t at once improved, sufficiently so to be able
to undergo a second exploration at a later date by Mr. Hanwell at the
Base, only dying of septicaemia at the end of twenty-one days. Even a
free supra-pubic vent might, I believe, have given him a chance of life.

When the perforation was at the base of the bladder, however, the
prognosis was very bad, and, as far as I know, not a single patient
escaped death. The increase of risk in an extra-peritoneal wound of this
viscus is indeed very great, while an intra-peritoneal perforation may
be considered an injury of lesser severity, provided the urine be of
normal character.

(194_a_) _Possible wound of the bladder._--Wounded at
Magersfontein. _Entry_ (Mauser), immediately above the
symphysis pubis; _exit_, in the buttock, behind the tip of the
left great trochanter. The man was struck while advancing, and
fell, thinking at the time 'that he was struck in the foot.' He
lay twelve hours on the field, and passed water for the first
time when the bearer removed him. During the next two days he
passed urine only twice, and no blood was noticed. The bowels
acted on the evening of the third day. When seen on the fourth
day he complained of aching pain in the lower part of the
belly, and a concentric patch of tender induration extended for
about 1-1/2 inch around the wound. The abdominal wall was
moving well. The tongue was clean and moist. There was no blood
in the urine, and micturition was not frequent. Temperature
99.4 deg.. Pulse 80, good strength. The patient was then sent to
the Base. At the end of seventeen days there was still a little
tenderness in the left iliac fossa; but the man was otherwise
well, and at the end of a month he was sent home.

(195) _Extra-peritoneal wound of the bladder._--Wounded at
Magersfontein. _Entry_ (Mauser), at the fore part of the right
buttock. No exit. The patient was seen on the third day. He had
an expression of extreme anxiety, and complained of very great
pain in the abdomen and thigh. The abdomen was greatly
distended and tympanitic, and the left thigh and groin were
very much swollen and oedematous, with some redness of
surface. Temperature 100 deg., pulse 120. No sickness, tongue
moist, bowels confined. Retention of urine. The condition of
the patient was very grave; but he was anaesthetised, cle