to
be able to be regarded as a favourable prognostic condition, since in
the very large majority of cases the velocity of the bullet causing the
injury will have been such as to inflict irreparable damage on the cord.
Still, cases may occasionally be met with where the velocity has been
sufficiently low, or contact with the bone slight enough, to allow of
the comparative escape of the cord. In this relation cases in which the
bullet is retained, especially if the symptoms of transverse lesion are
incomplete, may be regarded as relatively favourable.

Cervical and high dorsal injuries, as in civil practice, offered the
worst prognosis. In cases in which symptoms of total transverse lesion
were present, as far as my experience went, it was, however, only a
matter of importance as to the prolongation of a miserable existence.
All the patients eventually died; those with higher lesions at the end
of a few days; the lower ones, at the completion on an average of six
weeks of suffering.

The actual causes of death resembled exactly those met with in civil
practice, except in so far as it was more often influenced or determined
by concurrent injuries, a complication so characteristic of modern
gunshot wounds. Thus exhaustion, septicaemia from absorption from
suppurating bed-sores or from severe cystitis, secondary myelitis, and
pulmonary complications, carried off most of the patients.

_Treatment._--The general treatment of the cases demanded nothing
special to military surgery, except in so far as it was modified by the
disadvantage to the patient of necessarily having to be transported,
often for some distance. The ill effects of this, particularly in cases
of haemorrhage, are obvious, but in so far as fracture was concerned the
question of transport did not acquire the importance that it does in
civil practice, since the nature of the fractures and their strict
localisation did not render movement either painful or particularly
hurtful. It was indeed striking how little pain movement, made for the
purposes of examination, caused these patients. The treatment of
bed-sores, cystitis, or other secondary complications possessed no
special features.

The importance of insuring rest in the early stages of the cases of
haemorrhage is self-evident; hence, if the possibility exists of not
moving the patient, its advantage cannot be too strongly insisted upon.
Again, if transport is inevitable, the shorter distance that can be