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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.

ABBOTT, 111, 112

INDEX

Achilles tendon, Gallie tenodesis
of, 181

tenotomy of, for fracture near
ankle, 62

Adhesive bands, treatment of, near
or within joints, 87
Albee, 78, 80, 82, 83

Amputated, bilateral, 227, 229
life of, 217, 229

vocational training for, 223, 225,
237, 239

Amputation, aperiosteal method,
186

Amputation stump, disarticula-
tion of, 187

education of, 189, 197
furrow of, 192

kinetic operations for, Sauer-
bruch, 187, 189
maximum length of, 185
methods of healing wound, 182
physiotherapy for, 189, 192
postural treatment, 183
reamputation, Gritti method,
186

indications for, 184
technic of, 186, 187
treatment of, 182, 197

use of, as substitute for hand,
227, 228

Ankle, injuries to, 41
Ankylosis, 96

Ansinn method for extending thigh

and mobilizing knee, 63

Arthroplasty, 98

Artificial limbs, calf, 200

for upper arm amputations,
204, 217

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upper extremity, 200, 217
Axhausen, study of bone trans-
plantation, 76

BALKAN extension frame, 63
Bardenheuer treatment for hip
injuries, 32

Besley fracture splint, 66
Biceps, brachii, injury to, 55
femoris, transplantation of, for
paralyzed quadriceps, 165, 168
Bier osteoplastic amputation, 186
Biesalski artificial arm, 211, 213
method of tendon transplanta-
tion, 134

Blake, treatment of fractures, 66
Blood-vessels of tendon, 141, 143
Bone graft, fate of, 81

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Foot, equinus position of, 110
extensor muscles of, 58
hollow, development of, 163
tendon transplantations, 146-
165

tenodesis of, 180, 181

Forearm, fenestrated plaster dress-
ing, 28

injury to muscles of, 56

Foreign bodies in joints, 100-106
Fractures after-treatment of, 68,
69

compound, plaster dressings for,

22
duration of immobilization, 68
malunion, correction of, 61, 67
non-union, treatment of, 71, 73
of femur, 33, 37, 38

of humerus, 22, 69
of shoulder, 22

traction to overcome shortening,
61

Frame, Balkan for extension, 63

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