On Fractures

By Hippocrates
Translated by Francis Adams
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PART 1
In reating fractures and dislocations, te pysician must ma!e te
e"tension as straigt as possible, for tis is te most natural direction#
But if it incline to eiter side, it sould rater turn to tat of
pronation, for tere is tus less arm tan if it be to$ard supination#
Tose, ten, $o act in suc cases $itout deliberation, for te most
part do not fall into any great mista!e, for te person $o is to
a%e is arm bound, presents it in te proper position from necessity,
but pysicians $o fancy temsel%es learned in tese matters, are
tey $o commit blunders# Tere is no necessity for muc study, ten,
in order to set a bro!en arm, and in a $ord, any ordinary pysician
can perform it& but I am under te necessity of gi%ing te longer
directions on tis sub'ect, because I !no$ pysicians $o a%e te
reputation of being s!illed in gi%ing te proper positions to te
arm in binding it up, $ile in reality tey are only so$ing teir
o$n ignorance# But many oter tings in our art are 'udged of in tis
manner, for people rater admire $at is ne$, altoug tey do not
!no$ $eter it be proper or not, tan $at tey are accustomed to,
and !no$ already to be proper& and $at is strange, tey prefer to
$at is ob%ious# I must no$ state $at te mista!es of medical men
are, $ic I $is to unteac, and $at instructions I a%e to gi%e
as to te management of te arm& for $at I a%e to say regarding
it, $ill apply to te oter bones in te body#
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PART (
Te arm, ten, for tat is te sub'ect $e $ere treating of, $as presented
in te prone position to be bound, but te pysician forced is patient
to old it as te arcers do $en tey pro'ect te soulder, and in
tis position e bound it up, tin!ing $itin imself tat e $as
acting according to )ature, and in proof of tis e pointed out tat
all te bones in te fore-arm $ere tus in a straigt line, and tat
te integuments bot inside and outside, $ere also in a straigt line,
and tat te fles and ner%es *tendons+, $ere tus put in teir natural
position, and e appealed to $at appens in arcery, as a proof of
tis# And so saying, and so doing, e is loo!ed up to as a sage& and
yet e forgets tat in all te oter arts and performances, $eter
e"ecuted $eter e"ecuted by strengt or de"terity, $at is rec!oned
te natural position is not te same, and tat in te same piece of
$or! it may appen tat te natural position of te rigt arm is not
te same as tat of te left# For tere is one attitude in tro$ing
te 'a%elin, and anoter in slinging, anoter in casting stones, anoter
in bo"ing, and anoter in a state of repose# And $ate%er arts one
e"amines, it $ill be found tat te natural position of te arms is
not te same in eac, but tat in e%ery case te arms are put into
te attitude $ic suits best $it te instrument tat is used, and
te $or! to be performed# In practicing arcery, no doubt tis is
te best attitude of te left arm, for gingly-moid e"tremity of te
umerus being fi"ed in te ca%ity of te ulna, in tis position, tro$s
te bones of te forearm and arm into a line, as if tey constituted
a single bone, and all fle"ion at te 'oint is pre%ented in tis position#
It is no doubt certain tat te member is tus put into te most unbending
and e"tended position possible, so as not to be o%ercome or yield
$en te string is dra$n by te rigt arm, and tus $ill te arcer
be enabled to dra$ te string fartest, and discarge is arro$ $it
te greatest force and rapidity, for arro$s tus discarged a%e te
greatest s$iftness and force, and are carried to te greatest distances#
But tere is noting in common bet$een te binding up of an arm and
arcery# -oreo%er, if a%ing tus bound up te arm, te pysician
direct te patient to !eep it tus, e $ill occasion im greater pain
tan e ad from te $ound itself& and tus also, if te pysician
order im to bend te arm, neiter te bones, te ner%es, nor te
fles $ill any longer be in te same condition, but $ill be arranged
differently, a%ing o%ercome te bandaging# .at use, ten, is tere
of te arcer/s attitude+ And tese mista!es, te pysician, conceited
in is !no$ledge, $ould probably not a%e committed if e ad allo$ed
te patient imself to present is arm#
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PART 0
But anoter pysician putting te arm into te state of supination,
gi%es orders to e"tend te arm tus, and bandages it in tis position,
rec!oning it te one according to nature, 'udging tus from te s!in,
and also fancying te bones to be tus in teir natural position,
because te bone $ic protrudes at te $rist, $ere te little finger
is, appears to be in a line $it te bone from $ic people measure
te bone of te fore-arm# Tese tings e brings for$ard as proofs
tat te parts are in teir natural state, and e is supposed to spea!
correctly# But, indeed, if te arm be !ept stretced in a supine position,
it $ill become %ery painful, and tis fact any one may ascertain by
e"tending is o$n arm in tis attitude# And also a $ea!er man grasping
$it is ands a stronger man $ose arm is turned in a supine position,
could lead im $ere%er e cose, and neiter, if a man eld a s$ord
tus in is and, could e ma!e any proper use of it, so constrained
is tis position# And, moreo%er, if, $en a pysician as tus bound
up te arm, e allo$ it to remain in te same position, te patient
$ill endure greater pain if e $al! about, but considerable, e%en
if e remain at rest# And tus, too, if e sall bend te arm, te
muscles and te bones must necessarily assume a different position#
But, in addition to oter miscief, e is ignorant of tese facts
regarding te position, tat te bone $ic protrudes at te $rist,
close to te little finger, belongs to te fore-arm, $ereas te one
at te 'oint, from $ic people measure te fore-arm, is te ead
of te umerus# He fancies tat bot tese belong to te same bone,
and many oters are of tis opinion# Te latter, in fact, is te same
part as tat $ic is called te elbo$, upon $ic $e sometimes rest,
and $en e olds te arm tus in a supine position, in te first
place te bone appears distorted, and in te ne"t place te tendons
$ic e"tend from te carpus along te inner side and from te fingers
become distorted $ile te arm as a supine position& for tese tendons
proceed to te bone of te umerus, from $ic te fore-arm is measured#
1uc, and so many mista!es and mar!s of ignorance are committed, regarding
te natural construction of te arm# But if one $ill e"tend a bro!en
arm as I direct, e $ill turn te bone, situated at te e"tremity
of te little finger, into te straigt line, and also te one at
te elbo$, and te tendons $ic stretc from te carpus to te e"tremity
of te umerus $ill be placed in te straigt line& and $en te arm
is suspended in a sling, it $ill be in te same attitude as tat in
$ic it $as bound up, and $ill gi%e no pain to te patient $en e
$al!s about, nor $en e lies reclined, and $ill not become fatigued#
Te man sould be so seated tat te prominent part of te bone may
be turned to te brigtest ligt $ic is at and, so tat te operator
in ma!ing te e"tension, may be at no loss to disco%er if it be sufficiently
straigt# Te prominence of a bro!en bone could not escape being detected
by te and of an e"perienced person, $en applied for tis purpose,
and, moreo%er, te pro'ecting part is particularly painful to te
touc#
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PART 2
In cases of fracture in eiter of te bones of te forearm, it is
easier to effect a cure if te upper bone be bro!en, altoug it be
te tic!er one, bot because te sound bone is situated belo$, and
forms a support to it, and because te deformity is more easily concealed,
tere being a tic! mass of fles on te upper side, e"cept near to
te $rist# But te lo$er bone is $itout a co%ering of fles, is not
easily concealed, and re3uires stronger e"tension# If it is not tis
bone, but te oter $ic is bro!en, a more feeble e"tension pro%es
sufficient, but if bot be bro!en, a more po$erful e"tension is re3uired#
In te case of a young person I a%e !no$n te e"tension made more
strong tan $as necessary, but in general te e"tension made is less
tan $at is re3uired# And $en tey are e"tended, te pysician sould
apply te palms of te ands, and ad'ust te fractured parts and ten
a%ing rubbed te parts $it cerate, but not in large 3uantity so
tat te bandages may not come off, it is to be bound up in tis state,
care being ta!en tat te and be not lo$er tan te elbo$, but a
little iger, so tat te blood do not flo$ to$ard te e"tremity,
but may be determined to te upper part& and ten it is to be secured
$it te bandage, te ead of $ic is to be placed at te fracture,
and te bandage sould impart firmness to te parts $itout occasioning
strong compression# .en you a%e carried te bandage t$ice or trice
round at te seat of te fracture, it is to be carried up$ard, so
tat te afflu" of blood into it may be stopped, and te bandage sould
terminate tere, and te first bandages ougt not to be long# Te
ead of te second bandage is also to be placed upon te seat of te
fracture, and a single round of it being made tere, it is ten to
be carried do$n$ard, and is not to be applied so tigt as te oter,
and tere sould be greater distances bet$een te turns, so tat te
bandage may pro%e sufficient to re%ert to te spot $ere te oter
terminated# Te bandages may be rolled to te left and or to te
rigt, or to $ate%er side suits best $it te position of te fractured
arm, or according to te inclination $ic it may a%e# After$ard
$e must place along te arm, compresses, smeared $it a little cerate,
for tus tey occasion less uneasiness, and are more easily arranged#
And ten $e must apply te bandages cross$ays, sometimes to te rigt
and, and sometimes to te left, for te most part beginning belo$
and terminating abo%e, but sometimes commencing abo%e and ending belo$#
Te parts $ic are tinly co%ered $it fles sould be $rapped round
$it compresses, and ine3ualities sould be made up, not by a number
of folds at once, but by degrees# 1ome slac! turns are also to be
made around te $rist, to tis side and to tat# Tese t$o bandages
are sufficient at first#
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PART 4
And tese are te signs tat te patient as been $ell treated and
properly bandaged5 if you as! im if te arm feels tigt, and e says
it does, but moderately so, and especially about te fracture& and
tis reply e sould ma!e all along, if te bandage be properly applied#
And tese are symptoms of te bandaging being moderately tigt& if
for te first day and nigt e fancies tat te tigtness does not
diminis, but rater increases& and if on te ne"t day tere be a
soft s$elling in te and, for tis is a sign of moderate compression,
but at te end of te second day te compression sould feel less,
and on te tird day te bandaging sould appear loose# And if any
of tese symptoms be $anting, you may conclude tat te bandaging
is slac!er tan it sould be& or if any of tese symptoms be in e"cess,
you may infer tat te compression is more tan moderate& and 'udging
from tese, you $ill apply te ne"t bandages eiter slac!er or tigter#
Ha%ing remo%ed te bandages on te tird day, you must ma!e e"tension
and ad'ust te fracture, and bind it up again& and if te first bandaging
