Chapter XXXVIII: Part 38

[63] [A comparison of the results of the different kinds of treatment of disunited fracture, furnished by Dr. Norris of Philadelphia, in an able and elaborate article in the American Journal of the Medical Sciences, for January, 1842, leaves no doubt as to their relative value. Of forty-six cases in which the _seton_ was employed, thirty-six were cured, three partially relieved, five not benefited, and two died. In twenty-one the seton was introduced with, and in twenty-four without, previous incision: of the former seventeen were cured, two improved, one failed, and one died; of the latter eighteen were cured, one was benefited, five failed, and one died. In reference to the seat of the fracture, the cases stand as follows:—

13 for the femur, of which 9 were cured.
10 ” leg, ” 10 ”
16 ” humerus, ” 10 ”
6 ” forearm, ” 6 ”
1 ” jaw, ” 1 ”

The average period of the existence of the fracture in the above cases was nearly twelve months and a half, the longest ten years, the shortest six weeks. The mean period of the retention of the seton was seven weeks and three days. In one instance—that of a fractured humerus—it was left in thirteen months, notwithstanding which it finally failed. The average time required for the cure was nearly three months, the longest eight months, the shortest three weeks. Arterial hemorrhage occurred in two of the cases; in ten, severe fever, erysipelas, or profuse suppuration.

Of thirty-eight cases in which _resection_ was performed, twenty-four were cured, one improved, seven failed, and six died. The seat of the injury was as follows:—

12 were in the femur, of which 7 were cured.
6 ” leg, ” 5 ”
12 ” humerus, ” 6 ”
7 ” forearm, ” 5 ” and 1 improved.
1 ” jaw, ” 1 ”

The longest period of the existence of the fracture in these cases was five years, the shortest ten weeks, the average thirteen months and nineteen days. The average time required for effecting a cure was four months, the shortest one month, the longest thirteen months. In seventeen of the cases other methods of treatment had been ineffectually tried: in six the resection was followed by erysipelas, in one by phlegmasia dolens, and in two by profuse suppuration and abscesses.

Of thirty-six cases healed by _pressure and rest_, twenty-nine were cured, one improved, and six failed. The seat of fracture was:—

In 13 cases in the femur, of which 9 were cured.
” 7 ” leg, ” 7 ”
” 12 ” humerus, ” 9 ”
” 4 ” forearm, ” 4 ”

The average duration of the fracture in the above cases was five months and twelve days, the longest twenty-two months, the shortest four weeks. The mean period required for a cure was nine weeks, the longest nine months, the shortest eighteen days. In one of the cases the treatment was productive of excoriations, in three of severe pain and inflammation.

_Cauterization_ of the ends of the fragments, after free exposure of them by the knife, was successfully employed in six cases; in two others it completely failed. The article most frequently used was the caustic potash. Frictions succeeded in eleven cases.

From a careful analysis of all the circumstances connected with the preceding cases, one hundred and thirty-nine in number, and of which the above is an abstract, Dr. Norris has deduced the following conclusions:—1. That non-union after fracture is most common in the thigh and arm. 2. That the mortality after operations for its cure follows the same laws as after amputations and other great operations on the extremities, the danger being in proportion to the size of the limb and the proximity of the injury to the trunk. 3. That failures after operations are more frequent in the humerus than in other bones, and in middle-aged and elderly persons than in young ones. 4. That the seton, variously modified, is safer, speedier, and more successful than resection or caustic. 5. That incising the soft parts previously to introducing the seton augments the danger, but renders the cure more certain and expeditious. 6. That allowing the seton to remain in for a long time exposes to accidents, and does not facilitate the cure. 7. That the seton is least successful in the femur and humerus.—ED.]

INDEX.

Abdomen, affections of, 412
injuries, 438, 440

Abscess, 31
lumbar, 441

Adhesion, 25

Albugo, 264

Amaurosis, 275

Amputation, 612
arm, 624
fingers, 619
foot, 628
forearm, 622
hip-joint, 631
leg, 628
shoulder-joint, 625
thigh, 630

Anchylosis, 73

Aneurism, 118, 121
by anastomosis, 127
popliteal, 125, 541
axillary, 389
osseous, 158

Aneurismal varix, thigh, 542

Anthrax, 63

Antrum maxillare, inflammation of, 317

Anus, pruritus, 460 artificial, 434

Arterial system, diseases, 116, 121

Articular cartilages, atrophy and hypertrophy, 75

Artificial anus, 433, 434

Artificial pupil, 287

Ascites, 435

Axillary aneurism, 389

Bladder, inflammation of, 469
irritable, 470

Blennorrhœa, 247

Bone, diseases, 94
fractures, 552

Brasdor’s operation, 126

Bronchocele, 377

Bruise, 610

Bubo, 197

Bubonocele, 416

Bunnion, 544

Burns, 211

Bursæ, diseases of, 80
inflammation of, 543

Calculus, in the female, 530
salivary, 336
vesicæ, 508

Carbuncle, 63

Carcinomatous tumours, 142

Caries, 96

Castration, 507

Cataract, 277, 279, 280

Chancre, 201

Chemosis, 259

Chest affections, _see_ Thorax.

