第3章

类别:其他 作者:American Medical Association S字数:1820更新时间:18/12/17 12:41:52
12.Infractureswemustattendtothelength,breadth,thickness,andnumberofthecompresses.Thelengthshouldbethatofthebandaging;thebreadth,threeorfourfingers;thickness,threeorfourfold;numbersoastoencirclethelimb,neithermorenorless; thoseappliedforthepurposeofrectifyingadeformity,shouldbeofsuchalengthastoencircleit;thebreadthandthicknessbeingdeterminedbythevacuity,whichisnottobefilledupatonce.Theupperbandagesaretwo,thefirstofwhichistobecarriedfromtheseatoftheinjuryupwards,andthesecondfromtheseatoftheinjurydownwards,andfrombelowupwards;thepartsabouttheseatoftheinjurybeingmostcompressed,theextremitiesleast,andtherestinproportion.Theupperbandagesshouldtakeinaconsiderableportionofthesoundparts.Wemustattendtothenumber,length,andbreadthofthebandages;thenumbermustbesuchasnottobeinferiortowhattheinjuryrequires,noroccasioncompressionwiththesplints,norprovecumbersome,noroccasionanyslippingofthem,norrendertheminefficient.Astolengthandbreadth,theyshouldbethree,four,five,orsixcubitsinlength,andasmanyfingersbroad.Thefoldsofthestrings(selvages?)shouldbesuchasnottooccasionpressure;theyaretobesoftandnotthick;andallthesethingsaretobeproportionatetothelength,breadth,andthicknessofthepartaffected.Thesplintsaretobesmooth,even,androundedattheextremities;somewhatlessallalongthantheupperbandaging,andthickestattheparttowhichfractureinclines. Thosepartswheretherearetuberosities,andwhicharedevoidofflesh,suchastheanklesorfingers,wemustguardfromthesplintswhichareplacedoverthem,eitherbyposition,orbytheirshortness. Theyaretobesecuredbythestringsinsuchamannerasnottooccasionpressureatfirst.Asoft,consistent,andcleancerateshouldberubbedintothefoldsofthebandage. 13.Astothetemperatureandquantityofthewaterused,itsheatshouldbejustsuchasthehandcanbear,anditoughttobeknownthatalargequantityisbestforproducingrelaxationandattenuation,whereasamoderatequantityisbestforincarnatingandsoftening.Thelimittotheaffusionis,tostopwhenthepartsbecomeswelledup,andbeforetheswellingsubsides;forthepartsswellupatfirst,andfallafterward. 14.Theobjectonwhichto(thelimb?)islaidshouldbesoft,smooth,andslopingupwardstowardtheprotuberantpartsofthebody,suchastheheelorhips,sothattheremaybenoprojection,norbendinginwards,norturningaside.Thecanal(spoutorgutter?) shouldrathercomprehendthewholelimbthanthehalfofit,attentionbeingpaidtotheinjuryandtowhateverelseappearstocreateinconvenience. 15.Thepresentationoftheinjuredparttothephysician,theextension,thearrangement,andsoforth,aretoberegulatedaccordingtonature.Whatisnatureintheseoperationsistobedeterminedbytheaccomplishmentoftheobjectwhichwehaveinview,andforthispurposewemustlooktothepartinthestateofrest,initsmiddlestate,andtohabit;inregardtothestateofrestandrelaxation,asinthearm,thatitbeinalinewiththehand;andwithregardtothemediumbetweenflexionandextension,thattheforearmbeatrightanglestothearm;andwithregardtohabit,itshouldbeconsideredthatsomelimbsbearcertainpositionspreferably,as,forexample,thethighsextension;forinsuchattitudesthepartscanbestbeartobeplacedforaconsiderabletimewithoutachangeofposture.Andinthechangefromthestateofdistention,themuscles,veins,nerves,andbones,whenproperlyarrangedandsecured,willpreservetheirrelationstooneanotherwhilethelimbisraisedorplaced. 16.Theextensionshouldbemostpowerfulwhenthelargestandthickestbones,orwhenbotharebroken;nextwhentheunder—bone,andleastofall,whentheupper.Whenimmoderate,itisinjurious,exceptinthecaseofchildren.Thelimbshouldbealittleelevated.Themodelbywhichwejudgeifthepartbeproperlysetisthesoundpartofthesamename,orthepartwhichisitspair. 17.Frictioncanrelax,brace,incarnate,attenuate:hardbraces,softrelaxes,muchattenuates,andmoderatethickens.