A REPORT 
-ON- 
The Treatment of Fractures, 
By J. B. H AM I LTON, 
KANE, ILLINOIS. 
Reprinted from Transactions of the Illinois State Medical Society. 
CHICAGO: 
FERGUS PRINTING COMPANY, 
244—248 ILLINOIS STREET. 
I873- A REPORT 
-ON- 
The Treatment of Fractures, 
By J. B. H A M I LTO N, 
KANE, ILLINOIS. 
Reprinted from Transactions of the Illinois State Medical Society. 
CHICAGO: 
FERGUS PRINTING COMPANY, 
244—248 ILLINOIS STREET. 
I873- Treatment of Fractures 
In Illinois. 
To those who have been placed in similar circumstances, it 
will not appear strange that this report is, for one that ought 
to be in highest degree statistical, so meagre in outline and 
incomplete in detail. But those who, in verbis vidgaris, “have 
been there before,” will readily understand that negligence 
in business, so characteristic of professional men, prevents a 
prompt response to appeals for statistics. 
The writer ventures to express the hope that the records of 
private cases may be more fully kept as respects accuracy in 
the practical details, and that the next decade may be marked 
by a correspondingly higher scale of “ perfect results,” fewer 
cases of deformity, and a disposition to avoid routinism. 
The Treatment 'of Fractures is the subject of this paper, 
hence it is not within its scope to enter into details of diag- 
nosis or etiology, being barren of facts bearing on differential 
diagnosis or controversial points. 
First in importance, but not in frequency, are FRACTURES 
OF THE FEMUR, which we find to have been treated mainly 
with the long splint, and with good success. 
Dr. Plummer, of Rock Island, calls attention to his cases, 
treated with a Truesdale’s fracture-bed (a cut of which is 
subjoined) ; but we do not find that the results are in any 3 
way superior to those obtained by Prof. Sands, of New York, 
with a simple plaster Paris bandage, or to very many cases 
treated with the long splint of Dessault or Physick. Let us 
see. 
Dr. Truesclale’s ITractnre—Bed.. 
Dr. Plummer reports: “Case I. Michael Davis. Compound 
and comminuted fracture of the femur; crushed by the roof 
of a coal mine falling on him ; was called to amputate, but 
concluded to make an effort to save the limb ; applied 
Truesdale’s fracture-bed and lateral splints of binders’ board ; 
succeeded. Cured with a straight thigh and no perceptible 
shortening. 
“II- Patrick Kelly. Oblique fracture of middle-third of 
femur; used Truesdale’s fracture-bed and lateral splints of 
binders’ board. No shortening. 
“Ill- A. E. Eberhard. Oblique fracture of femur, middle- 
third ; used Truesdale’s fracture-bed and lateral splints of 
binders’ board. No shortening.” 
Now these are excellent results, and Dr. Plummer has our 
thanks for calling especial attention to Dr. Truesdale’s frac- 
ture-bed ; but then a question very naturally arises as to how 
much of these was due to the fracture-bed, and how much to 
those lateral splints of binders’ board ? Let us look a little 
farther. 4 
Dr. J. O. Hamilton, of Jerseyville, reports a case of fracture 
of femur, treated November 16, 1854: 
“ George W. Witt, aged 13. Fracture of right femur, upper- 
third ; improvised splint in imitation of Physick, extending 
from axilla to sole of foot. Recovery perfect; no deformity.” 
In regard to this case, the writer would say that he had 
been intimately acquainted with the gentleman for nearly a 
year before he knew that he had had a fracture, and that he 
never during that time saw a limp in his gait.* 
Dr. Bartlett, of Virden, reports four cases, one of which he 
reports as intra-capsular, and in all of which Hodgen’s splint 
was used. There was shortening in three cases, the maximum 
being of an inch. No shortening in one case. 
Dr. Herriott, of Grafton, reports thirteen cases of fracture of 
the femur, in only one of which the cure was effected without 
shortening, the maximum being about of an inch. His 
treatment was “ usually extension and counter-extension by 
weights and pulleys, the limbs flexed by resting on sand-bags, 
and short splints to internal and external aspect of limb.” He 
mentions that he has “frequently had patients walking without 
the aid of crutches, in from forty to forty-eight days.” 
Dr. Horace Wardner, of Cairo, reports ten cases of fracture 
of femur, six of which were treated with Physick’s long splint, 
and of these two recovered without perceptible shortening or 
deformity, although three were compound comminuted. Three 
cases were dressed with double inclined plane, and one case 
died from internal injuries received before a dressing could be 
applied. 
Dr. Breed, of Princeton, reports a case of fracture of the 
femur treated with long splint and extension by weight and 
pulley, and adhesive straps, which recovered without short- 
ening. 
