bandaging will not prevent the foot and the bones belonging to it from
following the rest of the body。 For if it had not been bound it
would have been less distorted； as it would have been the less
prevented from following the motion of the rest of the body。 But one
should sew two balls of Egyptian leather； such as are worn by
persons confined for a length of time in large shackles； and the balls
the balls should have coats on each side； deeper toward the wound； but
shorter toward the joints； and the balls should be well stuffed and
soft； and fit well； the one above the ankles； and the other below
the knee。 Sideways it should have below two appendages； either of a
single or double thong； and short； like loops； the one set being
placed on either side of the ankle； and the other on the knee。 And the
other upper ball should have others of the same kind in the same line。
Then taking four rods； made of the cornel tree； of equal length； and
of the thickness of a finger； and of such length that when bent they
will admit of being adjusted to the appendages； care should be taken
that the extremities of the rods bear not upon the skin； but on the
extremities of the balls。 There should be three sets of rods； or more；
one set a little longer than another； and another a little shorter and
smaller； so that they may produce greater or less distention； if
required。 Either of these sets of rods should be placed on this side
and that of the ankles。 If these things be properly contrived； they
should occasion a proper and equable extension in a straight line；
without giving any pain to the wound； for the pressure； if there is
any； should be thrown at the foot and the thigh。 And the rods are
commodiously arranged on either side of the ankles； so as not to
interfere with the position of the limb； and the wound is easily
examined and easily arranged。 And； if thought proper； there is nothing
to prevent the two upper rods from being fastened to one another；
and if any light covering be thrown over the limb； it will thus be
kept off from the wound。 If； then； the balls be well made； handsome；
soft； and newly stitched； and if the extension by the rods be properly
managed； as has been already described； this is an excellent
contrivance； but if any of them do not fit properly； it does more harm
than good。 And all other mechanical contrivances should either be
properly done； or not be had recourse to at all； for it is a
disgraceful and awkward thing to use mechanical means in an
unmechanical way。
31。 Moreover； the greater part of physicians treat fractures； both
with and without an external wound； during the first days； by means of
unwashed wool； and there does not appear to be anything improper in
this。 It is very excusable for those who are called upon to treat
newly…received accidents of this kind； and who have no cloth for
bandages at hand； to do them up with wool； for； except cloth for
bandages； one could not have anything better than wool in such
cases； but a good deal should be used for this purpose； and it
should be well carded and not rough； for in small quantity and of a
bad quality it has little power。 But those who approve of binding up
the limb with wool for a day or two； and on the third and fourth apply
bandages； and make the greatest compression and extension at that
period； such persons show themselves to be ignorant of the most
important principles of medicine； for； in a word； at no time is it
so little proper to disturb all kinds of wounds as on the third and
fourth day； and all sort of probing should be avoided on these days in
whatever other injuries are attended with irritation。 For；
generally； the third and fourth day in most cases of wounds； are those
which give rise to exacerbations； whether the tendency be to
inflammation； to a foul condition of the sore； or to fevers。 And if
any piece of information be particularly valuable this is； to which of
the most important cases in medicine does it not apply？ and that not
only in wounds but in many other diseases； unless one should call
all other diseases wounds。 And this doctrine is not devoid of a
certain degree of plausibility； for they are allied to one another
in many respects。 But those who maintain that wool should be used
until after the first seven days； and then that the parts should be
extended and adjusted； and secured with bandages； would appear not
to be equally devoid of proper judgment； for the proper judgment；
for the most dangerous season for inflammation is then past； and the
bones being loose can be easily set after the lapse of these days。 But
still this mode of treatment is far inferior to that with bandages
from the commencement； for； the latter method exhibits the patient
on the seventh day free from inflammation； and ready for complete
bandaging with splints； while the former method is far behind in
this respect； and is attended with many other bad effects which it
would be tedious to describe。
31a。 In those cases of fracture in which the bones protrude and
cannot be restored to their place； the following mode of reduction may
