see the directions given above. When the 
bones of the tarsus, metatarsus, and toes, are 
fractured, it will be necessary to apply a 
splint to the fractured part, and in general a 
large one beside over the sole of the foot. 
Fractures of the upper extremities. Frac- 
tures of the scapula are by no means com- 
mon : they are ascertained by the touch, by 
the great pain of the part, and by an incapa- 
bility of moving the arm. It is with difficulty 
that the parts are retained after replacement : 
a long roller is to be used, with which the 
shoulder is to be supported, and the arm.is to 
be kept suspended, in order to relax the 
muscles. 
A fracture of the humerus is generally easy 
of detection. When it has been reduced, two 
splints are to be employed, and a flannel or 
linen roller is to be applied gently over them. 
The arm is to be supported in a sling. In a 
few days, or a week, from the accident, it 
may be examined, to ascertain whether the 
broken ends have been properly adjusted. 
In fractures of the fore-arm, whether one 
or both bones are broken, the joint of the 
elbow is to be gently bent. Two splints of 
pasteboard are to be used, one large and 
long, upon which the arm is to be laid, the 
other smaller, is to be placed over it, and 
they are to be secured by slight tapes, rib- 
ands, rollers, or the twelve-tailed bandage. 
(See fig. 63.) The arm, during the cure, is 
to be supported in a sling, with the palm of 
the hand towards the breast. 
When the olecranon is fractured, the arm 
must be preserved in an extended state, by a 
long splint reaching from some way above 
the elbow-joint, down to the point of the 
fingers. The arm should be hung by, and 
connected to, the side. In little more than a 
week from the accident, the dressings are to 
be removed, and a slight motion given to 
the joints, in order to prevent anchyloses. 
When the carpal bones are fractured, there 
is usually considerable inflammation, which 
must, as much as possible, be obviated by 
local applications : splints are to be employed 
as in fractures of the fore-arm, and the arm is 
to be supported in a sling. 
In fractures of the metacarpus, a firm splint 
should be placed over the palm of ihe hand, 
which should be made to reach from the 
points of the fingers to the elbow. When a 
finger is broken, a splint ot pasteboard, moist- 
ened and moulded into the form, is to be 
used; and a large roller may be applied! all 
over the hand, in order to prevent the mo- 
tion of the fractured finger. 
Of fractures of the clavicle, ribs, sternum, 
and spine. A fractured clavicle may some- 
times be perceived by feeling along the 
course of the bone. The motions of die 
shoulder-joint are likewise necessarily im- 
peded. In reducing this fracture, the arm is 
to be raised, so as to bring the ends of the 
bones towards each other ; and it is to be pre- 
served in this position till union is accom- 
plished. 
When a rib is fractured, which may gene- 
rally be ascertained by feeling with the fin- 
gers, if one portion rises over another it should 
he reduced by moderate pressure, and a 
bandage applied round the chest, which 
should be continued for some weeks. It a 
portion of the rib is forced inwards, some 
surgeons direct thafc an opening be made 
SURGERY. 
over the depressed part, w hich is to be elevated 
by the finger or forceps. When the sternum 
is fractured, a similar treatment is said to be 
required. In this last case it is necessary 
sometimes to trepan. 
When the vertebrae are broken, the accident 
is for the most part fatal, and by the fractured 
pieces pressing upon the spinal marrow, a 
palsy is occasioned in the parts below the 
injury*. The surgeon, however, is to attempt 
the replacement ot the bones, and when part 
is depressed, an incision has been advised, in 
order to raise the depressed portion. 
Of compound fractures. 
Those fractures are called compound in 
which the external teguments are wounded, 
from the same accident by which the bone 
has been broken. These are necessarily of 
much more difficult management than cases 
of simple fracture. Some surgeons indeed 
have indiscriminately recommended ampu- 
tation of the limb in every case of compound 
fracture; while others have questioned the 
propriety of amputating, even for the 
worst accidents of this kind. r J his question, 
like many others, has been ■'agitated too much 
in the abstract. The propriety of immediate 
amputation, or a prior attempt to preserve a 
limb, will depend not merely on the extent 
of the injury, but on the age, habits, and 
constitution of the patient, as well as the cir- 
’ cumstances which he shall be under during 
the cure. In the army or navy practice, 
amputation is often necessary, where in pri- 
vate it would be premature and cruel. 
When we are to attempt the cure of a 
compound fracture, the first object is to re- 
move such pieces of bone as are detached in 
the form of splinters, as well as other extra- 
neous bodies. If there is merely a protru- 
sion of the bone through the wound, w ithout 
any separated pieces* w'e are to attempt an 
immediate reduction, as in simple fracture. 