Dr. J. P. Anthony, of Sterling, reports nine cases of fracture 
of femur, which were treated with long straight splints and 
extension by adhesive straps and weights. Of these there 
* Shortening exists of nearly ]/2 an inch, but the gentleman inclines the pelvis 
so that no limp results, except when very tired. 5 
was no shortening in three cases. The minimum shortening 
in the remainder was 1-16 of an inch, and the maximum only 
of an inch. 
Dr. Clark Roberts, of Winchester, reports eight cases of 
fracture of femur, which were treated with Gibson’s modifica- 
tion of Dessault’s splint. Two of these were compound. In 
only one case recovery took place without shortening, and the 
maximum shortening was of an inch. 
Dr. E. P. G. Holderness reports a case of fracture of femur 
in a child five years old, which was treated with Physick’s long 
splint, and in which a perfect cure resulted without deformity. 
Dr. A. K. Van Horne, of Jerseyville, reports three cases of 
fracture of the femur, of which one was compound commi- 
nuted, and the condyles separated. This case was treated 
with Hodgen’s modification of Smith’s anterior splint, short- 
ening inch. One other case was treated with the same 
dressing, and recovered without shortening or deformity ; and 
one case treated by simple extension on a double-inclined 
plane, with weights and pulley. The doctor says he used 
cold water dressings with all cases. 
Now, to go outside of Illinois, we shall find a report “On the 
use of plaster of Paris in the treatment of fractures, especially 
of the femur,” by Prof. Sands, of New York, which is very 
complete; and for the advocates of immovable dressings 
leaves nothing to be desired. It will be found in the New 
York Medical Journal for June, 1871. Prof. Sands justly 
remarks that plaster of Paris receives its severest test in frac- 
tures of the femur. He invariably makes use of extension by 
the compound pulley, where manual extension proves insuffi- 
cient, and in either case counter-extension. He employs for 
counter-extension an iron bar, similar to Volkmann’s. To use 
the doctor’s description : “ This bar is so fastened as to rise 
vertically from the table on which the patient is placed during 
the adjustment of the bandage. Before being used it should 
be covered with cotton, or any other soft material, to prevent 
injury to the perinaeum. The patient having been placed on 
the table, astride the iron bar, and if necessary ether admin- 6 
istered, sufficient extension is made to bring the limb to its 
proper length. The plaster bandage is then applied from the 
foot to the groin, and around the pelvis in the form of a stout 
spica.” While the patient is being lifted from the table by a 
couple of assistants, the bandage is passed around the pelvis, 
and counter-extension, by means of the iron bar, is at the 
same time effectually maintained. 
Dr. Sands has applied the plaster splint in twenty-three 
cases of fracture of the femur, two of which were compound. 
He gives the following analysis : 
“ In eighteen cases out of the twenty-three the bandage 
was applied within six days from the time of injury. An 
anaesthetic was found necessary to permit reduction in eleven 
cases. In one case the bandage caused excoriation of peri- 
naeum, and was removed. In no other instance was the 
bandage removed until bony union had taken place. In one 
case, although the union was firm, the presence of an old 
dislocation prevented the length of the limb from being accu- 
rately measured.” 
The remaining cases he arranges in the following form : 
“ Under 15 years, seven cases. No shortening in two cases; 
maximum shortening, inch ; average shortening, yi inch ; 
average period of union, weeks. 
“Over 15 years, fourteen cases. No shortening in six cases; 
maximum shortening, 1 inch ; average shortening, % inch ; 
average period of union, 7 weeks.” 
From the above it will be seen that Dr. Plummer has had 
three cases cured without deformity, with the use of lateral 
splints and Truesdale’s fracture-bed, and on these cases he 
argues that the fracture-bed is a sine qua non in the treatment 
of this fracture; but the testimony shows that equally good 
results have been obtained with long splints, Hodgen’s splint, 
and the plaster bandage. 
The cheapness of Hodgen’s splint, its easy adaptation to 
the surface of the limb, its efficient extension (counter-exten- 
sion being made by the gravity of the body), the freedom of 
motion allowed by it, must make it one of the most desirable 7 
contrivances in use for the treatment of this fracture. It is 
peculiarly well adapted to the treatment of compound or open 
fractures. 
The best arguments in favor of the plaster bandage that 
havebeen made on this side of the water are by Prof. Sands— 
already cited in this paper—and prove beyond a doubt that 
in skilled hands it may be used to admirable advantage. 
