SURGERY. 



465 



ture of the smaller vessels, and this is especially 

 the case on the head and other parts where the 

 bones lie near the surface. To relieve the local 

 part, and excite an action in the absorbed vessels, 

 itris customary to apply rags to the parts, two or 

 three times folded, wet with a solution of sugar of 

 lead or Goulard's extract, or equal parts of common 

 brandy, whisky, or rum, and Spirit Mindererus. 

 One drachm of sugar of lead, dissolved in six ounces 

 of water, and one ounce of vinegar, and the same 

 quantity of either of the spirits just named, will be 

 found an excellent formula. The rags should be 

 kept constantly moist with this lotion. 



In more severe cases, it is necessary to apply 

 leeches, and encourage the bleeding after the 

 leeches drop off, by the application of rags, wrung 

 out of warm water. A cooling regimen should be 

 enjoined, and the bowels kept open by a drachm or 

 two of Epsom salts in a wine glass of peppermint 

 tea twice or thrice a day. 



In the last stage of a bruise, where there is 

 merely a want of tone in the part, and where much 

 discolouration remains, the absorbents may be 

 excited to action by frictions night and morning 

 with the compound soap liniment, or equal parts 

 of laudanum and the soap liniment, especially if 

 much tenderness is felt in the parts. 



Sprains are somewhat different from bruises; 

 but the same treatment above recommended for 

 bruises may likewise be followed in the case of 

 sprains. The joints most exposed to this accident 

 ire the ankle and wrist, although the other joints 

 occasionally suffer. A sprain consists in an injury 

 of the soft parts surrounding the joint, the capsular 

 ligament which incloses it being either stretched 

 or torn. There is at first a sense of weakness and 

 partial inability to move the joint with more or 

 less pain, which gradually becomes more acute as 

 the inflammatory action advances, and the part soon 

 becomes swollen and tense, with a degree of warmth 

 tnd a reddish inflamed colour. In this stage there 

 is frequently a considerable degree of symptomatic 

 fever present, which should be abated by a cooling 

 regimen, gentle laxatives, rest, and the means above 

 recommended in bruises. Sprains of the greater 

 joints, especially of the knee, wrist, and ankle, 

 when neglected or improperly treated, especially in 

 persons of a scrofulous habit, frequently lay the 

 foundation of some severe disease of the joint, such 

 as white swelling or dropsy, of the capsular liga- 

 ment, i. e. a collection of fluid surrounding the 

 joint. Local bleeding by leeches should be freely 

 employed, and any consequent stiffness or discolour- 

 ation may be removed by the compound soap lini- 

 ment, either with, or without laudanum. 



Fractures and Luxations. The nature of our 

 work precludes us from entering here on the parti- 

 cular consideration of the doctrine and the treat- 

 ment of fractures and luxations ; and without 

 a considerable anatomical knowledge of the parts, 

 it would be impossible either to understand or put 

 in practice the precepts laid down. At the same 

 time, it cannot be doubted that a general acquain- 

 tance with the subject may be easily acquired, and 

 +.hat one may be placed in situations where such a 

 knowledge may prove particularly valuable, espe- 

 cially to seafaring people, and those residing at a 

 great distance from surgical assistance. Some 

 fractures may be readily perceived both by the suf- 

 ferer and even the most superficial observer, while 

 others require all the skill and discrimination of the 

 most experienced practitioner; for example, frac- 



tures of the neck, of the thigh bone, and even those 

 of some of the bones of the head. The general 

 symptoms are loss of motion and distortion ot the 

 injured limb, the extremities of the bone admitting 

 of being moved on each other, producing crepita- 

 tion, or a grating sound, and lastly, inflammation at 

 the site of the injury. Some one or more, how- 

 ever, of these symptoms are frequently absent. 

 When there is an external wound of the soft parts, 

 in conjunction with the fracture of the bone, the 

 injury is called a compound fracture, and this 

 always renders the case more dangerous and diffi- 

 cult of cure. When such an accident takes "place, 

 the greatest care should be taken by removing the 

 sufferer to a proper place in the gentlest manner, 

 attending especially to the injured limb, and not 

 allowing it to hang down. Great caution is espe- 

 cially necessary in fractures of the thigh bone, or 

 even when both bones of the leg are broken. 



In all fractures of the lower extremities the 

 patient must be confined to bed till the union of 

 the ends of the bones are completely consolidated, 

 which, in young persons, requires from twenty- 

 eight to thirty-five days; in adults, from thirty-two 

 to thirty-six ; and in the aged, from thirty-six to 

 forty-two days. In procuring the union of a frac- 

 ture, and preserving the natural length and shape 

 of the limb, it is absolutely necessary to bring the 

 ends of the bone together by extension and counter 

 extension, and then retain them in this position by 

 proper bandages and splints. (See figs. 7 and 9.) 

 In all cases of fracture of the lower extremities, 

 an eighteen tailed bandage is to be preferred, and 

 in compound fractures cannot be dispensed with. 

 It consists of three pieces of calico sewed together, 

 and then divided in three divisions on each side o( 

 a middle seam, which is best made by sewing on a 

 piece of ribbon or tape, an inch and a half broad 

 along the middle of the pieces of Calico : in this 

 way nine tails are formed on each side, and can be 

 applied and slackened and the limb exposed without 

 disturbing its position. Splints, as pasteboard, 

 such as is used for boarding books, thinner or 

 thicker, according to the size of the limb, is to be 

 dipped in warm water, so as to make them bend, 

 are applied above the bandage; and it is necessary, 

 especially in the case of the thigh, to apply wooden, 

 or even metal or whalebone splints, above the paste- 

 board, which are fastened with tapes. (See plate 

 LXXXVI. fig. 9; plate LXXXVII. fig. 3.) This 

 latter is termed secondary setting, and is applicable 

 to all the bones of the extremities, but as already 

 observed, quite indispensable in every case of frac- 

 tured thigh bone. 



A hair mattress is preferable to a softer bed, as 

 a feather or flock bed would sink, and alter the 

 position of the limb. 



Some surgeons of eminence have lately proposed 

 and tried an envelope of plaster of Paris, or alum, 

 or any substance that soon hardens, around the 

 limb, and keeps the ends of the broken bones in 

 their position ; but this requires further experiment 

 and observation before it be generally adopted, and 

 can only be used in simple fractures of the extremi- 

 ties. In fig. 2. is given a representation of the ap- 

 plication of a bandage for retaining a fractured clavi- 

 cle, or shoulder blade or collar bone, in its position. 



Dislocation. This is the dislodgement of the 

 head of the bone from the cavity in which it was 

 naturally placed. When this has been effected, 

 the usual appearances are a change of the form 

 of the joint, a lengthening or shortening of the 

 2o 



