on fractures-第3章

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middle　of　the　time；　or　a　little　earlier；　and　apply　them　again。　A
diet　slightly　restricted　will　be　sufficient　in　those　cases　in　which
there　was　no　external　wound　at　first；　or　when　the　bone　does　not
protrude；　but　one　should　live　rather　sparingly　until　the　tenth　day；　as
being　now　deprived　of　exercise；　and　tender　articles　of　food　should
be　used；　such　as　moderately　loosen　the　bowels；　but　one　should
abstain　altogether　from　flesh　and　wine；　and　then　by　degrees　resume　a
more　nourishing　diet。　This　diet。　may　be　laid　down　as　a　just　rule　in
the　treatment　of　fractures；　both　as　to　how　they　should　be　treated；　and
what　will　be　the　results　of　a　proper　plan　of　treatment；　so　that　one
may　know；　that　if　things　do　not　turn　out　thus；　there　has　been　some
defect　or　excess　in　the　treatment。　And　in　this　simple　plan　of
treatment　it　is　necessary　to　attend　also　to　the　following
directions；　which　some　physicians　pay　little　attention　to；　although；
when　improperly　executed；　they　are　capable　of　marring　the　whole
process　of　bandaging：　for　if　both　the　bones　be　broken；　or　the　lower
one　only；　and　the　patient　who　has　got　his　arm　bandaged　keep　it　slung
in　a　shawl；　and　that　the　shawl　is　particularly　loose　at　the
fracture；　so　that　the　arm　is　not　properly　suspended　at　this　end　or
that；　in　this　case　the　bone　must　necessarily　be　found　distorted
upwards；　whereas；　when　both　bones　are　thus　broken；　if　the　arm
recline　in　the　shawl　at　the　wrist　and　elbow；　but　the　rest　of　it　be　not
kept　up；　the　bone　in　this　case　will　be　distorted　to　the　lower　side。
The　greater　part　of　the　arm　and　the　wrist　of　the　hand　should　therefore
be　equally　suspended　in　a　broad　soft　shawl。
　　8。　When　the　arm　is　broken；　if　one　stretch　the　fore…arm　and　adjust　it
while　in　this　position；　the　muscle　of　the　arm　will　be　bound　while
extended；　but　when　the　dressing　is　over；　and　the　patient　bends　his　arm
at　the　elbow；　the　muscle　of　the　arm　will　assume　a　different　shape。　The
following；　then；　is　the　most　natural　plan　of　setting　the　arm：　having
got　a　piece　of　wood　a　cubit　or　somewhat　less　in　length；　like　the
handles　of　spades；　suspend　it　by　means　of　a　chain　fastened　to　its
extremities　at　both　ends；　and　having　seated　the　man　on　some　high
object；　the　arm　is　to　be　brought　over；　so　that　the　armpit　may　rest
on　the　piece　of　wood；　and　the　man　can　scarcely　touch　the　seat；　being
almost　suspended；　then　having　brought　another　seat；　and　placed　one
or　more　leather　pillows　under　the　arm；　so　as　to　keep　it　a　moderate
height　while　it　is　bent　at　a　right　angle；　the　best　plan　is　to　put
round　the　arm　a　broad　and　soft　skin；　or　broad　shawl；　and　to　hang
some　great　weight　to　it；　so　as　to　produce　moderate　extension；　or
otherwise；　while　the　arm　is　in　the　position　I　have　described；　a　strong
man　is　to　take　hold　of　it　at　the　elbow　and　pull　it　downward。　But　the
physician　standing　erect；　must　perform　the　proper　manipulation；　having
the　one　foot　on　some　pretty　high　object；　and　adjusting　the　bone　with
the　palms　of　his　hands；　and　it　will　readily　be　adjusted；　for　the
extension　is　good　if　properly　applied。　Then　let　him　bind　the　arm；
commencing　at　the　fracture；　and　do　otherwise　as　directed　above；　let
him　put　the　same　questions　and　avail　himself　of　the　same　signs　to
ascertain　whether　the　arm　be　moderately　tight　or　not；　and　every
third　day　let　him　bind　it　anew　and　make　it　tighter；　and　on　the　seventh
or　ninth　day　let　him　bind　it　up　with　splints；　and　leave　it　so　until
after　the　lapse　of　more　than　thirty　days。　And　if　he　suspect　that　the
bone　is　not　lying　properly；　let　him　remove　the　bandages　in　the
interval；　and　having　adjusted　the　arm；　let　him　bind　it　up　again。　The
bone　of　the　arm　is　generally　consolidated　in　forty　days。　When　these
are　past；　the　dressing　is　to　be　removed；　and　fewer　and　slacker
bandages　applied　instead　of　it。　The　patient　is　to　be　kept　on　a
stricter　diet；　and　for　a　longer　space　of　time　than　in　the　former　case；
and　we　must　form　our　judgment　of　it　from　the　swelling　in　the　hand；
looking　also　to　the　strength　of　the　patient。　This　also　should　be
known；　that　the　arm　is　naturally　inclined　outward；　to　this　side；