$as moderately applied, te second bandaging sould be made some$at
tigter# Te eads te bandages sould be placed on te fractures
as in te former case& for, so doing, te umors $ill be dri%en to
te e"tremities, $ereas if you bandage any oter part beforeand,
te umors $ill e forced from it to te seat of te fracture5 it
is of muc importance tat tis sould be properly understood# Tus
te bandaging and compression sould al$ays commence at te seat of
te fracture, and e%eryting else sould be conducted on te same
principle, so tat te farter you proceed from te fracture, te
compression sould al$ays be te less# Te bandages sould ne%er be
actually loose, but sould be smootly put on# At eac dressing te
number of bandages sould be increased& and te patient, if as!ed,
sould ans$er, tat e feels te bandages some$at tigter tan on
te former occasion, especially about te fracture, and e%eryting
else in proportion& and $it respect to te s$elling, te pain, and
reco%ery, e%eryting sould proceed as after te former dressing#
But on te tird day te outer bandaging sould appear looser# Ten
a%ing remo%ed te bandages, you sould bind it up again, some$at
tigter tan before, and $it all te bandages $ic $ill be re3uired
on te occasion, and after$ards one ougt to e"perience te same train
of symptoms as at te former periods of bandaging#
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PART 6
.en te tird day arri%es, tat is to say, te se%ent from te first
dressing, if properly done, te s$elling in te and sould be not
%ery great& and te part $ic as been bandaged sould be found more
slender and less s$elled at eac time, and on te se%ent day te
s$elling sould be 3uite gone, and te bro!en bones sould be more
readily mo%ed, and admit of being easily ad'usted# And if tese tings
be so, you sould, after setting te fracture, apply te bandages
so as to suit te splints, and a little more tigt tan formerly,
unless tere be more pain from te s$elling in te and# .en you
a%e applied te bandages, you must ad'ust te splints all around
te limb, and secure tem secure tem $it strings so loose as 'ust
to !eep tem in teir place, $itout te application of te splints
contributing at all to te compression of te arm# After tis te
pain and reco%ery sould proceed as in te preceding periods of te
bandaging# But if, on te tird day, te patient say tat te bandaging
is loose, you must ten fasten te splints, especially at te fracture,
but also else$ere, $ere%er te bandaging is rater loose tan tigt#
Te splint sould be tic!est $ere te fracture protrudes, but it
sould not be muc more so tan else$ere# Particular attention sould
be paid to te line of te arm corresponding to te tumb, so tat
no splint be laid on it, but upon eac side of it, nor in te line
of te little finger $ere te bone is prominent at te $rist, but
on eac side of it# And if it be found necessary tat splints sould
be applied in tese directions at te seat of te fracture, tey sould
be made sorter tan te oters, so as tat tey may not reac te
bones $ic are prominent at te $rist, for oter$ise tere is danger
of ulceration, and of te tendons being laid bare# Te splints sould
be ad'usted ane$ e%ery tird day, in a %ery gentle manner, al$ays
!eeping in mind tat te ob'ect of te splints is to maintain te
lo$er bandages in teir place, and tat tey are not needed in order
to contribute to te compression#
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PART 7
If, ten, you see tat te bones are properly ad'usted by te first
dressings, and tat tere is no troublesome pruritus in te part,
nor any reason to suspect ulceration, you may allo$ te arm to remain
bandaged in te splints until after te lapse of more tan t$enty
days# Te bones of te fore-arm generally get consolidated in tirty
days altogeter& but tere is noting precise in tis matter, for
one constitution differs from anoter, and one period of life from
anoter# .en you remo%e te bandages, you must pour ot $ater on
te arm and bind it up again, but some$at slac!er, and $it fe$er
bandages tan formerly5 and again on te tird day you undo te bandages,
and bind it still more loosely, and $it still fe$er bandages# And
if, $ile te arm is bound up in te splints, you sould at any time
suspect tat te bones do not lie properly, or if anyting about te
bandages annoys te patient, you sould loose tem at te middle of
te time, or a little earlier, and apply tem again# A diet sligtly
restricted $ill be sufficient in tose cases in $ic tere $as no
e"ternal $ound at first, or $en te bone does not protrude& but one
sould li%e rater sparingly until te tent day, as being no$ depri%ed
of e"ercise& and tender articles of food sould be used, suc as moderately
loosen te bo$els& but one sould abstain altogeter from fles and
$ine, and ten by degrees resume a more nourising diet# Tis diet#
may be laid do$n as a 'ust rule in te treatment of fractures, bot
as to o$ tey sould be treated, and $at $ill be te results of
a proper plan of treatment& so tat one may !no$, tat if tings do
not turn out tus, tere as been some defect or e"cess in te treatment#
And in tis simple plan of treatment it is necessary to attend also
to te follo$ing directions, $ic some pysicians pay little attention
to, altoug, $en improperly e"ecuted, tey are capable of marring
te $ole process of bandaging5 for if bot te bones be bro!en, or
te lo$er one only, and te patient $o as got is arm bandaged !eep
it slung in a sa$l, and tat te sa$l is particularly loose at te
fracture, so tat te arm is not properly suspended at tis end or
tat, in tis case te bone must necessarily be found distorted up$ards&
$ereas, $en bot bones are tus bro!en, if te arm recline in te
sa$l at te $rist and elbo$, but te rest of it be not !ept up, te
bone in tis case $ill be distorted to te lo$er side# Te greater
part of te arm and te $rist of te and sould terefore be e3ually
suspended in a broad soft sa$l#
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PART 8
.en te arm is bro!en, if one stretc te fore-arm and ad'ust it
$ile in tis position, te muscle of te arm $ill be bound $ile
e"tended& but $en te dressing is o%er, and te patient bends is
arm at te elbo$, te muscle of te arm $ill assume a different sape#
Te follo$ing, ten, is te most natural plan of setting te arm5
a%ing got a piece of $ood a cubit or some$at less in lengt, li!e
te andles of spades, suspend it by means of a cain fastened to
its e"tremities at bot ends& and a%ing seated te man on some ig
ob'ect, te arm is to be brougt o%er, so tat te armpit may rest
on te piece of $ood, and te man can scarcely touc te seat, being
almost suspended& ten a%ing brougt anoter seat, and placed one
or more leater pillo$s under te arm, so as to !eep it a moderate
eigt $ile it is bent at a rigt angle, te best plan is to put
round te arm a broad and soft s!in, or broad sa$l, and to ang some
great $eigt to it, so as to produce moderate e"tension& or oter$ise,
$ile te arm is in te position I a%e described, a strong man is
to ta!e old of it at te elbo$ and pull it do$n$ard# But te pysician
standing erect, must perform te proper manipulation, a%ing te one
foot on some pretty ig ob'ect, and ad'usting te bone $it te palms
of is ands& and it $ill readily be ad'usted, for te e"tension is
good if properly applied# Ten let im bind te arm, commencing at
te fracture, and do oter$ise as directed abo%e& let im put te
same 3uestions and a%ail imself of te same signs to ascertain $eter
te arm be moderately tigt or not& and e%ery tird day let im bind
it ane$ and ma!e it tigter& and on te se%ent or nint day let im
bind it up $it splints, and lea%e it so until after te lapse of
more tan tirty days# And if e suspect tat te bone is not lying
properly, let im remo%e te bandages in te inter%al, and a%ing
ad'usted te arm, let im bind it up again# Te bone of te arm is
generally consolidated in forty days# .en tese are past, te dressing
is to be remo%ed, and fe$er and slac!er bandages applied instead of
it# Te patient is to be !ept on a stricter diet, and for a longer
space of time tan in te former case& and $e must form our 'udgment
of it from te s$elling in te and, loo!ing also to te strengt
of te patient# Tis also sould be !no$n, tat te arm is naturally
inclined out$ard& to tis side, terefore, te distortion usually
ta!es place, if not properly treated& but indeed, all te oter bones
are usually distorted during treatment for fracture to tat side to
$ic tey naturally incline# .en, terefore, anyting of tis !ind
is suspected, te arm is to be encircled in a broad sa$l, $ic is
to be carried round te breast, and $en te patient goes to rest,
a compress of many folds, or some suc ting, is to be folded and
placed bet$een te elbo$ and te side, for tus te bending of te
bone $ill be rectified, but care must be ta!en lest it be inclined
too muc in$ards#
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PART 9
Te uman foot is composed of se%eral small bones li!e te and# Tese
bones terefore are scarcely e%er bro!en, unless te s!in at te same
time be $ounded by some sarp and ea%y body# Te treatment of stic
in'uries, terefore, $ill be deli%ered under te ead of $ounds# But
if any bone be mo%ed from its place, or a 'oint of te toes be lu"ated,
or any of te bones of te part called te tarsus be displaced, it
must be forced bac! again to its place as described $it regard to
te and& and is to be treated $it cerate, compresses, and bandages,
li!e te fractures, $it te e"ception of te splints& and is to be
secured tigtly in te same $ay, and te bandages rene$ed on te tird
day& and te patient tus bandaged sould return te same ans$ers
as in fractures, as to te bandages feeling tigt or slac!# All tese
bones reco%er perfectly in t$enty days, e"cept tose tat are connected
$it te bones of te leg, and are in a line $it tem# It is ad%antageous
to lie in bed during te $ole of tis time& but te patients, tin!ing
ligt of te complaint, a%e not perse%erance to do tis, and tey
$al! about before tey get $ell& $erefore many of tese do not ma!e
a perfect reco%ery# And often te pain puts tem in mind of te in'ury&
and deser%edly, for te feet sustain te $eigt of te $ole body#
.en, terefore, tey $al! about before tey are $ole, te 'oints
$ic a%e been lu"ated are cured incompletely& and, on tat account,
$ile $al!ing about, tey a%e pains in te leg from time to time#
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PART 1:
But tose bones $ic are connected $it te bones of te leg are
larger tan te oters, and te cure of tem $en lu"uated is more
protracted# Te mode of treatment ten is te same& but $e must use
more bandages and more splints, and te bandage is to be carried round
to tis side and to tat, and pressure is to be made as in te oter
cases, particularly at te seat of te lu"ation, and te first circles
of te bandages are to be made tere# And at eac time te bandages
are ta!en off, muc ot $ater is to be used, for in all in'uries at
'oints te affusion of ot $ater in large 3uantity is to be ad recourse
to# And te same symptoms of compression and rela"ation sould manifest
temsel%es in te same times, as in te cases formerly treated of,
and te subse3uent bandagings sould be conducted in li!e manner#