Fracture of the Tibia.—Of this fracture Dr. Horace 
Wardner, of Cairo, reports ten cases, in none of which any 
perceptible shortening resulted. Six cases, of which two were 
compound or open, were treated with fracture-box, four were 
dressed with posterior splint. With two exceptions, all these 
fractures were dressed on the day of fracture, and those were 
not dressed until the third day after the injury. 
Dr, J. P. Anthony, of Sterling, reports two cases of frac- 
tured tibiae, which were treated with fracture-box, and in 
which no shortening or deformity resulted. 
Dr. Clark Roberts, of Winchester, reports six cases treated 
with splints and inclined plane, and afterward starch bandage, 
all dressed on the day of fracture, and all recovered without 
deformity or shortening. 
In the writer’s practice, fractures of the tibia have been 
somewhat frequent; but he is under the necessity of regretting 
that imperfectly kept records prevent him from reporting in 
full. He can, however, present five cases in detail. 
Case I and II. Judson Pope, aet. 14, while riding on the 
same horse with Rickard Neece, aet. 13, the horse stumbled 
and fell on its side, breaking the right tibia of each boy, and, 
singularly enough, within a-quarter of an inch of the same 
distance from the malleolus in each, and about the junction of 
middle with lower-thirds. The boys were seen and their legs 
dressed with a quilt compress within two hours after the frac- 
ture occurred. On the fifth day this compress was removed, 
and a plaster bandage substituted. On the fourteenth day 
the boys were allowed to go on crutches ; of course, bearing 
no weight on the foot, it being supported by a sling reaching 
from the neck to the instep. Both cases recovered without 8 
deformity. Case I being in better health than the other pre- 
vious to the accident, recovered much sooner than the other— 
in fact, attended school in less than three weeks from the date 
of the injury, the limb being encased in plaster. 
I have two other cases on record, only differing from the 
above in the ages of the patients, the causes of the accident, 
and in duration of the treatment. The remaining case was 
somewhat peculiar: 
vS. J. Varblc, aet. 21, was driving mules in December, 1872 ; 
stopped to adjust the harness, and was kicked by one of the 
mules, receiving a fracture of the tibia; he fell, and on 
attempting to arise he again fell, and the upper fragment 
shot through the integuments immediately below the seat of 
fracture, constituting an open fracture. The fracture was very 
oblique. He was seen by the writer in about four hours ; 
considerable swelling had supervened, and the parts about 
the seat of fracture were ecchymosed. Owing to the intense 
pain complained of by the patient, the leg was placed upon a 
pillow, and a lotion of tinct. arnica and laudanum directed. 
On the following day, the leg was placed in a quilt compress. 
On the fifth day, a careful measurement showed a shortening 
of about y of an inch. Extension was now attempted with 
adhesive strips and weight, but patient, being impatient, 
objected, and removed the weight immediately after my 
departure. The following day he was warned of the conse- 
quences, but said that he preferred a shortened leg to the 
pain of extension, and utterly refused to allow extension to 
be made. After calling witnesses to hear his refusal, the leg 
was encased in plaster, and a fenestra made opposite the open 
wound. The wound was dressed with carbolic acid, and bony 
union took place in about six weeks, shortening nearly an 
inch. 
Fracture of the Tibia and Fibula.—This, judging 
from reports received, is not a very frequent fracture. 
Dr. R. M. Wilson, of Palmyra, reports three cases of fracture 
of both bones of the leg, of which two cases were simple and 
one complicated, with outward dislocation of ankle-joint. 9 
These cases were all treated with lateral splints ; well padded’ 
with cotton for the first fourteen days ; then a starch bandage 
was applied ; and, with the exception of the latter, which 
resulted in partial loss of motion of ankle-joint, the result 
was perfect. No shortening or deformity visible. 
Dr. J. O. Hamilton, Jerseyville, reports a case treated from 
the beginning with plaster splints ; removal at sixty days ; 
leg found to have united perfectly. No shortening or de- 
formity. 
Dr. Breed, of Princeton, reports two cases of this fracture, 
one of which was treated with a fracture-box and extension 
by weights and pulleys, shortening Lj inch 5 the other case 
was complicated, as was afterwards discovered, with rupture 
of the interosseous artery. Gangrene occurred. The leg was 
amputated, and patient died; the doctor thinks from pyemia. 
Dr. Bartlett, of Virden, reports four cases of this fracture, 
of which two were open and comminuted. One of these was 
dressed in fracture-box ; the remaining three were dressed 
with Hodgen’s suspension splint. 
Dr. J. T. Frazer, St. Elmo, reports a case of open commi- 
nuted fracture of tibia .and fibula, in a child eight years of 
age, treated with lateral splints ; applied dilute carbolic acid 
to wounds ; bones united perfectly ; time not stated. 
