evidenced by the position and shape of the
openings, the position of the patient's body at the time of reception of
the injury being taken into consideration. Later we may get some aid
from the possible improvement in the symptoms in the case of haemorrhage.
In cases with signs of total transverse lesion, however, the
discrimination of the conditions is of little practical importance,
since either is equally unfavourable and unsuitable for surgical
treatment.

In closing these remarks reference must be made to the occasional
occurrence of paraplegic symptoms of an apparently purely functional
nature. I saw these on one or two occasions, of which the following is
a fair example. A man was wounded in the lower extremity and fell. When
brought into the hospital he complained of loss of power in the legs and
inability to straighten his back. No very definite evidence was present
of serious impairment either of motor or sensory nerves, and the man was
got up and walked with crutches. While moving about the hospital camp,
another man pushed him down, and the patient then became completely
paraplegic. He was placed in bed, and the next day moved his limbs
without any difficulty, and gave rise to no further anxiety.

_Prognosis._--In slight concussion the importance of prognosis is as to
remote effects, and upon this no opinion can be given at the present
time. The same may be said concerning cases in which transient symptoms
followed the slighter degrees of surface and medullary haemorrhage. In
the case of the latter, however, I think it would be rash to give a too
confident opinion as to the future non-occurrence of secondary changes.

Severe concussion is probably irrecoverable.

Meningeal haemorrhage of either form is one of the slighter lesions, and
less dangerous, both as an immediate condition and as to the
probabilities of after trouble. None the less the possibilities of
secondary chronic meningitis, or chronic trouble from adhesions, must be
kept in mind.

Cases of medullary haemorrhage with incomplete signs are favourable in
prognosis, as far as life is concerned; as to complete recovery,
however, this is hardly possible; in many cases serious functional
deficiency at any rate will remain, while in others the healing of the
lacerated tissue and subsequent contraction can scarcely fail to
influence unfavourably an already imperfect recovery.

I think it must be a rare occurrence for pressure from bone fragments