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
8. It follows from what has just been said, that an opposite mode
of treatment ought to succeed the reduction, and this we see was
the case in the preceding instance. There, when the bones were once
reduced, all new displacement was prevented, because the apparatus
was so constructed, as to counteract the tendency of the bones to
be displaced. The external edge of the foot, which had been turned
outwards, was now pushed inwards by a thick compress; the same means
served to push outwards the internal malleolus, which had received by
the accident an inclination inwards, and to push the anterior part
of the tibia backward, and the os calcis forward, both of which were
displaced, as has been remarked, in contrary directions. Two strong
splints fixed the lateral compresses, while the anterior and posterior
ones were firmly secured by rollers. In the midst of all these
resistances, the foot being necessarily immoveable, no new displacement
could occur.
9. A suitable and judicious position, in which the foot, raised a
little higher than the leg, was placed on a pillow forming an inclined
plain, prevented swelling, while gentle compression, made by a bandage,
contributed to the same end. This end was also further attained by the
external topical applications. To relieve pain and remove congestion,
were here, as in sprains, the two indications to be fulfilled. To these
indications the spirituous and the relaxing applications formerly in
use, are alike opposed. Vegeto-mineral water, on the contrary, fulfils
them extremely well. Hence the necessity of keeping the apparatus
constantly wet with that liquid.
10. Regimen influences not a little the success of the treatment.
A strict diet is necessary during the time of the inflammatory and
unfavourable symptoms. Any excess might then prove fatal. Desault
gave, in his lectures, an account of a woman, who had her foot luxated
outward, and the astragulus forward. Her fever was considerable, her
pains excruciating, and the swelling wore an alarming aspect. The
luxations were reduced: all the threatening appearances vanished, and
every thing seemed to promise a favourable termination of the disease.
But, on the fiftieth day, the patient, having procured strong food, ate
largely of it: in the evening all the unfavourable symptoms returned;
the swelling became great, and a few days afterwards she died.
But if strong food be prejudicial during the time in which bad symptoms
are to be dreaded, a diet too strict would be equally injurious when
that time is passed. The weakened powers of the system would not be
adequate to the purposes of a cure, particularly to the consolidation
of the bone, should the case be a fracture. Desault, therefore,
permitted the patient to increase his diet by degrees, and at length to
return to his usual regimen.
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