WILLIAM L.CLEMENTS
LIBRARY OF
AMERICAN HISTORY
UNIVERSITY MICHIGAN







PLAIN
CONCISE
PRACTICAL REMARKS,
ON THE TREATMENT OF
WOUNDS
AND FRACTURES:
To which is Added, An APPENDIX,
ON
AND MILITARY HOSPITALS;
CAMP
PRINCIPALLY
Deſigned, for the Uſe of young Military and Naval Surgeons,
in NORTH - AMERICA.
By JOHN JONES, M. D.
Profeffor of Surgery, in King's College, New YORK.
PHILADELPHIA:
Printed, and Sold, by ROBERT BELL, in Third Street,
MDCCLXXVI.


TO
DOCTOR. THOMAS CADWALADER,
PHYSICIAN, IN PHILADELPHIA,
SIR,
W
HILE fpeculative Philoſophers are
diſputing about the origin of evil and
foundation of morals, and furious bigots
contending for different modes of faith, the
practical good man will endeavour to employ
himſelf in alleviating thoſe evils which he finds
incident to human nature, without too vain and
curious an inquiry into cauſes, the nature and
operation of which, lie far beyond the narrow
limits of human underſtanding.
The preſent calamitous ſituation of this
THE
once happy country, in a peculiar manner,
demands, the aid and aſſiſtance of every virtuous
citizen; and though few men are poffeffed of
thoſe ſuperior talents, which are requiſite, to
heal ſuch mighty evils as now threaten the
whole body politic with ruin and deſolation ;
yet, every man has it in his power to contribute
ſomething towards ſo deſireable an end; and if
he cannot cure the fatal diſeaſes of his unfortu.
nate country, it will, at leaſt, afford him ſome
conſolation, to have poured a little balm into
her bleeding wounds.
INFLUENCED by theſe motives, I have en-
deavoured to ſelect the ſentiments of the beſt
modern furgeons upon the treatment of thoſe
accidents, which are moſt likely to attend our
preſent

4
D E DI CA TIO N.
preſent unnatural conteſt; and as many of the
Gentlemen engaged in that ſervice are young
men, whoſe opportunities of inſtruction or
practice, have been confined within narrow li-
mits; I flatter myſelf, that ſuch of them, at
leaſt, as are conſcious of their own defects, will
find in the piece, no unuſeful guide. To you,
whoſe whole life has been one continued ſcene
of benevolence and humanity, the moſt feeble
efforts to ſoften human miſery, and ſmooth the
bed of death, will, I know, be an acceptable
prefent, however ſhort the well meant zeal of
the Author, may fall of his purpoſe. Nor will
you ſuſpect me of the vanity of ſuppoſing, I ſhall
convey any thing new or inſtructive to men of
knowledge and experience in their profeſſion,
much lefs to yourſelf, to whoſe excellent pre-
cepts, both in phyfic and morals, I owe the
beſt and earlieſt leffons of my life ; and if I
have attained to any degree of eſtimation with
my fellow citizens, it is with the moſt fincere
and heartfelt pleaſure, that I publickly acknow-
Jedge the happy ſource.—That your virtuous
life
may be long continued as a bleſſing to your-
ſelf, your friends and your country, is the ar-
dent with of
your
Moſt obliged Friend,
and affectionate Kinſman,
JOHN
JONES
NEW-YORK, 12th OCTOBER, 1775.

THE INTRODUCTION.
To the STUDENTS, and young Practitioners
in SURGERY, through all America.
GENTLEMEN,
TH
HE following remarks and obſervations
were thrown together under the diſadvan-
tageous circumſtances of ill health, and a
variety of occupations, which allowed little
leiſure for compoſition, and I flatter myſelf the
apparent neceffity for fome immediate produc-
tion of this nature, will apologize for thoſe de-
fects which a diſcerning reader will readily diſ-
cover: If any of
you, by obſerving the follow-
ing rules, ſhould ſave the life, or even limb of
but one citizen, who has bravely expoſed him-
felf in defence of his country, I ſhall think my-
ſelf richly rewarded for my labour. In the
mean time, inſtead of attempting an idle pane-
gyric upon the moſt uſeful of all arts, permit
me to point out to you ſome of the moſt eſſential
duties and qualifications of a good Surgeon ; the
proper requiſites of which reſpectable character,
are only to be found in a liberal education, fur-
niſhing every means of acquiring that knowledge,
which muſt be ripened by experience, and
graced by the conſtant practice of attention,
tenderneſs, and humanity. A judicious furgeon
will always find his powers and abilities of
affiling

6 INTRODUCTION.
affifting the wretched, proportionable to the time
he has ſpent, and the pains he has beſtowed in
acquiring the proper knowledge of his pro-
feffion.-In moſt European countries, an invi-
dious diſtinction has prevailed, between Phyfic
and Surgery; but in this part of the world, the
two profeſſions are generally united; indeed
both the branches of medicine, are, in the very
nature of things, ſo intimately connected, as not
to admit of abſolute ſeparation, without manifeft
injury to each. As a curious and intereſting
fact in the hiſtory of Surgery may ſerve to illuſ-
trate this opinion, I hope a ſhort digreſſion will
not be deemed wholly uninſtructive, or foreign
to the preſent purpoſe.
At the revival of letters in Europe, when a
cultivation of the languages had opened the
treaſures of the Greek and Latin writers, there
aroſé a number of great men, in all the different
branches of ſcience ;--but what was very pecu-
liar to the ſtate of Surgery, particularly in Italy
and Germany, is, that this ſcience was cultiva-
ted and practiſed by the fame men who ſtudied
and practiſed phyſic ; ſo that the ſame perſons
were at once admirable Surgeons, and excellent
Phyſicians; and it is preciſely at this æra, that
a crowd of celebrated men aroſe, whoſe works
will forever do honour to themſelves and their
profeſſion.
But it was not long before the operation of
ſome of thoſe paſſions which have ſo much in-
fluence in the affairs of mankind, occaſioned
the decline, and almoſt total extinction of Sur-
gery,
a
-

INTRODUCTION.
7
gery. The exterior of this ſcience, has nothing
pleaſing or attractive in it, but is rather diſguft-
ing to nice, timid, and delicate perſons :-Its
objects too, except in time of war, lying chief-
ly among the poor and lower claſs of mankind,
do not excite the induſtry of the ambitious or
avaritious, who find their beſt account among
the rich and great; for this reaſon, thoſe illuſ-
trious men who were at once great Phyſicians
and Surgeons, abandon's the moſt diſagreeable
and unprofitable part of their profeſſion, to fol-
low that branch alone, which at once gratify'd
their eaſe, their avarice, and their ambition :-
This regulation gave riſe to the ſecond ſtate of
Surgery. The medical Surgeons, in quitting
the exerciſe of the art, retained the right of di-
recting the barbers, to whom the operations
and external applications of Surgery were com-
mitted: From this ſeparation, the Surgeon was
no longer one and the ſame individual, but a
monſtrous and unnatural compoſition of two
perſons; of a Phyſician who arrogated to him-
felf an excluſive knowledge of ſcience, and con-
ſequently the right of directing, and a Surgeon
operator, to whom the mere manual part was
committed.
The danger of this ſeparation of the ſcience
of Surgery from the art of operating, was not
at firſt perceived. The great maſters who had
exerciſed Surgery as well as Phyſic, were ſtill
alive, and the dexterity they had acquired, was
fufficient to direct and affift the automaton,

8 INTRODUCTION.
or mere operator ; but as foon as this Hippo-
cratic race of men, as Fallopius juftlyftiles
them, were no more, the progreſs of Surgery
was not only rerarded, but the art itſelf was al-
moft extinguiſhed, little more than the bare
name remainingHence that animated and af-
fecting picture, which Cæſar Magatus, the
Venetian Phyſician, drew, of the miſery of
thoſe unfortunate citizens who languiſh'd with-
out reſource, under the moſt cruel and painful
diſeaſes which were formerly cur'd with cer-
tainty; but the patients were then abandoned
to their wretched fate, as the moſt favourable
alternative ; for they could but periſh by the
feverity of the diſeaſe, and they were ſure to
die, by the ignorance of their operator,
The fatal conſequences of a total ſeparation
of Phyſic and Surgery, are ſo ſtrikingly exem-
plified in this remarkable epocha of the ſcience;.
that I think it may ſerve as a fufficient proof,
of the erroneous concluſions of a late celebrated
profeffor of Phyfic at Edinburgh, who in an
excellent diſcourſe upon the duties and offices
of a Phyfician, is of opinion, that the art of Sur-
gery would be more advanced, by confining the
profeſſors of it to mere manual operation, un-
der the direction of an able Phyſician, than
it could be by thoſe who practiſe promiſcuouſly
the different branches of medicine.----It is with
the utmoſt diffidence and reluctance, that I
preſume to differ with fo truly liberal a character
as that of Dr, Gregory, but as truth is the
grand
a

INTRODUCTION.
9
a
grand object of our mutual inquiries, and that
upon a ſubject the moſt uſeful and intereſting
to mankind, no names however great or re-
ſpectable, ſhould implicitly influence our re-
ſearches. For this reaſon, though I readily
grant that a diviſion of the practical part of me-
dicine into two different branches, may; by
confining each to a more frequent attention to
the ſame objects, produce a degree of perfection
which a more promiſcuous practice could never
arrive at; yet I muſt at the ſame time declare, that
I can almoſt as readily conceive the poſſibility of
feeing a good play performed by Punche's com-
pany of Comedians, actuated by their director,
as to ſee a number of Surgeon machines, per-
form difficult and delicate operations, under the
directions of their medical maſters.
In ſhort, the variety of difficult operations,
performed with ſuch ſuperior ſucceſs and ſafety,
by the preſent race of Surgeons, who are diſ-
tinguiſhed for their knowledge in every branch
of medical learning, is an evident proof of the
benefit reſulting to operators from a more liberal
mode of education ; and I think it can no longer
remain a doubt with any unprejudiced perſon;
that an enlightened mind, united to the perſon
of the operator, muft and will conſtitute the
moſt accompliſhed and ſucceſsful Surgeon.
For theſe reaſons, Surgery may, with great
propriety, be divided into medical and manual ;
--the firſt comprehends an infinite variety of
diſeaſes, which require the affiſtance of both in-
B
ternal

I
INTRODUCTION.
ternal and external applications ;----the laſt is
confined to thoſe caſes which admit of relief
from the hand alone, or aſſiſted with inftru-
ments.
Hence it will appear very evident, how ne-
ceſſary it is for the ſtudent in Surgery, to make
himſelf thoroughly acquainted with moſt of
thoſe branches of medicine, which are requiſite
to form an accompliſhed Phyſician.
Besides a competent acquaintance with the
learned languages, which are to lay the founda-
tion of every other acquiſition ; he muſt poſſeſs
an accurate knowledge of the ſtructure of the
human body, acquired not only by attending
anatomical le&tures, but by frequent diſſec-
tions of dead bodies with his own hands.
This practice cannot be too warmly recom-
mended to the ſtudents in Surgery : It is from
this fource, and a knowledge in hydraulics,
they muſt derive any adequate notions of the
animal economy or phyfiology. Chymiſtry
and Materia Medica are very necefiary to a right
underſtanding of pharmacy or compofition.
To theſe ſhould be added ſome progreſs in the
mathematics and mechanics, which I will ven-
ture to aſſert may be applied with much more
utility and ſafety to the ſcience of Surgery, than
Phyfic. But there muſt be a happineſs, as well
as art, to complete the character of the great
Surgeon.
He ought to have firm ſteady hands, and be
able to use both alike; a ſtrong clear fight, and
abovs

INTRODUCTION.
II
above all, a mind calm and intrepid, yet humane
and compaſſionate, avoiding every appearance of
terror and cruelty to his patients, amidſt the moſt
ſevere operations.
FROM this ſhort view of the nature and ex-
tent of the art of Surgery, it will evidently ap-
pear how neceſſary an early and diligent pur-
fuit of thoſe branches of knowledge, which are
to lay the foundation of future eminence, is to
the young ſtudent, who will not find it ſo
eaſily attainable as the generality of pupils are
apt to imagine, To be proficients in an art
which requires reiterated experiment, and
whoſe ſubject is liable to ſo much variation, not
only requires a good deal of time, but much fa-
gacity and judgment. The great variety of
habits and conftitutions, and the frequent com-
plications of difcaſes with each other, conſtitutes
an ample field of contemplation, which be who
runs haſtily through, will not be likely to reap
much benefit from ſcampering round the wards
of an hoſpital, and reading a general ſyſtem of
Surgery, are too often the beſt foundation for
practice, which many gentlemen can boaſt;
but if a man duly reflects upon the importance
of that art, in the exerciſe of which, health and
life, the greateſt of human bleſſings are con-
cerned, he will deem himſelf accountable for
all errors, into which ignorance or inattention
muft infallibly betray him.
In new ſettled countries however, where op-
portunities of improvement are not within the
reach

12 INTRODUCTION.
a
a
a
reach of every ftudent, many gentlemen are
obliged to ſet out in practice, with ſuch a ſtock
of knowledge as they are able to acquire under
the tuition of a fingle maſter, who may, him-
ſelf, too often ſtand in need of inſtruction. To
ſuch gentlemen I would earneſtly recommend
a diligent, attentive, and repeated peruſal of
the beſt Engliſh practical writers, among which
Mr. Pott, in my humble opinion, claims the
firſt and moſt diſtinguiſhed rank.-Mr. Brom-
field's Chirurgical Remarks, contain a great deal
of uſeful inſtruction upon ſome of the moſt in-
tereſting and difficult diſeaſes in Surgery.--
The writings of Mr, Sharp, Mr. Gooch, and
Mr. White. of Mancheſter, merit a very atten-
tive peruſal; and the Medical Obſervations of
London and Edinburgh, abound with a great
variety of uſeful and inſtructive caſes, both in
Phyſic and Surgery-Monſieur Le Dran, whoſe
works are well tranſlated into Engliſh, is the
moſt celebrated writer amongſt the French;
his obſervations are the reſult of ſound learning,
and a prodigious experience of fixty years, both
in the army, as well as capital of the kingdom ;
his laſt work entitled Conſultations, is peculi-
arly deſigned for the aſſiſtance, and inſtruction
of young practitioners in Surgery.As to thoſe
gentlemen, who will neither read nor reaſon,
but practiſe at a venture, and ſport with the
lives and limbs of their fellow-creatures, I can
only with Dr. Huxham, adviſe them ſeriouſly
to peruſe the fixth commandment, which is,
66 Thou ſhalt not kill.'
CHAPTER
1

C Η Α Ρ Τ Ε R.
I
OF WOUNDS in GENERAL:
A
a
WOUND is very accurately defined by
the
great Boerhaave, to be a recent and
bloody ſolution of the union of a ſoft
part, by a hard and ſharp body in motion,
preſs’d againſt it, or reſiſting it.' It is obvious
from this definition, that the ſubject of a wound
is a ſoft part, and we learn from modern anato-
my, that the ſoft parts of a human body are a
congeries of veſſels of different kinds, and hence
there can be no wound without a diviſion of ver.
fels of many different ſeries: For no fanguife-
tous artery can be divided, without the veſſels
of almoſt every different kind being wounded ;
for the coats of this artery being made up of
other ſmaller veſſels, and theſe again of a ſtill
finer texture, till we come to the ſmalleſt; it is
evident by a ſimple wound of a ſanguiferous ar-
tery, the ferous and lymphatic veſſels are divided,
with the membranes and muſcular fibres which
conſtitute the muſcular coat of the artery;
Hence it is obvious that a very flight wound
may injure all the congeries of vefſels of which
the ſoft parts are compoſed. .
Hence thoſe actions are injured which depend
upon the cohæſion of the parts, and a deter-
mind circulation of liquids through the veſſels,
Thoſe wounds therefore are mortal, which
are inflicted in thoſe parts, whoſe cohæfion is
C
inſeparable

14 JONES ON WOUNDS
inſeparable from life ; every wound therefore,
which deſtroys the free influx of the blood into
the heart, and its expulfion from it, muſt be
inevitably mortal.
For this reaſon, every
wound of the aorta muſt be attended with inevi-
table death, as no aſſiſtance of art can poſſibly
be applied to ſtop the hæmorrhage; other
wounds may,
if left to themſelves become
mortal; but by the timely help of art, the
danger of death may be remov'd, as in
wounds of the arteries of the limbs, where
the tourniquet may be applied till the bleeding
veſſel can be taken up by a ligature ; and in the
reports given in by Surgeons to judges of courts,
theſe circumſtances ought carefully to be adverted
to, and diſtinguiſhed. Many wounds alſo in
themſelves not mortal, may be rendered fo by
neglect or erroneous treatment; this frequently
happens to ſoldiers and ſeamen in the day of
battle, when the multiplicity of caſes prevents
the Surgeons from paying a proper attention to
all-ence many die of hæmorrhages which
might have been ſtopped, and extravaſations
under the cranium, which the application of
the trepan might have relieved. Errors in
practice have the ſame fatal conſequence, per-
fons falling into a deliquium, from a great loſs
of blood, who by proper nouriſhing broths,
might have been recover'd, have loſt their
lives by an injudicious exhibition of fpirituous
liquors, which by their ſtimulus upon the
veſſels, produce freſh hæmorrhages.
The effects too of wounds are various, ac-
cording to the variety of actions exerciſed while
the

AND
FRACTURE $ IS
are
the wounded part was entire ; nor is there a
leſs variety of names, forms and effects in
wounds, ariſing from the diverſity of the wound.
ing cauſe,--and hence the inciſed, the contuſed,
the lacerated, and the punctured wound.
If in a healthy and robuſt body, a wound is
made in a viſible place, not irrigated by any
large artery ; the following phænomena ariſe,
provided the orifice of the wound is defended
from the cold, from air and exficcation.
Firſt, the parts between which the wounding
cauſe is forced, recede from each other more and
nore, though the cauſe is remov'd, unleſs
in punctured wounds, which
very
{mall. 2dly. The blood flows with more
or leſs impetuoſity according to the ſize of
the wounded veſſels; but by degrees ſtops
fpontaneouſly, the elaſticity of the arteries
contracting their bleeding orifices,
3dly. A
ſanguineous cruſt is formed in the cavity of
the wound, the blood naturally coagulating,
when extravaſated, and acquiring a degree of
dryneſs from the contiguous air. 4thly. A diluted
reddiſh thin liquor flows from it, reſembling
the waſhings of the new kill'd fleſh,—this
happens from the contraction of the larger vef-
ſels, while the ſerous and lymphatic, diſcharge
their contents. Sthly. The lips of the wound
begin to look red, become præternaturally hot,
painful, tumid, and retorted, while the bottom
becomes more prominent, the fat rifing into the
aperture of the wound, and there degenerating.
And bthly. A flight fever, accompanied with
thirst

36
JONES ON WOUNDS
thirſt is excited— Theſe latter ſymptoms happen
only in pretty large wounds, but the former in
all, where there is a proper degree of vital
force; and hence Hippocrates tells us that,
when fevere wounds are inflicted, if a tumor
does not ſucceed, it is a very bad fign,--and the
ſame admirable old ſurgeon as well as Phyſician
very juſtly lays it down as one of the moſt im-
portant rules in Surgery, “ that on the third
and fourth days, wounds are by no means to be
difturbed ; and that we are at this time to ab-
ftain from all ſearches with the probe, and every
thing that may irritate them."
7thly. About the fourth day, ſooner or later,
according to the age of the patient and heat of
the weather, a white, pinguious, equal matter,
called pus, is generated in the wound, and this
produces very happy effects, by ſeparating the
lacerated vefſels and extravaſated fluids from the
found parts which then grow up a-freſh,-
Hence laudable
pus
is eſteemed by Surgeons the
beſt of ſigns. Sthly. At this time the redneſs,
heat, tumor, pain, retorſion of the lips, and fever,
ceaſe, or are greatly diminiſhed; for all theſe
fymptoms ariſe in conſequence of an obſtruction
in the circulation, from a contraction of the
orifices of the wounded veſſels, which a lauda-
ble ſuppuration removes; and this ſtage of the
diſeaſe is called by Surgeons, the time of digeſtion.
9thly. The cavity of the wound is generally
filld up with new fleſh, whilſt the margins
becoming white, bluiſh, ſoft and equal are
united. Laſtly, the wound becomes dry, and
is cover'd with a cicatrix or fcar.”
From

