f the
body (Little's disease), by blindness, deafness, and varying degrees
of mental deficiency, or by Jacksonian epilepsy.

_Treatment._--To obviate these after-effects the clot may be removed
by raising an osteo-plastic flap, including nearly the whole of the
parietal bone. The operation should be undertaken within the first
week or two, and great care must be taken to keep up the body-warmth,
and to prevent undue loss of blood. It may be necessary to operate on
both sides, an interval being allowed to elapse between the two
operations.

For the immediate relief of increased intra-cranial tension, the daily
withdrawal of 10-12 c.c. of cerebro-spinal fluid by lumbar punctures
may be employed, or a sub-temporal decompression operation may be
performed.

WOUNDS OF THE BRAIN

#Wounds of the Brain.#--_Incised_ wounds of the brain usually result
from sabre-cuts, hatchet blows, or circular saws. A portion of the
scalp and cranium may be raised along with a slice of brain matter,
and in some cases the whole flap is severed. The extent of the injury,
the conditions under which it is received, and the liability to
infection, render such wounds extremely dangerous.

_Punctured wounds_ may be inflicted on the vault by stabs with a knife
or dagger, or by other sharp objects, such as the spike of a railing.
More frequently a pointed instrument, such as a fencing foil, the end
of an umbrella, or a knitting needle, is thrust through the orbit into
the base of the brain. Occasionally the base of the skull has been
perforated through the roof of the pharynx, for example, by the stem
of a tobacco-pipe. All such wounds are of necessity compound, and the
risk of infection is considerable, particularly if the penetrating
object is broken and a portion remains embedded within the skull. The
infective complications of such injuries are described later.

_Bullet wounds_ have many features in common with punctured wounds.
There is more contusion of the brain substance, disintegrated brain
matter is usually found in the wound of entrance, and the bullet often
carries in with it pieces of bone, cloth, or wad, thus adding to the
risk of infection.

Aseptic foreign bodies, especially bullets, may remain embedded in the
brain without producing symptoms.

The _treatment_ of punctured wounds consists in enlarging the wounds
in the soft parts, trephining the skull, and removing any foreign body
that may be in it, purifying the track, and