Tese cases get completely $ell for te most part in forty days, if
te patients a%e resolution to !eep teir bed& but if not, tey are
sub'ected to te complaints formerly described, or still $orse#
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PART 11
In persons $o 'umping from any ig ob'ect pitc upon teir eel
$it great force, te bones are separated, and te %eins pour fort
teir contents, o$ing to te contusion of te fles surrounding te
bone, and ence a s$elling and muc pain super%ene# For tis bone
*os calcis, is not a small one, protrudes beyond te line of te leg,
and is connected $it important %eins and tendons& for te bac! tendon
of te leg is inserted into tis bone# 1uc cases are to be treated
$it cerate, and $it compresses and bandages& and ot $ater is to
be used in large 3uantity& and tey re3uire many bandages, $ic ougt
to be particularly good and appropriate# And if te patient appen
to a%e a tender s!in about te eel, noting is to be done to it&
but if, as some a%e it, te s!in be tic! and ardened, it is to
be pared do$n smootly and tinned, but $itout $ounding it# It is
not e%erybody $o can apply te bandage properly in suc cases& for
if one sall bind te parts, as in oter accidents about te an!le,
sometimes bringing a fold round te foot and sometimes round te tendon,
tese turns lea%e out te eel, $ic is te seat of te contusion,
and tus tere is danger tat te os calcis may spacelate& and if
tis sould ta!e place, te impediment may endure for life and also
in all te oter cases of spacelus, not proceeding from suc a cause
as tis& as $en, from being carelessly allo$ed to lie in a certain
position during confinement to bed, te eel becomes blac!, or $en
a serious $ound as occurred in te leg and it is long of ealing,
and is connected $it te eel, or $en te same ting appens in
te tig, or $en in any disease a protracted decubitus ta!es place
on te bac!, in all suc cases te sores are in%eterate, troublesome,
and fre3uently brea! out again, unless particular attention be paid
to te cure, along $it muc rest, as in all te cases attended $it
spacelus# And cases of spacelus connected $it tis cause, in addition
to oter incon%eniences, are attended $it great danger to te $ole
body# For tey are apt to be attended $it %ery acute fe%ers, of te
continual type, accompanied $it tremblings, iccup, aberration of
intellect, and $ic pro%e fatal $itin a fe$ days5 and tere may
be li%idities of bloody %eins, $it nausea, and gangrene from pressure&
tese diseases may occur, besides te spacelus# Tose $ic a%e
been described are te most %iolent contusion& but in general te
contusions are mild, and no great care is re3uired $it regard to
te treatment, and yet it must be conducted properly# But $en te
contusion appears to be se%ere, $e must do as described abo%e, ma!ing
many turns of te bandage around te eel, sometimes carrying it to
te e"tremity of te foot, sometimes to te middle, and sometimes
around te leg& and, in addition, all te surrounding parts are to
be bandaged in tis direction and tat, as formerly described& and
te compression sould not be made strong, but $e sould ma!e use
of many bandages, and it is better also to administer ellebore te
same day or on te morro$& and te bandages sould be remo%ed on te
tird day and reapplied# And tese are te symptoms by $ic $e disco%er
$eter te case $ill get $orse or not5 $en te e"tra%asated blood,
te li%idities, and te surrounding parts become red and ard, tere
is danger of an e"acerbation# But if tere be no fe%er, $e must gi%e
emetics, as as been said, and administer te oter remedies $ic
are applicable $en te fe%er is not of a continual type& but if continual
fe%er be present, $e must not gi%e strong medicines, but en'oin abstinence
from solid food and soups, and gi%e $ater for drin!, and not allo$
$ine but o"ygly!y *a composition from %inegar and oney+,# But if
te case be not going to get $orse, te eccymosed and li%id parts,
and tose surrounding tem become greenis and not ard& for tis
is a satisfactory proof in all cases of eccymosis, tat tey are
not to get $orse& but $en li%idity is complicated $it ardness,
tere is danger tat te part may become blac!ened# And $e must so
manage te foot as tat it may be generally raised a little iger
tan te rest of te body# 1uc a patient $ill get $ell in si"ty days
if e !eep 3uiet#
----------------------------------------------------------------------
PART 1(
Te leg consists of t$o bones, of $ic te one is muc more slender
tan te oter at one part, but not muc more slender at anoter#
Tese are connected togeter at te foot, and form a common epipysis,
but tey are not united togeter along te line of te leg& and at
te tig tey are united togeter and form an epipysis, and tis
epipysis as a diapysis& but te oter bone in a line $it te little
toe is a little longer# 1uc is te nature of te bones of te leg#
----------------------------------------------------------------------
PART 10
1ometimes te bones connected $it te foot are displaced, sometimes
bot bones $it teir epipysis& sometimes te $ole epipysis is
sligtly mo%ed, and sometimes te oter bone# Tese cases are less
troublesome tan te same accidents at te $rist, if te patients
$ill a%e resolution to gi%e tem rest# Te mode of treatment is te
same as tat of te oter, for te reduction is to be made, as of
te oter, by means of e"tension, but greater force is re3uired, as
te parts of te body concerned are stronger in tis case# But, for
te most part, t$o men $ill be sufficient, by ma!ing e"tension in
opposite directions, but, not $itstanding, if tey are not sufficiently
strong, it is easy to ma!e more po$erful e"tension in te follo$ing
$ay5 a%ing fi"ed in te ground eiter te na%e of a $eel, or any
suc ob'ect, someting soft is to be bound round te foot, and ten
some broad tongs of o"-s!in being brougt round it, te eads of
te tongs are to be fastened to a pestle or any oter piece of $ood,
te end of $ic is to be inserted into te na%e, and it, te pestle,
is to be pulled a$ay, $ile oter persons ma!e counter-e"tension by
grasping te soulders and te am# It is also sometimes necessary
to secure te upper e"tremity oter$ise& tis if you desire to effect,
fasten deeply in te ground a round, smoot piece of $ood, and place
te upper e"tremity of te piece of $ood at te perineum, so tat
it may pre%ent te body from yielding to te pulling at te foot,
and, moreo%er, to pre%ent te leg $ile stretced, from inclining
do$n$ard& some person seated at is side sould pus bac! te ip,
so tat te body may not turn round $it te pulling, and for tis
purpose, if you tin! fit, pieces of $ood may be fastened about te
armpits on eac side, and tey are to be stretced by te ands, and
tus secured, $ile anoter person ta!es old of te limb at te !nee,
and aids in tus ma!ing counter-e"tension# Or tus, if you prefer
it5 a%ing bound oter tongs of leater about te limb, eiter at
te !nee, or around te tig, and a%ing fastened anoter na%e of
a $eel in te ground abo%e te ead, and ad'usted te tongs piece
of $ood adapted to te na%e, e"tension may tus be made in te opposite
direction to te feet# Or if you coose, it may be done tus5 instead
of te na%es, lay a moderate-si;ed beam under te couc, and ten
a%ing fastened pieces of $ood in tis beam, bot before and beind
te ead, ma!e counter-e"tension by means of tongs, or place $indlasses
at tis e"tremity and tat, and ma!e e"tension by means of tem# Tere
are many oter metods of ma!ing e"tension# But te best ting is,
for any pysician $o practices in a large city, to a%e prepared
a proper $ooden macine, $it all te mecanical po$ers applicable
in cases of fractures and dislocation, eiter for ma!ing e"tension,
or acting as a le%er# For tis purpose it $ill be sufficient to possess
a board in lengt, breadt, and tic!ness, resembling te 3uadrangular
tresing-boards made of oa!#
----------------------------------------------------------------------
PART 12
.en you a%e made proper e"tension, it is easy reduce te 'oint,
for te displaced bone is tus raised into a line $it te oter#
And te bones are to be ad'usted $it te palms of te ands, pressing
upon te pro'ecting bone $it te one, and ma!ing counter-pressure
belo$ te an!le $it te oter# .en you a%e replaced te bones,
you must apply te bandages $ile te parts are upon te stretc,
if you possibly can& but if pre%ented by te tongs, you must loose
tem, and ma!e counter-e"tension until you get te bandages applied#
Te bandage is to be applied in te manner formerly described, te
eads of te bandages being placed on te pro'ecting part, and te
first turns made in li!e manner, and so also $it regard to te number
of compresses and te compression& and turns of te bandages are to
be brougt fre3uently round on tis and on tat side of te an!le#
But tis 'oint must be bound more tigt at te first dressing tan
in te case of te and# But $en you a%e applied te bandage, you
must place te bandaged part some$at iger tan te rest of te
body, and in suc a position tat te foot may ang as little as possible#
Te attenuation of te body is to be made proportionate to te magnitude
of te lu"ation, for one lu"ation is to be a small, and anoter to
a great e"tent# But in general $e must reduce more, and for a longer
time, in in'uries about te legs, tan in tose about te ands& for
te former parts are larger and tic!er tan te latter, and it is
necessary tat te body sould be !ept in a state of rest, and in
a recumbent position# Tere is noting to pre%ent or re3uire te limb
to be bandaged ane$ on te tird day# And all te treatment oter$ise
is to be conducted in li!e manner, as in te preceding cases# And
if te patient a%e resolution to lie 3uiet, forty days $ill be sufficient
for tis purpose, if only te bones be properly reduced, but if e
$ill not lie 3uiet, e $ill not be able to use te limb $it ease,
and e $ill find it necessary to $ear a bandage for a long time# .en
te bones are not properly replaced, but tere as been some defect
in tis respect, te ip, te tig, and te leg become $asted, and
if te dislocation be in$ard, te e"ternal part of te tig is $asted,
and %ice %ersa# But for te most part te dislocation is in$ard#
----------------------------------------------------------------------
PART 14
And $en bot bones of te leg are bro!en $itout a $ound of te s!in,
stronger e"tension is re3uired# .e may ma!e e"tension by some of te
metods formerly described, pro%ided te bones ride o%er one anoter
to a considerable degree# But e"tension by men is also sufficient,
and for te most part t$o strong men $ill suffice, by ma!ing e"tension
and countere"tension# <"tension must naturally be made straigt in
a line $it te leg and tig, $eter on account of a fracture of
te bones of te leg or of te tig# And in bot cases tey are to
be bandaged $ile in a state of e"tension, for te same position does
not suit $it te leg and te arm# For $en te fractured bones of
te arm or fore-arm are bandaged, te fore-arm is suspended in a sling,
and if you bind tem up $ile e"tended, te figures of te flesy
parts $ill be canged in bending te arm at te elbo$, for te elbo$
cannot be !ept long e"tended, since persons are not in te custom
of !eeping te 'oint long in tis form, but in a bent position, and
persons $o a%e been $ounded in te arm, and are still able to $al!