AND FRACTURE S.
IZ
From the preceding account of the progreſs
of nature in the healing of wounds in healthy
bodies, it may eaſily be perceived, how ſmall a
ſhare art can juſtly boaſt in this very extenſive
branch of the diſeaſes in Surgery. And yet,
how many infallible, healing balſams, and
wonderful noſtrums have been and ſtill are
impoſed upon the world, not only by Quacks
and Empiricks, but too many, whoſe education
and knowledge of the animal economy ſhould
render them incapable of low artifice, or igno-
rance of nature's admirable efforts for her own
relief. It was this ſenſible and attentive obfer-
vation of nature's operations, which rendered
Hippocrates fo jud cious a Surgeon, without
thoſe helps which we derive from the great
modern diſcoveries in Anatomy and Phyſiology;
and the ſame good fenſe and obſervation, ren-
ders the practice of the preſent Engliſh Surgeons,
particularly in wounds, ſo much more fimple and
plain, than that of the Surgeons of other nations.
Mr. Sharp, in his excellent introduction to
the operations of Surgery, recommends nothing
but dry, ſoft lint, to recent wounds, which is
generally the beſt application through the
whole courſe of the cure. At firſt, it reſtrains
the hæmorrhage with leſs injury than any ftyptic
medicines; and afterwards, by abſorbing the
matter, which is at firſt thin and acrimonious,
it becomes, in effect, the beſt digeſtive: Dering
incarnation, it is the ſofteſt medium that can be
applied between the roller and tender granulati-
ons; and at the ſame time, an eaſy compreſs on
the ſprouting fungus.
For

18 3
WOUNDS
JONES ON
For theſe reaſons, I ſhall not recommend to
you any ointments for recent wounds, unleſs
ſome mild, ſoft one, to arm a pledget of tow,
to cover the lint.
When a wound degenerates into fo bad 2
ftate as to reſiſt this ſimple method of treatment,
and loſes that healthy, florid appearance, which
characterizes a recent wound; it is then deno-
minated an ulcer, which is diſtinguiſhed by va-
rious names, according to the different appear-
ances of the fore, the peculiar habit of body,
or particular diſeaſe, attending the patient. But
as this branch of Surgery does not come within
my preſent plan, I ſhall proceed to give you a
ſhort account of the uſual diviſion of wounds;
previous to which, I beg leave to offer a few
remarks upon the doctrine of inflammation ; a
;
ſubject, of which every perſon, who intends to
practiſe Surgery, ſhould endeavour to acquire
juſt and accurate ideas; for from this cauſe a
great many diſeaſes ariſe, which require the af-
fiſtance of chirurgical operations; and it is al-
ways more or leſs, the conſequence of operations
themſelves, as well as of wounds, fractures,
diſlocations, and other accidents.
C Η Α Ρ Τ Ε R -
II.
OF
INFLA M M A TION.
W.
THOUT entering into any minute
phyſiological inveſtigation of the theory
of inflammation, which would be incon-
fiftent

AND FRACTURE S.
I
fiſtent with my preſent plan, I ſhall content
myſelf with faying, that irritation and pain,
however they may be occaſioned, are at all
times its immediate or proximate cauſes; and
that, in moſt caſes, if we can prevent pain
we ſhall proportionably prevent, or at leaſt
leſſen the ſucceeding ſymptoms of infiammation.
This is to be done only by the immediate exhi-
bition of ſudorific anodynes, proportioned to
to the age and ſtrength of the patient, and the
feverity of the complaint. Bleeding, gentle
laxatives, warm baths, and foft cataplaſms to
the parts affected, will all contribute towards
this moſt defirable purpoſe, and ſhould never be
omitted; yet without premiſing opium, they
will ſeldom avail in preventing inflammation:
Let it be carefully obſerved however, that I
here ſuppoſe the Surgeon to be preſent in the
firſt ſtate of the diſeale, where prevention may
be happily ſubſtituted for a cure.
In other caſes, as frequently happens in the
day of battle, when this timely application can-
not be made; and when pain, continued for
ſome hours, has already induced a degree of heat,
tenſion, redneſs and ſwelling, a different mode
of treatment becomes neceſſary; for although
anodyne medicines may leffen the violence of
the pain, they will not remove the ſymptoms al-
ready occafioned by it: In this caſe more copi-
ous evacuations, cooling medicines, a moſt ex-
act diluting diet, and perfect quiet of body muſ
be inſiſted on, by which means a great deal of
the obftructing matter will be taken up by the
abſorbent veſſels, and the remaining part be
converted into pus.
A ftill
a

20
JONES ON WOUNDS
A ftill different and more difficult taſk preſenta
itſelf to the Surgeon, when any of the tendinous
and membranous parts are injured; for though
theſe ſubſtances have little or no feeling in a
found ftate, yet when they are diſeaſed, they
acquire a moſt exquiſite degree of ſenſibility :
And if to this third ſtate of the nature of inflam-
mation, we add a fourth, attended with fracture
of the bones, it will compriſe almoſt every cir-
cumſtance relative to the ſubject in queſtion.
Here all the ſkill and attention of the Surgeon
will be neceſſary to prevent, or alleviate the
dangerous and too frequently fatal fymptoms of
convulſion, abſceſs, and gangrene, which a more
violent inflammation induces in this ſpecies of
wounds; where bleeding, joined to the general
antiphlogiſtic method muſt be more rigidly in-
fiſted on,-all ſtimulating foreign bodies re-
moy'd ;-Sudorific anodynes exhibited accord-
ing to the violence of the pain and urgency of
the ſymptoms. Abſceſſes opened, and the firſt
appearance of gangrene obviated, by a more
cordial nouriſhing diet, ſpirituous fomentations,
and a liberal uſe of the bark. The application
of all which remedies will be particularly point-
ed out, in treating of compound fractures diſ-
tinctly. In the mean time, I ſhall proceed to
take ſome notice of the uſual diviſion of
wounds.
CHAPTER III:

AND FRACTURES
21
CH A P T E R III.
Of the DIVISION of WOUNDS.
Win
OUNDS have been generally divided
into four different fpecies, the inciſed,
the punctured, the lacerated, and the
contuſed; each of which, although they are all
attended with a greater or leſs degree of the
ſame ſymptoms, and require the ſame general
treatment, have ſome peculiarities, which
render this diſtinction both uſeful and ne-
ceſſary
The ſimple inciſed wound, when unattended
with any conſiderable hæmorrhage, or great
loſs of ſubſtance, is always to be healed by what
Surgeons call the firſt intention; which conſiſts
in approaching the lips of the wound, until they
come into the moſt exact contact, and preſer-
ving them in that ſituation, by future or ban-
dage, until the union is accompliſh'd.
Whenever a wound will admit of this con-
tact, by means of a ſticking plaſter, aſſiſted
with the uniting bandage ; the uſe of a ſuture is
unneceffary, and this is generally the cafe in
fuperficial wounds, and even pretty deep ones,
of the limbs, when made in a longitudinal di-
rection, where the uniting bandage can be
affifted with proper compreffes. But many
oblique wounds, of the body and face, particu-
larly, will not admit of this mode of union;
D
and

JONES ON WOUNDS
and the uſe of the future becomes abſolutely
neceſſary. That ſpecies of it uſually employed
in the union of common inciſed wounds, is cal-
led the interrupted, and is to be performed in
the following manner.
After cleanſing the wound from coagulated
blood, and all foreign bodies ; let your affiftant
approach the lips towards each other, and ha-
ving meaſured the depth of the wound with
your eye, paſs your needle, previoufy dipt in
oil, at ſuch a diſtance from the edge of the lip,
as will make it equal to the depth of the wound;
and carrying it out at the fame diſtance on the
oppoſite ſide, you draw your ligature cloſe
enough to bring both lips into immediate con-
tact, without wrinkling or puckering the parts,
and then make a double knot: The number
of ftitches muſt be proportioned to the length
of the wound. A good general rule will be, to
uſe no more than are juſt neceſſary to bring the
lips into exact contact, and this mode of paſſing
the ligatures by deſcribing a kind of ſemicircle,
will anſwer that intention perfectly, by ap-
proaching the lips from the bottom of the
wound to its external ſurface. A piece of adhe-
five plaſter, embracing a large portion of the
external integuments on each ſide, will contri-
bute to preſerve the parts in ſitu; The ligatures
ſhould be removed as ſoon as the union is com-
pleted, which generally happens either the ſe-
fe-
cond, or third day, often in twenty four hours.
Punctured

AND FRACTURE S.
23
Punctured wounds, which do not penetrate
into either cavity of the body, require no par-
ticular mode of treatment, unleſs they are deep
and winding, in which caſe ſome dilatation of
the external orifice becomes neceffary, in order
to diſcharge more freely any extravaſated fluids,
which might otherwiſe occafion troubleſome and
diſagreeable abſceſſes.
Surgeons are not entirely agreed in the method
of treating lacerated wounds; ſome adviſing a
removal of the lips, particularly, when large,
while others contend for their preſervation ;
however, as the ſkin, or common integument,
is a moſt uſeful, as well as ornamental part of
the human body, I believe it may be laid down
,
as a very juſt and general rule, to preſerve as
much of it as the nature of the caſe will admit;
we all know how readily, raw tender parts will
unite; and wherever moderate bandage can be
applied, there is a good proſpect of ſucceſs from
the attempt, which ſhould always be made:-
If the torn lips are very unequal, they may be
reduced nearly to the ſtate of a ſimple inciſed
wound, by the aſſiſtance of the knife;
and a
future will then not only forward the cure, but
prevent deformity; which every good Surgeon
will always endeavour to avoid.
Severe contuſed wounds have this peculiar cir-
cumſtance attending them; that the veſſels hav-
ing intirely loſt their tone, are no longer able to
circulate the contained fluids, or take
ир
what
are extravaſated by abſorption, for which reaſon
fuppuration

24
WOUNDS
JONES ON
ſuppuration muſt inevitably follow ;-and when
an opening has not been made by the accident,
it is the Surgeon's duty at the proper time, to
do it in the moſt advantageous manner, by
making a large dependent orifice ;-warm dif-
cutient fomentations, and ſpirituous embroca-
tions, to attenuate the obſtructing inatter, and
brace the relaxed, debilitated tone of the fibres,
are very uſeful, and in common contuſions,
will be ſufficient to anſwer every intention,
without any opening at all.-It is very evident,
that contufed wounds, under the preceding
circumſtances, will not admit of the future
with any degree of propriety, or proſpect of
ſucceſs.
I ſcarcely need obſerve, that moderate evacua-
tion, by bleeding, and gentle purging, together
with a low diet, are, in theſe caſes abſolutely
neceſſary.
Wounds of the tendons, with a cutting inftru-
ment, are now treated like other fimple inciſed
wounds; provided you can bring the extremities
of the divided tendon into contact, and preſerve
them by means of a proper bandage, in that
ſituation; no future is ever made uſe of.
The tendo achillis is often united in this way,
by bending the knee, and relaxing the flex or
muſcles of the leg, while the foot is extended
and preſerved in this fituation, by a proper ban-
dage.--Monſieur Le Dran recommends for this
purpoſe, a leather knee piece, to the poſterior,
and inferior part of which, a ſtrap, of a foot
long

AND FRACTURE S.
long, is faſtened; then a piece of thin wood,
being fixed to the ſole of an old Bipper, and one
end of it projecting near three inches beyond the
heel, with a ſhort ſtrap and buckle, to which
that from the knee reaches, and admits of being
drawn up ſufficiently to bring the extremities of
the divided tendon into perfect contact:---The
external wound is to be defended with an adhe-
five plaſter, and abſolute reſt injoined, till the
parts are united, which does not happen fome-
times for ſeveral weeks, particularly, if any in-
flammation attends the wound.
CHAPTER
IV.
Of Penetrating Wounds of the THORAX
and ABDOMEN.
W be
-OUNDS which enter either cavity, mày
be divided into three general claſſes,
ſuch as are mortal, ſuch as are neceſſarily
hazardous, and thoſe which are accidently fo;
and thoſe diſtinctions are founded in the ſtruc-
ture and office of the wounded parts, combined
with the natural conſequent ſymptoms, and the
treatment of the Surgeon.
All wounds of the heart, aorta, cerebellum,
medulla oblongata and receptaculum chyli, are
juftly deemed mortal, becauſe thoſe parts are
immediately ſubſervient to life; but thoſe of
the lungs, liver, inteſtines, kidneys, pancreas,
gall bladder, large veſſels, ſpleen, meſentery,
bladder

26 JONES ON WOUNDS.
bladder and ſtomach, are only hazardous in
proportion to the nature of the offices they per-
form in the animal economy, and the degree
of injury they have received; to which may
be
added, error's committed by the patient, or his
Phyſician, by which a greater degree of fever,
inflammation, and diſcharge are excited.
A ſhort view of the nature and fituation of
wounded viſcera, will fhew us how little we are
to expect from any external applications, unleſs
when ſome particular viſcus is protruded, through
a large wound of the abdomen, and of which
proper notice will be taken hereafter. The
great and principal attention of the Surgeon,
fhould be directed to the prevention or diminu-
tion of inflammation; therefore after a proper
dilatation of the external orifice, which in
punctured, penetrating wounds is almoſt always
neceffary, the patient ſhould immediately loſe
as much blood as his ſtrength will bear, and
this from a very large orifice, by which means
the hæmorrhage, if confiderable, will be moſt
effectually reſtrained. The bleedings ſhould be
repeated at ſhort intervals, according to the na-
ture and urgency of the ſymptoms ; emollient
glyſters, cooling nitrous drinks, anodynes to
afſuage pain, a moít rigid exact diet, conſiſting
ſolely of thin diluting drinks, perfect quiet,
and a poſture which at once contributes to the
patient's eaſe, and the diſcharge of any extrava-
fated matter, conſtitute the other moft eflential
aids, which we can call in to aſſiſt nature, to
whoſe

AND FRACTURE S. 27
whoſe admirable reſources we muſt chiefly truſt
the reſt of the cure.
Should any portion of the inteſtines or omen-
tum, the uſual parts protruded, be forced out,
they ought as early as poſſible to be reduced,
by placing the patient on his back, with his hips
a little elevated, and then with the fore finger
of each hand, gently and alternately preſſing
the protruded part into its proper place, but if
ſuch a degree of ftrangulation ſhould attend, as
to prevent this eaſy reduction, a ſufficient dilata-
tion muſt immediately be made, by introducing
a director, on which Mr. Pott's curved biſtoury
with a button point, may be conveyed, and the
enlargement performed without any difficulty
or danger, unleſs from wounding ſome blood
veffels, which a tolerable knowledge of anatomy
a
will teach us to avoid.
A mortification of the omentum is ſometimes
the conſequence of a long ftrangulation, in which
caſe the mortified part may be removed withi
the knife, and the reſt returned without mak-
ing any ligature upon it; the external wound
may be united by means of the interrupted
future, affifted with compreſs, bandage, and a
ſuitable poſture.
Penetrating wounds of the thorax, are in
general pretty eaſily diſtinguiſhed from the pe-
culiar ſymptoms which attend them. The moſt
remarkable of theſe, is the paſſage of air through
the wound in reſpiration, and the expectoration
of frothy blood from the lungs when they are
wounded

28
JONES ON WOUNDS.
wounded. If the wound be made with a baye
onet or ſmall ſword, the external orifice muſt be
immediately enlarged, in order to give a free
diſcharge of the blood lodged in the cavity.
The bleedings muſt be proportioned to the de-
gree of hæmorrhage, which, if violent, can
only be reſtrained by large, and repeated vene-
ſections,--frequent doſes of nitre, in barley-
water, or flax feed tea;---an extreme cool re-
gimen and perfect reſt, even ſpeaking ſhould be
abſolutely forbidden.
An emphyſematous tumor, ariſing from the
inſinuation of air into the cellular membrane,
ſometimes attends penetrating wounds of the
thorax, and occaſions very painful and trouble-
ſome ſymptoms, the proper treatment of which
I ſhall refer to the chapter on gun-ſhot wounds,
in which a fracture of the ribs has induced this
particular complaint.
Wounds of the containing parts about the
breaſt and belly, which do not penetrate the
cavities, are often attended with ſevere, and
fometimes dangerous fymptoms. Bleeding and
the general antiphlogiſtic method, will generally
fucceed in removing them. But the Surgeon is
often puzzled to know whether a wound in the
abdomen has penetrated the cavity, or not; for
if none of the contained parts are injured, the
fymptoms may be ſo equivocal, as to render it
very, uncertain; nor is it of any great confe-
quence to aſcertain this matter, as the method
of treatment in either caſe, is pretty much the
fame.
a

AND FRACTURĖ Så
20
fame. It is even very difficult in many caſes,
to determine preciſely, which of the viſcera
are wounded, unleſs in ſome of the principal
organs, ſuch as the liver, ftomach, or inteſtines,
whoſe injured functions pretty plainly indicate
the part affected; but the ſpleen, pancreas and
meſentery, may be very confiderably injured,
without exciting any other than the general
fymptoms of pain and inflammation; and in-
deed it is of leſs conſequence, with reſpect to
the patient's treatment, than the Surgeon's
prognoſtic, to find the exact ſeat of a wounded
viſcus. But as the reputation of a Surgeon
depends greatly on a juſt prognoſtic, he cannot
be too attentive in diſcovering the true feat of
the injury, which alone can determine the
degree of danger. For this purpoſe the pa-
tient during examination, thould be placed
as nearly as poſſible, in the ſame fituation he
was in at receiving the wound; every evacuation
muſt be carefully examined, and the utmoſt re-
gard paid to the peculiar ſymptoms, which
attend the injured function of the differene
organs.
É
CHAPTER

30
JONES ON WOUNDS
С Н А Р Т Е R
V.
On fimple FRACTURES of the LIMBS.
might reaſonably be ſuppoſed, that a branch
of Surgery, which has been conſtantly prac-
tiſed by the ableſt maſters of the art, both
ancient and modern, for above two thouſand
years, ſhould be well underſtood, and long
fince brought to its utmoſt degree of perfection.
This opinion, indeed has ſo univerſally prevail-
ed, that the most ordinary country Surgeon
has thought himſelf as well qualified to reduce
a fimple fracture, as the firſt man in the profeſ-
fion ;---even the moſt illiterate mechanics, who
make no other pretenſion to knowledge in Sur-
gery, than what they affume from their pre-
tended ſkill in boneſetting, put themſelves on a
footing with the moſt regular Surgeons in the
reduction of fractures, and often obtain a high-
er degree of reputation in the art, not only from
the vulgar, but even among the more enlighten-
,
ed and ſenſible part of mankind.
This ſtrange infatuation is not altogether to
be accounted for in the preſent cafe, from that
Itrong defire of health and eaſe, which like
the love of money, reduces all underſtandings
to a level; but may in ſome meaſure be owing
to that general error, which the regular pro-
feſſors of the art, as well as the moſt ignorant
practitioners, hare hitherto laboured under,
with

