on fractures-第7章

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guilty　of　great　mistakes　in　other　cases　of　fracture　as　well　as
these。　For　it　is　a　most　important　consideration　to　know　in　what　manner
the　head　of　the　bandage　should　be　placed　and　at　what　part　the　greatest
pressure　should　be；　and　what　benefits　would　result　from　applying　the
end　of　the　bandage　and　the　pressure　at　the　proper　place；　and　what
mischiefs　would　result　from　applying　the　head　of　the　bandage　and　the
pressure　otherwise　than　at　the　proper　place。　Wherefore　it　has　been
stated　in　the　preceding　part　of　the　work　what　are　the　results　of
either；　and　the　practice　of　medicine　bears　witness　to　the　truth　of　it；
for　in　a　person　thus　bandaged；　a　swelling　must　necessarily　arise　on
the　wound。　For；　if　even　a　sound　piece　of　skin　were　bandaged　on
either　side；　and　a　part　were　left　in　the　middle；　the　part　thus　left
unbandaged　would　become　most　swelled；　and　would　assume　a　bad　color；
how　then　could　it　be　that　a　wound　would　not　suffer　in　like　manner？　The
wound　then　must　necessarily　become　discolored　and　its　lips　everted；
the　discharge　will　be　ichorous　and　without　pus；　and　the　bones；　which
should　not　have　got　into　a　state　of　necrosis；　exfoliate；　and　the　wound
gets　into　a　throbbing　and　inflamed　condition。　And　they　are　obliged
to　apply　a　cataplasm　on　account　of　the　swelling；　but　this　is　an
unsuitable　application　to　parts　which　are　bandaged　on　both　sides；
for　a　useless　load　is　added　to　the　throbbing　which　formerly　existed　in
it。　At　last　they　loose　the　bandages　when　matters　get　very　serious；　and
conduct　the　rest　of　the　treatment　without　bandaging；　and
notwithstanding；　if　they　meet　with　another　case　of　the　same
description；　they　treat　it　in　the　same　manner；　for　they　do　not　think
that　the　application　of　the　bandages　on　both　sides；　and　the　exposure
of　the　wound　are　the　cause　of　what　happened；　but　some　other　untoward
circumstance。　Wherefore　I　would　not　have　written　so　much　on　this
subject；　if　I　had　not　well　known　that　this　mode　of　bandaging　is
unsuitable；　and　yet　that　many　conduct　the　treatment　in　this　way；　whose
mistake　it　is　of　vital　importance　to　correct；　while　what　is　here
said　is　a　proof；　that　what　was　formerly　written　as　to　the
circumstances　under　which　bandages　should　be　tightly　applied　to
fractures　or　otherwise　has　been　correctly　written。
　　26。　As　a　general　rule　it　may　be　said；　that　in　those　cases　in　which　a
separation　of　bone　is　not　expected；　the　same　treatment　should　be
applied　as　when　the　fractures　are　not　complicated　with　an　external
wound；　for　the　extension；　adjustment　of　the　bones；　and　the
bandaging；　are　to　be　conducted　in　the　same　manner。　To　the　wound　itself
a　cerate　mixed　with　pitch　is　to　be　applied；　a　thin　folded　compress
is　to　be　bound　upon　it；　and　the　parts　around　are　to　be　anointed　with
white　cerate。　The　cloths　for　bandages　and　the　other　things　should　be
torn　broader　than　in　cases　in　which　there　is　no　wound；　and　the　first
turn　of　the　bandage　should　be　a　good　deal　broader　than　the　wound。
For　a　narrower　bandage　than　the　wound　binds　the　wound　like　a　girdle；
which　is　not　proper；　or　the　first　turn　should　comprehend　the　whole
wound；　and　the　bandaging　should　extend　beyond　it　on　both　sides。　The
bandage　then　should　be　put　on　in　the　direction　of　the　wound；　and
should　be　not　quite　so　tight　as　when　there　is　no　wound；　but　the
bandage　should　be　otherwise　applied　in　the　manner　described　above。　The
bandages　should　be　of　a　soft　consistence；　and　more　especially　so　in
such　cases　than　in　those　not　complicated　with　a　wound。　The　number　of
bandages　should　not　be　smaller；　but　rather　greater　than　those　formerly
described。　When　applied；　the　patient　should　have　the　feeling　of　the
parts　being　properly　secured；　but　not　too　tight；　and　in　particular
he　should　be　able　to　say　that　they　are　firm　about　the　wound。　And　the
intervals　of　time　during　which　the　parts　seem　to　be　properly　adjusted；
and　those　in　which　they　get　loose；　should　be　the　same　as　those
formerly　described。　The　bandages　should　be　renewed　on　the　third　day；
and　the　after　treatment　conducted　in　the　same　manner　as　formerly
