INTREATINGfracturesanddislocations，thephysicianmustmaketheextensionasstraightaspossible，forthisisthemostnaturaldirection。Butifitinclinetoeitherside，itshouldratherturntothatofpronation，forthereisthuslessharmthanifitbetowardsupination。Those，then，whoactinsuchcaseswithoutdeliberation，forthemostpartdonotfallintoanygreatmistake，forthepersonwhoistohavehisarmbound，presentsitintheproperpositionfromnecessity，butphysicianswhofancythemselveslearnedinthesematters，aretheywhocommitblunders。Thereisnonecessityformuchstudy，then，inordertosetabrokenarm，andinaword，anyordinaryphysiciancanperformit；butIamunderthenecessityofgivingthelongerdirectionsonthissubject，becauseIknowphysicianswhohavethereputationofbeingskilledingivingtheproperpositionstothearminbindingitup，whileinrealitytheyareonlyshowingtheirownignorance。Butmanyotherthingsinourartarejudgedofinthismanner，forpeopleratheradmirewhatisnew，althoughtheydonotknowwhetheritbeproperornot，thanwhattheyareaccustomedto，andknowalreadytobeproper；andwhatisstrange，theyprefertowhatisobvious。Imustnowstatewhatthemistakesofmedicalmenare，whichIwishtounteach，andwhatinstructionsIhavetogiveastothemanagementofthearm；forwhatIhavetosayregardingit，willapplytotheotherbonesinthebody。
2。Thearm，then，forthatisthesubjectweweretreatingof，waspresentedinthepronepositiontobebound，butthephysicianforcedhispatienttoholditasthearchersdowhentheyprojecttheshoulder，andinthispositionhebounditup，thinkingwithinhimselfthathewasactingaccordingtoNature，andinproofofthishepointedoutthatallthebonesinthefore-armwerethusinastraightline，andthattheintegumentsbothinsideandoutside，werealsoinastraightline，andthatthefleshandnerves（tendons？）
werethusputintheirnaturalposition，andheappealedtowhathappensinarchery，asaproofofthis。Andsosaying，andsodoing，heislookeduptoasasage；andyetheforgetsthatinalltheotherartsandperformances，whetherexecutedwhetherexecutedbystrengthordexterity，whatisreckonedthenaturalpositionisnotthesame，andthatinthesamepieceofworkitmayhappenthatthenaturalpositionoftherightarmisnotthesameasthatoftheleft。Forthereisoneattitudeinthrowingthejavelin，andanotherinslinging，anotherincastingstones，anotherinboxing，andanotherinastateofrepose。Andwhateverartsoneexamines，itwillbefoundthatthenaturalpositionofthearmsisnotthesameineach，butthatineverycasethearmsareputintotheattitudewhichsuitsbestwiththeinstrumentthatisused，andtheworktobeperformed。Inpracticingarchery，nodoubtthisisthebestattitudeoftheleftarm，forgingly-moidextremityofthehumerusbeingfixedinthecavityoftheulna，inthisposition，throwsthebonesoftheforearmandarmintoaline，asiftheyconstitutedasinglebone，andallflexionatthejointispreventedinthisposition。Itisnodoubtcertainthatthememberisthusputintothemostunbendingandextendedpositionpossible，soasnottobeovercomeoryieldwhenthestringisdrawnbytherightarm，andthuswillthearcherbeenabledtodrawthestringfarthest，anddischargehisarrowwiththegreatestforceandrapidity，forarrowsthusdischargedhavethegreatestswiftnessandforce，andarecarriedtothegreatestdistances。Butthereisnothingincommonbetweenthebindingupofanarmandarchery。Moreover，ifhavingthusboundupthearm，thephysiciandirectthepatienttokeepitthus，hewilloccasionhimgreaterpainthanhehadfromthewounditself；andthusalso，ifthephysicianorderhimtobendthearm，neitherthebones，thenerves，northefleshwillanylongerbeinthesamecondition，butwillbearrangeddifferently，havingovercomethebandaging。Whatuse，then，isthereofthearcher’sattitude？Andthesemistakes，thephysician，conceitedinhisknowledge，wouldprobablynothavecommittedifhehadallowedthepatienthimselftopresenthisarm。
