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ordinarily so troublesome in rheumatic fever, are not felt, as the suspension of the patient is all upon one centre.
The following cases of fracture have been treated in the manner described :
CASE I. V position ; a middle-aged, medium-sized, robust man, aged 50 years, was thrown from his carriage early in July, 1872. He sustained a compound fracture of the right ankle joint, the lower portion of the thigh presented a Y fracture, and the malleolar process protruded one and one-half (11) inches through the skin. The ankle joint was laid open. He was placed upon the chair in the V position, the thigh and seat portion being on an elevated single plane. A fracture box was placed on the lower part of the chair, and the projecting part of the box supported by a stand. The fractured limb was surrounded with sponge soaked in glycerine and packed in three pads of linen, one below and one on either side of the leg; the pads were covered with oil-cloth near the side of the wound, no bandages or circular compression of the limb were employed.
At night, the back portion of the chair was lowered to the level of the other part; in the day time, it was raised to any desired elevation. He had during the course of treatment, pneumonia, secondary fever from inflammation and purulent infiltration of the joints and surrounding parts. The wound discharged at least one pint of pus. When he stood on his feet for the first time he immediately walked through the hall to an adjoining room, an exceptional circumstances in my experience of similar fractures, the reason being that an enforced recumbent posture for seven weeks or more, causes an accommodation of the system's circulation adapted to the posture. Any sudden change from the dorsal to the erect position is then followed by a disturbance of the nice economy of the heart-force, so that faintness results. The arrangement of this patient's bed allowed of frequent changes of position, so that there was no disturbance of the central circulation, and locomotion became immediately possible. This patient made a good recovery in joint and limb.
Under date of June, 1877, he writes “The relief on being placed on the chair after lying upon the bed for a few days was great. I was not taken from it for ten weeks, during the hottest of weather, when a bed is almost unbearable. I could eat, sleep or write upon it; my. position could be changed at any time, and this afforded much relief. It (the chair) is easily managed, and, I can honestly say, it is the best and most comfortable I have seen. Having tried it, I know.”
This was the first case of fracture treated in the chair, and thus it possesses an unusual interest.
CASE II. A boy, eight (8) years of age, very nervous and pale, was thrown off a pony in March, 1875, and sustained a simple fracture of the right femur, middle third. Fears were expressed as to the effect of the shock upon his nervous system, in view of the fact that he had been difficult to manage whenever he had been sick before. A chair was arranged with a ten-inch thigh portion. The back of the chair was upholstered with Brussels carpeting, the seat with sole leather and the leg portion with carpet. He was transferred to the chair as follows: Chair placed in the horizontal position; a pole six feet long and two inches in diameter was held over the boy as he lay in bed. A blanket on which he lay was then drawn over the pole from both sides of the boy, gently made tense and fastened by tacks driven through the blanket into the pole. He was then raised by the ends of the pole and placed upon the chair so easily that he did not know when it was done, as he could not see. Adhesive straps were fastened to the thigh and connected with a weight simply hung over the back of the chair. This furnished the extension. To ensure safety, a sole leather splint was placed around the fractured thigh. The chair was continually moved about, and the back, thigh and leg portions were repeatedly moved backwards and forwards, giving motion to the hip and knee joint without at all disarranging the extension. A common dust-pan covered with newspaper served for a bed utensil. In a few weeks he made a perfect recovery, so much so that his uncle said he could not tell from his gait which limb was broken. The quick recovery must be attributed partly to his youth, partly to a diet of animal food and unbolted grain, and partly to the movable and adjustable bed chair.
