No. in.] APPENDIX. 149 



St. Bartholomew's Hospital has been for some monthe the method first 

 adopted by Mr. John Lawrence, of Brighton. His plan was to form 

 two strong spUnts on either side of the inJTu-ed leg by successive 

 layers of pieces of bandage, united together by white of egg and flonr. 

 Now, as far as this method is concerned, it requires no improvement, as 

 durability, strength, and an accurate cast are obtained by this mode of 

 proceeding, and the numerous cases which have been treated by it at the 

 hospital show its complete success. By using the tablets formed of gum 

 and whiting, upon the same plan as that of Mr. John Lawrence, a great 

 saving of the surgeon's time is effected, and equal firmness and durability 

 obtained. The mode in which I have made splints for the leg is first to 

 obtain the exact shape by drawing a piece of sheeting or paper round the 

 limb, and marking the part which corresponds to the tibia for the whole 

 length of the leg, and continuing the line on the foot to the extent that it 

 may be considered necessary to cover.* By this means, it is apparent that 

 the exact size of the limb is obtained ; but as the leg is to be enclosed by two 

 splints, it becomes necessary to divide the cloth into two, which will give 

 the exact pattern of either splint. These splints are to be moistened and 

 moulded ; and after being first lined with lint or leather, the whole is to be 

 enveloped by a roller soaked in boiled starch. This composition of g^m 

 and whiting has answered perfectly in all the cases in which it has been 

 tried, and splints made with it are perhaps superior to the splints made 

 with flonr and white of egg, because, when dry, they preserve accurately 

 the shape of the limb, and do not at all corrugate, which all compositions 

 of flour are liable at times to do. 



Fractures of the patella are treated in a similar way, a splint being 

 placed on either side of the knee, extending from about the centre of the 

 thigh to about the centre of the leg. The patella is not to be covered viith 

 these splints, but a gap left corresponding to its shape, and the two pieces 

 or splints are not to meet accurately at any part, but an interval is to 

 be left of about three-fourths of an inch, or an inch, throughout their 

 whole extent. 



In enveloping these splints for fractures, they are not to be applied 

 when there is much inflammation or swelling, bnt the part should be 

 allowed first to get into a perfectly quiet state. Leeches, cold water, or 

 poultices should be applied, if necessary, to effect this object. In general, 

 a delay of a week, ten days, or even sometimes three weeks, is required, but 

 in some favourable cases there is no occasion to wait, and the splints may 

 be applied with safety and advantage on the second or third day after the 

 accident. This mode has also been adopted in favourable cases of com- 

 pound fracture, but most surgeons are agreed never to cover these wounds 

 with conceaUng bandages. 



It is not for me to expatiate upon the advantages with which this method 

 of treafing fractures is attended, for that belongs rather to Mr. John 

 Lawrence as the first adapter of the principle ; but the fixing of the bones 

 more firmly and securely than can be accomplished by any other method, 

 the pi'evention of loss of health by enabling the patients to walk on the 



* Either splitit should overlap the heel and under-surface of the foot in CEu=es 

 where they are used immediately after the accident, but where this application 

 is delayed this is of no importance. 