3。Butanotherphysicianputtingthearmintothestateofsupination，givesorderstoextendthearmthus，andbandagesitinthisposition，reckoningittheoneaccordingtonature，judgingthusfromtheskin，andalsofancyingthebonestobethusintheirnaturalposition，becausethebonewhichprotrudesatthewrist，wherethelittlefingeris，appearstobeinalinewiththebonefromwhichpeoplemeasuretheboneofthefore-arm。Thesethingshebringsforwardasproofsthatthepartsareintheirnaturalstate，andheissupposedtospeakcorrectly。But，indeed，ifthearmbekeptstretchedinasupineposition，itwillbecomeverypainful，andthisfactanyonemayascertainbyextendinghisownarminthisattitude。Andalsoaweakermangraspingwithhishandsastrongermanwhosearmisturnedinasupineposition，couldleadhimwhereverhechose，andneither，ifamanheldaswordthusinhishand，couldhemakeanyproperuseofit，soconstrainedisthisposition。And，moreover，if，whenaphysicianhasthusboundupthearm，heallowittoremaininthesameposition，thepatientwillenduregreaterpainifhewalkabout，butconsiderable，evenifheremainatrest。Andthus，too，ifheshallbendthearm，themusclesandthebonesmustnecessarilyassumeadifferentposition。But，inadditiontoothermischief，heisignorantofthesefactsregardingtheposition，thatthebonewhichprotrudesatthewrist，closetothelittlefinger，belongstothefore-arm，whereastheoneatthejoint，fromwhichpeoplemeasurethefore-arm，istheheadofthehumerus。Hefanciesthatboththesebelongtothesamebone，andmanyothersareofthisopinion。Thelatter，infact，isthesamepartasthatwhichiscalledtheelbow，uponwhichwesometimesrest，andwhenheholdsthearmthusinasupineposition，inthefirstplacetheboneappearsdistorted，andinthenextplacethetendonswhichextendfromthecarpusalongtheinnersideandfromthefingersbecomedistortedwhilethearmhasasupineposition；forthesetendonsproceedtotheboneofthehumerus，fromwhichthefore-armismeasured。Such，andsomanymistakesandmarksofignorancearecommitted，regardingthenaturalconstructionofthearm。ButifonewillextendabrokenarmasIdirect，hewillturnthebone，situatedattheextremityofthelittlefinger，intothestraightline，andalsotheoneattheelbow，andthetendonswhichstretchfromthecarpustotheextremityofthehumeruswillbeplacedinthestraightline；andwhenthearmissuspendedinasling，itwillbeinthesameattitudeasthatinwhichitwasboundup，andwillgivenopaintothepatientwhenhewalksabout，norwhenheliesreclined，andwillnotbecomefatigued。Themanshouldbesoseatedthattheprominentpartofthebonemaybeturnedtothebrightestlightwhichisathand，sothattheoperatorinmakingtheextension，maybeatnolosstodiscoverifitbesufficientlystraight。Theprominenceofabrokenbonecouldnotescapebeingdetectedbythehandofanexperiencedperson，whenappliedforthispurpose，and，moreover，theprojectingpartisparticularlypainfultothetouch。
4。Incasesoffractureineitherofthebonesoftheforearm，itiseasiertoeffectacureiftheupperbonebebroken，althoughitbethethickerone，bothbecausethesoundboneissituatedbelow，andformsasupporttoit，andbecausethedeformityismoreeasilyconcealed，therebeingathickmassoffleshontheupperside，exceptneartothewrist。Butthelowerboneiswithoutacoveringofflesh，isnoteasilyconcealed，andrequiresstrongerextension。Ifitisnotthisbone，buttheotherwhichisbroken，amorefeebleextensionprovessufficient，butifbothbebroken，amorepowerfulextensionisrequired。InthecaseofayoungpersonIhaveknowntheextensionmademorestrongthanwasnecessary，butingeneraltheextensionmadeislessthanwhatisrequired。Andwhentheyareextended，thephysicianshouldapplythepalmsofthehands，andadjustthefracturedpartsandthenhavingrubbedthepartswithcerate，butnotinlargequantitysothatthebandagesmaynotcomeoff，itistobeboundupinthisstate，carebeingtakenthatthehandbenotlowerthantheelbow，butalittlehigher，sothattheblooddonotflowtowardtheextremity，butmaybedeterminedtotheupperpart；andthenitistobesecuredwiththebandage，theheadofwhichistobeplacedatthefracture，andthebandageshouldimpartfirmnesstothepartswithoutoccasioningstrongcompression。