end of the finger over the back of the hand. It may sometimes be proper to have two additional splints for the sides of the finger.

Fractures of the Ribs.

When, after a fall or blow, the patient complains of a pricking in his side, we may suspect a rib is broken. It is ascertained by placing the tips of two or three fingers on the spot where the pain is, and desiring the patient to cough, when the grating sensation will be felt. All that is necessary is to pass a broad bandage round the chest, so tight as to prevent the motion of the ribs in breathing, and to observe a low diet.

Fractures of the Thigh.

This bone is frequently broken, and hitherto has been considered the most difficult of all fractures to manage. To the ingenuity, however, of the late Dr. J. Hartshorne, of this city, the world is indebted for an apparatus which does away the greatest impediments that have been found to exist in treating it, so as to leave a straight limb, without lameness or deformity. Nor is it the least of its merits, that any man of common sense can apply it nearly as well as a surgeon.

It consists of two splints made of half or threequarter inch well-seasoned stuff, from eight to ten inches wide, one of which should reach from a little above the hip to fifteen or sixteen inches beyond the foot, while the other extends the same length from the groin. The upper end of the inner splint is hollowed out and well padded or stuffed. Their lower ends are held together by a crosspiece, having two tenons, which enter two vertical mortices, one in each splint, and secured there by pins. In the centre of this cross-piece (which should be very solid) is a female, screw. Immediately above the vertical mortices are two horizontal ones of considerable length, in which slide the tenons of a second cross-piece, to the upper side of which is fastened a foot-block, shaped like the sole of a shoe, while in the other is a round hole for the reception of the head of the male screw, which passes through the female one just noticed. On the top of this cross-piece, to which the foot-block is attached, are two pins, which fall into grooves at the head of the screw, thereby firmly connecting them. The foot-block, as before observed, is shaped liks the sole of a shoe. Near the toe is a slit, through which passes a strap and buckle. Near the heel are a couple of straps, with two rings, arranged precisely like those of a skate, of which, in fact, the whole foot-block is an exact resemblance. A long male screw, of wood or other material, completes the apparatus.

To apply it, put a slipper on the foot of the broken limb, and lay the apparatus over the leg. By turning the screw the foot-block will be forced up to the foot in the slipper, which is to be firmly strapped to it, as boys fasten their skates. By turning the screw the contrary way, the padded extremity of the inner splint presses against the groin, and the foot is gradually drawn down, until the broken limb becomes of its natural length and appearance, when any projection or little inequality that may remain can be felt and reduced by a gentle pressure of the hand.

The great advantages of this apparatus, I again repeat, are the ease with which it is applied, and the certainty with which it acts. The foot once secured to the block, in a way that every schoolboy understands, nothing more is required than to turn the screw until the broken limb is found to be of the same length as the sound one. It is right to observe that this should not be effected at once, it being better to turn the screw a little every day, until the limb is sufficiently extended.

As this apparatus may not always be at hand, it is proper to mention the next best plan of treating the accident. It is found in the splints of Desault, improved by Dr. Physick, oonsisting of four pieces. The first has a crutch head, and extends from the arm-pit to six or eight inches beyond the foot. A little below the crutch are two holes, and near the lower end, on the inside, is a block, below which there is also a hole. The second reaches from the groin, the same length with the first, being about three inches wide above and two below. Two pieces of stout pasteboard, as many handkerchiefs or bands of muslin, with some tow or raw cotton, and a few pieces of tape, form the catalogue of the apparatus.

It is applied as follows. Four or five pieces of tape are to be laid across the bed, at equal distances from each other. Over the upper two is placed one of the short pasteboard splints, well covered with tow. The patient is now to be carefully and gently placed on his back, so that his thigh may rest on the splint. One of the handkerchiefs, or a strong soft band, is to be passed between the testicle and thigh of the affected side, and its ends held by an assistant standing near the head of the bed. The second handkerchief is to be passed round the ankle, crossed on the instep, and tied under the sole of the foot. Instead of this, a number of long strips of adhesive plaster, two inches wide, may be applied to the ankle and up the leg, and tied together below the foot. By steadily pulling these two handkerchiefs, the limb is to be extended, while, with the hand, the broken bones are replaced in their natural position. The long splint is now to be placed by the side of the patient, the crutch in the arm-pit (which is defended with tow), while the short one is laid along the inside of the thigh and leg. The ends of the first handkerchief, being passed through the upper holes, are to be drawn tight and secured by a knot, while the ends of the second one pass over the block before mentioned, to be fastened in like manner at the lower one. All that remains is the short pasteboard splint, which, being well covered with tow, to be laid on the top of the thigh. The tapes being tied so as to keep the four splints together, completes the operation.

