actures of the
shaft treated at No. 1 General Hospital during my stay in South Africa.
Thirty-two cases of fracture of the shaft of the bone came under
treatment, and of these 6 or 18.7 per cent. needed amputation, and of
the whole number 5 or 15.6 per cent. died. To emphasise the satisfactory
nature of these figures I need only quote the results attained in the
American War of the Rebellion; mortality in upper third, 46 per cent.;
middle third, 40.6 per cent.; lower third, 38.2 per cent.

[Illustration: PLATE XVI.

Engraved and Printed by Bale and Danielsson, Ltd.

(34) OBLIQUE FRACTURE OF THE SHAFT OF THE FEMUR

Range '300 to 400 yards.'

Aperture of entry just above the centre of the outer aspect of the
thigh. Exit, about 2 inches lower, at the junction of the inner and
posterior aspects. The bullet was retained just within the wound, and
when removed the mantle fell off in two parts. The leaden core was
mushroomed. The bullet had passed through another soldier previous to
entering the patient's thigh. Only two small fragments of the mantle
were retained, as seen in the skiagram. These were in the substance of
the great sciatic nerve, and were subsequently removed by Sir Thomas
Smith.

It is difficult to determine how the bone was struck; reference to plate
XXI. would suggest that the shaft may have been perforated, but no
evidence of this remains in the skiagram taken, which was five months
later.

The patient was standing at the moment of reception of the injury, and
the obliquity of the fracture no doubt depended on his fall and the
resulting influence of the weight of the body. The length of the
fracture cleft was 9 inches.]

I need hardly dwell upon the difference between the nature of the
injuries received in the American War of the Rebellion and in the
present campaign, as in the former the old large bullets were employed,
and shell injuries are possibly included; but I ought to add in this
relation, that the numbers quoted from No. 1 General Hospital included,
to my knowledge, at least three severe Martini-Henry wounds.

The first element for a favourable prognosis is a small wound, and
opportunity for an efficient primary treatment of the same; the second
the absence of necessity for transport of the patient. With regard to
the second of these requirements, we were unfortunately situated in
South Africa, and the majority of the cases which did badly were moved
during the first few days and for a