on fractures-第2章

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there　be　a　soft　swelling　in　the　hand；　for　this　is　a　sign　of　moderate
compression；　but　at　the　end　of　the　second　day　the　compression　should
feel　less；　and　on　the　third　day　the　bandaging　should　appear　loose。　And
if　any　of　these　symptoms　be　wanting；　you　may　conclude　that　the
bandaging　is　slacker　than　it　should　be；　or　if　any　of　these　symptoms　be
in　excess；　you　may　infer　that　the　compression　is　more　than　moderate；
and　judging　from　these；　you　will　apply　the　next　bandages　either
slacker　or　tighter。　Having　removed　the　bandages　on　the　third　day；
you　must　make　extension　and　adjust　the　fracture；　and　bind　it　up　again；
and　if　the　first　bandaging　was　moderately　applied；　the　second
bandaging　should　be　made　somewhat　tighter。　The　heads　the　bandages
should　be　placed　on　the　fractures　as　in　the　former　case；　for；　so
doing；　the　humors　will　be　driven　to　the　extremities；　whereas　if　you
bandage　any　other　part　beforehand；　the　humors　will　he　forced　from　it
to　the　seat　of　the　fracture：　it　is　of　much　importance　that　this　should
be　properly　understood。　Thus　the　bandaging　and　compression　should
always　commence　at　the　seat　of　the　fracture；　and　everything　else
should　be　conducted　on　the　same　principle；　so　that　the　farther　you
proceed　from　the　fracture；　the　compression　should　always　be　the
less。　The　bandages　should　never　be　actually　loose；　but　should　be
smoothly　put　on。　At　each　dressing　the　number　of　bandages　should　be
increased；　and　the　patient；　if　asked；　should　answer；　that　he　feels　the
bandages　somewhat　tighter　than　on　the　former　occasion；　especially
about　the　fracture；　and　everything　else　in　proportion；　and　with
respect　to　the　swelling；　the　pain；　and　recovery；　everything　should
proceed　as　after　the　former　dressing。　But　on　the　third　day　the　outer
bandaging　should　appear　looser。　Then　having　removed　the　bandages；
you　should　bind　it　up　again；　somewhat　tighter　than　before；　and　with
all　the　bandages　which　will　be　required　on　the　occasion；　and
afterwards　one　ought　to　experience　the　same　train　of　symptoms　as　at
the　former　periods　of　bandaging。
　　6。　When　the　third　day　arrives；　that　is　to　say；　the　seventh　from
the　first　dressing；　if　properly　done；　the　swelling　in　the　hand
should　be　not　very　great；　and　the　part　which　has　been　bandaged
should　be　found　more　slender　and　less　swelled　at　each　time；　and　on　the
seventh　day　the　swelling　should　be　quite　gone；　and　the　broken　bones
should　be　more　readily　moved；　and　admit　of　being　easily　adjusted。
And　if　these　things　be　so；　you　should；　after　setting　the　fracture；
apply　the　bandages　so　as　to　suit　the　splints；　and　a　little　more
tight　than　formerly；　unless　there　be　more　pain　from　the　swelling　in
the　hand。　When　you　have　applied　the　bandages；　you　must　adjust　the
splints　all　around　the　limb；　and　secure　them　secure　them　with
strings　so　loose　as　just　to　keep　them　in　their　place；　without　the
application　of　the　splints　contributing　at　all　to　the　compression　of
the　arm。　After　this　the　pain　and　recovery　should　proceed　as　in　the
preceding　periods　of　the　bandaging。　But　if；　on　the　third　day；　the
patient　say　that　the　bandaging　is　loose；　you　must　then　fasten　the
splints；　especially　at　the　fracture；　but　also　elsewhere；　wherever
the　bandaging　is　rather　loose　than　tight。　The　splint　should　be
thickest　where　the　fracture　protrudes；　but　it　should　not　be　much
more　so　than　elsewhere。　Particular　attention　should　be　paid　to　the
line　of　the　arm　corresponding　to　the　thumb；　so　that　no　splint　be
laid　on　it；　but　upon　each　side　of　it；　nor　in　the　line　of　the　little
finger　where　the　bone　is　prominent　at　the　wrist；　but　on　each　side　of
it。　And　if　it　be　found　necessary　that　splints　should　be　applied　in
these　directions　at　the　seat　of　the　fracture；　they　should　be　made