ÄND
31
FRACTURES
with reſpect to the moſt proper and ſucceſsful
method of creating fractures of the limbs in
general, and the larger ones in particular.
An implicit adherence to the opinions of
others without exerciſing our own reaſon, has
been the fcource of that blind attachment,
which men in all ages have paid to the authority
of names and characters, and the beſt under-
ſtandings have been ſo much fettered by theſe
ſhackles, as to overlook the moſt obvious truths,
and even when ſome enlightened and liberal
minds, have dared to deviate from the beaten
track, and boldly point out the abſurdity of
antiquated errors, it is with no little difficulty,
that men who have been long bigotted to forms
can be induced to adopt more juſt and rational
notions of practice. It is however to be
hoped, that the late improvements in this effential
branch of Surgery, for which we are principally
indebted to Mr. Pott, will ſoon become general,
and that the inoſt obftinate adherents to the
old practice, will quit their error, the moment
they are acquainted with a method, which is to
demonſtratively founded in the ſtructure of the
parts, the nature of the diſeaſe, and above all,
in the inconteftible evidence of the plaineſt facts.
The true curative indications in every fimple
fracture, are to reduce the broken extremities of
the bones, as nearly as poſſible to their natural
ſituation, and to retain them when there, by
the moſt eaſy, ſimple and effectual means.
How far the methods hitherto made uſe of, were
calculated

JONES ON WOUNDS
a
calculated to anſwer theſe deſirable purpofes,
will beſt appear from a fair and candid exami-
nation of them.
In the firſt place, an extenſion and counter-
extenſion, as it is called, was made by two al-
fiftants, with more or leſs violence, according
to the nature of the caſe, until the extremities of
the broken bone were brought oppoſite to each
other, when the Surgeon with his fingers fi-
nithes the coaptation or ſetting, after which a
Jong roller, making many turns both upon, as
well as above and below the fractured part,
was applied; upon this roller, ſplints of differ-
ent kinds, armed with tow or linen compreſſes,
to fill up the inequalities, were placed longi-
tudinally, and ſecured with tapes or ſome
kind of ligature, drawn pretty cloſe, to pre-
ſerve the fractured bones from flipping out of
their place, and for greater ſecurity, the limb
was fixed in a ſtrait direction fully extended,
and reſting upon the calf and heel, in a frac-
ture box, defended by a pillow or ſome ſoft
ſubſtances.
This is, I think, the general method of re-
ducing fimple fractures, formerly followed by
the Surgeons of moft countries; and which is
purſued to this day, by a great majority of prac-
titioners in Europe, as well as America; and
many a painful, tedious hour, has it coſt the
unfortunate patient, as well as difficulty and fo-
licitude to the Surgeon, to prevent all the
miſchiefs ariſing from this prepoſterous and ir-
rational mode of reducing and treating fimple

AND FRACTURES
33
fractures, I ſhall only mention ſome of the
moſt uſual difficulties attending it,
In the firſt place, the violent extenſion fre-
quently made uſe of by the aſſiſtants, often oc-
cafioned fo much pain as to induce ſuch a de-
gree of inflammation and ſwelling, as obliged
the Surgeon to looſen or remove his bandage;
which could only be done by cutting it at the
extremities with a ſciſfars, or taking it entirely
off ;-this neceffarily occafioned a rernoval and
diſturbance of the limb, which ſhould always
be avoided, as much as poſſible, in all fractures:
But if theſe miſchievous conſequences did not fol-
low the firſt reduction, others no leſs painful,
though not ſo eaſy relieved, aroſe from the ex-
tended poſition of the limbs-befides the ſtiffneſs
of the knee, and ſhrinking of the calf of the
leg; the moſt intolerable uneaſineſs is very ſoon
created to the patient, from the conſtant and
unavoidable preffure of the heel, upon what-
ever ſubſtance it reſts -- a long decumbiture
will frequently produce a mortification of the
integument; and I have more than once or
twice ſeen the bone laid bare, by this abſurd
and painful poſture.
To point out a more juſt, eaſy, and natural
method of cure, ſhall be the remaining buſineſs
of the preſent chapter,
To obtain any adequate ideas of the nature of
diſeaſes, it is abſolutely neceſſary to have a com-
petent knowledge of the ſtructure and offices of
the parts affected ; it is from this fource alone,
that

34
JONES ON WOUNDS.
a
that we can lay any reaſonable foundation for
juſt method of cure, even this neceſſary know-
ledge will be inſufficient, unleſs we are capable
of thinking, examining, and acting for ourſelves.
The general ſtructure and uſes of the bones and
muſcles have been well underſtood for
many
centuries ; yet nobody, until of late, has had
fagacity enough to apply this general knowledge,
to the particular purpoſes of the diſeaſe in
queſtion
It is obvious however, to the moſt common
underſtanding, that the bones, conſidered ab-
ftractedly in themſelves, are mere paflive in-
active bodies, without any locomotive faculties,
but are moved by powers firmly attached to
them; which powers are called by Anatomiſts
the muſcles, and theſe bodies have the fingular
property of contracting, or lengthening them-
ſelves, according as they are influenced by the
mind, or the operation of external bodies ſti-
mulating them to action.
When a bone therefore is broken and ſeparat-
ed, it has no power of reſtoring itſelf to its na-
tural fituation; whatever change of place it
receives, muſt be entirely owing to the action of
the muſcles, which alone poſſeſs this aſtoniſhing
power of contraction, and which is increaſed or
diminished more or leſs, according as they are
placed, in a ſtate of tenlion or relaxation.
Upon theſe ſelf evident principles the abſur-
dity of the old and general practice of reducing
fractures, will appear in the moſt ſtriking
light ;-

AND FRACTURES,
35
1
light ;-every man who has had the leaſt expe-
rience in Surgery, will eaſily recollect and ac-
knowledge the appearances which generally ex-
hibit themſelves in fractures of the lower extre-
mities, where the ends of the broken bone oc-
cafion more or leſs deformity, according to the
nature of the fracture and the force of the fur
rounding muſcles--in oblique fractures of the
thigh, this effect is very remarkable, the ends of
the bones lap over each other to a conſiderable
diſtance, and produce a very apparent inequality
in the appearance of the limb, often attended
with much pain, from the ſharp points or
edges of the broken extremities.
The poſition which the patient always endea-
vours to place himſelf in, under theſe circum-
ſtances, will clearly point out the true ſtate of
his cafe, as well as the moſt rational mode of
relief. Far from ſtretching out his injured limb,
or lying on his back, the ſituation in which
Surgeons place him for his relief, he naturally,
and inſtinctively ſeeks it by gently turning
himſelf upon the injured fide, drawing up the
thigh towards the body, and bending the knee,
by which means the muſcles or moving powers,
are immediately put into a ſtate of the utmoſt
relaxation, and their action upon the bones or
livers entirely removed, which reſtores the pa -
tient to a ftate of eaſe and quiet.
What is the reaſon, ſays Mr. Pott, that a
fracture of the os humeri is ſo eaſily reduced
and maintained in its ſituation, with ſo little
pain

36
JONES ON WOUNDS
pain and difficulty ? It is becauſe both the pati-
ent and operator, are obliged as it were, contrary
to the mode of treatment in the lower limbs, to
place the muſcles of the arm in a ſtate of relax
ation, by bending the elbow, ſupporting it in
a fling or ſcarf, and approaching it to the ſide
of the body, where it reſts in a ſtate of eaſe
and ſecurity,
Why is a fracture of the tibia, when the fibula
remains unbroken, attended with fo little pain
or deformity, and retained in its place with ſo
much facility ? The reaſon is moſt obvious,
the contraction of the muſcles is prevented
by the fibula, which keeps them in their natural
ftate.
From what has been ſaid, the true poſition of
a fractured leg or thigh for reduction, appears to
be the reverſe of that hitherto made uſe of. In-
ſtead of extending the leg in a right line, and
attempting to replace the broken bones while
the muſcles are in a ſtate of tenſion and con-
traction; the patient is to be placed on his fide,
with his knee half bent, one aſſiſtant taking hold
of the lower extermity of the leg, juſt above the
ancle, while the other embraces the fuperior end
juſt below the knee; both making at the ſame
time fuch gentle extenſion, and no more, as is
neceſſary to bring the bones oppoſite to each
other; when the Surgeon, with his own hands
reduces them to the moſt exact appoſition in his
power,
The relaxation of the muſcles of the thigh,
mult

AND
FRACTURES
37
part af.
muſt be made by drawing it gently towards the
body, and whoever examines with the leaſt at-
tention, the ſtructure of this bone and its arti-
culation with the hip, will readily diſcern how
admirably this fide poſition of the limb and
body, is calculated to promote the patient'seaſe
as well as happy union of the bone.
Extenſion and appoſition of the fractured limb,
having been made under the foregoing circum-
ſtances, the next confideration will be the
ap-
plication of proper medicaments to the
fected ; a variety of compofitions, conſiſting of
adhæfive plaſters, cerecloths, the white of an
egg with vinegar, or thin compreſſes dipped in
Spirit Vin Camphor, have been uſed for this
purpoſe, many of them well enough adapted to
anſwer the intention, while others, particularly
the adhæfive plaſter, by irritating and inflaming
the ſkin, and exciting a tetterous eruption, be-
comes exceedingly troubleſome and injuri-
ous;--the only rational view in any exter-
nal application, is to keep the fkin lax, moiſt
and perfpirable, and by ſuch means to repreſs
or abate inflammation, diſperſe extravaſation,
while very gentle compreffion ferves to re-
ſtrain the bones in fome meaſure to their
proper places; and theſe deſirable purpoſes are
moſt effectually anſwered by a cerate with a ſo-
lution of litharge in vinegar, to which ſuch a
proportion of ſoap, oil, and wax is added, as
will give a conſiſtence, that admits of being
ſpread without warming.
F
But

38
JONES ON WOUNDS.
But whatever be the form of the compoſition,
it is of great conſequence to have it applied in
ſuch a manner as will admit the fractured part
to be viewed occaſionally, without diſturbing or
removing the limb, and this is abſolutely im-
practicable where the roller is employed; for
which reaſon the eighteen tailed bandage which
has been long uſed for compound fractures, is
now with great propriety applied to fimple ones,
and the improvement made in the form of this
bandage by Mr. Pott, renders it much more
neat and commodious; for by giving the
flaps or tails an oblique direction, they lap over
each other with the utmoſt exactneſs, and lie
perfectly ſmooth and even. You can alſo give
them as much tightneſs as is ever neceſſary for
any of the uſeful purpoſes of bandage in fimple
fra&ures; for the old notions of reſtraining a
Aux of humours, or preventing the luxuriant
growth of callus have no foundation in reaſon,
experience, or common ſenſe ;-the callus is a
fluid, ſeparated by nature from the extremities
of the broken bones and periofteum, and its
quantity is always in proportion to the nature of
the fracture: If the bones can be brought into
exact and even contact, a ſmall quantity of callus
is ſufficient to unite them ; but when they lap
over each other, a larger portion becomes peceſ-
ſary to conſtitute a firm and ſolid union,--the
deformity which is frequently the conſequence
of broken bones, is not owing to the exuberance
of the uniting medium, but the ignorance or
neglect

AND
39
FRACTURE S.
7
7
1
1
I
1
3
)
neglect of the Surgeon, who is ever ready to
conceal his want of knowledge or attention, un-
der the cloak of luxurant callus.
I do not mean to infinuate that this is always
the caſe. A Surgeon may be called to a pati-
ent where the time elapſed fince the fracture, as
well as other circumſtances may render a perfect
reduction utterly impracticable, in theſe caſes
we muſt ſatisfy ourſelves with doing the beſt in
our power.
The next part of the apparatus for a fractured
limb are the ſplints, which are generally made
of, wood, or paſteboard, but ſo ſhort that they
can only act as a compreſs, and that a very hard
and uneaſy one, upon the ends of the fractured
bones: But as the true uſe of ſplints is to pre-
ſerve the whole limb in a ſteady, firm pofition,
without comprefling the fracture at all, they
ought to extend below the ancle and above the
knee; and with this rational view, the ingeni-
ous Mr. Sharp, one of the preſent Surgeons of
St. Bartholomew's Hoſpital, has invented a fet
of ſplints both for the leg and thigh, which are
admirably adapted to anſwer the foregoing in-
tentions; thoſe for the leg are only two in
number, they are made of ſtrong paſteboard,
cover'd with thin leather, and fitted to the
ſhape of the leg: The external or fibular ſplint,
on which the leg is to reſt on its fide, has a
hole at its inferior extremity, to receive the
prominent ancle, and thereby prevent the pain
and other ill conſequences of hard preſſure; the
tibial
a

40
JONES ON WOUNDS
tibial one has only a cavity adapted to the ſhape
of the internal malleolus ;---they are ſecured by
three leather ſtraps fixed to the outſide of the
fibular ſplint, which paffing round the leg are
faſtened by ſmall holes to little braſs ſtuds
ſtuck on the back of the tibial, or what, accor-
ding to the poſture in which the limb is placed
in this method of treatment becomes the fupe-
rior ſplint.
But as the beſt deſcription I can give will
fall ſhort of reality, and theſe ſplints are not to
be had here, I have endeavoured to ſupply their
place by wooden ones of the ſame ſhape, which
when lined with compreſſes of linen or flannel,
extending beyond their edges, and adapted to
the inequalities of the parts, anſwer the pur-
poſes of Mr. Sharp's, without the diſadvantages
to which paſteboard is ſubject; whenever you
apply either cataplaſms or embrocations, which
are often neceſſary on account of ſwelling and
inflammation.
After the ſplints are applied, the leg is to be
placed on a pillow with the knee half bent, the
poſture in which the reduction was made, and
as the poſition of the body as well as limb is on
its ſide, the patient may be removed from one
part of the bed to another with great eaſe and
ſafety, or even removed if neceſſary, to a
diſtance from the place of accident, which are
advantages not to be received in the old way,
without difficulty or danger.
The principles and practice here recommend-
ed

AND FRACTURE S.
1
ed for the treatment of fimple fractures of the
leg, are equally or more applicable to thoſe
of the thigh, where the ſuperior ſtrength of the
ſurrounding muſcles are more diſpoſed to pro-
duce a diſplacement of the bones, when kept
in a ſtrait extended direction with the patient
on his back. The ſplints for the thigh are
three in number, of a ſtrait hollow form, the
external or longeſt one extending from the hip
to the knee on the outſide, is attached by a
leather ſtrap to one paffing round the body;
the other two ſplints are placed at proper diſ-
tances on the anterior and inſide of the limb,
and the whole ſecured like thoſe of the leg, by
leather ſtraps faſtened to braſs fluds on the back
of the ſhort ſplints.
Before I quit this ſubject, it may not be im-
proper to take notice of a cant phraſe made uſe
of by many Surgeons called the riſing end of a
bone. This expreſſion, like many other abuſes
of words, only ſerves to veil our ignorance, for
it either conveys no idea at all, or a falſe one,
as will plainly appear from a juſt examination of
the fact which gave riſe to it. In every fracture
of the limbs, ſurrounded by ſtrong muſcles,
their contractile power forces the inferior extre-
mitiy of the fractured bone under the ſuperior
one, which is incapable of motion, but imme-
diately exhibits that appearance of inequality,
which has occafioned the falſe idea of a rifing
bone, and has put both Surgeons and Patient to
much uſeleſs trouble and pain in dreſſing.
The

42
JONES ON WOU N D $.
The only way to remedy the evil is, relaxing
the muſcles of the limb, and raiſing the depreff-
ed' end of the bone to an equality with the
other. This obſervation is equally applicable
to the clavicle as to the hip and thigh.
But here it will be probably aſked by ſome
perſons who have been long in practice, and ac-
quired no inconſiderable degree of reputation,
have not many good cures of fimple fractures
been performed by the old method, which in the
preceding pages is ſo much exploded? I anſwer
undoubtedly, yes,
I have performed many
myſelf, but it is equally true and certain, that
many of them were obtained with prodigious
trouble and difficulty to myſelf, as well as pain
to the ſuffering patient, to ſay nothing of the
deformities which too often aroſe in conſequence
of the old method of reducing fractures when
practiſed by the ableft operators.
Fractures of the cubit or fore-arm, particularly
of the radius, are reduced upon
ral principles already recommended. The dif-
poſition of the limb muft favour the relaxation
of the muſcles, and this is a kind of middle ftate
between pronation and ſupination. The palm
of the hand ſhould be applied to the breaſt, the
thumb fuperior with the fingers moderately bent,
the whole ſecured with a couple of ſplines, of
which the internal one ſhould be extended and
fitted to receive the hand and fingers in the po-
fition already deſcribed. Mr. Gooch, in his
ſurgery, has given the draught of a very neat
and ingenious contrivance for this purpoſe.
the ſame gene-

AND FRACTUR E So 43
There are two kinds of fractures however
which do not admit of the bent pofture of the
joint, and theſe are the fractured patella, and
proceffus olecranon at the elbow, where a ſtrait
poſition of the limb becomes neceſſary for the
fame reaſon that a bent one is fo in other frac-
tures, viz. the relaxation of the muſcles and
tendons attached to the fractured bone.
Whenever the patella is fractured tranſverſely,
the ſuperior fragment is drawn upwards by the
Aftrong action of the extenſor muſcles of the leg
while the lower part remains fixed by its liga-
ment. Extending the leg puts theſe muſcles
in a ſtate of relaxation, and enables the Surgeon
to approach the uppermoſt fragment pretty near-
ly to the loweſt, where it is eaſily retained by a
moderate compreſs and bandage, and as ſoon as
the ſwelling and inflammation are fubfided, the
knee ſhould be gently moved every day in order
to prevent ſtiffneſs, and preſerve the motion of
the joint.
As the leg in this ſpecies of fracture is neceſ-
farily kept in an extended poſture, it ſhould be
a little raiſed, and at the ſame time equally and
exactly ſupported, its whole length, with pil-
lows, to prevent too great preſſure upon the
heel, which would otherwiſe unavoidably hap-
pen.
If much ſwelling and tenſion ſhould have
come on before the Surgeon is called in, he ought
to wait fome days, until theſe ſymptoms are re-
moved

44 JONES ON
WOUND 9
moved by proper cataplaſms, fomentations
and evacuations, before he applies his bandage.
This practice has been recommended and not
without reaſon, under the ſame circumſtances
of fimple fractures of the leg and thigh, when
treated in the old way ; but few caſes will now
occur, where the Surgeon will not be able to
make the reduction immediately, or in a very
ſhort time, by placing the limb in a ſtate of
flexion and relaxation, and preſerving it in that
ſituation during the cure.
However, after all general directions, the pa-
tient's feelings will conſtitute one of the beſt rules
with reſpect to the fitneſs of time for the re-
duction of fractures attended with ſwelling and
inflammation, whenever it can be done with
tolerable eaſe to the patient, it will certainly be
proper.
CHAPTER
VI.
On COMPOUND FRACTURES.
W
HEN the bones are not only broken,
but their extremities are forced through
the muſcles and external integuments,
the accident is called a compound fracture, in
oppoſition to a ſimple one; and theſe two gene-
ral diſtinctions are all that are made uſe of by
Engliſh Surgeons, and will comprize every ef-
ſential difference in the nature of fractured
bones.
The

AND
45
FRACTURES
3
The firſt object of confideration in every com-
pound fracture is, whether the nature of the aca
cident is ſuch as to admit of the preſervation of
the limb with probable ſafety to the patient's
life, and this intereſting queſtion has given riſe
to very oppoſite opinions between ſeveral Sur-
geons of the moſt diftinguiſhed reputation, fome
of them, particularly Mr. Pott, adviſing immes
diate amputation in almoſt every bad compound
fracture attended with comminution or ſplinter-
ing of the bones, while others contend as ſtre
nuouſly for its abſolute inutility or at leaſt impro-
priety, in nineteen caſes out of twenty. As
both ſides appeal to experience in ſupport of
their affertions, it is no eaſy matter to reconcile
ſuch oppoſite extremes.
Truth perhaps may
lie ſomewhere between both, and to hit this
happy golden mean, conſtitutes the perfectioni
of human judgment. A candid and impartial
cxamination of the different ſentiments adopted
by the oppofite writers upon the preſent ſubject,
will, in a great meaſure, account for the con-
trarity of their opinions which ſeem to have
ariſen more from the difference of ſituation and
circumſtances in their patients, than any real
diſparity in their ideas of the diſeaſe:
Mr. Pott, who is the principal advocate for
amputation, has very probably formed his opi-
nions
upon the fatal conſeqences which generally
attend compound fractures in Hoſpitals, while
Mr. Bilguer, Mr. Kirkland, Mr. Gooch, and
fome other gentlemen who live in the country,
havo

