ctly
shot away: these latter had either been driven through the wound in the
soft parts, or remained embedded on the deep aspect of the enveloping
scalp (fig. 64). In the less common variety the scalp was slit to a
length corresponding with the injury to the bone, but more often oval
openings in the skin existed at either end of the track. The inner table
was practically never intact, but the amount of comminution naturally
varied with the depth to which the outer table was implicated (fig. 65
_A_, and _B_).

The following is an illustrative example of this degree, and also
emphasises the consequences which may follow primary non-interference.

[Illustration: FIG. 65.--Diagrammatic transverse sections of varying
condition of bones in Gutter Fractures of the first degree. _A._ With no
loss of substance. _B._ With comminution.]

(53) _Superficial gutter fracture in parietal region.
Convulsive twitchings. Secondary paralysis._--Wounded at Modder
River. Range, 400 yards. A scalp wound 3 inches in length ran
vertically downwards, commencing 1 inch from the median line,
and situated immediately over the upper third of the right
fissure of Rolando. The patient was unconscious for several
hours after the injury, and later suffered with severe
headache, and twitchings in the left shoulder and arm.

The wound healed, but a well-marked groove was palpable in the
bone beneath, and the twitchings persisted. The latter came on
about every twenty minutes, and loss of power in the left upper
extremity, and to a less degree in the lower, developed. The
memory was defective, and the patient suffered at times with
headache. The pupils were equal but sluggish in action. No
changes were discovered in the fundus beyond a well-developed
myopic crescent at the lower and outer part of the left disc
(Mr. Hanwell).

The twitchings became more frequent and latterly were
accompanied by somewhat severe muscular contractions in the
upper extremity, while the loss of power in the lower extremity
became more marked. Headache was also more troublesome.

The patient throughout refused any operation, saying he would
rather go home first, and at the end of a month he left for
England.

In the deeper injuries more and more of the outer table was cut away,
and the inner became gradually more depressed, fractured, or comminuted
(fi