on fractures-第2章

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near　to　the　wrist。　But　the　lower　bone　is　without　a　covering　of
flesh；　is　not　easily　concealed；　and　requires　stronger　extension。　If　it
is　not　this　bone；　but　the　other　which　is　broken；　a　more　feeble
extension　proves　sufficient；　but　if　both　be　broken；　a　more　powerful
extension　is　required。　In　the　case　of　a　young　person　I　have　known
the　extension　made　more　strong　than　was　necessary；　but　in　general
the　extension　made　is　less　than　what　is　required。　And　when　they　are
extended；　the　physician　should　apply　the　palms　of　the　hands；　and
adjust　the　fractured　parts　and　then　having　rubbed　the　parts　with
cerate；　but　not　in　large　quantity　so　that　the　bandages　may　not　come
off；　it　is　to　be　bound　up　in　this　state；　care　being　taken　that　the
hand　be　not　lower　than　the　elbow；　but　a　little　higher；　so　that　the
blood　do　not　flow　toward　the　extremity；　but　may　be　determined　to　the
upper　part；　and　then　it　is　to　be　secured　with　the　bandage；　the　head　of
which　is　to　be　placed　at　the　fracture；　and　the　bandage　should　impart
firmness　to　the　parts　without　occasioning　strong　compression。　When　you
have　carried　the　bandage　twice　or　thrice　round　at　the　seat　of　the
fracture；　it　is　to　be　carried　upward；　so　that　the　afflux　of　blood　into
it　may　be　stopped；　and　the　bandage　should　terminate　there；　and　the
first　bandages　ought　not　to　be　long。　The　head　of　the　second　bandage　is
also　to　be　placed　upon　the　seat　of　the　fracture；　and　a　single　round　of
it　being　made　there；　it　is　then　to　be　carried　downward；　and　is　not
to　be　applied　so　tight　as　the　other；　and　there　should　be　greater
distances　between　the　turns；　so　that　the　bandage　may　prove
sufficient　to　revert　to　the　spot　where　the　other　terminated。　The
bandages　may　be　rolled　to　the　left　hand　or　to　the　right；　or　to
whatever　side　suits　best　with　the　position　of　the　fractured　arm；　or
according　to　the　inclination　which　it　may　have。　Afterward　we　must
place　along　the　arm；　compresses；　smeared　with　a　little　cerate；　for
thus　they　occasion　less　uneasiness；　and　are　more　easily　arranged。
And　then　we　must　apply　the　bandages　crossways；　sometimes　to　the
right　hand；　and　sometimes　to　the　left；　for　the　most　part　beginning
below　and　terminating　above；　but　sometimes　commencing　above　and　ending
below。　The　parts　which　are　thinly　covered　with　flesh　should　be　wrapped
round　with　compresses；　and　inequalities　should　be　made　up；　not　by　a
number　of　folds　at　once；　but　by　degrees。　Some　slack　turns　are　also
to　be　made　around　the　wrist；　to　this　side　and　to　that。　These　two
bandages　are　sufficient　at　first。
　　5。　And　these　are　the　signs　that　the　patient　has　been　well　treated
and　properly　bandaged：　if　you　ask　him　if　the　arm　feels　tight；　and　he
says　it　does；　but　moderately　so；　and　especially　about　the　fracture；
and　this　reply　he　should　make　all　along；　if　the　bandage　be　properly
applied。　And　these　are　symptoms　of　the　bandaging　being　moderately
tight；　if　for　the　first　day　and　night　he　fancies　that　the　tightness
does　not　diminish；　but　rather　increases；　and　if　on　the　next　day
there　be　a　soft　swelling　in　the　hand；　for　this　is　a　sign　of　moderate
compression；　but　at　the　end　of　the　second　day　the　compression　should
feel　less；　and　on　the　third　day　the　bandaging　should　appear　loose。　And
if　any　of　these　symptoms　be　wanting；　you　may　conclude　that　the
bandaging　is　slacker　than　it　should　be；　or　if　any　of　these　symptoms　be
in　excess；　you　may　infer　that　the　compression　is　more　than　moderate；
and　judging　from　these；　you　will　apply　the　next　bandages　either
slacker　or　tighter。　Having　removed　the　bandages　on　the　third　day；
you　must　make　extension　and　adjust　the　fracture；　and　bind　it　up　again；
and　if　the　first　bandaging　was　moderately　applied；　the　second
bandaging　should　be　made　somewhat　tighter。　The　heads　the　bandages
should　be　placed　on　the　fractures　as　in　the　former　case；　for；　so
doing；　the　humors　will　be　driven　to　the　extremities；　whereas　if　you
bandage　any　other　part　beforehand；　the　humors　will　he　forced　from　it
to　the　seat　of　the　fracture：　it　is　of　much　importance　that　this　should
be　properly　understood。　Thus　the　bandaging　and　compression　should