Tow or raw cotton is to be everywhere interposed between the splints and the limb, and a large handful of it placed in the groin, to prevent irritation from the upper or counter extending band. It is necessary to be careful, while tying the two handkerchiefs, that they are not relaxed, so that if the operation is properly performed, the two limbs will be nearly of an equal length.

The superior advantages of Hartshorne's apparatus over this, as well as all others, must be evident to every one acquainted with the difficulty of keeping up that constant extension which is so absolutely necessary to avoid deformity and lameness, and which is so completely effected by the screw. Next to that, however, stands the one just described, which can be made by any carpenter in a few minutes, and which, if carefully applied, will be found to answer extremely well. While waiting for apparatus, the thigh may be kept extended by attaching a weight of a few pounds to the extending band below the foot, and suspending it beyond the foot of the bed.

Fractured thighs and legs generally reunite in six or eight weeks; in old men, however, they re quire three or four months.

In cases of fracture of the thigh or leg, the patient should always, if possible, be laid on a mattress, supported by boards instead of the sacking, which, from its elasticity and the yielding of

Fractures of the Knee-pan.

This accident is easily ascertained on inspection. It may be broken in any direction, but is most generally so across or transversely. It is reduced by bringing the fragments together, and keeping them in that position by a long bandage passed carefully round the leg, from the ankle to the knee, then pressing the upper fragment down so as to meet its fellow (the leg being extended), and placing a thick compress of linen above it, over which the bandage is to be continued.

The extended limb is now to be laid on a broad splint, extending from the buttock to the heel, thickly covered with tow to fill up the inequalities of the leg. For additional security, two strips of muslin may be nailed to the middle of the splint, and one on each side, and passed above the joint, the one below, the other above, so as to form a figure of eight. In twenty or thirty days the limb should be moved a little to prevent stiffness. But it usually requires two or three months for perfect union of this bone.

If the fracture is through its length, bring the parts together, place a compress on each side, and keep them together with a bandage, leaving the limb extended and at rest. Any inflammation in this or other fracture is to be combated by bleeding, low diet, etc., etc.

Fractures of the Leg.

From the thinness of the parts covering the principal bone of the leg, it is easy to ascertain if it be broken obliquely. If, however, the fracture be directly across, no displacement will occur, but the pain, swelling, and the grating sensation will sufficiently decide the nature of the accident.

If the fracture is oblique, let two assistants extend the limb, while the broken parts are placed by the hand in their natural position. Two splints,

by the swelling, and by the grating noise ca moving the heel. To reduce, take a long bandage, lay the end of it on the top of the foot, carry it over the toes under the sole, and then by several turns secure it in that position.

The foot being extended as much as possible, carry the bandage along the back of the leg above the knee, where it is to be secured by several turns, and then brought down on the front of the leg, to which it is secured by circular turns. In this way the broken pieces will be kept in contact, and in the course of a month or six weeks will be united.

Fractures of the foot, toes, etc., are to be treated like those of the hand and fingers.

Of Dislocations.

have been already mentioned. It is well to recolThe signs by which a dislocation may be known lect that the sooner the attempt is made to reduce it the easier it will be done. The strength of one dent, will often succeed in restoring the head of a man, properly applied, at the moment of the accibone to its place, which in a few days would have If after several trials with the best apparatus that required the combined efforts of men and pulleys. can be mustered, you find you cannot succeed, make the patient drink strong solution of tartar emetic until he is very sick. In this way, owing to the relaxed state of the muscles, a very slight force will often be sufficient, where a very great one has been previously used without effect.

