SURGERY.
'* In setting a broken limb,” says our author, “ there n no exten-sion required but such as common sense would direct you to use"’ere you not a surgeon. Lay the patient in bed, and lay the limblI l’on a pillow ; or if you design to use splints, have two longRoughs, or pieces of pastebord, (in figure JO is represented the" s uai splint employed in a fractured leg) bent into a hollow form,h"vd, or rather cushioned, with two or three piles of flannel, with* a pes or ribands, four or five in number, attached to the outside of0l ’e of the splints by which both splints, may, after all is over, begently tied together with bow-knots, to be slackened or tightenedRecording to the swelling of the limb. The pasteboard ought tobe soaked and softened a little, that it may take a shape suitable tomat of the limb. A long splint of this kind being laid tlat upon thebed by the side of the fractured leg, desire one of your assistants torPl’ly his hands broad round the upper part of the limb, and graspgently and steadily; take the fool and ancle in the same mannerj!’ your own hand, slip your left hand under the broken part of thebub, am [ f| ieil sliding it gently along, lay it upon the pillow or its“Plints. The pillow should be like a mat trass, tlat and firm. Be-ll 111 then to lay the limb smooth ; let your assistant again grasp it,y spreading his hands upon the thigh or below the knee, -vith the'esign of extending along with you, not by lifting the leg from theP'llow, but rather by keeping it down, and steadying it bv pres-llr e, while you with both bands lift the foot and ancle; grasp..b ,n gently, but very firmly; raise them a very little from theirjHilow, and draw them gently and very smoothly. 'When youhye ti uls extended and smoothed the broken leg, in a manner^birch you almost suppose agreeable rather than painful to thePatient, press it down steadily and gently ; keep it flat and presseddbtil it gets a seat and bed in the pillow, ff splints are applied, the,, n ’b is to be pressed against the lower splints; the upper splint is’bp to be laid above it, and by grasping the. soft and moistenedP'ints, you must model them a little. When the whole lias taken°"rr, take several tapes one after another ; and after having tied,1 e bi in a general way, go over them again one by one, and tiee m a little closer, so as to keep the limb agreeably firm.” Ithe proper to observe, that while much inflammation is present,bare to defer the application of splints, even in the gentle man-^above advised, till such inflammation lias in a considerable de-gi e b subsided. The splints may be made of thin slips of woodf bed on leather as in fig. 19 . See also fig. 23, which represents at ,'yher-splint for a fractured leg. Fractures of the body of thejTp-bone may generally be ascertained by the signs above enu-; t brated. When, - however, the injury is in the neck of the bone,|.i re< Uiires much attention to distinguish luxation from fracture!s[ e !’e we may observe, that luxation is- usually occasioned byW'b'ibg ot twisting of the limb; while perpendicular fails, ort a( .P s > are the more common causes of fracture. When the crepi-Cal' 011 I s discovered, the nature of tire accident will be unequivo-th e ’ i P racture of the thigh, on account of the strong contraction ofar 6° muscles of this part, is the most difficult of cure. Tok n ''foract this tendency to contraction, the joints of the thigh andV, t | e . are to be gently bended : one assistant is then to lake holdport ' la "ds of the upper part of the thigh ; another is to sup-tl le ’ an d very moderately to extend, the lower extremity, whilefr:w lll '8 p on adjusts tire fractured bones. After thus reducing theca Sf , llrs ;> the limb is to lie secured, by being laid in a well framedOrd e ’ st 'ft and adapted to the form of the limb, bending gently, inadmit of a relaxed posture, lined with woollen'cloth, ortow.^nnel, each hollow being filled up with little cushions of
'h'fth an ,°^ ler splint is then to be laid on the opposite side of thethe (I,’ ) e "’hole braced gently down with ribands, and then bothpr We ,S ’.and its case bound to the pillow by tapes. In order to>n av I Ve it against the weight of the bed-clothes, a frame with lroopsone '’b.l’huH-d over the thigh. Machines have been invented,J- l| larly by Mr. Gooch, represented in fig. 21, in order toI'li e ' p! llle contractile tendency, bv making a counter-extension.Pate|| u an " a S p sometimes employed in a transverse fracture of theho r< ‘preseuted in fig 22. Fractures of the scapula are bygreat |, anK coim «on: they are ascertained by the touch, by the. 18 witt' 11 part, and by an incapability of moving the arm.