about, re3uire to a%e te arm bent at te elbo$-'oint# But te leg,
bot in $al!ing and standing, is abitually e"tended, eiter completely
or nearly so, and is usually in a depending position from its construction,
and in order tat it may bear te $eigt of te rest of te body#
.erefore it readily bears to be e"tended $en necessary, and e%en
$en in bed te limb is often in tis position# And $en $ounded,
necessity subdues te understanding, since te patients become incapable
of raising temsel%es up, so tat tey neiter tin! of bending te
limb nor of getting up erect, but remain lying in te same position#
For tese reasons, neiter te same position nor te same mode of
bandaging applies to te arm and to te leg# If, ten, e"tension by
means of men be sufficient, $e sould not a%e recourse to any useless
contri%ances, for it any useless contri%ances, for it is absurd to
employ mecanical means $en not re3uired& but if e"tension by men
be not sufficient, you may use any of te mecanical po$ers $ic
is suitable# .en sufficiently e"tended, it $ill be easy to ad'ust
te bones and bring tem into teir natural position, by straigtening
and arranging tem $it te palms of te and#
----------------------------------------------------------------------
PART 16
.en te parts are ad'usted, you sould apply te bandages $ile te
limb is in a stretced position, ma!ing te first turns to te rigt
or to te left, as may be most suitable& and te end of te bandage
sould be placed o%er te fracture, and te first turns made at tat
place& and ten te bandage sould be carried up te leg, as described
$it regard to te oter fractures# But te bandages sould be broader
and longer, and more numerous, in te case of te leg tan in tat
of te arm# And $en it is bandaged it sould be laid upon some smoot
and soft ob'ect, so tat it may not be distorted to te one side or
te oter, and tat tere may be no protrusion of te bones eiter
for$ard or bac!$ard& for tis purpose noting is more con%enient tan
a cusion, or someting similar, eiter of linen or $ool, and not
ard& it is to be made ollo$ along its middle, and placed belo$ te
limb# .it regard to te canals *gutters+, usually placed belo$ fractured
legs, I am at a loss $eter to ad%ise tat tey sould be used or
not# For tey certainly are beneficial, but not to te e"tent $ic
tose $o use tem suppose# For te canals do not preser%e te leg
at rest as tey suppose& nor, $en te rest of te body is turned
to te one side or te oter, does te canal pre%ent te leg from
follo$ing, unless te patient imself pay attention& neiter does
te canal pre%ent te limb from being mo%ed $itout te body to te
one side or te oter# And a board is an uncomfortable ting to a%e
te limb laid upon, unless someting soft be placed abo%e it# But
it is a %ery useful ting in ma!ing any subse3uent arrangements of
te bed and in going to stool# A limb ten may be $ell or ill arranged
$it or $itout te canal# But te common people a%e more confidence,
and te surgeon is more li!ely to escape blame, $en te canal is
placed under te limb, altoug it is not secundum artem# For te
limb sould by all means lie straigt upon some le%el and soft ob'ect,
since te bandaging must necessarily be o%ercome by any distortion
in te placing of te leg, $ene%er or to $ate%er e"tent it may be
inclined# Te patient, $en bandaged, sould return te same ans$ers
as formerly stated, for te bandaging sould be te same, and te
same s$ellings sould arise in te e"tremities, and te slac!ening
of te bandages in li!e manner, and te ne$ bandaging on te tird
day& and te bandaged part sould be found reduced in s$elling& and
te ne$ bandagings sould be more tigtly put on, and more pieces
of clot sould be used& and te bandages sould be carried loosely
about te foot, unless te $ound be near te !nee# <"tension sould
be made and te bones ad'usted at e%ery ne$ bandaging& for, if properly
treated, and if te s$elling progress in a suitable manner, te bandaged
limb $ill a%e become more slender and attenuated, and te bones $ill
be more mobile, and yield more readily to e"tension# On te se%ent,
te nint, or te ele%ent day, te splints sould be applied as described
in treating of te oter fractures# Attention sould be paid to te
position of te splints about te an!les and along te tendon of te
foot $ic runs up te leg# Te bones of te leg get consolidated
in forty days, if properly treated# But if you suspect tat anyting
is $anting to te proper arrangement of te limb, or dread any ulceration,
you sould loose te bandages in te inter%al, and a%ing put e%eryting
rigt, apply tem again#
----------------------------------------------------------------------
PART 17
But if te oter bone *fibula+, of te leg be bro!en, less po$erful
e"tension is re3uired, and yet it must not be neglected, nor be performed
slo%enly, more especially at te first bandaging# For in all cases
of fracture tis ob'ect sould be attained ten as 3uic!ly as possible#
For $en te bandage is applied tigt $ile te bones are not properly
arranged, te properly arranged, te part becomes more painful# Te
treatment oter$ise is te same#
----------------------------------------------------------------------
PART 18
Of te bones of te leg, te inner one, called te tibia, is te more
troublesome to manage, and re3uires te greater e"tension& and if
te bro!en bones are not properly arranged, it is impossible to conceal
te distortion, for te bone is e"posed and $olly unco%ered $it
fles& and it is muc longer before patients can $al! on te leg $en
tis bone is bro!en# But if te outer bone be bro!en, it causes muc
less trouble, and te deformity, $en te bones are not properly set,
is muc more easily concealed, te bone being $ell co%ered $it fles&
and te patients speedily get on foot, for it is te inner bone of
te leg $ic supports te most of te $eigt of te body# For along
$it te tig, as being in a line $it $eigt tro$n upon te tig,
te inner bone as more $or! to sustain& inasmuc as it is te ead
of te tig-bone $ic sustains te upper part of te body, and it
is on te inner and not on te outer side of te tig, being in a
line $it te tibia& and te oter alf of te body appro"imates more
to tis line tan to te e"ternal one& and at te same time te inner
bone is larger tan te outer, as in te fore-arm te bone in te
line of te little finger is te slenderer and longer# But in te
'oint of te inferior e"tremity, te disposition of te longer bone
is not ali!e, for te elbo$ and te am are bent differently# For
tese reasons $en te e"ternal bone is bro!en, te patients can soon
$al! about& but in fractures of te inner, it is a long time before
tey can $al!#
----------------------------------------------------------------------
PART 19
.en te tig-bone is bro!en, particular pains sould be ta!en $it
regard to te e"tension tat it may not be insufficient, for $en
e"cessi%e, no great arm results from it# For, if one sould bandage
a limb $ile te e"tremities of te bone are separated to a distance
from one anoter by te force of te e"tension, te bandaging $ill
not !eep tem separate, and so te bones $ill come togeter again
as soon as te persons stretcing it let go teir old& for te flesy
parts *muscles+, being tic! and strong, are more po$erful tan te
bandaging, instead of being less so# In te case ten $ic $e are
no$ treating of, noting sould be omitted in order tat te parts
may be properly distended and put in a straigt line& for it is a
great disgrace and an in'ury to e"ibit a sortened tig# For te
arm, $en sortened, migt be concealed, and te mista!e $ould not
be great& but a sortened tig-bone $ould e"ibit te man maimed#
For $en te sound limb is placed beside it, being longer tan te
oter, it e"poses te mista!e, and terefore it $ould be to te ad%antage
of a person $o $ould be improperly treated tat bot is legs sould
be bro!en, rater tan eiter of tem& for in tis case te one $ould
be of te same lengt as te oter# .en, ten, proper e"tension as
been made, you must ad'ust te parts $it te palms of te ands,
and bandage te limb in te manner formerly described, placing te
ands of te bandages as $as directed, and ma!ing te turns up$ard#
And te patient sould return te same ans$ers to te same 3uestions
as formerly, sould be pained and reco%er in li!e manner, and sould
a%e te bandaging rene$ed in te same $ay& and te application of
te splints sould be te same# Te tig-bone is consolidated in
forty days#
----------------------------------------------------------------------
PART (:
But tis also sould be !no$n, tat te tig-bone is cur%ed rater
to te outside tan to te inside, and rater for$ard tan bac!$ard&
$en not properly treated, ten, te distortions are in tese directions&
and te bone is least co%ered $it fles at te same parts, so tat
te distortion cannot be concealed# If, terefore, you suspect anyting
of tis !ind, you sould a%e recourse to te mecanical contri%ances
recommended in distortion of te arm# And a fe$ turns of te bandage
sould be brougt round by te ip and te loins, so tat te groin
and te articulation near te perineum may be included in te bandage&
and moreo%er, it is e"pedient tat te e"tremities of te splints
sould not do miscief by being placed on parts not co%ered $it te
bandages# Te splints, in fact, sould be carefully !ept off te na!ed
parts at bot ends& and te arrangement of tem sould be so managed,
as tat tey may not be placed on te natural protuberances of te
bone at te !nee-'oint, nor on te tendon $ic is situated tere#
----------------------------------------------------------------------
PART (1
Te s$ellings $ic arise in te am, at te foot, or in any oter
part from te pressure, sould be $ell $rapped in unscoured and carded
$ool, $ased $it $ine and oil, and anointed $it cerate, before bandaging&
and if te splints gi%e pain tey sould be slac!ened# =ou may sooner
reduce te s$ellings, by laying aside te splints, and applying plenty
of bandages to tem, beginning from belo$ and rolling up$ard& for
tus te s$ellings $ill be most speedily reduced, and te umors be
propelled to te parts abo%e te former bandages# But tis form of
bandaging must not be used unless tere be danger of %esications or
blac!ening in te s$elling, and noting of te !ind occurs unless
te fracture be bound too tigt, or unless te limb be allo$ed to
