| MEDICAL INTRO |
| BOOKS ON OLD MEDICAL TREATMENTS AND REMEDIES |
THE PRACTICAL |
ALCOHOL AND THE HUMAN BODY In fact alcohol was known to be a poison, and considered quite dangerous. Something modern medicine now agrees with. This was known circa 1907. A very impressive scientific book on the subject. |
DISEASES OF THE SKIN is a massive book on skin diseases from 1914. Don't be feint hearted though, it's loaded with photos that I found disturbing. |
Broken Bones - Fractures.
In childhood the bones are quite soft and flexible. In fact, several of the bones of the body are composed more or less of gristle until near the age of 18 or 20 years. As the person advances in life, the bones become harder, because the proportion of mineral matter in them - lime and its compounds, especially - increases. Then, again, the weight of the body becomes greater, and, consequently, the force of a fall is increased.
As a result of these different factors, fractures of bones are far more frequent in adults than among children, and are most commonly met with among people in middle or advanced life. In consequence of the difference in occupation, fractures are more frequent among males than among females.
There are several causes which predispose to fracture, that is, which render the bones of some persons far more liable to fracture than those of others. Among these causes are certain diseases of the bone, especially rickets, long disuse of the limb, such as happens after accidents which compel the patient to keep his bed. There are, moreover, cases in which the bones are extremely brittle, as a result, apparently, of some error in the nutrition of the body, without any manifest disease.
Bones may be broken, first, by direct violence. A blow upon the head or the falling of a heavy body upon the arm illustrates this form.
Second, by indirect violence; that is, the force is applied to some other part of the body than that in which the bone is fractured. Thus a fall upon the shoulder frequently occasions a fracture of the collar-bone, and a fall, in which the individual throws out the hand to r reak the force of the blow, often results in a fracture of a bone of the forearm just above the wrist.
Third, fracture may result from muscular action. Thus the knee-pan is sometimes broken across by violent muscular efforts in jumping.
A fracture may be complete or incomplete. That is, the bone may be broken right across, or the break may extend only partway across - the remainder of the bone bending. This is illustrated by jie attempt to break a green stick; and the fracture is accordingly called a " green stick fracture. " This variety is especially apt to occur in children, whose bones are soft and flexible.
Another important distinction is the division of fractures into simple and compound.
A simple fracture is one in which the skin is not wounded. In a compound fracture, on the other hand, the skin is broken either by the violence which caused the fracture or by the protrusion of one of the broken ends of the bone through the skin.
The Repair of Fractures.-It is important to understand the general principles concerned in the repair of the fractures of bones, since the treatment is regulated by these principles.
For the first few days after the infliction of the injury, but little change occurs around the broken ends. The violence which caused the fracture has, of course, crushed a great many blood vessels, large or small, and considerable blood escapes from these into the tissues around the broken ends. There occurs, therefore, a swelling of the part, which becomes in a few days " black and blue." This blood is gradually absorbed just as it is when a bruise is inflicted without fracture.
After a period which varies from three to seven days, the process of repair begins. This consists in the formation of material between and around the broken ends of the bone. This material may be likened at first to glue, which it resembles indeed somewhat in its chemical composition. This material is called lymph, and serves to unite the ends of the bones temporarily.
In the course of several weeks, this lymph becomes converted into gristle, and finally into true bone. Meanwhile the seat of the fracture is marked by a lump, which consists of this lymph as it is changing into bone.
When we consider that this lymph is apt to be thrown out around the bone within a few days, and that it becomes gradually changed into bone, we can appreciate the importance of placing the broken ends in their proper position immediately after the fracture ; for the position which they assume at this time will become permanent by the formation of bone around the broken ends.
This lymph can readily be disturbed and broken during the early weeks of the healing process ; hence it is very important that measures should be taken for keeping the ends of the bones perfectly quiet.
The entire process of healing, that is, the transformation of all the new material into bone, requires a period of several months ; but usually within six to ten weeks the process is so far advanced that the ends of the bone are kept firmly in position without artificial assistance.
Fractures heal far more rapidly in children than in adults ; the power of repair diminishes in advanced life, so that in many aged individuals the ends of a broken bone never unite completely - that is, there is no true bone formed between the broken ends, which are bound together by a membranous attachment.
There are some bones, fractures of which do not readily unite. In some of these the formation of true bone-bony union, as it is called-rarely occurs. Fractures in the hip-joint, that is the head of the thigh-bone ; fractures of the point of the elbow and of the knee-pan are unusually troublesome in this respect. Moreover, if pieces of the skull are completely removed, the gap is filled up, not with true bone, but with a membranous material.
Symptoms.-There are certain general symptoms which are present in most cases of fracture. These are :
First-Pain usually immediately over the point of injury. In some cases, in which the other symtoms are obscure, the existence of a fracture is determined chiefly by the presence of a sharp pain when the finger is pressed upon a certain point. Second - Swelling,
Third-Deformity. This often consists simply in a shortening of a limb. In fractures of the thigh or of the arm, for instance, we can readily see, even without measuring, that the injured limb is considerably shorter than the other one.
At other times the deformity consists in a lump or a depression. Thus the fracture w'hich so frequently occurs just above the wrist is usually marked by a projection of one of the broken ends, so as to cause a painful lump under the skin.
Fourth-Unnatural mobility. This is a very important symptom, by which alone we can often detect the presence of a fracture positively. If the thigh be broken, for instance, there appears to be a new joint in the limb.
