~ oS es 
by manual examination ; except in simple fractures, where only one 
bone of a limb has suffered, when “it is often difficult to ; 
r Se ea 
precision, particularly when the parts have become tense and pain- 
ful. In such cases we must judge as correctly as we are able from” 
a view of all the circumstances and symptoms. ; ~ 
In old age, bones are more easily fractured than in the earlier pe- _ 
riods of life. In infancy bones will rather yield than break, with a 
moderate force ¢ whilst in old age they become so brittle, that even 
the largest are frequently broken by trifling falls or bruises. Dis- 
eases often induce this brittle state of the bones; particularly the ve- 
nereal disease, and the scurvy. “These diseases seem to destroy: the 
strengtl of the bone, insomuch that in some cases the hardest bone a 
are broken solely by the ordinary action of the muscles of the limbs. - 
Besides these, the bones themselves are subject to a disease that ren- 
ders them soft and flexible; and this, in somie-cases, has been known 
to proceed’so far as tu-render every bone in body crooked and dis- 
torted. 6h 
The symptoms that usually accompany a fracture, are: pain, 
swelling and tension in the contiguous parts ;—a’more or less crook- 
ed and distorted state of the limb; a crackling or grating noise on 
the parts being handled : and loss of power to a certain degree in the 
injured part. For the most part, the pain of a fracture is not very 
severe; but in some Cases it is so violent as to induce the most alarm- 
ing symptoms, as spasmodic twitchings of the muscles, high inflam- 
mation, fever, convulsions and delirium : which, if not soon relieved, 
often terminate in mortification of the parts; and death. 
The most important consequences of fractures, are: si 
immobility of the injured limb ; distortion, either from a f or 
thickness remaining in the contiguous muscles o1 ligaments ; an ac-_ 
cumulation of callus ; a contracted state of the contiguous joints; or - 
a waisting of the limb itself. of : 
Broken bones unite sooner in children than in old age, but not — 
with more certainty. Fractures of the small bones of the armsand 
legs, of the feet and hands, and of the ribs, in general heal easily ; 
while fractures of the larger bones, particularly of the thigh and up-_ 
per arm, are managed with more diffieulty. When the large bones — 
are broken near their extremities, the danger is grea iter t 
they are broken near their middle; for the Shortness 
etive 
Pate ine 
