on fractures-第3章

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incompletely；　and；　on　that　account；　while　walking　about；　they　have
pains　in　the　leg　from　time　to　time。
　　10。　But　those　bones　which　are　connected　with　the　bones　of　the　leg
are　larger　than　the　others；　and　the　cure　of　them　when　luxuated　is　more
protracted。　The　mode　of　treatment　then　is　the　same；　but　we　must　use
more　bandages　and　more　splints；　and　the　bandage　is　to　be　carried　round
to　this　side　and　to　that；　and　pressure　is　to　be　made　as　in　the　other
cases；　particularly　at　the　seat　of　the　luxation；　and　the　first　circles
of　the　bandages　are　to　be　made　there。　And　at　each　time　the　bandages
are　taken　off；　much　hot　water　is　to　be　used；　for　in　all　injuries　at
joints　the　affusion　of　hot　water　in　large　quantity　is　to　be　had
recourse　to。　And　the　same　symptoms　of　compression　and　relaxation
should　manifest　themselves　in　the　same　times；　as　in　the　cases　formerly
treated　of；　and　the　subsequent　bandagings　should　be　conducted　in
like　manner。　These　cases　get　completely　well　for　the　most　part　in
forty　days；　if　the　patients　have　resolution　to　keep　their　bed；　but
if　not；　they　are　subjected　to　the　complaints　formerly　described；　or
still　worse。
　　11。　In　persons　who　jumping　from　any　high　object　pitch　upon　their
heel　with　great　force；　the　bones　are　separated；　and　the　veins　pour
forth　their　contents；　owing　to　the　contusion　of　the　flesh
surrounding　the　bone；　and　hence　a　swelling　and　much　pain　supervene。
For　this　bone　（os　calcis）　is　not　a　small　one；　protrudes　beyond　the
line　of　the　leg；　and　is　connected　with　important　veins　and　tendons；
for　the　back　tendon　of　the　leg　is　inserted　into　this　bone。　Such
cases　are　to　be　treated　with　cerate；　and　with　compresses　and　bandages；
and　hot　water　is　to　be　used　in　large　quantity；　and　they　require　many
bandages；　which　ought　to　be　particularly　good　and　appropriate。　And
if　the　patient　happen　to　have　a　tender　skin　about　the　heel；　nothing　is
to　be　done　to　it；　but　if；　as　some　have　it；　the　skin　be　thick　and
hardened；　it　is　to　be　pared　down　smoothly　and　thinned；　but　without
wounding　it。　It　is　not　everybody　who　can　apply　the　bandage　properly　in
such　cases；　for　if　one　shall　bind　the　parts；　as　in　other　accidents
about　the　ankle；　sometimes　bringing　a　fold　round　the　foot　and
sometimes　round　the　tendon；　these　turns　leave　out　the　heel；　which　is
the　seat　of　the　contusion；　and　thus　there　is　danger　that　the　os　calcis
may　sphacelate；　and　if　this　should　take　place；　the　impediment　may
endure　for　life　and　also　in　all　the　other　cases　of　sphacelus；　not
proceeding　from　such　a　cause　as　this；　as　when；　from　being　carelessly
allowed　to　lie　in　a　certain　position　during　confinement　to　bed；　the
heel　becomes　black；　or　when　a　serious　wound　has　occurred　in　the　leg
and　it　is　long　of　healing；　and　is　connected　with　the　heel；　or　when　the
same　thing　happens　in　the　thigh；　or　when　in　any　disease　a　protracted
decubitus　takes　place　on　the　back；　in　all　such　cases　the　sores　are
inveterate；　troublesome；　and　frequently　break　out　again；　unless
particular　attention　be　paid　to　the　cure；　along　with　much　rest；　as
in　all　the　cases　attended　with　sphacelus。　And　cases　of　sphacelus
connected　with　this　cause；　in　addition　to　other　inconveniences；　are
attended　with　great　danger　to　the　whole　body。　For　they　are　apt　to　be
attended　with　very　acute　fevers；　of　the　continual　type；　accompanied
with　tremblings；　hiccup；　aberration　of　intellect；　and　which　prove
fatal　within　a　few　days：　and　there　may　be　lividities　of　bloody
veins；　with　nausea；　and　gangrene　from　pressure；　these　diseases　may
occur；　besides　the　sphacelus。　Those　which　have　been　described　are
the　most　violent　contusion；　but　in　general　the　contusions　are　mild；
and　no　great　care　is　required　with　regard　to　the　treatment；　and　yet　it
