importance.

When feeding is commenced at the end of twenty-four or thirty-six hours,
it must be in the form at first of warm water, then milk administered in
tea-spoonfuls only.

In doubtful cases the use of morphia must be avoided.

Operative treatment is required in a certain number of the cases, but in
the majority of instances we are met with the extreme difficulty that in
a very large proportion of the occasions upon which these wounds are
received an exploratory abdominal section is not warranted in
consequence of the conditions under which it has to be performed.

A word must be added as to these difficulties; they are in part purely
of an administrative nature, partly surgical. After a great battle the
wounded are numerous, and amongst them a very considerable proportion of
the wounds and injuries are of such a nature as to do extremely well if
promptly dealt with, and each of these makes small demands on the time
of the staff. Abdominal operations, on the other hand, are
unsatisfactory from a prognostic point of view, and their performance
requires much time and the assistance of a considerable number of the
men, who are obliged to neglect the treatment of the more promising
cases for those of doubtful issue. This difficulty, although not
surgical in its nature, is nevertheless a practical one of great
importance and appeals strongly to the Principal Medical Officers in
charge of the arrangements. It is only to be avoided by an increase of
the staff, which is not likely to be made except on very special
occasions.

Other difficulties are purely surgical. First, the difficulty
of diagnosing with certainty a perforating lesion. In the presence of
the fact that many incomplete lesions follow wounds crossing the
intestinal area, and that these give rise to modified symptoms, I
believe this determination to be impossible without the aid of an
exploratory incision. Here we are met with the remaining surgical
difficulties--disadvantages such as the absence of sufficient aid to the
operating surgeon, difficulties connected with the temperature, wind,
and dust, and as to the subsequent treatment of the patient. Again
difficulty in obtaining the most important adjunct, suitable water, or
indeed any water in a sufficient quantity.

It is of course obvious that conditions may exist in which all these
troubles may be avoided. Again, the practical difficulty adverted to
above does not come in the way when a single ma