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Dislocations (Positions as placing yourself)

positions, as placing yourself on the ground with | thigh is then to be made by the men who are stahim, laying him on a low bed, while you are standing near the foot of it, etc.

If this fails, pass a strong band over the shoulder, carry it across the breast, give the ends to assistants, or fasten them to a staple in the wall; the middle of a strong band or folded towel is now to be laid on the arm above the elbow, and secured there by numerous turns of a bandage. The two ends of the towel being then given to assistants, or connected with a pulley, a steady, continued, and forcible extension is to be made for a few moments, while with your hands you endeavor to push the head of the bone into its place.

Dislocation of the Elbow.

If the patient has fallen on his hands, or holds his arm bent at the elbow, and every endeavor to straighten it gives him pain, it is dislocated backwards. Seat him in a chair, let one person grasp the arm near the shoulder and another the wrist, and forcibly extend it, while you interlock the fingers of both hands just above the elbow, and pull it backwards, remembering that under those circumstances, whatever degree of force is required, should be applied in this direction. The elbow is sometimes dislocated sideways or laterally. To reduce it, make extension by pulling at the wrist, while some one secures the arm above, then push the bone into its place, either inwards or outwards, as may be required. After the reduction of a dislocated elbow keep the joint at perfect rest for five or six days, and then move it gently. If inflammation comes on, bleed, purge, etc., etc. Dislocation of the elbow is often accompanied by fracture, in which case it will not bear violence.

Dislocation of the Wrist, Fingers, etc.

Dislocations of the wrist, fingers and thumb are readily perceived on examination; they are all to be reduced by forcibly extending the lower extremity of the part, and pushing the bones into their place. If necessary, small bands may be secured to the fingers by a narrow bandage to facilitate the extension. These accidents should be attended to without delay, for if neglected for a little time they become irremediable.

Dislocation of the Thigh.

Notwithstanding the hip-joint is the strongest one in the body, it is sometimes dislocated. As a careful examination of the part, comparing the length and appearance of the limb with its fellow, etc., sufficiently mark the nature of the accident, we will proceed to state the remedy.

Place the patient on his back upon a table covered with a blanket. Two sheets, folded like cravats, are then to be passed between the thigh and testicle of each side, and their ends (one half of each sheet passing obliquely over the belly to the opposite shoulder, while the other half passes under the back in the same direction) given to several assistants, or what is much better, tied very firmly to a hook, staple, post, or some immovable body. A large, very strong napkin, folded as before, like a cravat, is now to be laid along the top of the thigh, so that its middle will be just above the knee, where it is to be well secured by many turns of a bandage. The two ends are then to be knotted. If you have no pulleys, a twisted sheet or rope may be passed through the loop formed by the napkin. If you can procure the former, however, cast the loop over the hook of the lower block and secure the upper one to the wall, directly opposite to the hooks or men that hold the sheets that pass between the thighs. A steadily increasing and forcible extension of the tioned at the pulleys or sheet while you are turning and twisting the limb to assist in dislodging it from its unnatural situation. By these means, properly applied, the head of the bone will frequently slip into the socket with a loud noise.

If, however, you are foiled, change the direction of the extending force, recollecting always that it is not by sudden or violent jerks that any benefit can be attained, but by a steady, increasing and long-continued pull. Should all your efforts prove unavailing (I would not advise you to lose much time before you resort to it), make the patient, as before directed, very sick or drunk, and when he cannot stand apply the pulleys. If this fails, or is objected to, bleed him till he faints, and then try it again.

Dislocation of the Knee-pan.

When this little bone is dislocated it is evident on the slighest glance. To reduce it, lay the patient on his back, straighten the leg, lift it up to a right angle with his body, and in that position push the bone back to its place. The knee should be kept at rest for a few days.

Dislocation of the Leg.

As these accidents cannot happen without tearing and lacerating the soft parts, but little force is required to place the bones in their natural situation. If the parts are so much torn that the bone slips again out of place, apply Hartshorne's or Desault's apparatus, as for a fractured thigh.

Dislocation of the Foot.

The foot is seldom dislocated. Should it happen, however, let one person secure the leg and another draw the foot, while you push the bone in the contrary way to that in which it was forced out. The part is then to be covered with compresses dipped in lead-water and a splint applied on each side of the leg that reaches below the foot. Accidents of this nature are always dangerous; all that can be done to remedy them consists in the speedy reduction of the bone, keeping the parts at rest and subduing the inflammation by bleeding, low diet, etc., etc.

Of Compound Accidents.

Having spoken of the treatment to be pursued for a bruise, wound, fracture, and dislocation, as happening singly, it remains to state what is to be done when they are united.

We will suppose that a man has been violently thrown from a carriage. On examination, a wound is found in his thigh, bleeding profusely, his ankle is out of joint, with a wound communicating with its cavity, and the leg broken.

In the first place stop the bleeding from the wound in the thigh, reduce the dislocation next, draw the edges of the wounds together with sticking plaster, and lastly, apply Hartshorne's or Desault's apparatus to remedy the fracture. If, instead of a wound, fracture, and dislocation, there is a concussion or compression of the brain, a dislocation and fracture, attend to the concussion first, the dislocation next, and the fracture the last Of Amputation.

As accidents sometimes happen at sea, or in situations where it is impossible to obtain a surgeon, and which require the immediate amputation of a limb, it is proper to say a few words on that subject. To perform the operation is one thing, to know when it ought to be performed is another. Any man of common dexterity and firmness can cut off a leg, but to decide upon the necessity of doing so, requires much judgment, instances having occured where, under the most seemingly desperate circumstances, the patient through fear or obstinacy has refused to submit to the knife, and yet afterwards recovered.

