on fractures-第7部分

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bandaging　will　not　prevent　the　foot　and　the　bones　belonging　to　it　from
following　the　rest　of　the　body。　For　if　it　had　not　been　bound　it
would　have　been　less　distorted；　as　it　would　have　been　the　less
prevented　from　following　the　motion　of　the　rest　of　the　body。　But　one
should　sew　two　balls　of　Egyptian　leather；　such　as　are　worn　by
persons　confined　for　a　length　of　time　in　large　shackles；　and　the　balls
the　balls　should　have　coats　on　each　side；　deeper　toward　the　wound；　but
shorter　toward　the　joints；　and　the　balls　should　be　well　stuffed　and
soft；　and　fit　well；　the　one　above　the　ankles；　and　the　other　below
the　knee。　Sideways　it　should　have　below　two　appendages；　either　of　a
single　or　double　thong；　and　short；　like　loops；　the　one　set　being
placed　on　either　side　of　the　ankle；　and　the　other　on　the　knee。　And　the
other　upper　ball　should　have　others　of　the　same　kind　in　the　same　line。
Then　taking　four　rods；　made　of　the　cornel　tree；　of　equal　length；　and
of　the　thickness　of　a　finger；　and　of　such　length　that　when　bent　they
will　admit　of　being　adjusted　to　the　appendages；　care　should　be　taken
that　the　extremities　of　the　rods　bear　not　upon　the　skin；　but　on　the
extremities　of　the　balls。　There　should　be　three　sets　of　rods；　or　more；
one　set　a　little　longer　than　another；　and　another　a　little　shorter　and
smaller；　so　that　they　may　produce　greater　or　less　distention；　if
required。　Either　of　these　sets　of　rods　should　be　placed　on　this　side
and　that　of　the　ankles。　If　these　things　be　properly　contrived；　they
should　occasion　a　proper　and　equable　extension　in　a　straight　line；
without　giving　any　pain　to　the　wound；　for　the　pressure；　if　there　is
any；　should　be　thrown　at　the　foot　and　the　thigh。　And　the　rods　are
commodiously　arranged　on　either　side　of　the　ankles；　so　as　not　to
interfere　with　the　position　of　the　limb；　and　the　wound　is　easily
examined　and　easily　arranged。　And；　if　thought　proper；　there　is　nothing
to　prevent　the　two　upper　rods　from　being　fastened　to　one　another；
and　if　any　light　covering　be　thrown　over　the　limb；　it　will　thus　be
kept　off　from　the　wound。　If；　then；　the　balls　be　well　made；　handsome；
soft；　and　newly　stitched；　and　if　the　extension　by　the　rods　be　properly
managed；　as　has　been　already　described；　this　is　an　excellent
contrivance；　but　if　any　of　them　do　not　fit　properly；　it　does　more　harm
than　good。　And　all　other　mechanical　contrivances　should　either　be
properly　done；　or　not　be　had　recourse　to　at　all；　for　it　is　a
disgraceful　and　awkward　thing　to　use　mechanical　means　in　an
unmechanical　way。
　　31。　Moreover；　the　greater　part　of　physicians　treat　fractures；　both
with　and　without　an　external　wound；　during　the　first　days；　by　means　of
unwashed　wool；　and　there　does　not　appear　to　be　anything　improper　in
this。　It　is　very　excusable　for　those　who　are　called　upon　to　treat
newly…received　accidents　of　this　kind；　and　who　have　no　cloth　for
bandages　at　hand；　to　do　them　up　with　wool；　for；　except　cloth　for
bandages；　one　could　not　have　anything　better　than　wool　in　such
cases；　but　a　good　deal　should　be　used　for　this　purpose；　and　it
should　be　well　carded　and　not　rough；　for　in　small　quantity　and　of　a
bad　quality　it　has　little　power。　But　those　who　approve　of　binding　up
the　limb　with　wool　for　a　day　or　two；　and　on　the　third　and　fourth　apply
bandages；　and　make　the　greatest　compression　and　extension　at　that
period；　such　persons　show　themselves　to　be　ignorant　of　the　most
important　principles　of　medicine；　for；　in　a　word；　at　no　time　is　it
so　little　proper　to　disturb　all　kinds　of　wounds　as　on　the　third　and
fourth　day；　and　all　sort　of　probing　should　be　avoided　on　these　days　in
whatever　other　injuries　are　attended　with　irritation。　For；
generally；　the　third　and　fourth　day　in　most　cases　of　wounds；　are　those
which　give　rise　to　exacerbations；　whether　the　tendency　be　to
inflammation；　to　a　foul　condition　of　the　sore；　or　to　fevers。　And　if
any　piece　of　information　be　particularly　valuable　this　is；　to　which　of
the　most　important　cases　in　medicine　does　it　not　apply？　and　that　not
only　in　wounds　but　in　many　other　diseases；　unless　one　should　call
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　p