Dr. J. P. Caldwell, of Glasgow, reports a case treated with 
fracture-box ; good result. 
Dr. S. C. Plummer, of Rock Island, reports two cases; one 
an open fracture at the junction of middle and lower-thirds. 
Used Mason’s-inclined plane splint and lateral splints of 
binders’ board for six weeks; then used Truesdale’s fracture- 
bed. This patient was seventy years old. The injury was 
received on December 2, 1871, and he was discharged on the 
4th of March following. He worked as a day laborer, but 
with x/% inch shortening. The remaining case was an open 
oblique fracture, near junction of middle with lower-thirds. 
Used Mason’s double-inclined plane (similar to Liston’s) and 
lateral splints of binders’ board. Shortening y& inch. Date 
of fracture, August 21. Discharged October 25. Dr. Clark Roberts, of Winchester, reports four cases treated 
with double-inclined plane and short lateral splints, followed 
by starch bandage. No shortening ; duration of treatment 
not stated. He also reports a case where there was a non- 
union of the tibia, but the fibula united perfectly. 
Dr. J. P. Anthony, of Sterling, reports eight cases of this 
fracture, of which a number (exact number is not stated) 
were treated with double-inclined plane, fracture-box, Day’s 
patent splint. Of these cases five were cured without short- 
ening ; the maximum shortening in the remainder was y2 an 
inch. Unfortunately, the doctor neglected to state which 
cases had the resulting shortening, so we are left to conjecture 
whether those cases with shortening occurred after the use of 
the inclined plane, the Day’s splint, or the fracture-box. 
Dr. E. L. Herriott, of Grafton, reports ten cases of this 
fracture. The doctor treated them all with extension by 
weights and pulleys, the leg being flexed upon sand-bags ; 
and he was fortunate enough to have all his patients recover 
without deformity or shortening. 
Dr. Van Horne, of Jerseyville, reports two cases of this 
fracture, both of which were open fractures ; one of which 
was treated with fracture-box, limb previously enveloped in 
roller bandage ; the other by Hodgen’s splint. No shortening 
in either case. Dressing in one case immediately (Hodgen) ; 
in the other one, on the fourth day. 
Dr. Geo. W. Lasher, Bluffdale, reports a case treated with 
fracture-box and extension by adhesive strips and weights, in 
which the shortening was about y inch. 
Dr. Horace Wardner, Cairo, reports three cases of this frac- 
ture treated with fracture-box. Dressed on day of fracture in 
two cases ; there was no shortening. In the other the short- 
ening was y inch. 
The writer had a case last summer of this fracture. Man 
thrown from a horse, breaking both bones. There was com- 
minution. Treated on the date of fracture with quilt compress. 
On the fifth day applied plaster splint. Patient used crutches 
on twenty-first day, and was discharged at the end of twelfth 
week. No shortening. 11 
Dr. J. H. Etheridge, Chicago, since this report was begun, 
reports a case treated with plaster splint without shortening. 
Duration of treatment not stated. 
Fracture of Fibula.—Dr. R. M. Wilson, of Palmyra, 
reports a case of fracture of fibula, complicated with an out- 
ward dislocation of the ankle-joint. Applied Dupuytren’s 
splint for the first five days, and then a starch bandage. No 
shortening. 
Dr. Plummer, of Rock Island, reports a case of fracture of 
fibula at lower end, complicated with crushing of astragalus. 
This fracture was produced by the patient jumping from a 
carriage while it was in rapid motion. Used Mason’s double- 
inclined plane splint, extension by adhesive strips, and lateral 
splints of binders’ board. No shortening, and a good ankle- 
joint. This fracture occurred November 3, 1870. He was 
discharged January 21, 1871. 
Fractures of Patella.—Dr. Anthony, of Sterling, re- 
ports two cases of fracture of the patella, which, he says, were 
each received by patient jumping from a wagon—a warning 
to peripatetic individuals who are emulous of circus tumblers. 
These fractures were dressed with straight splints. Good result. 
Fractures of Bones of Foot.—Dr. Plummer’s case, 
just cited in P'ractures of Tibia and Fibula, and two cases by 
Dr. Anthony, are all that have been reported to me. The 
latter were treated without apparatus ; one case made a good 
recovery, and the other resulted in deformity. 
Fractures of Clavicle.—Through a typographical 
error, this fracture was omitted from the printed list sent to 
the members of this Society, and I have only a limited num- 
ber of cases to report. 
Dr. Breed, of Princeton, reports a case of this fracture 
treated with Fox’s apparatus, in which a good result was 
obtained without deformity. This was a child aet. 1 years. 
