ecurrent
laryngeal branch, while in two others the recurrent branch itself was in
close contact with the wall of the aneurism (p. 135). In all such cases
signs of concussion or contusion of the nerve would be expected, judging
from the similar results observed in the brachial nerves when the
neighbouring artery was implicated. The only obvious symptoms occurring,
however, were laryngeal paralysis and acceleration of the pulse. As the
latter symptom was often observed in the cases of arterio-venous
communication, wherever situated, and as the sympathetic nerve also lay
in close contiguity to the wound track, it was difficult to ascribe it
with certainty solely to the vagus lesion. In the two cases of high
vagus injury the laryngeal paralysis steadily improved, and at the end
of six months was apparently well; in the two others it persisted at the
end of three months and a year respectively.

The nerve must have been very frequently damaged in wounds of the neck;
it is possible that this injury may have been an important factor in the
death of some of the patients with cervical wounds upon the field.

_Eleventh nerve._--I append the only case of localised spinal accessory
paralysis I observed. This was one of my earliest experiences, and when
I examined the neck, in the Field hospital, I assumed from the
completeness of the sterno-mastoid and trapezius paralysis that the
nerve was severed. The patient, however, made such a rapid recovery
that it became evident that the nerve had been contused only, and that
the recovery of function was not due, as is so often the case, to
vicarious compensation by the cervical supply to the muscles.

(115) _Entry_, immediately to the right of the fourth cervical
spinous process; _exit_, at the anterior border of the left
sterno-mastoid opposite the angle of the mandible. The left
shoulder was depressed, the head inclined to the injured side.
There was evident spinal accessory paralysis, and marked
hyperaesthesia of the whole left upper extremity, most severe in
the circumflex area. The hyperaesthesia gradually disappeared in
a few days, and was clearly due to concussion and possibly
slight contusion of the cervical nerve roots. The spinal
accessory paralysis improved, so that the patient returned to
the front at the end of a month: when I saw him some four
months later the shoulders were held quite symmetrically.

The _twelft