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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.

INDEX

Аввотт, 111, 112

Artificial limbs, forearm, 201, 204
Achilles tendon, Gallie tenodesis knee-joint, 198, 199
of, 181

lower extremities, 197, 200
tenotomy of, for fracture near manufacture of, in Recon-
ankle, 62

struction Hospital, 231
Adhesive bands, treatment of, near provisional, 192, 197
or within joints, 87

thigh, 198
Albee, 78, 80, 82, 83

upper extremity, 200, 217
Amputated, bilateral, 227, 229 Axhausen, study of bone trans-
life of, 217, 229

plantation, 76
vocational training for, 223, 225,
237, 239

BALKAN extension frame, 63
Amputation, aperiosteal method,

Bardenheuer treatment for hip
186

injuries, 32
Amputation stump, disarticula-

Besley fracture splint, 66
tion of, 187

Biceps, brachii, injury to, 55
education of, 189, 197

femoris, transplantation of, for
furrow of, 192

paralyzed quadriceps, 165, 168
kinetic operations for, Sauer-

Bier osteoplastic amputation, 186
bruch, 187, 189

Biesalski artificial arm, 211, 213.
maximum length of, 185

method of tendon transplanta-
methods of healing wound, 182

tion, 134
physiotherapy for, 189, 192

Blake, treatment of fractures, 66
postural treatment, 183

Blood vessels of tendon, 141, 143
reamputation, Gritti method,

Bone graft, fate of, 81
186

regeneration, 82
indications for, 184

tongs, extension to overcome
technic of, 186, 187

shortening, following fracture,
treatment of, 182, 197

62
use of, as substitute for hand,

transplantation, 73
227, 228

operative technic, 82
Ankle, injuries to, 41

Brachial plexus, symptoms of in-
Ankylosis, 96

jury to, 46
Ansinn method for extending thigh

treatment, 53
and mobilizing knee, 63

Brachialis anticus, injury to, 55
Arthroplasty, 98

Bradford frame for spine injuries,
Artificial limbs, calf, 200

30
for upper arm amputations,

Burns, 58, 113
204, 217

Calf, injury to bones of, 39

Cap experiment, of Mayer and

Wehner, 73
Carnes artificial limb, 203, 214
Circumflex nerve, symptoms of

injury to, 46

treatment of injury to, 52
Codivilla nail extension, 34
Contractures, 107–113
Corley artificial limb, 203, 208
Cranial nerves, symptoms of in-

jury to, 48

DELToid muscle, injury to, 54

reinforced plaster splint for

injuries to, 51
Drop-foot, treatment with dorsal

plaster splint, 52
Duchenne, 45

EDINGER method of nerve suture,

122
Elbow, contracture of, 107
fenestrated plaster dressing for

injuries to, 23, 65
injuries in neighborhood of, 26

Thomas (Jones) splint for, 22
Employment bureau for disabled
Mechano-therapeutics, 96
Median nerve, operative exposure

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

soldiers, 241
Endotenon, 141
Epitenon, 141
Equinus position of foot, 110
Extensor proprius hallucis trans-

plantation of, 146, 153

GALLIE tenodesis of Achilles ten-

don, 181
Gastrocnemius muscle, injury to,

58
Gluteal muscles, injury to, 58
Gritti amputation method, 186

Fascia, plastic operation, 160

transplantation of, 175
Femur, fractures of lower third, 38

of middle third, 37

of upper third, 33
Fingers, contracture of, 107

injuries to, 30
tendons, injury to, 58

operations for, 172–178
Fischer clamp, 206
Flexor longus hallucis, transplan-

tation of, for Achilles tendon,
162, 165

HAMMER and dam, method of

Thomas, 72
Hamstring muscles, injury to, 58
Hand, injuries to, 30, 57
operations on tendons of, 168–

178
Haversian canals, and new bone

formation, 78
Henze-Mayer, tendon research, 133
Hip, contracture of, 108
injuries to, 32

to flexor muscles, 58
Lilienfeld, roentgenogram

method, 99
resection of head of femur for

injuries to, 86

of, 127
symptoms of injury to, 45

treatment of injury, 51
Mesotenon, 141
Metacarpal bones, injuries to, 30
Metatarsal bones, injuries to, 42
Mitteldorf triangle, 19
Mobilization of joints after injury,

86–92
Mommsen provisional artificial

limbs, 193–197
Murphy, 99
Muscles, biceps and brachialis

anticus, 55
contracture of, 107–113
deltoid, injury to, 54
extensors of foot, injury to, 58

of forearm, injury to, 56
flexors of forearm, injury to, 56

of hip, injuries to, 58
gastrocnemius, injury to, 58
gluteal, injury to, 58
hamstring, injuries to, 58
of neck, injury to, 54, 110
of shoulder, injury to, 54
pectoralis major, contracture of,

107

injury to, 55
quadriceps extensor, injury to,

58
soleus, injury to, 58
sternocleidomastoid, 54, 110
trapezius, injury to, 54
triceps, injury to, 56
Zuppinger's studies in physi-

ology of, 66
Musculocutaneous nerve of arm,

46, 51, 128

of calf, 47, 53, 131
Musculospiral nerve, 43, 50, 124,

127

Hodgen splint, 67
Hoeftmann artificial hand, 207

IMMOBILIZATION, duration of, for

fracture, 68
Index finger, tenodesis of, 179
Iron bands, method of bending, 24

JONES abduction frame, 32, 33,37,67

crab splint, 41
hand splint, 30
splint for spine injuries, 30
tenodesis of foot, 180
treatment of contractures of

fingers, 107

of nerve injuries, 49
Joints, adhesive bands, treatment

of, 87
arthroplasty, 98
atypical operations, 106
injuries to, 17, 42, 86-102
mobilization of, 86–92
position for immobilization, 18,

26, 30, 32, 39

KELLER artificial limb for amputa-

tion of forearm, 201, 202
Knee, contracture of, 108

injuries to, 39
mobilization of, by Ansinn

method, 69
by brisement forcé, 91

by gravity, 93
Thomas splint, 34
transplantation of tendons,

165, 168

Lewis method of nerve suture, 122
Leyva splint for abduction treat-

ment of fractures of humerus, 18
Lilienfeld technic of roentgenogram

of hip, 99
Localization of foreign bodies in

joints, 101

MACEWEN, 72, 73, 77
Mayer and Wehner, experimental

study of osteogenesis, 76

Nail extension to overcome short-

ening, following fracture, 62
Neck, injury to, 54, 110

plaster dressing for injury to, 56

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