the stomach were observed, and
of these a certain number recovered spontaneously. The only two
instances that came under my own observation are recorded below. It will
be noted that in each the special symptoms were the classic ones of
vomiting and haematemesis. In the first case blood was also passed per
anum, and in the second the diagnosis was reinforced by the escape of
stomach contents from the external wound.

The second case was a surgical disappointment. No doubt the fatal issue
was mainly dependent on the fact that the external wound had to be kept
open to allow of the escape of the abundant discharge from the wounded
liver. In the absence of the hepatic wound, however, I believe it would
have been possible for this patient to have got well spontaneously, in
view of the firm adhesions which had formed around the opening in the
stomach, and the consequent localisation which had been effected.
Another unfortunate element in this case was the comminuted fracture of
the seventh costal cartilage, which maintained the patency of the
aperture of exit. The latter point, however, was of doubtful importance
from this aspect, as the vent provided for the gastric and biliary
secretions may have been the safety-valve that had allowed localisation
to develop.

I believe that the secondary haemorrhage was the main element in robbing
us of a success in this case, and that this depended on the digestion of
the wound by the gastric secretion. The early troubles which arose in
the treatment of this patient well illustrate the difficulties by which
the military surgeon is at times met; but the patient was admirably
attended to and nursed by my friend Mr. Pershouse, and an orderly who
was specially put on duty for the purpose.

(163) Wounded at Rensburg. _Entry_ (Mauser), in ninth left
intercostal space in posterior axillary line; _exit_, a
transverse slit 1/2 an inch in length to left of xiphoid
appendage. Patient was retiring when struck; he did not fall,
but ran for about 1,000 yards, whence he was conveyed to
hospital. He vomited half an hour after the injury (last meal
bread and 'bully beef,' taken two hours previously), and during
the evening three times again, the vomit consisting mainly 'of
dark thick blood.' He was put on milk diet, and not completely
starved; on the third day a large quantity of dark clotted
blood was passed per rectum with the stool, and this cont