If any objections are made to this proceeding, or if the patient will not consent to it, having your apparatus (which is presently to be mentioned) all ready, make him stand up, and bleed him in that position until he faints; the moment this happens, apply your extending and counterextending forces. Another important rule is to vary the direction of the extending force. A slight pull in one way will often effect what has been in vain attempted by great force in another. Dislocation of the Lower Jaw.

finished.

If the fracture is across, and no displacement exists, apply two splints of stout pasteboard, reaching from the heel to the knee, and well covered with tow, one on each side of the leg, securing them by a bandage passing round the limb, and outside the splints. Instead of splints, how ever, a fracture-box is often used, made by fastening, with hinges, to a bottom-piece rather longer than the leg, two side-pieces about six inches high, and reaching above the knee. The leg may rest in this on a pillow. A footboard fastened to the bottom-piece may serve to fix the foot by the aid of a bandage.

In cases of oblique fracture of the leg close to the knee, Hartshorne's apparatus for fractured thighs may be applied, as already directed.

Fractures of the Bones of the Foot. The bone of the heel is sometimes, though arely, broken. It is known by a crack at the

This accident, which is occasioned by blows or yawning, is known by an inability to shut the mouth, and the projection of the chin. To reduce seat the patient in a chair, with his head supbehind him. Your thumbs being covered with ported by the breast of an assistant, who stands leather, are then to be pushed between the jaws, side you grasp the bone, which is to be pressed as far back as possible, while with the fingers outdownwards at the same time that the chin is found moving, when the chin is to be pushed raised. If this is properly done, the bone will be backwards and the thumbs slipped between the jaws and the cheeks. If this is not done, they will be bitten by the sudden snap of the teeth as they come together. The jaws should be kept closed by a bandage for a few days, and the pa tient live on soup.

Dislocation of the Collar-bone.

This bone is rarely dislocated. Should it occur, apply the bandages, etc., directed for a fracture of the same part.

Dislocation of the Shoulder.

Dislocations of the shoulder are the most common of all the accidents of the kind. It is very easily known by the deformity of the joint, and the head of the bone being found in some unnatural position. To reduce it, lay the patient on the ground, place your heel in his arm-pit, and steadily and forcibly extend the arm by grasping it at the wrist. The same thing may be tried in various

positions, as placing yourself on the ground with him, laying him on a low bed, while you are standing near the foot of it, etc.

If this fails, pass a strong band over the shoulder, carry it across the breast, give the ends to assistants, or fasten them to a staple in the wall; the middle of a strong band or folded towel is now to be laid on the arm above the elbow, and secured there by numerous turns of a bandage. The two ends of the towel being then given to assistants, or connected with a pulley, a steady, continued, and forcible extension is to be made for a few moments, while with your hands you endeavor to push the head of the bone into its place.

Dislocation of the Elbow.

If the patient has fallen on his hands, or holds his arm bent at the elbow, and every endeavor to straighten it gives him pain, it is dislocated backwards. Seat him in a chair, let one person grasp the arm near the shoulder and another the wrist, and forcibly extend it, while you interlock the fingers of both hands just above the elbow, and pull it backwards, remembering that under those circumstances, whatever degree of force is required, should be applied in this direction. The elbow is sometimes dislocated sideways or laterally. To reduce it, make extension by pulling at the wrist, while some one secures the arm above, then push the bone into its place, either inwards or outwards, as may be required. After the reduction of a dislocated elbow keep the joint at perfect rest for five or six days, and then move it gently. If inflammation comes on, bleed, purge, etc., etc. Dislocation of the elbow is often accompanied by fracture, in which case it will not bear violence.

. Dislocation of the Wrist, Fingers, etc. Dislocations of the wrist, fingers and thumb are readily perceived on examination; they are all to be reduced by forcibly extending the lower extremity of the part, and pushing the bones into their place. If necessary, small bands may be secured to the fingers by a narrow bandage to facilitate the extension. These accidents should be attended to without delay, for if neglected for a little time they become irremediable.

Dislocation of the Thigh.

