In the 1,500 radiograph plates from which this collection was selected, only four were found showing operative interference for the repair of fractures.

While no data are available from which to determine accurately the ratio of these operations to the entire number of fracture cases under treatment, and as, most certainly, there were some formal amputations, excisions, immediate immobilization of fractures, and other operative procedures which were not submitted to radiography, it may nevertheless be justly inferred from this radiographic evidence that very few such operations were performed.

Operations—Plate 157.

Gunshot Fracture of the Humerus.

This plate shows an attempt to wire a fracture of the humerus, which, very probably, would have recovered as favorably without interference.

Operations—Plate 158.

Gunshot Fracture of the Ulna.

This plate shows an attempt to wire the ulna in a clean wound.

Operations—Plate 159.

Gunshot Fracture of the Radius and Ulna.

This plate shows an attempt to wire the radius and ulna where the indications were rather doubtful.

Operations—Plate 160.

Gunshot Fracture of the Tibia and Fibula.

This plate shows an attempt at immediate immobilization of the fragments of the tibia which has failed to meet the mechanical indications for maintaining correct position.

Operations—Plate 161.

Amputation at the Knee Joint.

This plate shows a satisfactory result of a secondary amputation at the knee, after the method of Gritti, following a severe naval shell wound of the leg.

Operations—Plate 162.

Excision of the Head of the Humerus.

This plate shows a case of Prof. De Page, of the Belgium Red Cross Mission at Tash Kishla Hospital, in which the head of the humerus was excised for extensive comminution of the head of the humerus with infection.

SOME MISSILES REMOVED FROM WOUNDED IN BALKAN WARS.
Figures reduced to two-thirds of natural size.

Plate 163.

Of the 46 missiles shown in the illustration, page 336, 1 to 14 are rifle bullets; 15 to 22 are assorted fragments; 23 to 43 and including 44 are shrapnel balls; 45 is an automatic pistol ball, and 43 and 46 are the base and the fuse, respectively, of a shrapnel “nose” or head of the 75-millimeter field gun.

Four rifle bullets, three shrapnel balls, and Nos. 20 and 27 were removed from Turkish soldiers admitted to my service at Tash Kishla Hospital in Constantinople. The remaining missiles, excepting No. 46, were removed from Bulgarian soldiers on my service at the Etap and the Queen’s Hospital at Kustendil, Bulgaria. The missile shown as No. 46 was removed by Dr. Tatarcheff, the Bulgarian surgeon in command of a fixed hospital at Kodemos, Bulgaria, from the upper anterior thigh of a patient whose history I have and whom I saw and photographed.

Of the fragments, Nos. 15 and 17 are pieces of the nickel jacket of rifle bullets; No. 16 is the lead “core” of a rifle bullet; No. 22 is a fragment of the nickel jacket of a rifle bullet which holds a small portion of the lead core; No. 18 is a brass tube which is carried in the base of a shell to hold the detonating plunger and fulminate cap; No. 19 is a piece of a foot plate or step of a gun carriage or caisson; No. 20 is a shell fragment, and No. 21 is a flattened piece of a shrapnel ball.

Of the bullets, No. 1 is Bulgarian, removed from a Bulgarian soldier in an operation for an abdominal wound accidently inflicted during the firing incident to the celebration attending the announcement of peace; Nos. 6, 10, 11, and 14 are of the same caliber as the Bulgarian and were fired from Montenegrin or Servian rifles; Nos. 2 and 3, slightly smaller in caliber than all the others, are Greek, and Nos. 4, 5, 7, 8, 9, 12, and 13 are Servian, slightly larger than the Greek and as much smaller than the Bulgarian. No. 1 is abraided at the base by the jaws of a forceps by which it was removed from the wing of the ilium in which it was firmly embedded; Nos. 4, 7, 8, 12, 13, 14 are deformed by ricochet. No. 5 has its nose slightly abraided by the same cause. No. 8 shows the lead core protruding from the base of the jacket. Nos. 1, 2, 3, 6, 9, 10, and 11 are normal, as they struck the body by direct impact. Nos. 2 and 3, which are Greek, have the nickel jacket worn off on the apex so that the lead core is exposed, which produces a slight degree of “dum-dum,” but as they struck the body at very long range and without hitting a bone, they produced no “dum-dum” effect.

Eight of the shrapnel balls were removed from the forearm of one Bulgarian soldier. (Vide plate 109.)

No. 43 was removed from between the thoracic wall and the scapula, to which position it passed by destroying the outer half of the clavicle, penetrating 6 inches from the surface.

For comparison it may be observed that the United States Army rifle bullet is 7 millimeters, equal 30 caliber or 0.30 inch.

The caliber of shrapnel balls varies somewhat, as do the weight and density, but all of them were approximately ½ inch or 125 millimeters in diameter.

The caliber of all field guns (of modern type) in the Balkan wars were 75 millimeters, the “soixante-quinze” of the French, or about 3 inches.