounds. Hence I should ascribe the
difference mainly to the extent of the primary infection.

This is perhaps a suitable place to further discuss the explanation of
the escape of a considerable number of the patients who received wounds
of the abdomen, possibly implicating the bowel. Although this was not, I
think, so common an occurrence as has been sometimes assumed, yet many
examples were met with. Several reasons have been advanced.

(1) Great importance has been given to the fact that many of the men
were wounded while in a state of hunger, no food having been taken for
twelve or more hours before the reception of the injury. In view of the
well-proved fact in these, as in other intestinal injuries, that free
intestinal escape does not occur, and that it is usually a mere question
of infection, this explanation, in my opinion, is of small importance.
It might with far more justice be pointed out that many of these wounded
men were for them in the happy position of not having friends freely
dosing them with brandy and water after the reception of the injury, and
this was possibly an element of some importance.

Some of the