the indications
both for localisation and interference were obvious, since the bullet
had palpably fractured the bone, although it had not retained sufficient
force to enable it to leave the skull. In two other cases that I saw, in
one the bullet was lodged in the zygomatic fossa, in the second just
below the mastoid process. The former patient died; the latter exhibited
symptoms indicative of injury to the occipital lobe (No. 68), and was
successfully treated by Mr. J. E. Ker. I never happened to see a case in
which a retained bullet in the skull was localised by the X rays, but
such might have been possible in case No. 64, p. 275. In no case is
primary interference indicated, unless a fracture exists where the
bullet has tried to escape, or secondary symptoms develop pointing to
irritation.

Under ordinary circumstances, moreover, the indications for removal of a
bullet are not likely to be sufficiently imperative to necessitate the
operation being undertaken until the patient can be placed under the
best conditions that can be secured. This is the more advisable since
such operations need the infliction of an additional wound, require
great delicacy, and may be very prolonged in performance. The experience
of civil practice has already sufficiently proved the small amount of
inconvenience likely to follow the retention of a bullet in the skull.

I may again mention the fact that in explorations for the removal of
bone fragments, fragments of lead, from breaking or setting up of the
bullet, are sometimes found.

Taken as a whole, the operations on the head were extremely satisfactory
from a technical point of view; the large depressed pulsating cicatrix
so often left was the chief defect observed. The circumstances under
which many of the operations had to be performed militated strongly,
however, against the successful replacement of separated bone fragments,
which might have rendered the defects less serious.

Secondary operations for traumatic epilepsy scarcely come within the
scope of these experiences. In case 73, p. 292, it is of interest to
note the manner in which the cavity due to loss of brain substance was
filled up. No doubt a similar vicarious arachnoid space develops in all
cases in which a soft pulsating swelling fills an aperture in the bones
of the skull.

WOUNDS OF THE HEAD NOT INVOLVING THE BRAIN

_Mastoid process._--The most important wound of the cranium not already
mentioned was that in