shorter　than　the　others；　so　as　that　they　may　not　reach　the　bones　which
are　prominent　at　the　wrist；　for　otherwise　there　is　danger　of
ulceration；　and　of　the　tendons　being　laid　bare。　The　splints　should
be　adjusted　anew　every　third　day；　in　a　very　gentle　manner；　always
keeping　in　mind　that　the　object　of　the　splints　is　to　maintain　the
lower　bandages　in　their　place；　and　that　they　are　not　needed　in　order
to　contribute　to　the　compression。
　　7。　If；　then；　you　see　that　the　bones　are　properly　adjusted　by　the
first　dressings；　and　that　there　is　no　troublesome　pruritus　in　the
part；　nor　any　reason　to　suspect　ulceration；　you　may　allow　the　arm　to
remain　bandaged　in　the　splints　until　after　the　lapse　of　more　than
twenty　days。　The　bones　of　the　fore…arm　generally　get　consolidated　in
thirty　days　altogether；　but　there　is　nothing　precise　in　this　matter；
for　one　constitution　differs　from　another；　and　one　period　of　life　from
another。　When　you　remove　the　bandages；　you　must　pour　hot　water　on
the　arm　and　bind　it　up　again；　but　somewhat　slacker；　and　with　fewer
bandages　than　formerly：　and　again　on　the　third　day　you　undo　the
bandages；　and　bind　it　still　more　loosely；　and　with　still　fewer
bandages。　And　if；　while　the　arm　is　bound　up　in　the　splints；　you　should
at　any　time　suspect　that　the　bones　do　not　lie　properly；　or　if　anything
about　the　bandages　annoys　the　patient；　you　should　loose　them　at　the
middle　of　the　time；　or　a　little　earlier；　and　apply　them　again。　A
diet　slightly　restricted　will　be　sufficient　in　those　cases　in　which
there　was　no　external　wound　at　first；　or　when　the　bone　does　not
protrude；　but　one　should　live　rather　sparingly　until　the　tenth　day；　as
being　now　deprived　of　exercise；　and　tender　articles　of　food　should
be　used；　such　as　moderately　loosen　the　bowels；　but　one　should
abstain　altogether　from　flesh　and　wine；　and　then　by　degrees　resume　a
more　nourishing　diet。　This　diet。　may　be　laid　down　as　a　just　rule　in
the　treatment　of　fractures；　both　as　to　how　they　should　be　treated；　and
what　will　be　the　results　of　a　proper　plan　of　treatment；　so　that　one
may　know；　that　if　things　do　not　turn　out　thus；　there　has　been　some
defect　or　excess　in　the　treatment。　And　in　this　simple　plan　of
treatment　it　is　necessary　to　attend　also　to　the　following
directions；　which　some　physicians　pay　little　attention　to；　although；
when　improperly　executed；　they　are　capable　of　marring　the　whole
process　of　bandaging：　for　if　both　the　bones　be　broken；　or　the　lower
one　only；　and　the　patient　who　has　got　his　arm　bandaged　keep　it　slung
in　a　shawl；　and　that　the　shawl　is　particularly　loose　at　the
fracture；　so　that　the　arm　is　not　properly　suspended　at　this　end　or
that；　in　this　case　the　bone　must　necessarily　be　found　distorted
upwards；　whereas；　when　both　bones　are　thus　broken；　if　the　arm
recline　in　the　shawl　at　the　wrist　and　elbow；　but　the　rest　of　it　be　not
kept　up；　the　bone　in　this　case　will　be　distorted　to　the　lower　side。
The　greater　part　of　the　arm　and　the　wrist　of　the　hand　should　therefore
be　equally　suspended　in　a　broad　soft　shawl。
　　8。　When　the　arm　is　broken；　if　one　stretch　the　fore…arm　and　adjust　it
while　in　this　position；　the　muscle　of　the　arm　will　be　bound　while
extended；　but　when　the　dressing　is　over；　and　the　patient　bends　his　arm
at　the　elbow；　the　muscle　of　the　arm　will　assume　a　different　shape。　The
following；　then；　is　the　most　natural　plan　of　setting　the　arm：　having
got　a　piece　of　wood　a　cubit　or　somewhat　less　in　length；　like　the
handles　of　spades；　suspend　it　by　means　of　a　chain　fastened　to　its
extremities　at　both　ends；　and　having　seated　the　man　on　some　high
object；　the　arm　is　to　be　brought　over；　so　that　the　armpit　may　rest
on　the　piece　of　wood；　and　the　man　can　scarcely　touch　the　seat；　being
almost　suspended；　then　having　brought　another　seat；　and　placed　one