Chimney-sweeper’s Cancer, 495

Choroiditis, 274

Cirsocele, 417

Club-foot, 545

Compression, 226

Concretions, salivary ducts, 336

Concussion, 218

Congestion, 23

Corectomia, 287

Corneitis, 261

Corodialysia, 288

Corotomia, 287

Coxalgia, 81

Croup, 354

Cynanche trachealis, 354

Deafness, 375

Delitescence, 26

Dislocations, 588
ankle, 606
carpus, 599
clavicle, 592
elbow-joint, 596
fingers, 599
hip-joint, 600
congenital luxation, 604
lower jaw, 591
patella, 605
radius, 597
shoulder-joint, 592
tarsus, 606
wrist-joint, 598

Distortion of the feet, 545
varus, 547
valgus, 548
pes equinus, 548
calcaneal, 549

Ear, diseases of, 373
foreign bodies in, 375

Ear, polypus, 375

Eburnation, 75, 113

Ectropion, 254

Eczema rubrum, 211

Emprosthotonos, 183

Empyema, 410

Encanthis, 252

Encysted tumours, 151, 336, 406
of eyelids, 253
of the breast, 406

Enterocele, 415

Entero-epiplocele, 415

Entropion, 255

Epiphora, 247

Epiplocele, 415

Epispadias, 495

Erethismus, 211

Erysipelas, common, 55
hospital, 57
phlegmonous, 56

Erythema, 55

Excision, diseased bone, 632
of joints, 634

Exomphalos, 415

Exophthalmia, 266

Exostosis, 153
of distal phalanx, 551

Eye, diseases, 245

Fever, hectic, 42
inflammatory, 19
irritative, 43

Fistula lachrymalis, 248
in ano, 449, 450
in perineo, 472

Fractures, 552
clavicle, 564
cranium, 227, 558
compound, 553, 556
disunited, 586
face, 558
femur, 575
humerus, 569
metacarpal bones, 574
olecranon, 571
patella, 581
pelvis, 574
phalanges, 574
radius, 572
ribs, 566
scapula, 565
shoulder, 567
simple, 553
spinal column, 560
sternum, 567
tarsus, 584

Fractures of the tibia and fibula, 583
ulna, 710

Frænum linguæ, division of, 334

Fragilitas ossium, 110

Fungus hæmatodes, 147

Furunculus, 62

Ganglia, 401

Gangrene, 43

Genital organs, affections of, 461

Glaucoma, 277

Gonorrhœa, common, 462
in females, 531
præputialis vel spuria, 490

Gonorrhœal lichen, 532

Gums, inflammation, 337
tumours, 337

Gunshot wounds, 180

Hare-lip, 323

Hæmatocele, 503

Hemorrhage, 129, 166

Hemorrhoids, 445
distinct varieties, 445

Hectic fever, 42

Hernia, 412
of the iris, 264
cerebri, 233
congenital exomphalos, 415
scrotal, 413
crural, or femoral, 416
infantilis, 414
inguinal, direct, 415
oblique, 416
scrotal, 416
umbilical, 430
humoralis, 467

Hospital gangrene, 191

Humeral artery, 394

Hydatic tumours, 161

Hydrocele, 417
of the neck, 381

Hydrops articuli, 68

Hydrophthalmia, 266

Hydrothorax, 410

Hypopium, 273

Hypospadias, 495

Incontinence of urine, in females, 489

Inflammation, 13

Injuries of the head, 215

Iritis, 272

Irritation, 20

Irritative fever, 43

Joints, diseases of, 67
growths from synovial membranes, 79
hip-joint disease, 81, 91
loose cartilages, 80
neuralgic affections, 78
scrofulous disease, 77

Keratonyxis, 284

Larynx, foreign bodies in, 363
ulceration, 361

Laryngitis, 354

Leucoma, 264

Leucorrhœa, 531

Ligature of arteries, 123
axillary, 392

Ligature, brachial, 392
carotid, 385
femoral, 159, 541
humeral, 394
iliac, 539

Ligature of innominata, 387
subclavian, 387, 389

Lips, congenital deficiencies, 322
ulcers, 319

Lithotomy, 519

Lithotrity, 517

Lower jaw, osteosarcoma, 343
spina ventosa, 341

Lumbar abscess, 441

Lupus, 310

Luxations, _see_ Dislocations.

