mpression fractures of civil life.

A few words will suffice to dismiss the questions of diagnosis,
prognosis, and treatment of the above injuries. The diagnosis depended
on attention to the signs above indicated, the prognosis almost entirely
on the concurrent injury to the nervous system, which will be considered
later, and the treatment consisted in enforcing rest alone.

INJURIES TO THE SPINAL CORD ACCOMPANYING SMALL-CALIBRE BULLET WOUNDS OF
THE VERTEBRAE

_Anatomical lesions._--In introducing the subject of the nature of the
lesions of the spinal cord and membranes, I should again enforce the
statement that their character and degree, in comparison with the slight
accompanying bone damage, are pathognomonic of gunshot wounds, and that
these characters find their completest exemplification in injuries
produced by bullets of small calibre, endowed with a high grade of
velocity. Again, that the varying degrees of damage depend comparatively
slightly on the position of the bone lesion, apart from actual
encroachment on the canal, while the degree of velocity retained by the
bullet at the moment of impact is all-important. In no other way are the
divergent results to be explained which follow an apparently identical
injury, in so far as extent, position, and external evidence of damage
to the spinal column are concerned.

Injuries to the nerve roots of the nature of concussion and contusion,
are dealt with in Chapter IX.

_Pure concussion_ of the spinal cord may, I believe, be studied from a
better standpoint in the case of small-calibre bullet injuries than in
any others, since in many instances it is, I think, possible to exclude
any complications such as wrenches and strains of the vertebral column,
and ascribe the symptoms to the pure effect of extreme vibratory force
communicated to the cord by its enveloping bony canal. The condition
must be considered under the two headings of slight and severe.

In _slight concussion_ the usually transient effects of the injury, and
its happy tendency not to destroy life, place us in a state of
uncertainty as to the occurrence of anatomical changes, since no
opportunity of post-mortem examination occurred. The clinical condition
included under this term corresponds with that implied in 'spinal
concussion' in civil practice. One point of extreme interest, whether
the subjects of small-calibre bullet spinal concussion will in the
future suffer from the remote effects commo