Dr. Herriott, of Grafton, and Dr. Bartlett, of Virden, each 
report several cases ; but both gentlemen unfortunately forgot 
to designate the apparatus or state the result. 
In the writer’s practice, three cases have occurred in 1872. 12 
Case I. Anna Knozvles, aet. 5, fell from fence, striking on 
shoulder, fracturing clavicle at middle-third. Dressed with 
figure of eight bandage. A little deformity resulted. 
CASE II. Amos Donny, aet. 70, thrown from wagon ; frac- 
ture of clavicle at middle-third. Applied a neck-yoke splint, 
with axillary pad. Recovery perfect, rapid union, and not the 
slightest deformity. 
Case III. Louan Williams, net. 16, thrown from open 
buggy, striking on shoulder; fractured clavicle at middle- 
third. Union rapid, but inner fragment is a little elevated, 
and some deformity results. A neck-yoke splint was used. 
Dr. E. M. Moore, of Rochester, N.Y., in a report on this 
subject to the New York State Medical Society for 1870, calls 
attention to the fact that in these fractures at the middle-third, 
when we attempt to use any retentive apparatus that has an 
axillary pad, we overcome, by the pressure of the pad, the 
normal contractility of the clavicular fibres of the pectoralis 
major muscle ; thus leaving the sterno-cleido mastoid muscle 
without an antagonist, and consequently the inner fragment is 
tilted upward and backward. To remedy these defects, the 
doctor proposes to apply a bandage which shall fulfil the in- 
dication of rendering the clavicular fibres of the great pectoral 
muscle tense; at the same time to fulfil the general indication, 
of keeping the shoulder upward, outward, and backward. As 
the Transactions of the New York State Medical Society are 
not in general circulation, I here reproduce the drawings of 
Dr. Moore illustrating his dressing : 
Fractures OF Humerus.—Dr. Clark Roberts, of Win- 
chester, reports four cases of fractured humeri, which were 
treated with lateral splints, and made good recoveries. No 
shortening resulted, and perfect union was obtained in every 
case. 
Dr. J. O. Hamilton, of Jerseyville, reports a case of frac- 
tured humerus just above condyles. Patient set. 3 ; colored. 
Dressed the arm with plaster splint more than usually firm. 
Saw the child the following day on the street drawing a little 
child’s wagon with the fractured arm. Recovery, however, Dr. Moore’s dressing for fracture of the clavicle. Front view. After Dr. Moore. 
Dr. Moore’s dressing for fracture of the clavicle. Back view. After Dr. Moore. 13 
was rapid, the bandage allowing no motion of fragments; and 
the child has no deformity, or loss of motion in the joint. 
Dr. R. M. Wilson, Palmyra, reports five cases of fracture of 
humerus, one of which was complicated with dislocation of 
forearm backward. (The writer would here state that, in his 
opinion, this dislocation cannot occur unless the coronoid pro- 
cess of the ulna be fractured.) Owing to the high state of 
inflammation, the doctor says, he could not apply a satisfac- 
tory dressing. Pie early resorted to passive motion ; but 
anchylosis of the elbow-joint was the result, and slight dis- 
placement of fragment. His remaining cases were treated 
with pasteboard splints, and after a few days starch bandage. 
Good results. 
Dr. A. K. Van Horne, Jerseyville, reports two cases of this 
fracture, in one of which there was also a longitudinal fracture 
of inner condyle, which was treated with roller bandage, and 
the other case complicated with a dislocation (what dislocation 
he does not state), which was treated with a starch bandage. 
In each case there was a good union without deformity. 
Dr. Bartlett, of Virden, reports a case of this fracture treated 
with pasteboard splints. Good union. 
Dr. Herriott, of Grafton, reports eight cases, but mentions 
neither the apparatus nor the results obtained. 
Dr. Wardner, of Cairo, reports eight cases, one of which 
was an open fracture, and two comminuted. They were all 
treated with straight splints; and he mentions no instance of 
non-union, and says there was no shortening. 
Dr. Anthony, of Sterling, reports six cases of this fracture 
treated with straight splints. No deformity or shortening. 
The writer had a case in 1869, which deserves mention in: 
this, that anchylosis of the elbow-joint, which had commenced, 
was prevented by persistent use of Rose’s splint, a cut of which 
may be seen figured in “ Hamilton’s Fractures and Disloca- 
tions,” p. 250. The patient was a little girl, set. 5, who fell 
from the steps of a house, fracturing humerus just above con- 
dyles. Plaster splint was applied in six hours, and on the 
fourteenth day removed, as anchylosis was threatened, and 
Rose’s splint applied. The screw was turned twice or thrice 14 
daily as far as patient could bear it. The arc of motion con- 
stantly increased, and patient in three weeks more was able 
to turn the screw until the arm was straight. She entirely 
recovered the use of the joint. 