51 ' 0| ’g rfll that the parts are retain d after replacement;
Ifort^i . ,e -t '» to be used, with winch the shoulder is to be sup-^'hclej i "' le arm ,0 he kept suspended, in order to relax tiie• In fractures of the fore-arm, whether one or both bones
are broken, the joint of the elbow is to be gently bent. Twosplints of pasteboard are to be used, one large and long, upon whichthe arm is to he laid; the other smaller, is to be placed over it, andthey are to be secured by slight tapes, ribbands, and rollers. Whena rib is fractured, which may generally be ascertained by feelingwith the fingers, if one portion rises over another it should be refdtieed by moderate pressure, and a bandage applied round thechest, which should be continued for some weeks. If a portionof tiie rib is forced inwards, some surgeons direct that an openingbe made over the depressed part, which is to be elevated by tiielinger or forceps. When the sternum is fractured, a similar treat-ment is said to be required. In this last case it is necessary some-times to trepan. When the vertebra: are broken, the accident isfor the most part fata!, and by tiie fractured pieces pressing uponthe spinal marrow, a palsy is occasioned in the parts below the in-jury. The surgeon, however, is to attempt the replacement oftiie bones, and when part is depressed, an incision has been ad-vised, in order to raise the depressed portion. Those fracturesare called compound in which the external teguments are wounded,by the same accident by which tiie bone has been broken. Theseare necessarily of much more difficult management than cases ofsimple fracture. Some surgeons indeed have indiscriminately re-commended amputation of the limb in every case of compoundfracture; while others have questioned the propriety of ampu-tating, even for the worst accidents of this kind. This question,like many others, has been agitated too much in the abstract. Tiiepropriety of immediate amputation, or a prior attempt to preservea limb, will depend not merely on tiie extent of tiie injury, buton the age, habits, and constitution, of the patient, as well" as tiiecircumstances which he shall be under during the cure. In thearmy or navy practice, amputation if often necessary, where inprivate it would be premature and cruel. When we are to at-tempt the cure of a compound fracture, the first object is to re-move such pieces of bone as are detached in tiie form of splinters,as well as other extraneous bodies. If there is merely a protrusionof the bone through tiie wound, without any separated pieces, weare to attempt an immediate reduction, as in simple fracture. Ifthis cannot be effected even by pretty strong extension, an en-deavour must be made to force in the bone by pressure. If, onaccount of the narrowness of the wound, it is impossible to reducethe fracture, the wound must be dilated by a straight probe-pointedbistoury. It is sometimes necessary to saw off part of the project-ing bone, in order to effect tiie reduction. When this has beenaccomplished, tiie wound is to be dosed as much as possible, apledget of emollient ointment placed over it, and the limb securedby an eighteen-tailed bandage. A machine has lately been in-vented by Mr. Samuel James surgeon in Iloddesden, Herts,which, we are told, will effectually relax the muscles, and retainthe thigh or fractured bones of the leg in their natural situation,without pain to the patient, or the least inconvenience to the ope-rator. See tig. 32, Plate C LXV.
A bone is said to be luxated when that part of it forming a jointis moved out of its place. When the bone is forced entirely outof its cavity, the luxation is termed complete ; when this is not thecase, it is”partial or incomplete. When there is also a wound ofof the soft parts communicating with the joint, it is called a com-pound, and when there is no wound, a simple luxation. Dislo-cations, like fractures, are sometimes difficult immediately todisco'ver. An incapability of moving the limb, pain, tension,lengthening, shortening, or other deformity, anti often considerableinflammation, are tiie general symptoms attending a dislocated ox*luxated bone. Endeavours to reduce luxations ought to be madeas speedilv as possible: as they grow older, tiiey grow more diffi-cult of treatment. Indeed, after a bone lias been a considerabletime dislodged from its place, it often forms a new and artificialjoint for itself among tiie contiguous muscles, .and the subject oftiie accident is by consequence rendered irrecoverably lame.■When, however, dislocation accompanies fracture, it is sometimes 'necessary to cure tiie latter before the reduction of the former isattempted. This is the case when the fracture is contiguous to thejoint. When much local inflammation accompanies luxation, it isto lie carefully subdued by the common anti-inflammatory appli-cations ; and, according tp circumstances, it wijl be sometimes re-quisite