on fractures-第4章

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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。
But　for　the　most　part　the　dislocation　is　inward。
　　15。　And　when　both　bones　of　the　leg　are　broken　without　a　wound　of　the
skin；　stronger　extension　is　required。　We　may　make　extension　by　some　of
the　methods　formerly　described；　provided　the　bones　ride　over　one
another　to　a　considerable　degree。　But　extension　by　men　is　also
sufficient；　and　for　the　most　part　two　strong　men　will　suffice；　by
making　extension　and　counterextension。　Extension　must　naturally　be
made　straight　in　a　line　with　the　leg　and　thigh；　whether　on　account
of　a　fracture　of　the　bones　of　the　leg　or　of　the　thigh。　And　in　both
cases　they　are　to　be　bandaged　while　in　a　state　of　extension；　for　the
same　position　does　not　suit　with　the　leg　and　the　arm。　For　when　the
fractured　bones　of　the　arm　or　fore…arm　are　bandaged；　the　fore…arm　is
suspended　in　a　sling；　and　if　you　bind　them　up　while　extended；　the
figures　of　the　fleshy　parts　will　be　changed　in　bending　the　arm　at
the　elbow；　for　the　elbow　cannot　be　kept　long　extended；　since　persons
are　not　in　the　custom　of　keeping　the　joint　long　in　this　form；　but　in　a
bent　position；　and　persons　who　have　been　wounded　in　the　arm；　and　are
still　able　to　walk　about；　require　to　have　the　arm　bent　at　the
elbow…joint。　But　the　leg；　both　in　walking　and　standing；　is
habitually　extended；　either　completely　or　nearly　so；　and　is　usually　in
a　depending　position　from　its　construction；　and　in　order　that　it　may
bear　the　weight　of　the　rest　of　the　body。　Wherefore　it　readily　bears　to
be　extended　when　necessary；　and　even　when　in　bed　the　limb　is　often
in　this　position。　And　when　wounded；　necessity　subdues　the
understanding；　since　the　patients　become　incapable　of　raising
themselves　up；　so　that　they　neither　think　of　bending　the　limb　nor　of
getting　up　erect；　but　remain　lying　in　the　same　position。　For　these
reasons；　neither　the　same　position　nor　the　same　mode　of　bandaging
applies　to　the　arm　and　to　the　leg。　If；　then；　extension　by　means　of　men
be　sufficient；　we　should　not　have　recourse　to　any　useless
contrivances；　for　it　any　useless　contrivances；　for　it　is　absurd　to
employ　mechanical　means　when　not　required；　but　if　extension　by　men
be　not　sufficient；　you　may　use　any　of　the　mechanical　powers　which　is
suitable。　When　sufficiently　extended；　it　will　be　easy　to　adjust　the
bones　and　bring　them　into　their　natural　position；　by　straightening　and
arranging　them　with　the　palms　of　the　hand。
　　16。　When　the　parts　are　adjusted；　you　should　apply　the　bandages　while
the　limb　is　in　a　stretched　position；　making　the　first　turns　to　the
right　or　to　the　left；　as　may　be　most　suitable；　and　the　end　of　the
bandage　should　be　placed　over　the　fracture；　and　the　first　turns　made
at　that　place；　and　then　the　bandage　should　be　carried　up　the　leg；　as
described　with　regard　to　the　other　fractures。　But　the　bandages
should　be　broader　and　longer；　and　more　numerous；　in　the　case　of　the
leg　than　in　that　of　the　arm。　And　when　it　is　bandaged　it　should　be　laid
upon　some　smooth　and　soft　object；　so　that　it　may　not　be　distorted　to
the　one　side　or　the　other；　and　that　there　may　be　no　protrusion　of
the　bones　either　forward　or　backward；　for　this　purpose　nothing　is　more
convenient　than　a　cushion；　or　something　similar；　either　of　linen　or
wool；　and　not　hard；　it　is　to　be　made　hollow　along　its　middle；　and
placed　below　the　limb。　With　regard　to　the　canals　（gutters？）　usually
placed　below　fractured　legs；　I　am　at　a　loss　whether　to　advise　that