Whenyouhavecarriedthebandagetwiceorthriceroundattheseatofthefracture，itistobecarriedupward，sothattheaffluxofbloodintoitmaybestopped，andthebandageshouldterminatethere，andthefirstbandagesoughtnottobelong。Theheadofthesecondbandageisalsotobeplacedupontheseatofthefracture，andasingleroundofitbeingmadethere，itisthentobecarrieddownward，andisnottobeappliedsotightastheother，andthereshouldbegreaterdistancesbetweentheturns，sothatthebandagemayprovesufficienttoreverttothespotwheretheotherterminated。Thebandagesmayberolledtothelefthandortotheright，ortowhateversidesuitsbestwiththepositionofthefracturedarm，oraccordingtotheinclinationwhichitmayhave。Afterwardwemustplacealongthearm，compresses，smearedwithalittlecerate，forthustheyoccasionlessuneasiness，andaremoreeasilyarranged。
Andthenwemustapplythebandagescrossways，sometimestotherighthand，andsometimestotheleft，forthemostpartbeginningbelowandterminatingabove，butsometimescommencingaboveandendingbelow。Thepartswhicharethinlycoveredwithfleshshouldbewrappedroundwithcompresses，andinequalitiesshouldbemadeup，notbyanumberoffoldsatonce，butbydegrees。Someslackturnsarealsotobemadearoundthewrist，tothissideandtothat。Thesetwobandagesaresufficientatfirst。
5。Andthesearethesignsthatthepatienthasbeenwelltreatedandproperlybandaged：ifyouaskhimifthearmfeelstight，andhesaysitdoes，butmoderatelyso，andespeciallyaboutthefracture；
andthisreplyheshouldmakeallalong，ifthebandagebeproperlyapplied。Andthesearesymptomsofthebandagingbeingmoderatelytight；ifforthefirstdayandnighthefanciesthatthetightnessdoesnotdiminish，butratherincreases；andifonthenextdaytherebeasoftswellinginthehand，forthisisasignofmoderatecompression，butattheendoftheseconddaythecompressionshouldfeelless，andonthethirddaythebandagingshouldappearloose。Andifanyofthesesymptomsbewanting，youmayconcludethatthebandagingisslackerthanitshouldbe；orifanyofthesesymptomsbeinexcess，youmayinferthatthecompressionismorethanmoderate；
andjudgingfromthese，youwillapplythenextbandageseitherslackerortighter。Havingremovedthebandagesonthethirdday，youmustmakeextensionandadjustthefracture，andbinditupagain；
andifthefirstbandagingwasmoderatelyapplied，thesecondbandagingshouldbemadesomewhattighter。Theheadsthebandagesshouldbeplacedonthefracturesasintheformercase；for，sodoing，thehumorswillbedriventotheextremities，whereasifyoubandageanyotherpartbeforehand，thehumorswillheforcedfromittotheseatofthefracture：itisofmuchimportancethatthisshouldbeproperlyunderstood。Thusthebandagingandcompressionshouldalwayscommenceattheseatofthefracture，andeverythingelseshouldbeconductedonthesameprinciple，sothatthefartheryouproceedfromthefracture，thecompressionshouldalwaysbetheless。Thebandagesshouldneverbeactuallyloose，butshouldbesmoothlyputon。Ateachdressingthenumberofbandagesshouldbeincreased；andthepatient，ifasked，shouldanswer，thathefeelsthebandagessomewhattighterthanontheformeroccasion，especiallyaboutthefracture，andeverythingelseinproportion；andwithrespecttotheswelling，thepain，andrecovery，everythingshouldproceedasaftertheformerdressing。Butonthethirddaytheouterbandagingshouldappearlooser。Thenhavingremovedthebandages，youshouldbinditupagain，somewhattighterthanbefore，andwithallthebandageswhichwillberequiredontheoccasion，andafterwardsoneoughttoexperiencethesametrainofsymptomsasattheformerperiodsofbandaging。
6。Whenthethirddayarrives，thatistosay，theseventhfromthefirstdressing，ifproperlydone，theswellinginthehandshouldbenotverygreat；andthepartwhichhasbeenbandagedshouldbefoundmoreslenderandlessswelledateachtime，andontheseventhdaytheswellingshouldbequitegone，andthebrokenbonesshouldbemorereadilymoved，andadmitofbeingeasilyadjusted。
