ently
commenced in the face and then became general.

Three months later no further fits had occurred, and the
patient, who throughout had said he felt remarkably well,
complained of nothing. The upper extremity was apparently
slightly less rigid than before the exploration, and the
patient said he walked somewhat better than before. The closure
of the skull was perfect.

_Treatment._--The treatment of fractures of the skull possesses a degree
of surgical interest that attaches to no other class of gunshot injury,
since operative interference is necessary in every case in which
recovery is judged possible. The injuries are, without exception, of the
nature of punctured wounds of the skull, and the ordinary rule of
surgery should under no circumstances be deviated from. An expectant
attitude, although it often appears immediately satisfactory, exposes
the patient to future risks which are incalculable, but none the less
serious. Happily the operations needed may be included amongst the most
simple as well as the most successful, and expose the patient with
ordinary precautions to no increase of risk beyond that dependent on the
original injury.

Cases of a general character, or in which the base has been directly
fractured other than in the frontal region, are seldom suitable for
operation, since surgical skill is in these of no avail; but in all
others an exploration is indicated. I use the word 'exploration'
advisedly, since what may be called the formal operation of trephining
is seldom necessary except in the case of the small openings due to
wounds received from a very long range of fire; in all others there is
no difficulty, but very great advantage, in making such enlargement of
the bone opening as is necessary with Hoffman's forceps.

The scalp should be first shaved and cleansed; if for any reason an
operation is impossible, this procedure at least should be carried out,
with a view to ensuring, as far as possible, future asepsis, infection
in head injuries being almost the only danger to be feared. The shaving
may need to be complete, but local clearance of the hair suffices in
many cases. The hair having been removed, the scalp is cleansed with all
care, a flap is raised of which the bullet opening forms the central
point, and the wound explored. In slight cases the entry opening is the
one of chief importance, and the exit may be simply cleansed and
dressed. In some ins