What has been said above as to fractures,
accompanied by loss of continuity, applies equally to cases of severe
wedge-fracture, where many loose fragments exist.

As to the disinfection of the limb, primary cleansing, mainly by soap
and water, of course precedes the exploration, and when the latter has
been carried out a second cleansing and disinfection, preferably with
spirit and carbolic acid lotion, are imperative.

Immobilisation is a more difficult problem. In practised hands
plaster-of-Paris splints answer most requirements except in the case of
the thigh; but the splints take time to apply and also to set firmly,
and, as sometimes needing frequent removal, are not altogether suitable
for Field hospital work. Of all the splints I saw in use, I think the
best were wire splints, and the Dutch cane folding splints for the thigh
and leg (figs. 56, 58); wire-gauze splints with steel at the margins
(fig. 54), or strips of ordinary cardboard applied with some variety of
adhesive bandage for the arm and forearm; and plain wooden of various
lengths for any situation.

A question of constant difficulty was that of frequency of dressing; in
a Stationary or Base hospital this is not difficult, as the same surgeon
has the patient continuously under his charge, and can readily decide as
to the proper moment for the renewal of the dressing. When the patient
is, however, being moved from the Field to the Stationary hospital, and
thence to the Base, a constant succession of surgeons has the case in
hand for short periods, the movements during transport disturb the
fixity of the dressing, and, in consequence, dressings are apt to be far
more frequent than is advisable. This question raises the larger one of
the advisability of _any_ transport beyond what may be an actual
necessity. There is only one answer to this. No fractures of the thigh
or leg, and few of the arm, can be transported for any distance without
material disadvantage. The risks attendant on disturbance of the
fracture and tissue injury, septic infection as a result of slipping of
the dressing and the impracticability of efficiently renewing it, far
more than counterbalance any advantage to be gained from the superior
comforts available at a Base hospital. For these reasons, if possible,
all fractures of the arm, thigh, or leg should be kept at a Stationary
hospital for a period of three or more weeks, and, as far as splints and
appliances are concerned, these sho