Andifthesethingsbeso，youshould，aftersettingthefracture，applythebandagessoastosuitthesplints，andalittlemoretightthanformerly，unlesstherebemorepainfromtheswellinginthehand。Whenyouhaveappliedthebandages，youmustadjustthesplintsallaroundthelimb，andsecurethemsecurethemwithstringssolooseasjusttokeepthemintheirplace，withouttheapplicationofthesplintscontributingatalltothecompressionofthearm。Afterthisthepainandrecoveryshouldproceedasintheprecedingperiodsofthebandaging。Butif，onthethirdday，thepatientsaythatthebandagingisloose，youmustthenfastenthesplints，especiallyatthefracture，butalsoelsewhere，whereverthebandagingisratherloosethantight。Thesplintshouldbethickestwherethefractureprotrudes，butitshouldnotbemuchmoresothanelsewhere。Particularattentionshouldbepaidtothelineofthearmcorrespondingtothethumb，sothatnosplintbelaidonit，butuponeachsideofit，norinthelineofthelittlefingerwheretheboneisprominentatthewrist，butoneachsideofit。Andifitbefoundnecessarythatsplintsshouldbeappliedinthesedirectionsattheseatofthefracture，theyshouldbemadeshorterthantheothers，soasthattheymaynotreachtheboneswhichareprominentatthewrist，forotherwisethereisdangerofulceration，andofthetendonsbeinglaidbare。Thesplintsshouldbeadjustedaneweverythirdday，inaverygentlemanner，alwayskeepinginmindthattheobjectofthesplintsistomaintainthelowerbandagesintheirplace，andthattheyarenotneededinordertocontributetothecompression。
7。If，then，youseethatthebonesareproperlyadjustedbythefirstdressings，andthatthereisnotroublesomepruritusinthepart，noranyreasontosuspectulceration，youmayallowthearmtoremainbandagedinthesplintsuntilafterthelapseofmorethantwentydays。Thebonesofthefore-armgenerallygetconsolidatedinthirtydaysaltogether；butthereisnothingpreciseinthismatter，foroneconstitutiondiffersfromanother，andoneperiodoflifefromanother。Whenyouremovethebandages，youmustpourhotwateronthearmandbinditupagain，butsomewhatslacker，andwithfewerbandagesthanformerly：andagainonthethirddayyouundothebandages，andbinditstillmoreloosely，andwithstillfewerbandages。Andif，whilethearmisboundupinthesplints，youshouldatanytimesuspectthatthebonesdonotlieproperly，orifanythingaboutthebandagesannoysthepatient，youshouldloosethematthemiddleofthetime，oralittleearlier，andapplythemagain。A
dietslightlyrestrictedwillbesufficientinthosecasesinwhichtherewasnoexternalwoundatfirst，orwhenthebonedoesnotprotrude；butoneshouldliverathersparinglyuntilthetenthday，asbeingnowdeprivedofexercise；andtenderarticlesoffoodshouldbeused，suchasmoderatelyloosenthebowels；butoneshouldabstainaltogetherfromfleshandwine，andthenbydegreesresumeamorenourishingdiet。Thisdiet。maybelaiddownasajustruleinthetreatmentoffractures，bothastohowtheyshouldbetreated，andwhatwillbetheresultsofaproperplanoftreatment；sothatonemayknow，thatifthingsdonotturnoutthus，therehasbeensomedefectorexcessinthetreatment。Andinthissimpleplanoftreatmentitisnecessarytoattendalsotothefollowingdirections，whichsomephysicianspaylittleattentionto，although，whenimproperlyexecuted，theyarecapableofmarringthewholeprocessofbandaging：forifboththebonesbebroken，ortheloweroneonly，andthepatientwhohasgothisarmbandagedkeepitslunginashawl，andthattheshawlisparticularlylooseatthefracture，sothatthearmisnotproperlysuspendedatthisendorthat，inthiscasethebonemustnecessarilybefounddistortedupwards；whereas，whenbothbonesarethusbroken，ifthearmreclineintheshawlatthewristandelbow，buttherestofitbenotkeptup，theboneinthiscasewillbedistortedtothelowerside。
Thegreaterpartofthearmandthewristofthehandshouldthereforebeequallysuspendedinabroadsoftshawl。