Although in many cases much doubt may exist in determining whether it is proper to amputate or not, yet in others, all difficulty vanishes, as when a ball has carried away an arm. Supposing for a moment while rolling in a heavy sea, during a gale, the lashings of a gun give way, by which a man has his knee, leg, or ankle completely mashed, or that either of those parts is crushed by a fall from the topgallant yard, a falling tree, etc. The great laceration of blood vessels, nerves, and tendons, the crushing and splintering of the bones, almost necessarily resulting from such accidents, render immediate amputation an unavoidable and imperious duty. If there are none of the regular instruments at hand, you must provide the following, which are always to be had, and which answer extremely well - being careful to have the knives as sharp and smooth as possible.

Instruments. The handkerchief and stick, a carving or other large knife, with a straight blade, a penknife, a carpenter's tenon or mitre saw, a slip of leather or linen, three inches wide and eighteen or twenty long, slit up the middle to the half of its length, a dozen or more ligatures, each about a foot long, made of waxed thread, bobbin, or fine twine, a hook with a sharp point, a pair of slender pincers, several narrow strips of sticking-plaster, dry lint, a piece of linen, large enough to cover the end of the stump, spread with simple ointment or lard, a bandage three or four yards long, the width of your hand; sponges and warm water.

Amputation of the Arm.

Operation. Give the patient ninety drops of laudanum, or let him breathe ether from a large sponge till sound asleep, and seat him on a narrow and firm table or chest, of a convenient height, so that some one can support him, by clasping him round the body. If the handkerchief and stick have not been previously applied, place it as high up on the arm as possible (the stick being very short) and so that the knot may pass on the inner third of it. Your instruments having been placed regularly on a table or waiter, and within reach of your hand, while some one supports the lower end of the arm, and at the same time draws down the skin, take the large knife and make one straight cut all round the limb, through the skin and fat only, then with the penknife separate as much of the skin from the flesh above the cut, and all round it, as will form a flap to cover the face of the stump; when you think there is enough separated, turn it back, where it must be held by an assistant, while with the large knife you make a second straight incision round the arm and down to the bone, as close as you can to the doubled edge of the flap, but taking great care not to cut it. The bone is now to be passed through the slit in the piece of linen before mentioned, and pressed by its ends against the upper surface of the wound by the person who holds the flap, while you saw through the bone as near to it as you can. With the hooks or pincers, you then seize and tie up every vessel that bleeds, the largest first, and smaller ones next, until they are all secured. When this is done, relax the stick a little; if an artery springs, tie it as before. The wound is now to be gently cleansed with a sponge and warm water, and the stick to be relaxed. If it is evident that the arteries are all tied, bring the flap over the end of the stump, draw its edges together with strips of sticking-plaster, leaving the ligature hanging out at the angles, lay the piece of linen spread with ointment over the straps, a pledget of lint over that, and secure the whole by the bandage, when the patient may be carried to bed, and the stump laid on a pillow.

The handkerchief and stick are to be left loosely round the limb, so that if any bleeding happens to come on, it may be tightened in an instant by the person who watches by the patient, when the dressings must be taken off, the flap raised, and the vessel be sought for and tied up, after which, every thing must be placed as before.

It may be well to observe that in sawing through the bone, a long and free stroke should be used, to prevent any hitching, as an additional security against which, the teeth of the saw should be well sharpened and set wide.

There is also another circumstance, which it is essential to be aware of the ends of divided arteries cannot at times be got hold of, or being diseased their coats give way under the hook, so that they cannot be drawn out; sometimes also, they are found ossified or turned into bone. In all these cases, having armed a needle with a ligature, pass it through the flesh round the artery, so that when tied, there will be a portion of it included in the ligature along with the artery. When the ligature has been made to encircle the artery, cut off the needle and tie it firmly in the ordinary way.

The bandages, etc., should not be disturbed for five or six days, if the weather is cool; if it is very warm, they may be removed in three. This is to be done with the greatest care, soaking them well with warm water until they are quite soft, and can be taken away without sticking to the stump. A clean plaster, lint, and bandage are then to be applied as before, to be removed every two days. At the expiration of ten or fifteen days the ligatures generally come away; and in three or four weeks, if every thing goes on well, the wound heals.

Amputation of the Thigh.

This is performed in precisely the same manner as that of the arm, care being used to prevent the edges of the flap from uniting until the surface of the stump has adhered to it.

Amputation of the Leg.

As there are two bones in the leg which have a thin muscle between, it is necessary to have an additional knife to those already mentioned, to divide it. It should have a long narrow blade, with a double-cutting edge, and a sharp point; a carving or case knife may be ground down to answer the purpose, the blade being reduced to rather less than half an inch in width. The linen or leather strip should also have two slits in it instead of one. The patient is to be laid on his back, on a table covered with blankets or a matress, with a sufficient number of assistants to secure him. The handkerchief and stick being applied on the upper part of the thigh, one person holds the knee, and another the foot and leg as steadily as possible, while with the large knife the operator makes an oblique incision round the limb, through the skin, and beginning at five or six inches below the knee-pan, and carrying it regularly round in such a manner that the cut will be lower down on the calf than in front of the leg. As much of the skin is then to be separated by the penknife as will cover the stump. When this is turned back, a second cut is to be made all round the limb and down to the bones, when, with the narrow-bladed knife just mentioned, the flesh between them is to be divided.

The middle piece of the leather strip is now to be pulled through between the bones, the whole being held back by the assistant, who supports the flap while the bones are sawed, which should be so