On fractures and dislocations / by Professor Dr. H. Helferich ; ill. with 68 plates and 126 figures in the text, drawn by B. Keilitz ; tr. from the 3d ed. (1897) with notes and additional illustrations, by J. Hutchinson.

Heinrich Helferich

Date:: 1899

Credit: On fractures and dislocations / by Professor Dr. H. Helferich ; ill. with 68 plates and 126 figures in the text, drawn by B. Keilitz ; tr. from the 3d ed. (1897) with notes and additional illustrations, by J. Hutchinson. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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$Fig. lo.—Old pseudarthvosis in the left forearm resulting from severe fracture and loss of bone in early life. The patient, a man aged forty-four, broke, when he was a child of eight, his left forearm in several places as the result of a fall. Pieces of bone came away, and it was only after nine months' treat- ment that healing resulted, though the arm remained almost useless. At the present time there is ankylosis in the left elbow, and the fingers are fixed in a flexed position. The left forearm is ii cm. (4^ inches) shorter than the right. There is a false joint at the junction of middle and lower thirds. In the peripheral part the ulna is wholly wanting, the radius alone remaining. If not supported it falls with the hand in a helpless manner. The patient uses a kind of splint devised by himself, and manages then to move the thumb slightly towards the ankylosed fingers. De])ressed scars are present at the site of fracture and at the elbow. Probably the fracture was compound from the first, wide-spread suppuration followed, and the lower end of the ulna had to be removed. The joints of the hand and the tendon sheaths have all stifEened. prophylactic measure the alcohol to which the patient is accustomed should not be wholly left off, and care taken that he does not pass a sleepless night.^ ^ As soon as the symptoms which foreshadow an attack of delirium tremens (tremor of hands or tongue, increased pulse-rate, restlessness, purposeless movement of the hands, air of suspicion, or commencing delu- sions) are observed, prompt measures should be taken to avert the attack. If the patient is not already taking beer or stout he should be given a moderate quantity, together with a sedative such as bromide of potassium grs. XX to grs. xxx, and chloral hydrate grs. x to grs. xv, every four hours. In addition he should be induced to drink fluids, such as water, freely. If the bromide is alone relied on it may be given in still larger doses.—J. H.$