nessed, a yellow discoloration of the
softened cord was the only macroscopic evidence of haemorrhage.

Haemorrhages of this nature may, however, account for the grave paralytic
symptoms in some cases of partial or total transverse lesion not due to
direct compression or laceration.

The conditions of concussion, contusion, or haematomyelia were, I
believe, responsible for at least nine-tenths of the cases in which a
total transverse lesion was indicated by the symptoms. The extreme
importance of realising this fact and the rarity of the production of
symptoms by continuing compression both from the prognostic and the
therapeutic point of view is obvious.

The analogous injuries termed generally in Chapter IX. nerve contusion,
although frequently accompanied by tissue destruction, may be followed
by reparative change, and are capable of complete or almost complete
spontaneous recovery; while the lesions in the spinal cord are
permanent, and complete recovery is only witnessed in the parts affected
by the remote pressure or irritation from blood extravasation, or in
those influenced by concussion.

I include below short abstracts of all the cases of lesion of the spinal
cord which terminated fatally, in which I had the opportunity of
witnessing the post-mortem conditions. In a considerable proportion of
the cases at the end of six weeks the spinal cord was softened over an
area of from two to four segments in such degree as to have practically
lost all continuity. Although the autopsies were made on patients who
had died slowly and in summer weather, often twelve to sixteen hours
after death, I think it can be but fair to assume, when the consistency
of the remaining portion of the spinal cord is considered, that the
softening was only in slight degree if at all exaggerated by post-mortem
change. Again symptoms of secondary myelitis and meningitis had been
observed in some of the fatal cases prior to death.

I had but one opportunity of observing a case in which a retained bullet
exercised compression, and none in which this was due to displaced bone
fragments. I also only once came across a case of complete section, but
no doubt both bone pressure and section may have occurred with greater
frequency amongst patients dying on the field or shortly after. The case
of section is illustrated in fig. 80. It will be noted that, although
the section is complete, the bullet lies to one side of the canal, and
hence the bullet