ation of the lesion, and
the probable velocity at which the bullet was travelling, were taken
into account; since the actual destructive lesion, when the velocity had
been insufficient to cause damage of a general nature, was often very
strictly localised.

Another very important point in the immediate prognosis was the primary
union of the scalp wound; if this could only be ensured, few cases went
wrong afterwards. Such remote effects as I witnessed were mainly the
results of the actual destructive lesion, such as paralyses and
contraction. I know of only one case in which early maniacal symptoms
closely followed on a frontal injury, and here the symptoms accompanied
the development of an abscess. Some patients were depressed and
irritable, and some were blind or deaf, probably from gross lesion; in
one patient the mental faculties generally were lowered.

In spite of the surprising immediate recoveries which occurred, and the
small amount of experience I am able to record as to remote ill effects
of these injuries, I feel certain that a long roll of secondary troubles
from the contraction of cicatricial tissue, irritation from distant
remaining bone fragments, as well as mental troubles from actual brain
destruction, await record in the near future.

Since my return to England I have heard of four cases of injury to the
head, which died on their return, as the result of the formation of
secondary residual abscesses; and of one who died suddenly, soon after
his return to active service in South Africa apparently well. These
occurrences are sufficiently suggestive.

It may be of interest to add here two cases of secondary traumatic
epilepsy of differing degree:--

(72) _Gutter fracture over left temporo-sphenoidal lobe.
Traumatic epilepsy._--A trooper in Brabant's Horse was wounded
at Aliwal North, in March, in several places. A Mauser bullet
entered the head 1-1/2 inch above the junction of the anterior
border of the left pinna with the side of the head. The exit
wound was situated just below and behind the left parietal
eminence. The patient stated that the shot was fired by a man
he recognised in a laager 150 yards distant from him.

The man remained unconscious eleven days, and when he came
round paralysis of the right upper extremity, and weakness of
both lower extremities, were noted. There was also ataxic
aphasia.

The wounds healed, but tw