Symptoms. order to bring a dislocated bone into much; inasmuch as the good which has its proper position again, that we not yet may still be done, whereas the strongly advise the reader never to evil that has been done cannot so interfere in these cases; unless, in- easily be undone. deed, it is altogether impossible to ob- Fractures of Bones. tain the services of a surgeon. But 1. Deformity of the part. 2. Unnatubecause any one of us may very possi-ral looseness. 3. A grating sound bly be placed in that emergency, we when the two ends of the broken bone give a few rough rules for the reader's are rubbed together. 4. Loss of natuguidance. In the first place make the ral motion and power. In some cases joint, from which the bone has been there is also shortening of the limb. displaced, perfectly steady, either by Fracture takes place from several fixing it to some firm object or else causes, as a fall, a blow, a squeeze, by holding it with the hands;. then and sometimes from the violent action pull the dislocated bone in a direction of muscles. Treatment. - In cases towards the place from which it has where a surgeon cannot be procured been thrust, so that, if it moves at immediately after the accident, the all from its unnatural position, it may following general rules are offered for have the best chance of returning to the reader's guidance The broken its proper place. Do not, however, limb should be placed and kept as pull or press against the parts too vio- nearly as possible in its natural po lently, as you may, perhaps, by doing sition. This is to be done by first so, rupture blood-vessels, and produce pulling the two portions of the bone most serious consequences. When in opposite directions, until the limb you do attempt to reduce a dislocated becomes as long as the opposite one, bone, do it as quickly as possible after and then by applying a splint, and the accident has taken place, every binding it to the part by means of hour making the operation more diffi- a roller. When there is no deforcult. When the patient is very strong, mity, the pulling is of course unhe may be put into a warm bath until necessary. If there is much swelling he feels faint, or have sixty drops of about the broken part, a cold lotion is antimonial wine given him every ten to be applied. This lotion (which we minutes until he feels sickish. These will call lotion No. 1) may be thus two means are of great use in relaxing made :-Mix a dessert-spoonful of the muscles. If the bone has been Goulard's extract and two table-spoonbrought back again to its proper place, fuls of vinegar in a pint of water. keep it there by means of bandages; When the leg or arm is broken, aland if there is much pain about the ways, if possible, get it to the same joint, apply a cold lotion to it, and length and form as the opposite limb. keep it perfectly at rest. The lotion The broken part should be kept pershould be, a dessert-spoonful of Gou- fectly quiet. When a broken limb is lard's extract, and two table-spoonfuls deformed, and a particular muscle is of vinegar, mixed in a pint of water. on the stretch, place the limb in such Leeches are sometimes necessary. Un- a position as will relax it. This will less the local pain, or general feverish in most cases cure the deformity. symptoms, are great, the patient's diet Brandy and water, or sal-volatile and should be the same as usual. Dislo- water, are to be given when the cations may be reduced a week, or patient is faint. Surgical aid should, even a fortnight, after they have taken of course, be procured as soon as posplace. As, therefore, although the sible sooner a bone is reduced the better, there is no very great emergency, and as the most serious consequences may follow improper or too violent treatment, it is always better for people in these cases to do too little than too Joints, Injuries to.-All kinds of injuries to joints, of whatever description, require particular attention, in consequence of the violent inflammations which are so liable to take place in these parts of the body, and which do so much mischief in a little time. The joint injured should always be kept perfectly at rest; and when it is very painful, and the skin about it red, swollen, hot, and shining, at the same time that the patient has general feverish symptoms, such as great thirst and head-ache-leeches, and when they drop off, warm poppy fomentations, are to be applied; the No. I pills above-mentioned are to be given (two are a dose for a grown person) with a black draught three hours afterwards. Give also two tablespoonfuls of the fever-mixture every four hours, and keep the patient on low diet. When the injury and swelling are not very great, warm applications, with rest, low diet, and a dose of aperient medicine, will be sufficient. When a joint has received a penetrating wound, it will require the most powerful treatment, and can only be properly attended to by a surgeon. The patient's friends will have to use their own judgment to a great extent in these and in many other cases, as to when leeches, fever mixture, &c., are necessary. A universal rule, however, without a single exception, is always to rest a joint well after it has been injured in any way whatever, to purge the patient, and to keep him on low diet, without beer, unless he has been a very great drinker indeed, in which case he may still be allowed to take a little; for if the stimulant that a person has been accustomed to in excess be all taken away at once, he is very likely to have an attack of delirium tremens. The quantity given should not, however, be much-say a pint, or, at the most, a pint and a half per day. Rubbing the joint with opodeldoc, or the application of a blister to it, is of great service in taking away the thickenings, which often remain after all heat, pain, and redness have left an injured joint. Great care should be observed in not using a joint too quickly after it has been injured. When the shoulder-joint