46
.
JONES ON WOUND 8.
have drawn their concluſions from the great fuc-
ceſs attending private practice; both parties
may be right, and their difference of opinion
very reconcileable to truth and experience.
If we reflect upon the ſtate of air in the
crowded wards of large Hoſpitals, in great cities,
we ſhall eaſily account for the different ſucceſs
which attends operations performed in ſuch
fituations, from that of private practice, parti-
cularly in the country.
In the firſt ſituation, the air is not only
rendered leſs healthy to breath in, from great
numbers of fick perſons confined within a ſmall
compaſs, but the putrid effluvia ariſing from
wounds and ulcers, renders it highly pernicious.
Every man who has attended Hoſpital practice
in London, muſt be ſenſible of the ill ſucceſs
which attends the operation of trepanning,
even in common caſes, and yet the ſame ope-
ration in the private practice of ſmall towns, and
the country, generally fucceeds very well.
For the ſame reaſon, compound fractures of
the limbs, will be attended with much more
danger in a large Hoſpital, than in private prac-
tice, and a Surgeon might with equal propri-
cty attempt to ſave a limb in the latter ſituation,
or amputate it in the former.
In general, all fractures about the joints where
the capfolar ligaments are torn, and the heads
of the bones are injured, require amputation,
and that ſhould be performed as ſoon as poffible,
before any fymptoms of inflammation are come
a
on;

AND FRACTURE S.
47
nature.
on; the leaſt delay in ſuch caſes often proves
fatal; for having miſſed the firſt opportunity, a
ſecond is often denied us, and when it is not,
the chances of recovery are much greater in the
firſt inſtance.
When a limb is thought capable of preſerva-
tion, the next confideration is the mode of re-
duction, and this muſt be determined by the
particular nature and circumſtances of the frac-
If the bones have been broken in near a
tranſverſe direction, and the protruded extremity,
(which is always the upper bone,) can be near-
ly reſtored again to its proper place, the reduce
tion and cure will be both very eaſy. But in
caſe of an oblique fracture, a long ſharp point of
bone, is ſometimes thruſt out through a ſmall
wound, which compreſſing and as it were gir-
ding the bone, prevents its return; and the
more you extend the limb, the ſtronger this
compreſſion becomes.
In this ſituation many
Surgeons adviſe an immediate removal of ſuch a
portion of the protruding bone, as will render
the return of it eaſily practicable; however,
before we proceed to this ſtep, it will be ad-
viſeable to attempt the reduction, by relaxing
the muſcles, and making a free dilatation, by
which method there are few caſes, I believe,
which will not admit of relief.
The advantages of making large dilatations
are very obvious; they facilitate the reduction
of the fractured bones, without any loſs in their
length, give the Surgeon a fair opportunity of
examining

4.8
JONES ON WOUNDS
For as
examining and extracting any detached ſplinters,
and what is of great conſequence in the courſe
of the cure, afford a free paſſage to the diſ-
charge of any extravaſations or collections of
matter ; and as theſe dilatations are only through
the integument, there is neither difficulty nor
danger in making them.
In the treatment of fractures, attended with
much comminution, or many ſplintered frag-
ments, and great laceration of the ſurrounding
muſcles, the utmoſt ſkill and judgment is re-
quifite. As many of the looſe fragments as can
be removed, without occaſioning much pain,
or riſking a dangerous hæmorrhage, ſhould im-
mediately be taken away, but no more.
pain, irritation, and inflammation,
grand objects of apprehenfion, it is of little con-
ſequence to the patient, whether they are induced
by the nature of the accident, or the Surgeon's
Tough and abſurd treatment.
The neceſſary dilatations having been made,
and all looſe bones, or the irritating points of
fixed ones removed, the next conſideration is
the reduction or ſetting ; and here the ſame
principles and rules recommended in the chapter
upon ſimple fractures, are more than equally
applicable; for if violent extenfion, and ſtrait
poſition were improper, where the bones were
only broken, without any external wound, and
very little injury to the internal parts, they
muſt be infinitely more ſo, where the muſcles
and integuments are much lacerated.
For
are the

AND FRACTURES .
49
For theſe reaſons, after the moſt gentle and
careful extention and exact appoſition of the
bones, the ſurgeon is next to conſider of the
proper dreſſings, which are of two kinds ;
ſuch as are requiſite for the wound, and ſuch
as are applicable to the limb. The former are
intended to promote a free eaſy diſcharge of any
matter or extraneous bodies; the latter reſpects
the prevention or removal of inflammation
and its uſual conſequences, ſuppuration, gan-
grene and mortification.
Dry ſoft lint applied fo lightly, and in ſuch
ſmall quantities as not to obſtruct the free dif-
charge of matter from the wound, will very
well anſwer the firſt intention, while the cerate
recommended in the chapter upon ſimple frac-
tures, with diſcutient embrocations and the ſpi-
ritus mindereeri, acetum lytharg, or goulards
aq. faturn. joined to moderate bleeding and the
.
general antiphlogiſtic regimen, perform the ſe-
cond, and a happy cure is frequently obtained
by what ſurgeons call the firſt intention, or at
leaſt with very little inflammation or ſuppurati-
on. But here it muſt be obſerved, that I ſup-
poſe the muſcles have not been much torn or
wounded, and no conſiderable degree of tenſion,
pain or ſwelling have ariſen, for under ſuch cir-
cumſtances, the wound ſhould be dreſſed di-
rectly with ſome mild digeſtive, and the whole
limb enveloped with a ſoft relaxing cataplaim,
which joined to fomentations, are the moſt ef-
fectual
.

50
JONES ON WOUNDS
fectual means of promoting a
kind ſpeedy
fuppuration, the next falutary intention of
cure.
With reſpect to evacuations, particularly
bleeding, which muſt be always uſed, but with
diſcretion, for profuſe or repeated bleeding,
though it may take off inflammation ſooner, yet
muſt inevitably weaken the patient too much,
and promote the future abſorption of matter,
What purges are uſed, ſhould be of the gentle
cooling kind, with fudorific anodynes interpoſed
to calm irritation and pain, and daring the tenſe
ſwollen ſtate of the wound, no heating tinctures
of myrh and aloes or terebinthinate balſams
ſhould be applied to it, but in the latter end of
the cure when the parts are become very lax and
flabby, they may be uſed with ſome propriety.
Scarifications, during the preceding ſtate, even
when a gangrene is threatened, are very impro-
per, as they ſtimulate the
parts
without
procur-
ing any diſcharge, for which alone they can be
intended by thoſe who have any rational views
of relief in the cure af diſeaſes.
Compound fractures require dreſſing at leaſt
once a day, and in hot weather under large diſ.
charges oftener. For this reaſon, the eighteen
tailed bandage becomes abſolutely neceſſary to
prevent a frequent removal of the limb, which
is extremely injurious, and ought to be avoided
as much as poffible; indeed without perfect
reft, and an eafy poſtare, no applications will
ſucceed.

AND FRACTURE S.
51
a
ſucceed. The ſplints to be made uſe of here,
are the ſame as directed in ſimple fractures.
As the large diſcharge of matter in bad com-
pound fractures, renders a change of the bandage
too often neceſſary and thereby diſturbs the quiet
of the limb, l generally apply a piece of fine oil
1
cloth between Mr. Pott's bandage and the ſkin;
this ſet ſmooth and eaſy on the part,
and
pre-
vents the matter from ſoaking through to the
bandage, which, by this means may be kept
clean and ſweet during the greateſt part of the
cure, particularly if we are careful to abſorb
the diſcharge with ſmall bits of foft ſponge at
every dreſſing, and when the ſwelling and in-
flammation are ſubſided, to moiſten the ban-
dage with a little fpt. vin. camphor,' or plain
ſpirit. During this ſtage of the diſeaſe, abſceſſes
and lodgments of matter are frequently formed
in various parts of the limb, either from the
deep'depending ſituation of the wound, or ſharp
ſplinters of the bone, irritating the nervous
and muſcular parts; and theſe accidents require
the utmoft ſkill and attention of the Surgeon.
If the miſchief is occafioned by a ſplinter,
it ought, if practicable, to be extracted, as it
will continue to excite new inflammations, and
thoſe attended with violent pricking pains,
which generally diſtinguiſh theſe collections of
matter from thoſe ariſing in conſequence of
unfavourable ſituation.
In the laſt caſe, counter-openings, in the moſt
depending part, are the only effectual remedies,
and

52
JONES ON WOUNDS
and I have ſometimes made them with great ad-
vantage on the inferior part of the leg, leaving
the orifice without any other application to it
than the oil cloth, rather than attempt to favour
the diſcharge, by a more painful poſture of the
limb.
Young Surgeons from a principal of timidity
are too apt to omit theſe openings, and attempt
to preſs out the matter, and unite the finus by
ſticking plaſters, compreſs, and bandage; which
beſides their inefficacy, are very injurious during
a ſtate of tenfion and ſwelling. They have their
uſes as preventatives, to reſiſt the diftention of
the veſſels, or to brace them up, when too
much relaxed and weakened, but ſhould never
be employed under the circumſtances above-
mentioned
The relaxing cataplaſms and fomentations;
should be continued during the whole ſtate of
inflammation and ſwelling, but no longer ; for
they afterwards tend to increaſe the diſcharge,
and weaken the patient, whoſe ſtrength, at this
time, requires to be ſupported by a more nou-
riſhing diet, and the uſe of the bark.
From what has been ſaid, it appears, that a
compound fracture is healed as it were by the
hand of nature, with little or no fuppuration ;
or it may be attended with high inflammation,
repeated abſceſſes, and a great diſcharge, de-
manding the utmoſt ſkill and attention of the
Surgeon, whoſe beſt efforts are fometimes baf-
fled, and the patient is obliged to com-
pound

AND
53
FRACTURES
pound for life with the loſs of his limb, in con-
ſequence of the exceſſive drain and conſtant ab.
ſorption of matter, which keeps up a continual
fever, and daily waſte of the patient's ſtrength.
Under theſe circumſtances, there is no remedy
left, but amputation, the propriety of which
muſt be determined by the judgment of the at-
tending ſurgeon, who ought always on theſe
occaſions, to call in the beſt advice and affiſtance
he can procure, both on account of his own re-
putation and his patient's ſatisfaction. But here
it may be right to obſerve, that amputation is
rarely, if ever neceſſary, in conſequence of the
drain, where the bones
are united, and
wherever it is neceſſary, the fracture will be
found in a looſe unconnected ſtate.
But it ſometimes happens that all our endea-
vours to preſerve both life and limb, prove
fruitleſs; from the beginning, a gangrene and
mortification coming on immediately in confe-
quence of high inflammation, bad habit of bo-
dy, or ignorance and innattention of the Sur-
geon. In the firſt caſe the diſeaſe may be re-
.
garded as merely local, being occafioned by ſuch
a degree of injury done to the parts, as to pre-
vent the circulation through them, which muſt
inevitably produce an early mortification, and
render immediate 'amputation the moſt adviſea
able remedy. Writers, however, are pretty
much divided in their opinions upon this ſub-
ject; nor is it an eaſy matter to define the preciſe
degree of injury which renders immediate am-
H
putation

54 JONES ON WOUNDS
putation abſolutely neceſſary; for after the beſt
general directions (and they are the moſt that
can be given the particular nature of the acci-
dent and circumſtances of the patient muſt de-
termine the Surgeon's judgment. Mr. Pott is
a warm advocate for early amputation, and
thinks that even a very few hours make all the
difference between probable ſafety, and certain
deſtruction. But here again it is very poſſible
the ill effects of Hoſpital air may have influenced
his opinion ; for it is certain that in private
practice, a mortification in conſequence of a lo-
cal injury, is much leſs dangerous, than one
produced by a gangrenous diſpofition of the
fluids; and the ſymptoms attending the former,
are by no means fo frightful and alarming as
thoſe which accompany the latter ; for theſe
reaſons I would adviſe the young practitioner
to be governed in ſuch difficult cafes by the par-
ticular ſituation of his patient; if placed in a
Jarge or crowded Hoſpital
, ſpeedy amputation
ſhould take place, but in private practice, and
in a pure and healthy air, every effort ſhould
be exerted to ſave the limb; the mortification
too, under theſe circumſtances rarely extends
beyond the limits of the injury; the patient pre-
ferves his countenance ſerene, is attended with
no more fever than is uſual in violent contuſions,
there is little or no previous gangrene of the
ſubcutaneous parts, or emphyſema from confin-
ed putrid air ; but the mortification takes pof-
feffion of the ſkin and fleſh at once, and if you
make

AND FRACTURE S.
55
make an inciſion through the ſkin, there is no
feeling in it, and nothing but extravaſated blood
is diſcharged.
On the contrary, when a mortification takes
place in conſequence of a gangrenous diſpoſi-
tion of the juices, whether the injury be more
or leſs ſevere, the muſcular and membranous
parts are corroded by an acrid lymph, the mem-
brana adipoſa is filled with air bubbles, produc-
ing an extenſive emphyſematous tumor in the
ſkin, which is not yet apparently diſceaſed,
though it plainly points out the tragedy which
is acting underneath ; at this period a fever of-
ten accompanied with a delirium, great dejection
of ſpirits, and particular wildneſs in the looks
comes on, the pulſe is generally quick, low,
fluttering, and unequal, according to the age
and ſtrength of the patient.
Inciſions now made through the ſkin, give
pain, and its veſſels diſcharge a florid blood,
which
proves
that the circulation is carried on,
during the gangrenous ſtate of the muſcles and
adipoſe membrane, which are of a yellowiſh
brown colour, and ſoon change for the worſe ;
the ſkin becomes greatly inflated, and when
pierced, diſcharges from beneath, a quantity of
frothy matter with air ; at laſt the ſkin itſelf
turns livid, and a general mortification cloſes
the ſcene.
To oppoſe this frightful train of ſymptoms,
and promote if poſſible, a ſeparation of the
found from the mortified parts, will require all
the

56 JONES Ο WOUNDS
ON
Ν
the aid of the chirurgic art. Immediate re-
courſe muſt be had to the bark, which ought
to be given in ſubſtance, and in as large quan-
tities as the patient's ſtomach can bear. Inci-
fions ſhould be made down to the membrana
adipofa, in order to diſcharge the confined air
and acrid matter, as well as to make room for
the application of warm, ſpiritous fomentations,
and proper digeſtive ointments, over which
fhould be applied double compreffes, wrung out
of common fpirits, and renewed two or three
times a day. The diet ſhould be cordial and
nouriſhing, and the patient's ſpirits ſupported
by every attention and encouragement in the
Surgeon's power. By theſe means the progreſs
of the mortification is ſometimes happily re-
ſtrained, and a ſeparation of the found, from the
mortified parts taking place, admits of a com-
poſition for life, with the loſs of the limb by
amputation, the method of performing which
operation will be deſcribed in the following
Chapter
CH A P T E R VII.
ON AMPUTATION.
А
A
S every operation is neceſſarily attended
with a certain degree of bodily pain, as
well as terrible apprehenſion to the pati-
ent's mind, a good Surgeon will be in the firſt
place,

AND FRACTURES. 57
place, well aſſured of the neceffity of an opera-
tion, before he proceeds to perform it; and (e-
condly he ought to conſider, whether the pati-
ent will in all probability be the better for it, or
whether he may not be the worſe.
It will alſo be of fingular advantage to young
ſurgeons particularly, before they begin an opera-
tion, to go through every part of it attentively
in their own minds, to conſider every poffible
accident which may happen, and to have the
proper remedies at hand in caſe they ſhould;
and in all operations of delicacy and difficulty,
to act with deliberation, and never affect
great
expedition, by which, very capital and even fatal
errors have been committed. The maxim of
“ feftina lente” is in no caſes more applicable
than in theſe; it is alſo of no ſmall importance
to ſupport the patient's ſpirits with a chearful
affurance of ſucceſs, and the appearance of ſuch
a degree of modeft confidence as may ſerve to
inſpire him with it, and by all means to avoid
terrifying him with the
appearance of the
appa-
ratus, or a vain and ridiculous parade of any
kind.
The ſurgeon ſhould chooſe his own aſſiſtants,
acquaint them with his intended mode of ope-
rating, and avoid a uſeleſs crowd of ſpectators.
With theſe prerequiſites, joined to thoſe qua-
lifications already mentioned in the introductory
diſcourte, as neceſſary to conſtitute a good ope-
rator, a Surgeon will undertake moſt operations
with at leaſt a ſtrong probability of relieving his
patient,

58
JONES ON WOUNDS,
patient, which is performing one of the moſt
effential offices of humanity.
When the amputation of a limb is determined
on, the following apparatus fhould be prepared
in a different room. A large diſh, with a com,
preſs to be placed over the veſſels made in the
form of a roller, flattened and fewed to the
middle of a flip of linen, between two and
three inches wide, and of ſufficient length, to
paſs two or three times round the limb. The
tourniquet or leather with a fillet and ſtick, a
yard of tape rolled up, the amputating knife, cat-
len, faw, tenaculum, crooked needles armed, and
ligatures of waxed thread, looſe, a pair of ſtrait
fciffars, and ſponges.
In another diſh ſhould be placed a ſufficient
quantity of lint, ſome long pledgets of the fame,
ſpread with ſimple cerate or foft digeſtive. A
large pledget or two, of tow armed with the ſame
cerate, and a few ſoft compreſſes of tow unarm-
ed. Slips of linen about three inches wide, to
croſs the ftump, and retain the pledgets, &c,
two rollers of different lengths, and a looſe,
knit woolen cap, to draw over the whole.
If the leg is to be removed, the moſt conve-
nient pofture for the patient, is lying on a firm
table of convenient height, covered with blan-
kets fufficiently doubled, and pillows to ſupport
the head. The operator, ſtanding on the inſide
of the leg, held in a ſteady horizontal line by the
affiftants, firſt fixes his compreſs longitudinally,
over the courſe of the artery in the ham; then
bringing
a
a

AND FRACTURE S.
59
bringing the two ends of the bandage to which
it is fixed, towards each other, and paſſing one
of them through a flit made in the oppoſite ex-
tremity,as in the uniting bandage, he makes two
or three turns round the limb, with the longeſt
end, and drawing it pretty tight, faſtens it with a
pin; over this is fixed the tourniquet, or leather,
with the fillet and ſtick, * which ever of them are
uſed, and having given it the neceſſary degree of
tightneſs, he delivers it into the hands of his af-
fiftant; then fixing upon that part where the firſt
inciſion is to be made, which is about four fingers
breadth below the patella, he paſſes the tape
about half an inch below this part, and making
a turn or two, pretty cloſe, faſtens it with a pin.
He then beginning the firſt inciſion on the
outſide of the leg, as high as he can carry the
knife without conſtraint, divides the ſkin, and
membrana adipoſa down to the muſcles; and
bringing his knife forwards, terminates his firſt
ſtroke far enough on the inſide, to make one
half of the circumference of the circle, which
is
* This is by many Surgeons, in private practice, preferred to
the ſcrew tourniquet, and conſiſts of a piece of ſtrong worſted
binding, an inch broad, and five quarters long, which ſur-
tounding the circular band, its extremities are paſſed through
two flits, cut tranſverſally one inch from each end of a piece
of firm fole leather, about three inches long, and two and a
half wide. The ends of the fillet are then tied in a ſtrong flip
knot, and a round ſtick, four or five inches long, and three
quarters thick, being paſſed between the leather and fillet, the
afiftant, by turning the ſtick, makes what degree of compref-
fion he pleaſes, upon the artery.

