on fractures-第9章

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all　other　diseases　wounds。　And　this　doctrine　is　not　devoid　of　a
certain　degree　of　plausibility；　for　they　are　allied　to　one　another
in　many　respects。　But　those　who　maintain　that　wool　should　be　used
until　after　the　first　seven　days；　and　then　that　the　parts　should　be
extended　and　adjusted；　and　secured　with　bandages；　would　appear　not
to　be　equally　devoid　of　proper　judgment；　for　the　proper　judgment；
for　the　most　dangerous　season　for　inflammation　is　then　past；　and　the
bones　being　loose　can　be　easily　set　after　the　lapse　of　these　days。　But
still　this　mode　of　treatment　is　far　inferior　to　that　with　bandages
from　the　commencement；　for；　the　latter　method　exhibits　the　patient
on　the　seventh　day　free　from　inflammation；　and　ready　for　complete
bandaging　with　splints；　while　the　former　method　is　far　behind　in
this　respect；　and　is　attended　with　many　other　bad　effects　which　it
would　be　tedious　to　describe。
　　31a。　In　those　cases　of　fracture　in　which　the　bones　protrude　and
cannot　be　restored　to　their　place；　the　following　mode　of　reduction　may
be　practiced：…　Some　small　pieces　of　iron　are　to　be　prepared　like　the
levers　which　the　cutters　of　stone　make　use　of；　one　being　rather
broader　and　another　narrower；　and　there　should　be　three　of　them　at
least；　and　still　more；　so　that　you　may　use　those　that　suit　best；　and
then；　along　with　extension；　we　must　use　these　as　levers；　applying
the　under　surface　of　the　piece　of　iron　to　the　under　fragment　of　the
bone；　and　the　upper　surface　to　the　upper　bone；　and；　in　a　word；　we　must
operate　powerfully　with　the　lever　as　we　would　do　upon　a　stone　or　a
piece　of　wood。　The　pieces　of　iron　should　be　as　strong　as　possible；
so　that　they　may　not　bend。　This　is　a　powerful　assistance；　provided　the
pieces　of　iron　be　suitable；　and　one　use　them　properly　as　levers。　Of
all　the　mechanical　instruments　used　by　men；　the　most　powerful　are
these　three；　the　axis　in　peritrochio；　the　lever；　and　the　wedge。
Without　these；　one　or　all；　men　could　not　perform　any　of　their　works
which　require　great　force。　Wherefore；　reduction　with　the　lever　is
not　to　be　despised；　for　the　bones　will　be　reduced　in　this　way；　or
not　at　all。　But　if　the　upper　fragment　which　rides　over　the　other
does　not　furnish　a　suitable　point　of　support　a　suitable　point　of
support　for　the　lever；　but　the　protruding　part　is　sharp；　you　must
scoop　out　of　the　bone　what　will　furnish　a　proper　place　for　the　lever
to　rest　on。　The　lever；　along　with　extension；　may　be　had　recourse　to　on
the　day　of　the　accident；　or　the　accident；　or　next　day；　but　by　no　means
on　the　third；　the　fourth；　and　the　fifth。　For　if　the　limb　is
disturbed　on　these　days；　and　yet　the　fractured　bones　not　reduced；
inflammation　will　be　excited；　and　this　no　less　if　they　are　reduced；
for　convulsions　are　more　apt　to　occur　if　reduction　take　place；　than　if
the　attempt　should　fail。　These　facts　should　be　well　known；　for　if
convulsions　should　come　on　when　reduction　is　effected；　there　effected；
there　is　little　hope　of　recovery；　but　it　is　of　use　to　displace　the
bones　again　if　this　can　be　done　with　out　trouble。　For　it　is　not　at　the
time　when　the　parts　are　in　a　particularly　relaxed　condition　that
convulsions　and　tetanus　are　apt　to　supervene；　but　when　they　are　more
than　usually　tense。　In　the　case　we　are　now　treating　of；　we　should
not　disturb　the　limb　on　the　aforesaid　days；　but　strive　to　keep　the
wound　as　free　from　inflammation　as　possible；　and　especially
encourage　suppuration　in　it。　But　when　seven　days　have　elapsed；　or
rather　more；　if　there　be　no　fever；　and　if　the　wound　be　not　inflamed；
then　there　will　be　less　to　prevent　an　attempt　at　reduction；　if　you
hope　to　succeed；　but　otherwise　you　need　not　take　and　give　trouble　in
vain。
　　32。　When　you　have　reduced　the　bones　to　their　place；　the　modes　of
treatment；　whether　you　expect　the　bones　to　exfoliate　or　not；　have　been
already　described。　All　those　cases　in　which　an　exfoliation　of　bone
is　expected；　should　be　treated　by　the　method　of　bandaging　with　cloths；
beginning　for　the　most　part　at　the　middle　of　the　bandage；　as　is　done
with　the　double…headed　bandage；　but　particular　attention　should　be
