Hemorrhage from an artery has been divided into primary and secondary ; the former when it occurs within thirty hours after the receipt of the wound, or rather when reaction of the system has taken place ; secondary, when it takes place after this pe riod, for the time is so very uncertain, that no defi nite time can be specified. When the smaller arte ries are wounded, as those in the palm of the hand or the sole of the foot, compression with dry sponge, sponge tent, agaric or lint, and a bandage should be employed ; and if this fails, the trunk of the bleeding artery secured proximad to the hand or foot, continuing however the pressure. Sponge tent consists of sponge clipped in melted wax, and forcibly pressed into the smallest possible size. The same kind of compression is applied to the internal pudic artery when wounded in lithotomy, to the intercostal arteries, the temporal, and the ex treme branches of the internal maxillary after the extraction of a tooth. When a vascular surface, as the mucous membrane of the flares is bleeding, escharotics, styptics, and compression by dry lint are used. If the bleeding proceeds from the sto mach, styptics are administered, and venesection to produce fainting, which highly favours the natural process of arresting hemorrhagy ; with these are combined cathartic enemata, low diet, and perfect rest. if from the lungs, the same remedies, com bined with narcotics and gentle laxatives. When from the corpus spongiosum or cavernosum penis, compression and bandage. The styptics in use are cold water, vinegar and cold water, solutions of the sulphates of zinc, alum, iron, or copper, of the ni trates of silver or copper, the mineral acids, diluted alcohol, alcohol, and sulphuric acid combined. If the bleeding is from the gums, or antrum maxillare, or orbit, after a surgical operation, compression or the actual cautery is requisite.
Fracture, from frango, to break, is applied to the bones, and is divided into simple and compound ; simple, when the bone only is injured ; compound, when the soft coverings are so injured that either one of the fractured ends protrudes through the skin, or the skin and muscles are so lacerated as to expose the bone, the long cylindrical bones of the limbs are most frequently fractured ; next the flat, particularly of the cranium, for those of the pelvis and scapula must be excluded ; and lastly, the round irregularly shaped bones of the tarsus, carpus, and vertebra. The bones are fractured by external violence, disease, and the action of the muscles. The long cylindrical bones are not un frequently broken in more than one point ; they are generally fractured at the centre of their shafts, in which case the fracture is more or less oblique ; whereas, when it occurs near the extremes, it be comes more and more transverse ; hence, fractures have been divided into oblique and transverse. The spongy bones are also fractured transversely. The fiat bones in various directions, occasionally stellated. A comminuted fracture occurs when a bone is broken in different places at once, and di vided into several fragments or splinters. Longi tudinal fractures also occur to the long cylindrical bones. Complicated fractures arc those accompa nied with luxation, severe contusions, wounded blood-vessels, pregnancy, gout, scurvy, rickets, fra gilitas,ossium, and syphilis, which diseases prevent the union of the bones, and also cause them to be very easily broken. Cold renders the bones more
fragile, and they are also more brittle in old age. The superficial are mare exposed to fracture than the deep seated bones ; thus the clavicle is more so than the os innorninatum. Others, from their functions, are more exposed ; as, for example, the radius from its affording support to the carpus.
When a fracture takes place, there is an effusion of blood from the vessels of the bone, periosteum, and contiguous soft parts, the muscles are violently excited, the periosteum and truncated ends of the bone inflame ; and after the inflammation subsides, the vessels of the periosteum and ends of the bone are formed to secrete callus, which is an effusion of gelatin that is gradually converted into cartilage, and lastly into bone by the secretion of phosphate of lime, precisely in the same manner as the forma tion and conversion of bone in the fetus. During the inflammatory action, no diseased secretion whatever takes place ; nay, even the healthy natu ral ones are more or less suspended, so that no ad vantage is gained by setting a fracture immedi ately after the injury ; on the contrary, this primary setting, as it is termed, re-excites the already spas modic action of the muscles, and in nine cases out of ten disappoints the hopes of the surgeon. Cal lus does not harden for many days ; in the adult, it begins generally about the tenth or twelfth day; Boyer, however, says that it is not formed until between the twentieth and seventieth day. The treatment of a simple fractured bone is to lay the limb in the easiest position for the patient, which is probably in M'Intyre's fracture splint, delineated in Fig. 6, of Plate DXV. to apply leeches and anodyne fomen tations or poultices, to put him on low diet, enjoin perfect rest, and administer gentle laxatives, until all inflammatory action is subdued ; then to extend the limb to its natural length, or apply pasteboard splints dipt in warm water, with wooden ones ex terior to them, and fastened with tapes. This latter is termed secondary setting, and is applicable to all the bones of the extremities, and is best exemplified in the os femoris.
The thigh bone is fractured at every point, but more frequently in its centre, in which case the fracture is oblique and splintery, accompanied with crepitus and great retraction of the muscles, ren dering the limb shorter and thicker, and the distal portion extremely moveable and overlapping the proximal, while the patient is unable to move the limb. If much spasmodic action of the muscles has taken place, no power we possess can lengthen and retain the limb in its situation. The limb should be retained in the fracture-splint, for fully three weeks after inflammation has been subdued, but may be examined every third or fourth day. More or less oedema supervenes, which is easily dis cussed by friction and bandage. This mode of treat ment is applicable to the tibia, fibula, os brachii, ulna, and radius, when affected with simple frac ture.