On The Surgery
occasion pressure; they are to be soft and not thick; and all these
things are to be proportionate to the length, breadth, and thickness
of the part affected. The splints are to be smooth, even, and
rounded at the extremities; somewhat less all along than the upper
bandaging, and thickest at the part to which fracture inclines.
Those parts where there are tuberosities, and which are devoid of
flesh, such as the ankles or fingers, we must guard from the splints
which are placed over them, either by position, or by their shortness.
They are to be secured by the strings in such a manner as not to
occasion pressure at first. A soft, consistent, and clean cerate
should be rubbed into the folds of the bandage.
13. As to the temperature and quantity of the water used, its heat
should be just such as the hand can bear, and it ought to be known
that a large quantity is best for producing relaxation and
attenuation, whereas a moderate quantity is best for incarnating and
softening. The limit to the affusion is, to stop when the parts become
swelled up, and before the swelling subsides; for the parts swell up
at first, and fall afterward.
14. The object on which to (the limb?) is laid should be soft,
smooth, and sloping upwards toward the protuberant parts of the
body, such as the heel or hips, so that there may be no projection,
nor bending inwards, nor turning aside. The canal (spout or gutter?)
should rather comprehend the whole limb than the half of it, attention
being paid to the injury and to whatever else appears to create
15. The presentation of the injured part to the physician, the
extension, the arrangement, and so forth, are to be regulated
according to nature. What is nature in these operations is to be
determined by the accomplishment of the object which we have in
view, and for this purpose we must look to the part in the state of
rest, in its middle state, and to habit; in regard to the state of
rest and relaxation, as in the arm, that it be in a line with the
hand; and with regard to the medium between flexion and extension,
that the forearm be at right angles to the arm; and with regard to
habit, it should be considered that some limbs bear certain
positions preferably, as, for example, the thighs extension; for in
such attitudes the parts can best bear to be placed for a considerable
time without a change of posture. And in the change from the state
of distention, the muscles, veins, nerves, and bones, when properly
arranged and secured, will preserve their relations to one another
while the limb is raised or placed.
16. The extension should be most powerful when the largest and
thickest bones, or when both are broken; next when the under-bone, and
least of all, when the upper. When immoderate, it is injurious, except
in the case of children. The limb should be a little elevated. The
model by which we judge if the part be properly set is the sound
part of the same name, or the part which is its pair.
17. Friction can relax, brace, incarnate, attenuate: hard braces,
soft relaxes, much attenuates, and moderate thickens.
18. The following should be the state of matters on the first
application of the bandage. The person to whom it has been applied
should say that he feels the compression particularly at the seat of
the injury, but very little at the extremities; the parts should be
adjusted but not pressed together, and that rather by the number of
the bandages than by the force of the constriction; and the
tightness should rather be on the increase during the first day and
night; but on the next it should be less, and on the third the
bandages should be loose. On the next day a soft swelling should be
observed in the extremities; and on the third day, when the
bandaging is loosed, the swelling should be found diminished in
size, and this should be the case every time the bandages are removed.
At the second application of the bandage, it should be ascertained
whether the dressing has been properly done, and then greater
compression should be made, and with more bandages; and on the