to injuries caused by bullets of small calibre.
The same observation was often made in the case of larger bullets in old
days, and the absence of severe haemorrhage has previously been regarded
as a special characteristic of gunshot wounds. None the less, as high a
proportion as 50 per cent. of deaths occurring on the field in earlier
days has been ascribed to this cause.

Unfortunately no new facts can be furnished on this point, although a
few cases of rapid death from primary haemorrhage will be found recounted
under the heading of visceral injuries. Beyond these the general
evidence offered by observations on men brought in from the field with
vascular injuries, was opposed to the frequent occurrence of death from
haemorrhage, at any rate of an external nature. This subject will be
dealt with under the classical three headings of primary, recurrent, and
secondary haemorrhage.

_Primary haemorrhage._--A marked distinction needs to be drawn between
external and internal haemorrhage. External haemorrhage from the great
vessels of the limbs, or even of the neck, proved responsible for a
remarkably small proportion of the deaths on the battlefield. This
statement may be made with confidence, since it is not only my own
experience, but coincides with what I was able to glean from many
medical officers with the Field bearer companies. It is, moreover,
supported by the facts that cases in which primary ligature had been
resorted to were extremely rare at the Base hospitals, while, on the
other hand, traumatic aneurisms and aneurismal varices of any one of the
great trunks of the neck and limbs were comparatively common. Again,
primary amputation for small-calibre bullet wounds, except when
complicated by severe injury to the bones, was so rare as to render more
than doubtful the frequent occurrence of severe primary haemorrhage on
the field. Only one case of rapid death due to bleeding from a limb
artery was recounted to me. In this a wound of the first part of the
axillary artery proved fatal in the twenty minutes occupied by the
removal of the patient to the dressing station. The amount of haemorrhage
in many instances was no doubt checked by the application of pressure at
the time of the first field dressing; but it can scarcely be argued that
such dressings as were applied were of sufficient firmness to control
bleeding from such trunks as the brachial, femoral, or carotid arteries.

The spontaneous cessation of haemo