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ON THE USE OF STRAW

AS A SUBSTITUTE FOR

SPLINTS OR THE FRACTURE-BOX,

IN THE TREATMENT OF FRACTURES OF THE LEG.

BY JOHN GREEN,

FILLOW OF THE MASSACHUSETTS MEDICAL SOCIETY.

THE following method of treating fractures of the leg has been submitted to very extensive trial during the past thirty years, and is now brought forward in the conviction that it offers important advantages over most of the ordinary plans of treatment.

Bundles of straw, reeds, small twigs, etc., have long been employed in surgery, under the name of junks, and have rendered good service both as temporary supports to frac tured limbs, and as adjuncts to other and more complicated forms of apparatus. They have not, however, been gonerally adopted as permanent appliances, although in some respects decidedly preferable to wooden splints.

The principal advantages claimed for straw over other materials commonly used for splints, are its lightness, combined with abundant stiffness, its ready adaptability to the form of the limb, and lastly, but by no means least, its cheapness, which, in cases of compound fracture, admits of the renewal of the apparatus as often as it becomes soiled by the discharges. The present method of using straw is even simpler than that by junks, and is especially adapted to the treatment of most of the varieties of fractures, whether simple or compound, in the leg.

The manner of applying the straw apparatus is very simple: the larger ends of the straw, which should be straight and whole, are cut to the proper length, extending usually from the knee, or a little higher, to a point a few inches below the foot; it is then arranged in a parallel direction in a common pillow-case, the quantity required being about as much as would make a bundle of from three to four inches in diameter. In this way we obtain a thin pillow of straw, which is now to be drawn under the injured leg and tied snugly around it with a sufficient number of tapes or cords, having first reduced the fracture and adjusted the limb in a correct position. Room is made for the heel by separating the straw a little immediately beneath it, and the whole arrangement is completed by supporting the limb on the sides by a couple of sand bags or billets of wood, to prevent rolling. If preferred, the limb in its straw case may be suspended by cords from a cradle or from the ceiling. No bandages of any kind need be used, and no splints but the straw, provided only that it is even moderately whole and stiff; if, however, the straw is of bad quality, or if, as often happens in the army, hay only can be procured, it may be advantageous to increase the rigidity of the apparatus by the addition of a few stiff twigs, or by placing two or three thin laths upon the outside of it.

The security which this simple apparatus affords against displacement is very much greater than might be supposed by one not familiar with its use; in a large proportion of cases the patient is able to move the leg readily, with a little aid from his hands, from one part of the bed to another. The limb is quickly and easily exposed and as easily readjusted, and any wound may be dressed with the greatest facility. There is no danger of constriction by bandages becoming tight in consequence of swelling, and the liability to accidental displacement is so slight that the patient or attendants may be safely allowed to loosen one or more of the tapes should it become necessary to relieve pain.

The accompanying wood-cut, copied from a photograph, shows the apparatus in use. The pillow-case is represented as cut off below the foot in order to show the straw.

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I owe the knowledge of this method to Dr. John Green, of Worcester, Mass., who first contrived it about the year 1835, as a temporary appliance in a case of severe compound and comminuted fracture of the leg resulting from a railroad accident. Struck by the advantages of the apparatus in ease of application and removal, and especially in the great comfort which it afforded to the patient, he was led to continue its use throughout the whole progress of the cure; and for a period of over fifteen years of extensive surgical practice he continued to employ the same method in the treatment of all cases of fracture of the leg. I have treated several cases of bad gun-shot fracture of both bones of the leg according to this plan, and believe that for such extreme cases, as well as for simple fractures, it is, on the whole, the best method of which I have any knowledge.

BOSTON, MAY 25, 1864.

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READ AT THE ANNUAL MEETING, MAY 31, 1865.*

MR. PRESIDENT, AND FELLOWS

OF THE MASSACHUSETTS MEDICAL SOCIETY:

THE profession we follow is capable alike of the divinest endeavor and the meanest purpose. To save it from degradation, and to elevate it to its true position as one of the noblest of human vocations, its faithful votaries have labored with untiring energy in past times and in our own, down to the present hour.

.

To understand disease, and to "cure" it, are the great objects and the laudable aspirations of the Medical Profession. The former is difficult; the latter often impossible, Notwithstanding the advanced state of medical science, numbers are at all times prostrate by sickness, and most of the race die prematurely. So uncertain are the effects of dis

* At an Adjourned Meeting of the Mass. Medical Society, held Oct. 3, 1860, it was Resolved, "That the Massachusetts Medical Society hereby declares that it does not consider itself as having endorsed or censured the opinions in former published Annual Discourses, nor will it hold itself responsible for any opinions or sentiments advanced in any future similar discourses."

Resolved, "That the Committee on Publication be directed to print a statement to that effect at the commencement of each Annual Discourse which may hereafter be published."

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