of the fracture, this
was always a matter of ease, needing only slight axis traction. The
provision of efficient means of extension and immobilisation was a very
different matter. These questions had to be considered under two sets of
conditions: (1) when it was possible to keep the patient at rest in the
hospital he was first deposited in; (2) when it was necessary for him to
be transported for a considerable distance, probably not less than 500
miles.

When transport is a necessity, the best method of immobilisation is the
application of breeches of plaster of Paris, and a long outside splint.
The latter we often had excellently made on emergency by the Ordnance
Department or the Royal Engineers. A perineal band is the only form of
extension possible under these circumstances. The Dutch ambulances were
provided with a very excellent emergency splint for cases of fractured
thigh, which is illustrated in fig. 56. I think something of this kind
should be carried in one of the ambulances going on to every field of
battle, as being far more suitable than a long outside splint for hasty
and inaccurate application. This splint, fixed with some kind of firm
bandage, is an excellent temporary one for use during transport.

[Illustration: PLATE XVIII.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson Ltd.

(36) OBLIQUELY TRANSVERSE FRACTURE OF THE PATELLA

Range 'short.'

The entry and exit wounds were small, and a distinct grooving from loss
of substance of the bone was palpable superficial to the actual cleft of
the fracture.]

[Illustration: FIG. 56.--Dutch Cane Field Emergency Splint for Thigh or
Lower Extremity. (Dutch Ambulance, Winberg)]

In cases which can be treated at a Stationary hospital near at hand, a
long outside splint supplemented by plaster breeches, and a well-applied
American extension, is a very good method of treatment, the only point
to bear in mind being frequent examination of the position of the limb
to ensure the extension being efficient. As already mentioned, the
shortening in the primary stages is often slight and easily combated,
but in many of these cases if examined in a few days the limbs are found
to have shortened considerably, principally as a result of recovery of
tone by the muscles, and the absence of any help from the resting of the
two fragments end to end. The weight, therefore, has often to be
progressively increased and the fracture readjusted if necess