bo JONES ON WOUNDS
is finiſhed by another ſtroke carried from the
place of beginning, to meet the oppoſite point.
It is to be obſerved that this incifion is to be
made above thé tape, which then falls below
the wound, without embarraſſing the operator,
The firſt inciſion being completed, ſo as
even to mark the muſcles, rather than ſuffer
any adheſion of the adipoſe membrane, the af-
fiftants are to draw up the integuments as high
as poſſible, when the muſcles are to be divided
by two ſemi-circular inciſions, quite down to
the bones.
The interoſſeous ligament muſt then be ſe-
parated by the Catlen or point of the amputa-
ting knife, puſhed between the bones, which
are next to be carefully ſawed through. *
The aſſiſtants obſerving to hold the limb in
the moſt exact horizontal line, leaſt by raiſing
the leg in the beginning or middle of the ope-
ration, the faw ſhould be compreſſed by the
extremities of the bones, or towards the latter
end of it, by letting the limb fall from the di-
rect line, the tibia ſhould break off and form
a ſharp point or ſplinter.
When
Mr. Bromfield recommends a piece of ſoft leather about
eighteen inches long, and of proportionable breadth, which being
fit half way down the middle, is eaſily received between the
divided fleſh, and one flap being lapped over the other, the
affittants take hold of the two ends, and drawing them up,
not only keep the muſcles out of the way of the faw,
but by forcing them higher up, enable the operator to re-
more of the bone, and by that means prevent a
pointed ftump.
9
move

AND FRACTURE S. 61
When the leg is removed, the principal arteries
are to be ſecured either with the common
crooked needles and thread, or the * tenaculum,
it is ſeldom neceſſary to take up more than three
or four vefſels, the mouths of which from their
fize are in general readily enough diſtinguiſhed
without looſening the tourniquet, which how-
ever ought to be quite looſe as ſoon as the prin-
cipal veſſels are tied, that the circulation may,
be carried on more ſpeedily in the minute colla-
teral branches of the ſtump, and diſcover ſuch
as need to be fecured. In taking up an artery,
the needle muſt be paſſed on each ſide of the
vefſel, but no deeper, nor more fleſh, incloſed,
than will ſerve to prevent the of ligature from
falling off. This laſt part of the operation
being finiſhed, the tourniquet removed, and
ſkin drawn down on the muſcles, the dreſſings
are next to be applied in the following manner.
Firſt, two round pledgets of lint upon the ex-
I
tremities
* The tenaculum is an inſtrument made in the ſhape of a
large crooked needle with a round point fixed in a ſmall wooden
handle, ſerves to pierce the end of the artery, and draw it out
ſuficiently for the aſliſtant to make a ligature upon it, by which
method leſs pain is excited, and the ligature drops off much
fooner than in the common way. This mode, however, though
warmly recommended by Mr. Bromfield and Mr. White, is not
generally adopted, and requires the ſanction of further expe-
rience, to give it the entire preference over the uſual method.
+ The ligatures ſhould be made of ſhoemakers thread, which
compreffes without cutting, and the fize of the ligature muſt als
ways be in proportion to the largeneſs of the veſſel.

62 JONES ON WOUNDS
tremities of the bones, over which I a piece of
fine old linen exactly fitted to the muſcular part
of the ſtump is to be laid, then doffils of lint
fprinkled with flour, are to fill up the cavities,
made by the circular edge of the fkin and mem-
brana adipoſa, upon which the armed pledgets
of lint are to be applied, and over theſe, the large
ones of tow; the long compreſſes or flips of
linen are then to croſs each other at right an-
gles, and paſs far enough on the ſides of the
Atump, to be retained by the firſt roller, a few
turns of which, but not tightly drawn, are ſuffi-
cient for the purpoſe; the ſecond roller is em-
ployed in making ſeveral fpiral turns from above
the joint, down to the edge of the flump, where
it is faſtened with a pin. Laſtly, the woolen
cap is drawn over the whole leg, ſtretching it
from top to bottom, with both hands, and flip-
ping it gently on. The patient is then to be
laid in his bed, his thigh a little elevated, and
the knee genily bent and ſupported by a ſoft
pillow, a ſudorific anodyne, to quiet pain, and
diſpoſe him to a gentle diaphoreſis, thould be
immediately given, and perfect quiet enjoined,
as an eſſential requifite to his recovery.gr
boo The
je 15 nad
† The circular piece of linen applied immediately to the
muſcular part of the ſtump, is preferred by Mr. Bromfield, to
dry lint, as it comes off much fooner and dafier than lint,
which adheres a long time, and very cloſely to the ſurface of
large wounds. The application of ſponge is attended with the
fame or greater inconveniencies, from the granulations of fleſha
infinuating themſelves into the porous ſubſtance of the ſponge.

AND FRACTURE S.
63
a
The mode of operation in amputating the thigh,
differs but in few particulars from that of taking
off the leg. The compreſs and tourniquet are
to be fixed higher upon the courſe of the artery,
and the Operator ſtands on the outſide of the
limb, the patient being ſeated in a chair as more
commodious for both. Before the boneis ſawed
through, Mr. Bromfield adviſes the operator to
ſeparate the muſcles which adhere cloſely to the
linea aſpera, with the catlen. This may be
done about half an inch or ſomething more in
length, and will, by that means allow a larger
portion of the bone to be removed without
fearing the muſcles, and conſequently a better
ſtump be made. The roller firſt applied, ſhould
be attached to a broad bandage ſurrounding the
body, and deſcend by ſpiral turns around the
thigh, until the edges of the laſt turn are ex-
actly even with the edges of the ſtump. This
mode of applying it, will prevent the lodgment
of matter, which happens when the roller is
carried beyond the edges of the wound, or that
retortion of the lips occafioned by the rollers
falling ſhort of them. As the principal uſes of
bandage after an operation, are to reſtrain hæ-
morrhage, and retain the dreſſings, it ſhould
never be tighter than to anſwer theſe purpoſes,
for any thing beyond theſe, will, by obſtructing
the freedom of the circulation, increaſe the
(welling, pain and inflammation of the parts.
Surgeons are generally too ſolicitons about
drawing down the ſkin, and retaining it by
cloſe

64 JONES ON WOUNDS
cloſe bandage immediately after the operation,
in order to make a good ſtump; but this is done
to much better advantage, when the tenſion
and ſwelling are carried off by digeſtion, and
the parts have acquired their natural tone. un
Should the Surgeon, however, be threatened
with a pointed ſtump, notwithſtanding the
mode of operation and bandage already recom-
mended, the following method of treatment
will contribute greatly towards preventing this
troubleſome conſequence of amputation.
Having ſpread a large piece of ſkin with the
adheſive plaiſter, let a ſufficient number of flips
two inches wide, and long enough to ſurround
the thigh, be cut from it. The firſt flip is
to be applied cloſe to the edge of the ſkin on the
ftump; the next, about a quarter of an inch
lapped over the firſt, and ſo continued till the
laſt flip is applied near the top of the thigh ;
over theſe a roller ſprinkled with powdered ro-
fin, is to be paſſed from above, downwards, in
the manner already mentioned, and then wetted
with ſpirit of wine, which foon grows dry, the
affiftants are then to draw down the ſkin and
muſcles over the end of the bone, and the Sur-
geon having applied his dreſſings, ſecures them
on, by a number of the flips of ſticking plaiſter,
which are to croſs each other, and paſs high
enough on the ſides of the ſtump, to retain the
integuments and fleſh in their defired fituation.
Thele ſlips and roller form a caſe which ſcarcely
requires
a

AND FRACTURE S.
65
requires to be renewed during the greateſt part
of the cure.
As a preſervation of the joint of the knee to
be uſed with the remaining part of the leg after
amputation, is attended with great advantage
to the patient, ſeveral ingenious Surgeons have
lately revived a method long fince recommend-
ed, but never practiced with ſucceſs, until
within a very few years. Inſtead of taking off
the leg at the uſual place below the knee, the
firſt inciſion is made about four inches above the
ancle joint, and the remaining part of the ope-
ration finiſhed in the common way; the ten-
dons, which are here neceffarily divided, are
apt to protrude beyond the fleſh after the ope-
ration, but may, without any pain, be taken
off with the knife or fciffars, to a level with the
reſt of the ſtump. One or two gentlemen of
the profeffion, particularly Mr. O'Halloran and
Mr. White, adviſe a flap to be formed of the
pofterior part of the fleſh and integument, which,
as ſoon as the digeſtion comes on, and the liga-
tures can be removed, is to be turned over the
end of the ſtump, and retained there, either
by future or compreſs and bandage, until the
parts unite by the firſt * intention; but as Mr.
Bromfield, and Mr. Wright very ingenious
Surgeons of Sheffield, have both performed the
bad operation
* The advantage propoſed by this fiap, is to form a cuſhion
for the bone of the ſtump to reft upon, without danger of un-
caſineſs or protruſion,

66 JONES ON WOUNDS
5050
operation with the moſt defirable ſucceſs, with:
out the flap, it is certainly the moſt eaſy and fim-
ple mode of doing it. 25
It is to be obſerved that when the operation
is to be performed in this way, the patient muſt
have an artificial foot and leg, the hollow of
which laſt ſhould be formed fo as to ſupport the
perſon's weight on its fide, as much as on the
extremity of the ſtump, which is thereby greatly
relieved.
The ſuperior advantages attending this mode
of amputating the leg, both in point of beauty
as well as utility, will, I imagine recommend it
to general practice, as ſoon as its merits are fuf-
ficiently known. It is an eſtabliſhed maxim in
Surgery to take off the fore-arm as near the writ
as poffible, and no objections are made to the
performance of it there, notwithſtanding its
tendinous and ligamentous ſtructure.
When the fingers and toes become carious,
they are beſt taken off at the joint; and in or-
der to ſave as much ſkin as poſſible, the circular
incifion ſhould be made on the extremity of the
bone which is to be removed, but not lo low as
to embarraſs the operator in coming at the ar-
ticulation; the capſular ligament of which will
be readily diſcovered, by bending the finger to-
wards the palm of the hand after the incifion is
made through the ſkin and tendons. y bood
Mr. Bromfield adviſes a removal of the car-
tilaginous extremity of the bone with the knife,
in order to promote a fpeedier growth of the
granulations,

AND
67
FRACTURES
granulations, which however, I have generally
found cover'd before the cicatrization took
place. If the fingers are to be taken off at the
firſt joint next to the metacarpal bones, it is
neceſſary to divide the ſkin and fleſh between
them, quite up to the joint, before you
make
the circular incifion.
Dry lint with moderate compreſs and ban-
dage, are generally ſufficient to reſtrain the
bleeding; yet if an-artery ſhould be trouble-
fome, it will be beſt to ſecure it with a liga-
ture.
die
We are frequently in this country obliged to
remove large portions of the metatarſal bones in
conſequence of mortifications from froſt; and
here it is to be obſerved, that as much as pof-
fible of the bone as well as ſkin is to be
faved, in order to afford the patient a better
ſupport; though inſtances are not wanting of
men's walking tolerabiy well upon the aſtraga-
lus and os calcis alone. After dividing the
fleſhy and tendinous parts between the bones
with the knife, and drawing up the ſkin as
much as poffible, before the circular incifion
is made, the bones are to be fawed through
with a ſmall ſpring faw; a bit of thin ſheet lead
being placed between the bones, to defend the
tendons and fleſh of the oppoſite fide from being
injured by the faw.
When anodyne, or antiphlogiſtic medicines
become neceſſary, after any of the preceding
operations, they are to be exhibited according
.
to

68 JONES ON WOUNDS
to the nature and urgency of the ſymptoms,
which are feldom exactly alike in any two caſes 9
for this reaſon the young Surgeon will eaſily
perceive the neceffity of acquiring ſome general
principles in his profeſſion, the application of
which to particular caſes muſt ever be left to
his own judgment.
The principle of a relaxed and non-reſiſtent
ftate of the muſcles, as ariſing from the bend-
ed poſition of the limb fo frequently recom-
mended in the Chapters upon ſimple and com-
pound fractures, is equally applicable to the
reduction of diſlocations, which have hitherto
been as little underſtood, if not leſs than thoſe
of fractures; but unleſs the Surgeon is very
competently acquainted, not only with the
ſtructure of the bones, but their connecting li-
gaments in a recent ſtate, together with the
force, direction, and attachments of the differ-
ent muſcles and tendons, he can derive little
more than a negative kind of inſtruction, from
the writings of the ableft men upon the ſubject
of diſlocations. All I ſhall venture to recom-
mend to the young Surgeon unacquainted with
anatomy, is cautiouſly to avoid thoſe miſchiefs
which always ariſe from a violent exertion of ill.
directed force. Whatever extenſion is made,
ſhould be done very gradually, by which means
the muſcles and ligaments will not receive half
the injury from a great degree of diftention,
which they would ſuſtain from even a moderate
one very haftily exerted :-The hold which the
affiftants

AND FRACTURES:
69
affiſtants take, ſhould always be applied to the
diflocated bone, for inſtance, if the os humeri
is diſlocated, the lower extremity of that bone;
and not the fore-arm, is to be held by the pere
ſon who affiſts in the reduction:-The poſition
of the limb below the luxated joint ſhould be
ſuch as to give the leaſt degree of reſiſtance to
the muſcles above it; for this reaſon, in the re-
duction of a luxation of the os humeri, the fores
arm ſhould be bent ; whenever a ſufficient det
gree of extenſion is judged to be made, the
Surgeon ought to make uſe of the diſlocated
bone as a lever to direct the head of it into the
focket Indeed when the head of a luxated
bone is brought by proper extenſion to a level
with the edge of its focket, little or no external
force is required, to replace it;--the ſurround-
ing muſcles of the joint perform that part of the
operation, better than the Surgeon himſelf.
CHAPTER VIII.
OF BLOWS ON THE HEAD:
TO
10 give the young unexperienced Surgeon,
ſome general and clear ideas of the nature
and treatment of this difficult and dange-
rous branch of chirurgical diſeaſes, I fhall con-
ſider the ſubject under three ſeparate heads
The firſt, comprehending the injuries to which
the ſcalp and inveſting membranes of the ſkull
К.
are

70 JONES ON
WOUNDS
are liable. The ſecond will treat of the ſymp-
toms ariſing from a commotion or concuſſion
of the brain; and the third, ſhall comprize thoſe
complaints which are occaſioned by a fracture
of the bones of the ſkull, and its effects on the
parts beneath.
Obu
If the ſtructure of the ſcalp was not different
from that of the common integument of the
body, and wounds inflicted on it, were attended
with no other conſequences, than thoſe of the
common parts, a particular inveſtigation of its
injuries, might be deemed a uſeleſs labour;
but when we conſider that this covering of the
head, conſiſts, not only of the ſkin and adipoſe
membrane, but the expanded tendons of the
frontal, occipital and temporal muſcles, beſides
the pericranium ; that it has a conſtant com-
munication, by means of the blood veſſels, be-
tween the parts within and without the ſkull;
the neceſſity of a particular attention will pretty
evidently appear.
a bas it
Although common inciſed wounds of the
ſcalp which penetrate no deeper than the cellu-
lar membrane, are not generally attended with
any particular circumſtances; yet in certain
conſtitutions of a peculiar habit and difpofition,
they fometimes produce very troubleſome, and
even alarming ſymptoms. Perfons of a nervous
a
and irritable ſyſtem, are ſubject to violent fpal-
modic affections, accompanied with a low quick
pulſe, frequent faintings, want of ſleep, and
flight delirium ; and I have known intemperate
perſons

AND FRACTURE'S:
71
perſons of this irritable claſs, who have ſuffered
even a jaw-lock, in conſequence of the removal
of a Imall incyíted tumor from the head, where
nothing more than the cellular membrane was
divided.
Sudorific anodynes, joined with ſome of the
fætid antiſpaſmodics, generally remove thoſe
complaints in a few days, though to the young
and unexperienced practitioner, they will ap-
pear very dangerous and alarming. Such as are
of a bilious habit of body, are attended with a
flight fever, a general tumefaction of the ſcalp,
extending to the eye-lids and ears'; the ſwelling
is of the ædematous kind, of a yellowiſh hue,
and is frequently beſet with ſmall bliſters, filled
with a ferum of the ſame colour. In ſhort,
the inflammation in this caſe appears evidently
to be of the eryſipelatous claſs, though it is ſel-
dom attended with danger, and generally re-
lieved by moderate bleeding, a few lenient pur-
gatives, and febrifuge medicines of the neutral
kind, the wound requiring no other than the
uſual dreſſings, with a warın diſcutient fomen-
tation, where the inflammation is ſo high, as
to render the diſeaſe very painful; in which cir-
cumſtances, the ſudorific anodynes may be given
with advantage.
Tubo game mo
Punctured wounds of the ſcalp are generally
more troubleſome than thoſe made with a cut-
ting inſtrument, probably owing to a confine-
ment of the diſcharged fluids, for which reaſon
fome dilatation will now and then be neceſſary;
anolia
otherwiſe

72
JONES ON WOUNDS
otherwiſe they require no other method of treat
ment, than what has been recommended for in
ciled wounds.
on tar
When a large portion of the ſcalp has been
ſeparated and detached from the pericranium,
either by a lacerated or inciſed wound; the
parts fo ſeparated, after being cleaned from
dirt and coagulated blood, ought to be
brought as nearly as poſſible into contact:
and then ſecured by the interrupted future,
with proper compreſs and bandage.--- In caſe
the lips of the wound are fo ragged and un-
even as not to admit of an exact appofition,
they may be brought to approach fo near each
other with a ligature and flip knot, as ta leffen
the deformity, and ſhorten the cure ---advan-
tages which a good Surgeon ſhould ever have
in view.--Should the parts not univerſally
unite, but form little abfceffes in different
places; theſe may eaſily be opened with the
point of a lancet, and the matter be diſcharged:
and this mode of practice, may take place with
propriety, where the pericranium itſelf is nei
moyed, and a flight exfoliation ſucceeds, with
out retarding or obſtructing the cure si eveni
where the pericranium and aponeurotic expan-
fion are become floughy and inflamed. if the il
Surgeon is not in too great hafte to cut, and
will have patience to wait until a ſeparation and
good digeſtion are come on, he will frequently
Tucceed in preſerving the ſcalp, and avoiding
that deformity, which a large ſcar and the lofsu
of hair, muſt inevitably produce ;---here, how-
ever,

AND FRACTURE S. 73
ever, it muſt carefully be remembered, that the
ſcalp is not abſolutely ſpoiled by contufion, and
that the injury extends no deeper than the exter-
nal coverings of the cranium; when it does a
very
different mode of treatment will be requi-
fite --For if befides the ſymptoms already enu-
merated, as attending inciſed and lacerated
wounds of the ſcalp, and which generally come
on within three or four days after the accident;
the patient ſhould be ſeized, fome time after this
period, with a ſmart fever, ſevere pain in the
head, great anxiety and refleſsneſs, frequent ſhiv.
erings, a nauſea, delirium and convulsions, the
wound at the ſame time putting on a ſpongy,
glaffy, unhealthy aſpect, with the pericranium
looſened, and detached from the ſkull; there
will be great reaſon to ſuſpect that the parts
within the ſkull are affected, either by ſome
extravaſated fluid, preſſing upon the brain, or
from an inflammation and ſuppuration of the
dura and pia mater : And as none of theſe ſymp-
toms appear at firſt, or immediately after the ac-
cident, ſo they come on in a kind of ſucceſlive
order; the firſt ſet, ariſing from an extravaſa-
tion of blood or lymph, preffing upon the brain
and origin of the nerves, ſo as to impair or abo-
Jithe voluntary motion, and the ſenſes, ſhew"
themſelves earlier ; whereas the other, being
cauſed by an inflamed and putrid ftate of the
membranes of the brain, feldom affects the or
gans of ſenſe, until late in the diſeaſe, when
ſuch a quantity of matter is generated, as to
wo
motoros van
Sidstioni occaſion
1995

