Thethigh-boneisconsolidatedinfortydays。
　　20。Butthisalsoshouldbeknown，thatthethigh-boneiscurvedrathertotheoutsidethantotheinside，andratherforwardthanbackward；whennotproperlytreated，then，thedistortionsareinthesedirections；andtheboneisleastcoveredwithfleshatthesameparts，sothatthedistortioncannotbeconcealed。If，therefore，yoususpectanythingofthiskind，youshouldhaverecoursetothemechanicalcontrivancesrecommendedindistortionofthearm。Andafewturnsofthebandageshouldbebroughtroundbythehipandtheloins，sothatthegroinandthearticulationneartheperineummaybeincludedinthebandage；andmoreover，itisexpedientthattheextremitiesofthesplintsshouldnotdomischiefbybeingplacedonpartsnotcoveredwiththebandages。Thesplints，infact，shouldbecarefullykeptoffthenakedpartsatbothends；andthearrangementofthemshouldbesomanaged，asthattheymaynotbeplacedonthenaturalprotuberancesoftheboneattheknee-joint，noronthetendonwhichissituatedthere。
　　21。Theswellingswhichariseintheham，atthefoot，orinanyotherpartfromthepressure，shouldbewellwrappedinunscouredandcardedwool，washedwithwineandoil，andanointedwithcerate，beforebandaging；andifthesplintsgivepaintheyshouldbeslackened。Youmaysoonerreducetheswellings，bylayingasidethesplints，andapplyingplentyofbandagestothem，beginningfrombelowandrollingupward；forthustheswellingswillbemostspeedilyreduced，andthehumorsbepropelledtothepartsabovetheformerbandages。Butthisformofbandagingmustnotbeusedunlesstherebedangerofvesicationsorblackeningintheswelling，andnothingofthekindoccursunlessthefracturebeboundtootight，orunlessthelimbbeallowedtohang，oritberubbedwiththehand，orsomeotherthingofanirritantnaturebeappliedtotheskin。
　　22。Moreinjurythangoodresultsfromplacingbelowthethighacanalwhichdoesnotpassfartherdownthantheham，foritneitherpreventsthebodynorthelegfrombeingmovedwithoutthethigh。
　　Anditcreatesuneasinessbybeingbroughtdowntotheham，andhasatendencytoproducewhatofallthingsshouldbeavoided，namely，flexionattheknee，forthiscompletelydisturbsthebandages；andwhenthethighandlegarebandaged，ifonebendthelimbattheknee，themusclesnecessarilyassumeanothershape，andthebrokenbonesarealsonecessarilymoved。Everyendeavorthenshouldbemadetokeepthehamextended。Butitappearstome，thatacanalwhichembracesthelimbfromthenatestothefootisofuse。Andmoreover，ashawlshouldbeputlooselyroundattheham，alongwiththecanal，aschildrenareswathedinbed；andthen，ifthethigh-bonegetsdisplacedeitherupwardortotheside，itcanbemoreeasilykeptinpositionbythismeansalongwiththecanal。Thecanalthenshouldbemadesoastoextendallalongthelimbornotusedatall。
　　23。Theextremityoftheheelshouldbeparticularlyattendedto，sothatitmaybeproperlylaid，bothinfracturesofthelegandofthethigh。Forifthefootbeplacedinadependentposition，whiletherestofthebodyissupported，thelimbmustpresentacurvedappearanceattheforepartoftheleg；andiftheheelbeplacedhigherthanisproper，andiftherestofthelegberathertoolow，theboneattheforepartofthelegmustpresentahollow，moreespeciallyiftheheelofthepatientbenaturallylarge。Butallthebonesgetconsolidatedmoreslowly，ifnotlaidproperly，andifnotkeptsteadyinthesameposition，andinthiscasethecallusismorefeeble。
　　24。Thesethingsrelatetocasesinwhichthereisfractureoftheboneswithoutprotrusionofthesameorwoundofanyotherkind。Inthosecasesinwhichthebonesaresimplybrokenacross，andarenotcomminuted，butprotrude，ifreducedthesamedayornext，andsecuredintheirplace，andiftherebenoreasontoanticipatethatanysplinteredboneswillcomeaway；andinthoseinwhichthebrokenbonesdonotprotrude，noristhemodeoffracturesuchthatthereisreasontoexpectthesplinterswillcomeout，somephysicianshealthesoresinawaywhichneitherdoesmuchgoodnorharm，bymeansofacleansingapplication，applyingpitchointment，orsomeofthedressingsforfreshwounds，oranythingelsewhichtheyareaccustomedtodo，andbindingabovethemcompresseswettedwithwine，orgreasywool，orsomethingelseofthelikenature。Andwhenthewoundsbecomecleanandarenewhealed，theyendeavortobindupthelimbwithplentyofbandages，andkeepitstraightwithtreatmentdoessomegood，andnevermuchharm。Thebones，however，canneverbeequallywellrestoredtotheirplace，butthepartisalittlemoreswelledthanitshouldbe；andthelimbwillbesomewhatshortened，providedbothboneseitherofthelegorfore-armhavebeenfractured。
