in the middle of the forearm; amputation at the wrist; in all injuries of the hand, requiring an operation, the thumb and one or more fingers to be preserved, if possible; treatment of metacarpal bones fractured by a musket-ball; of injured metacarpal bones, the fingers being destroyed; removal of the heads of the metacarpal bones when necessary; amputation of the phalanges; Langenbeck’s operation for excision of the phalangeal joints; excision of the metacarpal bone of the thumb by Langenbeck, the periosteum being separated from the bone, and left behind in the wound. pp. 120-141. LECTURE VII. Secondary amputations not so successful after injuries as after incurable disease; circumstances under which the operation is performed in military surgery, and the consequences; secondary hemorrhage; non-union of the stump; phlebitis and sloughing of the stump; depositions of matter in the viscera; in secondary amputations larger flaps required, or the bone to be cut shorter; directions for sawing the bone; larger number of arteries to be tied; torsion of arteries; bleeding from a small branch, cut short, above the ligature; mode of avoiding this; use of the tourniquet; and its inconveniences; in oozing of blood, the wound not to be finally closed for some hours; treatment in cases of non-union; cat-gut or other animal ligatures; hemorrhage from large veins to be controlled by pressure, not by ligatures; if the bone be too long, a piece to be sawn off; consequences of not doing so. COMPOUND FRACTURES: definition of; comminuted; compound fracture of the arm or leg does not necessitate amputation; of the thigh, amputation is requisite; difficulty of treating a gunshot fracture, with extensive splintering of the bone; consequences of the splintering; necrosis of the bone, and formation of sequestra; case of Lieut. Timbrell, fracture of both femurs; recovery without amputation: lodgment of a ball in, or its passage through, a bone, without splintering; consequences; its removal requisite when lodged in a bone; mere grazing a bone by a ball; simple transverse fracture of a bone by a ball; flattening of a ball; its lodgment between the broken portions of a bone; extensive shattering of the femur, a case for immediate amputation; gunshot fractures of head and neck of the femur; excision of the injured portions of bone-if the upper third, or middle of the bone, amputation necessary; in fractures of the lower third, not communicating with the knee-joint, an attempt is to be made to save the limb; when the femur is splintered, if the limb is to be saved, the principal splinters to be removed; the necessary incisions often neglected; if the splinters cannot be got at, amputation is requisite; secondary danger from the smaller splinters; a careful examination to be made for them when suppuration is established, and incisions made if requisite for their removal; consequences of their retention; proper bedsteads for the wounded