74 Jones ON
JONES
Ο
WOUNDS
occafion the fame ſymptoms of preſſure, with
any other fluid.
oyntovicofile
Both theſe cauſes, with their effects, may
happen to be combined in the fame patient, and
render the caſe a little more perplexed, and dif-
ficult; yet there are generally ſome characte:
riſtic marks, which ſerve at leaſt to diſtinguiſh
the inflammatory effects of contufion, from thoſe
occafioned by commotion and extravaſation.
In ſuch caſes, that is, where an inflammation
of the meninges or membranes of the brain
is the conſequence of contufion, and where little
or no mark of external injury appears, the mil-
chief is feldom diſcovered until ſeveral days,
often ſeven or eight, after the accident;--a pain
in the ſpot which received the blow, is gene-
rally the firſt fymptom.---This pain is foon ex-
tended over all the head, and is attended with
a languor and dejection of ſpirits, followed by a
vertigo, inclination to vomit, reſtleſsneſs and
fever.-A day or two after this, if no evacuati-
ons have been uſed, a paffy tumor of the ſcalp,
not riſing very high, or exciting much pain,
generally appears. If this tumor is laid
open, the pericranium will be found of a dark-
ich hue, and either detached or eaſily ſeparable
from the ſkull; between which, and the mem-
brane, a ſmall quantity of a browniſh ichor is
generally lodged; the cranium itſelf being al-
tered in its colour. ---From this period, the
fymptoms are all haſtily exaſperated; the head-
ach and thirſt become more intenſe, the ſtrength
bagdadi sic awoich long decreaſes,

AND FRACTURES.
75
a
decreaſes, the rigors are more frequent, and at
laſt convulfive motions, attended either with de-
lirium, paralyſis or comatoſe ſtupidity, cloſe the
ſcene. so ga bodo
If, under theſe circumſtances, the bone be
perforated, matter will be found between it and
the dura mater; and that, more or leſs in
quantity, according to the violence of the inju-
ry, and the length of time ſince it was receiv-
ed. Sometimes, the matter lies between the
dura , and pia mater, and even upon the ſur-
face of the brain,
If the ſcalp was wounded at the time of the
accident, or any portion of it removed to ex-
amine the ſtate of the ſkull, the wound will
look perfectly well for fome time; but after
few days it begins to loſe its florid complexion,
turns pale and glaffy, diſcharges a thin diſcolour-
a
ed ichor, the lint ſticks cloſe to all parts of the
fore, and the pericranium, inſtead of adhering
firmly to the bone, eaſily ſeparates all round, to
fome diſtance from its edges: the bone itſelf
changing from its natural whiteneſs, to a kind
of purulent hue, or yellowiſh caſt.--All theſe
changes in the appearance of the wound, indi-
cate the diſeaſed ſtate of the parts beneath the
cranium ; which can only be relieved by per-
forating the bone, and this operation ihould
never be delayed when the ſymptoms of an
oppreffed brain, or inflamed dura mater, are
not ſpeedily removed by proper evacuations,
which have frequently prevented the dangerous
confequences of violent blows on the head,

76
JONES ON WOUNDS
CHAPTER IX.
Don
OF INJURIES ariſing from CONCUSSION or
COMMOTION.
A
LTHOUGH the terms of commotion, or
concuſſion of the brain, have been uſed by
many writers in fo looſe and vague a man-
ner, as to convey very inadequate ideas of the na-
ture of the diſeaſes yet it is very certain, that the
medullary part of the brain, receives ſuch a degree
of injury or derangement from violent ſhocks,
as ſenſibly to impair its ordinary functions;
and
this injury is produced, without any fracture or
fiffure of the bone, or even the head receiving
any particular blow upon it; as frequently hap
pens in falls from conſiderable heights, where
the ſhoulders, breech, and ſometimes the feet,
firſt ftrike the ground, and that ſuch ſhocks are
capable of producing, not only a diſorder in the
fubftance of the brain, but an inflammation
and ſuppuration of its membranes, is evident
from the hiſtory of ſome well atteſted facts. *
The ſymptoms, however, which attend
injuries ariſing from mere concuffion, and thoſe
occafioned
* The late Mr. Hewſon uſed to mention in his lectures, the
hiſtory of a lady who was ſeized with all the ſymptoms of an
oppreſſed brain ſome days after receiving a violent jolt in a poſt-
chaiſe, but which was not ſuſpected as the cauſe of her complaints
until after her death, when, on opening the head he diſcovered
an inflammation of the dura-mater, with large fuppuration:

AND FRACTURE si
77
a
becafioned by extravaſation, or inflammation of
the dura mater, admit of a pretty clear diſtinc-
tion.--In the firſt caſe, or that of commotion
fimply, there is generally an immediate ſuſpen-
fion of the common functions of the brain, to
a certain degree:--- The patient has a vertigo or
giddineſs, an inclination to vomit, upon (wal-
lowing any liquid; has a wildneſs in his looks,
talks incoherently, is reſtleſs and fleepleſs, with
little or no fever, or any of the other ſymptoms,
already deſcribed as uſually attending an extra-
vafation or inflammation.
Gentle evacuations by bleeding, lenient pur-
gatives and ſudorific anodynes, frequently re-
move moſt of the complaints occafioned by
concuſſion, in twenty-four hours, or two or
three days at fartheſt : but if after this period,
and the patient having been conſiderably re-
lieved, the ſymptoms ſhould be again renew-
ed, and neither accidental cold, or irregularity in
diet have been productive of their return; the
Surgeon ought, immediately to be upon his
guard, as further miſchief than a mere ſhock or
derangement of the brain is to be ſuſpected.------
Under theſe circumſtances, the evacuations al-
ready mentioned, and particularly bleeding, are
to be repeated with more freedom ---the head is
to be ſhaved and carefully examined, in order to
fee, whether no marks of contuſion point out
the ſeat of the complaint ; for if they do not,
we muſt truſt to evacuations and the general an-
tiphlogiſtic regimet), for the relief of the patient,
L
as

78
JONES ON WOUNDS
a
as the trephine cannot be applied with any toler
able propriety, unleſs we are guided by fome ex-
ternal appearances, to the ſeat of the injury.--.
Mr. Bromfield has lately recommended a liberal
uſe of fudorific anodynes, without bleeding, not
only under the preceding circumſtances of con-
cuffion, but in fractures of the cranium, with-
out applying the trephine :--- However, as he
adduces no more than three or four caſes, and
thoſe not very preciſe, in ſupport of a practice
fo oppoſite to that of the moſt eminent modern
Surgeons, I would adviſe the young practitioner,
to be vety cautious how far he adopts the opini-
ons, even of ſo reſpectable a name as that of
Mr. Bromfield, upon a ſubject which requires
the united judgments of the ableft men of the
profeffion, to aſcertain with precifion. We
As anodyne medicines are the moſt effectual
preventatives of inflammation after ſevere opera-
tions in general, and perhaps act as attenuants
beſides; I think they may, with great propriety,
be employed io fractures of the fkull, as well as
concuſſions of the brain; but as evacuations in
general, and bleeding in particular, are univer-
lally allowed to promote the power of abſorbtion,
as well as leſſen inflammation, I think they
ſhould never be omitted in complaints ariſing
from concuſſion of the brain, extravaſation of any
kind of fluid, or inflammation of the dura ma-
ter; thoſe injuries, in particular, which arife
from the preffure of a lymphatic extravaſation,
occafioned by a rupture of the fineſt vefſels of the
brain,

AND F A C T UR E S.
79
brain, can alone be relieved by abſorbtion, as
there are no ſymptoms, in ſuch caſes, which
clearly indicate the preciſe fear of the collection
and, if there were, it would not be in our power
to relieve them, by an operation,
I fall conclude this chapter, upon concur-
fions of the brain, with the hiſtory of a caſe,
which fell under my care many years ago, and
which may ſerve to fhew the perplexing obſcu-
rity ſometimes attending certain caſes of this
nature, both with reſpect to the cauſes and cure
of the diſeaſe.
A woman, about twenty years of age, in
running haſtily out of a cellar, firuck the crown
of her head with great violence againſt a beam.
---She was ſtunned with the blow, but after a
few minutes, was able to go about her buſineſs,
and continued apparently well for three or four
days, when the complained of a giddineſs and
pain in her head, attended with a ſlight fever.
Under theſe circumſtances, I was applied to
for aſſiſtance, and, after enquiring into the hiſ-
tory of her caſe, and examining her head, where
no appearance of contuſion was obſervable, I
took fixteen ounces of blood from her arm,
gave her a gentle purge, and ordered a low di-
lesing diet, which foon removed all her com-
plaints, and the continued perfectly eaſy for ten
or twelve days, when her former fymptoms
again returned, and were as fpeedily relieved by
the ſame remedies.-In ſhort, ſhe continued to
faffer periodical attacks of pain in her head with
a fever, every twelve or fourteen days for near
three

80
JONES ON WOUNDS
three months, and was as often relieved by
gentle evacuations, until the eightieth day from
the accident, when the ſuddenly becaine per-
fectly frantic and delirious, with a hard quick
pulíe, and moſt of the fymptsms uſually
attendant on an inflammation of the dura
mater.---A copious bleeding, and ſeveral gly-
ſters afforded very little relief, and as her fitua-
tion was then to the laſt degree threatening, I
was induced to examine the ſcalp with great at-
tention, and thought I was ſenſible of ſome
{mail degree of thickening on the part, where
The first ftruck her head, and which ſhe al-
ways pointed out, while fenfible, as particularly
painfui: Upon this I made two ſemi-circular
incifions, and removed a ſufficient portion of
the ſcalo, with the pericranium, which adhered
pretty firmly ;--- then perforating the bone, and
taking out the circular piece, I was ſurprized to
fied only a Qight degree of inflammation upon
the dura mater, which I immediately divided
with the point of a lancet, but without any
diſcharge of blood or matter ;---all her dange-
rous ſymptoms diſappeared the next day, re-
tarned no more, and the was cured in the uſual
time, without any other remarkable circumſtance,
ainstic HAPTER
CH
X.
OF INJURIES ariſing from a FRACTURE
Si eu of the SKULL,
be
7 HOEVER has read with attention the
two preceding chapters upon blows of
the head and concuſſions of the brain,
bno
GO
a
W.

AND FRACTURE S.
81
will readily perceive, that a ſimple undepreſſed
fracture of the ſkull, conſidered merely as a ſo-
lution of continuity of the bones, can never oc-
cafion thoſe dangerous ſymptoms, which often
arile in conſequence of ſuch blows and concuf-
fions --It is the injury, which the brain and
its inveſting membranes ſuftain from extravaſa-
tion and inflammation, which conſtitute the
whole danger of ſuch accidents, as is evident
in many undepreſſed fractures of the ſkull,
where no bad fymptoms at all appear, and where
the application of the trephine is ſometimes un-
neceſſary.---Whereas the moſt dangerous and
fatal caſes are generally thoſe, in which there is
not the leaſt fracture or filure to be found,
For theſe reaſons the operation of trepanning
in undepreſſed fractures of the cranium, may be
performed with three different intentions; either
to relieve the complaints ariſing from the preſ-
fure of an extravaſated fluid.---To give a dif-
charge to matter formed in conſequence of an
inflammation of the dura mater,---or it may be
uſed as a preventative of future miſchief. In
the firſt caſe, the relief from perforation, is not
only ſometimes immediate, but frequently is
not attainable by any other means---in the ſe-
cond, it is the only chance for life; as there is
no natural outlet for the diſcharge of matter
forned in conſequence of inflammation.-.-In
the third, or preventative intention, it is a mat-
ter of choice, more than immediate neceflity,
dowolo noqo tada goibo9519 ów
Few
sotagos
bus bag that

82 JONES ON WOUNDS
Few perfons, I believe, will hefitate to per
form the operation under the two firſt circum-
frances, of extravaſation and inflammation
with reſpect to the third or preventative means,
fome doubts may ariſe with the young practi-
tioner, about the propriety of performing the
operation, while no bad fymptoms appear, par-
ticularly as ſome writers adviſe us to wait until
its neceſſity is indicated by ſuch complaints as
may bosh require and vindicate it.
To aſcertain as nearly as poſſible the true line
of conduct in to intereſting a matter, it will
not be amiſs to compare the dangers reſulting
from the operation conſidered in itſelf, with
thoſe conſequences which we may reaſonably
expect from an omiſlion of the performance
of it.
no
As to the operation itſelf, and particularly that
part of it, which confifts in perforating the
bone, there is neither pain, difficulty, nor dan-
ger in it:---the loſs of ſubſtance in the bone
does not long retard the cure, and as to the ad-
million of air upen the dura mater, it will in a
great meaſure produce its effects through the
fracture, where the perforation is not made.
The danger of omitting the operation, ariſes
in conſequence of the preſſure upon the brain,
and the inflammation of its membranes, ſo of
ten repeated in the preceding pages; and as
the most dangerous fymptoms occaſioned by
theſe cauſes, do not come on immediately,
frequently not until many days after the injury,
it

AND FRACTURES:
83
it is impoſſible for the Surgeon to aſcertain the
miſchiefs which may be occafioned by it; and
when thoſe miſchiefs are indicated by the ſymp-
toms, the operation is the principal remedy we
have in our power, and that is too frequently,
under ſuch circumſtances, unſucceſsful.
In ſhort, if we compare the numbers of per-
fons who die from collections of matter formed
within the cranium, where the perforation has
been peglected, with thoſe who ſurvive, under
an early application of the trephine, the propor-
tional ſucceſs of the latter will be found ſo much
greater, as to render the operation adviſeable, in
almoſt every caſe of a fimple undepreſſed frac-
ture of the cranium.
When a fracture of the ſkull is attended with
a depreſſion of the bone, the neceffity of eleva-
ting the depreſſed part, in order to take off the
preſſure upon the brain is univerſally acknow-
ledged, and when the injury, which the brain
receives, is no more than what ariſes from that
compreffion, the mere elevation of the bone, will
procure effectual relief-But as preſſure, from
this cauſe, may be, and moſt frequently is, com-
bined with that ariſing from extravafation, the
Surgeon is by no means to confide in the favour-
able appearances, with which we are often
flattered after raiſing a depreſſed bone, but
fhonld purſue ſuch methods as are moſt likely
to prevent the more remote conſequences of in-
jury done to the brain and its membranes; and
iuinis ayb w lott som vanthele

84
JONES ON WOUNDS
theſe means have been already pointed out fuffia
ciently, in the two preceding Chapters.
A fingle perforation may fuffice in ſmall frac-
tures with little depreſſion, but when the force
producing them was great, the depreſſion con-
fiderable, and the fracture extenſive, winding
into a circolar form, with the depreffed part
cracked and ſplintered; the beſt and ſafeſt way
is to remove the whole, or at leaſt the greater
portion of the bone ſo depreffed and injured ;
for whatever ill conſequences may ariſe from
denuding fo large a ſpace of the dura mater,
much greater miſchief is to be apprehended,
from the confinement of that matter, which
may of courſe be generated throughout the
whole extent of the fracture and depreſſion.
As rules laid down by the ableft writers,
upon ſuch a ſubject, can only be general, the
peculiar circumſtances of each individual, muſt
furniſh directions to the Surgeon, for his particu-
lar conduct. All depreſſed parts muſt be elevat-
ed; looſe, ſplintered, and irritating ones remov-
ed; and at all events, a free diſcharge afforded
to whatever extravaſated fluids may be formed,
fooner or later, in conſequence of the injury:-
The earlieſt and moſt careful attention ſhould
be paid to every ſymptom and appearance, in
order to obviate them in due ſeaſon, for the
proper opportunity once loft, is ſeldom to be re-
gained by any future management.
There are certain parts of the cranium,
where, on account of their ſtructure, the appli-
cation

AND FRACTURES
85
cation of the trephine has been uſually forbid-
den, by moſt writers---theſe are the futures,
the inferior part of the occipital bone, that part
of the frontal where the finus is ſituated, and
the temporal bones: The ſtrong adheſion of the
dura mater, and the courſe of the finuſes under
the futures, have been deemed ſufficient objec-
tions to the operation on thoſe parts; but expe- -
rience has taught us, that the dura mater may
be ſeparated without laceration; and that in
cafe the finufes are wounded, the hæmorrhage
does not prove dangerous:---The occipital bone
is rarely fractured without immediate death
being the conſequence, yet the ſuperior part of
it has been fractured, and the trephine applied,
with fucceſs : ---In caſe of a fracture in the fron-
tal finus, particularly from a muſket ball ſhatter-
ing the poſterior part of the finus, Monſieur
Le Dran adviſes the application of the trephine,
to relieve the injury of the dura mater :---As to
the temporal bones, they may be perforated any
where above the ears, as the hæmorrhage from
the artery is eaſily reſtrained by ligature where
preffure does not ſucceed; and that convulſion,
vulgarly called the jaw-lock as frequently at-
tends wounds made in other parts of the body,
as thoſe of the temporal muſcles; the aponeuro-
tic expanſion of which, covers a large portion
of the parietal bones, where the trephine is
daily applied without any apprehenfion.
In ſhort, the danger incurred from an applica-
tion of the trephine to any of the afore-menti-
M
a
oned

$6 JONES ON WOUNDS
oned parts, is by no means equal to the miſchief
ariſing from its neglect; for though many of
theſe operations do not ſucceed, the failure is to
be attributed much more to the nature of the
injury, than the violence occaſioned by the ap-
plication of the inſtrument.
When the operation is determined on, it is
generally performed in the following manner :-
The patient being conveniently feated on a low
chair, or lying on a bed, with his head firmly
fixed and ſupported by the affiftants, the opera-
tor, with a ſtrong fcalpel, is to divide the ſcalp
with the pericranium, quite down to the bone;
and having diſcovered the fracture, is to trace it
to its utmoſt extent, in order to fix upon the
moſt advantageous ſpot, for making the perfo-
ration ;---Theſe being done, ſuch a portion of
the ſcalp and pericranium is to be removed, as
will admit of ſufficient room for the application
of the trephine ------If any vefſels ſhould be di-
vided, the bleeding of which cannot eafily be
reſtrained with dry lint and moderate preffure,
they muſt be taken up with the needle and liga-
ture:---the crown of the trephine being then
applied ſo as to embrace an equal portion of the
bone on each ſide of the fracture; if it be ſmall
and undepreffed, the operator works his faw,
until he has made a furrow in the bone ſufficiently
deep to prevent it from flipping; then removing
the pin, he continues the operation pretty briſkly,
taking up the crown every now and then to clear
the teeth with a ſmall bruſh, and wipe the duſt
with

AND
87
FRACTURE S.
with a pointed probe and lint from the circular
furrow, as well as to examine whether the faw
works equally, or the bone begins to be looſe,
(for the appearance of the diploe is not to be de-
pended on, as a guide to aſcertain the thickneſs
of the ſkull, as in very thin ones, there is often
none at all; and in old perſons, it is generally
obliterated; for which reaſon, if a Surgeon was
implicitly to rely on the appearance of the diploe
as a criterion of the ſkull's chickneſs, he might
fatally plunge the crown of the trephine into the
patient's brain ; an accident, which has happen-
ed to fome incautious operators.) When the
)
bone is ſo nearly divided in the circumference of
the circle as only to adhere, in one ſmall
in one ſmall part, it
may eaſily be taken out with the forceps; and
if any little ſharp points ſhould remain at the
broken part, they muſt be removed with the
lenticular.
Should any extravaſated blood now appear
between the dura mater and the cranium, and
the patient in a few hours be relieved of his
complaints, there will be no neceſſity for punc-
turing the dura mater: But if on the other hand,
the ſymptoms of an oppreſſed brain ſhould con-
tinue after the bone is perforated, and no extra-
vaſation appears on the dura mater, it ought to
be divided with the point of a lancet, in order
to diſcharge whatever collection may be formed
beneath. The part where the perforation of
the bone was made, muſt be lightly filled with
dry lint, and the whole wound dreſſed in the
uſual

