ms which attended these injuries, it is somewhat
difficult to speak with precision, and it must be left to my readers to
form an opinion as to how many of the cases recounted below were really
instances of perforating wounds. My own view is that in the majority of
the cases that got well spontaneously, the injury was not of a
perforating nature, and that for reasons which have been already set
forth. It will, however, be at once noted that in all the five cases in
which the injury was certainly diagnosed in hospital death occurred.

The cases of injury to the small intestine are perhaps best arranged in
three classes.

1. Those who died upon the field, or shortly after removal from it. In
these the external wounds were often large, the omentum was not rarely
prolapsed, and escape of faeces sometimes occurred early. Shock from the
severity of the lesion, and haemorrhage, were no doubt important factors
in the early lethal issue in this class. Many of the injuries were no
doubt produced by bullets striking irregularly, by ricochets, by bullets
of the expanding forms, or by bullets of large calibre. As being beyond
the bounds of surgical aid, this class possessed the least interest.

2. Cases brought into the Field, or even the Stationary hospitals, with
symptoms of moderate severity, or even of an insignificant character,
in which evidence of septic peritonitis suddenly developed and death
ensued.

3. Cases in which the position of the wounds raised the possibility of
injury to the intestine, but in which the symptoms were slight or of
moderate severity, and which recovered spontaneously.

The whole crux in diagnosis lay in the attempt to separate the two
latter classes, and, personally, I must own to having been no nearer a
position of being able to form an opinion on this point, in the late
than in the early stage of my stay in South Africa. The advent of
peritoneal septicaemia was in many instances the only determining moment.
On this matter I can only add that, in civil practice, an exploratory
abdominal section is often the only means of determination of a rupture
of the bowel wall.

With regard to the cases of suspected injury to the bowel which
recovered spontaneously, the symptoms were somewhat special in their
comparative slightness, and in the limited nature of the local signs.
Thus the pulse seldom rose to as much as 100 in rate, 80 was a common
average. Respiration was never greatly quickened, 24 was a c