Dr. E. M. Moore, of Rochester, N.Y., in a short lecture 
delivered in the Surgical Section of the American Medical 
Association, which met at St. Louis within the present month, 
exhibited a fractured humerus, which was fractured at the 
anatomical neck; and the doctor clearly showed that the 
anatomical neck is not the constricted portion just beneath 
the head of the bone, as the latter is simply a groove for the 
attachment of the capsular ligament. Fracture actually takes 
place, partly through this groove and partly through the 
tuberosities, the original line of union of the shaft with the 
epiphysis. 
Fracture of the Radius and Ulna.—Dr. Bartlett, of 
Virden, reports five cases of this fracture treated with paste- 
board splints ; but he makes no mention of the duration of 
treatment. They recovered without deformity. 
Dr. Herriott, of Grafton, reports seven cases of this fracture, 
but omits to state how they were treated, or with what result. 
Dr. J. O. Hamilton, Jerseyville, reports five cases of this 
fracture all treated with plaster splint, all of which made good 
recoveries. He relates them in detail: 
Case I. Jno. Gormon, set. 14, took hold of the “tumbling 
shaft ” of a threshing machine while it was revolving at the 
rate of 500 revolutions per minute; his glove, being wet, ad- 
hered to the shaft; his hand and arm were wound around it, 
fracturing the humerus, radius, and ulna ; the latter was an 
open fracture, the ulna protruding through the skin ; the 
humerus was comminuted. The arm was dressed with Paris 
plaster, and healed rapidly. Slight deformity of contour, but 
motion is perfect. 
CASE II. Mrs. Wallpool, aet. 81, was thrown to the ground 
by a pair of restive horses ; radius and ulna fractured at the 
upper portion of middle-third. Applied plaster splint. Dress- 
ing unremoved for sixty days. A good union and no de- 
formity. 15 
Case III. James Fitzgerald, set. 13, fell from fence and 
fractured radius and ulna at middle-third. Applied plaster 
splint. No deformity. 
CASE IV. Precisely similar to above. 
Case V. John Lane, set. 9, fell from back part of wagon- 
box while the wagon was in motion ; fractured middle-third 
of radius and ulna. Dressed with plaster. Recovery was 
rapid ; but after the splint had been removed, he fell from a 
porch to the ground, a distance of four feet; broke up the 
callus that had formed. Arm was redressed with same splint; 
unremoved for sixty days. Recovery this time permanent 
and without deformity. 
Barton’s Fracture of the Radius.—The very exist- 
ence of this fracture has been doubted by many; but a case 
has been reported to the writer, by Dr. Breed, of Princeton, 
which was treated with Barton’s dressing, which is identical 
with that recommended by Dr. Collins, of Dublin—i. e., a 
straight palmar and dorsal splint, and does not incline the 
hand. 
Colle’s Fracture of the Radius.—And now we ap- 
proach a fracture about which volumes have been written, 
scores of splints and manifold dressings invented; all speaking 
plainly that a satisfactory mode of treatment had not yet been 
found, or the variety recommended would have been less. 
To the mind of the writer, the discovery by Dr. Moore, of 
Rochester, N.Y., that nearly every case of Colie’s fracture was 
complicated with a dislocation of the ulna, “ which had a 
regular position, and which must be rectified before replace- 
ment of the fracture should be made, and without which 
imperfect results are to be expected,” whatever be the dressing 
used. The doctor’s mode of procedure is as follows : 
“ The patient may be etherized or not. An assistant holding 
the forearm of the patient, the surgeon grasps his hand, the 
right with the right, and vice versa the other hand placed 
under the forearm above the fracture. He now brings the 
thumb over the back of the ulna, the fingers wrapping around 
the radius. Traction is first made by extension, then drawing 
the hand laterally to the radial side, then backward, next 16 
keeping it backward ; and while making extension it is swung 
to the ulnar side, bending laterally, the extension of the hand 
is changed for flexion ; thus describing nearly a semicircle in 
circumduction. The test of the reduction is to be found by 
the presence of the head of the ulna on the radial side of the 
extensor ulnaris. The anatomy of the dislocation is this: 
the head of the ulna rests mediately through the triangular 
fibro-cartilage on the cuneiform bone, and is restrained from 
replacement by the annular ligament—holding on each side 
the tendons of the extensor minimi digiti—and the extensor 
carpi ulnaris ; thus making a concavity corresponding in form 
to a socket. When it is pressed into this pocket, and the hand 
flexed so that the head is supported by the wrist, and the 
position of the hand is also restored in its relation to the 
radius as a result of the displacement of the ulna, the ulnar 
extensor is carried from its place above the styloid process to 
the opposite side of the bone in an extreme displacement, 
but sometimes remains above its centre. To disentangle the 
styloid, and swing the tendon of the extensor over into its 
place, is the purpose of the manoeuvre. The hand is drawn 
toward the radius to pull off (by stretching) the annular liga- 
ment. The backward motion, accompanied with extension, 
renders the extensor tendon tense, which serves to draw the 
annular ligament backward. This is effected by pressing the 
thumb upon the ulna. The circumduction carries the tendon 
over the side.” 
