on fractures-第5部分

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the　inner　bone　of　the　leg　which　supports　the　most　of　the　weight　of　the
body。　For　along　with　the　thigh；　as　being　in　a　line　with　weight
thrown　upon　the　thigh；　the　inner　bone　has　more　work　to　sustain；
inasmuch　as　it　is　the　head　of　the　thigh…bone　which　sustains　the
upper　part　of　the　body；　and　it　is　on　the　inner　and　not　on　the　outer
side　of　the　thigh；　being　in　a　line　with　the　tibia；　and　the　other
half　of　the　body　approximates　more　to　this　line　than　to　the　external
one；　and　at　the　same　time　the　inner　bone　is　larger　than　the　outer；
as　in　the　fore…arm　the　bone　in　the　line　of　the　little　finger　is　the
slenderer　and　longer。　But　in　the　joint　of　the　inferior　extremity；
the　disposition　of　the　longer　bone　is　not　alike；　for　the　elbow　and　the
ham　are　bent　differently。　For　these　reasons　when　the　external　bone
is　broken；　the　patients　can　soon　walk　about；　but　in　fractures　of　the
inner；　it　is　a　long　time　before　they　can　walk。
　　19。　When　the　thigh…bone　is　broken；　particular　pains　should　be
taken　with　regard　to　the　extension　that　it　may　not　be　insufficient；
for　when　excessive；　no　great　harm　results　from　it。　For；　if　one
should　bandage　a　limb　while　the　extremities　of　the　bone　are
separated　to　a　distance　from　one　another　by　the　force　of　the
extension；　the　bandaging　will　not　keep　them　separate；　and　so　the　bones
will　come　together　again　as　soon　as　the　persons　stretching　it　let　go
their　hold；　for　the　fleshy　parts　（muscles？）　being　thick　and　strong；
are　more　powerful　than　the　bandaging；　instead　of　being　less　so。　In　the
case　then　which　we　are　now　treating　of；　nothing　should　be　omitted　in
order　that　the　parts　may　be　properly　distended　and　put　in　a　straight
line；　for　it　is　a　great　disgrace　and　an　injury　to　exhibit　a
shortened　thigh。　For　the　arm；　when　shortened；　might　be　concealed；
and　the　mistake　would　not　be　great；　but　a　shortened　thigh…bone　would
exhibit　the　man　maimed。　For　when　the　sound　limb　is　placed　beside　it；
being　longer　than　the　other；　it　exposes　the　mistake；　and　therefore
it　would　be　to　the　advantage　of　a　person　who　would　be　improperly
treated　that　both　his　legs　should　be　broken；　rather　than　either　of
them；　for　in　this　case　the　one　would　be　of　the　same　length　as　the
other。　When；　then；　proper　extension　has　been　made；　you　must　adjust　the
parts　with　the　palms　of　the　hands；　and　bandage　the　limb　in　the
manner　formerly　described；　placing　the　hands　of　the　bandages　as　was
directed；　and　making　the　turns　upward。　And　the　patient　should　return
the　same　answers　to　the　same　questions　as　formerly；　should　be　pained
and　recover　in　like　manner；　and　should　have　the　bandaging　renewed　in
the　same　way；　and　the　application　of　the　splints　should　be　the　same。
The　thigh…bone　is　consolidated　in　forty　days。
　　20。　But　this　also　should　be　known；　that　the　thigh…bone　is　curved
rather　to　the　outside　than　to　the　inside；　and　rather　forward　than
backward；　when　not　properly　treated；　then；　the　distortions　are　in
these　directions；　and　the　bone　is　least　covered　with　flesh　at　the　same
parts；　so　that　the　distortion　cannot　be　concealed。　If；　therefore；
you　suspect　anything　of　this　kind；　you　should　have　recourse　to　the
mechanical　contrivances　recommended　in　distortion　of　the　arm。　And　a
few　turns　of　the　bandage　should　be　brought　round　by　the　hip　and　the
loins；　so　that　the　groin　and　the　articulation　near　the　perineum　may　be
included　in　the　bandage；　and　moreover；　it　is　expedient　that　the
extremities　of　the　splints　should　not　do　mischief　by　being　placed　on
parts　not　covered　with　the　bandages。　The　splints；　in　fact；　should　be
carefully　kept　off　the　naked　parts　at　both　ends；　and　the　arrangement
of　them　should　be　so　managed；　as　that　they　may　not　be　placed　on　the
natural　protuberances　of　the　bone　at　the　knee…joint；　nor　on　the　tendon
which　is　situated　there。
　　21。　The　swellings　which　arise　in　the　ham；　at　the　foot；　or　in　any
other　part　from　the　pressure；　should　be　well　wrapped　in　unscoured
and　carded　wool；　washed　with　wine　and　oil；　and　anointed　with　cerate；
before　bandaging；　and　if　the　splints　give　pain　they　should　be
