第3章

12.Infractureswemustattendtothelength,breadth,thickness,andnumberofthecompresses.Thelengthshouldbethatofthebandaging;thebreadth,threeorfourfingers;thickness,threeorfourfold;numbersoastoencirclethelimb,neithermorenorless;

thoseappliedforthepurposeofrectifyingadeformity,shouldbeofsuchalengthastoencircleit;thebreadthandthicknessbeingdeterminedbythevacuity,whichisnottobefilledupatonce.Theupperbandagesaretwo,thefirstofwhichistobecarriedfromtheseatoftheinjuryupwards,andthesecondfromtheseatoftheinjurydownwards,andfrombelowupwards;thepartsabouttheseatoftheinjurybeingmostcompressed,theextremitiesleast,andtherestinproportion.Theupperbandagesshouldtakeinaconsiderableportionofthesoundparts.Wemustattendtothenumber,length,andbreadthofthebandages;thenumbermustbesuchasnottobeinferiortowhattheinjuryrequires,noroccasioncompressionwiththesplints,norprovecumbersome,noroccasionanyslippingofthem,norrendertheminefficient.Astolengthandbreadth,theyshouldbethree,four,five,orsixcubitsinlength,andasmanyfingersbroad.Thefoldsofthestrings(selvages?)shouldbesuchasnottooccasionpressure;theyaretobesoftandnotthick;andallthesethingsaretobeproportionatetothelength,breadth,andthicknessofthepartaffected.Thesplintsaretobesmooth,even,androundedattheextremities;somewhatlessallalongthantheupperbandaging,andthickestattheparttowhichfractureinclines.

Thosepartswheretherearetuberosities,andwhicharedevoidofflesh,suchastheanklesorfingers,wemustguardfromthesplintswhichareplacedoverthem,eitherbyposition,orbytheirshortness.

Theyaretobesecuredbythestringsinsuchamannerasnottooccasionpressureatfirst.Asoft,consistent,andcleancerateshouldberubbedintothefoldsofthebandage.

13.Astothetemperatureandquantityofthewaterused,itsheatshouldbejustsuchasthehandcanbear,anditoughttobeknownthatalargequantityisbestforproducingrelaxationandattenuation,whereasamoderatequantityisbestforincarnatingandsoftening.Thelimittotheaffusionis,tostopwhenthepartsbecomeswelledup,andbeforetheswellingsubsides;forthepartsswellupatfirst,andfallafterward.

14.Theobjectonwhichto(thelimb?)islaidshouldbesoft,smooth,andslopingupwardstowardtheprotuberantpartsofthebody,suchastheheelorhips,sothattheremaybenoprojection,norbendinginwards,norturningaside.Thecanal(spoutorgutter?)

shouldrathercomprehendthewholelimbthanthehalfofit,attentionbeingpaidtotheinjuryandtowhateverelseappearstocreateinconvenience.

15.Thepresentationoftheinjuredparttothephysician,theextension,thearrangement,andsoforth,aretoberegulatedaccordingtonature.Whatisnatureintheseoperationsistobedeterminedbytheaccomplishmentoftheobjectwhichwehaveinview,andforthispurposewemustlooktothepartinthestateofrest,initsmiddlestate,andtohabit;inregardtothestateofrestandrelaxation,asinthearm,thatitbeinalinewiththehand;andwithregardtothemediumbetweenflexionandextension,thattheforearmbeatrightanglestothearm;andwithregardtohabit,itshouldbeconsideredthatsomelimbsbearcertainpositionspreferably,as,forexample,thethighsextension;forinsuchattitudesthepartscanbestbeartobeplacedforaconsiderabletimewithoutachangeofposture.Andinthechangefromthestateofdistention,themuscles,veins,nerves,andbones,whenproperlyarrangedandsecured,willpreservetheirrelationstooneanotherwhilethelimbisraisedorplaced.

16.Theextensionshouldbemostpowerfulwhenthelargestandthickestbones,orwhenbotharebroken;nextwhentheunder—bone,andleastofall,whentheupper.Whenimmoderate,itisinjurious,exceptinthecaseofchildren.Thelimbshouldbealittleelevated.Themodelbywhichwejudgeifthepartbeproperlysetisthesoundpartofthesamename,orthepartwhichisitspair.

17.Frictioncanrelax,brace,incarnate,attenuate:hardbraces,softrelaxes,muchattenuates,andmoderatethickens.