Hints to Travellers, Scientific and General, Vol. 2 / Tenth edition, revised and corrected

by Royal Geographical Society

If there is great swelling and tenderness of a limb, then it is advisable not to apply splints at once. Sand pillows should be made, or stockings nearly filled with sand and their mouths tied, and applied one on either side of the limb, to keep it absolutely still; the painful swelling may be reduced by applying ice or evaporating lotions. When the swelling is somewhat reduced, splints may be applied after proper manipulation.

Whilst the bandages should be firmly applied so as to keep the splints in position, they must not be bound too tightly, otherwise swelling and ulceration may be caused. If there is much pain and swelling after a fracture has been set, it will be necessary to loosen the bandages.

Union of the fractured bones is generally completed in about six weeks.

Collar-bones.—Fracture of the collar-bone should be treated by placing a large wedge-shaped pad (about six inches long, by three in thickness at the upper end) in the armpit, and securing it with tapes tied over the opposite shoulder. The elbow should then be brought forward, and raised and well supported by a broad triangular bandage or handkerchief, used as a sling, and with the ends tied over the opposite shoulder. A flannel or other bandage should then be wound round the chest, so as to secure the arm from accidental movements.

Ribs.—Fracture of the ribs may be treated by wrapping a flannel bandage round the chest pretty tightly, so as to limit the movements of breathing, which are very painful. The flannel should be secured by stitching, and the upper turns should be fixed by broad tapes passed over the shoulders and firmly stitched. Firm strapping of the side with adhesive plaster is still better. For this purpose about six strips of plaster one to two inches wide and eighteen inches long should be applied evenly round the side of the chest; each piece should be overlaid by the next piece above it for about half an inch. To secure rest for the affected side of the chest, the strapping should not only cover the broken bone, but should extend to about three inches above and below it, and should reach well beyond the middle line both in front and behind.

Upper Arm.—Fracture of the upper arm may be treated by the application of several narrow splints reaching from the armpit to the elbow, well padded, and supported in position by a bandage carried from the fingers to the armpit. Care must be taken that the splints on the inner side do not chafe the folds of the armpit. The hand and wrist should then be supported in a sling, but the elbow must be allowed to hang free.

Forearm.—Fractures of the forearm must be treated by two splints, each wider than the limb. The injured limb is allowed to hang down by the side, palm forwards. One splint reaching from the elbow to the finger-tips is applied to the back of the limb; the other is placed on the front, and only reaches from the bend of the elbow to the level of the ball of the thumb. The splints are secured temporarily by a couple of slip knots. Now bend the arm to a right angle, thumb uppermost, and bandage securely from the tips of the fingers up to the elbow.

Thigh.—Fractures of the thigh are serious; they require the patient to be kept in bed till union has been effected, and they are more likely to lead to shortening and permanent lameness if not very carefully treated, and the assistance of a skilled surgeon is urgently needed. A long splint is applied to the outside of the limb, reaching from the armpit to beyond the foot, and secured above by a bandage passing round the body, whilst the foot and leg are firmly bandaged to it below.

Leg.—Fractures of the leg should be treated by applying a splint on each side, long enough to reach from the knee to a little below the sole of the foot. They should be carefully applied with bandages, keeping the great toe in a line with the inner border of the knee-cap. When the accident occurs in the open air, the injured limb should be tied to the sound one, till the patient is brought to a place of security, the toes being prevented from pointing inwards.

Lower Jaw.—Manipulate the parts into their normal position and mould a splint of gutta percha, or other material, as accurately as possible to the lower jaw. If a tooth is loose and prevents the two jaws meeting properly it should be taken out.