BROKEN BONES.

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" The most unequivocal symptoms of fractures are, the crepitusor grating noise distinguished on moving the limb, occasioned bythe fractured ends ; the separation and inequalities of the ends ofthe fracture, when the bone is superficial ; the change in the formof the limb, and the shortening of it.

The treatment oí fractures in general embraces three principalindications. 1. To reduce the pieces of the bones into their natu-ral situation. 2. To secure and keep them in their place by properbandages and splints. 3. To prevent unpleasant symptoms, andto relieve them, when, in spite of every effort to the contrary, theydo arise."

If any of the large bones which support the body are broken,the patient must keep his bed for several weeks. It is by no meansnecessary, however, that he should lie all that time, as is customa-ry, upon his back. This situation sinks the spirits, galls and fretsthe patient's skin, and renders him very uneasy. After the secondweek, he may be gently raised up, and may sit several hours, sup-ported by a bed-chair, or the like, which will greatly relieve him.Great care, however, must be taken in raising him up and layinghim down, that he make no exertions himself, otherwise the ac-tion of the muscles may pull the bone out of its place.*

It is of great importance to keep the patient dry and cleanwhile in this situation. By neglecting this, he is often so galledand excoriated, that he is forced to keep shifting places for ease.I have known a fractured thigh-hone, after it had been kept straightfor above a fortnight, displaced by this means, and continue Lentfor life, in spite of all that could be done.

It has been customary when a bone was broken, to keep thelimb for five or six weeks continually upon the stretch. But thisis a bad posture. It is both uneasy to the patient, and unfavoura-ble to the cure. The best situation is to keep the joint a little bent.This is the posture into which every animal puts its limbs when itgoes to rest, and in which fewest muscles are upon the stretch. Itis easily effected, by either laying the patient upon his side, ormaking the bed so as to favour this position of the limb.

Bone-setters ought carefully to examine whether the bone be notshattered or broken into several pieces. In this case it will some-times be necessary to have the limb immediately taken off, other-wise a gangrene or mortification may ensue. The horror whichattends the very idea of an amputation often occasions its being de-layed in such cases till too late. I have known this principle ope-rate so strongly, that a limb, where the bones were shattered intomore than twenty pieces, was not amputated before the third dayafter the accident, when the gangrene had proceeded so far as torender the operation useless.

* Various pieces of machinery have been contrived for counteracting the force of themuscles, and retaining the fragments of broken bones ; but as descriptions of thesewithout drawings would be of little use, Ï shall refer the reader to a cheap and usefulperformance, On the Nature and Cure of Fractures, lately published by my ingeniousfriend Mr. Aitkin, surgeon, in Edinburgh ; wherein that gentleman has not only givenan account of the machines recommended in fractures by former authors, but has like-wise added several improvements of his own, which are peculiarly useful in compoundfractures, and in cases where patients with broken bones are obliged to be transportedfrom one place to another.

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