ang, or it be rubbed $it te and, or some oter ting of an irritant
nature be applied to te s!in#
----------------------------------------------------------------------
PART ((
-ore in'ury tan good results from placing belo$ te tig a canal
$ic does not pass farter do$n tan te am, for it neiter pre%ents
te body nor te leg from being mo%ed $itout te tig# And it creates
uneasiness by being brougt do$n to te am, and as a tendency to
produce $at of all tings sould be a%oided, namely, fle"ion at te
!nee, for tis completely disturbs te bandages& and $en te tig
and leg are bandaged, if one bend te limb at te !nee, te muscles
necessarily assume anoter sape, and te bro!en bones are also necessarily
mo%ed# <%ery endea%or ten sould be made to !eep te am e"tended#
But it appears to me, tat a canal $ic embraces te limb from te
nates to te foot is of use# And moreo%er, a sa$l sould be put loosely
round at te am, along $it te canal, as cildren are s$ated in
bed& and ten, if te tig-bone gets displaced eiter up$ard or to
te side, it can be more easily !ept in position by tis means along
$it te canal# Te canal ten sould be made so as to e"tend all
along te limb or not used at all#
----------------------------------------------------------------------
PART (0
Te e"tremity of te eel sould be particularly attended to, so tat
it may be properly laid, bot in fractures of te leg and of te tig#
For if te foot be placed in a dependent position, $ile te rest
of te body is supported, te limb must present a cur%ed appearance
at te forepart of te leg& and if te eel be placed iger tan
is proper, and if te rest of te leg be rater too lo$, te bone
at te forepart of te leg must present a ollo$, more especially
if te eel of te patient be naturally large# But all te bones get
consolidated more slo$ly, if not laid properly, and if not !ept steady
in te same position, and in tis case te callus is more feeble#
----------------------------------------------------------------------
PART (2
Tese tings relate to cases in $ic tere is fracture of te bones
$itout protrusion of te same or $ound of any oter !ind# In tose
cases in $ic te bones are simply bro!en across, and are not comminuted,
but protrude, if reduced te same day or ne"t, and secured in teir
place, and if tere be no reason to anticipate tat any splintered
bones $ill come a$ay& and in tose in $ic te bro!en bones do not
protrude, nor is te mode of fracture suc tat tere is reason to
e"pect te splinters $ill come out, some pysicians eal te sores
in a $ay $ic neiter does muc good nor arm, by means of a cleansing
application, applying pitc ointment, or some of te dressings for
fres $ounds, or anyting else $ic tey are accustomed to do, and
binding abo%e tem compresses $etted $it $ine, or greasy $ool, or
someting else of te li!e nature# And $en te $ounds become clean
and are ne$ ealed, tey endea%or to bind up te limb $it plenty
of bandages, and !eep it straigt $it treatment does some good, and
ne%er muc arm# Te bones, o$e%er, can ne%er be e3ually $ell restored
to teir place, but te part is a little more s$elled tan it sould
be& and te limb $ill be some$at sortened, pro%ided bot bones eiter
of te leg or fore-arm a%e been fractured#
----------------------------------------------------------------------
PART (4
Tere are oters $o treat suc cases at first $it bandages, applying
tem on bot sides of te seat of te in'ury, but omit tem tere,
and lea%e te $ound unco%ered, and after$ard tey apply to te $ound
some cleansing medicine, and complete te dressing $it compresses
dipped in $ine and greasy $ool# Tis plan of treatment is bad, and
it is clear tat tose $o adopt tis mode of practice are guilty
of great mista!es in oter cases of fracture as $ell as tese# For
it is a most important consideration to !no$ in $at manner te ead
of te bandage sould be placed and at $at part te greatest pressure
sould be, and $at benefits $ould result from applying te end of
te bandage and te pressure at te proper place, and $at misciefs
$ould result from applying te ead of te bandage and te pressure
oter$ise tan at te proper place# .erefore it as been stated in
te preceding part of te $or! $at are te results of eiter& and
te practice of medicine bears $itness to te trut of it, for in
a person tus bandaged, a s$elling must necessarily arise on te $ound#
For, if e%en a sound piece of s!in $ere bandaged on eiter side, and
a part $ere left in te middle, te part tus left unbandaged $ould
become most s$elled, and $ould assume a bad color& o$ ten could
it be tat a $ound $ould not suffer in li!e manner+ Te $ound ten
must necessarily become discolored and its lips e%erted, te discarge
$ill be icorous and $itout pus, and te bones, $ic sould not
a%e got into a state of necrosis, e"foliate& and te $ound gets into
a trobbing and inflamed condition# And tey are obliged to apply
a cataplasm on account of te s$elling, but tis is an unsuitable
application to parts $ic are bandaged on bot sides, for a useless
load is added to te trobbing $ic formerly e"isted in it# At last
tey loose te bandages $en matters get %ery serious, and conduct
te rest of te treatment $itout bandaging& and not$itstanding,
if tey meet $it anoter case of te same description, tey treat
it in te same manner, for tey do not tin! tat te application
of te bandages on bot sides, and te e"posure of te $ound are te
cause of $at appened, but some oter unto$ard circumstance# .erefore
I $ould not a%e $ritten so muc on tis sub'ect, if I ad not $ell
!no$n tat tis mode of bandaging is unsuitable, and yet tat many
conduct te treatment in tis $ay, $ose mista!e it is of %ital importance
to correct, $ile $at is ere said is a proof, tat $at $as formerly
$ritten as to te circumstances under $ic bandages sould be tigtly
applied to fractures or oter$ise as been correctly $ritten#
----------------------------------------------------------------------
PART (6
As a general rule it may be said, tat in tose cases in $ic a separation
of bone is not e"pected, te same treatment sould be applied as $en
te fractures are not complicated $it an e"ternal $ound& for te
e"tension, ad'ustment of te bones, and te bandaging, are to be conducted
in te same manner# To te $ound itself a cerate mi"ed $it pitc
is to be applied, a tin folded compress is to be bound upon it, and
te parts around are to be anointed $it $ite cerate# Te clots
for bandages and te oter tings sould be torn broader tan in cases
in $ic tere is no $ound, and te first turn of te bandage sould
be a good deal broader tan te $ound# For a narro$er bandage tan
te $ound binds te $ound li!e a girdle, $ic is not proper, or te
first turn sould compreend te $ole $ound, and te bandaging sould
e"tend beyond it on bot sides# Te bandage ten sould be put on
in te direction of te $ound, and sould be not 3uite so tigt as
$en tere is no $ound, but te bandage sould be oter$ise applied
in te manner described abo%e# Te bandages sould be of a soft consistence,
and more especially so in suc cases tan in tose not complicated
$it a $ound# Te number of bandages sould not be smaller, but rater
greater tan tose formerly described# .en applied, te patient sould
a%e te feeling of te parts being properly secured, but not too
tigt, and in particular e sould be able to say tat tey are firm
about te $ound# And te inter%als of time during $ic te parts
seem to be properly ad'usted, and tose in $ic tey get loose, sould
be te same as tose formerly described# Te bandages sould be rene$ed
on te tird day, and te after treatment conducted in te same manner
as formerly described, e"cept tat in te latter case te compression
sould be some$at less tan in te former# And if matters go on properly,
te parts about te $ound sould be found at e%ery dressing al$ays
more and more free of s$elling, and te s$elling sould a%e subsided
on te $ole part compreended by te bandages# And te suppurations
$ill ta!e place more speedily tan in te case of $ounds treated oter$ise&
and te pieces of fles in te $ound $ic a%e become blac! and dead,
$ill sooner separate and fall off under tis plan of treatment tan
any oter, and te sore $ill come more 3uic!ly to cicatri;ation $en
tus treated tan oter$ise# Te reason of all tis is, tat te parts
in $ic te $ound is situated, and te surrounding parts, are !ept
free of s$elling# In all oter respects te treatment is to be conducted
as in cases of fracture $itout a $ound of te integuments# 1plints
sould not be applied# On tis account te bandages sould be more
numerous tan in te former case, bot because tey must be put on
less tigt, and because te splints are later of being applied# But
if you do apply te splints, tey sould not be applied along te
$ound, and tey are to be put on in a loose manner, especial care
being ta!en tat tere may be no great compression from te splints#
Tis direction as been formerly gi%en# And te diet sould be more
restricted, and for a longer period, in tose cases in $ic tere
is a $ound at te commencement, and $en te bones protrude troug
te s!in& and, in a $ord, te greater te $ound, te more se%ere and
protracted sould te regimen be#
----------------------------------------------------------------------
PART (7
Te treatment of te sores is te same in tose cases of fracture
in $ic tere $as no $ound of te s!in at first, but one as formed
in te course of treatment, o$ing to te pressure of te splints occasioned
by te bandages, or from any oter cause# In suc cases it is ascertained
tat tere is an ulcer, by te pain and te trobbing& and te s$elling
in te e"tremities becomes arder tan usual, and if you apply your
finger te redness disappears, but speedily returns# If you suspect
anyting of te !ind you must loose te dressing, if tere be any
itcing belo$ te under-bandages, or in any oter part tat is bandaged,
and used a pitced cerate instead of te oter# If tere be noting
of tat, but if te ulcer be found in an irritable state, being %ery
blac! and foul, and te flesy parts about to suppurate, and te tendons
to sloug a$ay, in tese cases no part is to be e"posed to te air,
nor is anyting to be appreended from tese suppurations, but te
treatment is to be conducted in te same manner as in tose cases