88 JONES ON WOUNDS
uſual
way, with no other bandage than a hand-
kerchief, folded in a triangular form and paſſed
round the head, ſo as ſimply to retain the dreſ-
fing,
in fractures with depreſſion, the crown of
the trephine muft be applied on the ſound part
of the bone, but ſo near the fracture, that one
ſide of the crown may make part of the circum-
ference of the circle, and by that means form
the moſt convenient introduction to the elevator,
With reſpect to the number of perforations, they
muft depend entirely on the nature of the inju-
ry, and conſequently the Surgeon's judgment
can alone direct his particular conduct. Who-
ever has acquired Just and GENERAL IDEAS
of the nature of a difeafe, will ſeldom be at a
loſs how to apply Them on particular occaſions;
and to him, who wants thoſe ideas, no rules or
directions will be of much conſequence.
In the courſe of the cure, a troubleſome
fungus fometimes riſes up from the dura mater
through the perforations, or from thoſe ſpaces
where large portions of the bone has been re-
moved. A variety of remedies have been re-
commended to repreſs this fungus, which, if
not kept down in the beginning, grows amaz-
ingly faſt, and reliſts every attempt to check it.
The moſt uſeful application I have ever tried,
is the prepared ſponge, cut into ſlices, and laid
immediately on the fungus, or with very thin
pledgets of lint between the ſponge and
fungus, which laſt is very apt to infinuate
itſelf into the porous ſubſtance of the ſponge,
and

AND
89
FRACTURE S.
a
and render its removal troubleſome and diffi-
cult; a moderate preffure may be made on
the dreſſings, by drawing the handkerchief
ſomething tighter than uſual. In theſe caſes,
the diſcharge is generally very conſiderable,
for which realon, as well as to prevent the
adheſion of the ſponge, the dreſſings ought
to be renewed twice a day, and the patient kept
to a ſtrict regimen, with a free uſe of the bark.
Indeed there are no caſes in ſurgery which re-
quire an exact diet and pure air in order to ob-
tain a cure, more than thoſe of fractures of the
cranium.
As the following caſe was attended with ſome
fingular circumſtances, I ſhall cloſe this ſubject
with a ſhort account of it.
A boy, about fourteen years of age, by a fall
from a window, fractured the left parietal bone,
and was trepanned two days after the accident:
The trephine was applied twice, and ſome ex-
travaſated blood diſcharged from between the
dura mater and ſkull; no unuſual ſymptoms
appeared for ſeveral days after the operation,
when a fungus ſuddenly ſprouted up through
the perforations, which no applications could
reſtrain ;--the trephine was applied a third time
between the two firſt appertures, in order to
relieve the ſtricture formed by the edges of the
bone, and to view the ſtate of the dura mater at
the baſe of the fungus, where we found an
opening, from which fome matter was diſ-
charged from the brain :--- The ſame dreſſings
were continued, with moderate compreſſion,
but

go
JONES
ON
but without any effect; for the furgus in a few
days increaſed to the ſize of a large orange, and
as the weather was hot, became ſo extremely of
fenſive and troubleſome, we had no other way
to get rid of it, but by making a ligature around
the baſe; and in two or three days it dropped
off.-A new one however foon aroſe, and in a
ſhort time ſoon exceeded the firſt in fize, diſ-
charging vaft quantities of a foetid matter.--
The boy was now feveriſh, and often attended
with a flight delirium, waſting faſt in his fleſh
and ſtrength, but preſerving his ſenfes perfectly
well in general :---we were now reduced to the
neceſſity of removing the fungus by another li-
gature, which foon produced the ſame effect,
but in three days after it dropped off, the pati-
ent died. Upon opening the head, which was
done by Doctor Middleton and myſelf, we
found the left lobe of the cerebrum entirely
deſtroyed, and more than half of the right lobe
converted into pus; yet the patient retained his
underſtanding and ſenfes, very accurately to the
laſt hour of his life.
C Η Α Ρ Τ Ε R
XI.
OF GUN-SHOT WOUNDS.
ΤΗ
HE firſt intention, with regard to wounda
made by a maſket or piſtol ball, is, if poſ-
fible, to extract the ball, or any other ex-
traneous bodies lodged in the wounded part.-
The next object of attention, is the hæmorr-
hage

GUN-S HOT WOU N D S. gr
hage, which muſt be reſtrained, if practicable,
by tying up the veſſel with a proper ligature,
as no ftyptic is to be relied on, excluſive of the
miſchief they otherwiſe occafion.
In order to extract the ball, or foreign
body, Mr. Ranby, and Monſ. Le Dran, whoſe
judgment and experience in theſe caſes are cer-
tainly ſuperior to moſt men's, adviſe as little
ſearch, with the probe or forceps as poffible, as
all irritation on theſe occafions increaſes the con-
ſequent pain and inflammation.-Mr. Ranby is
of opinion we ought not to attempt the extrac-
tion of any thing which lies beyond the reach
of the finger, though if the ball can be felt un-
der the ſkin, in an oppoſite direction to the
wound; it ought immediately to be cut upon
and taken out.--As the external wound made
by a muſket ball is very narrow, the orifice
ſhould be conſiderably dilated, and that on both
fides, when it has penetrated through any part of
the body or limbs, particularly the moſt depend-
ing orifice :---Yer in wounds near the joint,
or in very membranous or tendinous parts, the
knife as well as forceps ſhould be put under
ſome reſtraint, and no more dilatation made,
than what is abſolutely neceffary for the free
diſcharge of the matter lodged within ;---for
we know from experience, that wounds about
the joints, are always attended with great pain
and inflammation, are always diſpoſed to ſhoot
out fungous fleſh, and form new abſceffeſs
found all the adjacent parts ;---The air too,
ſeems

92
JONES
ON
a
ſeems to produce worſe effects upon membranous
and nervous parts, than thoſe which are more
fleſhy; for all which reaſons the young Surgeon
ſhould be very cautious in wounding them.----
The firſt dreſſings to a gun-ſhot wound, ſhould
be light, ealy, and ſuperficial, with a barely res
tentive bandage, which ought to be made of ſoft
flannel rather than linen ;---if the lint be dipped
in oil,it will not only fit much eaſier on the wound,
but allow a freer diſcharge to the extravaſated
fluids, which nature always endeavours to expel
as early as poſſible.---At the ſecond dreſſing,
ſome mild digeſtive may be uſed, and where
the wound is large, the bread and milk poul-
tice, or one compoſed of the farina lini, over all;
and if much tenſion and inflammation attend,
an emollient fomentation will be very neceſſary,
.
-- Though theſe ſymptoms will be much lefſen-
ed, if when we are firſt called in, a proper
quantity of blood is taken from the patient, his
body kept open by clyſters and gentle purgatives,
an eaſy perſpiration promoted, and in general a
cool moderate regimen preſcribed, avoiding every
thing hot or ſpirituous, either internally or ex-
ternally, which during the ſtate of inflammation
is extremely injurious to wounds:---Nor ſhould
the Surgeon, if not called in until the inflam-
mation is come on, attempt to remove any ex-
traneous bodies before it is almoſt entirely abat-
ed, and a good digeſtion appears ; unleſs the
foreign body lies ſo near as to render its extrac-
tion certain, without much pain or difficulty.
If

GUN-SHOT
93
WOUNDS
If a wound be of ſuch a deſperate nature as
to require amputation, which is frequently the
caſe where it happens in a large joint, it is of
the utmoſt importance to perform the operation
immediately; as the conſequent pain and inflam-
mation, renders it improper during theſe
fymptoms; and, when they are paſt, the pati-
ent is often reduced to ſo low and weak a ſtate,
as to make an amputation a very dangerous and
doubtful operation. Wounds, that border
on any confiderable artery, are very apt to bleed
afreſh upon motion, or the return of a free cir-
culation of the blood into the parts; and this is
frequently the caſe when the cruſt and flough be-
gins to ſeparate,--for which reaſon one ſhould
never attempt to remove it by force, but wait
with patience until there is a perfect ſeparation
of the flough. The Surgeon in the mean time
ſhould be on his guard againſt this accident of a
ſecond hæmorrhage, which is frequently indi-
cated by the patient's complaining of a greater
weight and fulneſs in the limb, attended with
more or leſs pulſation in the wounded parts
which latter is an almoſt infallible ſign of the
approaching danger, to obviate which, recourſe
muſt be had to bleeding and the bark. Mr.
Ranby ſays he has known many inſtances of
perſons loſing their lives from the burſting of an
artery after amputation, and affirms, that in
ſome of the caſes, which proved mortal, not above
twelve ounces of blood were loſt, which ap-
pears very extraordinary, and almoſt unaccounta
N
ables

94
JONES ON
a
a
able, unleſs from the previous hæmorrhage, and
broken texture of the blood, by which a ſudden
guſh may give ſuch a check to the circulation,
as to cauſe immediate death. This obſerva-
tion ought to be a leſſon of in truction to the
young Surgeon, to be particularly attentive in
ſecuring every veſſel with a proper ligature.
For this reaſon too, repeated bleedings in the
beginning of an inflammation, or rather before
it, are attended with ſuch beneficial conſequen-
ces ; they generally prevent, and always leffen
the fever and inflammation, and conſequently
thoſe impoftumations, which generally attend
them :-Mild laxative medicines contribute
greatly to anſwer the ſame purpoſes--and to
remove the rack of pain, recourſe muſt be had
to the ſovereign and almoſt divine power of
opium,--next to which, the bark may be ad-
ded, as a medicine, which Mr. Ranby ſays,
no human eloquence can deck with panegyric
proportionable to its virtues. He declares, he
has known it procure reft, if given in large
doſes, when opium had been taken without
any effect. ---In all large wounds, particularly
thoſe made by a cannon ball, there is conſtant-
ly a laceration of the membranes and exquiſitely
tenſible parts, which are ever attended with ex-
cruciating pain, and a great diſcharge of gleety
matter, which if not reſtrained, proves of the
moſt dangerous conſequence ;-under theſe un-
happy circumſtances, the bark given in the
quantity of a dram every.three hours, or oftner
if
Dondupan socle bois Hose
ay ho an bis om
ons

GUN-SHOT WOUNDS.
95
if the ſtomach will bear it, has a moſt ſurpriſing
efficacy in removing theſe terrible ſymptoms.
The elixir of vitriol taken three or four times
a day in a glaſs of water, is in theſe caſes of fins
gular benefit, and proves a very good affiftant to
the virtues of the bark. If the body be coſtive,
a few grains of rhubarb may be added to each
doſe of the bark, till that inconveniency is re-
moved ;-but on the contrary, if the bark ſhould
run off in more than three or four ſucceflive
ftools, its operation that way muſt be checked
by a few drops of the tin&tura thebaica, or a
ſpoonful of the Diaſcordium mixture, given in
each doſe. From what has been ſaid, it is evi-
dent, that the bark is one of the beſt remedies
hitherto diſcovered, for contracting the veſſels,
and reſtoring their due action upon the blood,
when too great a quantity of that neceſſary fluid
is loft by a prefuſe Fænorrhage, provided the
larger wounded veſſels are ſecured by a proper
ligature from future bleeding. It alſo not only
ſecures the moſt tender ſolids and ſmall veffels
from being diſſolved by the acrimony of any
matter abforbed and returned into the whole mais
of blood, from large wounds or latent abſceſſes,
but it likewiſe preſerves the texture of the blood
itſelf, from being too much broken, or render-
ed too watery from the ſame cauſe, which would
otherwiſe inevitably produce a fatal, colliquative
hectic:---But where there is too great a fulneſs,
or too much ftrength and contractile force in
the ſolids, and an inflammatory tenacity or fizi-
neſs in the blood, it may occaſion obſtructions,
pains, inflammations, and their conſequences,
unleſs it be timely laid afide, upon the appear-
ance of ſuch effects.

96
JONES ON
Fractures of the bones of the limbs by a mur
ket ball, are attended with the ſame general
fymptoms of other compound fractures, the
proper treatment of which, has already been
pretty fully explained in the chapter upon that
ſubject; for which reaſon I need not here repeat
what has been there ſaid.
It'ſometimes happens that two balls pafs into
a limb, making only one orifice where they en-
tered, and afterwards diverging in their courſe,
form too openings on the oppoſite ſide. In fuch
caſes, if the two orifices are pretty near each
other, they ought to be laid into one, in order
to facilitate the diſcharge of extraneous bodies
or matter that may be lodged in the wound.
Where there is reaſon to ſuſpect, from the
courſe of the ball, that fo large an artery is
wounded as to occafion a dangerous hæmorr-
hage; upon the approach of the ſymptomatic
fever, and removal of the eſchar, the tourniquet
ought to be left looſe about the limb, with di-
rections to the patient or ſome perſon near him,
to tighten it in caſe of bleeding, until the ſur-
geen comes to his aſſiſtance.
nad
When the os bumeri is fractured, after making
the neceſſary dilatations, and extracting fuch
looſe ſplinters as can ſafely be diſengaged from
the muſcles, the wound being dreſſed in the
uſual way, the bones muſt be preſerved in the
moſt appofite-fituation by means of the hollow
ſplints recommended in the chapter upon fim-
ple fractures, only with this difference, that
openings muſt be made in them oppofite to the
wound, to admit of the application of the dreſ-
fings, and afford a free diſcharge to the matter,
a

GUN-SHOT
97
WOUNDS,
;
without removing the ſplints, which would un-
avoidably excite pain and inflammation, by diſ-
turbing the poſition of the bones.
Monfieur Le Dran, lays it down as a general
rule, never to attempt ſaving the leg, when the
bones of the tarſus are fractured by a muſket
ball, for as the tendinous and ligamentous ſtruc-
ture of the part, does not admit of the neceſſary
dilatations, the conſequent fever and inflamma-
tion proves fatal in almoſt every cafe; imrnedi-
ate amputation is therefore the moſt adviſeable
practice.
A leg or an arm is frequently carried off by a
cannon ball, which accident generally leaves the
extremities of the bones as well as tendons in ſo
ſhattered a ſtate, as to render ampuration neceſ-
ſary. When this happens to be the caſe, ſo
much of the limb ought to be preſerved, as is
conſiſtent with the nature of the injury; but the
operation ſhould always be performed high
enough to leave no looſe fractured bones above
the amputated part.
A complaint of a very ſingular nature, known
by the name of an Empbyſema, is fometimes the
conſequence of a fractured rib, either from
blows, falls, or a muſket ball palling in an ob-
lique direction, fo as to fracture the rib without
entering into the cavity of the thorax; and this
complaint is occafioned by ſmall charp points of
the fractured rib, wounding the veficular
part
of the ſubſtance of the langs, ſo as to permit the
air to paſs into the cavity of the thorax, where
being retained, it induces ſuch a degree of di-
ficulty in reſpiration, by compreſſing the lobes
of the lungs, as ſometimes to terminate in an

98
JONES
QN
32
abfolute ſuffocation. The only remedy, capa-
ble of affording effectual relief in fo diſtreffing a
ſituation, is, to perform the operation of the
peracentefis thoracis or opening into the cavity of
the cheſt, through which the confined air may
be diſcharged.---This opening may be made
without much difficulty or danger, by dividing
the integument fomething better than half an
inch in length, and then cautiouſly purſuing the
diflection through the intercoſtal muſcles and
pleura, with the point of the ſcalpel.---There
is no danger of wounding the lungs under ſuch
circumſtances, as they are ſufficiently comprefied
by the air in the cheſt to keep them out of the
way of the knife.
But when the wound made in the pleura by
the points of the fractured ribs, is large enough
to permit the air to ruſh freely out of the cavity
of the thorax, it paffes into the cellular mem-
brand, and ſometimes diftends it to a monſtrous
fize, extending over great part of the body, face
and limbs. ? he proper remedies in this species
of diſeaſe, are ſmall ſcarifications, made with the
koife or lancet into the cellular membrane,
and then compreffing the integument to as to
force out the confined air. Repeated bleeding
in both ſpecies of Emphyſema, and particularly
the left, is neceſſary to relieve the urgency
of
the ſymptoms, wbich are ſometimes very le-
vere and oppreflive; the emphyſematous tumor
of the cellalar membrane, ofren laſting ſeveral
days, before it entirely fubfides.
There is ſo much affinity between wounds
made by fire-arms, and burns, that I ſhall con-
clude the preſent ſubject with a few obſervations
POSISI
a

GUN-SHOT WOUNDS.
99
on the latter.---Burns have generally been con-
fidered as a diſtinct ſpecies of fores; and the
idea of fire remaining in the burnt pari, has
given riſe to a great many whimſical applica-
tions, which the more rational theory of the pre-
fent Surgery has very rightly rejected.--Super-
ficial burns or ſcalds, which penetrate no deeper
than the cuticle, are moſt effectually and ſpeed-
ily relieved by the immediate application of
ſpirit of wine. But when they produce vefica-
tions, fome ſoft, mild application, ſuch as lin-
feed oil, or a cerate of oil, wax, and ſperma-
ceti, are neceſſary to heal the excoriated
parts.
When they peneirate ſtill deeper, and the true
ſkin and membrana adipoſa down to the muſcles
are affected, and ſlough away, a different me-
thod of treatment is to be made uſe of. In theſe
laſt circumſtances, where the burn or ſcald has
extended itielf over an entire limb, or a large
ſurface of the body, a violent inflammation im-
mediately enſues, attended with moſt exquiſite
pain, and ſometimes even convulſions.--Bleed-
ing in ſuch caſes, according to the age and
ftrength of the patient, muſt precede every other
remedy; the body muſt be kept open by cly-
fters and gentle purgative medicines, and the
parts affected covered with an emollient poultice,
and fomented twice a day or oftener, with
anodyne fomentations, till the mortified parts
begin to flough away, when they may be
dreffed with ſome mild digeſtive, though fach
an exquifite tenderneſs affects large burns, thar
very few ointments are applied, which do not
irritate them. One of the moſt ſucceſsful I have
asi be

100 JONES ON GUN-SHOT WOUNDS,
ever tried, is the unguentum e ſtramonio, pre*
pared by boiling the leaves of the ſtramonium,
or thorn apple in freſh hog's-lard, till the lard
will take up no more of the juice ; and then
adding as much wax as will give a fufficient
degree of conſiſtence to withſtand the ſummer's
heat.---This ointment is pofleffed of an ano-
dyne quality, which renders it the eaſieſt appli-
cation during the whole ſtate of inflammation,
which, with the extreme flowneſs of the
cicatrization, generally laſts long enough to
tire both the patient and Surgeon :-- For,
where the burn or ſcald is very extenſive, the
elongation of the found ſkin is produced with
great difficulty, and is extremely apt to break
open upon the flighteſt occaſion ;------the
ulcer too, by remaining ſo long open, is very
much ditpoted to ſhoot out into fungous excre-
ſcences, which are with great difficulty kept
down by mild eſcharotics, ſuch as the Roman
vitriol, aq calcis, or even lunar cauſtic and the
pulvis ongelicus,---for dry lint adheres ſo cloſely,
that
you cannot remove it at every dreſſing, and
the fungus ſhoots up amazingly if not corrected
daily by fome or other of the efcharotics juſt
mentioned, even though you ſhould apply a well
adapted roller, which is highly neceffary and
uſeful, to prevent this luxuriant growth of fleſh,
and preſerve the parts from unſeemingly ſcars.
A ſtrict regimen is very neceffary in theſe fe-
vere caſes, which are ſometimes ſo obftinately
flow, that a twelve month will elapſe before
you can entirely heal fome of them.
APPENDIX,

