on fractures-第6部分

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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
suitable　bandages　cooperate。
　　28。　If　you　are　deceived　with　regard　to　a　recent　wound；　supposing
there　will　be　no　exfoliation　of　the　bones；　while　they　are　on　the　eve
of　coming　out　of　the　sore；　you　must　not　hesitate　to　adopt　this　mode　of
treatment；　for　no　great　mischief　will　result；　provided　you　have　the
necessary　dexterity　to　apply　the　bandages　well　and　without　doing　any
harm。　And　this　is　a　symptom　of　an　exfoliation　of　bone　being　about　to
take　place　under　this　mode　of　treatment；　pus　runs　copiously　from　the
sore；　and　appears　striving　to　make　its　escape。　The　bandage　must　be
renewed　more　frequently　on　account　of　the　discharge；　since　otherwise
fevers　come　on；　if　the　sore　and　surrounding　parts　be　compressed　by　the
bandages　they　become　wasted。　Cases　complicated　with　the　exfoliation　of
very　small　bones；　do　not　require　any　change　of　treatment；　only　the
bandages　should　be　put　on　more　loosely；　so　that　the　discharge　of　pus
may　not　be　intercepted；　but　left　free；　and　the　dressings　are　to　be
frequently　renewed　until　the　bone　exfoliate；　and　the　splints　should
not　be　applied　until　then。
　　29。　Those　cases　in　which　the　exfoliation　of　a　larger　piece　of　bone
is　expected；　whether　you　discover　this　at　the　commencement；　or
perceive　subsequently　that　it　is　to　happen；　no　longer　require　the　same
mode　of　treatment；　only　that　the　extension　and　arrangement　of　the
parts　are　to　be　performed　in　a　manner　that　has　been　described；　but
having　formed　double　compresses；　not　less　than　half　a　fathom　in
breadth　（being　guided　in　this　by　the　nature　of　the　wound）；　and
considerably　shorter　than　what　would　be　required　to　go　twice　round　the
part　that　is　wounded；　but　considerably　longer　than　to　go　once　round；
and　in　number　what　will　be　sufficient；　these　are　to　be　dipped　in　a
black　austere　wine；　and　beginning　at　the　middle；　as　is　done　in
applying　the　double…headed　bandage；　you　are　to　wrap　the　part　around
and　proceed　crossing　the　heads　in　the　form　of　the　bandage　called
〃ascia。〃　These　things　are　to　be　done　at　the　wound；　and　on　both　sides
of　it；　and　there　must　be　no　compression；　but　they　are　to　be　laid　on　so
as　to　give　support　to　the　wound。　And　on　the　wound　itself　is　to　be
applied　the　pitched　cerate；　or　one　of　the　applications　to　recent
wounds；　or　any　other　medicine　which　will　suit　with　the　embrocation。
And　if　it　be　the　summer　season；　the　compresses　are　to　be　frequently
damped　with　wine；　but　if　the　winter　season；　plenty　of　greasy　wool；
moistened　with　wine　and　oil；　should　be　applied。　And　a　goat's　skin
should　be　spread　below；　so　as　to　carry　off　the　fluids　which　run　from
the　wound；　these　must　be　guarded　against；　and　it　should　be　kept　in
mind；　that　parts　which　remain　long　in　the　same　position　are　subject　to
excoriations　which　are　difficult　to　cure。
　　30。　In　such　cases　as　do　not　admit　of　bandaging　according　to　any　of
the　methods　which　have　been　described；　or　which　will　be　described；
great　pains　should　be　taken　that　the　fractured　part　of　the　body　be
laid　in　a　right　position；　and　attention　should　be　paid　that　it　may
incline　upward　rather　than　downward。　But　if　one　would　wish　to　do　the
thing　well　and　dexterously；　it　is　proper　to　have　recourse　to　some
mechanical　contrivance；　in　order　that　the　fractured　part　of　the　body
may　undergo　proper　and　not　violent　extension；　and　this　means　is
particularly　applicable　in　fractures　of　the　leg。　There　are　certain
physicians　who；　in　all　fractures　of　the　leg；　whether　bandages　be
applied　or　not；　fasten　the　sole　of　the　foot　to　the　couch；　or　to　some
other　piece　of　wood　which　they　have　fixed　in　the　ground　near　the
couch。　These　persons　thus　do　all　sorts　of　mischief　but　no　good；　for　it
contributes　nothing　to　the　extension　that　the　foot　is　thus　bound；　as
the　rest　of　the　body　will　no　less　sink　down　to　the　foot；　and　thus
the　limb　will　no　longer　be　stretched；　neither　will　it　do　any　good
toward　keeping　the　limb　in　a　proper　position；　but　will　do　harm；　for
when　the　rest　of　the　body　is　turned　to　this　side　or　that；　the
bandaging　will　not　prevent　the　foot　and　the　bones　belonging　to　it　from
following　the　rest　of