第16章

16. When the parts are adjusted, you should apply the bandages while the limb is in a stretched position, ****** the first turns to the right or to the left, as may be most suitable; and the end of the bandage should be placed over the fracture, and the first turns made at that place; and then the bandage should be carried up the leg, as described with regard to the other fractures. But the bandages should be broader and longer, and more numerous, in the case of the leg than in that of the arm. And when it is bandaged it should be laid upon some smooth and soft object, so that it may not be distorted to the one side or the other, and that there may be no protrusion of the bones either forward or backward; for this purpose nothing is more convenient than a cushion, or something similar, either of linen or wool, and not hard; it is to be made hollow along its middle, and placed below the limb. With regard to the canals (gutters?) usually placed below fractured legs, I am at a loss whether to advise that they should be used or not. For they certainly are beneficial, but not to the extent which those who use them suppose. For the canals do not preserve the leg at rest as they suppose; nor, when the rest of the body is turned to the one side or the other, does the canal prevent the leg from following, unless the patient himself pay attention; neither does the canal prevent the limb from being moved without the body to the one side or the other. And a board is an uncomfortable thing to have the limb laid upon, unless something soft be placed above it. But it is a very useful thing in ****** any subsequent arrangements of the bed and in going to stool. A limb then may be well or ill arranged with or without the canal. But the common people have more confidence, and the surgeon is more likely to escape blame, when the canal is placed under the limb, although it is not secundum artem. For the limb should by all means lie straight upon some level and soft object, since the bandaging must necessarily be overcome by any distortion in the placing of the leg, whenever or to whatever extent it may be inclined. The patient, when bandaged, should return the same answers as formerly stated, for the bandaging should be the same, and the same swellings should arise in the extremities, and the slackening of the bandages in like manner, and the new bandaging on the third day; and the bandaged part should be found reduced in swelling; and the new bandagings should be more tightly put on, and more pieces of cloth should be used; and the bandages should be carried loosely about the foot, unless the wound be near the knee. Extension should be made and the bones adjusted at every new bandaging; for, if properly treated, and if the swelling progress in a suitable manner, the bandaged limb will have become more slender and attenuated, and the bones will be more mobile, and yield more readily to extension. On the seventh, the ninth, or the eleventh day, the splints should be applied as described in treating of the other fractures. Attention should be paid to the position of the splints about the ankles and along the tendon of the foot which runs up the leg. The bones of the leg get consolidated in forty days, if properly treated. But if you suspect that anything is wanting to the proper arrangement of the limb, or dread any ulceration, you should loose the bandages in the interval, and having put everything right, apply them again.