deposition of blood-clot on the inner aspect of the same.

The only treatment indicated was a short period of rest, accompanied in
the early stages by pressure and slight fixation, followed later by
massage and movement if necessary.

Before dismissing this subject, I should like to particularly emphasise
the fact, that in the cases described there was no reason to suspect the
extension of fissures from the point of fracture in the shafts into the
articular ends of the bones. This was as far as possible excluded by
clinical examination, and in the cases where wounds of the soft parts
only were present, the rapid return of the patients to active duty, with
absence of remaining joint trouble, negatived the possibility of such
fractures.

I only saw one case in which a longitudinal fracture actually extended
for any considerable distance into a neighbouring joint. In this a
comminuted fracture occurred just above the centre of the shaft of the
humerus. At the time of examination and putting up of the fracture there
was considerable swelling of the whole arm, and nothing special was
noticed about the shoulder-joint. Three weeks later, however, when the
fracture was consolidating, difficulty in abduction of the shoulder was
noted, and the arm could not be placed closely in contact with the
trunk. There was no evident displacement of the head of the humerus
forwards. A skiagram, which I much regret I have not been able to
insert, showed that a longitudinal fissure extended from the seat of
fracture upwards in such a manner as to divide the upper fragment into
two parts, of which the outer bore the greater tuberosity, the inner the
articular surface of the head. The latter fragment had become somewhat
displaced downwards, and had united in such a manner that the head
rested on the lower part of the glenoid cavity. Abduction of the limb
therefore brought the greater tuberosity into contact with the acromion
process, and movement was checked. This case passed out of my
observation shortly afterwards, and I have no knowledge of the final
result as to movement.

Fractures of the bony processes surrounding the elbow-joint, and of the
malleoli of the tibia and fibula, were not infrequent, but offered no
special features.

One other form of injury indirectly affecting the joints is perhaps
worthy of mention, but I observed it only once, and that in the case of
the shoulder, the only joint where it is likely to be marked. I refer