ommon rate.
The temperature rarely exceeded 100 deg.. Vomiting was occasionally severe,
but usually not persistent, ceasing on the second day. A good quantity
of urine was passed. As to the local signs, these again were of a
limited nature; distension did not occur, or was slight; movement of the
abdominal wall was only restricted in the neighbourhood of the wound,
the affected area amounted to a quarter, or at most half, the abdominal
wall, and rigidity was localised to a similar segment. Local tenderness
usually existed; but, as a rule, there was little or no dulness to point
to the occurrence either of fluid effusion or a considerable deposition
of lymph.

Again many of the patients suffered with very slight symptoms of
constitutional shock, although there was considerable variation in this
particular.

(165*) Wounded at Graspan, sustaining a compound fracture of
the fibula. While being carried off the field, a second bullet
(Lee-Metford) entered immediately outside the left posterior
superior iliac spine, perforated the pelvis, and emerged 1-1/2
inch within the left anterior superior spine. The patient was
then put down and left on the field ten hours; later he was
carried to shelter for the night, and arrived at Orange River
on the second day. He suffered with some pain in the abdomen,
especially during the journey in the train, but was not sick;
the bowels were confined.

When seen on the third day at 6 P.M., some pain was complained
of in the abdomen, which moved freely in the upper part, but
was motionless below the umbilicus. No distension. Tenderness
around wound of exit and some rigidity. The bowels had acted
four times during the day; motions loose, dark brown, and
containing no blood. Face not anxious, eyes bright, temperature
102 deg.. Pulse 96, regular, and of good strength. Tongue moist and
little furred.

The abdomen was opened at 5 A.M. on the fourth day, as the
local signs had become more pronounced, and the patient had
passed a restless night in great abdominal pain. A local
incision was chosen, as the wound was presumably in the sigmoid
flexure. The sigmoid flexure was adherent to the abdominal wall
opposite the wound of exit, and a dark ecchymosed patch was
found, but no perforation could be detected. Foul pus and gas
escaped freely from the pelvis, but no wound of