SURGERY. 
740 
be passed round it by means of a blunt 
needle, or crooked probe, and the wound 
treated in the common manner. 
In the aneurism by anastomosis, Mr. Bell 
observes that the only radical cure is com- 
plete extirpation : we are not to cut into it, 
or to attempt the interruption of any par- 
ticular vessels leading into it, but the whole 
group of vessels by which the tumour is sup- 
plied must be entirely extirpated. 
Of fractures. 
Fractures are not in all instances easy of 
detection. Pain, swelling, distortion, loss of 
power in the injured member, shortening of 
the limb, and a peculiar crepitating sound 
upon the part being handled, are described 
as the signs denoting a broken bone ; these, 
however, are all, excepting the last, which 
cannot in every case be perceived, in a 
greater or inferior degree, common to 
bruises, sprains, dislocations, and injuries in- 
clependant of fracture. 
When a bone is simply divided, without 
any protrusion of its broken ends, lacerations 
of considerable blood-vessels, or any other 
circumstance to render the accident compli- 
cated, the practice of the surgeon is obvious 
and easy. In wounds of soft parts, we have 
seen, adhesion is insured by merely bringing 
their divided edges together ; in like manner, 
though much more tardily, junction will be 
effected between the divided extremities of a 
fractured bone, by replacing and preserving 
them in even and steady contact. The heal- 
ing of wounds is not accelerated, but on the 
contrary retarded, by the several contriv- 
ances and interferences of the older sur- 
geons: so by the cruel practice of tight 
.compressing, bandaging, and the use of ma- 
chinery, in fracture, not only unnecessary 
pain is occasioned to the patient, but the 
process of cure, instead of being facilitated 
and hastened, is considerably impeded. Na- 
ture, in either case, will not be interfered 
with. 
The time which bones take in uniting is 
proportioned to the age and health of the 
individual. In persons of middle age and 
firm constitution, a simple fracture of the 
arm will for the most part be fully and firmly 
united in a little more than a month from the 
accident. Fractures of the shoulder and 
thigh-bone are, under the same circumstances, 
about six weeks or two months in healing ; 
while the smaller bones, as the clavicle, the 
ribs, the fibula, and the bones of the hand, 
seldom occupy in their cure more than three 
weeks. 
In simple fractures, provided the parts have 
not been unduly irritated, either by much 
motion after the accident, or by tight strain- 
ing bandages, the symptoms of inflammation 
will subside in a few days. Sometimes, es- 
pecially when the surgeon has been called 
late, it is necessary to subdue the local irrita- 
tion by solution of lead, the application of 
leeches, and other means used in common 
inflammation, and these it is often necessary 
to continue for sfeveral days. Now and then 
it will be found expedient to bleed from the 
arm. These requisitions must be determined 
by the good sense and judgment of the sur- 
geon. It is impossible to lay down abstract 
rules for conduct. To bleed, however, 
merely because a bone is broken, is a prac- 
tice equally unmeaning and erroneous with 
that before alluded to, with regard to wounds 
in soft parts. 
Before speaking of individual fractures, we 
shall present the reader with the following 
instructions of Mr. J. Bell, which, although 
especially applied to a broken leg, will be 
found applicable with proper exceptions to 
fractures in general. 
“ In setting a broken limb,” says our au- 
thor, “ there is no extension required but 
such as common sense would direct you to 
use were you not a surgeon. Lay the patient 
in bed, and lay the limb upon a pillow; or if 
you design to use splints, have two long 
troughs, or pieces of pasteboard, (in figure 
66 is represented the usual splint employed 
in a fractured leg) bent into a hollow form, 
lined, or rather cushioned, with two or three 
piles of flannel, with tapes or ribands, four or 
live in number, attached to the outside of 
one of the splints, by which both splints may, 
after all is over, be gently tied together with 
bow-knots, to be slackened or tightened ac- 
cording to the swelling of the limb. The paste- 
board ought to be soaked and softened a 
little, that it may take a shape suitable to 
that of the limb. 
A long splint of this kind being laid flat 
upon the bed by the side of the fractured leg, 
desire oue of your assistants to apply his 
hands broad round the upper part of the 
limb, and grasp it gently and steadily; take 
the foot and ancle in the same manner in 
your own hand, slip your left hand under the 
broken part of the limb, and then sliding it 
gently along, lay it upon the pillow or its 
splints. The pillow should be like a mat- 
trass, flat and firm. 
