I., Mr. W. P. Nicholson's pamphlet : and II., Dr. B. W. Dudley's reply.

  • Nicholson, W. P.
Date:
[1829]
Catalogue details

Licence: Public Domain Mark

Credit: I., Mr. W. P. Nicholson's pamphlet : and II., Dr. B. W. Dudley's reply. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    faculty, and in many instances an impossibility of pointing out the seal-. of a former fracture, by a bare examination of the superficies of a bone. When fractures are managed by the skilful application of the bandage, the tendency of which goes to suppress all tumefaction and inflamma- tion in the soft parts, the increased difficulty of ascertaining, by a sub- sequent examination, the seat of fracture, must be palpable to the most superficial thinker; nor is it possible to decide this question with cer- tainty, by any examination of the superficies of the bone, where the fragments have been placed fairly in apposition. The facility of retain- ing the head of the fibula in its place by the bandage, could scarcely be doubted by the most skeptical. There is no one point of the osseous system more accessible to the controlling influence of the bandage than the head of the fibula: hence the facility of effecting reunion with the preservation of the natural aspect of the bone. But without any design to derogate from the anatomical acumen of the gentlemen who have placed their names to the certificates, it is pro- per for me to make a remark on the difficulty of deciding upon the na- tural form and appearances of the head of the fibula. Without regard to the size of the individual, it is large or small, flat or protuberant, pro- tected by the tibia or standing in relief by its side; while it is completely shielded by tendinous matter inserted into it, and dense fasciae and eel hilar substance surrounding it. Hence a fracture, even with a change of its natural form, would most easily escape detection after reunion; while it would be impossible to decide upon it in cases where, by the in- fluence of the bandage or otherwise, no deformity supervened. To re- cognize an insulated head taken from this bone, would puzzle most phy- sicians. From the language of the certificates, the reader is at liberty to infer that they were signed by the gentlemen after a bare inspection of the external appearances of the bone. I have already stated that in cases where the fragments of a fractured bone are replaced in perfect apposi- tion, and retained there by means of the bandage, no superficial appear- ances remain permanently, whereby to detect the site of the original fiacture. But I am warranted by facts to go much farther. Neither the superficies, nor the interior organization of a bone, will betray any marks of fracture, provided the fragments are perfectly adjusted to each other, and secured there by the aid of a bandage.. Such a bone examined one or two years after the injury is sustained, will be so perfectly natu- ral in all its exterior manifestations, and so uniform in its interior or- ganization, as to elude the most scrutinizing investigation: nor will a bone, less judiciously set, present at all times the external marks indi- cating the site of the fracture. On the contrary, even where considera- ble deformity is manifest in a bone recently fractured, every observing surgeon has seen such deformity gradually disappear, while the super- ficies of the bone when subsequently examined, will often be found void of all appearance of previous injury. Many causes, of constitutional as well as of local origin, conduce to change the external aspect of a bone much more than fractures, while any abrupt change in the general direction of the bone is a manifestation equally equivocal in character with others mentioned.