Α Ρ Ρ Ε Ν DI X,
Containing, ſome sort hints on the Structure and
OEconomy of HOSPITALS; particu-
larly applied to MILITARY ONES : With the
general means of preſerving HEALTH in an
ARMY.
MONG the variety of public errors and
A
abuſes, to be met with in human affairs,
there is not one perhaps which more loud-
ly calls for a ſpeedy and effectual reformation,
than the miſapplied benevolence of Hoſpitals
for the fick and wounded.
We daily ſee perſons of every rank and ſex,
contributing to theſe charities, with a ſpirit of
liberality, which does honor to humanity; while
many of them, with the moſt becoming zeal,
are devoting their time, and facrificing their pri-
vate intereſt to the care of ſuperintending the
ſtructure and management of the houſe ; and
yet, an abſurd miſtaken æconomy, has hitherto
not only rendered all this pious labour and ex-
pence, in a great meaſure uſeleſs, but even fa-
tal and deſtructive to the very end and aim of
the intended purpoſe, that of healing the diſeaſes
of the fick poor.
To thoſe who are unacquainted with the ſub-
ject in queſtion, it will doubtleſs appear a very
extraordinary

102
HINTS CONCERNING
extraordinary aſſertion that there is not at preſent
in the capital of the kingdom, a ſingle hoſpital
conſtructed upon proper medical principles ;
yet it is a fact very generally acknowledged by
the moſt eminent men in the profeſſion of
Phyfic and Surgery in England. 10 aasa
If we enquire into the cauſes of ſuch glaring
abſurdities, we ſhall eaſily trace them to thoſe
ſources of darkneſs and ignorance, from which
moſt of our civil and religious abuſes have ori-
ginated ; but how they ſhould be continued to
diſgrace the improvements of more enlightened
times, can only be reſolved, by reflecting on
the pride; obftinacy and ſelf-intereft, which are
too generally annexed to ancient errors.
If
great and populous cities, have been juſtly
ſtiled the graves, of the human ſpecies; the large
and crowded hoſpitals, generally built in them,
may with equal truth and propriety be deemed
the lazarrettos or peſt-houſes of moſt of the un-
fortunate perſons, who from ill-directed motives
of compaſſion, are carried into theſe charities.
In the two great Hoſpitals of St. Thomas, and
St. Bartholomew, in London, about fix hundred
patients die annually which is about one in thir-
teen of thoſe who are admitted as in-patients.
In Paris it is ſuppoſed that one third of all
who die there, die in Hoſpitals. The Hotel
Dieu, a vaſt building ſituated in the middle of
that great city, receives about twenty two
thouſand perſons annually, one fifth of which
number die every year,---- It is impoflible for a
man

MILITARY HOSPITAL S. 103
man of any humanity to walk through the long
wards of this crowded Hoſpital, without a mix-
ture of horror and commiſeration, at the fad
ſpectacle of miſery which preſents itſelf: The
;
beds are placed in triple rows, with four and
fix patients on each bed; and I have more than
once in the morning rounds, found the dead
lying with the living ; for, notwithſtanding the
great affiduity and tenderneſs of the nurſes, ſome
of whom are women of family, who take the
veil and piouſly devote themſelves to that office;
yet it is almoſt impoffible, from the vaſt num-
ber of patients, to beſtow timely aſſiſtance upon
every individual.
If we compare the numbers of patients who
die in the county infirmaries of England, with
thoſe of the London and Paris Hoſpitals, the
proportional difference will be greatly in favor
of the former; * and although the putrid air of
great cities is more unfavourable to health in
general, than that of country towns; yet the
greateſt difference in mortality, will be found,
upon a cloſe and fair examination, to ariſe from
the ſtructure and crowded wards of the Hoſpi-
tals, in over-grown capitals. +
For
In the Northampton Infirmary, one in nineteen die annu-
ally, and in that of Mancheſter, placed in a more airy ſituati-
on, one in twenty two.
+ It is to be hoped that the Hoſpital lately built in the City
of New York, will have fewer objections to its plan, than any
Hoſpital hitherto conſtructed ;--the principal wards, which are
to contain no more than eight beds, are thirty fix feet in length,
twenty four wide, and eighteen high ;----they are all well
ventilated, not only from the oppofite diſpoſition of the win-
dows, but proper openings in the fide walls, and the doors
open into a long paſſage or gallery, thoroughly ventilated from
aorth to fouth.
*

104
CONCERNING
HINTS
For, if to the compariſon between the more
tality in large City-Hoſpitals, and thoſe of
Country Towns, we further add, the propora
tional difference between the laft and that of
private practice, it will be found to be in favor
of the latter :--From all which facts, it evi-
dently appears, how eſſentially neceſſary pure
freſh air is, to the cure of diſeaſes in gene-
ral, and particularly thoſe, which ariſe from
putreſcent cauſes either internal or external im
It is computed that a gallon of air is conſumed
every minute by a man in health, and much
more muſt be neceſſary to one who is fick, as
the morbid effluvia, which are continually ex-
haling from all parts of the body and lungs,
muſt contaminate a larger portion of the ſur-
rounding atmoſphere, and render it leſs health
ful to breathe in; for animals are obſerved to
die much ſooner in foul air, than in vacuo.
But the preceding facts, not having been fuf-
ficiently underſtood or attended to, a falſe eco-
nomy has univerſally prevailed, in the ftructure
of Hoſpitals for the fick; for thoſe that have
hitherto had a principal direction, both in the
architecture and management of them, have
confined their views entirely to objects of con-
veniency, cheapneſs, or ornament; and in one
of the laſt Hoſpitals built in London, for lying
in-women, there is more expence beſtowed on
an elegant chapel in it, than would have finiſhed
four wards.
In ſhort the Phyſician and Architect, have
generally

MILITARY HOSPITALS. IOS
generally two very oppoſite and incompatible
views ; the latter laying out his plan ſo as to
contain the greateſt number of perſons in the
leaſt poſſible ſpace;--whereas the former always
aims at having the utmoft room which is conſiſt-
ent with uſe and conveniency.
The ſame faire maxims of economy, which
have prevailed in the conſtruction of Hoſpitals
in large Cities, are too much adopted in the
military Hoſpitals of Camps and Garriſons, as
evidently appears from the complaints made of
them, by Sir John Pringle, to whoſe excellent
obſervations, on the diſeaſes of the Army, I am
principally indebted for the few following re-
marks on the means of preventing diſeaſes in
Camp or Garriſon.
As changes in the ſenſible qualities of the air,
exceffes in diet, and irregularities in exerciſe,
are the principal ſources of diſeaſes; lo che
means made uſe of to prevent or remove di-
ſtempers, muſt be chiefly directed to the three
general cauſes above mentioned.
As the extremes of heat and cold, are pretty
ſeverely felt in theſe northern colonies, and the
tranſitions from one to the other, remarkably
ſudden, they occafion fo large a proportion of
American diſorders, as to claim the first conſi-
deration.
To obviate the effects of intemperate heat
during the ſummer seaſon, the clothing of the
troops ought to be lighter than what is gener-
ally worn by the Britiſh ſoldiers.---The fanned

106
CONCERNING
HINTS
rifle ſhirt, over a ſhort linen coat or waiſtcoat,
with fleeves, would be a much cooler and
healthier dreſs to march in during the heat of the
ſummer, than a thick woollen coat, which, by
its weight and warmth, promoting exceffive
ſweat, muſt neceſſarily exhauſt the ſoldiers
ſtrength, the linen dreſs too is cheaper, and bears
waſhing, no trifling confiderations in the cloth-
ing of an army.
The marches ſhould always be ſo ordered, if
poſſible, that the men may come to their ground
before the heat of the day; and ſtrict orders
ſhould be given, that none of the men ſhould
fleep out of their tents, which in fixed encamp-
ments may be covered with boughs of trees to
ſhade them from the ſun. The uſual military
exerciſes too, ſhould be performed before the
cool of the morning is over, by which means
the fibres will be braced up, and the blood
cooled, ſo as to enable the men to bear exceſſive
heat the better, when it becomes abſolutely ne-
ceſſary; and in very hot weather, the centinel
duty ought to be ſhortened.
no
The preſervatives againſt cold, conſiſts in
clothes, bedding and fire: Winter clothing is
one of the moſt expenſive articles in a cold
country, for which reaſon, too much attention
can hardly be paid to the ſubject. --Sir John
Pringle recommends ſhort flannel waiſtcoats,
which are worn by moſt of the northern Euro-
pean foldiers, with warm watch-coats for thoſe
who are upon centinel dury. It is well
known

MILITARY HOSPITAL S. 107
known from experience, particularly in many
parts of New England, that a flannel waiſtcoat
or ſhirt, worn next to the ſkin, will keep a man
much warmer than nearly double the quantity
of covering over a linen ſhirt, and conſequently
a very great ſaving might be made in this part
of a ſoldier's dreſs.-----The watch-coats for
centinel duty, may be made of coarſe furs,
which in dry froſty weather, are preferable to
cloth, and Indian ſhoes or Mockaſins, under
the ſame circumſtances, are much warmer than
common leather ones, which, however, ought
to be provided with firm thick foles, to keep
the feet dry when the ground is wet.
The next means of preſervation mentioned,
was bedding ; by which, according to Sir John
Pringle, is underſtood, a blanket to every tent
of the infantry; but in this climate, if a blanket
was allowed to every ſoldier, particularly at the
beginning and end of a campaign, the advan-
tages accruing to the ſervice, by preſerving the
health of the men, would infinitely more than
counterbalance the expence.
As to fuel, a ſoldier ought to be allowed as
much as will ferve to dreſs his victuals, keep his
barrack dry, to moderate, rigorous froſt---but
in general warm clothing and exerciſe, are the
beſt preſervatives againſt cold.
To prevent the ill effects of moiſture in
camps, trenches ſhould be made around the
tents to carry off the water, and it is of great
importance to allow the ſoldiers plenty of ſtraw,
and

168
HINTS CONCERNING
and to have it frequently changed. But in fixed
camps, where a large quantity cannot eaſily be
procured, matraffes made of ſtraw or corn
huſks, might poffibly be ſubſtituted for it,
without much expence, and this kind of bed-
ding, would admit of being conſtantly aired,
and even waſhed and dried again, in good
weather. If a ſoldier's bedding could be raiſed
to a ſmall height from the ground, particularly
in damp ſituations, it would certainly contribute
much to the preſervation of his health, the
tents ſhould be well opened and aired every
day when the weather will allow it,
The wearing of wet clothes is a common
fource of a great many complaints, for which
teafon, as marches and out-duty neceffarily ex
poſe the men to rain, they ought to be allowed
fires in the rear of the camp, to dry their cloth-
ing, an indulgence which has been found to be
of
great
benefit.
To obviate the effects of putrid air, aring
from marſhes and ſtagnating waters, the en-
campments ſhould be frequently changed; but
if this is incompatible with the nature of the
ſervice, other means muſt be ſubſtituted, to
preſerve as much purity of air as is poffible
under ſuch circumſtances, particularly during
the dyſenteric ſeaſon, when the putrid effluvia
ariſing from the diſcharges of the fick, combined
with thoſe already mentioned, render the air of
a camp almoſt peftilential.
For this reaſon no ſoldier fhould be permitted

MILITARY HOSPITALS:
10g
to eaſe himſelf any where about the camp, ex-
cept in the privies, under the forfeiture of ſome
flight but ftri&tly inflicted penalty; and upon
the firſt appearance of a ſpreading flux, the pri-
yies ſhould be made deeper than uſual, and
once a day a thick layer of earth thrown into
them, till the pits are near full, when they
ſhould be well covered and ſupplied by others :
It will alſo be a proper caution, to order the
privies to be made either in the front or rear of
the camp, according to the uſual ſtationary
winds, which will carry off the putrid effluvia,
without proving offenfive or noxious. The
ſtraw too, and bedding, ought to be more
frequently changed and aired, at ſuch times,
than is uſual.
When the dyſentery begins to be frequent in
camp, the fick ſhould never be ſent to one ge-
neral Hoſpital ; the conſequences of which, after
the battle of Dettingen, were ſo fatal, that the
whole village of Feckenheim, where the Hoſpi-
tal was fixed, received the diſtemper, and the air
became at laſt ſo vitiated and contagious, from
the numbers of fick and wounded crowded to-
gether, as to generate the jail or hoſpital fever,
which combined with the dyfentery, became a
perfect plague, and ſwept off the Apothecaries,
nurſes, and attendants, equally with the pati-
ents who were brought in ;-at the ſame time,
thoſe who remained fick in the camp though
they wanted many of the conveniencies and ne-
ceſſaries found in the Hoſpitals, ſuffered only
P
the

10
HINTS CONCERNING
the original diſeaſes, and generally recovered
For this reaſon, when the dyſentery prevails,
Sir John Pringle adviſes the flighter caſes to be
treated by the regimental Surgeons in camp,
while the reſt, or as many as can be attended
by the fame Surgeons, ſhould be put into regi-
mental Hoſpitals, the ſituation of which, ought
to be as dry and as airy as poſſible. The build-
ings too, appropriated to ſuch purpoſes, ſhould
be the moſt ſpacious that can be found; for
which reaſon, churches, barns, and every kind
of large out-houſes, are preferable to cloſe pri-
vate dwellings; for as the greateſt danger ariſes
from foul air, it can never be compenſated by
diet or medicine.
As theſe regimental Hoſpitals are of the
greateſt conſequence, they ought to be ſupplied
with blankets and medicines from the public
ftores, with an allowance to nurſes, and other
neceffaries. And to enable the regimental Sur-
geons to pay more attention to the fick, an ad-
ditional mate ſhould be added to each regiment ;
for in fickly ſeaſons, one or both mates may
fall
ill at once; and it is then impoſſible for the
Surgeon to do his duty.
As to the diſpoſition of Hoſpitals, with regard
to preſerving the purity of air, the beſt rule
is, to admit fo few patients into each ward,
that a perſon unacquainted with the danger of
had air, might imagine there was room to take
in triple the numbers-When the ceilings are
low.

MILITARY HOSPITALS.
I11
low, it will be a good expedient; to remove
ſome part of them, and to open the garret ſtory
to the roof; for Sir John Pringle fays, it is in-
credible in how few days the air will be corrupt-
ed in thronged and cloſe wards; and what
makes it harder to remedy the evil, is, the im-
poſſibility of convincing the nurſes, or even the
fick themſelves, of the neceffity of opening the
doors, or windows, at any time, for the ad-
miffion of air.
The fick or wounded ſhould by no means be
put into common rooms, without fire-places ;
as by that means, the foul air is confined, and
increaſed to a ten-fold degree; nor will the uſual
ventilators, anſwer the purpoſe of correcting or
expelling the putrid effluvia.
Laſtly, the utmoſt poflible cleanlineſs is to be
obſerved, both in the perſons and bedding of
the fick, whoſe diſcharges and dreſſings, ſhould
be removed immediately out of the wards; and
the floors, after being properly cleaned, may be
ſprinkled with vinegar, of which a large quan-
tity ſhould be allowed to every Hoſpitala
With reſpect to thoſe diſeaſes which ariſe
from improper diet, Sir John Pringle obſerves,
that no orders will reſtrain ſoldiers from eating
and drinking what they like, while they have
money to purchaſe it; and the only way to pre-
vent exceffts, will be to oblige the men to eat in
meſſes ; by which means, the beſt part of their
pay will be beſtowed on wholeſome food, the
choice

II 2
HINTS CONCERNING
choice of which may be left to their taſte, at
moſt men commit more errors in the quantity,
than quality of their food. ou o
Pork has been ſometimes forbidden in camps,
being regarded as unwholeſome, Sanctorius
ſays, it retards perfpiration, and has it cor-
rupts fooner than beef or mutton, it may be
prelumed to afford leſs proper nouriſhment,
where there is any tendency to putrefaction.
However, it certainly conſtitutes more than one
half of the animal food conſumed by the Ame-
merican peaſanty, and when mixed with vege-
tables, is found to be a very nouriſhing and whole
some diet. It may not be amiſs to obterve, that fat
meats are ſo much more nutritive than lean ones,
that two ounces of ſuet, will afford more nou-
riſhment, than eight or ten of lean meat, and
conſequently in long marches, through uninha-
bited countries, a ſoldier's proviſion, might be
Tendered much lighter, by taking only ſuet or
fat pork with his biſcuit. hooo0001
As to ſpiritous liquors, though the exceſs of
them is undoubtedly pernicious, yet ſomething
Itronger than water or ſmall beer is neceſſary,
for men who are expoſed to all the extremes of
heat and cold, to long marches and wet clothes;
for which reaſon, a moderate quantity of ſpirits
may be allowed with great propriety 3 and if,
during the heats of ſummer, the allowance of
funt was mixed with vinegar, it would make a
good anuileptic drink, and ſerve to correct in
fome

MILITARY HOSPITALS.
113
ſome meaſure, the natural tendency of the hu-
mours to corruption, at that ſeaſon.
2002
With reſpect to the means of preventing diſ-
eaſes, ariſing from errors in exerciſe, they may
be confined to the two oppoſite extremes, of in-
dolence and fatigue .When the ſervice re-
quires it, every fatigue muſt be endured ; yet, in
general, there is leſs danger from exceſſes in
the latter than the former, particularly if good
proviſions and dry ſtraw are to be procured.
In fixed camps, the exerciſe of a ſoldier may
a
be confidered under three heads ;---the firſt re-
lates to his duty, the ſecond, to his living more
commodioufly, and the third, to his diverſions.
The firſt, confifting chiefly in the exerciſe
of his arms, will be no leſs the means of his
preſerving health, than of making him expert
in his duty ; and frequent returns of this, early
and before the ſun grows hot, will be more ad-
vantageous, than repeating it ſeldom, and ſtay-
ing out too long at a time; for a camp affording
little conveniency for refreſhment, all unneceſ-
fary fatigue is to be avoided, duobau mode
VI
As to the ſecond article, cutting boughs for
Thading the tents, making trenches round them
for carrying off the water, airing the ſtraw,
cleaning their clothes and accoutrements, and
affifting in the buſineſs of the mels, are all,
things, which, as they muſt be ſtrictly executed
by orders, ought to be no diſagreeable exerciſe
to the men, for ſome part of the day, a kogu
Laftly,

114
CONCERNING
HINTS
Laſtly, as to diverſions, fince nothing of that
fort can be enforced by orders, the men muſt be
encouraged to them by the example of their
officers, or by ſmall premiums to thoſe who
fhall excel in any kind of ſports, which ſhall
be judged moſt proper for anſwering this pur-
poſe: But, herein ſome caution is neceffary,
with regard to exceſs, becauſe our common
people obſerve no medium between their love of
eaſe, and purſuing the moſt violent exerciſe ;
and however neceſſary, motion may be to troops,
in fixed camps, we are to beware of giving
them too much fatigue, eſpecially in hot wea-
ther, and in times of fickneis; and above all in
expoſing them to wet clothes, which, as it has
been already obſerved, are the moſt common
cauſes of camp diſeaſes.
IN T$.

с
TS
Ο . Ν Τ
Ν Τ
N
E
of
21
JONES on Wounds and FRACTURES.
CHAPTER I. Of Wounds in General. 13
II. Of Inflammation.
18
III. Of the Diviſion of Wounds.
IV. Of penetrating Wounds of the Thorax and
Abdomen.
25
V. On fimple fractures of the Limbs.
3@
'VI. On compound Fraćtures.
44
VII. On Amputation.
VIII. Of blows on the Head.
69
IX. Of Injuries ariſng from Commotion.
56
76
90
X. Injuries ariſing from Fracture of the Skull. 80
XI. Of Gun-Shot Wounds.
APPENDIX, Containing Hints concerning
Military Hoſpitals.
101








cz
Jones, John
1776
Jo
williaun Sa
1926