I should
add that in the only one I left untouched, I regretted my want of
courage for the five days during which the patient continued to carry on
a miserable existence.

4. The treatment of the cases in which an expectant attitude is followed
by the advent of localised suppuration presents no difficulty; simple
incision alone is needed, and healing follows.

As a rule this is a late condition. In one case of injury to the
ascending colon recounted above, however, considerable local escape of
faeces had occurred, and a successful result was obtained by a local
incision on the third day without suture of the bowel. In this case I
believe the wound in the bowel to have been of the nature of a long
slit, but the surrounding adhesions were so firm as to render any
interference with them a great risk, and a successful result was
obtained at the cost of a somewhat prolonged recovery. I am convinced
that the best course was followed here. (No. 131.)

When the suppuration was of a less acute character, it was generally
advisable to allow the pus to make its way towards the surface before
interference.

5. Cases of injury to the colon in which the posterior aspect is
involved should be treated by free opening up of the wound, and either
by suture of the bowel or else its fixation to the surface. I operated
on one such case, and although the patient eventually died on the eighth
day, from septicaemia, he certainly had a chance. Two cases where the
opening looked so free that one almost thought the wound could be
regarded as a lumbar colotomy did badly; in both infection of the
pleura took place, besides extension of suppuration into the
retro-peritoneal areolar tissue. In the future I should always feel
inclined to enlarge such wounds and bring the bowel to the surface.

As regards actual technique the majority of the wounds are particularly
well suited to suture; three stitches across the opening and one at
either end of the resulting crease sufficed to close the opening
effectively. The openings in the small intestine were not as a rule
difficult to find, on account of the ecchymosis which surrounded them.
From what I have seen stated in the reports given by other surgeons,
there seems to have been more difficulty in discovering wounds in the
large gut. Under ordinary circumstances the only instruments specially
needed are a needle and some silk. At my first two operations, as my
instruments had gone astray, the wounds w