Notwithstanding the hip-joint is the strongest one in the body, it is sometimes dislocated. As a careful examination of the part, comparing the length and appearance of the limb with its fellow, etc., sufficiently mark the nature of the accident, we will proceed to state the remedy.

Place the patient on his back upon a table covered with a blanket. Two sheets, folded like cravats, are then to be passed between the thigh and testicle of each side, and their ends (one half of each sheet passing obliquely over the belly to the opposite shoulder, while the other half passes under the back in the same direction) given to several assistants, or what is much better, tied very firmly to a hook, staple, post, or some immovable body. A large, very strong napkin, folded as before, like a cravat, is now to be laid along the top of the thigh, so that its middle will be just above the knee, where it is to be well secured by many turns of a bandage. The two ends are then to be knotted. If you have no pulleys, a twisted sheet or rope may be passed through the loop formed by the napkin. If you can procure the former, however, cast the loop over the hook of the lower block and secure the upper one to the wall, directly opposite to the hooks or men that hold the sheets that pass between the thighs. A steadily increasing and forcible extension of the

thigh is then to be made by the men who are stationed at the pulleys or sheet while you are turning and twisting the limb to assist in dislodging it from its unnatural situation. By these means, properly applied, the head of the bone will frequently slip into the socket with a loud noise.

If, however, you are foiled, change the direction of the extending force, recollecting always that it is not by sudden or violent jerks that any benefit can be attained, but by a steady, increasing and long-continued pull. Should all your efforts prove unavailing (I would not advise you to lose much time before you resort to it), make the patient, as before directed, very sick or drunk, and when he cannot stand apply the pulleys. If this fails, or is objected to, bleed him till he faints, and then try it again.

Dislocation of the Knee-pan.

When this little bone is dislocated it is evident on the slighest glance. To reduce it, lay the patient on his back, straighten the leg, lift it up to a right angle with his body, and in that position push the bone back to its place. The knee should be kept at rest for a few days.

The foot is seldom dislocated. Should it happen, however, let one person secure the leg and another draw the foot, while you push the bone in the contrary way to that in which it was forced out. The part is then to be covered with compresses dipped in lead-water and a splint applied on each side of the leg that reaches below the foot. Accidents of this nature are always dangerous; all that can be done to remedy them consists in the speedy reduction of the bone, keeping the parts at rest and subduing the inflammation by bleeding, low diet, etc., etc.

Of Compound Accidents.

Having spoken of the treatment to be pursued for a bruise, wound, fracture, and dislocation, as happening singly, it remains to state what is to be done when they are united.

We will suppose that a man has been violently thrown from a carriage. On examination, a wound is found in his thigh, bleeding profusely, his ankle is out of joint, with a wound communicating with its cavity, and the leg broken.

In the first place stop the bleeding from the wound in the thigh, reduce the dislocation next, draw the edges of the wounds together with sticking plaster, and lastly, apply Hartshorne's or Desault's apparatus to remedy the fracture.

If, instead of a wound, fracture, and dislocation, there is a concussion or compression of the brain, a dislocation and fracture, attend to the concussion first, the dislocation next, and the fracture the last.

Of Amputation.

As accidents sometimes happen at sea, or in situations where it is impossible to obtain a surgeon, and which require the immediate amputation of a limb, it is proper to say a few words on that subject. To perform the operation is one thing, to know when it ought to be performed 18 another. Any man of common dexterity and firmness can cut off a leg, but to decide upon the necessity of doing so, requires much judgment, in

managed that the smaller one is completely cut through by the time the other is only half so. The arteries are then to be taken up, the flap brought down and secured by adhesive plasters, etc. as already directed.

Amputation of the Forearm.

warm wine, wine whey, brandy and water, etc., may be given to him from time to time. If, after he has recovered, a stupor or drowsiness remains (but not before) bleed him very moderately. Should the accident occur in winter, and the body feel cold, as if frozen, previously to apply

Amputation of Fingers and Toes. Draw the skin back, and make an incision round the finger, a little below the joint it is intended to remove, turn back a little flap to cover the stump, then cut down to the joint, bending it so that you can cut through the ligaments that connect the two bones, the under one first, then that on the side. The head of the bone is then to be turned out, while you cut through the remaining soft parts. If you see an artery spirt, tie it up, if not, bring down the flap and secure it by a strip of sticking-plaster, and a narrow bandage over the whole.