must　be　conducted　properly。　But　when　the　contusion　appears　to　be
severe；　we　must　do　as　described　above；　making　many　turns　of　the
bandage　around　the　heel；　sometimes　carrying　it　to　the　extremity　of　the
foot；　sometimes　to　the　middle；　and　sometimes　around　the　leg；　and；　in
addition；　all　the　surrounding　parts　are　to　be　bandaged　in　this
direction　and　that；　as　formerly　described；　and　the　compression
should　not　be　made　strong；　but　we　should　make　use　of　many　bandages；
and　it　is　better　also　to　administer　hellebore　the　same　day　or　on　the
morrow；　and　the　bandages　should　be　removed　on　the　third　day　and
reapplied。　And　these　are　the　symptoms　by　which　we　discover　whether　the
case　will　get　worse　or　not：　when　the　extravasated　blood；　the
lividities；　and　the　surrounding　parts　become　red　and　hard；　there　is
danger　of　an　exacerbation。　But　if　there　be　no　fever；　we　must　give
emetics；　as　has　been　said；　and　administer　the　other　remedies　which　are
applicable　when　the　fever　is　not　of　a　continual　type；　but　if　continual
fever　be　present；　we　must　not　give　strong　medicines；　but　enjoin
abstinence　from　solid　food　and　soups；　and　give　water　for　drink；　and
not　allow　wine　but　oxyglyky　（a　composition　from　vinegar　and　honey？）。
But　if　the　case　be　not　going　to　get　worse；　the　ecchymosed　and　livid
parts；　and　those　surrounding　them　become　greenish　and　not　hard；　for
this　is　a　satisfactory　proof　in　all　cases　of　ecchymosis；　that　they　are
not　to　get　worse；　but　when　lividity　is　complicated　with　hardness；
there　is　danger　that　the　part　may　become　blackened。　And　we　must　so
manage　the　foot　as　that　it　may　be　generally　raised　a　little　higher
than　the　rest　of　the　body。　Such　a　patient　will　get　well　in　sixty
days　if　he　keep　quiet。
　　12。　The　leg　consists　of　two　bones；　of　which　the　one　is　much　more
slender　than　the　other　at　one　part；　but　not　much　more　slender　at
another。　These　are　connected　together　at　the　foot；　and　form　a　common
epiphysis；　but　they　are　not　united　together　along　the　line　of　the　leg；
and　at　the　thigh　they　are　united　together　and　form　an　epiphysis；　and
this　epiphysis　has　a　diaphysis；　but　the　other　bone　in　a　line　with
the　little　toe　is　a　little　longer。　Such　is　the　nature　of　the　bones
of　the　leg。
　　13。　Sometimes　the　bones　connected　with　the　foot　are　displaced；
sometimes　both　bones　with　their　epiphysis；　sometimes　the　whole
epiphysis　is　slightly　moved；　and　sometimes　the　other　bone。　These　cases
are　less　troublesome　than　the　same　accidents　at　the　wrist；　if　the
patients　will　have　resolution　to　give　them　rest。　The　mode　of　treatment
is　the　same　as　that　of　the　other；　for　the　reduction　is　to　be　made；
as　of　the　other；　by　means　of　extension；　but　greater　force　is　required；
as　the　parts　of　the　body　concerned　are　stronger　in　this　case。　But；　for
the　most　part；　two　men　will　be　sufficient；　by　making　extension　in
opposite　directions；　but；　not　withstanding；　if　they　are　not
sufficiently　strong；　it　is　easy　to　make　more　powerful　extension　in　the
following　way：　having　fixed　in　the　ground　either　the　nave　of　a
wheel；　or　any　such　object；　something　soft　is　to　be　bound　round　the
foot；　and　then　some　broad　thongs　of　ox…skin　being　brought　round　it；
the　heads　of　the　thongs　are　to　be　fastened　to　a　pestle　or　any　other
piece　of　wood；　the　end　of　which　is　to　be　inserted　into　the　nave；　and
it；　the　pestle；　is　to　be　pulled　away；　while　other　persons　make
counter…extension　by　grasping　the　shoulders　and　the　ham。　It　is　also
sometimes　necessary　to　secure　the　upper　extremity　otherwise；　this　if
you　desire　to　effect；　fasten　deeply　in　the　ground　a　round；　smooth
piece　of　wood；　and　place　the　upper　extremity　of　the　piece　of　wood　at
the　perineum；　so　that　it　may　prevent　the　body　from　yielding　to　the
pulling　at　the　foot；　and；　moreover；　to　prevent　the　leg　while