in $ic tere $as an e"ternal $ound at first# =ou must begin to apply
te bandages loosely at te s$elling in te e"tremities, and ten
gradually proceed up$ard $it te bandaging, so tat it may be tigt
at no place, but particularly firm at te sore, and less so else$ere#
Te first bandages sould be clean and not narro$, and te number
of bandages sould be as great as in tose cases in $ic te splints
$ere used, or some$at fe$er# To te sore itself a compress, anointed
$it $ite cerate, $ill be sufficient, for if a piece of fles or
ner%e *tendon+, become blac!, it $ill fall off& for suc sores are
not to be treated $it acrid, but $it emollient applications, li!e
burns# Te bandages are to be rene$ed e%ery tird day, and no splints
are to be applied, but rest is to be more rigidly maintained tan
in te former cases, along $it a restricted diet# It sould be !no$n,
tat if any piece of fles or tendon be to come a$ay, te miscief
$ill spread muc less, and te parts $ill muc more speedily drop
off, and te s$elling in te surrounding parts $ill muc more completely
subside, under tis treatment, tan if any of te cleansing applications
be put upon te sore# And if any part tat is to come a$ay sall fall
off, te part $ill incarnate sooner $en tus treated tan oter$ise,
and $ill more speedily cicatri;e# 1uc are te good effects of !no$ing
o$ a bandage can be $ell and moderately applied# But a proper position,
te oter parts of te regimen, and suitable bandages cooperate#
----------------------------------------------------------------------
PART (8
If you are decei%ed $it regard to a recent $ound, supposing tere
$ill be no e"foliation of te bones, $ile tey are on te e%e of
coming out of te sore, you must not esitate to adopt tis mode of
treatment& for no great miscief $ill result, pro%ided you a%e te
necessary de"terity to apply te bandages $ell and $itout doing any
arm# And tis is a symptom of an e"foliation of bone being about
to ta!e place under tis mode of treatment& pus runs copiously from
te sore, and appears stri%ing to ma!e its escape# Te bandage must
be rene$ed more fre3uently on account of te discarge, since oter$ise
fe%ers come on& if te sore and surrounding parts be compressed by
te bandages tey become $asted# >ases complicated $it te e"foliation
of %ery small bones, do not re3uire any cange of treatment, only
te bandages sould be put on more loosely, so tat te discarge
of pus may not be intercepted, but left free, and te dressings are
to be fre3uently rene$ed until te bone e"foliate, and te splints
sould not be applied until ten#
----------------------------------------------------------------------
PART (9
Tose cases in $ic te e"foliation of a larger piece of bone is
e"pected, $eter you disco%er tis at te commencement, or percei%e
subse3uently tat it is to appen, no longer re3uire te same mode
of treatment, only tat te e"tension and arrangement of te parts
are to be performed in a manner tat as been described& but a%ing
formed double compresses, not less tan alf a fatom in breadt *being
guided in tis by te nature of te $ound,, and considerably sorter
tan $at $ould be re3uired to go t$ice round te part tat is $ounded,
but considerably longer tan to go once round, and in number $at
$ill be sufficient, tese are to be dipped in a blac! austere $ine&
and beginning at te middle, as is done in applying te double-eaded
bandage, you are to $rap te part around and proceed crossing te
eads in te form of te bandage called ?ascia#? Tese tings are
to be done at te $ound, and on bot sides of it& and tere must be
no compression, but tey are to be laid on so as to gi%e support to
te $ound# And on te $ound itself is to be applied te pitced cerate,
or one of te applications to recent $ounds, or any oter medicine
$ic $ill suit $it te embrocation# And if it be te summer season,
te compresses are to be fre3uently damped $it $ine& but if te $inter
season, plenty of greasy $ool, moistened $it $ine and oil, sould
be applied# And a goat/s s!in sould be spread belo$, so as to carry
off te fluids $ic run from te $ound& tese must be guarded against,
and it sould be !ept in mind, tat parts $ic remain long in te
same position are sub'ect to e"coriations $ic are difficult to cure#
----------------------------------------------------------------------
PART 0:
In suc cases as do not admit of bandaging according to any of te
metods $ic a%e been described, or $ic $ill be described, great
pains sould be ta!en tat te fractured part of te body be laid
in a rigt position, and attention sould be paid tat it may incline
up$ard rater tan do$n$ard# But if one $ould $is to do te ting
$ell and de"terously, it is proper to a%e recourse to some mecanical
contri%ance, in order tat te fractured part of te body may undergo
proper and not %iolent e"tension& and tis means is particularly applicable
in fractures of te leg# Tere are certain pysicians $o, in all
fractures of te leg, $eter bandages be applied or not, fasten te
sole of te foot to te couc, or to some oter piece of $ood $ic
tey a%e fi"ed in te ground near te couc# Tese persons tus do
all sorts of miscief but no good& for it contributes noting to te
e"tension tat te foot is tus bound, as te rest of te body $ill
no less sin! do$n to te foot, and tus te limb $ill no longer be
stretced, neiter $ill it do any good to$ard !eeping te limb in
a proper position, but $ill do arm, for $en te rest of te body
is turned to tis side or tat, te bandaging $ill not pre%ent te
foot and te bones belonging to it from follo$ing te rest of te
body# For if it ad not been bound it $ould a%e been less distorted,
as it $ould a%e been te less pre%ented from follo$ing te motion
of te rest of te body# But one sould se$ t$o balls of <gyptian
leater, suc as are $orn by persons confined for a lengt of time
in large sac!les, and te balls te balls sould a%e coats on eac
side, deeper to$ard te $ound, but sorter to$ard te 'oints& and
te balls sould be $ell stuffed and soft, and fit $ell, te one abo%e
te an!les, and te oter belo$ te !nee# 1ide$ays it sould a%e
belo$ t$o appendages, eiter of a single or double tong, and sort,
li!e loops, te one set being placed on eiter side of te an!le,
and te oter on te !nee# And te oter upper ball sould a%e oters
of te same !ind in te same line# Ten ta!ing four rods, made of
te cornel tree, of e3ual lengt, and of te tic!ness of a finger,
and of suc lengt tat $en bent tey $ill admit of being ad'usted
to te appendages, care sould be ta!en tat te e"tremities of te
rods bear not upon te s!in, but on te e"tremities of te balls#
Tere sould be tree sets of rods, or more, one set a little longer
tan anoter, and anoter a little sorter and smaller, so tat tey
may produce greater or less distention, if re3uired# <iter of tese
sets of rods sould be placed on tis side and tat of te an!les#
If tese tings be properly contri%ed, tey sould occasion a proper
and e3uable e"tension in a straigt line, $itout gi%ing any pain
to te $ound& for te pressure, if tere is any, sould be tro$n
at te foot and te tig# And te rods are commodiously arranged
on eiter side of te an!les, so as not to interfere $it te position
of te limb& and te $ound is easily e"amined and easily arranged#
And, if tougt proper, tere is noting to pre%ent te t$o upper
rods from being fastened to one anoter& and if any ligt co%ering
be tro$n o%er te limb, it $ill tus be !ept off from te $ound#
If, ten, te balls be $ell made, andsome, soft, and ne$ly stitced,
and if te e"tension by te rods be properly managed, as as been
already described, tis is an e"cellent contri%ance& but if any of
tem do not fit properly, it does more arm tan good# And all oter
mecanical contri%ances sould eiter be properly done, or not be
ad recourse to at all, for it is a disgraceful and a$!$ard ting
to use mecanical means in an unmecanical $ay#
----------------------------------------------------------------------
PART 01
-oreo%er, te greater part of pysicians treat fractures, bot $it
and $itout an e"ternal $ound, during te first days, by means of
un$ased $ool, and tere does not appear to be anyting improper in
tis# It is %ery e"cusable for tose $o are called upon to treat
ne$ly-recei%ed accidents of tis !ind, and $o a%e no clot for bandages
at and, to do tem up $it $ool& for, e"cept clot for bandages,
one could not a%e anyting better tan $ool in suc cases& but a
good deal sould be used for tis purpose, and it sould be $ell carded
and not roug, for in small 3uantity and of a bad 3uality it as little
po$er# But tose $o appro%e of binding up te limb $it $ool for
a day or t$o, and on te tird and fourt apply bandages, and ma!e
te greatest compression and e"tension at tat period, suc persons
so$ temsel%es to be ignorant of te most important principles of
medicine& for, in a $ord, at no time is it so little proper to disturb
all !inds of $ounds as on te tird and fourt day& and all sort of
probing sould be a%oided on tese days in $ate%er oter in'uries
are attended $it irritation# For, generally, te tird and fourt
day in most cases of $ounds, are tose $ic gi%e rise to e"acerbations,
$eter te tendency be to inflammation, to a foul condition of te
sore, or to fe%ers# And if any piece of information be particularly
%aluable tis is& to $ic of te most important cases in medicine
does it not apply+ and tat not only in $ounds but in many oter diseases,
unless one sould call all oter diseases $ounds# And tis doctrine
is not de%oid of a certain degree of plausibility, for tey are allied
to one anoter in many respects# But tose $o maintain tat $ool
sould be used until after te first se%en days, and ten tat te
parts sould be e"tended and ad'usted, and secured $it bandages,
$ould appear not to be e3ually de%oid of proper 'udgment, for te
proper 'udgment, for te most dangerous season for inflammation is
ten past, and te bones being loose can be easily set after te lapse
of tese days# But still tis mode of treatment is far inferior to
tat $it bandages from te commencement& for, te latter metod e"ibits
te patient on te se%ent day free from inflammation, and ready for
complete bandaging $it splints& $ile te former metod is far beind
in tis respect, and is attended $it many oter bad effects $ic