　　25。Thereareotherswhotreatsuchcasesatfirstwithbandages，applyingthemonbothsidesoftheseatoftheinjury，butomitthemthere，andleavethewounduncovered，andafterwardtheyapplytothewoundsomecleansingmedicine，andcompletethedressingwithcompressesdippedinwineandgreasywool。Thisplanoftreatmentisbad，anditisclearthatthosewhoadoptthismodeofpracticeareguiltyofgreatmistakesinothercasesoffractureaswellasthese。Foritisamostimportantconsiderationtoknowinwhatmannertheheadofthebandageshouldbeplacedandatwhatpartthegreatestpressureshouldbe，andwhatbenefitswouldresultfromapplyingtheendofthebandageandthepressureattheproperplace，andwhatmischiefswouldresultfromapplyingtheheadofthebandageandthepressureotherwisethanattheproperplace。Whereforeithasbeenstatedintheprecedingpartoftheworkwhataretheresultsofeither；andthepracticeofmedicinebearswitnesstothetruthofit，forinapersonthusbandaged，aswellingmustnecessarilyariseonthewound。For，ifevenasoundpieceofskinwerebandagedoneitherside，andapartwereleftinthemiddle，thepartthusleftunbandagedwouldbecomemostswelled，andwouldassumeabadcolor；
　　howthencoulditbethatawoundwouldnotsufferinlikemanner？Thewoundthenmustnecessarilybecomediscoloredanditslipseverted，thedischargewillbeichorousandwithoutpus，andthebones，whichshouldnothavegotintoastateofnecrosis，exfoliate；andthewoundgetsintoathrobbingandinflamedcondition。Andtheyareobligedtoapplyacataplasmonaccountoftheswelling，butthisisanunsuitableapplicationtopartswhicharebandagedonbothsides，forauselessloadisaddedtothethrobbingwhichformerlyexistedinit。Atlasttheyloosethebandageswhenmattersgetveryserious，andconducttherestofthetreatmentwithoutbandaging；andnotwithstanding，iftheymeetwithanothercaseofthesamedescription，theytreatitinthesamemanner，fortheydonotthinkthattheapplicationofthebandagesonbothsides，andtheexposureofthewoundarethecauseofwhathappened，butsomeotheruntowardcircumstance。WhereforeIwouldnothavewrittensomuchonthissubject，ifIhadnotwellknownthatthismodeofbandagingisunsuitable，andyetthatmanyconductthetreatmentinthisway，whosemistakeitisofvitalimportancetocorrect，whilewhatisheresaidisaproof，thatwhatwasformerlywrittenastothecircumstancesunderwhichbandagesshouldbetightlyappliedtofracturesorotherwisehasbeencorrectlywritten。
　　26。Asageneralruleitmaybesaid，thatinthosecasesinwhichaseparationofboneisnotexpected，thesametreatmentshouldbeappliedaswhenthefracturesarenotcomplicatedwithanexternalwound；fortheextension，adjustmentofthebones，andthebandaging，aretobeconductedinthesamemanner。Tothewounditselfaceratemixedwithpitchistobeapplied，athinfoldedcompressistobebounduponit，andthepartsaroundaretobeanointedwithwhitecerate。Theclothsforbandagesandtheotherthingsshouldbetornbroaderthanincasesinwhichthereisnowound，andthefirstturnofthebandageshouldbeagooddealbroaderthanthewound。
　　Foranarrowerbandagethanthewoundbindsthewoundlikeagirdle，whichisnotproper，orthefirstturnshouldcomprehendthewholewound，andthebandagingshouldextendbeyonditonbothsides。Thebandagethenshouldbeputoninthedirectionofthewound，andshouldbenotquitesotightaswhenthereisnowound，butthebandageshouldbeotherwiseappliedinthemannerdescribedabove。Thebandagesshouldbeofasoftconsistence，andmoreespeciallysoinsuchcasesthaninthosenotcomplicatedwithawound。Thenumberofbandagesshouldnotbesmaller，butrathergreaterthanthoseformerlydescribed。Whenapplied，thepatientshouldhavethefeelingofthepartsbeingproperlysecured，butnottootight，andinparticularheshouldbeabletosaythattheyarefirmaboutthewound。Andtheintervalsoftimeduringwhichthepartsseemtobeproperlyadjusted，andthoseinwhichtheygetloose，shouldbethesameasthoseformerlydescribed。Thebandagesshouldberenewedonthethirdday，andtheaftertreatmentconductedinthesamemannerasformerlydescribed，exceptthatinthelattercasethecompressionshouldbesomewhatlessthanintheformer。Andifmattersgoonproperly，thepartsaboutthewoundshouldbefoundateverydressingalwaysmoreandmorefreeofswelling，andtheswellingshouldhavesubsidedonthewholepartcomprehendedbythebandages。Andthesuppurationswilltakeplacemorespeedilythaninthecaseofwoundstreatedotherwise；
　　andthepiecesoffleshinthewoundwhichhavebecomeblackanddead，willsoonerseparateandfalloffunderthisplanoftreatmentthananyother，andthesorewillcomemorequicklytocicatrizationwhenthustreatedthanotherwise。Thereasonofallthisis，thatthepartsinwhichthewoundissituated，andthesurroundingparts，arekeptfreeofswelling。Inallotherrespectsthetreatmentistobeconductedasincasesoffracturewithoutawoundoftheinteguments。Splintsshouldnotbeapplied。Onthisaccountthebandagesshouldbemorenumerousthanintheformercase，bothbecausetheymustbeputonlesstight，andbecausethesplintsarelaterofbeingapplied。Butifyoudoapplythesplints，theyshouldnotbeappliedalongthewound，andtheyaretobeputoninaloosemanner，especialcarebeingtakenthattheremaybenogreatcompressionfromthesplints。Thisdirectionhasbeenformerlygiven。Andthedietshouldbemorerestricted，andforalongerperiod，inthosecasesinwhichthereisawoundatthecommencement，andwhenthebonesprotrudethroughtheskin；and，inaword，thegreaterthewound，themoresevereandprotractedshouldtheregimenbe。
