the deltoid was
wasted and powerless; on the other hand the fingers could be
flexed, and although the elbow could not be, there were signs
of returning power in the biceps, and some movements of the
shoulder could be performed by the capsular muscles. It was
remarkable that common sensation was more acute in the left
than the right lower extremity, but I attributed this to the
remains of hyperaesthesia on the left side. The patient left for
home shortly after the last note.

In both these cases the absence of marked hyperaesthesia or pain points
to medullary haemorrhage (haemato-myelia) as the pathological condition
produced by the injury. In this particular they contrast well with case
94 quoted on page 315, where the degree of both hyperaesthesia and pain
indicated a combination of pressure and irritation of the nerve roots by
surface haemorrhage on the affected side. In case 97 the persistence for
four weeks of paralysis of the bladder and rectum suggested medullary
haemorrhage in addition, while the return of patellar reflex in the
paralysed limb negatived the occurrence of an extensive destructive
lesion.

In view of the extreme interest of these cases I will shortly detail one
other in which the cauda equina alone was affected.

I must confess my inability to place the case definitely in the
category either of concussion or medullary haemorrhage. As so often
happened, both conditions probably took part in the lesion. The
immediate development of the primary symptoms is no doubt to be referred
to concussion, while the patchy nature of the prolonged lesion and
gradual recession of the symptoms point to the presence of haemorrhages.
We find here the link most nearly connecting the spinal cord and the
peripheral systemic nerves. Such a case goes far to show that the
condition which I have in the next chapter often referred to as nerve
contusion may in fact be produced by an injury far short of actual
contact.

(98) A trooper in the Imperial Yeomanry, while advancing in the
crouching attitude, was struck by a bullet from his left front,
at an estimated distance of 300 yards. The bullet traversed the
right arm anteriorly to the humerus, entered the trunk in the
line of the posterior axillary fold, 1-1/2 inch below the level
of the nipple, crossed the thoracic and abdominal cavities,
deeply striking the lumbar spine, and finally lodged beneat