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Show f3 DISLOCA'HON or we ANCLE 10mm. DISLOCATIQN or THE ANGLE 10m. 5. If the wheel has passed over the joint, so as to displace the bones and open the joint, though' in exactly the same degree, amputation will be necessary, from the general contu. sion of the parts. I state the circumstances thus to prevent my reader from imagining that in any such case he is to trust to an absolute rule or aphorism, for with the same degree of laceration in the joint, the degree of injury may be greatly varied. The uncle joint may be dislocated by the tibia and fibula slipping before the astragalus. It will be ascertained by the great projection of the heel. It is to be reduced by applying the laques so as to catch upon the heel, and at the same time to pull on the fore part of the foot, by which means the toes are pointed, and the gastrocnemius relaxed. ids- - , "-3 m [1131114 50W :mui sif- d,n‘ qwe‘fl" In closing my observations on the injuries of the bones and joints it becomes a duty to remind the young surgeon of the great advantage to be derived from the general healthy state of the body in the final cure of local injuries of these parts ; that is, of good air most especially, of better diet than that to which the patient has been accustomed* ; even of exercise, if it can be allowed in the circumstances of the case. It becomes him to observe too, if there be any scrophulous tendeney in his patient, and to endeavour to counteract it ; for inju~ ry of the bones and joints is apt to reuse scrophulous action if there be the slightest tendency to it. We are infermed that the bones of scrophulous people contain a smaller portion of earth than when the part has its healthy constitution. I would not be understood to say, however, that on this account ,.w»‘ "j- Q'Naijrfh'fi‘ , . Nu. they are more susceptible of diseased action, though they certainly are more liable to disease ; they are more liable to be fractured and the ligaments of the joint having a tendency to " Even although the patient has been nursed in luxury and great abundance it is possible to ameliorate his condition ; though it must be confessed we possess more advantage when from the privations to which an hospi- ml patient has been accustomed he can be put on a more generous diet. 263 inflame and soften, they are also more likely to be injured by sprains. For these reasons it is necessary that we should know the characters of scrophula, that we should be able to recognize the disease under its symptoms,-the indolent swellings of the glands of the neck ; the softness of the skin, and the laxity of flesh; the largeness of the joints; the light hair and fair com- plexion, and smooth skin ; the tender eye-lids and swelled lips; or the dark sooty hair, with checks of a broken ruddy colour and swelled features. If there be ulcers, either previous to the injury or in consequence of it, we find them pale, shining, and indolent, with little pain or inflammation. If such should chance to be the constitution of a patient who has Suffered injury of the bones or joints, the cure is more precarious, and certainly more tedious ; the predisposition must be watched and counteracted. The skin ought to be kept soft, and the vessels of the sur= face active, by the use of the warm bath and friction. The glands and glandular viscera may be kept free of the conges tion of the indolent habit by occasional doses of calomel, and perhaps bark, iron, or acids, eventually used as giving vigour to the system. "‘1‘"- "WWW l' VlUNl M999? ‘ |
