The deformation of a limb, accompanied by pain and discoloration, with or without a wound was understood to be a broken bone by patients in the nineteenth century. Most people could readily identify a broken bone, although they were sometimes confused with contusions and dislocations. Whenever possible, a doctor was called in to confirm the diagnosis and perform the setting.

The treatment involved three steps. First, the doctor would align the patient's bone fragments as closely to their natural state as possible. Second, the wound would be wrapped in a bandage before wood or leather splints were added to stabilize the limb. Finally, the doctor would attempt to minimize the possibility that the patient might re-break the limb by banging it through slings and canes. In some cases, casts were formed around the limb with plaster-like substances such as gutta percha.

A compound fracture, the most severe and noticeable type of this injury, was an extremely grave danger for a person in the first half of the nineteenth century. A compound fracture--where the bone sticks out from the skin--necessitated either surgery or a painful amputation. In addition to the extreme pain of the injury and treatment--numbed somewhat by opium and alcohol--the chances of recovery were often low. By some estimates, up to 40 to 50% of those with compound fractures died as a result of complications from surgery. (1)

In a practical manual on treating fractures from 1860, we can see the author's opinion that treating fractures was mostly a matter of having the proper touch, and not advanced training. This is consistent with the fact that most physicians during this period were not able to offer their patients care that was much beyond what they might receive at home from a family member.

"Yet it is difficult to state the precise manner in which the surgeon ought to proceed. Much will depend upon the circumstances of the case, something upon one's natural tact, and upon the amount of experience, but more, I think upon natural kindness of heart and social education. The man of refinement and sensibility will know instinctively how to proceed and needs no instruction. They who lack these qualities can never learn, and it would be quite useless to undertake to teach them. I sincerely wish such men as these latter would find some more suitable employment than the practice of a humane art." (2)

Notes

1. Keen, William Williams, ed. Surgery: its Principles and Practices. Philadelphia: W.B. Saunders Company, 1909. Page 131.

2. Hamilton, Frank Hastings. Practical Treatise on Fractures and Dislocations. Philadelphia: Blanchard & Lea, 1860. Page 52.