SPRAIN. 



treatment, however, and particularly the uiimanageablenefs 

 and imprudence ef patients, who fatigue the joint in ufing 

 it too foen and before the pain is over, may render a fprain 

 ▼ery bad even in fubjefts who are in other refpefts perfeftly 

 found. In this cafe, fometimes the pain and fwelling, after 

 having undergone a greater or lefler abatement, ftill continue 

 in a degree, fo that a difeafe, which might have been cured 

 in five or fix weeks, lads five or fix months, and frequently 

 a whole year. Sometimes the fymptoms get worfe initead 

 of becominn- better. The pain and fwelhng occur in the 

 highelt degree, and fuppuration itfelf, followed by caries of 

 the bones, may follow, and even create a neceflity for ampu- 

 tation in order to fave the patient's life. 



But fymptoms of this violent nature are feldom remarked 

 after fprains, except in fubjefts who labour under fome con- 

 ftitutional difordcr, which may extend its effefts to the 

 joints. The moft common, and at the fame time the mod 

 afflifting, is fcrofula. In patients difpofed to this difeafe, 

 fprains often become the occafional or exciting caufe of 

 white-fwellings, which too frequently baffle ail the efforts 

 of the moft flcilful furgeons, and make amputation indif- 

 penfable. 



The fymptoms which charafterize fprains are eafy of 

 comprehenfion. An application of external violence, the 

 nature and direfl ion of which are always known ; a more or 

 lefs acute pain in the affefted joint, without deformity, with- 

 out any manifeft alteration in the natural relations of the 

 articular furfaces ; a free power of motion immediately after 

 the accident ; and a fudden fwelling proportioned to the 

 violence of the fiiock. Such are the circumftances denot- 

 ing a fprain. A fprain may readily be diftinguifhed from 

 every other affeftion of the joints. Uninformed praAitioners 

 have been known, however, to millake its nature, and thence 

 do confiderable mifchief, by ill-judged attempts to remedy 

 a feparation of bones, or to reduce a diflocation which 

 never exifted. So grofs a miftake may eafily be avoided by 

 the leaft attention. 



The prognofis of fprains differs according to the degree 

 of the injury, the nature of the joint, and the particular 

 conftitution of the patient. A flight fprain is a cafe of little 

 importance, being generally cured in a few weeks, when 

 properly treated, and when the patient, obedient to the ad- 

 vice of the furgeon, keeps the joint perfeftly motionlefs, and 

 avoids ufing the limb until the pain and fwelling are entirely 

 removed. A violent fprain, occurring to a joint that is 

 ftrengthened by very ftrong ligaments, like that of the ankle 

 for example, is a fevere cafe, which often lafts feveral months, 

 and which, as we have already explained, may have afflifting 

 confequences, when it is badly treated, or the patient does 

 not conform to the advice of his furgeon. Even a flight 

 fprain is always a fevere accident in fcrofulous fubjefts, be- 

 caufe it may become an exciting caufe of a white-fwelling, 

 and produce a neceflity for amputation. 



The treatment of fprains confifls in preventing the inflam- 

 matory fwellinj;, difperfing it when it has taken place, pro- 

 moting the union of the torn ligaments, and re-eftablifhing 

 the tone, force, and freedom of motion in the affefted 

 joint. 



Experience has taught, that cold water is the beft appli- 

 cation which can be ufed for fulfilling the firft indication. 

 This difcutient appeafes the pain, and tends to prevent fwel- 

 ling and inflammation. Cold water is rendered more feda- 

 tive and efficacious, when a little of the liquor plumbi ace- 

 tatis is added to it. Thus, when a furgeon is confulted 

 immediately after the accident, the part fhould be immerfed 

 in a pail of fpring water, into which the liquid acetite of 

 lead has been put in the proportion of a drachm to a pint. 



Some praftitioners make tiie quantity greater ; but, we be» 

 lieve, what is here mentioned is quite fufficient. In order 

 to derive all the advantage poffible from the employment of ■ 

 cold water, the part fhould remain immerfed feveral hours 

 without interruption, and the water fhould be changed al 

 foon as it becomes warmed. Boyer does not approve, how« 

 ever, of ufing this application for women who have their 

 menfes on them ; or for patients whofe lungs are weak, or 

 wlio are fubjeft to haemoptyfis ; or for any perfons who are 

 in a great perfpiration. Perhaps, in fuch inflances, it may 

 be as well to ufe a warm linfeed poultice. 



After the part has been taken out of the water, it is to 

 be covered with linen wet witli the fame application, and 

 care niufl be taken frequently to wet the cloths anew, fo 

 that they may be as cold as poflible, and the evaporation 

 effeftual. 



When the fprain is flight, difcutients are commonly ade- 

 quate to the prevention of the inflammatory fwelling, and 

 they may be continued till the cafe is quite well. But if 

 the injury be too fevere to yield to thefe means, or fhould 

 they nut have been tried in the firft inflance, fo that teiifion 

 and fwelhng have already come on, recourfe mull be had 

 to the means proper for fulfilling the fecund indication, 

 that is to fay, for difperfing the pain and inflammatory fwel- 

 ling. The patient may be bled more or lefs copioufly ac- 

 cording to his age, ftrength, conftitution, and feverity of 

 the accident. Low diet and abfolute reft are to be direfted, 

 and topical emollient anodyne applications are to be made 

 to the part affefted ; fuch as linfeed poultices, and fomenta- 

 tions of white poppy-heads. When the pain is excedively 

 fevere, a fmall quantity of laudanum, or of a watery folu- 

 tion of opium, may be mixed with the poultice. 



The ufe of thefe local applications is to be continued a? 

 long as the pain and fwelling exill ; but as foon as they are 

 removed, difcutients muft be employed ; fuch as camphorated 

 fpirit of wine, foap liniment, ammoniatcd oil, and many 

 kinds of mineral waters. _ 



During the whole treatment, and even a long while after- I 

 wards in fevere cafes, the part affefted muft be kept ftriftly 

 at reft. On one hand, moving the joint might keep up the 

 irritation and inflammation ; on the other, when the fprain 

 has been confiderable and the ligaments lacerated, a firm 

 union of them, and the return of the ilrength which is el- 

 fential to the perfeft fundlions of the articulation, can only 

 be obtained by long reft. I 



When a fprain happens to the ankle, as is moft common, ■ 

 the patient fhould not be fuffered to walk before the pain 

 and fwelling are entirely removed. As there remains in the 

 joint almolt always a weakneis, which fubjefts the patient 

 to the fame accident again, when he walks too quickly, or 

 carelefsly, it is proper, with a view of obviating this incon- 

 venience, to apply a moderately tight roller to the part, or 

 to direft him to wear for fome time a laced foft leather 

 buflcin. 



It frequently happens, after the cure of a fprain, when 

 the joint has recovered all its ftrength and freedom of motion, 

 that the furrounding cellular fubftance is puffy and (Edema- 

 tous, efpecially in the evening, after the patient has been 

 long in the ereft pofition. The moft efficacious means 

 which can be ufed againft this local infirmity, which may 

 contmue a long while, is the compreffion of a bandage, or 

 laced dog-fkin ttocking. 



In other cafes, the ligaments, which have been violently 



diftended and lacerated, become rigid, and the motion of 



the joint remains imperfeft. Here fomentations, emollient 



baths, vapour baths, and oily liniments, are indicated. 



4 Laftly, 



