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of the slide. A pair of spiral springs is placed in the auger holes at the upper end of the main shaft: which constitute the extending power. A padded crutch of the same width and thickness of the shaft, is placed at its superior extremity, having two legs or rounded slides adapted to play in the auger holes containing the spiral springs, and intended to press upon them when the splint is applied to the limb. On the exterior side of the crutch is a steel spring or hand, which plays upon the ratchet on the corresponding side of the shaft, in order to secure all the extensive power of the springs. A few knobs or buttons on the bevelled edges of the splint, and one on each end of the perinæal crutch, are convenient to attach straps or bandages to, for securing the splint to the thigh, and for other similar purposes. Before applying this splint, the patient should be placed in a recumbent position, his injured limb extended and abducted eight or nine inches out of a straight line with his body, and a gaiter put upon the foot and ankle, with the bandage of Scultites to the thigh; the padded crutch should then be pressed down upon the spiral springs, so as to rest upon the superior end of the shaft, and be placed against the perinæum; the gaiter is next fastened to the block at the inferior end of the grooved slide; the length of the splint should now be adjusted, and secured by the pins in the bevelled edge of the shaft; the proper degree of extension will be known by the straps of the gaiter being drawn tight, and by the pad pressing firmly against the perineum. Three short splints should now be applied to the thigh, one posteriorly, one anteriorly, and one externally, and be safely secured by straps or bandages attached to the main splint. The padded crutch should be liberated from its close attachment to the shaft, so as to admit the free motion and force of the spiral springs; and the whole limb should be placed upon a soft pillow or bolster. To each splint there should be four springs, one having a force of three, one of six, one of nine, and one of twelve pounds, so that the surgeon can regulate the power of extension according to the requisite demand. No more extending power should be applied, than is necessary for the successful treatment of the case ; and we believe that very little is necessary, after ossific matter begins to be deposited around the fragments of the fractured bone.
The mechanism of this splint, I think has been made to correspond with the mechanism of the thigh ; the extension is from the perinæum, and counter extension from the ankle. When a person lies in a horizontal position or sits upright, with the thighs in contact, the distance from the trochanter to the condyle of the os femoris, is much greater than from the perinæum to the condyle of the same bone; but let the thigh be abducted to its fullest extent, the distance from the perinæum to the condyle will be as great, and sometimes greater than it is from the trochanter : this length is gained at the perinæum, therefore the extending power should be there ; such is the arrangement of this apparatus, while the retaining power is there also. Let abduction take place either by the motion of the limb or of the body, the length of the splint will adjust itself to the increased length of the thigh. If the counter extending bands become relaxed, it will also tighten them. If perpetual extension will keep a fractured thigh from becoming shortened, this splint will accomplish that end. In luxation of the hip-joint, I see no reason why the lever can not in some instances be used, instead of the pulley or other means of extension for the purpose of reduction. I do conceive that a luxation could be reduced by first abducting the limb to its fullest extent, then taking an ordinary crutch, and pressing the pad on the perinæum of the sound side, fastening the knee or ankle securely to the shaft, and then abducting it; an extension of three or four inches could be obtained in this way. Any person, with common intelligence, could produce an extending power of more than a thousand pounds, if required, being directed by the surgeon, while the latter would be at liberty to manage the thigh according to his pleasure. I have never treated a dislocation in this way, but all the cases of fracture of the os femoris, where the self-adjusting splint has been used, have terminated without deformity.
Vincenttown, September 8th, 1847.
NOTE.—Dr. Woolston's splint has certainly the merit of sim plicity in its construction, and may be very conveniently carried from place to place by the country practitioner. The Doctor has kindly left one with us, and shown us a recommendatory certificate signed by several physicians of this county. We hope the apparatus may be fairly tried.Ed.
REMARKS ON DISSECTING WOUNDS.
BY HENRY HARTSHORNE, M, D.,
Resident Physician to the Pennsylvania Hospital.
In these affections, the writer has had some positive expeience; having been twice very severely affected, besides seeing and being cognizant of several cases among the residents and nurses of the hospital at different times. The first of my own attacks, and the most serious, was caused by pus from the living boily; the other was strictly a dissecting wound. A full account of the former was published in the American Journal of Medical Sciences, for April, 1846.
