only possible to estimate the real extent of the
injury by administering an anaesthetic and exploring the wound. In
doubtful cases the possibility of rendering the parts aseptic will often
decide the question for or against amputation. If thorough purification
is accomplished, the success which attends conservative measures is
often remarkable. It is permissible to run an amount of risk to save an
upper extremity which would be unjustifiable in the case of a lower
limb. The age and occupation of the patient must also be taken into
account.

It having been decided to try and save the limb, the question is only
settled for the moment; it may have to be reconsidered from day to day,
or even from hour to hour, according to the progress of the case.

When it is decided to make the attempt to save the limb, the wound must
be thoroughly purified. All bruised tissue in which gross dirt has
become engrained should be cut away with knife or scissors. The raw
surface is then cleansed with eusol, washed with sterilised salt
solution followed by methylated spirit, and rubbed all over with "bipp"
paste. If the purification is considered satisfactory the wound may be
closed, otherwise it is left open, freely drained or packed with gauze,
and the limb is immobilised by suitable splints.

WOUNDS BY FIREARMS AND EXPLOSIVES

It is not necessary here to do more than indicate the general characters
of wounds produced by modern weapons. For further details the reader is
referred to works on military surgery. Experience has shown that the
nature and severity of the injuries sustained in warfare vary widely in
different campaigns, and even in different fields of the same campaign.
Slight variations in the size, shape, and weight of rifle bullets, for
example, may profoundly modify the lesions they produce: witness the
destructive effect of the pointed bullet compared with that of the
conical form previously used. The conditions under which the fighting is
carried on also influence the wounds. Those sustained in the open,
long-range fighting of the South African campaign of 1899-1902 were very
different from those met with in the entrenched warfare in France in
1914-1918. It has been found also that the infective complications are
greatly influenced by the terrain in which the fighting takes place. In
the dry, sandy, uncultivated veldt of South Africa, bullet wounds seldom
became infected, while those sustained in the highly manured field