A Treatise on Fractures, Luxations, and Other Affections of the BonesDesault, P.-J. (Pierre-Joseph)
Science
A Treatise on Fractures, Luxations, and Other Affections of the Bones
Desault, P.-J. (Pierre-Joseph)
Dislocations; Fractures; Surgery
2. To furnish suitable examples on this head constitutes my only object
in the present memoir, which will consist of the histories of a few
cases, with such inferences and remarks as the occasion may seem most
naturally to suggest. Here the practice of a great master, varying his
means with the varying forms of disease, will serve as models to those
who may meet with similar cases. Our experience is composed of the
facts which we receive from reading, as well as of those derived from
observation. Who would have a right to call himself a surgeon, if he
had no other title to that name, but such as resulted exclusively from
his own personal observation?
3. However difficult it may be, as already observed, to speak in
general terms, on the present subject, we may yet assert with safety,
that authors have greatly exaggerated the danger of complicated
luxations of the foot. Terrified at the extent and unpromising
appearance of the accidents, these writers have lost that confidence in
the powers of nature which we never ought to abandon. They have taken
up an opinion, that luxations of the foot, differing in their symptoms
from other luxations, require also a different mode of treatment; that
reduction, by perpetuating the accidents of the case, must prove fatal,
and that amputation ought to be adopted as the only resource. Cases do
certainly at times occur, where a doctrine different from this would be
fatal in its effects: such are those terrible lacerations, where the
foot is entirely separated from the leg, except some shreds of flesh
with a few tendons among them that still retain it.
4. But, provided the blood-vessels have escaped, and any hope of
circulation and life in the part still remain, the success of reduction
should always be first tried; and the following examples will show,
what ought to be expected from this practice, when accompanied by
skilful treatment.
§ II.
LUXATION OF THE FOOT, COMPLICATED BY A FRACTURE OF THE FIBULA, TIBIA,
&C.
CASE I. (The following case was collected by Leveille.) Abraham Genty,
aged forty-three, a dealer in wine, as he was running along the street,
slipped, and made a false step on his left foot, which turned with
its external edge under him, and its internal edge upwards. He fell,
luxated his foot, and fractured the fibula.
The patient was carried home, where a surgeon who was ignorant of his
profession being called, did nothing but apply a cataplasm to the foot.
In the evening the parts began to swell, and were extremely painful;
fever supervened, accompanied with great restlessness. Third day, to a
rapid increase of all the symptoms was added a delirium; blood-letting
from the jugular vein was prescribed to no purpose; things continued
to grow worse till the sixth day, when the patient was brought to the
Hotel-Dieu, in extreme danger.
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