=Treatment.= _When the fracture is associated with mild concussion._ During the stage of concussion no active treatment is required, beyond putting the patient to bed--with the head low--enveloping him in hot blankets, and applying hot bottles to the extremities. These bottles are wrapped up in flannel: they should never be placed in contact with the patient’s skin. As soon as the reaction stage _commences_, the bottles and blankets should be removed, the patient covered with light clothing only, and an ice-bag applied to the head, over the region at which the injury was inflicted. Calomel, in suitable doses, should be given by mouth, and a copious enema administered per rectum. Perhaps the most essential point in the general consideration of the case is the after-treatment. The patient should be kept in hospital or home for at least one month, and for the next three months or more, according to the urgency of the case, he should abstain from all mental and bodily work. At the end of that period of time he may return to work, though still kept under observation. _When the fracture is associated with severe concussion._ In the event of persistence of concussion symptoms of a severe type the prognosis is decidedly unfavourable. This prolongation of cerebral shock is undoubtedly dependent in its persistence on severe vaso-motor depression, and in the majority of cases ending unfavourably it will be found that the brain is generally œdematous and regionally contused or lacerated. In cases of this nature the surgeon should confine his attention, for the time being, to an endeavour at terminating this vaso-motor depression, raising the blood-pressure and inducing a definite reaction; the patient being treated after the manner indicated on p. 118. _When the fracture is associated with general cerebral irritation._ The patient should be put to bed in a quiet and darkened room, under the continuous attention of a trained nurse. An ice-bag or Leiter’s tubes may be applied to the head, though the patient seldom tolerates such attentions. I regard morphia as of the greatest service in this class of cases. It should be given freely, subcutaneously, either by itself or in combination with atropin. I generally order ¹⁄₄ gr. morphia with ¹⁄₁₀₀ gr. atropin every six hours, till the irritative symptoms subside. Insomuch as all evidence tends to prove that general cerebral irritation, as resulting from injury, implies a condition of contusion or superficial laceration, a prolonged period of bodily and mental rest is essential before the patient is discharged from treatment and allowed to return to work--a period of not less than six months. =The operative treatment of fractures of the vault.= The usual preparatory treatment is carried out, the scalp-tourniquet applied, a suitable scalp-flap framed and turned down, advantage being taken of all existent scalp lacerations. The subsequent details vary according to the circumstances of the case:--