　　27。Thetreatmentofthesoresisthesameinthosecasesoffractureinwhichtherewasnowoundoftheskinatfirst，butonehasformedinthecourseoftreatment，owingtothepressureofthesplintsoccasionedbythebandages，orfromanyothercause。Insuchcasesitisascertainedthatthereisanulcer，bythepainandthethrobbing；andtheswellingintheextremitiesbecomesharderthanusual，andifyouapplyyourfingertherednessdisappears，butspeedilyreturns。Ifyoususpectanythingofthekindyoumustloosethedressing，iftherebeanyitchingbelowtheunder-bandages，orinanyotherpartthatisbandaged，andusedapitchedcerateinsteadoftheother。Iftherebenothingofthat，butiftheulcerbefoundinanirritablestate，beingveryblackandfoul，andthefleshypartsabouttosuppurate，andthetendonstosloughaway，inthesecasesnopartistobeexposedtotheair，norisanythingtobeapprehendedfromthesesuppurations，butthetreatmentistobeconductedinthesamemannerasinthosecasesinwhichtherewasanexternalwoundatfirst。Youmustbegintoapplythebandageslooselyattheswellingintheextremities，andthengraduallyproceedupwardwiththebandaging，sothatitmaybetightatnoplace，butparticularlyfirmatthesore，andlesssoelsewhere。Thefirstbandagesshouldbecleanandnotnarrow，andthenumberofbandagesshouldbeasgreatasinthosecasesinwhichthesplintswereused，orsomewhatfewer。Tothesoreitselfacompress，anointedwithwhitecerate，willbesufficient，forifapieceoffleshornerve（tendon？）becomeblack，itwillfalloff；forsuchsoresarenottobetreatedwithacrid，butwithemollientapplications，likeburns。Thebandagesaretoberenewedeverythirdday，andnosplintsaretobeapplied，butrestistobemorerigidlymaintainedthanintheformercases，alongwitharestricteddiet。Itshouldbeknown，thatifanypieceoffleshortendonbetocomeaway，themischiefwillspreadmuchless，andthepartswillmuchmorespeedilydropoff，andtheswellinginthesurroundingpartswillmuchmorecompletelysubside，underthistreatment，thanifanyofthecleansingapplicationsbeputuponthesore。Andifanypartthatistocomeawayshallfalloff，thepartwillincarnatesoonerwhenthustreatedthanotherwise，andwillmorespeedilycicatrize。Sucharethegoodeffectsofknowinghowabandagecanbewellandmoderatelyapplied。Butaproperposition，theotherpartsoftheregimen，andsuitablebandagescooperate。
　　28。Ifyouaredeceivedwithregardtoarecentwound，supposingtherewillbenoexfoliationofthebones，whiletheyareontheeveofcomingoutofthesore，youmustnothesitatetoadoptthismodeoftreatment；fornogreatmischiefwillresult，providedyouhavethenecessarydexteritytoapplythebandageswellandwithoutdoinganyharm。Andthisisasymptomofanexfoliationofbonebeingabouttotakeplaceunderthismodeoftreatment；pusrunscopiouslyfromthesore，andappearsstrivingtomakeitsescape。Thebandagemustberenewedmorefrequentlyonaccountofthedischarge，sinceotherwisefeverscomeon；ifthesoreandsurroundingpartsbecompressedbythebandagestheybecomewasted。Casescomplicatedwiththeexfoliationofverysmallbones，donotrequireanychangeoftreatment，onlythebandagesshouldbeputonmoreloosely，sothatthedischargeofpusmaynotbeintercepted，butleftfree，andthedressingsaretobefrequentlyreneweduntiltheboneexfoliate，andthesplintsshouldnotbeapplieduntilthen。
　　29。Thosecasesinwhichtheexfoliationofalargerpieceofboneisexpected，whetheryoudiscoverthisatthecommencement，orperceivesubsequentlythatitistohappen，nolongerrequirethesamemodeoftreatment，onlythattheextensionandarrangementofthepartsaretobeperformedinamannerthathasbeendescribed；buthavingformeddoublecompresses，notlessthanhalfafathominbreadth（beingguidedinthisbythenatureofthewound），andconsiderablyshorterthanwhatwouldberequiredtogotwiceroundthepartthatiswounded，butconsiderablylongerthantogoonceround，andinnumberwhatwillbesufficient，thesearetobedippedinablackausterewine；andbeginningatthemiddle，asisdoneinapplyingthedouble-headedbandage，youaretowrapthepartaroundandproceedcrossingtheheadsintheformofthebandagecalled"ascia。"Thesethingsaretobedoneatthewound，andonbothsidesofit；andtheremustbenocompression，buttheyaretobelaidonsoastogivesupporttothewound。Andonthewounditselfistobeappliedthepitchedcerate，oroneoftheapplicationstorecentwounds，oranyothermedicinewhichwillsuitwiththeembrocation。
　　Andifitbethesummerseason，thecompressesaretobefrequentlydampedwithwine；butifthewinterseason，plentyofgreasywool，moistenedwithwineandoil，shouldbeapplied。Andagoat’sskinshouldbespreadbelow，soastocarryoffthefluidswhichrunfromthewound；thesemustbeguardedagainst，anditshouldbekeptinmind，thatpartswhichremainlonginthesamepositionaresubjecttoexcoriationswhicharedifficulttocure。
