reaction. Possibly in some cases the symptoms
of irritation depended upon an increase in the amount of haemorrhage, and
in others upon the development of local inflammatory changes.

Local pressure, or actual destruction of brain tissue, was evidenced by
temporary paralysis in the former, permanent loss of function in the
latter, condition.

Fractures of the anterior fossa of the skull were attended by very
marked evidence of orbital haemorrhage, as subconjunctival ecchymosis
(rarely pure), increased tension, and proptosis.

Injuries to the cranial nerves at the base, with the single exception of
lesion of the optic nerves, which was not rare, were in my experience
uncommon in the hospitals--a fact pointing to the very fatal nature of
direct basal injuries, except in the anterior fossa of the skull. Signs
indicative of injury to the olfactory lobe were occasionally observed.

I should, perhaps, again insist here on the rarity with which acute
diffuse septic infection occurred in cases of these degrees of severity,
also on the fact that interference with the wounds in the way of
secondary exploration, even when they were manifestly the seat of local
infection, was followed almost without exception by good immediate
results; and, lastly, that when suppuration did occur, it was usually
strictly local in character. The influence of the climate of South
Africa and our surroundings has already been discussed, but whether
climate, condition of the patients, or peculiarity in the nature of
causation of the wounds was responsible, in no series of cases was the
absence of acute inflammatory troubles more striking than in this one of
brain injuries.

Frontal injuries were those most frequently unaccompanied by primary
symptoms of severity; slowing of the pulse--this often fell to 40--and
occasional irregularity, were almost the only constant signs of cerebral
damage. Some patients temporarily lost consciousness, others rose at
once and walked to the dressing station, and in few cases was any
psychical disturbance noted in the early stages.

I think, however, it may be affirmed that frontal injuries, accompanied
by trivial signs, resulted without exception from the passage of bullets
travelling at a low rate of velocity. Thus in several of the instances
here related the patients at the time of reception of the wound were
under the impression that they were entirely beyond the range of fire,
and in one, in which well-marked si