Malignant pustule, 193
polypi, 303

Mamma, diseases, 405
encysted tumours, 406

Melanosis, 142

Metastasis, 26

Mollities ossium, 110

Morbus coxarius, 81

Mortification, 43

Mucous membranes, inflammation, 65

Myocephalon, 264

Nasal polypi, 310
nævi, 128, 130

Nebula, 264

Necrosis, 103

Neuralgia of the rectum, 460

Neck, hydrocele, 381 distortion, 382

Noli me tangere, 310

Nose, diseases, 308

Œdema glottidis, 358

Œsophagus, foreign bodies, 371
stricture, 369

Œsophagotomy, 372

Onychia, 399

Opisthotonos, 183

Ophthalmia, 257
neonatorum, 261
purulent, 260
tarsi, 265

Osseous aneurism, 156

Osteosarcoma, 154

Otitis, 373

Ovarian dropsy, 436

Ozœna, 310

Palate, congenital deficiencies, 332
ulcers, 329

Paracentesis abdominis, 435

Paraphymosis, 491

Paronychia, 396

Periostitis, 94

Pes equinus, 548

Phagædena, sloughing, 191

Pharyngitis, 368

Phlebitis, 130

Phlegmonous erysipelas, 56

Phthisis laryngea, 360

Phymosis, 491

Piles, 445

Polypus, 150
nasal, 301
ear, 375

Prolapsus ani, 453

Pruritus of the anus, 460

Pterygium, 256

Puncture of the bladder, 488

Pus, 29

Pustule, malignant, 193

Rachitis, 110, 112

Ranula, 335

Rectum, affections, 445
inflammation, 447
schirro-contracted, 452
neuralgia, 460

Resolution, 25

Retention of urine, 478
in females, 533

Rhinoplastic operations, 312

Rickets, 110

Sarcocele, 505

Scalds, 211

Scrofula, 34

Serous membranes, inflammation, 66

Sinus, 40

Sphacelus, 44

Spina bifida, 444

Spina ventosa, 157

Sprain, 607

Strabismus, 292

Staphyloma, 261

Stillicidium lachrymarum, 247

Stricture of the œsophagus, 369
rectum, 450
urethra, 470

Struma, 34

Subclavian artery, 387, 389

Suppuration, 29

Sympathies, 19

Syphilis, 195 tertiary, 203, 209

Teeth, caries, 338 extraction, 340

Testis, inflammation of, 467

Tetanus, 183

Tertiary syphilis, 203, 209

Thecæ, collections of fluid in, 401

Thorax, affections of, 409

Thrombus, 405

Tongue, inflammation of, 332
ulcers, 331

Tonsils, abscess of, 327
enlargement, 328

Tonsils, inflammation of, 326

Trachea, foreign bodies in, 363
stricture, 369

Tracheotomy, 364

Trichiasis, 255

Trismus, 183

Tubercle, painful, 149

Tumours, 134
adipose, 137
of the antrum, 304
of bones, 153
carcinomatous, 142
encephaloid, 142
encysted, 151, 336, 406
fibrous, 138
melanoid, 142
aneurismal, 158
osseous, 158
hydatic, 161
in the neck, 379
in the orbit, 290
painful tubercle, 149
of the scalp, 243

Tympanum, puncture of, 377

Ulcers, 186
of the genital organs, 195

Ulcers, indolent, 188
irritable, 189
of lips, 319

Urethra, stricture of, 470

Urinary organs, affections of, 461

Urinary calculi, 508

Uterus, affections of, 537

Uvula, elongation of, 328

Vagina, affections of, 534

Valgus, 548

Varicose aneurism, 393
veins, 132

Varix, aneurismal, 393
of thigh, 542

Varus, 547

Vein, external jugular of, 384

Veins, inflammation of, 130

Venesection, bend of the arm, 403
jugular vein, 384

Vertebral column, diseases of, 442

Vesico-vaginal fistula, 534

Whitlow, 396

Wounds, 164
by stings of insects, 177, 178
of the brain, 232
bruised and lacerated, 175
of the face and neck, 347
gunshot, 180
of the palmar arches, 395
poisoned, 176
punctured, 176
of the scalp, 215
of the temporal artery, 216
of the intestine, 440

Wry-neck, 382

THE END.