described；　except　that　in　the　latter　case　the　compression　should　be
somewhat　less　than　in　the　former。　And　if　matters　go　on　properly；　the
parts　about　the　wound　should　be　found　at　every　dressing　always　more
and　more　free　of　swelling；　and　the　swelling　should　have　subsided　on
the　whole　part　comprehended　by　the　bandages。　And　the　suppurations　will
take　place　more　speedily　than　in　the　case　of　wounds　treated　otherwise；
and　the　pieces　of　flesh　in　the　wound　which　have　become　black　and　dead；
will　sooner　separate　and　fall　off　under　this　plan　of　treatment　than
any　other；　and　the　sore　will　come　more　quickly　to　cicatrization　when
thus　treated　than　otherwise。　The　reason　of　all　this　is；　that　the　parts
in　which　the　wound　is　situated；　and　the　surrounding　parts；　are　kept
free　of　swelling。　In　all　other　respects　the　treatment　is　to　be
conducted　as　in　cases　of　fracture　without　a　wound　of　the
integuments。　Splints　should　not　be　applied。　On　this　account　the
bandages　should　be　more　numerous　than　in　the　former　case；　both　because
they　must　be　put　on　less　tight；　and　because　the　splints　are　later　of
being　applied。　But　if　you　do　apply　the　splints；　they　should　not　be
applied　along　the　wound；　and　they　are　to　be　put　on　in　a　loose
manner；　especial　care　being　taken　that　there　may　be　no　great
compression　from　the　splints。　This　direction　has　been　formerly
given。　And　the　diet　should　be　more　restricted；　and　for　a　longer
period；　in　those　cases　in　which　there　is　a　wound　at　the
commencement；　and　when　the　bones　protrude　through　the　skin；　and；　in
a　word；　the　greater　the　wound；　the　more　severe　and　protracted　should
the　regimen　be。
　　27。　The　treatment　of　the　sores　is　the　same　in　those　cases　of
fracture　in　which　there　was　no　wound　of　the　skin　at　first；　but　one　has
formed　in　the　course　of　treatment；　owing　to　the　pressure　of　the
splints　occasioned　by　the　bandages；　or　from　any　other　cause。　In　such
cases　it　is　ascertained　that　there　is　an　ulcer；　by　the　pain　and　the
throbbing；　and　the　swelling　in　the　extremities　becomes　harder　than
usual；　and　if　you　apply　your　finger　the　redness　disappears；　but
speedily　returns。　If　you　suspect　anything　of　the　kind　you　must　loose
the　dressing；　if　there　be　any　itching　below　the　under…bandages；　or
in　any　other　part　that　is　bandaged；　and　used　a　pitched　cerate
instead　of　the　other。　If　there　be　nothing　of　that；　but　if　the　ulcer　be
found　in　an　irritable　state；　being　very　black　and　foul；　and　the　fleshy
parts　about　to　suppurate；　and　the　tendons　to　slough　away；　in　these
cases　no　part　is　to　be　exposed　to　the　air；　nor　is　anything　to　be
apprehended　from　these　suppurations；　but　the　treatment　is　to　be
conducted　in　the　same　manner　as　in　those　cases　in　which　there　was　an
external　wound　at　first。　You　must　begin　to　apply　the　bandages
loosely　at　the　swelling　in　the　extremities；　and　then　gradually　proceed
upward　with　the　bandaging；　so　that　it　may　be　tight　at　no　place；　but
particularly　firm　at　the　sore；　and　less　so　elsewhere。　The　first
bandages　should　be　clean　and　not　narrow；　and　the　number　of　bandages
should　be　as　great　as　in　those　cases　in　which　the　splints　were　used；
or　somewhat　fewer。　To　the　sore　itself　a　compress；　anointed　with
white　cerate；　will　be　sufficient；　for　if　a　piece　of　flesh　or　nerve
（tendon？）　become　black；　it　will　fall　off；　for　such　sores　are　not　to　be
treated　with　acrid；　but　with　emollient　applications；　like　burns。　The
bandages　are　to　be　renewed　every　third　day；　and　no　splints　are　to　be
applied；　but　rest　is　to　be　more　rigidly　maintained　than　in　the
former　cases；　along　with　a　restricted　diet。　It　should　be　known；　that
if　any　piece　of　flesh　or　tendon　be　to　come　away；　the　mischief　will
spread　much　less；　and　the　parts　will　much　more　speedily　drop　off；
and　the　swelling　in　the　surrounding　parts　will　much　more　completely
subside；　under　this　treatment；　than　if　any　of　the　cleansing
applications　be　put　upon　the　sore。　And　if　any　part　that　is　to　come
away　shall　fall　off；　the　part　will　incarnate　sooner　when　thus
treated　than　otherwise；　and　will　more　speedily　cicatrize。　Such　are　the
good　effects　of　knowing　how　a　bandage　can　be　well　and　moderately
applied。　But　a　proper　position；　the　other　parts　of　the　regimen；　and
su