ary.
Although this method of treatment is satisfactory in cases with a small
wound, it is very troublesome to carry out, even when a bracket is
inserted opposite the wound, when frequent dressing is necessary, as is
generally at first the case when the wounds are large. For this purpose
a much more satisfactory method is the use of Hodgen's splint. This
allows of automatic adjustment of the degree of extension, and the
dressing of the wound without interference with the position of the
fracture. A continuous many-tailed bag is preferable to the strips
usually employed for the suspension of the limb, as more easily
adjustable and as offering a more even support to the limb.

[Illustration: PLATE XIX.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson Ltd.

(37) OBLIQUE COMMINUTED FRACTURE OF THE TIBIA

Range '600 yards.'

The entrance wound was large and the exit also. The fracture may have
been caused by a Mannlicher (8 mm.) soft-nosed bullet, or possibly a
ricochet. The fragmentation is somewhat coarse at the periphery, but
very fine in the track of the bullet. Several fragments of the mantle
are visible.

The fracture affords a good example of obliquity due to cutting by the
bullet, and contrasts well with those due to rectangular impact such as
are shown in plates IV. and XIV.]

While at Orange River, in conjunction with Major Knaggs, R.A.M.C., and
Mr. Langmore, we treated several cases of fracture of the shaft of the
femur by this method. The splints were made for us by the Ordnance
Department, while the Royal Engineers erected a kind of gallows for us
down the centre of a commissariat marquee in order to avoid the risk of
using the tent poles for suspension. The patients were then ranged on
each side of the tent in two rows so that the pull of the two sets of
limbs opposed each other on the gallows from which they were suspended.
Although these patients had to lie on the ground, they were really
comfortable compared with those treated with long outside splints, and
the results obtained were very good: in three cases which I had the
opportunity of measuring later the bones were in good position and the
shortening was less than one inch.

I have no doubt whatever that Hodgen's splint is by far the best method
of treating all cases of fractured thigh in the Stationary field
hospitals; and, more than this, I believe it is the only practicable and
efficient one. It can be applied without t