The doctor’s after-treatment is sufficiently simple. He 
“ places along the ulna, from the pisiform bone upward, a 
cylindrical compress about two inches in length and a-half 
an inch in thickness. This is placed against the ulna, resting 
also on its radial border against the tendon of the flexor carpi 
ulnaris.” This compress is retained in place by adhesive 
strips. 
Dr. Anthony, of Sterling, reports seven cases of Colle’s 
fracture treated with pistol-shaped splints, which made good 
recoveries. 
Dr. Wardner, of Cairo, reports two cases treated with pistol- 
shaped splints, which made good recoveries. Dr. Clark Roberts, of Winchester, reports three cases of 
Colle’s fracture, which were treated with straight splints, and 
which recovered with but slight deformity. 
Dr. J. P. Caldwell reports three cases of this fracture, which 
were treated with pasteboard splints, and which recovered 
without shortening. 
Fractures of the Carpus.—Dr. Bartlett, of Virden, 
reports three cases, all of which required amputation. 
Dr. Anthony, of Sterling, reports two cases, both of which 
were treated with curved splints and hand-block, after the 
manner of E. P. Smith’s splint. Good recovery. 
Fractures of Vertebra.—Dr. Bartlett, of Virden, re- 
ports a case of vertebral fracture, which was (August 20, 1872) 
under treatment for paralysis. 
Dr. Wardner, of Cairo, reports two cases, one under treat- 
ment for paralysis (October 16, 1872), and one case in which 
was paralysis and death in forty days. 
Dr. Van Horne, of Jerseyville, reports a case of this fracture 
followed by death in three days. 
Dr. Anthony, of Sterling, reports a case of this fracture 
from a gun-shot wound which resulted favorably. Used no 
dressings, save those applicable to the external wound. 
Dr. Etheridge, Chicago, reports (since the above was written) 
a case in which the posterior arch of sixth cervical vertebra 
was crushed. There was complete paralysis. Breathing wholly 
diaphragmatic. Death at fiftieth day, large bed-sores previ- 
ously supervening. 
The writer saw a case in 1869, in which a negro had been 
struck across the back of the neck with a club. He immedi- 
ately fell, and died in three hours. At the autopsy it was 
found that the transverse process of the atlas was broken, no 
other lesion perceptible, no extravasation of blood, and it was 
supposed the man died from concussion. 
But a single case of FRACTURE OF THE SACRUM has been 
reported, and that by Dr. Clark Roberts, of Winchester. No 
dressing was applied, and the case terminated favorably. 
Fractures of Cranium.—The same gentleman reports 18 
four cases, two of which were trephined, one died, the remain- 
der recovered. 
Dr. Anthony, of Sterling, reports six cases, of which four 
recovered and two proved fatal. All were trephined but one, 
and that the most hopeless case. 
Dr. Wardner, of Cairo, reports four cases. Heads were 
bandaged, and all recovered. 
Dr. Van Horne, of Jerseyville, reports three cases, all of 
which recovered. 
I. Was produced by the tine of a pitchfork passing into the 
cranium through the parital bone, penetrating through ante- 
rior lobe of the cerebrum to the frontal bone. Treatment, 
cold water dressing and Rochelle salts. Complete recovery. 
II. Fracture of external angular process of frontal bone and 
adjoining portion of malar. The outer portion of the orbit 
came away in fragments. 
III. Fracture and depression of temporal bone, which re- 
sulted in recovery. The doctor does not state whether he 
trephined or not. 
Fractures of Bones of the Face.—Dr. Anthony, of 
Sterling, reports two cases of fracture of the bones of the face. 
Were treated with adhesive strips and bandages. One made 
a good recovery ; the other imperfect. 
Dr. Bartlett, Virden, reports six cases treated in a similar 
manner. Some resulted in permanent deformity. 
Dr. Wilson, of Palmyra, reports a case of fracture of the 
nasal bones, which he treated with a pledget of lint, firmly 
packed within the nostrils for counter-pressure, against adhe- 
sive strips across the nose. Result fair. Nose very slightly 
flattened, not in any way distorted. 
