On Fractures   

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.


PART 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