8。Whenthearmisbroken，ifonestretchthefore-armandadjustitwhileinthisposition，themuscleofthearmwillbeboundwhileextended；butwhenthedressingisover，andthepatientbendshisarmattheelbow，themuscleofthearmwillassumeadifferentshape。Thefollowing，then，isthemostnaturalplanofsettingthearm：havinggotapieceofwoodacubitorsomewhatlessinlength，likethehandlesofspades，suspenditbymeansofachainfastenedtoitsextremitiesatbothends；andhavingseatedthemanonsomehighobject，thearmistobebroughtover，sothatthearmpitmayrestonthepieceofwood，andthemancanscarcelytouchtheseat，beingalmostsuspended；thenhavingbroughtanotherseat，andplacedoneormoreleatherpillowsunderthearm，soastokeepitamoderateheightwhileitisbentatarightangle，thebestplanistoputroundthearmabroadandsoftskin，orbroadshawl，andtohangsomegreatweighttoit，soastoproducemoderateextension；orotherwise，whilethearmisinthepositionIhavedescribed，astrongmanistotakeholdofitattheelbowandpullitdownward。Butthephysicianstandingerect，mustperformthepropermanipulation，havingtheonefootonsomeprettyhighobject，andadjustingthebonewiththepalmsofhishands；anditwillreadilybeadjusted，fortheextensionisgoodifproperlyapplied。Thenlethimbindthearm，commencingatthefracture，anddootherwiseasdirectedabove；lethimputthesamequestionsandavailhimselfofthesamesignstoascertainwhetherthearmbemoderatelytightornot；andeverythirddaylethimbinditanewandmakeittighter；andontheseventhorninthdaylethimbinditupwithsplints，andleaveitsountilafterthelapseofmorethanthirtydays。Andifhesuspectthattheboneisnotlyingproperly，lethimremovethebandagesintheinterval，andhavingadjustedthearm，lethimbinditupagain。Theboneofthearmisgenerallyconsolidatedinfortydays。Whenthesearepast，thedressingistoberemoved，andfewerandslackerbandagesappliedinsteadofit。Thepatientistobekeptonastricterdiet，andforalongerspaceoftimethanintheformercase；
andwemustformourjudgmentofitfromtheswellinginthehand，lookingalsotothestrengthofthepatient。Thisalsoshouldbeknown，thatthearmisnaturallyinclinedoutward；tothisside，therefore，thedistortionusuallytakesplace，ifnotproperlytreated；butindeed，alltheotherbonesareusuallydistortedduringtreatmentforfracturetothatsidetowhichtheynaturallyincline。When，therefore，anythingofthiskindissuspected，thearmistobeencircledinabroadshawl，whichistobecarriedroundthebreast，andwhenthepatientgoestorest，acompressofmanyfolds，orsomesuchthing，istobefoldedandplacedbetweentheelbowandtheside，forthusthebendingofthebonewillberectified，butcaremustbetakenlestitbeinclinedtoomuchinwards。
9。Thehumanfootiscomposedofseveralsmallboneslikethehand。Thesebonesthereforearescarcelyeverbroken，unlesstheskinatthesametimebewoundedbysomesharpandheavybody。Thetreatmentofstichinjuries，therefore，willbedeliveredundertheheadofwounds。Butifanybonebemovedfromitsplace，orajointofthetoesbeluxated，oranyofthebonesofthepartcalledthetarsusbedisplaced，itmustbeforcedbackagaintoitsplaceasdescribedwithregardtothehand；andistobetreatedwithcerate，compresses，andbandages，likethefractures，withtheexceptionofthesplints；
andistobesecuredtightlyinthesameway，andthebandagesrenewedonthethirdday；andthepatientthusbandagedshouldreturnthesameanswersasinfractures，astothebandagesfeelingtightorslack。
Allthesebonesrecoverperfectlyintwentydays，exceptthosethatareconnectedwiththebonesoftheleg，andareinalinewiththem。Itisadvantageoustolieinbedduringthewholeofthistime；butthepatients，thinkinglightofthecomplaint，havenotperseverancetodothis，andtheywalkaboutbeforetheygetwell；
whereforemanyofthesedonotmakeaperfectrecovery。Andoftenthepainputstheminmindoftheinjury；anddeservedly，forthefeetsustaintheweightofthewholebody。When，therefore，theywalkaboutbeforetheyarewhole，thejointswhichhavebeenluxatedarecuredincompletely；and，onthataccount，whilewalkingabout，theyhavepainsinthelegfromtimetotime。