Remarks. To prevent the troublesome consequences of secondary bleeding, before the strips of plaster are applied over the edges of the flap, give the patient, if he is faint, a little wine and water, and wait a few minutes to see whether the increased force it gives to the circulation, will cccasion a flow of blood; if it does secure the ves

sel it comes from. If there is a considerable flow of blood from the hollow of the bone, place a small cedar plug in it. Should violent spasms of the stump ensue, have it carefully held by assistants, and give the patient large doses of laudanum; it may in fact be laid down as a general rule, that after every operation of the kind, laudanum should be given in greater or less doses, as the patient may be in more or less pain.

Of Suspended Animation.

From Drowning.-The common methods of rolling the body of a drowned person on a barrel, or holding it up by the heels, etc., are full of danger, and should never be permitted. If a spark of life should happen to remain, this violence would extinguish it forever. As soon, therefore, as the body is found, convey it as gently as possible to the nearest house, strip it of the wet clothes, dry it well, and place it on a bed between warm blankets. First draw the tongue out for a few moments while the body is prone to open the windpipe. Every part is now to be well rubbed with flannels dipped in warm brandy, or spirits of any kind, while a warming-pan, hot bricks, or bottles or bladders filled with warm water, are applied to the stomach, back, and soles of the feet. During these operations a certain number of the assistants (no more persons are to be allowed in the room than are absolutely necessary) should try to inflate the lungs by blowing through the nozzle of a common bellows, or a pipe of any kind, placed in one nostril, while the other with the mouth is kept closed. This should be done at intervals about sixteen times a minute. Raising both arms forward and upward, over the head, at the same time and at the same intervals, will aid in expanding the chest. If a warm bath can be procured, place the body in it. Clysters of warm brandy and water, salt and water, or peppermintwater may be injected.

All these operations, particularly rubbing the body, and trying to inflate the lungs should be continued for six or eight hours, and when the patient has come to himself, small quantities of

From Cold. Take the body into a room, the doors and windows of which are open, and where there is no fire, and rub it with snow or cold water; the exception of his face, which should be left out, if this can be procured in plenty, the patient, with may be completely covered with it to the thickness of two feet. After a while, friction with flannels and hot spirits is to be used, as in the preceding case, and warmth very gradually applied. The lungs are to be inflated, as directed in cases of drowning, and when the patient is able to swallow, warm wine, etc., may be given in smal! quantities.

If a limb is frost-bitten, the cold applications should be continued longer, and warmth be more gradually applied than when the whole body is frozen. Care should be taken to handle the parts carefully, so as not to break off the ear, tip of the

nose, etc.

From Foul Air. Throw open the doors and windows, or take the patient into the open air, and seat him, undressed, well wrapped in a blanket, his feet or whole body in a bath, and sprinkle his in a chair, leaning a little to the right side, place stomach with cold vinegar or water, and rub it immediately with flannels dipped in oil. Clysters of vinegar and water are to be injected, and when animation returns, continue the frictions, and give warm mint tea, etc.

Oil of vitriol, aqua fortis, muriatic acid, oxalic acid.

Symptoms.-A burning heat in the mouth, throat, and stomach, stinking breath, an inclination to vomit, or vomiting various matters mixed with blood, hiccups, costiveness, or stools more or less bloody, pain in the belly, so great that the weight of a sheet cannot be borne, burning thirst, difficulty of breathing, suppression of urine, etc.

Remedies.-Mix an ounce of calcined magnesia with a pint of water and give a glassful every two minutes. If it is not at hand, use flaxseed tea, rice-water, or water alone, in large quantities, until the former can be procured. If it cannot be obtained, dissolve an ounce of soap in a pint of water and take a glassful every two minutes; chalk or whiting may also be taken by the mouth, and clysters of milk be frequently injected. If the patient will not vomit, put him in the warm bath, bleed him freely and apply leeches and blisters over the parts pained. If the cramps and convulsions continue, give him a cup of common tea, with an ounce of sugar, forty drops of Hoff