On the other hand, the toxæmia may be of a profound type associated with marked pallor and progressive failure of strength, which, of itself, even when the danger from hæmorrhage has been overcome, may have a fatal termination. The _prognosis_ therefore in cases of secondary hæmorrhage can never be other than uncertain and unfavourable; the danger from loss of blood _per se_ is less when the artery concerned is amenable to control by surgical measures. _Treatment._--The treatment of secondary hæmorrhage includes the use of local measures to arrest the bleeding, the employment of general measures to counteract the accompanying toxæmia, and when the loss of blood has been considerable, the treatment of the bloodless state. _Local Measures to arrest the Hæmorrhage._--The occurrence of even slight hæmorrhages from a septic wound in the vicinity of a large blood vessel is to be taken seriously; it is usually necessary to _open up the wound_, clear out the clots and infected tissues with a sharp spoon, disinfect the walls of the cavity with eusol or hydrogen peroxide, and _pack_ it carefully but not too tightly with gauze impregnated with some antiseptic, such as "bipp," so that, if the bleeding does not recur, it may be left undisturbed for several days. The packing should if possible be brought into actual contact with the leaking point in the vessel, and so arranged as to make pressure on the artery above the erosion. The dressings and bandage are then applied, with the limb in the attitude that will diminish the force of the stream through the main artery, for example, flexion at the elbow in hæmorrhage from the deep palmar arch. Other measures for combating the local sepsis, such as the irrigation method of Carrel, may be considered. If the wound involves one of the extremities, it may be useful; and it imparts confidence to the nurse, and, it may be, to the patient, if a Petit's tourniquet is loosely applied above the wound, which the nurse is instructed to tighten up in the event of bleeding taking place. _Ligation of the Artery._--If the hæmorrhage recurs in spite of packing the wound, or if it is serious from the outset and likely to be critical if repeated, ligation of the artery itself or of the trunk from which it springs, at a selected spot higher up, should be considered. This is most often indicated in wounds of the extremities. As examples of proximal ligation for secondary hæmorrhage may be cited ligation of the hypogastric artery for hæmorrhage in the buttock, of the common iliac for hæmorrhage in the thigh, of the brachial in the upper arm for hæmorrhage from the deep palmar arch, and of the posterior tibial behind the medial malleolus for hæmorrhage from the sole of the foot.