10。Butthoseboneswhichareconnectedwiththebonesofthelegarelargerthantheothers，andthecureofthemwhenluxuatedismoreprotracted。Themodeoftreatmentthenisthesame；butwemustusemorebandagesandmoresplints，andthebandageistobecarriedroundtothissideandtothat，andpressureistobemadeasintheothercases，particularlyattheseatoftheluxation，andthefirstcirclesofthebandagesaretobemadethere。Andateachtimethebandagesaretakenoff，muchhotwateristobeused，forinallinjuriesatjointstheaffusionofhotwaterinlargequantityistobehadrecourseto。Andthesamesymptomsofcompressionandrelaxationshouldmanifestthemselvesinthesametimes，asinthecasesformerlytreatedof，andthesubsequentbandagingsshouldbeconductedinlikemanner。Thesecasesgetcompletelywellforthemostpartinfortydays，ifthepatientshaveresolutiontokeeptheirbed；butifnot，theyaresubjectedtothecomplaintsformerlydescribed，orstillworse。
11。Inpersonswhojumpingfromanyhighobjectpitchupontheirheelwithgreatforce，thebonesareseparated，andtheveinspourforththeircontents，owingtothecontusionofthefleshsurroundingthebone，andhenceaswellingandmuchpainsupervene。
Forthisbone（oscalcis）isnotasmallone，protrudesbeyondthelineoftheleg，andisconnectedwithimportantveinsandtendons；
forthebacktendonofthelegisinsertedintothisbone。Suchcasesaretobetreatedwithcerate，andwithcompressesandbandages；
andhotwateristobeusedinlargequantity；andtheyrequiremanybandages，whichoughttobeparticularlygoodandappropriate。Andifthepatienthappentohaveatenderskinabouttheheel，nothingistobedonetoit；butif，assomehaveit，theskinbethickandhardened，itistobepareddownsmoothlyandthinned，butwithoutwoundingit。Itisnoteverybodywhocanapplythebandageproperlyinsuchcases；forifoneshallbindtheparts，asinotheraccidentsabouttheankle，sometimesbringingafoldroundthefootandsometimesroundthetendon，theseturnsleaveouttheheel，whichistheseatofthecontusion，andthusthereisdangerthattheoscalcismaysphacelate；andifthisshouldtakeplace，theimpedimentmayendureforlifeandalsoinalltheothercasesofsphacelus，notproceedingfromsuchacauseasthis；aswhen，frombeingcarelesslyallowedtolieinacertainpositionduringconfinementtobed，theheelbecomesblack，orwhenaseriouswoundhasoccurredintheleganditislongofhealing，andisconnectedwiththeheel，orwhenthesamethinghappensinthethigh，orwheninanydiseaseaprotracteddecubitustakesplaceontheback，inallsuchcasesthesoresareinveterate，troublesome，andfrequentlybreakoutagain，unlessparticularattentionbepaidtothecure，alongwithmuchrest，asinallthecasesattendedwithsphacelus。Andcasesofsphacelusconnectedwiththiscause，inadditiontootherinconveniences，areattendedwithgreatdangertothewholebody。Fortheyareapttobeattendedwithveryacutefevers，ofthecontinualtype，accompaniedwithtremblings，hiccup，aberrationofintellect，andwhichprovefatalwithinafewdays：andtheremaybelividitiesofbloodyveins，withnausea，andgangrenefrompressure；thesediseasesmayoccur，besidesthesphacelus。Thosewhichhavebeendescribedarethemostviolentcontusion；butingeneralthecontusionsaremild，andnogreatcareisrequiredwithregardtothetreatment，andyetitmustbeconductedproperly。Butwhenthecontusionappearstobesevere，wemustdoasdescribedabove，makingmanyturnsofthebandagearoundtheheel，sometimescarryingittotheextremityofthefoot，sometimestothemiddle，andsometimesaroundtheleg；and，inaddition，allthesurroundingpartsaretobebandagedinthisdirectionandthat，asformerlydescribed；andthecompressionshouldnotbemadestrong，butweshouldmakeuseofmanybandages，anditisbetteralsotoadministerhelleborethesamedayoronthemorrow；andthebandagesshouldberemovedonthethirddayandreapplied。Andthesearethesymptomsbywhichwediscoverwhetherthecasewillgetworseornot：whentheextravasatedblood，thelividities，andthesurroundingpartsbecomeredandhard，thereisdangerofanexacerbation。Butiftherebenofever，wemustgiveemetics，ashasbeensaid，andadministertheotherremedieswhichareapplicablewhenthefeverisnotofacontinualtype；butifcontinualfeverbepresent，wemustnotgivestrongmedicines，butenjoinabstinencefromsolidfoodandsoups，andgivewaterfordrink，andnotallowwinebutoxyglyky（acompositionfromvinegarandhoney？）。