stretched；　from　inclining　downward；　some　person　seated　at　his　side
should　push　back　the　hip；　so　that　the　body　may　not　turn　round　with　the
pulling；　and　for　this　purpose；　if　you　think　fit；　pieces　of　wood　may　be
fastened　about　the　armpits　on　each　side；　and　they　are　to　be
stretched　by　the　hands；　and　thus　secured；　while　another　person　takes
hold　of　the　limb　at　the　knee；　and　aids　in　thus　making
counter…extension。　Or　thus；　if　you　prefer　it：　having　bound　other
thongs　of　leather　about　the　limb；　either　at　the　knee；　or　around　the
thigh；　and　having　fastened　another　nave　of　a　wheel　in　the　ground　above
the　head；　and　adjusted　the　thongs　piece　of　wood　adapted　to　the　nave；
extension　may　thus　be　made　in　the　opposite　direction　to　the　feet。　Or
if　you　choose；　it　may　be　done　thus：　instead　of　the　naves；　lay　a
moderate…sized　beam　under　the　couch；　and　then　having　fastened　pieces
of　wood　in　this　beam；　both　before　and　behind　the　head；　make
counter…extension　by　means　of　thongs；　or　place　windlasses　at　this
extremity　and　that；　and　make　extension　by　means　of　them。　There　are
many　other　methods　of　making　extension。　But　the　best　thing　is；　for　any
physician　who　practices　in　a　large　city；　to　have　prepared　a　proper
wooden　machine；　with　all　the　mechanical　powers　applicable　in　cases
of　fractures　and　dislocation；　either　for　making　extension；　or　acting
as　a　lever。　For　this　purpose　it　will　be　sufficient　to　possess　a
board　in　length；　breadth；　and　thickness；　resembling　the　quadrangular
threshing…boards　made　of　oak。
　　14。　When　you　have　made　proper　extension；　it　is　easy　reduce　the
joint；　for　the　displaced　bone　is　thus　raised　into　a　line　with　the
other。　And　the　bones　are　to　be　adjusted　with　the　palms　of　the　hands；
pressing　upon　the　projecting　bone　with　the　one；　and　making
counter…pressure　below　the　ankle　with　the　other。　When　you　have
replaced　the　bones；　you　must　apply　the　bandages　while　the　parts　are
upon　the　stretch；　if　you　possibly　can；　but　if　prevented　by　the　thongs；
you　must　loose　them；　and　make　counter…extension　until　you　get　the
bandages　applied。　The　bandage　is　to　be　applied　in　the　manner
formerly　described；　the　heads　of　the　bandages　being　placed　on　the
projecting　part；　and　the　first　turns　made　in　like　manner；　and　so
also　with　regard　to　the　number　of　compresses　and　the　compression；
and　turns　of　the　bandages　are　to　be　brought　frequently　round　on　this
and　on　that　side　of　the　ankle。　But　this　joint　must　be　bound　more　tight
at　the　first　dressing　than　in　the　case　of　the　hand。　But　when　you
have　applied　the　bandage；　you　must　place　the　bandaged　part　somewhat
higher　than　the　rest　of　the　body；　and　in　such　a　position　that　the　foot
may　hang　as　little　as　possible。　The　attenuation　of　the　body　is　to　be
made　proportionate　to　the　magnitude　of　the　luxation；　for　one
luxation　is　to　be　a　small；　and　another　to　a　great　extent。　But　in
general　we　must　reduce　more；　and　for　a　longer　time；　in　injuries
about　the　legs；　than　in　those　about　the　hands；　for　the　former　parts
are　larger　and　thicker　than　the　latter；　and　it　is　necessary　that　the
body　should　be　kept　in　a　state　of　rest；　and　in　a　recumbent　position。
There　is　nothing　to　prevent　or　require　the　limb　to　be　bandaged　anew　on
the　third　day。　And　all　the　treatment　otherwise　is　to　be　conducted　in
like　manner；　as　in　the　preceding　cases。　And　if　the　patient　have
resolution　to　lie　quiet；　forty　days　will　be　sufficient　for　this
purpose；　if　only　the　bones　be　properly　reduced；　but　if　he　will　not　lie
quiet；　he　will　not　be　able　to　use　the　limb　with　ease；　and　he　will　find
it　necessary　to　wear　a　bandage　for　a　long　time。　When　the　bones　are　not
properly　replaced；　but　there　has　been　some　defect　in　this　respect；　the
hip；　the　thigh；　and　the　leg　become　wasted；　and　if　the　dislocation　be
inward；　the　external　part　of　the　thigh　is　wasted；　and　vice　versa。