or　more　leather　pillows　under　the　arm；　so　as　to　keep　it　a　moderate
height　while　it　is　bent　at　a　right　angle；　the　best　plan　is　to　put
round　the　arm　a　broad　and　soft　skin；　or　broad　shawl；　and　to　hang
some　great　weight　to　it；　so　as　to　produce　moderate　extension；　or
otherwise；　while　the　arm　is　in　the　position　I　have　described；　a　strong
man　is　to　take　hold　of　it　at　the　elbow　and　pull　it　downward。　But　the
physician　standing　erect；　must　perform　the　proper　manipulation；　having
the　one　foot　on　some　pretty　high　object；　and　adjusting　the　bone　with
the　palms　of　his　hands；　and　it　will　readily　be　adjusted；　for　the
extension　is　good　if　properly　applied。　Then　let　him　bind　the　arm；
commencing　at　the　fracture；　and　do　otherwise　as　directed　above；　let
him　put　the　same　questions　and　avail　himself　of　the　same　signs　to
ascertain　whether　the　arm　be　moderately　tight　or　not；　and　every
third　day　let　him　bind　it　anew　and　make　it　tighter；　and　on　the　seventh
or　ninth　day　let　him　bind　it　up　with　splints；　and　leave　it　so　until
after　the　lapse　of　more　than　thirty　days。　And　if　he　suspect　that　the
bone　is　not　lying　properly；　let　him　remove　the　bandages　in　the
interval；　and　having　adjusted　the　arm；　let　him　bind　it　up　again。　The
bone　of　the　arm　is　generally　consolidated　in　forty　days。　When　these
are　past；　the　dressing　is　to　be　removed；　and　fewer　and　slacker
bandages　applied　instead　of　it。　The　patient　is　to　be　kept　on　a
stricter　diet；　and　for　a　longer　space　of　time　than　in　the　former　case；
and　we　must　form　our　judgment　of　it　from　the　swelling　in　the　hand；
looking　also　to　the　strength　of　the　patient。　This　also　should　be
known；　that　the　arm　is　naturally　inclined　outward；　to　this　side；
therefore；　the　distortion　usually　takes　place；　if　not　properly
treated；　but　indeed；　all　the　other　bones　are　usually　distorted
during　treatment　for　fracture　to　that　side　to　which　they　naturally
incline。　When；　therefore；　anything　of　this　kind　is　suspected；　the
arm　is　to　be　encircled　in　a　broad　shawl；　which　is　to　be　carried
round　the　breast；　and　when　the　patient　goes　to　rest；　a　compress　of
many　folds；　or　some　such　thing；　is　to　be　folded　and　placed　between　the
elbow　and　the　side；　for　thus　the　bending　of　the　bone　will　be
rectified；　but　care　must　be　taken　lest　it　be　inclined　too　much
inwards。
　　9。　The　human　foot　is　composed　of　several　small　bones　like　the
hand。　These　bones　therefore　are　scarcely　ever　broken；　unless　the
skin　at　the　same　time　be　wounded　by　some　sharp　and　heavy　body。　The
treatment　of　stich　injuries；　therefore；　will　be　delivered　under　the
head　of　wounds。　But　if　any　bone　be　moved　from　its　place；　or　a　joint　of
the　toes　be　luxated；　or　any　of　the　bones　of　the　part　called　the　tarsus
be　displaced；　it　must　be　forced　back　again　to　its　place　as　described
with　regard　to　the　hand；　and　is　to　be　treated　with　cerate；　compresses；
and　bandages；　like　the　fractures；　with　the　exception　of　the　splints；
and　is　to　be　secured　tightly　in　the　same　way；　and　the　bandages　renewed
on　the　third　day；　and　the　patient　thus　bandaged　should　return　the　same
answers　as　in　fractures；　as　to　the　bandages　feeling　tight　or　slack。
All　these　bones　recover　perfectly　in　twenty　days；　except　those　that
are　connected　with　the　bones　of　the　leg；　and　are　in　a　line　with
them。　It　is　advantageous　to　lie　in　bed　during　the　whole　of　this
time；　but　the　patients；　thinking　light　of　the　complaint；　have　not
perseverance　to　do　this；　and　they　walk　about　before　they　get　well；
wherefore　many　of　these　do　not　make　a　perfect　recovery。　And　often
the　pain　puts　them　in　mind　of　the　injury；　and　deservedly；　for　the　feet
sustain　the　weight　of　the　whole　body。　When；　therefore；　they　walk　about
before　they　are　whole；　the　joints　which　have　been　luxated　are　cured
incompletely；　and；　on　that　account；　w