slackened。　You　may　sooner　reduce　the　swellings；　by　laying　aside　the
splints；　and　applying　plenty　of　bandages　to　them；　beginning　from　below
and　rolling　upward；　for　thus　the　swellings　will　be　most　speedily
reduced；　and　the　humors　be　propelled　to　the　parts　above　the　former
bandages。　But　this　form　of　bandaging　must　not　be　used　unless　there
be　danger　of　vesications　or　blackening　in　the　swelling；　and　nothing　of
the　kind　occurs　unless　the　fracture　be　bound　too　tight；　or　unless
the　limb　be　allowed　to　hang；　or　it　be　rubbed　with　the　hand；　or　some
other　thing　of　an　irritant　nature　be　applied　to　the　skin。
　　22。　More　injury　than　good　results　from　placing　below　the　thigh　a
canal　which　does　not　pass　farther　down　than　the　ham；　for　it　neither
prevents　the　body　nor　the　leg　from　being　moved　without　the　thigh。
And　it　creates　uneasiness　by　being　brought　down　to　the　ham；　and　has
a　tendency　to　produce　what　of　all　things　should　be　avoided；　namely；
flexion　at　the　knee；　for　this　completely　disturbs　the　bandages；　and
when　the　thigh　and　leg　are　bandaged；　if　one　bend　the　limb　at　the　knee；
the　muscles　necessarily　assume　another　shape；　and　the　broken　bones　are
also　necessarily　moved。　Every　endeavor　then　should　be　made　to　keep　the
ham　extended。　But　it　appears　to　me；　that　a　canal　which　embraces　the
limb　from　the　nates　to　the　foot　is　of　use。　And　moreover；　a　shawl
should　be　put　loosely　round　at　the　ham；　along　with　the　canal；　as
children　are　swathed　in　bed；　and　then；　if　the　thigh…bone　gets
displaced　either　upward　or　to　the　side；　it　can　be　more　easily　kept
in　position　by　this　means　along　with　the　canal。　The　canal　then
should　be　made　so　as　to　extend　all　along　the　limb　or　not　used　at　all。
　　23。　The　extremity　of　the　heel　should　be　particularly　attended　to；　so
that　it　may　be　properly　laid；　both　in　fractures　of　the　leg　and　of
the　thigh。　For　if　the　foot　be　placed　in　a　dependent　position；　while
the　rest　of　the　body　is　supported；　the　limb　must　present　a　curved
appearance　at　the　forepart　of　the　leg；　and　if　the　heel　be　placed
higher　than　is　proper；　and　if　the　rest　of　the　leg　be　rather　too　low；
the　bone　at　the　forepart　of　the　leg　must　present　a　hollow；　more
especially　if　the　heel　of　the　patient　be　naturally　large。　But　all
the　bones　get　consolidated　more　slowly；　if　not　laid　properly；　and　if
not　kept　steady　in　the　same　position；　and　in　this　case　the　callus　is
more　feeble。
　　24。　These　things　relate　to　cases　in　which　there　is　fracture　of　the
bones　without　protrusion　of　the　same　or　wound　of　any　other　kind。　In
those　cases　in　which　the　bones　are　simply　broken　across；　and　are　not
comminuted；　but　protrude；　if　reduced　the　same　day　or　next；　and　secured
in　their　place；　and　if　there　be　no　reason　to　anticipate　that　any
splintered　bones　will　come　away；　and　in　those　in　which　the　broken
bones　do　not　protrude；　nor　is　the　mode　of　fracture　such　that　there
is　reason　to　expect　the　splinters　will　come　out；　some　physicians
heal　the　sores　in　a　way　which　neither　does　much　good　nor　harm；　by
means　of　a　cleansing　application；　applying　pitch　ointment；　or　some
of　the　dressings　for　fresh　wounds；　or　anything　else　which　they　are
accustomed　to　do；　and　binding　above　them　compresses　wetted　with
wine；　or　greasy　wool；　or　something　else　of　the　like　nature。　And　when
the　wounds　become　clean　and　are　new　healed；　they　endeavor　to　bind　up
the　limb　with　plenty　of　bandages；　and　keep　it　straight　with
treatment　does　some　good；　and　never　much　harm。　The　bones；　however；　can
never　be　equally　well　restored　to　their　place；　but　the　part　is　a
little　more　swelled　than　it　should　be；　and　the　limb　will　be　somewhat
shortened；　provided　both　bones　either　of　the　leg　or　fore…arm　have　been
fractured。
　　25。　There　are　others　who　treat　such　cases　at　first　with　bandages；
applying　them　on　both　sides　of　the　seat　of　the　injury；　but　omit　them
there；　and　leave　the　wound　uncovered；　and　afterward　they　apply　to
the　wound　some　cleansing　medicine；　and　complete　the　dressing　with
compresses　dipped　in　wine　and　greasy　wool。　This　plan　of　treatment　is
bad；　and　it　is　clear　that　those　who　adopt　this　mode　of　practice　are
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