distance of between five and six
hundred miles. On the other hand, as a rule, the external wounds were
small.

As to functional result, the fractures did well. I think an average of
an inch and a half would well cover the shortening, and in many the
length was little altered. Considering the serious nature of many of
these fractures, this was good.

_Treatment._--In all punctured fractures of the lower extremity,
dressing of the wounds like uncomplicated ones and a short period of
immobilisation were all that was necessary. In oblique fractures, and
those with slight comminution, closure of the wound by dressings, after
it had been carefully cleansed, was all that was necessary prior to
applying the splints for immobilisation.

[Illustration: PLATE XVII

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson, Ltd. (35) PERFORATION OF
THE SHAFT OF THE FEMUR. FLAP OF BONE RAISED AT THE APERTURE OF EXIT IN
THE POPLITEAL SURFACE OF THE SHAFT.

Range 'over 1,000 yards.'

Compare with fig. 52, p. 169.]

In the highly comminuted fractures a more radical treatment was
indicated, especially if the exit wound was large. In these, after
careful preliminary cleansing of the limb, the wounds, especially the
exit aperture, needed exploration and, if necessary, enlargement, and
all free splinters needed removal. If interference with the entry wound
could be avoided, this was always preferable, as it was rare for this
not to heal by primary union unless free suppuration occurred. Under
Field hospital conditions I think the exit wound should never be
sutured, whatever its situation; and in the present campaign, where
carbolic acid lotion was freely used, this step was manifestly
inadvisable, in view of the abundant serous discharge always to be
expected when this disinfectant has been employed. Except in cases
manifestly infected at the time of exploration, the use of drainage
tubes or plugs is not to be recommended. I would point out also that in
the majority of cases it is quite hopeless to attempt to make the entry
wound the safety-valve for drainage, as its natural tendency, even if
enlarged, is to heal, while the condition of the tissues in the exit
segment of the track usually renders primary union an impossibility.

The wound having been dealt with, the next indications were for the
reduction of deformity, immobilisation of the limb, and the provision of
a proper degree of extension. As to the reduction