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patient say that the bandaging is loose； you must then fasten the
splints； especially at the fracture； but also elsewhere； wherever
the bandaging is rather loose than tight。 The splint should be
thickest where the fracture protrudes； but it should not be much
more so than elsewhere。 Particular attention should be paid to the
line of the arm corresponding to the thumb； so that no splint be
laid on it； but upon each side of it； nor in the line of the little
finger where the bone is prominent at the wrist； but on each side of
it。 And if it be found necessary that splints should be applied in
these directions at the seat of the fracture； they should be made
shorter than the others； so as that they may not reach the bones which
are prominent at the wrist； for otherwise there is danger of
ulceration； and of the tendons being laid bare。 The splints should
be adjusted anew every third day； in a very gentle manner； always
keeping in mind that the object of the splints is to maintain the
lower bandages in their place； and that they are not needed in order
to contribute to the compression。
7。 If； then； you see that the bones are properly adjusted by the
first dressings； and that there is no troublesome pruritus in the
part； nor any reason to suspect ulceration； you may allow the arm to
remain bandaged in the splints until after the lapse of more than
twenty days。 The bones of the fore…arm generally get consolidated in
thirty days altogether； but there is nothing precise in this matter；
for one constitution differs from another； and one period of life from
another。 When you remove the bandages； you must pour hot water on
the arm and bind it up again； but somewhat slacker； and with fewer
bandages than formerly： and again on the third day you undo the
bandages； and bind it still more loosely； and with still fewer
bandages。 And if； while the arm is bound up in the splints； you should
at any time suspect that the bones do not lie properly； or if anything
about the bandages annoys the patient； you should loose them at the
middle of the time； or a little earlier； and apply them again。 A
diet slightly restricted will be sufficient in those cases in which
there was no external wound at first； or when the bone does not
protrude； but one should live rather sparingly until the tenth day； as
being now deprived of exercise； and tender articles of food should
be used； such as moderately loosen the bowels； but one should
abstain altogether from flesh and wine； and then by degrees resume a
more nourishing diet。 This diet。 may be laid down as a just rule in
the treatment of fractures； both as to how they should be treated； and
what will be the results of a proper plan of treatment； so that one
may know； that if things do not turn out thus； there has been some
defect or excess in the treatment。 And in this simple plan of
treatment it is necessary to attend also to the following
directions； which some physicians pay little attention to； although；
when improperly executed； they are capable of marring the whole
process of bandaging： for if both the bones be broken； or the lower
one only； and the patient who has got his arm bandaged keep it slung
in a shawl； and that the shawl is particularly loose at the
fracture； so that the arm is not properly suspended at this end or
that； in this case the bone must necessarily be found distorted
upwards； whereas； when both bones are thus broken； if the arm
recline in the shawl at the wrist and elbow； but the rest of it be not
kept up； the bone in this case will be distorted to the lower side。
The greater part of the arm and the wrist of the hand should therefore
be equally suspended in a broad soft shawl。
8。 When the arm is broken； if one stretch the fore…arm and adjust it
while in this position； the muscle of the arm will be bound while
extended； but when the dressing is over； and the patient bends his arm
at the elbow； the muscle of the arm will assume a different shape。 The
following； then； is the most natural plan of setting the arm： having
got a piece of wood a cubit or somewhat less in length； like the
handles of spades； suspend it by means of a chain fastened to its
extremities at both ends； and having seated the man on some high
object； the arm is to be brought over； so that the armpit may rest
on the piece of wood； and the man can scarcely touch the seat； being
almost suspended； then having brought another seat； and placed one
or more leather pillows under the arm； so as to keep it a moderate
height while it is bent at a right angle； the best plan is to put
round the arm a broad and soft skin； or broad shawl； and to hang
some great weight to it； so as to produce moderate extension； or
otherwise； while the arm is in the position I have described； a strong
man is to take hold of it at the elbow and pull it downward。 But the
physician standing erect； must perform the proper manipulation； having
the one foot on some pretty high object； and adjusting the bone with
the palms of his hands； and it will readily be adjusted； for the
extension is good if properly applied。 Then let him bind the arm；
commencing at the fracture； and do otherwise as directed above； let
him put the same questions and avail himself of the same signs to
ascertain whether the arm be moderately tight or not； and every
third day let him bind it anew and make it tighter； and on the seventh
or ninth day let him bind it up with splints； and leave it so until
after the lapse of more than thirty days。 And if he suspect that the
bone is not lying properly； let him remove the bandages in the
interval； and having adjusted the arm； let him bind it up again。 The
bone of the arm is generally consolidated in forty days。 When these
are past； the dressing is to be removed； and fewer and slacker
bandages applied instead of it。 The patient is to be kept on a
stricter diet； and for a longer space of time than in the former case；
and we must form our judgment of it from the swelling in the hand；
looking also to the strength of the patient。 This also should be
known； that the arm is naturally inclined outward； to this side；
therefore； the distortion usually takes place； if not properly
treated； but indeed； all the other bones are usually distorted
during treatment for fracture to that side to which they naturally
incline。 When； therefore； anything of this kind is suspected； the
arm is to be encircled in a broad shawl； which is to be carried
round the breast； and when the patient goes to rest； a compress of
many folds； or some such thing； is to be folded and placed between the
elbow and the side； for thus the bending of the bone will be
rectified； but care must be taken lest it be inclined too much
inwards。
9。 The human foot is composed of several small bones like the
hand。 These bones therefore are scarcely ever broken； unless the
skin at the same time be wounded by some sharp and heavy body。 The
treatment of stich injuries； therefore； will be delivered under the
head of wounds。 But if any bone be moved from its place； or a joint of
the toes be luxated； or any of the bones of the part called the tarsus
be displaced； it must be forced back again to its place as