n, progressive bleeding
was seldom observed. Again, when the wounds were explored, the amount of
blood, although considerable, was usually not more than sufficed to fill
up the space consequent on the loss of brain tissue. This was especially
striking when large venous sinuses, as the superior longitudinal, were
involved in the injury. None the less, haemorrhage at the base of the
brain was, I believe, responsible for early death in many of the severe
cases, especially when the wounds were near the lower regions of the
skull.

Escape of cerebro-spinal fluid was not so prominent a feature as might
have been expected, considering how freely the arachnoid space was
opened up in many cases. I think this was usually checked by early
coagulation of the blood, and later by adhesions. It must be remembered
also that extensive wounds were most common on the vertex, or at any
rate over the convex surface of the brain, while fractures of the middle
fossa were usually rapidly fatal.

_Concussion._--Cases exhibiting symptoms of pure uncomplicated
concussion were distinctly rare, as would be expected from the
mechanism of the injuries. On the other hand, symptoms of concussion
formed the dominant feature of all severe cases.

The symptoms in many instances consisted in great part in transitory
signs of the so-called 'radiation' type, such as are seen in destructive
lesions where the signs of nervous damage rapidly tend to diminish and
localise themselves.

As to the causation of the 'radiation' symptoms, it is difficult to
discriminate the effects of neighbouring parenchymatous haemorrhages from
those of local vibratory concussion of the nervous tissue. The local
character of the signs seems, however, to point to causation by
molecular disturbance, resulting from the conduction of forcible
mechanical vibration to the brain tissue rather than to upset in the
intra-cranial pressure. Again the limited nature of the paralysis
observed, sharply defines it from the general loss of power accompanying
ordinary cases of concussion of the brain. The similarity of the
phenomena to those described in other parts of the body under the
heading of 'local shock' is sufficiently obvious.

The following instance well exemplifies the condition in question:

(55) Wounded at Spion Kop. A scalp wound 3 inches in length
crossed the left parietal bone nearly transversely, starting
1-1/2 and ending 2 inches from the median line: the cen