《on the surgery》

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on the surgery- 第2部分


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worst which quickly falls off; but those are bad bandages which

neither compress nor yet come off。

  11。 The following are the object which the upper bandage; the

under bandage; or both aim at: The object of the under bandage is

either to bring together parts that are separated; or to compress such

as are expanded; or to separate what are contracted; or to restore

to shape what are distorted; or the contrary。 It is necessary to

prepare pieces of linen cloth; which are light; thin; soft; clean;

having no seams nor protuberances on them; but sound; and able to bear

some stretching; or even a little more than required; not dry; but

wetted with a juice suitable to the purpose required。 We must deal

with parts separated (in a sinus?) in such wise; that the parts

which are raised may touch the bottom without producing pressure; we

must begin on the sound part; and terminate at the wound; so that

whatever humor is in it may be expelled; and that it may be

prevented from collecting more。 And straight parts are to be

bandaged in a straight direction; and oblique obliquely; in such a

position as to create no pain; and so that there may be no

constriction nor falling off on a change of position; either for the

purpose of taking hold of anything; or laying the limb; and that

muscles; veins; nerves; and bones may be properly placed and

adjusted to one another。 It should be raised or laid in a natural

position; so as not to occasion pain。 In those cases in which an

abscess is formed; we must act in a contrary way。 When our object is

to bring together parts which have become expanded; in other

respects we must proceed on the same plain; and we must commence the

bringing together from some considerable distance; and after their

approach; we must apply compression; at first slight; and afterwards

stronger; the limit of it being the actual contact of the parts。 In

order to separate parts which are drawn together; when attended with

inflammation; we must proceed on the opposite plan; but when without

inflammation; we must use the same preparations; but bandage in the

opposite direction。 In order to rectify distorted parts; we must

proceed otherwise on the same principles; but the parts which are

separated must be brought together by an underbandage; by

agglutinants; and by suspending it (the limb?) in its natural

position。 And when the deformities are the contrary; this is to be

done on the contrary plan。

  12。 In fractures we must attend to the length; breadth; thickness;

and number of the compresses。 The length should be that of the

bandaging; the breadth; three or four fingers; thickness; three or

fourfold; number so as to encircle the limb; neither more nor less;

those applied for the purpose of rectifying a deformity; should be

of such a length as to encircle it; the breadth and thickness being

determined by the vacuity; which is not to be filled up at once。 The

upper bandages are two; the first of which is to be carried from the

seat of the injury upwards; and the second from the seat of the injury

downwards; and from below upwards; the parts about the seat of the

injury being most compressed; the extremities least; and the rest in

proportion。 The upper bandages should take in a considerable portion

of the sound parts。 We must attend to the number; length; and

breadth of the bandages; the number must be such as not to be inferior

to what the injury requires; nor occasion compression with the

splints; nor prove cumbersome; nor occasion any slipping of them;

nor render them inefficient。 As to length and breadth; they should

be three; four; five; or six cubits in length; and as many fingers

broad。 The folds of the strings (selvages?) should be such as not to

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

inconvenience。

  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

third; still greater; and still more。 On the seventh day from the

first dressing; when the bandages are loosed; the limb should be found

slender and the bones mobile。 We must then have recourse to the

splints; provided the limb be free of swelling; pruritus; and

ulceration; and allow them to remain until twenty days after the

accident; but if any suspicions arise; the bandages must be loosed

in the interval。 The splints should be tightened every third day。

  19。 The suspending of a fractured limb in a sling; the disposition

of it; and the bandaging; all have for their object to preserve it

in position。 The principal considerations with regard to the

position are the habits and the peculiar nature of each of the

limbs: the varieties are shown in running; walking; standing; lying;

action; repose。

  20。 It should be kept in mind that exercise strengthens; and

inactivity wastes。

  21。 Compression should be produced by the number of bandages; rather

than by the force of the constriction。

  22。 In cases of ecchymosis; contusions; sprains; or swellings not

attended with inflammations; blood is to be expelled from the wound;

in greatest quantity to the upper part; and in smallest to the

inferior; neither the arm nor the le
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