on fractures-第6章

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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　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　i