n happens to sustain an
abdominal wound on the march. Under such circumstances an exploration
may be not only justifiable, but obligatory, and the general rules of
surgery must be followed rather than such incomplete indications as are
suggested below.

My own experience led me to the following conclusions:

1. A wound in the intestinal area should be watched with care. In the
face of the numerous recoveries in such cases, habitual abdominal
exploration is not justified, under the conditions usually prevailing in
the field.

2. The very large class of patients excluded by this rule from operation
leads us to a smaller and less satisfactory number to be divided into
two categories:

Patients who die during the first twelve hours. The whole of these are
naturally unfit for operation, and their general condition when seen
often precludes any thought of it.

Patients with very severe injuries, as evidenced by the escape of faeces,
or with wounds from flank to flank or taking an antero-posterior course
in the small intestinal area. These patients die, and the majority of
them will always die whether operated upon or not. The undertaking of
operations upon them is unpleasant to the surgeon, as being unlikely to
be attended with any great degree of success, whence the impression may
gain ground that patients are killed by the operations. None the less, I
think these operations ought to be undertaken when the attendant
conditions allow, and it is from this class of case that the real
successes will be drawn in the future. The history of such injuries,
after all, corresponds exactly with what we were long familiar with in
traumatic ruptures in civil practice, and now know may be avoided by a
sufficiently early interference. The whole question here is one of time,
and this will always be the trouble in military work.

3. The expectant attitude which is obligatory under the above rules in
doubtful cases, brings us face to face with a large proportion of
patients in the early or late stage of peritoneal septicaemia. These
cases run on exactly the same lines as those in which the same condition
is secondary to spontaneous perforation of the bowel, in which we
consider it our duty to operate, and in which a definite percentage of
recoveries is obtained. Hence another unpleasant duty is here imposed
upon the surgeon. Two such cases on which I operated are recounted
above, and although I cannot say they give much encouragement,