membrane
(_Pleural septicaemia_).

No. 190 is a most striking instance of spontaneous cure, since no doubt
can exist that both rectum and bladder were perforated.

(180*) _Injury to the caecum and ascending colon._--Boer,
wounded at Graspan while sheltering behind a rock, lying on his
back.

_Entry_ (Lee-Metford), in right thigh, 3 inches below and 1
inch within anterior superior spine of ilium; _exit_, in back,
on a level with the fourth lumbar spinous process and 3 inches
from that point.

Half an hour after the wound the patient commenced to suffer
severe stabbing pain; he lay on the field one hour; later he
was taken to a Field hospital, and on the second day was sent
by train a distance of twenty-five miles.

When seen at the end of fifty hours the condition was as
follows. Face anxious, complexion dusky. Great abdominal pain,
especially about the umbilicus. Vomiting frequent and
distressing; bowels confined since the accident; tongue dry and
furred. Urine scanty. Pulse full and strong, 125; respirations,
entirely thoracic, 30.

Abdomen generally distended and tympanitic, wall rigid and
motionless. Dulness in right flank, together with superficial
oedema and emphysema.

Abdominal section fifty-three and a half hours after accident.
Incision in right linea semilunaris. Great omentum adherent to
ascending colon, which was covered with plastic lymph. Gas and
intestinal contents escaped from an opening at the line of
reflexion of the peritoneum from the ascending colon;
retro-peritoneal extravasation and emphysema extended the whole
length of the ascending colon and around duodenum, the wall of
the colon itself exhibiting subperitoneal emphysema. The colon
was freed and the rent sewn up with interrupted sutures. About
[Symbol: ounce] iv of foul faecal fluid were evacuated from
loin, and a free counter-opening made. The opening in the ilium
by which the bullet had entered the abdomen was found at the
brim of the pelvis; the loin and peritoneal cavity were sponged
dry and flushed with boiled water; no lymph was seen on the
small intestine. A large gauze plug was inserted into the
posterior wound, one end of the plug being brought out of the
operation incision.

During the succeeding six days progress was not unsatisfactory