is the one injured, the arm should be bound tightly to the body by means of a linen or flannel roller, and the elbow raised; when the elbow, it should be kept raised in the straight position, on a pillow; when the wrist, it should be raised on the chest, and suspended in a sling; when the knee, it should be kept in the straight position; and, lastly, when the ankle, it should be a little raised on a pillow. Bruises, Lacerations, and Cuts. Wherever the bruise may be, or however swollen or discoloured the skin may become, two or three applications of the extract of lead, kept to hour or little more, remove all pain, the part by means of lint, will, in an swelling, and tenderness. Simple or clean cuts only require the edges of the wound to be placed in their exact situation, drawn close together, and secured there by one or two slips of however, is jagged, or the flesh or adhesive plaster. When the wound, cuticle lacerated, the parts are to be laid as smooth and regular as possible, and a piece of lint, wetted in the exand a piece of greased lint placed tract of lead, laid upon the wound, above it to prevent the dressing sticking; the whole covered over to pro in the same manner once a day till tect from injury, and the part dressed the cure is effected. (See also p. 143). Bruises and their Treatment.-The best application for a bruise, be it large or small, is moist warmth; therefore, a warm breadand-water poultice in hot moist flannels should be put on, as they supple the skin. If the bruise be very severe, and in the neighbourhood of a joint, it will be well to apply ten or a dozen leeches over the whole bruised part, and afterwards a poultice. But leeches should not be put on young children. If the bruised part be the knee or the ankle, walking should not be attempted till it can be performed without pain. Inattention to this point often lays the foundation for serious mischief in these joints, especially in the case of scrofulous persons. In all conditions of bruises occurring in children, whether swellings or abrasions, no remedy is so quick or certain of effecting a cure as the pure extract of lead applied to cotton-wool with flour dredged well the part. (See also p. 143.) Burns and Scalds. Burns and Scalds being essentially the same in all particulars, and differing only in the manner of their production, may be spoken of together. As a general rule, scalds are less severe than burns, because the heat of water, by which are mostly produced, is not, even when it is boiling, so intense as that of flame; oil, however, and other liquids, whose boiling-point is high, produce scalds of a very severe nature. Burns and scalds have been divided into three classes. The first class comprises those where the burn is altogether superficial, and merely reddens the skin; the second, where the injury is greater, and we get little bladders containing a fluid (called serum) dotted over the affected part; in the third class we get, in the case of burns, a charring, and in that of scalds, a softening or pulpiness, perhaps a complete and immediate separation of the part. This may occur at once, or in the course of a little time. The pain from the second kind of burns is much more severe than that in the other two, although the danger, as a general rule, is less than it is in the third class. These injuries are much more dangerous when they take place on the trunk than when they happen on the arms or legs. The danger arises more from the extent of surface that is burnt than from the depth to which the burn goes. This rule, of course, has certain exceptions; because a small burn on the chest or belly penetrating deeply is more dangerous than a more extensive but superficial one on the arm or leg. When a person's clothes are in flames, the best way of extinguishing them is to wind a rug, or some thick material, tightly round the whole of the body. Treatment of the First Class of Burns and Scalds. Of the part affected. Cover it immediately with a good coating of common flour, or better still with finely-powdered whiting, or into it. The great thing is to keep the affected surface of the skin from the contact of the air. The part will shortly get well, and the skin may or may not peel off. Constitutional Treatment.-If the burn or scald is not extensive, and there is no prostration of strength, this is very simple, and consists in simply giving a little aperient medicine-pills (No. 2), as follows:-Mix 5 grains of blue pill and the same quantity of compound extract of colocynth, and make into two pills-the dose for a full-grown person. Three hours after the pills give a black draught. If there are general symptoms of fever, such as hot skin, thirst, head-ache, &c., &c., two tablespoonfuls of fever-mixture are to be given every four hours. The fever-mixture, we remind our readers, is made thus :-Mix a drachm of powdered nitre, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitre, in half a pint of water. Second Class. Local Treatment.As the symptoms of these kinds of burns are more severe than those of the first class, so the remedies appropriate to them are more powerful. Having, as carefully as possible, removed the clothes from the burnt surface, and taking care not to break the bladders, spread the following liniment (No. 1) on a piece of linen or lint-not the fluffy side--and apply it to the part; the liniment should be equal parts of lime-water and linseed-oil, well mixed. If the burn is on the trunk of the body, it is better to use a warm linseed-meal poultice. After a few days dress the wound with Turner's cerate. If the burn is at the bend of the elbow, place the arm in the straight position; for if it is bent, the skin, when healed, will be contracted, and the arm, in all probability, always remain in the same unnatural position. This, indeed, applies to all parts of the body; therefore, always place the part affected in the most stretched position possible. Constitutional Treatment. |