A
CASE OF FRACTURE OF BOTH COMMINUTED:
RECOVERY
THIGHS, ONE WITHOUT
BEING
SHORTEN.
ING OF EITHER LEG.
Bishop, M.R.C.S.E., &c., Koomtai Tea Estate, Upper Assam. On September 29th a Bengalee boy about 16, was descending from a rolling machine while in motion, though he had been repeatedly cautioned against doing so ; his cloth caught in a revolving rod which seems to have dragged his body round, and as the cloth tightened and before the machine could be stopped, crushed his thighs between rod and machine ; he was at once removed ; the gentleman who saw him as he was being taken out, says he presented a terrible sight?both limbs dangling down, and apparently broken. No time was lost in sending off for myself, and I arrived some three hours after the accident, in the meantime the boy had been laid on a plank covered by blankets on a native bed. On arrival he was somewhat collapsed, but not to the extent one would suspect after such an accident; he was quite sensible. As his pulse was quick and rather feeble, I gave him some stimulant and proceeded to examine his limbs ; I found a comminuted fracture of upper third of left thigh, the right thigh was found to be fractured in the lower third but not comminuted ; there was no wound, only a considerable deal of swelling and some slight abrasion of the skin at the places the rolling machine had caught. I had the patient removed to the Bungalow, and small quantities of champagne and beef-tea given now and then. The next thing to do was to manufacture some splints, for in Assam we as a rule have not all the latest things in splints and instruments to hand, and a well-appointed hospital with every appliance, and nice trim nurses, so we do the best we I managed by evening to get some long splints made can. out of the top of an old box, and proceeded to set the thighs, By T. O.
which I did in the usual way, but by way of additional security I put on short splints on the inner side and over top of thigh. I managed to get the thighs in good position. He was very restless during the night, and had very little sleep ; towards morning he became quite delirious : during night he had two doses of chloral consisting of 30 grains in each dose. In the morning he seemed feverish and very restless : was with difficulty restrained. He was ordered a draught every 4 hours consisting of Quinine 5 grs., Chloral 10 grs., Bromide of Potash 5 grs., 15 drops of Dilute Sulphuric Acid and 1 oz. water. As I had broken my thermometer I was unable to take his temperature ; he passed his water from time to time, and took beef-tea and sago with a little stimulant. The same evening he was much better, more quiet and sensible ; he was removed from the Bungalow to his own house in the lines ; the splints being all tightened up ; progressing well; to continue medicine and nourishment; he slept at intervals that night. October 1st.?Still better ; was able to take his temperature to-day, 101?; his bowels not being opened, he was ordered a dose of castor oil ; this acted freely : to continue treatment. I did not get a chance of seeing him again till October 3rd, when he seemed feverish, and tongue dirty ; complaining of much pain. Temperature 102? ; he was ordered to discontinue mixture ; to have another dose of castor oil and some I loosened the bandages and made him saline mixture. comfortable. October 4th.?Much better : bowels have been well moved ; tongue is clearing, and has no fever to speak about : temperature 100?: does not complain of much pain. October 5th.?No seen. 6th.?Still improving; temperature 99? tongue clean ; appetite good ; no fever ; to discontinue saline mixture and 15
drops of Tincture Ferri Perchlor. and Infus. Quassia 1 ounce three times daily. It would be tedious to report the daily state further. Suffice it to say that on the 9th of October I had to remove the perineal bands as a sore had formed on the right side and the skin was inflamed on the left. The sore, which was situated over Poupart's ligament, was dressed with carbolic oil, the other side was dressed with spirit lotion and never got into a sore. The perineal bandages I never put on again ; at this time I used sand bags instead of the short splints, and I made further extension by fastening ropes to his feet by a bandage passing round posts ; these I could tighen up as I wished, and used to do so daily, getting both limbs as
near.equal length
as
possible.
In the middle of December I removed the splints and found union had taken place, though there was some overlapping in the right thigh. I just let him lay for another fortnight with only sand bags, and ordered him to lift his limbs and work them about several times a day ; oil was likewise well rubbed in. At the end of this time he used to get up every day and walk about with sticks for a short time. At the present time. February 5th, he can walk with one short stick : has no lameare of equal length : he gains strength ness, and both limbs daily, and will in a day or so throw his remaining stick on examination do we away ; there is no deformity, and only find the overlapping of one bone. Remarhs.?This case presents one or two points of interest. The first is the apparently slight constitutional disturbance after such an injury, and I believe myself that if he had not had any stimulants he would have been far less delirious and feverish. Another point of interest is that both perineal bands were removed without hindering the cure, except the overlapping of the bone on the right side, which, in my opinion, accounts somewhat for the limbs being of equal length, and is rather a gain than a loss. It's as well to notice that after the removal of the splints, nothing further was used in the way of starch or gum and chalk bandages.
