THERE is, in most country villlages, some person who pretends to the art of reducing fractures. Though, in general, such persons are very ignorant, yet some of them are very successful; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, will enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had; but when that is impracticable, they must be employed: we shall therefore recommend the following hints to their consideration.
WHEN a large bone is broken, the patient's diet ought, in all respects, to be the same as in an inflammatory fever. He should likewise be kept quiet and cool, and his body open by emollient clysters, or, if these cannot be conveniently administered, by food that is of an opening quality; as stewed prunes, apples boiled in milk, boiled spinage, and the like. It ought however to be here remarked, that persons who have been accustomed to live high, are not all of a sudden to be reduced to a very low diet. This might have fatal effects. There is often a necessity for indulging even bad habits, in some measure, where the nature of the disease might require a different treatment.
IT will generally be necessary to bleed the patient immediately after a fracture, especially if he be young, of a full habit, or has, at the same time, received any bruise or contusion. This operation should not only be performed soon after the accident happens, but if the patient be very feverish, it may be repeated next day. When several of the ribs are broken, bleeding is peculiarly necessary.
IF any of the large bones which support the body are broken, the patient must keep his bed for several weeks. It is by no means necessary, however, that he should lie all that time upon his back. This situation sinks the spirits, galls and frets the patient's skin, and renders him very uneasy. After the second week he may be gently raised up, and may sit several hours, supported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raising him up, and laying him down, that he make no exertions himself, otherwise the action of the muscles may pull the bone out of its place. Various pieces of machinery have been contrived for counteracting the force of the muscles, and retaining the fragments of broken bones; but as descriptions of these without drawings would be of little use, I shall refer the reader to a cheap and useful performance on the nature and cure of fractures, lately published by my ingenious friend Mr. Aitken, surgeon in Edinburgh; wherein that gentleman has not only given an account of the machines recommended in fractures by former authors, but has likewise added several improvements of his own, which are peculiarly useful in compound fractures, and in cases where patients with broken bones are obliged to be transported from one place to another.
IT is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoriated, that he is forced to keep shifting places for ease. I have known a fractured thigh-bone, after it had laid straight for above a fortnight, displaced by this means, and continue bent for life, in spite of all that could be done.
IT has been customary when a bone was broken, to keep the limb for five or six weeks continually upon the stretch, But this is a bad posture. It is both uneasy to the patient, and unfavourable to the cure.
THE best situation is to keep the limb a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which fewest muscles are upon the stretch. It is easily effected by either laying the patient upon his side, or making the bed so as to favour this position of the limb.
BONE-SETTERS ought carefully to examine whether the bone be not shattered or broken into a great many pieces. In this case it will sometimes be necessary to have the limb immediately taken off, otherwise a gangrene or mortification may ensue. The horror which attends the very idea of an amputation, often occasions its being delayed in such cases till too late. I have known this principle operate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, when the gangrene had proceeded so far as to render the operation useless.
WHEN a fracture is accompanied with a wound, it must be dressed in all respects as a common wound.
ALL that art can do towards the cure of a broken bone, is to lay it perfectly straight, and to keep it quite easy. All tight bandages do hurt. They had much better be wanting altogether. A great many of the bad consequences which succeed to fractured bones are owing to tight bandages. This is one of the ways in which the excess of art, or rather the abuse of it, does more mischief than would be occasioned by the want of it. Some of the most sudden cures of broken bones which were ever known, happened where no bandages were applied at all. Some method however must be taken to keep the member steady; but this may be done many ways without bracing it with a tight bandage.
THE best method of retention is by two or more splints made of leather or pasteboard. These, if moistened before they be applied, soon assume the shape of the included member, and are sufficient, by the assistance of a very slight bandage, for all the purposes of retention. The bandage which we would recommend is that made with twelve or eighteen tails. It is much easier applied and taken off than rollers, and answers all the purposes of retention equally well. The splints should always be as long as the limb, with holes cut for the ancles when the fracture is in the leg.
IN fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The patient in this case ought to keep himself quite easy, avoiding every thing that may occasion sneezing, laughing, coughing, or the like. He ought to keep his body in a straight posture, and should take care that his stomach be constantly distended, by taking frequently some light food, and drinking freely of weak watery liquors.
THE most proper external application for a fracture is oxyerate, or a mixture of vinegar and water. The bandages should be wet with this at every dressing.
STRAINS are often attended with worse consequences than broken bones. The reason is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, because he cannot make use of it; but when a joint is only strained, the person, finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, and converts into an incurable malady what might have been removed by only keeping the part easy for a few days.
COUNTRY people generally immerse a strained limb in cold water. This is very proper, provided it be done immediately, and not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one.
WRAPPING a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tone of the vessels, and prevents the action of the parts from increasing the disease. It should not however be applied too tight. I have frequently known bleeding near the afffected part have a very good effect: But what we would recommend above all is ease. It is more to be depended on than any medicine, and seldom fails to remove the complaint. A great many external applications are recommended for strains, some of which do good, and others hurt. The following are such as may be used with the greatest safety, viz. poultices made of stale beer or vinegar and oatmeal, camphorated spirits of wine, Mindererus's spirit, volatile liniment, volatile aromatic spirit diluted with a double quantity of water, and the common fomentation, with the addition of brandy or spirit of wine.
CHILDREN and very old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, carrying great weights, &c. In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this disease.
A RUPTURE sometimes proves fatal before it is discovered. Whenever sickness, vomiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where ruptures usually happen ought carefully to be examined. The protrusion of a very small part of the gut will occasion all these symptoms; and, if not returned in due time, will prove mortal.
ON the first appearance of a rupture in an infant, it ought to be laid upon its back, with its head very low. While in this posture, if the gut does not return of itself, it may easily be put up by gentle pressure. After it is returned, a piece of sticking-plaster may be applied over the part, and a proper truss or bandage must be constantly worn for a considerable time. The method of making and applying these rupture bandages for children is pretty well known. The child must, as far as possilble, be kept from crying, and from all violent motion, till the rupture is quite healed.
IN adults, when the gut has been forced down with great violence, or happens, from any cause, to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite impracticable without an operation, a description of which is foreign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without having recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue.
AFTER the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. In this situation flannel cloths wrung out of a decoction of mallows and camomile-flowers, or, if these are not at hand, of warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter and a little salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be necessary; but it is not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hand, must with his fingers artfully conduct the gut in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavours prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often known to succeed where every other method failed.
THERE is reason to believe that, by persisting in the use of these, and such other means as the circumstances of the case may suggest, most hernias might be reduced without an operation. Cutting for the hernia is a nice and difficult matter. I would therefore advise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my endeavours, after eminent surgeons had declared the reduction of the gut impracticable without an operation. I would here beg leave to recommend it to every practitioner, when his patient complains of pain in the belly with obstinate costiveness, to examine the groins and every place where a rupture may happen, in order that it may be immediately reduced. By neglecting this, many perish who were not suspected to have had ruptures till after they were dead. I have known this to happen where half a dozen of the faculty were in attendance.
AN adult, after the gut has been returned, must wear a steel bandage. It is needless to describe this, as it may always be had ready-made from the artists. Such bandages are generally uneasy to the wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man's estate, should ever be without one of these bandages.
PERSONS who have a rupture ought carefully to avoid all violent exercise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors; and should carefully guard against catching cold.