On Fractures   

power. But those who approve of binding up the limb with wool for
a day or two, and on the third and fourth apply bandages, and make
the greatest compression and extension at that period, such persons
show themselves to be ignorant of the most important principles of
medicine; for, in a word, at no time is it so little proper to disturb
all kinds of wounds as on the third and fourth day; and all sort of
probing should be avoided on these days in whatever other injuries
are attended with irritation. For, generally, the third and fourth
day in most cases of wounds, are those which give rise to exacerbations,
whether the tendency be to inflammation, to a foul condition of the
sore, or to fevers. And if any piece of information be particularly
valuable this is; to which of the most important cases in medicine
does it not apply? and that not only in wounds but in many other diseases,
unless one should call all other diseases wounds. And this doctrine
is not devoid of a certain degree of plausibility, for they are allied
to one another in many respects. But those who maintain that wool
should be used until after the first seven days, and then that the
parts should be extended and adjusted, and secured with bandages,
would appear not to be equally devoid of proper judgment, for the
proper judgment, for the most dangerous season for inflammation is
then past, and the bones being loose can be easily set after the lapse
of these days. But still this mode of treatment is far inferior to
that with bandages from the commencement; for, the latter method exhibits
the patient on the seventh day free from inflammation, and ready for
complete bandaging with splints; while the former method is far behind
in this respect, and is attended with many other bad effects which
it would be tedious to describe.
31a. In those cases of fracture in which the bones protrude and cannot
be restored to their place, the following mode of reduction may be
practiced:- Some small pieces of iron are to be prepared like the
levers which the cutters of stone make use of, one being rather broader
and another narrower; and there should be three of them at least,
and still more, so that you may use those that suit best; and then,
along with extension, we must use these as levers, applying the under
surface of the piece of iron to the under fragment of the bone, and
the upper surface to the upper bone; and, in a word, we must operate
powerfully with the lever as we would do upon a stone or a piece of
wood. The pieces of iron should be as strong as possible, so that
they may not bend. This is a powerful assistance, provided the pieces
of iron be suitable, and one use them properly as levers. Of all the
mechanical instruments used by men, the most powerful are these three,
the axis in peritrochio, the lever, and the wedge. Without these,
one or all, men could not perform any of their works which require
great force. Wherefore, reduction with the lever is not to be despised,
for the bones will be reduced in this way, or not at all. But if the
upper fragment which rides over the other does not furnish a suitable
point of support a suitable point of support for the lever, but the
protruding PART is sharp, you must scoop out of the bone what will
furnish a proper place for the lever to rest on. The lever, along
with extension, may be had recourse to on the day of the accident,
or the accident, or next day, but by no means on the third, the fourth,
and the fifth. For if the limb is disturbed on these days, and yet
the fractured bones not reduced, inflammation will be excited, and
this no less if they are reduced; for convulsions are more apt to
occur if reduction take place, than if the attempt should fail. These
facts should be well known, for if convulsions should come on when
reduction is effected, there effected, there is little hope of recovery;
but it is of use to displace the bones again if this can be done with
out trouble. For it is not at the time when the parts are in a particularly
relaxed condition that convulsions and tetanus are apt to supervene,
but when they are more than usually tense. In the case we are now
treating of, we should not disturb the limb on the aforesaid days,
but strive to keep the wound as free from inflammation as possible,
and especially encourage suppuration in it. But when seven days have