is pain by the exploration, and
lived four days. On the second day after operation, however,
the temperature rose to 107 deg., while on the last two days the
temperature was normal in the mornings, rising to 105 deg. in the
evenings. No alteration resulted in the trunk symptoms.

_Diagnosis._--The pure question of the fact of injury of the spinal cord
needs no discussion; but it is necessary to make some remarks on the
discrimination between concussion, contusion and haemorrhage, meningeal
and medullary haemorrhage, the latter condition and compression, and on
partial and complete severance of the cord.

The sharp discrimination of cases of concussion from those of slight
medullary haemorrhage was necessarily impossible. I think the only points
of any importance in diagnosing pure concussion were the transitory
nature of the symptoms, and the uniformity of recovery, without
persistence of any signs of minor destructive lesion. In medullary
haemorrhage the tendency for a certain period was towards increase in
gravity in the signs. It goes almost without saying that the latter
point was seldom accurately determined in patients struck on the field
of battle; these perhaps lay out for hours before they were brought in,
and when they were placed in the Field hospital the rush of work did not
usually allow the careful observation necessary to clear up this
difference in the development of the symptoms. Nevertheless it is
preferable to consider the cases in which transitory symptoms persist
for a period of hours, or even a couple of days, as instances of pure
concussion, unless the existence of this condition can be disproved by
actual observation.

Extra-medullary haemorrhage, accompanied by only slight encroachment on
the spinal canal, certainly results with some frequency from
small-calibre wounds. Some of the quoted cases show this decisively by
_post-mortem_ evidence, others by such clinical signs of irritation as
pain and hyperaesthesia. I think its presence may also be assumed in
cases of total transverse lesion due to medullary haemorrhage or severe
concussion, accompanied by well-marked pain and hyperaesthesia above the
level of paralysis. As affecting treatment, however, determination of
its presence is of small importance.

The important conditions for discriminative diagnosis are those of local
compression, actual destructive lesion, whether from concussion changes,
contusion, or medullary h