y moderately contracted. Wide dilatation was
uncommon throughout.

The pulse was with very few exceptions slow, sometimes irregular. In
some instances, when the wounds had been thought suitable for
exploration, the slow pulse was altered after operation to a rapid one,
and death usually quickly supervened.

Respiration was irregular, sometimes sighing; in the late stage often of
the Cheyne-Stokes type; actual stertor was exceptional, but the
respiration was often noisy.

The temperature was often raised from an early stage to 99 deg. or 100 deg., and
if the patient survived a day or two, it often rose to 103 deg. or 104 deg.. How
far the secondary rise depended on sepsis it was not always easy to
determine. The urine was usually retained.

Cases presenting the above characters were usually those suffering from
lesions such as are described in class I., and mostly died in
twenty-four to forty-eight hours. The correspondence of the train of
symptoms with those due to combined brain destruction and severe
concussion is at once apparent.

To illustrate the nature of the symptoms in patients suffering from the
less extensive forms of injury, such as those included in classes II.
and III. under the heading of anatomical lesion, the relation of a short
series of histories will be advisable. I may first premise, however,
that the special characteristics of these were in some instances the
almost entire absence of primary symptoms of gravity; in others general
symptoms of a severity out of apparent proportion to the external
lesion; while in all destructive lesions, very widely distributed
radiation symptoms developed, often disappearing with great rapidity.

The symptoms consisted in those of concussion, irritation, local
pressure, and actual destruction.

The symptoms of concussion were either general, and then usually
transient, or local paralysis of the radiation variety, which also
rapidly improved.

Signs of irritation consisted in irritability of temper, drowsiness,
closure of the eyes and objection to light, contracted pupils sometimes
unequal, a tendency to the assumption of the flexed position at all the
joints, twitchings, and sometimes convulsions. Sometimes these appeared
early as a direct result of mechanical irritation from bone fragments or
blood-clot; sometimes only in the course of a few days, as a result of
irritation of parts recovering from the radiation effects which had
prevented earlier nervous