　　30。Insuchcasesasdonotadmitofbandagingaccordingtoanyofthemethodswhichhavebeendescribed，orwhichwillbedescribed，greatpainsshouldbetakenthatthefracturedpartofthebodybelaidinarightposition，andattentionshouldbepaidthatitmayinclineupwardratherthandownward。Butifonewouldwishtodothethingwellanddexterously，itispropertohaverecoursetosomemechanicalcontrivance，inorderthatthefracturedpartofthebodymayundergoproperandnotviolentextension；andthismeansisparticularlyapplicableinfracturesoftheleg。Therearecertainphysicianswho，inallfracturesoftheleg，whetherbandagesbeappliedornot，fastenthesoleofthefoottothecouch，ortosomeotherpieceofwoodwhichtheyhavefixedinthegroundnearthecouch。Thesepersonsthusdoallsortsofmischiefbutnogood；foritcontributesnothingtotheextensionthatthefootisthusbound，astherestofthebodywillnolesssinkdowntothefoot，andthusthelimbwillnolongerbestretched，neitherwillitdoanygoodtowardkeepingthelimbinaproperposition，butwilldoharm，forwhentherestofthebodyisturnedtothissideorthat，thebandagingwillnotpreventthefootandthebonesbelongingtoitfromfollowingtherestofthebody。Forifithadnotbeenbounditwouldhavebeenlessdistorted，asitwouldhavebeenthelesspreventedfromfollowingthemotionoftherestofthebody。ButoneshouldsewtwoballsofEgyptianleather，suchasarewornbypersonsconfinedforalengthoftimeinlargeshackles，andtheballstheballsshouldhavecoatsoneachside，deepertowardthewound，butshortertowardthejoints；andtheballsshouldbewellstuffedandsoft，andfitwell，theoneabovetheankles，andtheotherbelowtheknee。Sidewaysitshouldhavebelowtwoappendages，eitherofasingleordoublethong，andshort，likeloops，theonesetbeingplacedoneithersideoftheankle，andtheotherontheknee。Andtheotherupperballshouldhaveothersofthesamekindinthesameline。
　　Thentakingfourrods，madeofthecorneltree，ofequallength，andofthethicknessofafinger，andofsuchlengththatwhenbenttheywilladmitofbeingadjustedtotheappendages，careshouldbetakenthattheextremitiesoftherodsbearnotupontheskin，butontheextremitiesoftheballs。Thereshouldbethreesetsofrods，ormore，onesetalittlelongerthananother，andanotheralittleshorterandsmaller，sothattheymayproducegreaterorlessdistention，ifrequired。Eitherofthesesetsofrodsshouldbeplacedonthissideandthatoftheankles。Ifthesethingsbeproperlycontrived，theyshouldoccasionaproperandequableextensioninastraightline，withoutgivinganypaintothewound；forthepressure，ifthereisany，shouldbethrownatthefootandthethigh。Andtherodsarecommodiouslyarrangedoneithersideoftheankles，soasnottointerferewiththepositionofthelimb；andthewoundiseasilyexaminedandeasilyarranged。And，ifthoughtproper，thereisnothingtopreventthetwoupperrodsfrombeingfastenedtooneanother；
　　andifanylightcoveringbethrownoverthelimb，itwillthusbekeptofffromthewound。If，then，theballsbewellmade，handsome，soft，andnewlystitched，andiftheextensionbytherodsbeproperlymanaged，ashasbeenalreadydescribed，thisisanexcellentcontrivance；butifanyofthemdonotfitproperly，itdoesmoreharmthangood。Andallothermechanicalcontrivancesshouldeitherbeproperlydone，ornotbehadrecoursetoatall，foritisadisgracefulandawkwardthingtousemechanicalmeansinanunmechanicalway。
　　31。Moreover，thegreaterpartofphysicianstreatfractures，bothwithandwithoutanexternalwound，duringthefirstdays，bymeansofunwashedwool，andtheredoesnotappeartobeanythingimproperinthis。Itisveryexcusableforthosewhoarecalledupontotreatnewly-receivedaccidentsofthiskind，andwhohavenoclothforbandagesathand，todothemupwithwool；for，exceptclothforbandages，onecouldnothaveanythingbetterthanwoolinsuchcases；butagooddealshouldbeusedforthispurpose，anditshouldbewellcardedandnotrough，forinsmallquantityandofabadqualityithaslittlepower。Butthosewhoapproveofbindingupthelimbwithwoolforadayortwo，andonthethirdandfourthapplybandages，andmakethegreatestcompressionandextensionatthatperiod，suchpersonsshowthemselvestobeignorantofthemostimportantprinciplesofmedicine；for，inaword，atnotimeisitsolittlepropertodisturballkindsofwoundsasonthethirdandfourthday；andallsortofprobingshouldbeavoidedonthesedaysinwhateverotherinjuriesareattendedwithirritation。For，generally，thethirdandfourthdayinmostcasesofwounds，arethosewhichgiverisetoexacerbations，whetherthetendencybetoinflammation，toafoulconditionofthesore，ortofevers。Andifanypieceofinformationbeparticularlyvaluablethisis；towhichofthemostimportantcasesinmedicinedoesitnotapply？andthatnotonlyinwoundsbutinmanyotherdiseases，unlessoneshouldcallallotherdiseaseswounds。Andthisdoctrineisnotdevoidofacertaindegreeofplausibility，fortheyarealliedtooneanotherinmanyrespects。Butthosewhomaintainthatwoolshouldbeuseduntilafterthefirstsevendays，andthenthatthepartsshouldbeextendedandadjusted，andsecuredwithbandages，wouldappearnottobeequallydevoidofproperjudgment，fortheproperjudgment，forthemostdangerousseasonforinflammationisthenpast，andthebonesbeingloosecanbeeasilysetafterthelapseofthesedays。Butstillthismodeoftreatmentisfarinferiortothatwithbandagesfromthecommencement；for，thelattermethodexhibitsthepatientontheseventhdayfreefrominflammation，andreadyforcompletebandagingwithsplints；whiletheformermethodisfarbehindinthisrespect，andisattendedwithmanyotherbadeffectswhichitwouldbetedioustodescribe。