Begin then to lay the limb smooth ; let 
your assistant again grasp it, by spreading 
his hands upon the thigh or below the knee, 
with the design of extending along with you, 
not by lifting the leg from the pillow, but 
rather by keeping it down, and steadying it 
by pressure, while you with both hands 
lift the foot and ancle; grasp them gently, 
but very firmly; raise them a very little 
from the pillow, and draw them gently and 
very smoothly. When you have thus ex- 
tended and smoothed the broken leg, in a 
manner which you almost suppose agreeable 
rather than painful to the patient, press it 
down steadily and gently; keep it flat and 
pressed until it gets a seat and bed in the pil- 
low. If splints are applied, the limb is to be 
pressed against the lower splints ; the upper 
splint is then to be laid above it, and by grasp- 
ing the soft and moistened splints, you must 
model them a little. When the whole has 
taken a form* take several tapes one after an- 
other ; and after having tied them in a ge- 
neral way, go over them again one by one, 
and tie them a little closer, so as to keep 
the limb agreeably firm.” 
This author, in another place, remarks 
(when speakingof fracture in general), “ when 
the limb by accident has been disordered or 
shortened, you are to venture, without fear of 
hurting the callus, to extend it anew, and lay 
it straight.” 
It may be proper to observe, that while 
much inflammation is present, w 7 eare to defer 
the application of splints, even in the gentle 
manner above advised, till such inflammation 
has in a considerable degree subsided. 
1 Of fractures of the lower extremities . 
Fractures of the body of the thigh bone may 
generally be ascertained by the signs above 
enumerated. When, however, the injury is 
in the neck of the bone, it requires much at- 
tention to distinguish luxation from fracture 
(see the section on Luxation.). Here we f 
may observe, that luxation is usually occa- 
sioned by straining or twisting of the* limb ; 1 
while perpendicular falls, or leaps, are the J 
more common causes of fracture. When the I 
crepitation is discovered, the nature of the | 
accident will he unequivocal. 
Fracture of the thigh, on account of the 
strong contraction of the large muscles of ; 
this part, is the most difficult of cure. To 
counteract this tendency to contraction, the 
joints of the thigh and knee are to be gently 
bended; one assistant is then to take hold 
with both hands of the upper part of the thigh ; , 
another is to support, and very moderately \ 
to extend the lower extremity, while the 
surgeon adjusts the fractured bones. After ‘ 
thus reducing the fracture, the limb is to be i 
secured, by being laid in a well framed case, 1 
stiff, and adapted to the form of the limb, | 
bending gently, in order to admit of a relax- j 
ed posture, lined with a woollen cloth, or 
with flannel, each hollow being filled up with- 
little cushions of tow ; another splint is then 
to be laid on the opposite side of the thigh, 
the whole braced gently down with ribands, 
and then both the thigh and its case bound to 
the pillow by tapes. In order to preserve it 
against the weight of the bed-clothes, a frame 
with hoops may be placed over the thigh. 
F rom time to time the limb is to be examin- 
ed, in order to ascertain whether the bones 
retain their situation : if it is disordered or 
shortened, the limb may be again gently 
extended and properly adjusted. After the 
second week, a small degree of flexion and 
extension may be used daily, in order to 
prevent an anchylosed joint. 
Machines have been invented, one parti- 
cularly by Mr. Gooch, represented in fig. 
64, in order to obviate the contractile ten- 
dency, by making a counter-extension. 
1 hese machines, however, do by no means 
answer the intention proposed. The counter- 
extension should not be continual, but must 
be made occasionally, and with the bands. 
When the patella is fractured, it is generally 
in the transverse direction. In healing such 
a fracture, the leg should be extended, the 
patient should be laid on a mattrass, and a 
splint placed under the limb, of sufficient 
length to reach from the upper part of the 
thigh to the under part of the leg, to which 
the limb is to be attached by straps. The frac- 
tured bones are then to be brought together* ' 
and the inflammation subdued "by local ap- 
plications. Here the pressure of the bed- 
clothes should likewise be guarded against by 
a frame of hoops, or some other contrivance. 
When the bone has been divided longitudi- 
nally, the common adhesive plaster is usually 
sufficient to maintain the junction. In trans- 
verse fractures, the divided pieces of bone 
recede from each other: and unless it can be 
done with facility, they are not to be brought 
together, for much force employed in this 
case would occasion a stiffness of the knee- 
joints and lameness. The bandage some- 
times employed in a transverse fracture of 
the patella is represented in fig. 65. 
For the treatment of fractures of the leg,. 
