and 27, or 5.8 per cent, through the upper third. In 38, or 8.2 per cent, of cases the location was not stated. The total number of

davs lost was 15,059.

Operation was performed on 316 patients; 12 being complicated by infection, 3 by malunion, and 1 by nerve injury. The method of operation was not stated in 103 cases; among these 1 patient died. Plaster of Paris cast was applied to 78 patients after the reduction of fracture. Wiring was the method of operation in 37 cases, bon graft in 3, and the application of a band in 1. The removal of bone fragments was necessary in 10 fractures. Decompression was performed for 6 cases, with a mortality of 33.4 per cent.

II. COMPOUND FRACTURES.

Of the causative factors producing this type of fracture, 140 were by agents not stated, 61 by falls, 59 by animals, 42 by crushing, and 40 by automobiles. Only 4 were caused by aeroplane accidents, and 1 by hand grenade. Other agents were the cause of a lesser number.

The tibia, nasal, superior maxilla, and skull were the most common locations and comprised 52.8 per cent of the cases.

There were 87 compound fractures of the tibia, 33 occurring without an associated fracture of the fibula. Of these, 7, or 21.2 per cent, were of the lower; 15, or 45.5 per cent, of the middle; and 6, or 18.2 per cent, of the upper third. Two cases, or 6 per cent, were through the head, and in 3, or 9.1 per cent, the location of the fracture was not stated. The fibula was fractured in 54 cases, 19 being of the lower, 26 of the middle, and 5 of the upper third. In 4 cases the location of the fracture was not stated. The total number of days lost in fracture of the tibia alone was 1,993, and in cases where both tibia and fibula were broken, 3,167.

There were 69 cases of fractures of the nasal bone with a total of 637 days lost, 9 cases of the superior maxilla with 186 days, and 29 cases of fracture of the skull with 174 days. Of the skull fractures, 21, or 72.4 per cent, were at the base; 7, or 24.1 per cent, at the vault; and in 1, or 3.4 per cent, the location was not stated.

Operation was performed on 80 patients, 8 being complicated by infection. The method of reduction was not stated in 23 cases, 10 required amputation of all or part of the upper extremity, 4 were reduced by the application of a plate, 4 by wiring the fragments, and 2 by bone graft. Amputation of all or part of the lower extremity was necessary in 9 cases; among these 2 patients died. Decompression was performed in 5, with a mortality of 40 per cent.

III. COMMINUTED FRACTURES.

Fifty-two were caused by falls, 48 by agents not stated, 30 by crushing, and 21 by automobiles. One was caused by aeroplane, 2 by pistol ball, 4 by rifle ball, 1 by shell, and other agents figure as causative factors in a varying proportion of cases.

The tibia, metacarpals, humerus, and radius were the most common locations and comprised 47.2 per cent of all cases.

There were 44 cases of fracture of the tibia, 18 without and 26 with an accompanying fracture of the fibula. In 4, or 22.2 per cent,

87894-1816

of cases the bone was fractured in the lower; 9, or 50 per cent, in the middle; and 4, or 22.2 per cent, in the upper third. In 1 case the location was not stated. Of the fibula fractures, 10 were of the lower, 10 the middle, and 2 the upper third. In 4 cases the location was not stated. The total number of days lost in fracture of the tibia alone was 1,243 and in cases with both tibia and fibula frac tured 1,649.

There were 21 cases in which the metacarpal bones were frac tured, 1 case having two and 1 case five bones broken. The total number of days lost was 385.

The humerus was fractured in 15 cases, 7, or 46.6 per cent, being in the lower; 6, or 40 per cent, the middle; and 1, or 6.6 per cent, the upper third. The total number of days lost was 610. One case had an associated fracture of the ulna with the loss of 48 days. The radial fractures were 14 in number; 7, or 50 per cent, were of the lower; 5, or 35.7 per cent, of the middle third; 1, or 7.1 per cent, through the head; and 1, or 7.1 per cent, in which the location was not stated. No associated fractures were present and the total days lost were 294.

