24. The pain ceases as soon as the apparatus is applied, because the
fragments, now brought into perfect contact, cease to irritate the
surrounding parts. Nor does it return during the treatment, as they are
firmly retained, and not suffered again to separate.
It is rare that any serious accident follows this fracture, and, among
the numerous examples met with by Desault, he has scarcely ever had
one such to encounter: yet he generally paid but little attention to
those internal means which are usually combined with external ones. In
most cases, the patients pursued the regimen to which they had been
accustomed.
In cases, where a considerable swelling attacked the upper part of
the joint, a circumstance which occasionally occurs in practice, one
or two bleedings, a diet more or less strict, and the use of diluent
drinks, constituted the internal treatment. Of this the following case,
related by Brochier, furnishes a detail.
CASE II. Maria Catharine Bardelle, aged forty-five, of a high
complexion, fell, as she was carrying a heavy load, on the elbow of the
right side, the arm being extended a little from the body. The neck of
the humerus was fractured, and all the usual signs combined in pointing
out the nature of the accident.
A surgeon was immediately called, who mistaking it for a luxation, made
useless attempts to reduce it, tormented the patient for half an hour,
and then left her to be sent to the Hotel-Dieu.
Desault discovered it at first sight to be a fracture, and foreseeing
the consequences of the improper steps that had been taken, ordered
blood-letting, and a low diet, after having effected the reduction, and
applied the apparatus already described (20).
In the evening, a considerable swelling appeared around the
articulation; the pains continued; a diluting drink composed of
dog-grass and oxymel was prescribed. Second day, the swelling is
gaining ground; pains increased; blood drawn again; diet and drink
continued; apparatus is frequently wet with vegeto-mineral water,
particularly at the upper part. Third day, a little better; pains
diminished, swelling checked; weak soup is allowed. Fourth day, a
diminution of the swelling; pains almost gone. Sixth day, the swelling
has almost disappeared; light food; bandage, having become loosened, is
reapplied.
Tenth day, tongue foul; nausea; want of appetite; symptoms of a bilious
diathesis. Bitter drink is prescribed; the day following, a grain of
tartar emetic is given in solution.
Thirteenth day, the patient is in her ordinary state; the apparatus
is renewed. Twenty-fourth day, the reunion is evidently advancing.
Thirty-second day, the consolidation is complete.
The patient now began to perform gentle motions with the limb, which
she gradually increased, till about the fortieth day, when she was
perfectly well, and free in all her motions.
25. I will here repeat an observation, already made, on the subject
of the bandage for the clavicle, of which this is nothing else than a
modification. In a short time the bolster sinking downward, the bandage
becoming relaxed, and the splints less tight, do not effectually oppose
a displacement, unless the bandage be daily examined, and reapplied,
when it seems to act too feebly. There are many surgeons, who have not
been fortunate in retaining the fragments with exactness, because,
trusting too far to the action of the bandage, they have for a long
time neglected to examine it; this remark is applicable to every
apparatus composed of rollers.
26. Here, much more than in other cases, it is all-important that the
limb be accustomed to motion, after the process of consolidation.
Situated near to the joint, the fracture always leaves some stiffness
in it, which time no doubt wears away, but which will sooner disappear
under the above treatment.
§ VIII.