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1-^ -r.y 
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SURGERY. 
tierally In weak children. The constitution examination. The bone must he restored 
should be strengthened, and mechanical by means of force, to its proper place, and 
means will often in an early stage have con- ' the limb kept quiet, until the effects of thq 
siderable effect in restoring the deformed violence are gone off. Compound disloca- 
tions must be treated on the same princi- 
jpal L« * 
Fractures are either simple or compound, plos as compound fractures. Sawing off 
The former are usually attended with a dis- the end of the bone is quite unjustifiable in 
tortion of the limb ; with a grating or ere- any case. If a luxation be unreduced for 
pitus perceptible on rubbing the broken a few weeks, the bone in general cannot 
ends against each other; with pain and be replaced, and the patient becomes crip- 
swelling • and often with spasms of the pled. Dislocations are sometimes produced 
muscles,’ The accident is remedied by the by diseases of the joints, destroying the 
effusion of a soft vascular matter between ligaments. 
the broken ends ; and by the gradual depo- particular surgical subjects. 
sition of earth in this ; where it acquires a 
sufficient firmness to admit of the part be- The great number of these, and the limits 
ing used again at various periods, from prescribed by the nature of this work, ren- 
three to seven weeks. The new matter is . der it necessary for us to pass over several, 
called callus. The treatment must, conse- and attend only to the more important, 
quently, consist simply in bringing the* limb Injuries of the head. Fractures of the 
into its natural position, and' retaining it skull are not dangerdus in themselves, but 
there firmly, until the union is accomplished, they indicate that considerable violence has - 
In effecting the former object, some force been inflicted. We must guard against in- 
is often necessary where the muscles have flammation of the contents of the cranium ; 
shortened the limb, as is frequent in the and continue the antiphlogistic regimen for 
thigh ; and this is termed extension. The three or four weeks. If the bone be even 
latter end is attained by means of instru- slightly depressed, the same plan may be 
ments called splints, which are firmly bound pursued. Bleeding from the arm or tempo- 
on the broken limb, including generally ral artery, saline purges, and diaphoretics, 
tlie joints, which connect it to the neigh- are usual means. 
bouring parts, and which of course must Compression of the brain may be caused 
vary in their form, &c. according to that by fracture with depression, or from extra- 
of the part on which they are placed. vasation of blood under tlie skull. Its 
Compound fractures are those in which symptoms are insensibility, dilated and im- 
there is an external wound, made by the moveable pupil, slow and labouring pulse, 
broken bone, which generally protrudes ditficult and stertorous respiration. These 
through it. Here the violence suffered by demand the application of the trephine, for 
the limb is much greater; inflammation of the purpose of elevating depressed bone, 
tlie surrounding parts, extensive abscesses, or removing effused blood. Compression 
exfoliations of the broken ends, and great may also be caused by suppuration of the 
constitutional sympathy, may be naturally dura mater. This happens several days 
expected. Where the injury is very vio- after the accident, is indicated by peculiar 
lent, the bone much shattered, and the soft symptoms, as pain, feel of tightness, and 
parts lacerated considerably, immediate puffy tumour iff the integuments ; and de- 
amputation may be performed. Otherwise mands the use Of the trephine, 
close the external wound ; lay the limb in Concussion of the brain is an injury of that 
its natural position, and keep it so ; and pay orgin produced by the blow, independent 
strict attention to the constitution. Ex- of actual fracture of the skull. After the 
tensive abscesses, &c. may render amputa- first stunning subsides, there is sickness, 
tion necessary at a subsequent time. contracted pupil, a degree of sensibility 
Dislocations, or luxations, are the dis- and irritability, and free respiration. The 
placementsof the articular surfaces of bones, patient gradually goes into a state of phre- 
by external violence. Hence their symp- nitis. Copious and repeated bleedings 
toms arise from the altered form, and im- from the temporal artery and arm, saline 
paired functions of the parts. The head of purges, low diet, &c. are the only means 
a bone is out of its natural socket, and is of safety, and must be followed up until the 
lodged in some unnatural situation ; tlie symptoms are subdued, 
limb cannot be moved by the patient ; there Trepanning consists in removing, by means 
is great pain, aggravated by the surgeon’s. ofacirculai:saw,aportionoftheskul], inor- 