From these cases, then, carefully studied, I infer:
1. That there is a poisonous property in many dead bodies, and in pus and other morbid products of diseased living bodies, which makes it dangerous, much more to some constitutions than to others, for these matters to touch the abraded skin. I am aware that this is doubted by some very respectable physicians, who ascribe the symptoms in all cases to the state of the constitution of the person; asserting that exactly similar effects have resulted from slight wounds of any kind, where a virus could not possibly be suspected.
Sych cases have occurred, doubtless; such idiosyncrasies or vitiated states of body, rendering any injury serious and perilous, do exist. But from the history of my own system, and its accidents alone, I am thoroughly convinced, that there is a cause, external to the body, vastly more liable to be followed by painful and dangerous results than any mere wound ever is.
2. That the affection, certainly in my case, is inflummatory; and commences with inflammation of the lymphatics, which absorb the poisonous matter, and carry it along their trunks, lighting up inflammation even to the axilla or farther.
The evidence of the distinctness in character between this angioleucitis and erysipelas, is also plain. They may exist together; violent erysipelas is almost always accompanied by angioleucitis; but the one is inflammation of the skin, diffusive, general; the other of one set of absorbents only, and often clearly marked by locality in them alone. I have seen, in my own person, and in repeated instances in patients, a considerable inflammation of the lympathic vessels to the whole length of an arm or leg, with no diffuse inflammation of the skin whatever, and therefore without erysipelas.
3. In my first case an abscess formed in the axilla, three weeks after the wound. Now this was not a metastatic abscess, from transfer of pus from the inflamed hand, or even from the original pus inoculation ; it was the result of violent lymphatic inflammation, terminating finally in suppuration. This is proved clearly by the length of time which elapsed be fore its appearance, and the complete hardness of the tumour for a week or two after it became apparent and painful.
4. From this establishment of the inftammatory character of the affection, then, it is to be deduced of course, that the treatment should, as a general rule, be antiphlogistic. There may, however, be constitutions whose want of vigour requires that depletion and reduction should be only local; I have seen no such instance yet.
In my second attack, I was at once more freely depleted, and dieted more perseveringly than in the first; and the constitutional symptoms were much less violent and protracted.
The recovery of George O'Brien, assistant nurse, may illustrate what I believe to be the best mode of treatment.
The day after the side of his thumb was punctured by a needle in sewing up a body, it swelled and grew very stiff and painful, and redness followed the lympatic lines up to the arm-pit.
He at once was directed to take an ounce of epsom salts, and
knock off all animal food, (his fever was not high enough for the lancet,) and also had at once a score or more of foreign leeches applied to the thumb. A blister was then put upon
the wrist and allowed to vesicate. Cold water was kept to the hand at first, and then simple cerate. I avoided a poultice, because it had increased the pain to torture in my own case. The low diet was kept up, with rest to the arm in a sling. In three or four days he was well. It
may not be amiss to repeat, that a flaxseed poultice increased the agony of my first night of the last attack three-fold, while cold water constantly applied gave great relief. The inflammation in this case took on more the character of diffuse erysipelas; my first was one of pure angioleucitis alone.
On about the fifth day of the former, when the violence of inflammatory action had somewhat abated, and suppuration was contending with a slight tendency to sloughing, great relief and improvement was derived from a blister which my father directed immediately over the back of the hand, then enormously swelled. It finally pointed, and was opened almost exactly over the first joint of the fore-finger. For two or three days a bloody sanious pus was discharged, and, for two or three weeks, serum to the amount of a teaspoonful daily. A sinus, which existed through to the palm of the hand, finally closed, and the opening healed up. A great deal of lymph was thrown out, fastening all my fingers, especially the fore-finger and thumb, in false anchylosis ; gradually it was all absorbed, except that which glued together the perforans and perforatus tendons of the affected finger. This remains yet, after several months, so that I have no flexor power over the last two phalanges of that finger, although the joints are perfectly free and limber.
8th mo. 23d, 1847. I find upon my notes that I just escaped another attack, threatened in consequence of the prick of a pin, while dressing cases in the ward. As the puncture was not deep enough to draw blood, I had paid no attention to it. In all instances in which I have thoroughly sucked the wound instantly, no symptoms have resulted. I believe this preventive more effectual than caustic. Here, however, so great was my