Plastic apparatus in surgery : with especial reference to that variety made with plaster of Paris / by Samuel B. St. John.

  • St. John, Samuel B., 1813-1876.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Plastic apparatus in surgery : with especial reference to that variety made with plaster of Paris / by Samuel B. St. John. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    says,1 “we understand, then, that the accomplishment of this end (Bunion) will be the easier and the more rapid, the more perfect the quietude in which the fractured limb is kept.” Who does not see, then, that, other things being equal, an apparatus which is never, or but rarely, renewed after its first application, is that which presents the greatest chance to insure this immobility so favourable to the consolidation of the callus ? Excoriation from Pressure has already been discussed, and applies only to those cases where the apparatus is so applied as to maintain exten- sion. Even here it^is less liable to excoriate than other forms, because it takes hold of a broader surface. Becoming displaced when Swelling subsides.—This is fully met by the longitudinal section and taking in the slack. Softening of Apparatus, if it is wet from urine, etc., especially in chil- dren. This may be averted by protecting it with oiled silk, or by making the spliut waterproof, in exposed places, by a coating of varnish. (Edema through traps left for dressing wounds. This will seldom give any trouble if oakum is firmly bound on, or if it does, it shows that the whole splint is too tight and needs section. Special skill required in applying and managing it. This is a valid objection, and was so acknowledged thirty years ago by Velpeau.2 “ To reap the good effects of the compression of the immovable apparatus in cases of fracture, I cannot too frequently repeat that the bandage must be ap- plied in a very methodical manner, because, though compression well exercised is a truly heroic means in such cases, I must also warn you that when employed by incompetent hands, it may become the cause of more or less serious acci- dents. Never forget it, it is a powerful resource, but it will not admit of me- diocrity.” The longitudinal section of the apparatus is a great safeguard against constriction, and I would recommend it to every one not practised in the management of this form of splint. Even with this precaution, there is danger which only intelligent watchfulness can surely avert. Minor ob- jections have been raised, that this method is uncleanly; soils the bed, the surgeon’s clothes, etc. This is exactly in proportion to the surgeon’s un- skilfulness. With the plaster bandage especially, it is possible to put on a splint without soiling the bed linen or clothes, if only care be taken to squeeze the bandage tolerably dry. Dr. Piersou3 says that this apparatus causes by its pressure a painful affection of the nerves and loss of power in the muscles, so that the disability of the limb is more lasting than after other treatment. Richter* states that it arrests perspiration and thus causes superficial excoriation. I can only say that neither of these points is sustained by my experience. I cannot forbear adducing, at the close of 1 Considerations Pratiques sur le Traitement des Fractures, Lepons Orales, p. 628. ■* Lepons Orales du Clin. Chirurg., Bruxelles, 1841. 2 ‘.Remarks on Fractures, 1840, Boston, Abliandluugeu aus dem Geb. der Bract. Med. und Cliir., Berlin, 1S32.
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