On Fractures   

in the direction of the wound, and should be not quite so tight as
when there is no wound, but the bandage should be otherwise applied
in the manner described above. The bandages should be of a soft consistence,
and more especially so in such cases than in those not complicated
with a wound. The number of bandages should not be smaller, but rather
greater than those formerly described. When applied, the patient should
have the feeling of the parts being properly secured, but not too
tight, and in particular he should be able to say that they are firm
about the wound. And the intervals of time during which the parts
seem to be properly adjusted, and those in which they get loose, should
be the same as those formerly described. The bandages should be renewed
on the third day, and the after treatment conducted in the same manner
as formerly described, except that in the latter case the compression
should be somewhat less than in the former. And if matters go on properly,
the parts about the wound should be found at every dressing always
more and more free of swelling, and the swelling should have subsided
on the whole part comprehended by the bandages. And the suppurations
will take place more speedily than in the case of wounds treated otherwise;
and the pieces of flesh in the wound which have become black and dead,
will sooner separate and fall off under this plan of treatment than
any other, and the sore will come more quickly to cicatrization when
thus treated than otherwise. The reason of all this is, that the parts
in which the wound is situated, and the surrounding parts, are kept
free of swelling. In all other respects the treatment is to be conducted
as in cases of fracture without a wound of the integuments. Splints
should not be applied. On this account the bandages should be more
numerous than in the former case, both because they must be put on
less tight, and because the splints are later of being applied. But
if you do apply the splints, they should not be applied along the
wound, and they are to be put on in a loose manner, especial care
being taken that there may be no great compression from the splints.
This direction has been formerly given. And the diet should be more
restricted, and for a longer period, in those cases in which there
is a wound at the commencement, and when the bones protrude through
the skin; and, in a word, the greater the wound, the more severe and
protracted should the regimen be.


PART 27
The treatment of the sores is the same in those cases of fracture
in which there was no wound of the skin at first, but one has formed
in the course of treatment, owing to the pressure of the splints occasioned
by the bandages, or from any other cause. In such cases it is ascertained
that there is an ulcer, by the pain and the throbbing; and the swelling
in the extremities becomes harder than usual, and if you apply your
finger the redness disappears, but speedily returns. If you suspect
anything of the kind you must loose the dressing, if there be any
itching below the under-bandages, or in any other part that is bandaged,
and used a pitched cerate instead of the other. If there be nothing
of that, but if the ulcer be found in an irritable state, being very
black and foul, and the fleshy parts about to suppurate, and the tendons
to slough away, in these cases no part is to be exposed to the air,
nor is anything to be apprehended from these suppurations, but the
treatment is to be conducted in the same manner as in those cases
in which there was an external wound at first. You must begin to apply
the bandages loosely at the swelling in the extremities, and then
gradually proceed upward with the bandaging, so that it may be tight
at no place, but particularly firm at the sore, and less so elsewhere.
The first bandages should be clean and not narrow, and the number
of bandages should be as great as in those cases in which the splints
were used, or somewhat fewer. To the sore itself a compress, anointed
with white cerate, will be sufficient, for if a piece of flesh or
nerve (tendon?) become black, it will fall off; for such sores are
not to be treated with acrid, but with emollient applications, like