of
healing of the fractures._--Peculiarities in the initial signs may be
rapidly passed over. The first depended on the large number of lesions
of the bone which were unaccompanied by loss of continuity. In the case
of perforations attention to the course of the track, external
palpation, and possibly the detection of bone dust in the aperture of
exit, were usually sufficient to indicate injury to the bones. When
these did not suffice the introduction of a probe would usually set the
question at rest; but this is always to be avoided if possible, as
adding a fresh item of risk to the wound. The X rays were not always to
hand, and are not always capable of giving reliable information in the
matter of perforations, although very useful in detecting grooves or
notching. The latter injuries are those in which information as to the
condition of the bones is often of most interest in view of the
characters of the external wounds.

Fractures with solution of continuity were, as a rule, easy of
detection, but the relative prominence of the classical signs varied
somewhat from what we are accustomed to see in civil practice.

The first striking peculiarity noted in comminuted fractures of the long
bones was the degree of local shock; the limbs were often quite
powerless, the muscles flaccid, and common sensation lowered. This was
of importance in two ways; firstly, shortening of the limb was often
absent as a sign, and, secondly, pain was sometimes not at all
pronounced even when the patient was moved. The primary absence of
shortening, even persisting for the first two or three days, was a
phenomenon always important to bear in mind, as it affected the degree
of extension needed in the treatment of the fracture, which, if
sufficient at the moment, often proved quite inadequate with the return
of tone in the muscles. Secondly, abnormal mobility was usually strongly
marked, and this sometimes without very definite crepitus, as a result
of the fine nature of the comminution and the displacement of the small
fragments.

During the course of healing some other peculiarities are worthy of
mention. First of all, union was tardy and often not strong. On the
other hand, an abundance of provisional callus was common, which formed
large swellings apt to implicate neighbouring nerves, and sometimes to
interfere with the movements of joints. The slowness of healing was
particularly noticeable in those cases where the degree of local sho