on fractures-第5章

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may　hang　as　little　as　possible。　The　attenuation　of　the　body　is　to　be
made　proportionate　to　the　magnitude　of　the　luxation；　for　one
luxation　is　to　be　a　small；　and　another　to　a　great　extent。　But　in
general　we　must　reduce　more；　and　for　a　longer　time；　in　injuries
about　the　legs；　than　in　those　about　the　hands；　for　the　former　parts
are　larger　and　thicker　than　the　latter；　and　it　is　necessary　that　the
body　should　be　kept　in　a　state　of　rest；　and　in　a　recumbent　position。
There　is　nothing　to　prevent　or　require　the　limb　to　be　bandaged　anew　on
the　third　day。　And　all　the　treatment　otherwise　is　to　be　conducted　in
like　manner；　as　in　the　preceding　cases。　And　if　the　patient　have
resolution　to　lie　quiet；　forty　days　will　be　sufficient　for　this
purpose；　if　only　the　bones　be　properly　reduced；　but　if　he　will　not　lie
quiet；　he　will　not　be　able　to　use　the　limb　with　ease；　and　he　will　find
it　necessary　to　wear　a　bandage　for　a　long　time。　When　the　bones　are　not
properly　replaced；　but　there　has　been　some　defect　in　this　respect；　the
hip；　the　thigh；　and　the　leg　become　wasted；　and　if　the　dislocation　be
inward；　the　external　part　of　the　thigh　is　wasted；　and　vice　versa。
But　for　the　most　part　the　dislocation　is　inward。
　　15。　And　when　both　bones　of　the　leg　are　broken　without　a　wound　of　the
skin；　stronger　extension　is　required。　We　may　make　extension　by　some　of
the　methods　formerly　described；　provided　the　bones　ride　over　one
another　to　a　considerable　degree。　But　extension　by　men　is　also
sufficient；　and　for　the　most　part　two　strong　men　will　suffice；　by
making　extension　and　counterextension。　Extension　must　naturally　be
made　straight　in　a　line　with　the　leg　and　thigh；　whether　on　account
of　a　fracture　of　the　bones　of　the　leg　or　of　the　thigh。　And　in　both
cases　they　are　to　be　bandaged　while　in　a　state　of　extension；　for　the
same　position　does　not　suit　with　the　leg　and　the　arm。　For　when　the
fractured　bones　of　the　arm　or　fore…arm　are　bandaged；　the　fore…arm　is
suspended　in　a　sling；　and　if　you　bind　them　up　while　extended；　the
figures　of　the　fleshy　parts　will　be　changed　in　bending　the　arm　at
the　elbow；　for　the　elbow　cannot　be　kept　long　extended；　since　persons
are　not　in　the　custom　of　keeping　the　joint　long　in　this　form；　but　in　a
bent　position；　and　persons　who　have　been　wounded　in　the　arm；　and　are
still　able　to　walk　about；　require　to　have　the　arm　bent　at　the
elbow…joint。　But　the　leg；　both　in　walking　and　standing；　is
habitually　extended；　either　completely　or　nearly　so；　and　is　usually　in
a　depending　position　from　its　construction；　and　in　order　that　it　may
bear　the　weight　of　the　rest　of　the　body。　Wherefore　it　readily　bears　to
be　extended　when　necessary；　and　even　when　in　bed　the　limb　is　often
in　this　position。　And　when　wounded；　necessity　subdues　the
understanding；　since　the　patients　become　incapable　of　raising
themselves　up；　so　that　they　neither　think　of　bending　the　limb　nor　of
getting　up　erect；　but　remain　lying　in　the　same　position。　For　these
reasons；　neither　the　same　position　nor　the　same　mode　of　bandaging
applies　to　the　arm　and　to　the　leg。　If；　then；　extension　by　means　of　men
be　sufficient；　we　should　not　have　recourse　to　any　useless
contrivances；　for　it　any　useless　contrivances；　for　it　is　absurd　to
employ　mechanical　means　when　not　required；　but　if　extension　by　men
be　not　sufficient；　you　may　use　any　of　the　mechanical　powers　which　is
suitable。　When　sufficiently　extended；　it　will　be　easy　to　adjust　the
bones　and　bring　them　into　their　natural　position；　by　straightening　and
arranging　them　with　the　palms　of　the　hand。
　　16。　When　the　parts　are　adjusted；　you　should　apply　the　bandages　while
the　limb　is　in　a　stretched　position；　making　the　first　turns　to　the
right　or　to　the　left；　as　may　be　most　suitable；　and　the　end　of　the
bandage　should　be　placed　over　the　fracture；　and　the　first　turns　made
at　that　place；　and　then　the　bandage　should　be　carried　up　the　leg；　as
described　with　regard　to　the　other　fractures。　But　the　bandages
should　be　broader　and　longer；　and　more　numerous；　in　the　case　of　the
leg　than　in　that　of　the　arm。　And　when　it　is　bandaged　it　should　be　laid
