294 



the joints as tlieir only centers or bases of action, with no participation 

 of intermediate points, while with a fracture the flexibility and motion 

 which will bo observed at unnatural points are among the most strongly 

 characteristic signs of the lesion. No one need be told that when tbe 

 shaft of a limb is seen to bend midway between the joints, with the 

 lower portion swinging freely, that the leg is broken. But there are 

 still some conditions where the excessive mobility is not easy to detect 

 with certainty. Such are the cases where the fracture exists in a short 

 bone, near a movable joint, or in a bone of a region Vt'here several 

 short and small bones are united in a group, or even in a long bone 

 where its situation is such that the muscular covering prevents the vis- 

 ible manifestation of the symptom. 



If the situation of a fracture precludes its discovery by means of 

 this abnormal flexibilitv, other detective metliods remain. And after 

 all there is one decisive sign which, though it may not avail in every 

 case, as it does not, is in cases where its testimony can be secured ab- 

 solute and positive beyond question. This is crepitation, or the pecu- 

 liar effect which is produced by the friction of the fractured surfaces 

 one against another. Though discerned by the organs of hearing it 

 can scarcely be called a sound, for the grating of the parts as the 

 rubbing takes place is more felt than heard, but there is no mistaking 

 its import in cases favorable for the application of the test. The con- 

 ditions in which it is not available are those of incomplete fracture, in 

 which the mobility of the parts is lacking, and those in which the whole 

 arraj' of phenomena are usually obscure. To obtain the benefit of this 

 pathognomonic sign requires deliberate, careful, and gentle manipula- 

 tion. Sometimes the slightest of movements will be sufficient for its 

 development, after mnch rougher handling has failed to discover it. 

 Perha])s the failure in the latter case is due to a sort of defensive 

 spasmodic rigidity caused by the pain resulting from the rude interfer- 

 ence. 



More or less reactive fever is a usual accompaniment of a fracture, 

 and an ecchymosis of the parts is but a natural occurrence, more easily 

 discovered in animals possessing alight colored and delicate skin than 

 in those of the opposite character. 



There are difficulties in the way of the diagnosis of an incomplete 

 fracture, even sometimes when there is a degree of impairment in the 

 function of locomotion, with evidences of pain and swelling at the seat 

 of lesion. There should then be a careful examination for evidences of 

 a blow or other violence sufficient to account for the fracture, though 

 very often a suspicion of its existence can only be converted into a cer- 

 tainty by a minute history of the patient if it can be obtained up to the 

 moment of the occurrence of the iniury. A diagnosis ought not to be hast- 

 ily pronounced, and where good ground for suspicion exists it ought not 

 to be rejected upon any evidence less than the best. Serious and fatal 

 complications are too often recorded of the results following careless con- 



