treated on this assumption. It is
often found that, when there are no cerebral symptoms present, it is
difficult to convince the patient of the necessity for undergoing
treatment, and of the risk involved in his leaving his bed and
resuming work.

_Prognosis in Basal Fractures._--The prognosis depends upon the
severity of the cerebral lesions, and on the occurrence of traumatic
oedema or infective intra-cranial complications. Many cases prove
fatal within a few hours from the associated injury to the brain, the
patient dying from cerebral compression due to haemorrhage. If the
patient survives two days, the prognosis is more hopeful (Wagner). It
is possible that the free escape of blood from the nose or ear may in
some cases prevent compression, and to a certain extent render the
prognosis more favourable. Punctured fractures are frequently fatal
from infective complications--meningitis, sinus thrombosis, and
cerebral abscess. These complications are also liable to occur in
fractures rendered compound by opening into the nose, pharynx, or ear,
but they are less common than might be expected.

_Treatment._--The general treatment includes that for all head
injuries. In a number of cases attended with symptoms of compression,
benefit has followed the relief of intra-cranial tension by a
decompression operation. The withdrawal of 30 or 40 c.c. of
cerebro-spinal fluid by lumbar puncture has also proved beneficial in
the same way; Quenu strongly recommends repeated puncture in serious
cases. In a few cases this procedure has been followed by sudden
death.

Steps must be taken to prevent infection from the mucous surfaces
implicated. This is exceedingly difficult in fractures opening into
the pharynx and nose. Owing to the general condition of the patient,
it is usually impossible to employ nasal douching or mouth washes, but
spraying the cavities with peroxide of hydrogen or other antiseptics
may be employed with benefit. In fractures of the middle fossa, the
ear should be gently sponged out and the meatus plugged with gauze,
retained in position by adhesive plaster or a bandage. When there is a
persistent escape of blood or cerebro-spinal fluid, the dressing
requires to be changed frequently.

In compound fractures of the anterior fossa due to perforation through
the orbit, the frontal bone should be trephined to admit of the
removal of loose fragments or of any foreign body that may have
entered the skull and to prov