Bilroth, in an edition of his " Surgical Pathology," written before antisepticism had begun to struggle for an existence, says: "The treatment of complicated fractures is one of the most difficult problems in surgery. We never cease learning on this point." In this view of the case may be found my apology for the introduction of a seemingly exhausted topic for discussion.
In the procedure I am about to describe, there is no single detail which is strictly original, but the procedure as a whole deserves the attention of the profession. When a comminuted fracture comes under my observation, the affected part and its surroundings are carefully cleansed and shaven. Soft parts so ragged and contused, and so situated as to produce separation of the fragments and to act as foreign bodies, are removed; as likewise all foreign bodies; the external wound being enlarged, if necessary, for this purpose. If the