they　should　be　used　or　not。　For　they　certainly　are　beneficial；　but　not
to　the　extent　which　those　who　use　them　suppose。　For　the　canals　do
not　preserve　the　leg　at　rest　as　they　suppose；　nor；　when　the　rest　of
the　body　is　turned　to　the　one　side　or　the　other；　does　the　canal
prevent　the　leg　from　following；　unless　the　patient　himself　pay
attention；　neither　does　the　canal　prevent　the　limb　from　being　moved
without　the　body　to　the　one　side　or　the　other。　And　a　board　is　an
uncomfortable　thing　to　have　the　limb　laid　upon；　unless　something
soft　be　placed　above　it。　But　it　is　a　very　useful　thing　in　making　any
subsequent　arrangements　of　the　bed　and　in　going　to　stool。　A　limb
then　may　be　well　or　ill　arranged　with　or　without　the　canal。　But　the
common　people　have　more　confidence；　and　the　surgeon　is　more　likely
to　escape　blame；　when　the　canal　is　placed　under　the　limb；　although
it　is　not　secundum　artem。　For　the　limb　should　by　all　means　lie
straight　upon　some　level　and　soft　object；　since　the　bandaging　must
necessarily　be　overcome　by　any　distortion　in　the　placing　of　the　leg；
whenever　or　to　whatever　extent　it　may　be　inclined。　The　patient；　when
bandaged；　should　return　the　same　answers　as　formerly　stated；　for　the
bandaging　should　be　the　same；　and　the　same　swellings　should　arise　in
the　extremities；　and　the　slackening　of　the　bandages　in　like　manner；
and　the　new　bandaging　on　the　third　day；　and　the　bandaged　part　should
be　found　reduced　in　swelling；　and　the　new　bandagings　should　be　more
tightly　put　on；　and　more　pieces　of　cloth　should　be　used；　and　the
bandages　should　be　carried　loosely　about　the　foot；　unless　the　wound　be
near　the　knee。　Extension　should　be　made　and　the　bones　adjusted　at
every　new　bandaging；　for；　if　properly　treated；　and　if　the　swelling
progress　in　a　suitable　manner；　the　bandaged　limb　will　have　become　more
slender　and　attenuated；　and　the　bones　will　be　more　mobile；　and　yield
more　readily　to　extension。　On　the　seventh；　the　ninth；　or　the
eleventh　day；　the　splints　should　be　applied　as　described　in　treating
of　the　other　fractures。　Attention　should　be　paid　to　the　position　of
the　splints　about　the　ankles　and　along　the　tendon　of　the　foot　which
runs　up　the　leg。　The　bones　of　the　leg　get　consolidated　in　forty
days；　if　properly　treated。　But　if　you　suspect　that　anything　is　wanting
to　the　proper　arrangement　of　the　limb；　or　dread　any　ulceration；　you
should　loose　the　bandages　in　the　interval；　and　having　put　everything
right；　apply　them　again。
　　17。　But　if　the　other　bone　（fibula？）　of　the　leg　be　broken；　less
powerful　extension　is　required；　and　yet　it　must　not　be　neglected；
nor　be　performed　slovenly；　more　especially　at　the　first　bandaging。　For
in　all　cases　of　fracture　this　object　should　be　attained　then　as
quickly　as　possible。　For　when　the　bandage　is　applied　tight　while　the
bones　are　not　properly　arranged；　the　properly　arranged；　the　part
becomes　more　painful。　The　treatment　otherwise　is　the　same。
　　18。　Of　the　bones　of　the　leg；　the　inner　one；　called　the　tibia；　is　the
more　troublesome　to　manage；　and　requires　the　greater　extension；　and　if
the　broken　bones　are　not　properly　arranged；　it　is　impossible　to
conceal　the　distortion；　for　the　bone　is　exposed　and　wholly　uncovered
with　flesh；　and　it　is　much　longer　before　patients　can　walk　on　the
leg　when　this　bone　is　broken。　But　if　the　outer　bone　be　broken；　it
causes　much　less　trouble；　and　the　deformity；　when　the　bones　are　not
properly　set；　is　much　more　easily　concealed；　the　bone　being　well
covered　with　flesh；　and　the　patients　speedily　get　on　foot；　for　it　is
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