upon　some　smooth　and　soft　object；　so　that　it　may　not　be　distorted　to
the　one　side　or　the　other；　and　that　there　may　be　no　protrusion　of
the　bones　either　forward　or　backward；　for　this　purpose　nothing　is　more
convenient　than　a　cushion；　or　something　similar；　either　of　linen　or
wool；　and　not　hard；　it　is　to　be　made　hollow　along　its　middle；　and
placed　below　the　limb。　With　regard　to　the　canals　（gutters？）　usually
placed　below　fractured　legs；　I　am　at　a　loss　whether　to　advise　that
they　should　be　used　or　not。　For　they　certainly　are　beneficial；　but　not
to　the　extent　which　those　who　use　them　suppose。　For　the　canals　do
not　preserve　the　leg　at　rest　as　they　suppose；　nor；　when　the　rest　of
the　body　is　turned　to　the　one　side　or　the　other；　does　the　canal
prevent　the　leg　from　following；　unless　the　patient　himself　pay
attention；　neither　does　the　canal　prevent　the　limb　from　being　moved
without　the　body　to　the　one　side　or　the　other。　And　a　board　is　an
uncomfortable　thing　to　have　the　limb　laid　upon；　unless　something
soft　be　placed　above　it。　But　it　is　a　very　useful　thing　in　making　any
subsequent　arrangements　of　the　bed　and　in　going　to　stool。　A　limb
then　may　be　well　or　ill　arranged　with　or　without　the　canal。　But　the
common　people　have　more　confidence；　and　the　surgeon　is　more　likely
to　escape　blame；　when　the　canal　is　placed　under　the　limb；　although
it　is　not　secundum　artem。　For　the　limb　should　by　all　means　lie
straight　upon　some　level　and　soft　object；　since　the　bandaging　must
necessarily　be　overcome　by　any　distortion　in　the　placing　of　the　leg；
whenever　or　to　whatever　extent　it　may　be　inclined。　The　patient；　when
bandaged；　should　return　the　same　answers　as　formerly　stated；　for　the
bandaging　should　be　the　same；　and　the　same　swellings　should　arise　in
the　extremities；　and　the　slackening　of　the　bandages　in　like　manner；
and　the　new　bandaging　on　the　third　day；　and　the　bandaged　part　should
be　found　reduced　in　swelling；　and　the　new　bandagings　should　be　more
tightly　put　on；　and　more　pieces　of　cloth　should　be　used；　and　the
bandages　should　be　carried　loosely　about　the　foot；　unless　the　wound　be
near　the　knee。　Extension　should　be　made　and　the　bones　adjusted　at
every　new　bandaging；　for；　if　properly　treated；　and　if　the　swelling
progress　in　a　suitable　manner；　the　bandaged　limb　will　have　become　more
slender　and　attenuated；　and　the　bones　will　be　more　mobile；　and　yield
more　readily　to　extension。　On　the　seventh；　the　ninth；　or　the
eleventh　day；　the　splints　should　be　applied　as　described　in　treating
of　the　other　fractures。　Attention　should　be　paid　to　the　position　of
the　splints　about　the　ankles　and　along　the　tendon　of　the　foot　which
runs　up　the　leg。　The　bones　of　the　leg　get　consolidated　in　forty
days；　if　properly　treated。　But　if　you　suspect　that　anything　is　wanting
to　the　proper　arrangement　of　the　limb；　or　dread　any　ulceration；　you
should　loose　the　bandages　in　the　interval；　and　having　put　everything
right；　apply　them　again。
　　17。　But　if　the　other　bone　（fibula？）　of　the　leg　be　broken；　less
powerful　extension　is　required；　and　yet　it　must　not　be　neglected；
nor　be　performed　slovenly；　more　especially　at　the　first　bandaging。　For
in　all　cases　of　fracture　this　object　should　be　attained　then　as
quickly　as　possible。　For　when　the　bandage　is　applied　tight　while　the
bones　are　not　properly　arranged；　the　properly　arranged；　the　part
becomes　more　painful。　The　treatment　otherwise　is　the　same。
　　18。　Of　the　bones　of　the　leg；　the　inner　one；　called　the　tibia；　is　the
more　troublesome　to　manage；　and　requires　the　greater　extension；　and　if
the　broken　bones　are　not　properly　arranged；　it　is　impossible　to
conceal　the　distortion；　for　the　bone　is　exposed　and　wholly　uncovered
with　flesh；　and　it　is　much　longer　before　patients　can　walk　on　the
leg　when　this　bone　is　broken。　But　if　the　outer　bone　be　broken；　it
causes　much　less　trouble；　and　the　deformity；　when　the　bones　are　not
properly　set；　is　much　more　easily　concealed；　the　bone　being　well
covered　with　flesh；　and　the　patients　speedily　get　on　foot；　for　it　is
the　inner　bone　of　the　leg　which　supports　the　most　of　the　weight　of　the
body。　For　along　with　the　thigh；　as　being　in