n the left iliac fossa, the left thigh continued
flexed, and resonance was impaired to the left of the
umbilicus.

At the end of six weeks a distinct hard swelling in two parts,
separated by a resonant area, was noted to the left of the
umbilicus and in the left iliac fossa. The abdomen moved
fairly, and there was little tenderness over the swelling.
During the next week the swelling appeared to increase and to
fluctuate; at the same time the temperature again began to rise
to 100 deg. and 101 deg. at eve. The swelling was taken to be a
localised peritoneal suppuration, and an incision was made over
it; but this led down to a free peritoneal cavity, with a
tumour pressing up from the posterior abdominal wall. The wound
was therefore closed, and a fresh extra-peritoneal incision
made, immediately above Poupart's ligament, when the swelling
proved to be a large retro-peritoneal haematoma. As the cavity
extended into the pelvis and up to the level of the costal
margin, it was deemed wise only to evacuate a part of the
blood-clot. The origin of the bleeding was not determined, and
the wound was closed and healed by first intention. The man
continued to improve, and left for home five weeks later.

This patient has continued to improve since his return, but the
left thigh is still somewhat flexed.

_Prognosis in intestinal injuries._--This was of a most discouraging
character compared with the prognosis in abdominal injuries as a whole.
The cases were of two classes, however: those that died within
twenty-four hours, and those that died at the end of from three days to
a week.

Cases falling into the first category are obviously of little importance
from the point of view of surgical treatment. Many of them died from the
widespread nature of the injury, and the shock produced by it; others
from haemorrhage from the large abdominal vessels. It is unlikely that
any could have been saved, even under the most satisfactory conditions.

In the following small table, therefore, I have included only the cases
which have been already quoted, which survived long enough to be
amenable to surgical treatment, and which were for some days under my
own observation. Some of them, in fact almost all, I watched until they
were either convalescent, or died, and in six I performed operations.

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