If this cannot be effected even by pretty 
strong extension, an endeavour must be made 
to force in the bone by pressure. It, on ac- 
count of the narrowness ot the wound, it is 
impossible to reduce the fracture, the wound 
must be dilated by a straight probe-pointed 
bistoury. It is sometimes necessary to saw' 
off part of the projecting bone, in order to 
effect the reduction. When this has been 
accomplished, the wound is to be closed as 
much as possible, a pledget of emollient oint- 
ment placed over it, and the limb secured by 
an eighteen-tailed bandage. In order to en- 
courage adhesion, and prevent suppuration 
of the wound as much as may be, the limb 
without inordinate pressure should be sup- 
ported as firmly as- possible. When suppu- 
ration has come on, the limb is to be care- 
fully dressed every morning. Indeed the 
chief business of the surgeon will be to pre- 
serve the wound clean and clear by regular 
washing and sponging, bv laying clean lint 
upon it, and by the occasional use of spiri- 
tuous application. It is scarcely necessary 
to add, that the patient’s health must be sup- 
ported with much care. While causes of 
irritation are avoided, a due excitement must 
be kept up. (See the section on wounds.) 
Of luxations. 
Dislocations, like fractures, are sometimes 
difficult immediately to discover. An inca- 
pability of moving the limb, pain, tension, a 
lengthening, shortening, or other deformity, 
T*i 
and often considerable inflammation, are the 
general symptoms attending a dislocated or 
luxated bone. 
Endeavours to reduce luxations ought to 
be made as speedily as pos ible : as they 
grow older, they grow' more difficult of treat- 
ment. Indeed, after a bone has been a con- 
siderable time dislodged from its place, it 
often forms a new and artificial joint for itself 
among the contiguous muscles, and the sub- 
ject of the accident is by consequence ren- 
dered irrecoverably lame. When, however, 
dislocation accompanies fracture, it is some- 
times necessary to cure the latter before the 
reduction of the former is attempted. 1 his 
is the case when the fracture is contiguous to 
the joint. 
When much local inflammation accompa- 
nies luxation, it is to be carefully subdued by 
the common anti-inflammatory applications ; 
and, according to circumstances, it will be 
sometimes requisite to bleed at the arm. 
When the luxation has been reduced, the 
parts must be retained in their situation, by 
placing the limb in a relaxed position, ai\d by 
applying appropriate bandages. 
Luxation of the superior extremities. 
Of the os humeri. I he shoulder-joint may 
be luxated by the head of the humerus falling 
downwards and backwards. The more usual 
kind of dislocation, however, is by the head 
being forced downwards and forwards. An 
upward luxation cannot happen without a 
fracture of the upper parts of the scapula. 
Idle signs of a disiocacted shoulder are inabi- 
lity to raise the arm, the head of the humerus 
being felt oul of its proper place, while a 
vacuity is observed under the acromion. 
This luxation is often extremely easy of 
reduction. The surgeon should be provided 
with assistants to extend the arm, by means, 
if necessary, of a belt, or any substitute for 
this placed round the arms, with long straps 
attached to it, by which to extend the limb : 
another assistant is to draw back the shoulder- 
blade, while the operator, standing on the 
outside of the arm, directs the extension ac- 
cording to the situation of the bone, and thus 
raises it into the socket. Sometimes, when 
assistants are not at hand, an arm-dislocation 
may be reduced by placing it on the knee, 
and thus acting as wfith a lever. The arm, 
especially if the patient has been subject 
to the accident, may be supported in a sling 
some time after the reduction. 
Luxation at the elbow is not common ; 
it is attended with a shortening of the fare 
arm, a projection behind above the elbow; 
while in the bend of the elbow the extremity 
of the humerus may be felt. 
It is to be reduced by gradually extending 
the fore-arm rather in an oblique direction, 
and gently increasing the curvature of the 
elbow, and by endeavours to disengage the 
ends of the bones. After the reduction, the 
muscles should be relaxed by preserving the 
elbow for some time rather in a bent posi- 
tion. 
When the fore-arm is dislocated at the 
wrist, the rotatory motion of the hand is pre- 
vented. After the bones are replaced, a 
tight flannel roller should be bound round 
the wrist, and the arm supported in a sling. 
When the bones of the wrist are luxated, 
which is by no means a common accident, 
much pain and inflamixjation follows, and the 