Fracture of Ileum.—Dr. Plummer, of Rock Island, 
reports two cases : 
I. Hudson Engle. Man run over by a wagon loaded with 
coal. The right ileum was fractured through the acetabulum 
and the pubis near the iliac extremity. The leg was extended 
on a straight splint improvised for the case. The two legs 
were bandaged together, and pelvis bandaged with many- 
tailed bandage, extended well down the thigh. Recovery 19 
perfect. Has perfect use of hip-joint, and attends to his 
ususl labor on his farm. Date, December 3, 1870, and dis- 
charged June 1, 1871. 
II. Peter Gormley. This man was crushed under a stone- 
door cap of a falling building, and literally buried under brick 
and mortar. He was severely bruised all over his body ; had 
three wounds of the scalp and an open comminuted fracture 
of the left ileum. The opening in iliac wound extended 
into the peritoneal cavity, and there was profuse hemorrhage. 
Introduced three fingers within the wound, and removed the 
detached portions of bone ; the others were then brought into 
position. The wound unclosed, dressed with lint compress 
and broad, many-tailed bandage around pubes. Passive 
hemorrhage continued for a number of days. Only slight 
peritonitis resulted, which the doctor attributes to the fact 
that the wound was kept open, allowing free drainage. Man 
recovered with a slight displacement of crest and superior 
spinous process of ileum ; otherwise the recovery is perfect. 
In the practice of the writer a fracture of the ileum occurred, 
which was only discovered at the autopsy of the patient. The 
man was accidentally shot, gun in the hand of another man, 
patient standing with his hand in his breeches pocket very 
close to the muzzle of the gun, which was loaded with squirrel 
shot. The charge passed through the pocket, through his 
hand, fracturing and comminuting the phalanges and meta- 
carpal bones of the third and fourth fingers. The charge 
passed directly into the thigh, just below the trochanter major, 
and was lost to sight or probe. Even a flexible bougie failed 
to pass into the wound any farther than the thigh-bone, which 
was not found to be fractured—in fact, could be seen through 
the open wound. Upon turning patient over for a more 
thorough examination, a tumor was discovered over the lum- 
bo-sacral articulation. An incision was made at that point, 
the shot and pieces of clothing extracted, wound thoroughly 
cleansed with warm water. The third and little fingers were 
amputated through the upper fragments of their metacarpal 
bones, and a full dose of morphia administered. The next 
day a very offensive discharge, partly sanious, was issuing 20 
from the wound in the thigh and the incision in the back. 
Injected the compound solution of bromine. Continued mor- 
phia. Patient sank of peritonitis on the fifth day. Found the 
ala of ileum fractured, not comminuted ; and mortification 
had taken place in the peritoneal lining of the iliac fossa. 
From the above reports that have been sent me, it will be 
seen that, with the exception of Dr. Truesdale’s fracture-bed, 
no one reports an invention of his own, but that the results 
obtained by the apparatus already in use are exceedingly 
good, and reflect credit upon Illinois surgery. * It will also be 
seen that in but a single instance was amputation performed 
for a fracture of the long bones, and that, in consequence of a 
rupture of the interosseous artery and mortification of the 
leg. But one case of non-union is reported. Immovable 
dressings, whatever may be their merits or demerits, are 
evidently not much in use in the State of Illinois ; and the 
majority of the profession in the State do not adhere to the 
doctrine of waiting for the primary swelling to abate before 
applying a permanent dressing. The frequency of shortening 
after the use of weights and pulleys deserves especial notice. 
I would also call attention to the use of Truesdale’s fracture- 
bed, in case a patient with fracture is to be transported from 
one place to another. With this bed a patient may be taken 
to New York or Chicago without injury to, or motion of, the 
limb. The variety of dressings which have been reported for 
the same fractures, and the almost uniform success attending 
their efforts, would seem to indicate that in skilled hands 
almost any kind of apparatus that fulfills a majority of the 
indications to be met, will meet with reasonable success. And 
that surgeons everywhere may take more pains to preserve 
records, and thus place the treatment of fracture more upon 
an equality, and that each may heartily try to find the best, 
is the wish of the writer. 
* The writer declines to vouch for the accuracy of all reports, that have been 
handed him, especially upon fractures of the femur, recognizing the fact that, even 
in medicine, there are those who will gloss over a glaring defect to make a good 
showing; and that inaccurate diagnoses, and, in some instances, impossibility of 
measuring limbs after treatment owing to removal, death, or turpitude of patient, 
may also tend to modify the results; but, in the main, the author can verify nearly 
every case mentioned above.