　　31a。Inthosecasesoffractureinwhichthebonesprotrudeandcannotberestoredtotheirplace，thefollowingmodeofreductionmaybepracticed：-Somesmallpiecesofironaretobepreparedliketheleverswhichthecuttersofstonemakeuseof，onebeingratherbroaderandanothernarrower；andthereshouldbethreeofthematleast，andstillmore，sothatyoumayusethosethatsuitbest；andthen，alongwithextension，wemustusetheseaslevers，applyingtheundersurfaceofthepieceofirontotheunderfragmentofthebone，andtheuppersurfacetotheupperbone；and，inaword，wemustoperatepowerfullywiththeleveraswewoulddouponastoneorapieceofwood。Thepiecesofironshouldbeasstrongaspossible，sothattheymaynotbend。Thisisapowerfulassistance，providedthepiecesofironbesuitable，andoneusethemproperlyaslevers。Ofallthemechanicalinstrumentsusedbymen，themostpowerfularethesethree，theaxisinperitrochio，thelever，andthewedge。
　　Withoutthese，oneorall，mencouldnotperformanyoftheirworkswhichrequiregreatforce。Wherefore，reductionwiththeleverisnottobedespised，fortheboneswillbereducedinthisway，ornotatall。Butiftheupperfragmentwhichridesovertheotherdoesnotfurnishasuitablepointofsupportasuitablepointofsupportforthelever，buttheprotrudingpartissharp，youmustscoopoutofthebonewhatwillfurnishaproperplaceforthelevertoreston。Thelever，alongwithextension，maybehadrecoursetoonthedayoftheaccident，ortheaccident，ornextday，butbynomeansonthethird，thefourth，andthefifth。Forifthelimbisdisturbedonthesedays，andyetthefracturedbonesnotreduced，inflammationwillbeexcited，andthisnolessiftheyarereduced；
　　forconvulsionsaremoreapttooccurifreductiontakeplace，thaniftheattemptshouldfail。Thesefactsshouldbewellknown，forifconvulsionsshouldcomeonwhenreductioniseffected，thereeffected，thereislittlehopeofrecovery；butitisofusetodisplacethebonesagainifthiscanbedonewithouttrouble。Foritisnotatthetimewhenthepartsareinaparticularlyrelaxedconditionthatconvulsionsandtetanusareapttosupervene，butwhentheyaremorethanusuallytense。Inthecasewearenowtreatingof，weshouldnotdisturbthelimbontheaforesaiddays，butstrivetokeepthewoundasfreefrominflammationaspossible，andespeciallyencouragesuppurationinit。Butwhensevendayshaveelapsed，orrathermore，iftherebenofever，andifthewoundbenotinflamed，thentherewillbelesstopreventanattemptatreduction，ifyouhopetosucceed；butotherwiseyouneednottakeandgivetroubleinvain。
　　32。Whenyouhavereducedthebonestotheirplace，themodesoftreatment，whetheryouexpectthebonestoexfoliateornot，havebeenalreadydescribed。Allthosecasesinwhichanexfoliationofboneisexpected，shouldbetreatedbythemethodofbandagingwithcloths，beginningforthemostpartatthemiddleofthebandage，asisdonewiththedouble-headedbandage；butparticularattentionshouldbepaidtotheshapeofthewound，sothatitslipsmaygapeorbedistortedaslittleaspossibleunderthebandage。Sometimestheturnsofthebandagehavetobemadetotheright，andsometimestotheleft，andsometimesadouble-headedbandageistobeused。
　　33。Itshouldbeknownthatbones，whichithasbeenfoundimpossibletoreduce，aswellasthosewhicharewhollydenudedofflesh，willbecomedetached。Insomecasestheupperpartoftheboneislaidbare，andinothersthefleshdiesallaround；and，fromasoreoflongstanding，certainofthebonesbecomecarious，andsomenot，somemore，andsomeless；andinsomethesmall，andinothersthelargebones。Fromwhathasbeensaiditwillbeseen，thatitisimpossibletotellinonewordwhentheboneswillseparate。Somecomeawaymorequickly，owingtotheirsmallness，andsomefrombeingmerelyfixedatthepoint；andsome，frompiecesnotseparating，butmerelyexfoliating，becomedriedupandputrid；andbesides，differentmodesoftreatmenthavedifferenteffects。Forthemostpart，thebonesseparatemostquicklyinthosecasesinwhichsuppurationtakesplacemostquickly，andwhennewfleshismostquicklyformed，andisparticularlysound，forthefleshwhichgrowsupbelowinthewoundgenerallyelevatesthepiecesofbone。Itwillbewellifthewholecircleoftheboneseparateinfortydays；forinsomecasesitisprotractedtosixtydays，andinsometomore；forthemoreporouspiecesofboneseparatemorequickly，butthemoresolidcomeawaymoreslowly；buttheothersmallersplintersinmuchlesstime，andothersotherwise。Aportionofbonewhichprotrudesshouldbesawnoffforthefollowingreasons：ifitcannotbereduced，andifitappearssons：thatonlyasmallpieceisrequiredinorderthatitmaygetbackintoitsplace；andifitbesuchthatitcanbetakenout，andifitoccasionsinconvenienceandirritatesanypartoftheflesh，andpreventsthelimbfrombeingproperlylaid，andif，moreover，itbedenudedofflesh，suchapieceofboneshouldbetakenoff。Withregardtotheothers，itisnotofmuchconsequencewhethertheybesawedoffornot。Foritshouldbeknownforcertain，thatsuchbonesasarecompletelydeprivedofflesh，andhavebecomedried，allseparatecompletely。Thosewhichareabouttoexfollateshouldnotbesawnoff。Thosethatwillseparatecompletelymustbejudgedoffromthesymptomsthathavebeenlaiddown。
