y other cases of the same nature, particularly in
men who, as a result of unfortunate circumstances, were necessarily left
out on the field for more than twenty-four hours. In some of these
maggots were found in the wounds only thirty-six hours after the
infliction of the injury.

I have said nothing as to the treatment of the large primary herniae
cerebri in wounds of an explosive nature, since these were rarely
subjects suitable for operation; but in the instances of minor severity
they were treated as the other cases where the pulped brain lay mostly
within the skull.

In cases where the wounds were in the frontal or fronto-parietal
regions, and hemiplegia existed, the rapid improvement in the paralytic
symptoms, after operation, was very marked, showing that the signs were
mainly, or entirely, due to 'radiation' injury. I am inclined to think
that temporary injury of this kind from vibratory disturbance and small
parenchymatous haemorrhages, were far more often the cause of the
paralysis than surface haemorrhage, since the latter was rarely found in
large quantity. Large clots, however, no doubt growing in both size and
firmness, occasionally occupied the area of destroyed brain, and these
sometimes manifestly exercised pressure that was at once relieved by
their evacuation.

In cases where inflammatory hernia cerebri developed, a secondary
exploration was often indicated for the removal of fragments of bone or
the evacuation of pus, otherwise the condition was best treated by dry
dressings and gentle support.

Abscess of the brain was treated by simple evacuation and drainage by
metal or rubber tubes: the operations were always of extreme simplicity,
since the abscess in every case I saw was in the direct line of the
wound track, and was readily opened by the insertion of a director or
blunt knife. The only trouble in the after treatment was that already
referred to, of preventing premature closure of the drainage opening.

I have made no special reference to the method of dressing, since it was
of the ordinary routine kind. The most important factor in success was
the efficient primary disinfection of the scalp; a piece of antiseptic
gauze and some absorbent wool, efficiently secured, was all that was
needed later.

As usual the consideration of the treatment of cases in which the bullet
was retained may be considered last. Such accidents were distinctly
rare. I operated in only one (No. 54, p. 260) in whom