330 DISEASES OF THE HOUSE. 



as possible in their normal position. The second is their retention in 

 that position for a period sufficient for the formation of the provi- 

 sional callus, and the third, which, in fact, is but an incident of the 

 second, the careful avoidance of any accidents or causes of miscar- 

 riage which might disturb the curative process. 



In reference to the first consideration, it must be remembered that 

 the accident may befall the patient at a distance from his home, and 

 his removal becomes the first duty to be attended to. Of course, this 

 must be done as carefully as possible. If he can be treated on the 

 spot, so much the better, though this is seldom practicable, and the 

 method of removal becomes the question calling for settlement. But 

 two ways present themselves — he must either walk or be carried. If 

 the first, it is needless to say that every caution must be observed in 

 order to obviate additional pain and to avoid any aggravation of the 

 injury. Led slowly, and with partial support, if practicable, the 

 journey will not always involve untoward results. If he is carried, 

 it must be by means of a wagon, a truck, or an ambulance ; the last 

 being designed and adapted to the purpose, would, of course, be 

 the most suitable vehicle. As a precaution which should never be 

 overlooked, a temporary dressing should first be applied. This 

 may be so done as for the time to answer all the purposes of the per- 

 manent adjustment and bandaging. "Without thus securing the 

 patient, a fracture of an inferior degree may be transformed to one of 

 the severest kind, and, indeed, a curable changed to an incurable 

 injury. We recall a case in which a fast- trotting horse, after run- 

 ning away in a fright caused by the whistle of a locomotive, was 

 found on the road limping with excessive lameness in the off fore 

 leg, and walked with comparative ease some 2 miles to a stable before 

 being seen by a surgeon. His immediate removal in an ambulance 

 was advised, but before that vehicle could be procured the horse lay 

 down, and upon being made to get upon his feet was found with a 

 well-marked comminuted fracture of the os suffraginis, with con- 

 siderable displacement. The patient, however, after long treat- 

 ment, made a comparatively good recovery and though with a large, 

 bony deposit, a ringbone, was able to trot in the forties. 



The two obvious indications in cases of fracture are reduction, or 

 replacement, and retention. 



In an incomplete fracture, where there is no displacement; the 

 necessity of reduction does not exist. With the bone kept in place 

 by an intact periosteum, and the fragments secured by the unin- 

 jured fibrous and ligamentous structure which surrounds them, there 

 is no dislocation to correct. Reduction is also at times rendered 

 impossible by the seat of the fracture itself, by its dimensions, alone, 

 or by the resistance arising from muscular contraction. That is 

 illustrated even in small animals, as in dogs, by the exceeding diffi- 



