aemorrhage, and partial and total section of the
cord.

First, with regard to compression of the cord, the possible sources are
three; (i) extra-dural haemorrhage, which may, I think, be dismissed with
mention as rarely capable of producing severe symptoms. (ii) The
displacement of bone fragments. This is of less importance than in civil
practice, because an injury by a bullet of small calibre, capable of
seriously displacing fragments, has probably at the same time produced
grave changes in the cord. In the presence of severe immediate symptoms
we may tentatively assume that a simultaneous destructive lesion has
been produced. In such injuries pain, combined with a tendency to
improvement in the paralytic symptoms and return of reflexes, is the
only point in favour of bone pressure, unless considerable deformity of
the spinal column can be detected by palpation or examination with the
X-rays.

(iii) Pressure from the bullet. This is the most important form of
compression, because the mere fact of retention of the bullet is
evidence of a low degree of velocity, and therefore opposed to the
existence of the most severe form of intramedullary lesion. In a case of
apparent transverse lesion with retained bullet, shown to me at No. 3
General Hospital by Mr. J. E. Ker, the pain was very severe, and so
greatly aggravated by movement that an anaesthetic had to be administered
prior to the renewal of some necessary dressings. The general condition
of this patient precluded a projected operation, and after death the
bullet was found to be pressing laterally upon a cord not materially
altered on macroscopic inspection. In the case of retained bullet
recorded (No. 104), the slight degree to which the severed ends of the
cord appeared altered has been already remarked upon.

Beyond this we are helped by the position of the aperture of entry, and
its shape, as evidence of the direction in which the bullet passed, the
presence of pain, and positive proof may be obtained by examination with
the X-rays.

Lastly, we come to the discrimination of total or partial section,
destruction by vibratory concussion or contusion, and severe
intramedullary haemorrhage. Except in the case of partial section with
localised symptoms, which must be rare, I believe this to be impossible
from the primary symptoms, although some indication of possible
encroachment on the canal may be obtained from careful consideration of
the course of the wound, as