Fifth - Loss of power in the limb. If a bone be broken, the patient carefully refrains from every muscular effort to move the part, since every movement causes extreme pain.
Sixth - A grating sound and feeling. When the limb is moved so that the ends of the broken bone come in contact, the patient feels a rasping sensation, which is also communicated to the fingers of the surgeon. Sometimes a corresponding sound can be heard at the same time.
All of these six symptoms may be present in case of fracture, yet we must not assume the absence of a fracture because one or more of them cannot be detected. In fact, the only absolutely positive proofs of the existence of a fracture are the unnatural mobility of the part and the grating sound, technically called crepitus. In many cases it is a simple matter, even for the uninitiated, to detect the existence of a fracture. In other instances the symptoms are so obscure that the skill of the most experienced surgeon is taxed to decide the question. In every such case it will be well to proceed for some days upon the supposition that fracture has actually occurred; for if the bone be not broken, no damage will be inflicted by the treatment ; while on the other hand, if there be a fracture, incalculable injury may result from neglect.
In every case in which the least doubt exists as to whether a bone be actually broken, the injured member should be closely compared with that of the opposite side. The sound limb should be completely bared, and the injured one compared with it as to outline, movement, etc. Then we should take a tape-measure and compare as accurately as possible the length of the corresponding parts of the two limbs. After this we may grasp the injured member with both hands, placing one above and the other below the seat of the injury. The hands should then be moved in opposite directions from the axis of the limb ; thus one hand should be pressed backward and the other forward at the same time. In this way we detect any unnatural mobility and feel the grating sensation, if a fracture exist.
It is important to know how the fracture was made. For we can form a better estimate of the extent of the injury, as well as of the direction of the break, if we know in what way the force was applied.
Fractures which are produced by direct violence are usually more serious than others, because they are commonly accompanied by bruising or laceration of the tissues.
As to the direction of the fracture -that is whether the bone is broken squarely across or obliquely-we are thrown for information upon the position and appearance of the part. It is sometimes possible to feel distinctly the broken ends ; this is especially often the case in those bones which lie close to the skin, such as the collar-bone, the shin-bone, and portions of the bone constituting the forearm. Fractures of long bones-that is, those of the thigh, leg, arm, and forearm - are usually oblique.
It is extremely important to ascertain as definitely as possible the line of direction of the fracture ; since the " setting " of the bone will require different manipulations according to the relative position of the ends of the fragment.
A fracture is sometimes mistaken for a severe bruise, for a sprain and for a dislocation.
Such a mistake may be made by even the most experienced surgeon, especially if the parts around the seat of the injury are much swollen and very tender. For unless the surgeon's finger can be brought into pretty close contact with the injured bone, there may remain a doubt in many cases as to what the exact condition of things is.
If there be much swelling, so that au accurate examination of the part is impossible, the limb should be enveloped in cloths saturated with hot water, which are changed every two hours. These cloths may be covered with oiled silk or a piece of rubber cloth, in order to retain the warmth and moisture as long as possible.
After a few days the swelling usually subsides, and the pain is so much decreased that the parts can \be handled to much better advantage.
A bruise may be accompanied with as much p.¾in, swelling and loss of power in the limb as a fracture. But these symptoms subside in a few hours or days, after which it becomes apparent that the loss of power was but temporary.
A sprain may resemble a fracture in many respects ; there is apt to be a point of extreme tenderness just as is the case when the bone is broken. But the sprain, as well as the bruise, is distinguished from a fracture by the absence of unnatural mobility and of crepitus.
A dislocation is usually characterized by a lack of mobility of the limb. There is also in most cases a deformity which shows at once that the bone is out of place.
The distinction between a fracture and a dislocation is, however, in some instances extremely difficult even for the surgeon. In fact the two accidents are often combined. These injuries in the neighborhood of joints are the most puzzling of all which the surgeon is called upon to treat.
General Treatment of Fractures.-After it is apparent that a bone has been broken, a temporary dressing should be arranged until the patient can be transported to his home or to a hospital where he is to remain during the healing of the fracture.
The object of this temporary dressing should be simply to keep the limb quiet so that the broken ends shall not move and tear the flesh during transportation. If the wounded limb be a leg, a piece of wood long enough to stretch from the hip to the ankle should be obtained and applied to the back of the leg. This is to be kept in position by bandages placed around the thigh and the leg. A few laths will answer the purpose very well.
If the wounded member be the forearm, it may be slung temporarily in a large handkerchief knotted around the neck. If the arm be injured it will be well to apply a short piece of wood, fastened to the arm by bandages so as to render the part immovable. The patient should be laid upon a hard bed which stands firmly. The fracture may then be more carefully examined, and the nature of the required dressing determined.
If there be much swelling at the seat of injury, it is in most cases advisable to delay the the application of splints for a day or two, until the swelling has been reduced. To accomplish this the limb should be wrapped in cloths saturated with hot water, which should be changed sufficiently often to keep the part moist and warm. Meanwhile the limb may be steadied and prevented from moving by rolling up two blankets and placing the rolls one on either side of the limb. If the operator have a little skill, a single blanket may be made to accomplish the purpose by making two rolls of it, one from either end, between which the limb can be laid ; or sticks of wood may be wrapped in soft cloth and placed on either side of the injured member. If there be a wound at the seat of injury, a piece of rubber cloth should be laid under the limb. In any case the injured part may rest upon a pillow.
Above are several pictures of broken bones.
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