injury has been also inflicted, and delay will be necessary for further observation of the patient. When active operations are proceeding, and it is necessary to carry the wounded to any distance, the advantages of early removal of shattered limbs are obvious. SECONDARY HEMORRHAGE. Army surgeons meet in practice with secondary more frequently than primary hemorrhage in gunshot wounds. It may arise in several ways. Sometimes it results from the coagulum being forced out of an artery in which hemorrhage had previously been spontaneously averted by the ordinary natural process, this accident being consequent upon muscular exertion or increased impulse of the circulating system from any cause. This occurrence in the bottom of a deep wound will be often found to be a very troublesome complication. Sometimes an artery which did not appear to be injured in the first instance ulcerates or sloughs; or, without direct injury, a vessel may become involved in unhealthy deterioration of the wound, and give way; or, in a granulating wound, general capillary hemorrhage may be excited by stimulus of any kind, such as venereal excitement or excess in drinking; or the coats of the vessel may ulcerate under pressure from a detached fragment of bone or from some foreign body; or the artery may be accidentally penetrated by the end of a sharp spiculum. Secondary hemorrhage has been said to arise from increased arterial action, from the first to the fifth day; from sloughing, the effects of contusion, from the fifth to the tenth; from ulceration, to any more distant date. M. Baudens has remarked that he has observed secondary hemorrhage to be most frequent about the sixth day after the wound—the traumatic fever having then reached its highest point of intensity, and the sharp, hurried contractions of the heart having most power in forcing out the coagula. If we could compare all the cases of hemorrhage which occur, secondary would, perhaps, statistically appear less dangerous than primary hemorrhage; for the latter, when happening from large vessels, must be very generally fatal, while, when hemorrhage occurs in them secondarily, the collateral branches have become partially adapted to the interruption of the flow of blood through the regular channel. Moreover, the larger arteries, when once filled with coagula and well contracted, fortunately do not frequently yield to the impulse which serves to produce secondary hemorrhage in vessels of smaller caliber.