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Show .- a, -9m .» [20 ,.'r t 'II, l .' new at gunmen. murmur or IRACIURE. wine and brandy give but a temporary excitement, without returning vigour, the question of amputation comes to be discussed. If the powers of the constitution be not entirely exhausted, so that there is not vigour to produce the necessary tumefaction, and adhesion of the flaps on the stump, amputation will be safe. There is one point of doctrine on which I believe it necessary to say a few words in these introductory remarks. It regards the nature of callus, and the question concerning the extent of motion which may be allowed to a fractured limb. If this book possess any merit in proceeding directly to that point, the consideration of which most embarrasses the. surgeon, it results from my having observed the difficulties which my house pupils experience in fully comprehending their teachers, and from attending to their remarks and their V . l A \. l t. If t reasoning. It was only a few days ago that I heard a very ingenious young man, who lives with me, say, that the frac- tured thigh bone should not be set until the end of the third week; and he supported his opinion by the practice of an hospital surgeon of some reputation. A short and energetic expression of my conviction of the folly of this dogma would not carry the same weight with it here as I hope it did with my pupil. I shall therefore insist upon it more at length, and discuss also the question of the degree of motion to be allowed to a limb in fracture, somewhat largely. I have before me the short notes of three dissections, which, if I mistake not, afford me full ground upon which to reason securely. 1. The first describes the state of the parts immediately after the fracture. The bones have suffered a complicated fracture, being much shattered; they hang together by the "" "3‘ "i'i'dtvwr','-w,u~.a . . snrronmling cellular membrane, and the periosteum-they are surrounded with coagulated blood. 2. The second refers to a fracture of the thigh bone, if I recollect, three weeks after the fracture occurred. " The bone has been broken across in two places, leaving an intermediate portion. The intermediate portion is immersed in a sub GENERAL TREATMENT OF FRACTURE. 121 stance, which to the eye is like jelly, but which has a considerable degree of toughness. It appears as if the periosteum were continued from the circumference of the bone ; yet this cannot be. There is here a new formed membrane, which in time would have been the periosteum of the new formed bone. This periosteum is remarkably strong and thick, and the toughness which it has in a remarkable degree is possessed also by the callus to a considerable depth. In this mass I discover with my hook or probe many distinct particles of bone." 3. In a preparation of a fractured bone, which had been firmly knit together, and which after being injected had been made in a degree transparent, I observe the old bone white and little porous, but the new formed bone which unites the old portions is more vascular, and deprived in a greater pron portion by the acid of its phosphate of lime. From these facts, without entering upon a physiological View of the subject, I shall endeavour to draw the practi- cal lesson. When the injury is first committed, the cellular membrane around the broken bone is torn; the lesser vessels are open ed; and the blood is unusually efl‘used. At this time any slight motion of the bone does no harm unless it tears up new parts. Presently the blood is absorbed ; the injured parts throw out a more regular secretion; the membranes. form new: adhesions to the bones ; a tough membraneous sub. stance unites them, and in the apparently confused mass, which surrounds the extremities of the bones, small irregular points of bone are formed. Is not this sutlicient. to give con viction that if the limb be rudely moved after the new adhem zions are formed, these adhesions must be again torn up .9 and if these particles of bone be formed, must not the motion of the limb cause them to cut and tear the vessels and menr branes by which they are surrounded .9 so that at last if this motion be allowed to any extent, the disposition to the formation of bone is destroyed, and the process baffled as it were, in its design, stops short of the true effect, and the bones are united not by bone but- by a tough ligamentous snlwtanee. ""0 L . ‘1'! L in", ‘ '1 , mm |