n are of importance. Short of actual section, it may be broadly
stated that no lesion is too serious to render ultimate recovery
impossible.

In cases in which the injury has been produced by a bullet fired at a
short range, or in which contact with the nerve has been close, the
return of functional activity is very slow. In such instances the
condition probably resembles that in which a divided nerve has been
sutured, with the additional disadvantage that a considerable portion of
the nerve, both above and below the point actually struck, has been
destroyed as far as the conduction of nervous impulses is concerned.
This may reasonably be concluded in the light of the evidence offered by
the injuries of the spinal cord, in which several segments usually
suffered if the velocity of the bullet was great, and also if the fact
is remembered that, when thickening takes place, a considerable length
of the nerve is usually implicated.

Recovery is notably slow in the case of certain nerves, _e.g._
musculo-spiral and peroneal, even when the injury has not been of
extreme severity. Again, these same nerves are apparently more seriously
affected by moderate degrees of damage than are others.

As favourable prognostic elements we may bear in mind: low velocity on
the part of the travelling bullet, and with this a lesser degree of
contiguity of the track to the nerve. The early return of sensation is a
favourable sign, and in this relation the development of hyperaesthesia,
whether preceded by anaesthesia or no, points to the maintenance of
continuity of, and a moderate degree of damage to, the nerve. The early
return of sensation, even if modified in acuteness, was always a very
hopeful sign; also the production of formication in the area of
distribution of the nerve on manipulation of the injured spot. As in the
case of nerve injuries of every nature, the disposition and temperament
of the patient exerted considerable influence on the course of the
cases.

Complete section of the nerves in these bullet wounds only obtained
special importance in two ways: first, in that a considerable portion of
the trunk might be shot away in oblique tracks, and, secondly, in that
very severe contusion might affect the nerve for a considerable
distance beyond the point actually implicated. In point of fact,
complete section when treated by suture was often more rapidly recovered
from than an injury in which only a portion of the width of a tr