SURGERY. 219 
13. FRACTURES. 
These occur in all the individual bones, although more rarely in some 
than in others. 
In treating fractures, a point especially to be attended to is the trans- 
portation of the patient, especially if the distance be considerable. In the 
treatment proper, the first step consists in properly approximating the 
fractured extremities, and then in keeping them undisturbed in close con- 
tact; the rest must be left mainly to the recuperative energies of the 
system. Pl. 140, fig. 91, represents a bed well adapted for the ease and 
-Immobility of the patient while under treatment for the union of a broken 
limb. 
14.. CALCULUS. 
Calculus, or stone in the bladder, is a very painful disease of frequent 
occurrence. Owing to the danger of a direct operation for this disease, 
efforts have frequently been made to discover methods by means of which 
such operation might be avoided. The great objection to these methods, 
known under the general name of lithontripsy, 1s, that they do not act 
directly upon the calculus, and that their long continued use, which is 
usually necessary, introduces a train of new evils. 
We cannot pretend to enter into even a brief account of the various 
methods of performing operations of lithotomy, or extracting the calculus 
directly, as this would of itself require a volume. We must confine our- 
selves to a reference to some forms of apparatus, by which the stone may 
frequently be broken up in the bladder and evacuated in minute fragments. 
The instrument invented by Civiale, and called lithotriptor, has been made 
use of with considerable success, although liable to the danger of lacerating 
the coats of the bladder, and of bruising the parts about the neck. It is 
represented in pl. 140, figs. 81—88, and consists essentially of a straight 
cylindrical canula introduced into the bladder, and containing three or 
four branches which can be protruded by external machinery. These are 
then made to grasp the stone and hold it tightly, whilst it is bored, scooped, 
and excavated by drills contained in the centre and worked by a bow. 
When the stone is sufficiently excavated, its shell is crushed into small 
pieces. 
. The instrument most used at the present day is the screw lithotrite, com- 
posed of two sliding blades, between which the stone is seized and crushed 
by gradual pressure with a screw. 
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