it $ould be tedious to describe#
01a# In tose cases of fracture in $ic te bones protrude and cannot
be restored to teir place, te follo$ing mode of reduction may be
practiced5- 1ome small pieces of iron are to be prepared li!e te
le%ers $ic te cutters of stone ma!e use of, one being rater broader
and anoter narro$er& and tere sould be tree of tem at least,
and still more, so tat you may use tose tat suit best& and ten,
along $it e"tension, $e must use tese as le%ers, applying te under
surface of te piece of iron to te under fragment of te bone, and
te upper surface to te upper bone& and, in a $ord, $e must operate
po$erfully $it te le%er as $e $ould do upon a stone or a piece of
$ood# Te pieces of iron sould be as strong as possible, so tat
tey may not bend# Tis is a po$erful assistance, pro%ided te pieces
of iron be suitable, and one use tem properly as le%ers# Of all te
mecanical instruments used by men, te most po$erful are tese tree,
te a"is in peritrocio, te le%er, and te $edge# .itout tese,
one or all, men could not perform any of teir $or!s $ic re3uire
great force# .erefore, reduction $it te le%er is not to be despised,
for te bones $ill be reduced in tis $ay, or not at all# But if te
upper fragment $ic rides o%er te oter does not furnis a suitable
point of support a suitable point of support for te le%er, but te
protruding part is sarp, you must scoop out of te bone $at $ill
furnis a proper place for te le%er to rest on# Te le%er, along
$it e"tension, may be ad recourse to on te day of te accident,
or te accident, or ne"t day, but by no means on te tird, te fourt,
and te fift# For if te limb is disturbed on tese days, and yet
te fractured bones not reduced, inflammation $ill be e"cited, and
tis no less if tey are reduced& for con%ulsions are more apt to
occur if reduction ta!e place, tan if te attempt sould fail# Tese
facts sould be $ell !no$n, for if con%ulsions sould come on $en
reduction is effected, tere effected, tere is little ope of reco%ery&
but it is of use to displace te bones again if tis can be done $it
out trouble# For it is not at te time $en te parts are in a particularly
rela"ed condition tat con%ulsions and tetanus are apt to super%ene,
but $en tey are more tan usually tense# In te case $e are no$
treating of, $e sould not disturb te limb on te aforesaid days,
but stri%e to !eep te $ound as free from inflammation as possible,
and especially encourage suppuration in it# But $en se%en days a%e
elapsed, or rater more, if tere be no fe%er, and if te $ound be
not inflamed, ten tere $ill be less to pre%ent an attempt at reduction,
if you ope to succeed& but oter$ise you need not ta!e and gi%e trouble
in %ain#
----------------------------------------------------------------------
PART 0(
.en you a%e reduced te bones to teir place, te modes of treatment,
$eter you e"pect te bones to e"foliate or not, a%e been already
described# All tose cases in $ic an e"foliation of bone is e"pected,
sould be treated by te metod of bandaging $it clots, beginning
for te most part at te middle of te bandage, as is done $it te
double-eaded bandage& but particular attention sould be paid to
te sape of te $ound, so tat its lips may gape or be distorted
as little as possible under te bandage# 1ometimes te turns of te
bandage a%e to be made to te rigt, and sometimes to te left, and
sometimes a double-eaded bandage is to be used#
----------------------------------------------------------------------
PART 00
It sould be !no$n tat bones, $ic it as been found impossible
to reduce, as $ell as tose $ic are $olly denuded of fles, $ill
become detaced# In some cases te upper part of te bone is laid
bare, and in oters te fles dies all around& and, from a sore of
long standing, certain of te bones become carious, and some not,
some more, and some less& and in some te small, and in oters te
large bones# From $at as been said it $ill be seen, tat it is impossible
to tell in one $ord $en te bones $ill separate# 1ome come a$ay more
3uic!ly, o$ing to teir smallness, and some from being merely fi"ed
at te point& and some, from pieces not separating, but merely e"foliating,
become dried up and putrid& and besides, different modes of treatment
a%e different effects# For te most part, te bones separate most
3uic!ly in tose cases in $ic suppuration ta!es place most 3uic!ly,
and $en ne$ fles is most 3uic!ly formed, and is particularly sound,
for te fles $ic gro$s up belo$ in te $ound generally ele%ates
te pieces of bone# It $ill be $ell if te $ole circle of te bone
separate in forty days& for in some cases it is protracted to si"ty
days, and in some to more& for te more porous pieces of bone separate
more 3uic!ly, but te more solid come a$ay more slo$ly& but te oter
smaller splinters in muc less time, and oters oter$ise# A portion
of bone $ic protrudes sould be sa$n off for te follo$ing reasons5
if it cannot be reduced, and if it appears sons5 tat only a small
piece is re3uired in order tat it may get bac! into its place& and
if it be suc tat it can be ta!en out, and if it occasions incon%enience
and irritates any part of te fles, and pre%ents te limb from being
properly laid, and if, moreo%er, it be denuded of fles, suc a piece
of bone sould be ta!en off# .it regard to te oters, it is not
of muc conse3uence $eter tey be sa$ed off or not# For it sould
be !no$n for certain, tat suc bones as are completely depri%ed of
fles, and a%e become dried, all separate completely# Tose $ic
are about to e"follate sould not be sa$n off# Tose tat $ill separate
completely must be 'udged of from te symptoms tat a%e been laid
do$n#
----------------------------------------------------------------------
PART 02
1uc cases are to be treated $it compresses and %inous applications,
as formerly laid do$n regarding bones $ic $ill separate# .e must
a%oid $etting it at te beginning $it anyting cold& for tere is
danger of febrile rigors, and also of con%ulsions& for con%ulsions
are induced by cold tings, and also sometimes by $ounds# It is proper
to !no$ tat te members are necessarily sortened in tose cases
in $ic te bones a%e been bro!en, and a%e ealed te one across
te oter, and in tose cases in $ic te $ole circle of te bone
as become detaced#
----------------------------------------------------------------------
PART 04
Tose cases in $ic te bone of te tig, or of te arm, protrudes,
do not easily reco%er# For te bones are large, and contain muc marro$&
and many important ner%es, muscles, and %eins are $ounded at te same
time# And if you reduce tem, con%ulsions usually super%ene& and,
if not reduced, acute bilious fe%ers come on, $it singultus and mortification#
Te cances of reco%ery are not fe$er in tose cases in $ic te
parts a%e not been reduced, nor any attempts made at reduction# 1till
more reco%er in tose cases in $ic te lo$er, tan tose in $ic
te upper part of te bone protrudes& and some $ill reco%er $en reduction
as been made, but %ery rarely indeed# For modes of treatment and
peculiarity of constitution ma!e a great difference as to te capability
of enduring suc an in'ury# And it ma!es a great difference if te
bones of te arm and of te tig protrude to te inside& for tere
are many and important %essels situated tere, some of $ic, if $ounded,
$ill pro%e fatal& tere are suc also on te outside, but of less
importance# In $ounds of tis sort, ten, one ougt not to be ignorant
of te dangers, and sould prognosticate tem in due time# But if
you are compelled to a%e recourse to reduction, and ope to succeed,
and if te bones do not cross one anoter muc, and if te muscles
are not contracted *for tey usually are contracted,, te le%er in
suc cases may be ad%antageously employed#
----------------------------------------------------------------------
PART 06
Ha%ing effected te reduction, you must gi%e an emollient draugt
of ellebore te same day, pro%ided it as been reduced on te day
of te accident, but oter$ise it sould not be attempted# Te $ound
sould be treated $it te same tings as are used in fractures of
te bones of te ead, and noting cold sould be applied& te patient
sould be restricted from food altogeter, and if naturally of a bilious
constitution, e sould a%e for a diet a little fragrant o"ygly!y
sprin!led on $ater& but if e is not bilious, e sould a%e $ater
for drin!& and if fe%er of te continual type come on, e is to be
confined to tis regimen for fourteen days at least, but if e be
free of fe%er, for only se%en days, and ten you must bring im bac!
by degrees to a common diet# To tose cases in $ic te bones a%e
not been reduced, a similar course of medicine sould be administered,
along $it te same treatment of te sores and regimen& and in li!e
manner te suspended part of te body sould not be stretced, but
sould rater be contracted, so as to rela" te parts about te $ound#
Te separation of te bones is protracted, as also $as formerly stated#
But one sould try to escape from suc cases, pro%ided one can do
so onourably, for te opes of reco%ery are small, and te dangers
many& and if te pysician do not reduce te fractured bones e $ill
be loo!ed upon as upon as uns!illful, $ile by reducing tem e $ill
bring te patient nearer to deat tan to reco%ery#
----------------------------------------------------------------------
PART 07
@u"ations and sublu"ations at te !nee are muc milder accidents tan
sublu"ations and lu"ations at te elbo$# For te !nee-'oint, in proportion
to its si;e, is more compact tan tat of te arm, and as a more
e%en conformation, and is rounded, $ile te 'oint of te arm is large,
and as many ca%ities# And in addition, te bones of te leg are nearly
of te same lengt, for te e"ternal one o%ertops te oter to so
small an e"tent as ardly to deser%e being mentioned, and terefore
affords no great resistance, altoug te e"ternal ner%e *ligament+,
at te am arises from it& but te bones of te fore-arm are une3ual,
and te sorter is considerably tic!er tan te oter, and te more
slender *ulna+, protrudes, and passes up abo%e te 'oint, and to it
*te olecranon+, are attaced te ner%es *ligaments+, $ic go do$n$ard
to te 'unction of te bones& and te slender bone *ulna+, as more
to do $it te insertion of te ligaments in te arm tan te tic!