paid　to　the　shape　of　the　wound；　so　that　its　lips　may　gape　or　be
distorted　as　little　as　possible　under　the　bandage。　Sometimes　the　turns
of　the　bandage　have　to　be　made　to　the　right；　and　sometimes　to　the
left；　and　sometimes　a　double…headed　bandage　is　to　be　used。
　　33。　It　should　be　known　that　bones；　which　it　has　been　found
impossible　to　reduce；　as　well　as　those　which　are　wholly　denuded　of
flesh；　will　become　detached。　In　some　cases　the　upper　part　of　the
bone　is　laid　bare；　and　in　others　the　flesh　dies　all　around；　and；
from　a　sore　of　long　standing；　certain　of　the　bones　become　carious；　and
some　not；　some　more；　and　some　less；　and　in　some　the　small；　and　in
others　the　large　bones。　From　what　has　been　said　it　will　be　seen；
that　it　is　impossible　to　tell　in　one　word　when　the　bones　will
separate。　Some　come　away　more　quickly；　owing　to　their　smallness；　and
some　from　being　merely　fixed　at　the　point；　and　some；　from　pieces　not
separating；　but　merely　exfoliating；　become　dried　up　and　putrid；　and
besides；　different　modes　of　treatment　have　different　effects。　For
the　most　part；　the　bones　separate　most　quickly　in　those　cases　in　which
suppuration　takes　place　most　quickly；　and　when　new　flesh　is　most
quickly　formed；　and　is　particularly　sound；　for　the　flesh　which　grows
up　below　in　the　wound　generally　elevates　the　pieces　of　bone。　It　will
be　well　if　the　whole　circle　of　the　bone　separate　in　forty　days；　for　in
some　cases　it　is　protracted　to　sixty　days；　and　in　some　to　more；　for
the　more　porous　pieces　of　bone　separate　more　quickly；　but　the　more
solid　come　away　more　slowly；　but　the　other　smaller　splinters　in　much
less　time；　and　others　otherwise。　A　portion　of　bone　which　protrudes
should　be　sawn　off　for　the　following　reasons：　if　it　cannot　be　reduced；
and　if　it　appears　sons：　that　only　a　small　piece　is　required　in　order
that　it　may　get　back　into　its　place；　and　if　it　be　such　that　it　can
be　taken　out；　and　if　it　occasions　inconvenience　and　irritates　any　part
of　the　flesh；　and　prevents　the　limb　from　being　properly　laid；　and
if；　moreover；　it　be　denuded　of　flesh；　such　a　piece　of　bone　should　be
taken　off。　With　regard　to　the　others；　it　is　not　of　much　consequence
whether　they　be　sawed　off　or　not。　For　it　should　be　known　for
certain；　that　such　bones　as　are　completely　deprived　of　flesh；　and　have
become　dried；　all　separate　completely。　Those　which　are　about　to
exfollate　should　not　be　sawn　off。　Those　that　will　separate
completely　must　be　judged　of　from　the　symptoms　that　have　been　laid
down。
　　34。　Such　cases　are　to　be　treated　with　compresses　and　vinous
applications；　as　formerly　laid　down　regarding　bones　which　will
separate。　We　must　avoid　wetting　it　at　the　beginning　with　anything
cold；　for　there　is　danger　of　febrile　rigors；　and　also　of
convulsions；　for　convulsions　are　induced　by　cold　things；　and　also
sometimes　by　wounds。　It　is　proper　to　know　that　the　members　are
necessarily　shortened　in　those　cases　in　which　the　bones　have　been
broken；　and　have　healed　the　one　across　the　other；　and　in　those　cases
in　which　the　whole　circle　of　the　bone　has　become　detached。
　　35。　Those　cases　in　which　the　bone　of　the　thigh；　or　of　the　arm；
protrudes；　do　not　easily　recover。　For　the　bones　are　large；　and　contain
much　marrow；　and　many　important　nerves；　muscles；　and　veins　are　wounded
at　the　same　time。　And　if　you　reduce　them；　convulsions　usually
supervene；　and；　if　not　reduced；　acute　bilious　fevers　come　on；　with
singultus　and　mortification。　The　chances　of　recovery　are　not　fewer
in　those　cases　in　which　the　parts　have　not　been　reduced；　nor　any
attempts　made　at　reduction。　Still　more　recover　in　those　cases　in　which
the　lower；　than　those　in　which　the　upper　part　of　the　bone　protrudes；
and　some　will　recover　when　reduction　has　been　made；　but　very　rarely
indeed。　For　modes　of　treatment　and　peculiarity　of　constitution　make
a　great　difference　as　to　the　capability　of　enduring　such　an　injury。
And　it　makes　a　great　difference　if　the　bones　of　the　arm　and　of　the
thigh　protrude　to　the　inside；　for　there　are　many　and　important　vessels
situated　there；　some　of　which；　if　wounded；　will　prove　fatal；　there　are
such　also　on　the　out