se to much
discomfort; again, in the transverse wounds the action of the heart was
often affected by the local cardiac shock accompanying the injury. In
one case in which the colon was at the same time wounded (No. 188), an
abscess formed at the site of the hepatic wound, as might have been
expected.

As uncomplicated injuries, these wounds were little to be feared. Except
as a source of haemorrhage in rapidly dying patients, I never heard of a
fatality. As a complication of other injuries, however, the wound of the
liver, as has been shown, was sometimes of importance. It was remarkable
in case 204 how little trouble the biliary fistula gave rise to,
although the bile was discharged across the pleural cavity.

The treatment consisted in rest, and morphia in the cases of suspected
progressive haemorrhage, or in the presence of great pain. In cases where
bile was escaping, it was important to ensure a free vent for the
secretion.

(204) _Wound of liver. Biliary fistula._--Wounded at
Magersfontein. _Entry_ (Lee-Metford), below the seventh rib, in
the left nipple line; _exit_, through the eighth rib, in the
mid axillary line on the right side. The patient lay for
seventeen hours on the field, during which time the bowels
acted once, but there was no sickness. The bowels then remained
confined. When seen on the third day the abdomen was normal and
the chest resonant throughout on both sides; bile to the amount
of some ounces escaped from the wound on the right side.
Suffering no pain; temperature 99 deg., pulse 100. The bowels acted
freely the following day.

During the next fortnight there was little change; [Symbol:
ounce]ii-iij of bile escaped daily, and there was occasional
diarrhoea. At the end of that time, however, the temperature
rose; there was local redness and evidence of retention of pus.
The wound was therefore enlarged, some fragments of rib removed,
and a drainage tube inserted. After this the temperature fell,
and for the next two months the patient suffered little except
from the discharge from the sinus; this persisted for three
months, becoming less in amount and less bile-stained, the
fistula eventually closing in the fourteenth week, when the
patient was sent home on parole.

(205) _Wound of liver_.--_Entry_ (Mauser), 1 inch below and to
the left of the ensiform cartilage; _exit