CASE OF FRACTURE OF BOTH COMMINUTED:
RECOVERY
THIGHS, ONE WITHOUT
BEING
SHORTEN.
ING OF EITHER LEG.
Bishop, M.R.C.S.E., &c., Koomtai Tea Estate, Upper Assam. On September 29th a Bengalee boy about 16, was descending from a rolling machine while in motion, though he had been repeatedly cautioned against doing so ; his cloth caught in a revolving rod which seems to have dragged his body round, and as the cloth tightened and before the machine could be stopped, crushed his thighs between rod and machine ; he was at once removed ; the gentleman who saw him as he was being taken out, says he presented a terrible sight?both limbs dangling down, and apparently broken. No time was lost in sending off for myself, and I arrived some three hours after the accident, in the meantime the boy had been laid on a plank covered by blankets on a native bed. On arrival he was somewhat collapsed, but not to the extent one would suspect after such an accident; he was quite sensible. As his pulse was quick and rather feeble, I gave him some stimulant and proceeded to examine his limbs ; I found a comminuted fracture of upper third of left thigh, the right thigh was found to be fractured in the lower third but not comminuted ; there was no wound, only a considerable deal of swelling and some slight abrasion of the skin at the places the rolling machine had caught. I had the patient removed to the Bungalow, and small quantities of champagne and beef-tea given now and then. The next thing to do was to manufacture some splints, for in Assam we as a rule have not all the latest things in splints and instruments to hand, and a well-appointed hospital with every appliance, and nice trim nurses, so we do the best we I managed by evening to get some long splints made can. out of the top of an old box, and proceeded to set the thighs, By T. O.
which I did in the usual way, but by way of additional security I put on short splints on the inner side and over top of thigh. I managed to get the thighs in good position. He was very restless during the night, and had very little sleep ; towards morning he became quite delirious : during night he had two doses of chloral consisting of 30 grains in each dose. In the morning he seemed feverish and very restless : was with difficulty restrained. He was ordered a draught every 4 hours consisting of Quinine 5 grs., Chloral 10 grs., Bromide of Potash 5 grs., 15 drops of Dilute Sulphuric Acid and 1 oz. water. As I had broken my thermometer I was unable to take his temperature ; he passed his water from time to time, and took beef-tea and sago with a little stimulant. The same evening he was much better, more quiet and sensible ; he was removed from the Bungalow to his own house in the lines ; the splints being all tightened up ; progressing well; to continue medicine and nourishment; he slept at intervals that night. October 1st.?Still better ; was able to take his temperature to-day, 101?; his bowels not being opened, he was ordered a dose of castor oil ; this acted freely : to continue treatment. I did not get a chance of seeing him again till October 3rd, when he seemed feverish, and tongue dirty ; complaining of much pain. Temperature 102? ; he was ordered to discontinue mixture ; to have another dose of castor oil and some I loosened the bandages and made him saline mixture. comfortable. October 4th.?Much better : bowels have been well moved ; tongue is clearing, and has no fever to speak about : temperature 100?: does not complain of much pain. October 5th.?No seen. 6th.?Still improving; temperature 99? tongue clean ; appetite good ; no fever ; to discontinue saline mixture and 15
drops of Tincture Ferri Perchlor. and Infus. Quassia 1 ounce three times daily. It would be tedious to report the daily state further. Suffice it to say that on the 9th of October I had to remove the perineal bands as a sore had formed on the right side and the skin was inflamed on the left. The sore, which was situated over Poupart's ligament, was dressed with carbolic oil, the other side was dressed with spirit lotion and never got into a sore. The perineal bandages I never put on again ; at this time I used sand bags instead of the short splints, and I made further extension by fastening ropes to his feet by a bandage passing round posts ; these I could tighen up as I wished, and used to do so daily, getting both limbs as
near.equal length
as
possible.
In the middle of December I removed the splints and found union had taken place, though there was some overlapping in the right thigh. I just let him lay for another fortnight with only sand bags, and ordered him to lift his limbs and work them about several times a day ; oil was likewise well rubbed in. At the end of this time he used to get up every day and walk about with sticks for a short time. At the present time. February 5th, he can walk with one short stick : has no lameare of equal length : he gains strength ness, and both limbs daily, and will in a day or so throw his remaining stick on examination do we away ; there is no deformity, and only find the overlapping of one bone. Remarhs.?This case presents one or two points of interest. The first is the apparently slight constitutional disturbance after such an injury, and I believe myself that if he had not had any stimulants he would have been far less delirious and feverish. Another point of interest is that both perineal bands were removed without hindering the cure, except the overlapping of the bone on the right side, which, in my opinion, accounts somewhat for the limbs being of equal length, and is rather a gain than a loss. It's as well to notice that after the removal of the splints, nothing further was used in the way of starch or gum and chalk bandages.
