The depression, varying greatly in depth and extent, may be situated over any part of the skull, but commonly involves the fronto-parietal region. It is often obscured in the early stages by the presence of an overlying hæmatoma, the condition perhaps only being discovered after the absorption of the blood-clot. In many cases no symptoms result, partly owing to the shallowness of the depression and partly due to the situation of the lesion over one of the so-called ‘silent’ areas of the brain. Under other circumstances the child may evidence the general increase in the intracranial pressure by cyanosis, difficulty in respiration, unconsciousness, and slow pulse. The anterior fontanelle will be tense, and pulsation will be absent or greatly diminished--a feature of the greatest diagnostic value. Localizing symptoms ensue when an extensive depression is situated over the motor area, the extremities of the opposite side being flaccid, or evidencing irritation by twitchings and convulsions. The ready response of the infant to cortical irritation frequently results in the early transformation of local twitchings into general convulsions. =Course and treatment.= It is often stated that these depressed fractures remedy themselves in the course of time, the development of the underlying cortex curing the depression by the outward leverage exerted. In the minor degrees of depression there may be some chance of such spontaneous cure. I am, however, entirely opposed to the view that spontaneous cure is the rule, and there can be no question that the more severe types of depression remain as permanent defects unless surgical remedies are adopted. Furthermore, even if the deformity should cure itself in time, the intermediate dangers are not to be disregarded, for, during the process of spontaneous cure, there is a decided liability for the depressed cortex to lag behind in the process of development, or to undergo degenerative changes as the result of the pressure exerted--with disastrous results on the parts supplied by the region compressed. Mental deficiency, paralyses, and contractures will result, and there is every reason to believe that some cases of infantile paralysis are dependent on this lesion. The following case, recently under my care, adds further proof to the statement that spontaneous cure is usually out of the question:--