Surgical lectures and essays / by A. Marmaduke Sheild.

  • Sheild, A. Marmaduke (Arthur Marmaduke)
Date:
[1904?]
Catalogue details

Licence: In copyright

Credit: Surgical lectures and essays / by A. Marmaduke Sheild. Source: Wellcome Collection.

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    violent means, and sometimes require so much alcohol to sustain their own strength and nerves that they may become almost as bad as the patient! Much has lately been written about the treatment of fractures by massage. Many of the worst results of “ simple” fractures, as stiffness and adhesions in the neigh- bouring joints, implication of bones in inflammatory material, and the adhesion of tendons to their sheaths, are due to the long confinement and the undue interference with the circulation by the pressure of splints and band- ages. Accordingly in these cases of fracture, where no great displacement occurs, as is notably the case in some frac- tures of the tibia and femur, daily massage may be employed with great advantage. Personally I would not advocate commencing before the end of the first week, for the danger of disturbing the newly-formed venous clots, though remote, must not lie ignored. In very oblique fractures, however, that start out of position when restraining splints or bandages are removed, 1 question whether this method can be safely employed until some union has occurred. Nothing is so important as the methodical and careful use of massage and movement in fractures so soon as ever the bones have united. Much of the dissatisfac- tion that occurs as the result of treatment is due to neglect of this most important consideration. The surgeon should see to this himself, and not leave it entirely in the hands of “ rubbers.” I have several times had occasion to treat painful joints after fractures by movement under anaesthetics. An unexpected adhesion gives way, and the functions of the joint are restored as if by magic. It is better to do this for yourselves than allow the nearest bone-setter to shame you by doing it for you ! If a joint is painful and insecure after a fracture, there is generally an adhesion in or about it which needs “ snapping.” The treatment of simple fractures by the operation of wiring, or screwing the fragments together, must next engage attention. I have elsewhere drawn attention to this method, and I may only point out to you no>v why it