The more remote results are exceedingly difficult to determine, for it is impossible to obtain an accurate account of the subsequent course of events in all cases. With regard to the question of the after-history, Makins[68] writes, ‘I feel certain that a long roll of secondary troubles from the contraction of the cicatricial tissue, irritation from distant remaining bone fragments, as well as mental troubles from actual brain destruction, await record in the near future.’ In the experience of the writer, this statement is fully justified. The hospital surgeon continually meets with cases exemplifying the more remote effects, varying from slight lesions associated with chronic headache to others showing considerable deficiency in the vault of the skull with cortical degeneration.
Some of these cases are still capable of being cured, others are hopelessly inoperable.
In the consideration of the more remote results, it must be remembered that the surgeon comes mainly into communication with those cases which require further treatment. The more favourable are lost to view. Hence the difficulty in estimating with certainty the absolute results obtained after lesions of this nature.
[59] A Civilian War Hospital.
[60] Gunshot Wounds, p. 170.
[61] Gunshot Wounds.
[62] A Civilian War Hospital, p. 228.
[63] Surgical Experiences in South Africa, p. 293.
[64] Lancet, March 3, 1906.