h nerve accompanying
perforating wounds of the mastoid process.

IV. _Secondary implication of the nerves._--This was a striking
characteristic in many at first apparently simple wounds of the soft
parts. In such cases it was due to implication of the contiguous trunk
in the process of cicatrisation, and its importance varied with the size
of the nerve in question. In the smaller sensory trunks it was often
evidenced by the occurrence of neuralgic pain, especially liable to be
influenced by climatic changes; in the larger, by signs of more or less
severe motor, sensory, and trophic disturbance. Musculo-spiral paralysis
from implication in, or pressure from, callus in cases of fracture of
the humerus was very frequent. This would naturally be expected from the
extreme degree the comminution of the bone often reached, and the
consequently large amount of callus developed.

The effect of cicatrisation of the tissues surrounding the nerves
varied somewhat according to the degree of fixation of the individual
nerve implicated. Thus if a nerve lay in a fixed bed some form of
circular constriction resulted; if, on the other hand, the nerve was
readily displaceable, the cicatrix often drew it considerably out of its
course; in either case symptoms corresponding with those of pressure
resulted.

_Symptoms of nerve lesion_.--These differed little in character from
those common to such injuries in civil practice, except in the relative
frequency with which they assumed a serious aspect. After all in civil
practice nerve concussion is most familiar to us in the degree common
after knocking the elbow against a hard object, and the same may be said
in regard to the allied injury of contusion. It is in small-calibre
bullet wounds alone that the occurrence of such severe and sharply
localised injury to deep parts as was observed is possible.

_Concussion_.--Temporary loss of function was often observed in the
limbs, corresponding to the distribution of one or more nerve trunks
when wound tracks had passed in their vicinity. Interference with
function sometimes amounted to loss of sensation alone: in others to
loss of both sensation and motor power. Such symptoms were of a
transitory character, lasting for a few days or a week; if both
sensation and motion were impaired, sensation was usually the first to
be regained. In these cases secondary trouble was not uncommon, since
the near proximity of the track to the originally affected