Case III. Miss A. R., aged 70 years, single; fell while crossing the oiled hard pine floor of her kitchen in April, 1875. She had been in miserable health during the fall and winter previous, with digestive troubles which an autopsy shows to have beeen due to cancer of the liver. Her debility was so great that she kept swooning away after the fracture, and it was with great difficulty that she could be kept from dying, by the use of diffusible stimulants. She was, however, placed upon an invalid chair. Adhesive plasters, an India rubber tubing, and a fixed point beyond the foot furnished the means of extension. The tubing furnished an adjustable, direct, elastic extension in a small compass. At the very outset of her confinement in the chair, Miss R. fainted away frequently from sheer weak
Whenever this occurred, it was only necessary to turn the chair backward and to lower the head until the equilibrium was restored. At the time it seemed as if this change of position alone saved her life, as the fainting fits were so long continued that medicines lost their effect, the gravity proving more valuable than the drugs. A singular and unusual experience followed this, in that she had an attack of diphtheria, the membrane being abundant and visible in the throat. There was fever, and cervical adenopathy. At times she was choked by the detached membrane, and when this occurred, she was rapidly brought to an erect position. She was thus enabled to manage her throat and mouth, as she could not have done in the ordinary horizontal position. So that in fainting and vomiting she tested the chair quite thoroughly. Curiously enough, the fractured bone united well and promptly with threefourths of an inch shortening. When it was healed she was replaced in bed.
Her miserable and painful existence, however, was in a few weeks brought to a conclusion by cancer of the liver. The organ was found to be enlarged, and studded with yellowish globules of considerable consistency. Her life certainly seemed to have been prolonged by the use of the chair.
CASE IV. In Dec., 1876, Mr. J. D— - tried to remove some ice from his boot-heel by kicking, and fell. When raised he was found to have sustained a dislocation of the left ankle joint, and a complete fracture of both malleoli. The dislocation was relieved by bystanders. He was placed upon a cane chair covered with a hair mattrass. The extension apparatus represented in the cut, was employed in this case. It worked well. There was no difficulty in assuming comfortable positions. The malleoli became rapidly attached in place, but the ligaments and torn fascia were as usual, long in healing. The patient and his friends expressed great satisfaction with the use of the chair, as it relieved the tedium of confinement. Recovery was good, though the patient was a man of full habit, very strong and muscular, and unused to being shut up in the house.
CASE V. Dr. S. W. Kelly, of North Cambridge, Mass., aged 55 years, was walking down Hanover street, Boston, when he suddenly found himself lying upon the icy pavement. He had slipped over an iron coal scuttle. On examination he was found to have a dislocation of the ankle and fracture of the internal malleolus of the tibia.
His subsequent experience was almost the same as that of Case IV, though being of a nervous temperament the confinement was more irksome. He, also, had a slight attack of inflammation of the lungs. He made a speedy and good recovery, and says that he can conscientiously recommend the chair from personal knowledge. He is a regularly educated physician and a member of the Massachusetts Medical Society, in good standing. He has had a large experience in the practice of his profession.
Mrs. A. W., of Boston, while visiting in Dec. last, fell and sustained an impacted fracture of the neck of the femur. She was a widow 82 years of age, and of active habits. The diagnosis was concurred in by three surgeons.
She was not rendered helpless. With assistance she could change from bed to lounge or chair. There was inability to use or move actively the injured limb. For the first month she used a common Holmes' reclining chair. She was, however, not satisfied with it, and later made trial of the device herein described. This proved so satisfactory that she declared she gained “two days in one" by its use. No extension or bandage was used, the position on the chair being solely relied upon. She has made a remarkable recovery considering her age, with but one-half inch shortening. She walks up and down stairs, and about the house with a cane, and now has gone to the sea-shore for the summer. To the writer, this case has shed a new light upon the treatment of fractures of the thigh. Is it not a mistake to invariably apply bandages and extension? The physical changes resulting from the injury must obstruct the circulation in the limb. This may be called a central obstruction. Is it well to add a peripheral obstruction by bandaging? This patient might have recovered by the aid of other appliances, but it is not disparaging them to say that the chair last used certainly did well and facilitated recovery.
3. As an operating chair. Dr. Gilman Kimball, of Lowell, has employed it in a case of amputation of the breast. He expressed himself as pleased with it. In ordinary chairs, the patients when anæsthetized slip downwards. With this device this difficulty is obviated by simply using the chair as a V and elevating the feet. A point of resistance is thus formed. In a late case of modified thyrotomy for the removal of a sessile growth that lined the whole larynx, the writer found his chair