MECHANI tAL TREATMENT OF FRACTURES

I HAVE been asked to offer some suggestions as to a suitable way of treating certain fractures of tlle upper and lover limbs as they occur at time seat of war. We realize tllat wounds as imlet witlh during the Boer and Russo-Japanese camLpaigns were very different in cllaracter from those occurring on the riclhly manured fields in Flanders wlhere suppuration so commonly follows. Time point, tlherefore, is to decide upon the best way of immobilizing compound fractures in the presence of pus. The method employecl ilust be both efficient and simple; it must allow easy and painless access to tlle wound, and protect the Iiinub from llaril during tranisport. From experiences gained by a slhort visit to the front, and from conversatiolns witlh muany surgeons at lhome and abroad, I feel strongly tllat surgeons slhould abandon all operative methods designed to immobilize the fractured ends. They are fraught with danger, and lhave no place in this campaign. Plaster-of-Paris, so often used in the treatment of simiiple fractures, becomes a filtlhy m-letlhod wlhere suppuration lhas occutrre'd. Despite evety precaution for the exposure of the wound the plaster mops up discharges like blotting. paper, and becomes horribly offensive, adding to the infection of tlle wound.I woulId urge my young colleagues at the front to discard it Mltogether.