第4章

18.Thefollowingshouldbethestateofmattersonthefirstapplicationofthebandage.Thepersontowhomithasbeenappliedshouldsaythathefeelsthecompressionparticularlyattheseatoftheinjury,butverylittleattheextremities;thepartsshouldbeadjustedbutnotpressedtogether,andthatratherbythenumberofthebandagesthanbytheforceoftheconstriction;andthetightnessshouldratherbeontheincreaseduringthefirstdayandnight;butonthenextitshouldbeless,andonthethirdthebandagesshouldbeloose.Onthenextdayasoftswellingshouldbeobservedintheextremities;andonthethirdday,whenthebandagingisloosed,theswellingshouldbefounddiminishedinsize,andthisshouldbethecaseeverytimethebandagesareremoved.

Atthesecondapplicationofthebandage,itshouldbeascertainedwhetherthedressinghasbeenproperlydone,andthengreatercompressionshouldbemade,andwithmorebandages;andonthethird,stillgreater,andstillmore.Ontheseventhdayfromthefirstdressing,whenthebandagesareloosed,thelimbshouldbefoundslenderandthebonesmobile.Wemustthenhaverecoursetothesplints,providedthelimbbefreeofswelling,pruritus,andulceration,andallowthemtoremainuntiltwentydaysaftertheaccident;butifanysuspicionsarise,thebandagesmustbeloosedintheinterval.Thesplintsshouldbetightenedeverythirdday.

19.Thesuspendingofafracturedlimbinasling,thedispositionofit,andthebandaging,allhavefortheirobjecttopreserveitinposition.Theprincipalconsiderationswithregardtothepositionarethehabitsandthepeculiarnatureofeachofthelimbs:thevarietiesareshowninrunning,walking,standing,lying,action,repose.

20.Itshouldbekeptinmindthatexercisestrengthens,andinactivitywastes.

21.Compressionshouldbeproducedbythenumberofbandages,ratherthanbytheforceoftheconstriction.

22.Incasesofecchymosis,contusions,sprains,orswellingsnotattendedwithinflammations,bloodistobeexpelledfromthewound,ingreatestquantitytotheupperpart,andinsmallesttotheinferior;neitherthearmnorthelegshouldbeplacedinadecliningposition:theheadofthebandageshouldbeplacedonthewound,andtherethegreatestpressureshouldbemade;theleastattheextremities,andintermediatelyinthemiddle;thelastfoldofthebandageshouldbeattheupperpartofthebody.Astobindingandcompression,theseobjectsaretobeattainedratherbythenumberofthebandagesthantheforceoftheconstriction;andmoreover,inthesecasesthebandagesshouldbethin,light,soft,clean,broad,sound,sothattheymayeffecttheirpurpose,evenwithoutsplints.

Andwemustuseaffusions.

23.Dislocations,sprains,diastasesofbones,violentseparation,abruptionoftheextremitiesofbones,anddistrainings,soastoinducevarusorvalgus,inthesecaseswemustapplythebandagessoasnottocompressthepartwhencethedisplacementtookplace,andthatwemayrenderthemtightatthesidetowhichthedisplacementwas,andgivethelimbaninclinationintheoppositedirection,andthatinanexcessivedegree.Weemploybandages,compresses,suspensionofthelimbinasling,attitude,extension,friction,rectification;andalongwiththesetheaffusionofmuchwater.

24.Intreatingpartswhichareatrophied,wemustcomprehendaconsiderablepartofthesoundlimbwiththebandage,sothatbytheinfluxtherebyproduced,thewastedpartmayacquireasupplygreaterthanitsloss,andmaybethusdisposedtogrowthandrestorationofitsfleshyparts.Itisbetteralsotobandagethepartsabove,asthethighinthecaseoftheleg,andalsothethighandlegoftheoppositeside,sothattheymaybeplacedinsimilarcircumstances,andmaybothequallybedeprivedofmotion;andthatthesupplyofnourishmentmaybealikecurtailedandopentoboth.Thecompressionshouldbetheeffectratherofthenumberofthebandagesthanoftheirtightness.Werelaxfirstthepartmostrequiringit,andhaverecoursetothatkindoffrictionwhichwillpromotethegrowthofflesh,andtoaffusion.Nosplints.

25.Thosethingswhichareforthepurposeofgivingsupportandstrengthtothepart,astothebreast,side,head,andsoforth,areusedinsuchcasesasthefollowing:forpulsations,thattheremaybenomotioninthepart;andinseparationatthesuturesoftheskull,inordertogivesupport;andinordertostrengthenthechestandhead,incoughs,sneezings,andothermovements.Inallthesecasesthesamemeasureofbandagingistobeobserved,forwheretheinjuryis,therethebandageshouldcompressmost,andsomethingsoftistobeplacedbelowthatsuitswiththecomplaint;andwemustnotapplythebandagestighterthanjusttostopthepulsationsfromcreatingdisturbance,andthattheseparatedpartsatthesuturesmaybebroughtintocontact,theymustnotbesuchasabsolutelytostopthecoughsandsneezings,butsoastogivesupport,and,withoutoccasioninguneasiness,preventthepartsfrombeingshaken.