impact together with high velocity is well
illustrated. Had the resistance been greater, as in the case of the
femur, a nearer resemblance to the effect seen in plate XV. would have
been the result.]

Of _fractures of the hand_ I have little to say. In the case of the
_carpus_, the slight degree of resistance offered by the bones rendered
injuries of an explosive character rare. I never saw one. Fractures of
the _metacarpus_, on the other hand, presented exactly the opposite
features. The density of these small bones was well illustrated by the
frequency with which the bullet suffered injury, even amounting to
fragmentation, and the great comminution they themselves suffered. The
breaking up of the bullet in these fractures was a curious feature,
which may perhaps be explained by the tendency of the distal part of the
limb to be driven in the course of the bullet, with the result of
somewhat lengthening the period of contact of the projectile, or more
probably by somewhat frequently occurring irregular impact. Plate XI. is
a good example of an injury of this nature of moderate severity. The
soft parts suffered much in these injuries, the tendons were torn and
lacerated at the moment, and were very apt to acquire more or less
permanent adhesion. This latter condition was sometimes to be improved
by the removal of bone fragments, and I have freed tendons from actual
clefts in the bones where they had been carried in by the bullet. In
some cases very great deformity of the digits, due to shortening,
developed, even when no fragments were removed beyond those blown away
by the bullet.

One form of injury of some interest was multiple fracture of the
phalanges produced by a bullet travelling in a course parallel to the
length of the rifle when pointed by the patient. Occasionally several
digits were lost.

_Treatment of fractures of the upper extremity._--The general lines of
this have already been foreshadowed in the general section, the remarks
as to transport being applicable to all serious fractures of the shaft
of the humerus, and this is the only one of the bones of the upper
extremity on which anything special need be said, as the treatment of
all the other fractures exactly coincides with that of ordinary civil
practice.

[Illustration: PLATE VII.

Engraved and Printed by Bale and Danielsson, Ltd.

(26_a_) CONDITION OF THE SAME FRACTURE SHOWN IN PLATE VI., A YEAR AFTER
ITS PRODUCTION

The ensheathing callu