erness. He remained in bed on ordinary light
diet, but at the end of the third week he was seized by a
sudden attack of pain, the temperature rising to 103 deg. and the
pulse to 140, the abdomen becoming swollen and tender. He was
then under the charge of Mr. Bowlby, who ordered some opium,
and the symptoms rapidly subsided. Although this wound crossed
the small intestine area, it is probable that the symptoms may
have been due to an injury of the rectum or sigmoid flexure.

3. _Wounds of the large intestine._--Injuries to every part of the large
bowel were observed, and spontaneous recoveries were seen in all parts
except the transverse colon, which, as already remarked, is near akin
to the small intestine with regard to its position and anatomical
arrangement.

The only case of perforation of the vermiform appendix that I heard of,
one under the care of Mr. Stonham, died of peritoneal septicaemia.
Several cases of recovery from wounds of the caecum and ascending colon
are recounted below. The only points of importance in the nature of the
signs of these injuries were their primary insignificance, and the
comparative frequency with which _local_ peritoneal suppuration followed
them. The absence of a similar sequence in some of the cases in which
wounds of the small intestine were assumed, was, in my opinion, one of
the strongest reasons for doubting the correctness of the diagnosis. It
is also a significant fact that injuries of the ascending colon--that is
to say, of the portion of the large bowel which perhaps lies most free
from the area occupied by the small intestine--were those which most
frequently recovered.

The following cases afford examples of the course followed in a number
of injuries to the large intestine, and illustrate both the
uncomplicated and the complicated modes of spontaneous recovery.

No. 180 affords a good example of an extra-peritoneal injury, and of the
especially fatal character of such lesions. This case was also one of my
surgical disappointments.

Nos. 182, 183 are of great interest in several particulars. First, the
aperture of exit was large and allowed the escape of faeces, not a very
common feature in wounds not proving immediately fatal. Secondly, in
neither were any peritoneal signs observed. Thirdly, in each the exit
wound communicated with the pleura, and the patients died from
septicaemia mainly due to absorption from the surface of that