bone *radius+,# Te configuration ten of te articulations, and of
te bones of te elbo$, is suc as I a%e described# O$ing to teir
configuration, te bones at te !nee are indeed fre3uently dislocated,
but tey are easily reduced, for no great inflammation follo$s, nor
any constriction of te 'oint# Tey are displaced for te most part
to te inside, sometimes to te outside, and occasionally into te
am# Te reduction in all tese cases is not difficult, but in te
dislocations in$ard and out$ard, te patient sould be placed on a
lo$ seat, and te tig sould be ele%ated, but not muc# -oderate
e"tension for te most part sufficet, e"tension being made at te
leg, and counter-e"tension at te tig#
----------------------------------------------------------------------
PART 08
Aislocations at te elbo$ are more troublesome tan tose at te !nee,
and, o$ing to te inflammation $ic comes on, and te configuration
of te 'oint, are more difficult to reduce if te bones are not immediately
replaced# For te bones at te elbo$ are less sub'ect to dislocation
tan tose of te !nee, but are more difficult to reduce and !eep
in teir position, and are more apt to become inflamed and an!ylosed#
----------------------------------------------------------------------
PART 09
For te most part te displacements of tese bones are small, sometimes
to$ard te ribs, and sometimes to te outside& and te $ole articulation
is not displaced, but tat part of te umerus remains in place $ic
is articulated $it te ca%ity of te bone of te forearm tat as
a protuberance *ulna+,# 1uc dislocations, to $ate%er side, are easily
reduced, and te e"tension is to be made in te line of te arm, one
person ma!ing e"tension at te $rist, and anoter grasping te armpit,
$ile a tird, applying te palm of is and to te part of te 'oint
$ic is displaced, puses it in$ard $ard, and at te same time ma!es
counterpressure on te opposite side near te 'oint $it te oter
and#
----------------------------------------------------------------------
PART 2:
Te end of te umerus at te ,elbo$ gets displaced *sublu"ated+,
by lea%ing te ca%ity of te ulna# 1uc lu"ations readily yield to
reduction, if applied before te parts get inflamed# Te displacement
for te most part is to te inside, but sometimes to te outside,
and tey are readily recogni;ed by te sape of te limb# And often
suc lu"ations are reduced $itout any po$erful e"tension# In dislocations
in$ard, te 'oint is to be pused into its place, $ile te fore-arm
is brougt round to a state of pronation# 1uc are most of te dislocations
at te elbo$#
----------------------------------------------------------------------
PART 21
But if te articular e"tremity of te umerus be carried to eiter
side abo%e te bone of te fore-arm, $ic is prominent, into te
ollo$ of te arm *+,, tis rarely appens& but if it does appen,
e"tension in te straigt line is not so proper under suc circumstances&
for in suc a mode of e"tension, te process of te ulna *olecranon+,
pre%ents te bone of te arm *umerus+, from passing o%er it# In dislocations
of tis !ind, e"tension sould be made in te manner described $en
treating of te bandaging of fractured bones of te arm, e"tension
being made up$ard at te armpit, $ile te parts at te elbo$ are
pused do$n$ard, for in tis manner can te umerus be most readily
raised abo%e its ca%ity& and $en so raised, te reduction is easy
$it te palms of te and, te one being applied so as to ma!e pressure
on te protuberant part of te arm, and te oter ma!ing counter-pressure,
so as to pus te bone of te fore-arm into te 'oint# Tis metod
ans$ers $it bot cases# And peraps tis is te most suitable mode
of reduction in suc a case of dislocation# Te parts may be reduced
by e"tension in a straigt line, but less readily tan tus#
----------------------------------------------------------------------
PART 2(
If te arm be dislocated for$ard- tis rarely appens, indeed, but
$at $ould a sudden soc! not displace+ for many oter tings are
remo%ed from teir proper place, not$itstanding a great obstacle,-
in suc a %iolent displacement te part *olecranon+, $ic passes
abo%e te prominent part of te bones is large, and te stretcing
of te ner%es *ligaments+, is intense& and yet te parts a%e been
so dislocated in certain cases# Te follo$ing is te symptom of suc
a displacement5 te arm cannot be bent in te least degree at te
elbo$, and upon feeling te 'oint te nature of te accident becomes
ob%ious# If, ten, it is not speedily reduced, strong and %iolent
inflammation, attended $it fe%er, $ill come on, but if one appen
to be on te spot at te time it is easily reduced# A piece of ard
linen clot *or a piece of ard linen, not %ery large, rolled up in
a ball, $ill be sufficient, is to be placed across te bend of te
elbo$, and te arm is ten to be suddenly bent at te elbo$, and te
and brougt up to te soulder# Tis mode of reduction is sufficient
in suc displacements& and e"tension in te straigt line can rectify
tis manner of dislocation, but $e must use at te same time te palms
of te ands, applying te one to te pro'ecting part of te umerus
at te bend of te arm for te purpose of pusing it bac!, and applying
te oter belo$ to te sarp e"tremity of te elbo$, to ma!e counter-pressure,
and incline te parts into te straigt line# And one may use $it
ad%antage in tis form of dislocation te metod of e"tension formerly
described, for te application of te bandages in te case of fracture
of te arm& but $en e"tension is made, te parts are to be ad'usted,
as as been also described abo%e#
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PART 20
But if te arm be dislocated bac!$ard *but tis %ery rarely appens,
and it is te most painful of all, and te most sub'ect to bilious
fe%ers of te continual type, $ic pro%e fatal in te course of a
fe$ days,, in suc a case te patient cannot e"tend te arm# If you
are 3uic!ly present, by forcible e"tension te parts may return to
teir place of teir o$n accord& but if fe%er a%e pre%iously come
on, you must no longer attempt reduction, for te pain $ill be rendered
more intense by any suc %iolent attempt# In a $ord, no 'oint $ate%er
sould be reduced during te pre%alence of fe%er, and least of all
te elbo$-'oint#
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PART 22
Tere are also oter troublesome in'uries connected $it te elbo$-'oint&
for e"ample, te tic!er bone *radius+, is sometime partially displaced
from te oter, and te patient can neiter perform e"tension nor
fle"ion properly# Tis accident becomes ob%ious upon e"amination $it
te and at te bend of te arm near te di%ision of te %ein tat
runs up te muscle# In suc a case it is not easy to reduce te parts
to teir natural state, nor is it easy, in te separation of any t$o
bones united by sympysis, to restore tem to teir natural state,
for tere $ill necessarily be a s$elling at te seat of te diastasis#
Te metod of bandaging a 'oint as been already described in treating
of te application of bandages to te an!le#
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PART 24
In certain cases te process of te ulna *olecranon+, beind te umerus
is bro!en& sometimes its cartilaginous part, $ic gi%es origin to
te posterior tendon of te arm, and sometimes its fore part, at te
base of te anterior coronoid process& and $en tis displacement
ta!es place, it is apt to be attended $it malignant fe%er# Te 'oint,
o$e%er, remains in place, for its $ole base protrudes at tat point#
But $en te displacement ta!es place $ere its ead o%ertops te
arm, te 'oint becomes looser if te bone be fairly bro!en across#
To spea! in general terms, all cases of fractured bones are less dangerous
tan tose in $ic te bones are not bro!en, but te %eins and important
ner%es *tendons+, situated in tese places are contused& for te ris!
of deat is more immediate in te latter class of cases tan in te
former, if continual fe%er come on# But fractures of tis nature seldom
occur#
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PART 26
It sometimes appens tat te ead of te umerus is fractured at
its epipysis& and tis, altoug it may appear to be a muc more
troublesome accident, is in fact a muc milder one tan te oter
in'uries at te 'oint#
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PART 27
Te treatment especially befitting eac particular dislocation as
been described& and it as been laid do$n as a rule, tat immediate
reduction is of te utmost ad%antage, o$ing to te rapid manner in
$ic inflammation of te tendons super%enes# For e%en $en te lu"ated
parts are immediately reduced, te tendons usually become stiffened,
and for a considerable time pre%ent e"tension and fle"ion from being
performed to te ordinary e"tent# are to be treated in a similar $ay,
$eter te e"tremity of te articulating bone be snapped off, $eter
te bones be separated, or $eter tey be dislocated& for tey are
all to be treated $it plenty of bandages, compresses, and cerate,
li!e oter fractures# Te position of te 'oint in all tese cases
sould be te same, as $en a fractured arm or fore-arm as been bound
up# For tis is te most common position in all dislocations, displacements,
and fractures& and it is te most con%enient for te subse3uent mo%ements,
$eter of e"tension or fle"ion, as being te intermediate stage bet$een
bot# And tis is te position in $ic te patient can most con%eniently
carry or suspend is arm in a sling# And besides, if te 'oint is
to be stiffened by callus, it $ere better tat tis sould not ta!e
place $en te arm is e"tended, for tis position $ill be a great
impediment and little ad%antage& if te arm be $olly bent, it $ill
be more useful& but it $ill be muc more con%enient to a%e te 'oint
in te intermediate position $en it becomes an!ylosed# 1o muc $it
regard to position#
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PART 28
In bandaging, te ead of te first bandage sould be placed at te
seat of te in'ury, $eter it be a case of fracture, of dislocation,
or of diastasis *separation+,, and te first turns sould be made
tere, and te bandages sould be applied most firmly at tat place,
and less so on eiter side# Te bandaging sould compreend bot te
arm and te fore-arm, and on bot sould be to a muc greater e"tent
tan most pysicians apply it, so tat te s$elling may be e"pelled
from te seat of te in'ury to eiter side# And point of te fore-arm
sould be compreended in te bandaging, $eter te in'ury be in
tat place or not, in order tat te s$elling may not collect tere#
In applying bandages, $e must a%oid as muc as possible accumulating
many turns of te bandage at te bend of te arm# For te principal
compression sould be at te seat of te in'ury, and te same rules
are to be obser%ed, and at te same periods, $it regard to compression
and rela"ation, as formerly described respecting te treatment of
bro!en bones& and te bandages sould be rene$ed e%ery tird day&
and tey sould appear loose on te tird day, as in te oter case#
And splints sould be applied at te proper time *for tere is noting
unsuitable in tem, $eter te bones be fractured or not, pro%ided
tere is no fe%er,& tey sould be particularly loose, $eter applied
to te arm or te forearm, but tey must not be tic!# It is necessary
tat tey sould be of une3ual si;e, and tat te one sould ride
o%er te oter, $ene%er from te fle"ion it is 'udged proper# And
te application of te compresses sould be regulated in te same
manner as as been stated $it regard to te splints& and tey sould
be put on in a some$at more bul!y form at te seat of te in'ury#
Te periods are to be estimated from te inflammation, and from $at
as been $ritten on tem abo%e#
TH< <)A