Trephining is seldom necessary, the hole in the bone usually allowing of the application of craniectomy forceps, if any enlargement should be requisite. A good view of the dura mater can now be obtained. If that membrane be merely punctured or incised, the tear must be enlarged with blunt-pointed scissors so as to allow of complete examination of the underlying brain. Hæmorrhage from meningeal vessels is controlled by the application of ligatures to all vessels that cross the line of dural section. The lacerated brain is _gently_ irrigated with saline solution (at a temperature between 110° and 115° Fahrenheit), and all blood and pulped brain matter washed away. The cortex is then lightly examined with the finger and probe for any fragments of bone that may be embedded in the brain substance. The removal of such fragments should be conducted with all possible gentleness. The surgeon should be satisfied that no foreign body remains. The bullet, when encountered, is removed. Needless to say, the presence of a bullet and the existence of in-driven fragments of bone should be investigated previous to the adoption of operative measures by means of X-ray photography. If the brain be penetrated or perforated a drainage tube is introduced through scalp-flap and dura mater in such a manner that its distal end lies in relation to the track through the brain or flush with its lacerated surface. Elsewhere the dura is sewn up (fine catgut sutures) and the scalp-flap replaced, the drainage tube being anchored to the scalp with a single suture. The tube should be allowed to remain _in situ_ for at least forty-eight hours and longer if necessary, the surgeon being guided by the amount of discharge and by the general progress of the case. In all cases of doubt the surgeon should err on the side of leaving the tube in position for a longer period of time, merely shortening it daily. Premature removal may lead to disastrous results. There can be no question that ultimate success hinges to a large extent on primary or early healing of the wound. _The search for and removal of the bullet._ In the event of a wound of entry only, it may be presumed that the bullet is within the skull. Bullets, however, pursue such unexpected and devious courses within the skull, and possess such a tendency to gravitate towards the base of the brain, that no attempt should be made at removal except after full X-ray investigation, stereoscopic if possible.