This accident is frequently attended with many bad symptoms, and often requires the operation of the trepan; which I shall here pass over, being too prolix for this place. I have only to observe, that we have frequent instances of the patient doing well without any other help than bleeding; and where there is no surgeon on board, this is the only remedy first to fly to, and gives the greatest chance for the patient’s life: next to this, shave the head, and treat him as circumstances shall direct, without meddling with the fracture, any farther than applying gentle fomentations, with flowers of chamomile (11) boil’d in claret, and some linament of soap (B) added to it; and if there is any wound, have it properly dressed as directed in the article of wounds.
Fracture of the Arm.
If the upper arm is fractured, proceed in the following manner:
First of all be sure it is a fracture; to know this, put one hand on the middle of the arm, and the other on the elbow, move it gently to and fro, and if there is a fracture, you will find it crackle by the touch, which sometimes is so distinct as to be heard. The arm at the same time is somewhat swelled, and either the patient cannot move it, or else it is attended with very great pain.
When the fracture is certain, then proceed in the following manner; Let the patient sit upon a low chair, or chest, let an assistant hold him steady, and let another lift up the arm, and extend it gradually, horizontal to the shoulder, keeping the elbow bent somewhat all the while.
Then with both your hands gently press the fractured bone, so that it may feel perfectly joined again. Sometimes it happens that the ends of the bones are somewhat slipt over each other; in which case, extension is the more requisite.
When this is done, then take a bandage of about two yards long, first rolled up, and wrung out of spirit of wine and camphor (A.); begin near the elbow, and lay it smoothly on, laping over a little; and proceed gradually till it comes to the shoulder, and then return with it back again till it is done.
This bandage should not be too tight, nor too slack, but so as immediately to suit the arm exactly. Over this bandage again, lay a double folded rag, called a compress, so as to cover the bandage; and over this again two splints, one above, and another below; which tie gently together with some tape in three places. Then put the arm into a sling; cover up the whole arm and hand, and let the patient go to rest.
If the fracture is upon the under arm, the reduction is a little more difficult; but only in the care it requires of reduction. As there are two bones in the under arm, it should well be examined which it is, or if both. In reducing of it, let the arm be bent as before; one assistant to hold the patient, one to hold the elbow, and another the wrist; gently extending, till the fracture is reduced, as before directed, and the bandage, compress, and splints, put on according to the same Method.
In this fracture the wrist and hand should be kept from moving; as the motion of their muscles will be apt in a great measure to hinder the bones from uniting again.