　　34。Suchcasesaretobetreatedwithcompressesandvinousapplications，asformerlylaiddownregardingboneswhichwillseparate。Wemustavoidwettingitatthebeginningwithanythingcold；forthereisdangeroffebrilerigors，andalsoofconvulsions；forconvulsionsareinducedbycoldthings，andalsosometimesbywounds。Itispropertoknowthatthemembersarenecessarilyshortenedinthosecasesinwhichtheboneshavebeenbroken，andhavehealedtheoneacrosstheother，andinthosecasesinwhichthewholecircleofthebonehasbecomedetached。
　　35。Thosecasesinwhichtheboneofthethigh，orofthearm，protrudes，donoteasilyrecover。Forthebonesarelarge，andcontainmuchmarrow；andmanyimportantnerves，muscles，andveinsarewoundedatthesametime。Andifyoureducethem，convulsionsusuallysupervene；and，ifnotreduced，acutebiliousfeverscomeon，withsingultusandmortification。Thechancesofrecoveryarenotfewerinthosecasesinwhichthepartshavenotbeenreduced，noranyattemptsmadeatreduction。Stillmorerecoverinthosecasesinwhichthelower，thanthoseinwhichtheupperpartoftheboneprotrudes；
　　andsomewillrecoverwhenreductionhasbeenmade，butveryrarelyindeed。Formodesoftreatmentandpeculiarityofconstitutionmakeagreatdifferenceastothecapabilityofenduringsuchaninjury。
　　Anditmakesagreatdifferenceifthebonesofthearmandofthethighprotrudetotheinside；fortherearemanyandimportantvesselssituatedthere，someofwhich，ifwounded，willprovefatal；therearesuchalsoontheoutside，butoflessimportance。Inwoundsofthissort，then，oneoughtnottobeignorantofthedangers，andshouldprognosticatetheminduetime。Butifyouarecompelledtohaverecoursetoreduction，andhopetosucceed，andifthebonesdonotcrossoneanothermuch，andifthemusclesarenotcontracted（fortheyusuallyarecontracted），theleverinsuchcasesmaybeadvantageouslyemployed。
　　36。Havingeffectedthereduction，youmustgiveanemollientdraughtofhelleborethesameday，providedithasbeenreducedonthedayoftheaccident，butotherwiseitshouldnotbeattempted。Thewoundshouldbetreatedwiththesamethingsasareusedinfracturesofthebonesofthehead，andnothingcoldshouldbeapplied；thepatientshouldberestrictedfromfoodaltogether，andifnaturallyofabiliousconstitution，heshouldhaveforadietalittlefragrantoxyglykysprinkledonwater；butifheisnotbilious，heshouldhavewaterfordrink；andiffeverofthecontinualtypecomeon，heistobeconfinedtothisregimenforfourteendaysatleast，butifhebefreeoffever，foronlysevendays，andthenyoumustbringhimbackbydegreestoacommondiet。Tothosecasesinwhichtheboneshavenotbeenreduced，asimilarcourseofmedicineshouldbeadministered，alongwiththesametreatmentofthesoresandregimen；andinlikemannerthesuspendedpartofthebodyshouldnotbestretched，butshouldratherbecontracted，soastorelaxthepartsaboutthewound。Theseparationofthebonesisprotracted，asalsowasformerlystated。Butoneshouldtrytoescapefromsuchcases，providedonecandosohonourably，forthehopesofrecoveryaresmall，andthedangersmany；andifthephysiciandonotreducethefracturedboneshewillbelookeduponasuponasunskillful，whilebyreducingthemhewillbringthepatientnearertodeaththantorecovery。
　　37。Luxationsandsubluxationsatthekneearemuchmilderaccidentsthansubluxationsandluxationsattheelbow。Fortheknee-joint，inproportiontoitssize，ismorecompactthanthatofthearm，andhasamoreevenconformation，andisrounded，whilethejointofthearmislarge，andhasmanycavities。Andinaddition，thebonesofthelegarenearlyofthesamelength，fortheexternaloneovertopstheothertososmallanextentashardlytodeservebeingmentioned，andthereforeaffordsnogreatresistance，althoughtheexternalnerve（ligament？）atthehamarisesfromit；butthebonesofthefore-armareunequal，andtheshorterisconsiderablythickerthantheother，andthemoreslender（ulna？）protrudes，andpassesupabovethejoint，andtoit（theolecranon？）areattachedthenerves（ligaments？）
　　whichgodownwardtothejunctionofthebones；andtheslenderbone（ulna？）hasmoretodowiththeinsertionoftheligamentsinthearmthanthethickbone（radius？）。Theconfigurationthenofthearticulations，andofthebonesoftheelbow，issuchasIhavedescribed。Owingtotheirconfiguration，thebonesatthekneeareindeedfrequentlydislocated，buttheyareeasilyreduced，fornogreatinflammationfollows，noranyconstrictionofthejoint。Theyaredisplacedforthemostparttotheinside，sometimestotheoutside，andoccasionallyintotheham。Thereductioninallthesecasesisnotdifficult，butinthedislocationsinwardandoutward，thepatientshouldbeplacedonalowseat，andthethighshouldbeelevated，butnotmuch。Moderateextensionforthemostpartsufficeth，extensionbeingmadeattheleg，andcounter-extensionatthethigh。