be practiced：… Some small pieces of iron are to be prepared like the
levers which the cutters of stone make use of； one being rather
broader and another narrower； and there should be three of them at
least； and still more； so that you may use those that suit best； and
then； along with extension； we must use these as levers； applying
the under surface of the piece of iron to the under fragment of the
bone； and the upper surface to the upper bone； and； in a word； we must
operate powerfully with the lever as we would do upon a stone or a
piece of wood。 The pieces of iron should be as strong as possible；
so that they may not bend。 This is a powerful assistance； provided the
pieces of iron be suitable； and one use them properly as levers。 Of
all the mechanical instruments used by men； the most powerful are
these three； the axis in peritrochio； the lever； and the wedge。
Without these； one or all； men could not perform any of their works
which require great force。 Wherefore； reduction with the lever is
not to be despised； for the bones will be reduced in this way； or
not at all。 But if the upper fragment which rides over the other
does not furnish a suitable point of support a suitable point of
support for the lever； but the protruding part is sharp； you must
scoop out of the bone what will furnish a proper place for the lever
to rest on。 The lever； along with extension； may be had recourse to on
the day of the accident； or the accident； or next day； but by no means
on the third； the fourth； and the fifth。 For if the limb is
disturbed on these days； and yet the fractured bones not reduced；
inflammation will be excited； and this no less if they are reduced；
for convulsions are more apt to occur if reduction take place； than if
the attempt should fail。 These facts should be well known； for if
convulsions should come on when reduction is effected； there effected；
there is little hope of recovery； but it is of use to displace the
bones again if this can be done with out trouble。 For it is not at the
time when the parts are in a particularly relaxed condition that
convulsions and tetanus are apt to supervene； but when they are more
than usually tense。 In the case we are now treating of； we should
not disturb the limb on the aforesaid days； but strive to keep the
wound as free from inflammation as possible； and especially
encourage suppuration in it。 But when seven days have elapsed； or
rather more； if there be no fever； and if the wound be not inflamed；
then there will be less to prevent an attempt at reduction； if you
hope to succeed； but otherwise you need not take and give trouble in
vain。
32。 When you have reduced the bones to their place； the modes of
treatment； whether you expect the bones to exfoliate or not； have been
already described。 All those cases in which an exfoliation of bone
is expected； should be treated by the method of bandaging with cloths；
beginning for the most part at the middle of the bandage； as is done
with the double…headed bandage； but particular attention should be
paid to the shape of the wound； so that its lips may gape or be
distorted as little as possible under the bandage。 Sometimes the turns
of the bandage have to be made to the right； and sometimes to the
left； and sometimes a double…headed bandage is to be used。
33。 It should be known that bones； which it has been found
impossible to reduce； as well as those which are wholly denuded of
flesh； will become detached。 In some cases the upper part of the
bone is laid bare； and in others the flesh dies all around； and；
from a sore of long standing； certain of the bones become carious； and
some not； some more； and some less； and in some the small； and in
others the large bones。 From what has been said it will be seen；
that it is impossible to tell in one word when the bones will
separate。 Some come away more quickly； owing to their smallness； and
some from being merely fixed at the point； and some； from pieces not
separating； but merely exfoliating； become dried up and putrid； and
besides； different modes of treatment have different effects。 For
the most part； the bones separate most quickly in those cases in which
suppuration takes place most quickly； and when new flesh is most
quickly formed； and is particularly sound； for the flesh which grows
up below in the wound generally elevates the pieces of bone。 It will
be well if the whole circle of the bone separate in forty days； for in
some cases it is protracted to sixty days； and in some to more； for
the more porous pieces of bone separate more quickly； but the more
solid come away more slowly； but the other smaller splinters in much
less time； and others otherwise。 A portion of bone which protrudes
should be sawn off for the following reasons： if it cannot be reduced；
and if it appears sons： that only a small piece is required in order
that it may get back into its place； and if it be such that it can
be taken out； and if it occasions inconvenience and irritates any part
of the flesh； and prevents the limb from being properly laid； and
if； moreover； it be denuded of flesh； such a p