s is still very abundant, but less so than at an
earlier date. No trouble with the musculo-spiral nerve was noted, but
residual abscesses occurred from time to time in connection with the
fracture.]

[Illustration: FIG. 54.--German Wire Gauze Splint on steel wire
foundation.

(German Ambulance, Heilbron)]

The treatment of wounds should be on the lines already laid down:
thorough cleansing, and then an attempt to seal. In severely comminuted
fractures, however, the exit wound may be of very large size, and then
frequent dressings are necessary. Loose fragments, by which those freed
from their periosteal connections are meant, need removal. The question
which most interested me was the best method of fixation. This needs to
be sufficient to effect immobility, but on the other hand in many cases
the weight of the arm as a means of extension is very valuable. Some of
the most successfully treated cases that I saw were fixed by means of
simple strips of pasteboard, applied moist, and fixed with an adhesive
bandage. Ordinary book-muslin bandages are as good as anything for this
purpose, as they can be reinforced by a stronger form outside them.
Where necessary, an angular piece of cardboard can be applied on the
inner aspect, or a wooden angular splint may be substituted, if it is at
hand; but in this case most of the advantage of the weight of the arm as
a means of extension is lost. The cardboard cases possess the great
advantage of being readily cut off and reapplied much as is done with
plaster of Paris. During the period in which dressing may be necessary I
believe this form of splint is as good as can be got for use in Field
hospitals, the only point needing care being to ensure that the
bandaging is not too tight. It is much more reliable than are ordinary
splints if transport is unavoidable, and is much lighter and less
irksome to the patient. With such strips of cardboard, a few of the
gauze splints (fig. 54), and a few angular and wooden splints, I believe
a Field hospital is fully equipped for the treatment of any fractures of
the upper extremity.

[Illustration: PLATE VIII.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson, Ltd.

(27) OBLIQUE FRACTURE OF THE HUMERUS OF THE NATURE OF A PERFORATION

Range more than '1,000 yards.'

The distance was probably much greater, as the bullet was retained and
undeformed, and the comminution of the bone was very slight. The wound
of entry was