356 SURGERY 



The Surgery of the Bones and Joints. The management of frac- 

 tures has brought out the wonderful mechanical ingenuity which is 

 a characteristic of the human mind. The application of the plaster- 

 of-paris bandage in the treatment of fractures is one of the greatest 

 improvements of the century. To the perfection of its technic, 

 Fluhrer's work deserves special commendation. The use of flexible 

 narrow strips of tin or zinc in the management of fractures was de- 

 vised by Fluhrer in 1872, with the object of securing immobility of 

 the fractured bones. The strips are not designed to act as rigid sup- 

 ports, although incidentally, by their width (a quarter of an inch) 

 they edgewise oppose resistance to angular motion when passing 

 through or near an axis of motion. Their principal effect is by virtue 

 of their inextensibility, not shortening or lengthening under strain 

 when bandaged to the limb in the principal planes of motion. They 

 are roughened on each side by perforations, so that they may be 

 securely held in position by the retaining bandage. They are not 

 designed to serve as an accessory strengthening of an immovable 

 splint; the strips themselves are the splint. The plaster-of-paris or 

 other material incorporated in the retaining bandages gives to the 

 provisional effect of the strips durability, which, of course, cannot 

 be obtained by a simple bandage. The work of Dr. James L. Little, 

 in the use of plaster-of-paris bandage, must not be overlooked, since 

 he utilized this dressing for various fractures, and perfected several 

 dressings for special fractures, notably the patella. Time will not 

 permit of a discussion of the manifold ways that this dressing can 

 be employed in the different fractures. It will suffice to mention the 

 present method of treatment of fractures of the thigh, in order to 

 afford the best illustration of the evolution of the general plan of the 

 treatment of fractures. If we start with Desault's splint, which was 

 crude and unsatisfactory, the first change that occurred was Physick's 

 modification, which consisted in making Desault's splint, which 

 reached only to the crest of the ilium, extend above to the axilla 

 and downward below the foot, with a perineal band for extension 

 and counter-extension. In 1819 Daniell of Georgia introduced the 

 weight and pulley. In 1851 Buck still further modified Physick's 

 splint, so as to do away with the perineal band, and accomplished 

 extension of the limb by the weight and pulley, after the manner of 

 its present use. This was a great improvement, in order to overcome 

 shortening of a fractured limb. 



Van Ingen, in 1857, suggested the elevation of the foot of the bed 

 to permit the body to act as a counter-extending force. The coapta- 

 tion splints were used by Buck, in 1861, so that the present complete 

 and perfect method is one that is the result of evolution, the con- 

 summation of which has been accomplished by the work of American 

 surgeons. In 1827 Nathan R. Smith adopted the principle of suspen- 



