=Complications.= The more important early complications are meningitis, hernia cerebri, and brain abscess. For the Symptomatology and Treatment of these conditions the reader is referred to Chapter VIII. =Results.= The prognosis in any given case depends on the degree of bone and brain injury, on the presence or absence of the bullet in the brain, and on the ‘cleanliness’ of the wound. In the American Civil War 61·2 per cent. of all fractures of the skull terminated fatally, in the Franco-German War 51·3 per cent., and in the South African War 33·1 per cent. This decreasing mortality is undoubtedly dependent on the improved methods of treatment. When the injury is inflicted at short range the prognosis is undoubtedly less favourable. ‘At short range, the characters of the wounds, and the severity of the symptoms, rendered the immediate prognosis uniformly bad, a very great majority of the patients dying, and that at the end of a few hours or days.’ (Makins.) The best results were obtained when the injury was received in the frontal region. The occipital region comes second, and the cerebellar last. Most injuries near the base of the skull were fatal. Longitudinal wounds were more serious than transverse. However, the most surprising recoveries were made, both with and without operative treatment. The prognosis with regard to pistol wounds is absolutely bad. Phelps[67] records the following results in cases that came under his own observation. Death occurred at once or within the first hour in 15 cases. Death occurred within twelve hours in 7 cases. Death occurred within fifteen hours to forty days in 10 cases. Recovery in but 8 cases. 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._