therefore；　the　distortion　usually　takes　place；　if　not　properly
treated；　but　indeed；　all　the　other　bones　are　usually　distorted
during　treatment　for　fracture　to　that　side　to　which　they　naturally
incline。　When；　therefore；　anything　of　this　kind　is　suspected；　the
arm　is　to　be　encircled　in　a　broad　shawl；　which　is　to　be　carried
round　the　breast；　and　when　the　patient　goes　to　rest；　a　compress　of
many　folds；　or　some　such　thing；　is　to　be　folded　and　placed　between　the
elbow　and　the　side；　for　thus　the　bending　of　the　bone　will　be
rectified；　but　care　must　be　taken　lest　it　be　inclined　too　much
inwards。
　　9。　The　human　foot　is　composed　of　several　small　bones　like　the
hand。　These　bones　therefore　are　scarcely　ever　broken；　unless　the
skin　at　the　same　time　be　wounded　by　some　sharp　and　heavy　body。　The
treatment　of　stich　injuries；　therefore；　will　be　delivered　under　the
head　of　wounds。　But　if　any　bone　be　moved　from　its　place；　or　a　joint　of
the　toes　be　luxated；　or　any　of　the　bones　of　the　part　called　the　tarsus
be　displaced；　it　must　be　forced　back　again　to　its　place　as　described
with　regard　to　the　hand；　and　is　to　be　treated　with　cerate；　compresses；
and　bandages；　like　the　fractures；　with　the　exception　of　the　splints；
and　is　to　be　secured　tightly　in　the　same　way；　and　the　bandages　renewed
on　the　third　day；　and　the　patient　thus　bandaged　should　return　the　same
answers　as　in　fractures；　as　to　the　bandages　feeling　tight　or　slack。
All　these　bones　recover　perfectly　in　twenty　days；　except　those　that
are　connected　with　the　bones　of　the　leg；　and　are　in　a　line　with
them。　It　is　advantageous　to　lie　in　bed　during　the　whole　of　this
time；　but　the　patients；　thinking　light　of　the　complaint；　have　not
perseverance　to　do　this；　and　they　walk　about　before　they　get　well；
wherefore　many　of　these　do　not　make　a　perfect　recovery。　And　often
the　pain　puts　them　in　mind　of　the　injury；　and　deservedly；　for　the　feet
sustain　the　weight　of　the　whole　body。　When；　therefore；　they　walk　about
before　they　are　whole；　the　joints　which　have　been　luxated　are　cured
incompletely；　and；　on　that　account；　while　walking　about；　they　have
pains　in　the　leg　from　time　to　time。
　　10。　But　those　bones　which　are　connected　with　the　bones　of　the　leg
are　larger　than　the　others；　and　the　cure　of　them　when　luxuated　is　more
protracted。　The　mode　of　treatment　then　is　the　same；　but　we　must　use
more　bandages　and　more　splints；　and　the　bandage　is　to　be　carried　round
to　this　side　and　to　that；　and　pressure　is　to　be　made　as　in　the　other
cases；　particularly　at　the　seat　of　the　luxation；　and　the　first　circles
of　the　bandages　are　to　be　made　there。　And　at　each　time　the　bandages
are　taken　off；　much　hot　water　is　to　be　used；　for　in　all　injuries　at
joints　the　affusion　of　hot　water　in　large　quantity　is　to　be　had
recourse　to。　And　the　same　symptoms　of　compression　and　relaxation
should　manifest　themselves　in　the　same　times；　as　in　the　cases　formerly
treated　of；　and　the　subsequent　bandagings　should　be　conducted　in
like　manner。　These　cases　get　completely　well　for　the　most　part　in
forty　days；　if　the　patients　have　resolution　to　keep　their　bed；　but
if　not；　they　are　subjected　to　the　complaints　formerly　described；　or
still　worse。
　　11。　In　persons　who　jumping　from　any　high　object　pitch　upon　their
heel　with　great　force；　the　bones　are　separated；　and　the　veins　pour
forth　their　contents；　owing　to　the　contusion　of　the　flesh
surrounding　the　bone；　and　hence　a　swelling　and　much　pain　supervene。
For　this　bone　（os　calcis）　is　not　a　small　one；　protrudes　beyond　the
line　of　the　leg；　and　is　connected　with　important　veins　and　tendons；
for　the　back　tendon　of　the　leg　is　inserted　into　this　bone。　Such
cases　are　to　be　treated　with　cerate；　and　with　compresses　and　bandages；
and　hot　water　is　to　be　used　in　large　quantity；　and　they　require　many
bandages；　which　ought　to　be　particularly　good　and　appropriate。　And
if　the　patient　happen　to　have　a　tender　skin　about　the　heel；　nothing　is
to　be　done　to　it；　but　if；　as　some　have　it；　the　skin　be　thick　and
hardened；　it　is　to　be　pared　down　smoothly　and　thinned；　but　without
wounding　it。　It　is　not　everybody　who　can　apply　the　bandage　properly　in
such　cases