on fractures-第4节

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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。
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　tha