　　38。Dislocationsattheelbowaremoretroublesomethanthoseattheknee，and，owingtotheinflammationwhichcomeson，andtheconfigurationofthejoint，aremoredifficulttoreduceifthebonesarenotimmediatelyreplaced。Forthebonesattheelbowarelesssubjecttodislocationthanthoseoftheknee，butaremoredifficulttoreduceandkeepintheirposition，andaremoreapttobecomeinflamedandankylosed。
　　39。Forthemostpartthedisplacementsofthesebonesaresmall，sometimestowardtheribs，andsometimestotheoutside；andthewholearticulationisnotdisplaced，butthatpartofthehumerusremainsinplacewhichisarticulatedwiththecavityoftheboneoftheforearmthathasaprotuberance（ulna？）。Suchdislocations，towhateverside，areeasilyreduced，andtheextensionistobemadeinthelineofthearm，onepersonmakingextensionatthewrist，andanothergraspingthearmpit，whileathird，applyingthepalmofhishandtothepartofthejointwhichisdisplaced，pushesitinwardward，andatthesametimemakescounterpressureontheoppositesidenearthejointwiththeotherhand。
　　40。Theendofthehumerusatthe，elbowgetsdisplaced（subluxated？）byleavingthecavityoftheulna。Suchluxationsreadilyyieldtoreduction，ifappliedbeforethepartsgetinflamed。Thedisplacementforthemostpartistotheinside，butsometimestotheoutside，andtheyarereadilyrecognizedbytheshapeofthelimb。Andoftensuchluxationsarereducedwithoutanypowerfulextension。Indislocationsinward，thejointistobepushedintoitsplace，whilethefore-armisbroughtroundtoastateofpronation。Sucharemostofthedislocationsattheelbow。
　　41。Butifthearticularextremityofthehumerusbecarriedtoeithersideabovetheboneofthefore-arm，whichisprominent，intothehollowofthearm（？），thisrarelyhappens；butifitdoeshappen，extensioninthestraightlineisnotsoproperundersuchcircumstances；forinsuchamodeofextension，theprocessoftheulna（olecranon？）preventstheboneofthearm（humerus？）frompassingoverit。Indislocationsofthiskind，extensionshouldbemadeinthemannerdescribedwhentreatingofthebandagingoffracturedbonesofthearm，extensionbeingmadeupwardatthearmpit，whilethepartsattheelbowarepusheddownward，forinthismannercanthehumerusbemostreadilyraisedaboveitscavity；andwhensoraised，thereductioniseasywiththepalmsofthehand，theonebeingappliedsoastomakepressureontheprotuberantpartofthearm，andtheothermakingcounter-pressure，soastopushtheboneofthefore-armintothejoint。Thismethodanswerswithbothcases。Andperhapsthisisthemostsuitablemodeofreductioninsuchacaseofdislocation。Thepartsmaybereducedbyextensioninastraightline，butlessreadilythanthus。
　　42。Ifthearmbedislocatedforward-thisrarelyhappens，indeed，butwhatwouldasuddenshocknotdisplace？formanyotherthingsareremovedfromtheirproperplace，notwithstandingagreatobstacle，-insuchaviolentdisplacementthepart（olecranon？）
　　whichpassesabovetheprominentpartofthebonesislarge，andthestretchingofthenerves（ligaments？）isintense；andyetthepartshavebeensodislocatedincertaincases。Thefollowingisthesymptomofsuchadisplacement：thearmcannotbebentintheleastdegreeattheelbow，anduponfeelingthejointthenatureoftheaccidentbecomesobvious。If，then，itisnotspeedilyreduced，strongandviolentinflammation，attendedwithfever，willcomeon，butifonehappentobeonthespotatthetimeitiseasilyreduced。Apieceofhardlinencloth（orapieceofhardlinen，notverylarge，rolledupinaball，willbesufficient）istobeplacedacrossthebendoftheelbow，andthearmisthentobesuddenlybentattheelbow，andthehandbroughtuptotheshoulder。Thismodeofreductionissufficientinsuchdisplacements；andextensioninthestraightlinecanrectifythismannerofdislocation，butwemustuseatthesametimethepalmsofthehands，applyingtheonetotheprojectingpartofthehumerusatthebendofthearmforthepurposeofpushingitback，andapplyingtheotherbelowtothesharpextremityoftheelbow，tomakecounter-pressure，andinclinethepartsintothestraightline。Andonemayusewithadvantageinthisformofdislocationthemethodofextensionformerlydescribed，fortheapplicationofthebandagesinthecaseoffractureofthearm；butwhenextensionismade，thepartsaretobeadjusted，ashasbeenalsodescribedabove。
　　43。Butifthearmbedislocatedbackward（butthisveryrarelyhappens，anditisthemostpainfulofall，andthemostsubjecttobiliousfeversofthecontinualtype，whichprovefatalinthecourseofafewdays），insuchacasethepatientcannotextendthearm。Ifyouarequicklypresent，byforcibleextensionthepartsmayreturntotheirplaceoftheirownaccord；butiffeverhavepreviouslycomeon，youmustnolongerattemptreduction，forthepainwillberenderedmoreintensebyanysuchviolentattempt。Inaword，nojointwhatevershouldbereducedduringtheprevalenceoffever，andleastofalltheelbow-joint。