always　commence　at　the　seat　of　the　fracture；　and　everything　else
should　be　conducted　on　the　same　principle；　so　that　the　farther　you
proceed　from　the　fracture；　the　compression　should　always　be　the
less。　The　bandages　should　never　be　actually　loose；　but　should　be
smoothly　put　on。　At　each　dressing　the　number　of　bandages　should　be
increased；　and　the　patient；　if　asked；　should　answer；　that　he　feels　the
bandages　somewhat　tighter　than　on　the　former　occasion；　especially
about　the　fracture；　and　everything　else　in　proportion；　and　with
respect　to　the　swelling；　the　pain；　and　recovery；　everything　should
proceed　as　after　the　former　dressing。　But　on　the　third　day　the　outer
bandaging　should　appear　looser。　Then　having　removed　the　bandages；
you　should　bind　it　up　again；　somewhat　tighter　than　before；　and　with
all　the　bandages　which　will　be　required　on　the　occasion；　and
afterwards　one　ought　to　experience　the　same　train　of　symptoms　as　at
the　former　periods　of　bandaging。
　　6。　When　the　third　day　arrives；　that　is　to　say；　the　seventh　from
the　first　dressing；　if　properly　done；　the　swelling　in　the　hand
should　be　not　very　great；　and　the　part　which　has　been　bandaged
should　be　found　more　slender　and　less　swelled　at　each　time；　and　on　the
seventh　day　the　swelling　should　be　quite　gone；　and　the　broken　bones
should　be　more　readily　moved；　and　admit　of　being　easily　adjusted。
And　if　these　things　be　so；　you　should；　after　setting　the　fracture；
apply　the　bandages　so　as　to　suit　the　splints；　and　a　little　more
tight　than　formerly；　unless　there　be　more　pain　from　the　swelling　in
the　hand。　When　you　have　applied　the　bandages；　you　must　adjust　the
splints　all　around　the　limb；　and　secure　them　secure　them　with
strings　so　loose　as　just　to　keep　them　in　their　place；　without　the
application　of　the　splints　contributing　at　all　to　the　compression　of
the　arm。　After　this　the　pain　and　recovery　should　proceed　as　in　the
preceding　periods　of　the　bandaging。　But　if；　on　the　third　day；　the
patient　say　that　the　bandaging　is　loose；　you　must　then　fasten　the
splints；　especially　at　the　fracture；　but　also　elsewhere；　wherever
the　bandaging　is　rather　loose　than　tight。　The　splint　should　be
thickest　where　the　fracture　protrudes；　but　it　should　not　be　much
more　so　than　elsewhere。　Particular　attention　should　be　paid　to　the
line　of　the　arm　corresponding　to　the　thumb；　so　that　no　splint　be
laid　on　it；　but　upon　each　side　of　it；　nor　in　the　line　of　the　little
finger　where　the　bone　is　prominent　at　the　wrist；　but　on　each　side　of
it。　And　if　it　be　found　necessary　that　splints　should　be　applied　in
these　directions　at　the　seat　of　the　fracture；　they　should　be　made
shorter　than　the　others；　so　as　that　they　may　not　reach　the　bones　which
are　prominent　at　the　wrist；　for　otherwise　there　is　danger　of
ulceration；　and　of　the　tendons　being　laid　bare。　The　splints　should
be　adjusted　anew　every　third　day；　in　a　very　gentle　manner；　always
keeping　in　mind　that　the　object　of　the　splints　is　to　maintain　the
lower　bandages　in　their　place；　and　that　they　are　not　needed　in　order
to　contribute　to　the　compression。
　　7。　If；　then；　you　see　that　the　bones　are　properly　adjusted　by　the
first　dressings；　and　that　there　is　no　troublesome　pruritus　in　the
part；　nor　any　reason　to　suspect　ulceration；　you　may　allow　the　arm　to
remain　bandaged　in　the　splints　until　after　the　lapse　of　more　than
twenty　days。　The　bones　of　the　fore…arm　generally　get　consolidated　in
thirty　days　altogether；　but　there　is　nothing　precise　in　this　matter；
for　one　constitution　differs　from　another；　and　one　period　of　life　from
another。　When　you　remove　the　bandages；　you　must　pour　hot　water　on
the　arm　and　bind　it　up　again；　but　somewhat　slacker；　and　with　fewer
bandages　than　formerly：　and　again　on　the　third　day　you　undo　the
bandages；　and　bind　it　still　more　loosely；　and　with　still　fewer
bandages。　And　if；　while　the　arm　is　bound　up　in　the　splints；　you　should
at　any　time　suspect　that　the　bones　do　not　lie　properly；　or　if　anything
about　the　bandages　annoys　the　patient；　you　should　loose　them　at　the
middle　of　the　time；　or　a　little　earlier；　and　apply　them　again。　A
diet　slightly　restricted　will　be　sufficie