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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.
Аввотт, 111, 112
Artificial limbs, forearm, 201, 204
lower extremities, 197, 200
struction Hospital, 231
upper extremity, 200, 217
BALKAN extension frame, 63
Bardenheuer treatment for hip
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-
Blake, treatment of fractures, 66
Blood-vessels of tendon, 141, 143
Bone graft, fate of, 81
tongs, extension to overcome
shortening, following fracture,
operative technic, 82
Brachial plexus, symptoms of in-
jury to, 46
Brachialis anticus, injury to, 55
Bradford frame for spine injuries,
Burns, 58, 113
CALF, injury to bones of, 39
FASCIA, plastic operation, 160
HAMMER and dam, method of
transplantation of, 175
of middle third, 37
of upper third, 33
injuries to, 30
operations for, 172-178
tation of, for Achilles tendon,
to flexor muscles, 58
injuries to, 86
treatment of injury, 51
of forearm, injury to, 56
of hip, injuries to, 58
injury to, 55
ology of, 66
46, 51, 128
of calf, 47, 53, 131
Hodgen splint, 67
IMMOBILIZATION, duration of, for
JONES abduction frame, 32, 33, 37,67
crab splint, 41
of nerve injuries, 49
26, 30, 32, 39
KELLER artificial limb for amputa-
tion of forearm, 201, 202
injuries to, 39
by gravity, 93
LEWIS method of nerve suture, 122
ment of fractures of humerus, 18
of hip, 99
MACEWEN, 72, 73, 77
study of osteogenesis, 76
Nail extension to overcome short-
ening, following fracture, 62
plaster dressing for injury to, 56