　　44。Therearealsoothertroublesomeinjuriesconnectedwiththeelbow-joint；forexample，thethickerbone（radius？）issometimepartiallydisplacedfromtheother，andthepatientcanneitherperformextensionnorflexionproperly。Thisaccidentbecomesobviousuponexaminationwiththehandatthebendofthearmnearthedivisionoftheveinthatrunsupthemuscle。Insuchacaseitisnoteasytoreducethepartstotheirnaturalstate，norisiteasy，intheseparationofanytwobonesunitedbysymphysis，torestorethemtotheirnaturalstate，fortherewillnecessarilybeaswellingattheseatofthediastasis。Themethodofbandagingajointhasbeenalreadydescribedintreatingoftheapplicationofbandagestotheankle。
　　45。Incertaincasestheprocessoftheulna（olecranon？）behindthehumerusisbroken；sometimesitscartilaginouspart，whichgivesorigintotheposteriortendonofthearm，andsometimesitsforepart，atthebaseoftheanteriorcoronoidprocess；andwhenthisdisplacementtakesplace，itisapttobeattendedwithmalignantfever。Thejoint，however，remainsinplace，foritswholebaseprotrudesatthatpoint。Butwhenthedisplacementtakesplacewhereitsheadovertopsthearm，thejointbecomeslooserifthebonebefairlybrokenacross。Tospeakingeneralterms，allcasesoffracturedbonesarelessdangerousthanthoseinwhichthebonesarenotbroken，buttheveinsandimportantnerves（tendons？）situatedintheseplacesarecontused；fortheriskofdeathismoreimmediateinthelatterclassofcasesthanintheformer，ifcontinualfevercomeon。Butfracturesofthisnatureseldomoccur。
　　46。Itsometimeshappensthattheheadofthehumerusisfracturedatitsepiphysis；andthis，althoughitmayappeartobeamuchmoretroublesomeaccident，isinfactamuchmilderonethantheotherinjuriesatthejoint。
　　47。Thetreatmentespeciallybefittingeachparticulardislocationhasbeendescribed；andithasbeenlaiddownasarule，thatimmediatereductionisoftheutmostadvantage，owingtotherapidmannerinwhichinflammationofthetendonssupervenes。Forevenwhentheluxatedpartsareimmediatelyreduced，thetendonsusuallybecomestiffened，andforaconsiderabletimepreventextensionandflexionfrombeingperformedtotheordinaryextent。aretobetreatedinasimilarway，whethertheextremityofthearticulatingbonebesnappedoff，whetherthebonesbeseparated，orwhethertheybedislocated；fortheyarealltobetreatedwithplentyofbandages，compresses，andcerate，likeotherfractures。Thepositionofthejointinallthesecasesshouldbethesame，aswhenafracturedarmorfore-armhasbeenboundup。Forthisisthemostcommonpositioninalldislocations，displacements，andfractures；anditisthemostconvenientforthesubsequentmovements，whetherofextensionorflexion，asbeingtheintermediatestagebetweenboth。Andthisisthepositioninwhichthepatientcanmostconvenientlycarryorsuspendhisarminasling。Andbesides，ifthejointistobestiffenedbycallus，itwerebetterthatthisshouldnottakeplacewhenthearmisextended，forthispositionwillbeagreatimpedimentandlittleadvantage；ifthearmbewhollybent，itwillbemoreuseful；butitwillbemuchmoreconvenienttohavethejointintheintermediatepositionwhenitbecomesankylosed。Somuchwithregardtoposition。
　　48。Inbandaging，theheadofthefirstbandageshouldbeplacedattheseatoftheinjury，whetheritbeacaseoffracture，ofdislocation，orofdiastasis（separation？），andthefirstturnsshouldbemadethere，andthebandagesshouldbeappliedmostfirmlyatthatplace，andlesssooneitherside。Thebandagingshouldcomprehendboththearmandthefore-arm，andonbothshouldbetoamuchgreaterextentthanmostphysiciansapplyit，sothattheswellingmaybeexpelledfromtheseatoftheinjurytoeitherside。
　　Andpointofthefore-armshouldbecomprehendedinthebandaging，whethertheinjurybeinthatplaceornot，inorderthattheswellingmaynotcollectthere。Inapplyingbandages，wemustavoidasmuchaspossibleaccumulatingmanyturnsofthebandageatthebendofthearm。Fortheprincipalcompressionshouldbeattheseatoftheinjury，andthesamerulesaretobeobserved，andatthesameperiods，withregardtocompressionandrelaxation，asformerlydescribedrespectingthetreatmentofbrokenbones；andthebandagesshouldberenewedeverythirdday；andtheyshouldappearlooseonthethirdday，asintheothercase。Andsplintsshouldbeappliedatthepropertime（forthereisnothingunsuitableinthem，whetherthebonesbefracturedornot，providedthereisnofever）；theyshouldbeparticularlyloose，whetherappliedtothearmortheforearm，buttheymustnotbethick。Itisnecessarythattheyshouldbeofunequalsize，andthattheoneshouldrideovertheother，wheneverfromtheflexionitisjudgedproper。Andtheapplicationofthecompressesshouldberegulatedinthesamemannerashasbeenstatedwithregardtothesplints；andtheyshouldbeputoninasomewhatmorebulkyformattheseatoftheinjury。Theperiodsaretobeestimatedfromtheinflammation，andfromwhathasbeenwrittenonthemabove。