The first intention is to disperse the extravasated humour, and to strengthen the tone of the injured fibres. To this intention the parts should immediately be bathed with spirit of wine and camphor (A). But if the bruise is immediately on the joints, the linament of soap (B) is still superior. A bandage over the part, so as to keep it in rest as much as possible, is also of great service. If, however, the part is so very much bruised, that there appears a collection of crumous blood, and that an aposthume is actually the consequence, recourse may be had to the above poultice in order to ripen it the more, and bring it the sooner to a head; and then treat it as a common ulcer. But that seldom is the case.
If the contusion is great, and the patient is full of blood, bleeding is necessary; for in such a case a fever is apt to ensue, which should be guarded against, and the patient treated accordingly.
SECT. IV.
Of Dislocations
There are many accidents by which a limb may become dislocated; the reduction of which is a material point in surgery. But if a surgeon is not at hand, a man ought nevertheless, not to remain in that painful and deplorable state, that endangers not only the limb of becoming useless, but even the loss of life itself.
I shall proceed therefore in my directions as plain as possible, avoiding every expression that may render this operation prolix.
It must first of all be remembered what was said of joints, articulations, and ligaments in the first lecture under that head. We must thence observe, that a dislocation of the upper arm with the shoulder is the most common that happens, because of the great variety of motion, and the flatness of the head of the arm-bone, and the cavity of the shoulder blade. Next to this is the thigh bone, with the hip. But this is done by much greater force, and therefore more troublesome in reducing. All other joints that are angular are seldom really dislocated, being stronger secured, and cannot be separated from their articulation, without first tearing the ligamentous capsula that surround them; yet nevertheless, some are subjected to be partly dislocated; and this is what is commonly called sprains.
Dislocations may be from two causes; first from violence, secondly from weakness of the ligament. In the latter case the reduction is the easiest, but the limb is apt to slip out again by the least accident.[[11]]
[11]. I remember a man who frequently had his shoulder dislocated, and was his own operator in reducing it again. The first time the accident happened in the ship I was surgeon of, I was naturally called to his assistance: “Stop Doctor,” (said Tom) “I have got a tackle in my chest, and I will soon bouse it in again;” and sure enough, he had a pully, with which he immediately reduced it.