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
5. It is difficult to find an instance where the advantages of
reduction have been more remarkable than in the preceding one.
The patient had passed six days in pain, extreme agitation, and
uninterrupted delirium: the foot was reduced, and these unfavourable
appearances instantly vanished, and were succeeded by a state of
tranquillity. Alarmed by such a state of things, the ancients would
doubtless have proceeded to amputation. Let us examine into the motives
which led Desault to an opposite line of practice, and then inquire
into the cause of the success with which that practice was crowned.
6. Had amputation been performed here, it must have been for one of the
two following reasons; 1st, for fear of gangrene; or 2dly, to remove
the unfavourable symptoms that existed. The first apprehension would
have been quite visionary, in as much as all the blood-vessels were
sound. Would the second consideration have been any better founded? It
was perfectly obvious, that the unfavourable symptoms which existed
arose from the tension and overstretching of the parts, in consequence
of the preternatural position of the bones of the foot. The indication
was evident. Replace these bones in their natural situations, the
strained parts will then necessarily become relaxed, and all the
troublesome and alarming symptoms cease with the cause that produced
them. Experience confirmed the justness of this reasoning.
7. But the mere replacement of the parts would be of very little avail,
if it were not permanently maintained, and followed up by a judicious
mode of treatment. Without such treatment there would doubtless be
reason to apprehend all that train of troublesome consequences, of
which authors speak in such frightful terms, and which arise, not from
the nature of the luxation, but from the manner in which the patient
is treated. A loose apparatus, incapable of preventing displacement,
would allow the bones to be deranged anew, and to produce again an
overstraining of the parts, accompanied with pain, swelling, &c.
Irritating local applications, such as camphorated spirits of wine,
&c. would increase these pains; emollients which are employed in other
cases would keep up the swelling.
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