A Case of Compound Fracture of the Skull

. examination, it was found that a semicircular flap of the scalp, measuring 5 in. by 4 in., composed of the occipito-frontalis and temporal jfiuscles of the left side, had been stripped from scalp and was hanging over the face and ^lr-1 he bones forming the temporal fossa had ee11 exposed and flattened by the pressure of ie wheel of the cart. The antero-inferior angle 0 the left parietal bone had been disarticulated aiid depressed, causing considerable haemorrhage '"side the skull. The torn flap had been badly crushed and was full of embedded particles of earth and sand. The child was conscious and Without any symptoms of brain injury, despite lle severe character of the skull injuries. His parents, who lived close to the dispensary, refused 0 have him admitted as an in-patient. He ^as, therefore, operated upon, and transferred 0 his home to be treated as an out-patient. Operation.?The flap was cleansed as ^roughly as possible and all foreign particles removed. Loose pieces of skin and muscles Were excised and the flap sutured into position With a few loose sutures here and there, as it was recognised that sepsis would be almost inevitabJe. The entire wound was cleaned, dressed, aild the patient returned to his home. As was to be expected, the entire wound became septic, with a very foul discharge for more one month. Almost the whole of the flap s oughed, laying bare the underlying bones. iPus was evident issuing from within the cranial cavity. The parents were repeatedly advised to