IV. OPERATIONS.

Operation was performed on 27 patients, 3 having a complication of infection. Amputation, all or in part, was necessary in 1 case of the upper and in 3 of the lower extremity. The method of opertion was not stated in 5, and 3 required the removal of bone fragments.

There were 31,057 operations performed in the Army during 1917, 28,664 for disease and 2,393 for traumatism. Operations for the correction of physical defects of drafted men form a large percentage of the total number.

Chloroform was the anesthetic of choice for 493 operations, ether for 11,325, and gas for 380. Local anesthesia was used for 11,356 operations and in 7,503 the anesthetic was not stated.

Recoveries numbered 26,911 and the incomplete cases 3,882. The mortality was ninety-eight one-hundredths of 1 per cent.

The appendicectomies were 3,849 in number, 3,667 without and 182 with drainage. Recovery took place in 3,030 cases, 71 patients died, and 748 cases were incomplete. Among the cases requiring drainage, 49 had a complication of abscess, resulting in the death of 2 patients, 58 acute diffuse peritonitis with the death of 27, and 23 with acute local peritonitis with the death of 10. In 44 cases the appendix was gangrenous, resulting in the death of 5 patients, or a mortality of 11.4 per cent.

The herniotomies were 2,620 in number, of which 16 were femoral, 2,592 inguinal, 9 lumbar, and 3 umbilical. Of the cases requiring inguinal repair, 17 had complications, 6 were strangulated hernias, and 1 relaxed inguinal rings.

Mastoidotomy with drainage was performed in 238 cases of mastoiditis, with a mortality of 4.6 per cent. Mastoiditis complicating measles required operation in 42 cases and in 1 of mumps.

There were 336 cases of rib resection with drainage, with a mortality of 15.2 per cent. Measles, lobar and broncho-pneumonia were the leading primary diseases requiring this operation when complicated by suppurative pleurisy.

Thoracotomy with drainage was performed in 93 cases, with a mortality of 25.8 per cent. Lobar and broncho pneumonia were likewise the leading primary diseases requiring this operation.

The amputations were 517 in number. Recovery occurred in 449 cases, 8 patients died, and 60 remained as incomplete. Traumatic amputation required amputation of all or part of the upper extremity in 48 cases, compound fracture in 10, and gunshot wound in 43. Crushing injury requ red amputation of all or part of the lower extremity in 43 cases, gunshot wound in 26, compound fracture in 9, and traumatic amputation in 8.

Tonsillectomy was performed in 3,835 cases of hypertrophied tonsils, with a mortality of one-tenth of 1 per cent. Adenoidectomy was an additional operation in 367 cases in which adenoids were associated with hypertrophied tonsils.

There were 2,155 operations for hemorrhoids. Phlebectomy was the method of operation in 690 cases, ligation in 440, and clamp and cautery in 1,009.

Nephrectomy was performed for 3 cases of hydronephrosis, 2 of pyonephritis, 1 of pyonephrosis, and 3 of nephrolithiasis, and 1 of nephritis.

Gastroenterostomy was performed for 20 cases of gastric ulcer, 13 of duodenal ulcer, and 1 of intestinal obstruction. Recovery took took place in 22 cases, 1 patient died, and 10 remained as incomplete. The comminuted fractures requiring operation were 27 in number. Of these, 3 were reduced by the application of a plate, 3 by wiring the fragments, and 1 by bone graft. Laminectomy was performed on 1 patient and plaster of Paris cast was applied to 4. The method of operation was not stated in 6 cases.

The compound fractures requiring operation were 80 in number. Of these, 4 were reduced by the application of a plate, 4 by wiring the fragments, and 2 by bone graft.

There were 316 simple fractures requiring operation, 38 being reduced by the application of a plate, 1 by band, 6 by bone graft, and 37 by wiring the fragments. Laminectomy was performed on 2 patients.

Trephining was performed in 8 cases of head injury, with a mortality of 37.5 per cent.

The thyroidectomies were 23 in number. Of these, 15 were for simple and 8 for exophthalmic goiter.

Enterorrhaphy was performed in 4 cases for the result of traumatism. The mortality was 75 per cent.

Enucleation of the eye was performed in 30 cases for the result of traumatism; 6 were for gunshot wounds.