uld be as numerous and complete as at
a Base hospital. I have had a useful set made of aluminium. A word will
be added later as to the splints suitable for different regions of the
body.

The necessity for _primary amputation_ chiefly depends on the nature of
the injury to the soft parts, less commonly on the extent of the injury
to the bones, and should be decided on exactly the same lines as in
civil practice. So-called intermediate amputations are always to be
avoided if possible; the results were consistently bad, and the
operation should only be undertaken in cases of severe sepsis where
little can be hoped from it, or for secondary haemorrhage. When the
operation could be tided over until the septic process had settled down
and localised itself, secondary amputation gave very fair results. In
either intermediate or secondary amputation for suppurating fractures,
it was necessary to bear in mind the special likelihood of the existence
of extensive osteo-myelitis. If this condition affected the upper
fragment, an amputation was of little use unless the whole bone was
removed, as septic infection continued and brought about a fatal issue,
or a fresh amputation was required in order to obtain a stump that would
heal.

SPECIAL FRACTURES

_Upper Extremity._--Fractures of the _scapula_ were not uncommon, but
were mostly of the perforative variety; thus perforations both of the
spine in longitudinal wounds of the back, and of the ala in perforating
wounds of the thorax, were tolerably frequent. They possessed little
practical interest; as a rule, the openings were not large, and the most
unexpected feature was the small interference with the movements of the
bone on the chest wall that resulted. It might be assumed that
comminuted fragments would project into the muscles and cause both pain
and interference with movement; but neither was the case. I saw grooving
of the crest of the spine, but never happened to meet with a fracture
of the acromion process. Many axillary tracks passed in the closest
proximity to the coracoid, but this again I never saw separated. One
practical point of importance with regard to the scapula was the
frequency with which bullets lodged in the venter, or the firmly
bound-down muscles of the supra- and infra-spinous fossae. These retained
bullets often gave rise to remarkably little trouble in this situation;
thus I have a skiagram of a shrapnel bullet lying in the deepest part of
the subs