of the patient and properly filled out the folder in which the various papers-medical, military, social-relating to the patient can be filed away. Another patient of the group has an injury to one of the peripheral nerves. He is examined by the physicians in charge of the neurologial ward who decides whether the case is one for nerve or tendon operation, or, in case the patient has already been operated upon elsewhere, what type of splint is necessary and what form of physiotherapy. It may be that no further medical treatment is indicated. In that event the head of the vocational department is called upon for advice. He confers with the physician as to the nature of the work which the patient is best fitted to perform. A third patient has a non-union of the femur. The surgeon in charge of the ward dealing with injuries to bones decides whether operation should be performed at once, or whether conservative treatment should be tried. If a splint is necessary he is taken in charge by the head of the brace department and placed in the suitable ward. Since healing will require several months, he is also referred to the vocational department for educational work during his stay in the hospital. The fourth patient has a contracture of a joint. He, too, is examined by the ward physician in charge of joint injuries and contractures, and referred either to the operative division or to the physiotherapeutic department. These four cases represent the four main types of injuries referred to the hospital, and in outlining what happens to them an idea is given of the routine procedure of this centralizing bureau. As the patients progress from one ward to another, from the operative to the physiotherapeutic, and from this into purely vocational wards, their course is followed by the clerks who register the notes sent them by the respective departmental heads, relative to time of operation, delivery of splint, enrollment in workshops or business school, etc. If there is a hitch anywhere it can be noted at once, and called to the attention of the physician in charge. Construction of the Hospital.-The unit system is the best, since it allows readily for expansion and adopts itself excellently to the systematization outlined in the preceding paragraphs. The patients are referred to the barracks according to the type of injury and the nature of the treatment; thus, there is the ward for the amputated, whose stumps still require surgical intervention, another for those whose prostheses are in course of construction, etc. The barracks are arranged somewhat in the style of a military camp, with, of course, due regard to the medical exigencies. The operating pavilion should be connected by a covered, well-warmed passage with the ward for the immediate reception of postoperative cases. If this precaution is not adopted there will be an unduly high percentage of postoperative pneumonias. In planning the internal arrangement of the pavilions, opportunity should be given for initiative on the part of the physician in charge. In selecting the personnel for the hospital, special care must be taken in the selection of the chief orthopedic surgeon, for with him rests success or failure. He must be a master of his art, thoroughly versed in reconstructive surgery, in orthopedic after-treatment, and in the application of braces. Besides, he must have a social conscience and a ready sympathy for the individual needs of his patients. The other members of the hospital staff must also be chosen with care, and particular reference must be paid to grouping together men who are in sympathy with the common aim of the hospital, and who, despite the differences in their technical qualifications, are one in their ability to work harmoniously with their fellows. INDEX ABBOTT, 111, 112 Achilles tendon, Gallie tenodesis tenotomy of, for fracture near Adhesive bands, treatment of, near Amputated, bilateral, 227, 229 229 vocational training for, 223, 225, Amputation, aperiosteal method, Amputation stump, disarticula- education of, 189, 197 kinetic operations for, Sauer- indications for, 184 use of, as substitute for hand, Ankle, injuries to, 41 Ansinn method for extending thigh and mobilizing knee, 63 Arthroplasty, 98 Artificial limbs, calf, 200 for upper arm amputations, Artificial limbs, forearm, 201, 204 lower extremities, 197, 200 upper extremity, 200, 217 BALKAN extension frame, 63 Besley fracture splint, 66 paralyzed quadriceps, 165, 168 Blake, treatment of fractures, 66 Cap experiment, of Mayer and Carnes artificial limb, 203, 214 treatment of injury to, 52 Corley artificial limb, 203, 208 Cranial nerves, symptoms of in- DELTOID muscle, injury to, 54 Drop-foot, treatment with dorsal EDINGER method of nerve suture, Elbow, contracture of, 107 fenestrated plaster dressing for injuries in neighborhood of, 26 Equinus position of foot, 110 FASCIA, plastic operation, 160 of upper third, 33 Fingers, contracture of, 107 tendons, injury to, 58 operations for, 172–178 Fischer clamp, 206 Flexor longus hallucis, transplan- Foot, equinus position of, 110 tenodesis of, 180, 181 Forearm, fenestrated plaster dress- injury to muscles of, 56 Foreign bodies in joints, 100-106 compound, plaster dressings for, of humerus, 22, 69 traction to overcome shortening, Frame, Balkan for extension, 63 |