Butifthecasebenotgoingtogetworse，theecchymosedandlividparts，andthosesurroundingthembecomegreenishandnothard；forthisisasatisfactoryproofinallcasesofecchymosis，thattheyarenottogetworse；butwhenlividityiscomplicatedwithhardness，thereisdangerthatthepartmaybecomeblackened。Andwemustsomanagethefootasthatitmaybegenerallyraisedalittlehigherthantherestofthebody。Suchapatientwillgetwellinsixtydaysifhekeepquiet。
12。Thelegconsistsoftwobones，ofwhichtheoneismuchmoreslenderthantheotheratonepart，butnotmuchmoreslenderatanother。Theseareconnectedtogetheratthefoot，andformacommonepiphysis，buttheyarenotunitedtogetheralongthelineoftheleg；
andatthethightheyareunitedtogetherandformanepiphysis，andthisepiphysishasadiaphysis；buttheotherboneinalinewiththelittletoeisalittlelonger。Suchisthenatureofthebonesoftheleg。
13。Sometimesthebonesconnectedwiththefootaredisplaced，sometimesbothboneswiththeirepiphysis；sometimesthewholeepiphysisisslightlymoved，andsometimestheotherbone。Thesecasesarelesstroublesomethanthesameaccidentsatthewrist，ifthepatientswillhaveresolutiontogivethemrest。Themodeoftreatmentisthesameasthatoftheother，forthereductionistobemade，asoftheother，bymeansofextension，butgreaterforceisrequired，asthepartsofthebodyconcernedarestrongerinthiscase。But，forthemostpart，twomenwillbesufficient，bymakingextensioninoppositedirections，but，notwithstanding，iftheyarenotsufficientlystrong，itiseasytomakemorepowerfulextensioninthefollowingway：havingfixedinthegroundeitherthenaveofawheel，oranysuchobject，somethingsoftistobeboundroundthefoot，andthensomebroadthongsofox-skinbeingbroughtroundit，theheadsofthethongsaretobefastenedtoapestleoranyotherpieceofwood，theendofwhichistobeinsertedintothenave，andit，thepestle，istobepulledaway，whileotherpersonsmakecounter-extensionbygraspingtheshouldersandtheham。Itisalsosometimesnecessarytosecuretheupperextremityotherwise；thisifyoudesiretoeffect，fastendeeplyinthegroundaround，smoothpieceofwood，andplacetheupperextremityofthepieceofwoodattheperineum，sothatitmaypreventthebodyfromyieldingtothepullingatthefoot，and，moreover，topreventthelegwhilestretched，fromincliningdownward；somepersonseatedathissideshouldpushbackthehip，sothatthebodymaynotturnroundwiththepulling，andforthispurpose，ifyouthinkfit，piecesofwoodmaybefastenedaboutthearmpitsoneachside，andtheyaretobestretchedbythehands，andthussecured，whileanotherpersontakesholdofthelimbattheknee，andaidsinthusmakingcounter-extension。Orthus，ifyoupreferit：havingboundotherthongsofleatheraboutthelimb，eitherattheknee，oraroundthethigh，andhavingfastenedanothernaveofawheelinthegroundabovethehead，andadjustedthethongspieceofwoodadaptedtothenave，extensionmaythusbemadeintheoppositedirectiontothefeet。Orifyouchoose，itmaybedonethus：insteadofthenaves，layamoderate-sizedbeamunderthecouch，andthenhavingfastenedpiecesofwoodinthisbeam，bothbeforeandbehindthehead，makecounter-extensionbymeansofthongs，orplacewindlassesatthisextremityandthat，andmakeextensionbymeansofthem。Therearemanyothermethodsofmakingextension。Butthebestthingis，foranyphysicianwhopracticesinalargecity，tohavepreparedaproperwoodenmachine，withallthemechanicalpowersapplicableincasesoffracturesanddislocation，eitherformakingextension，oractingasalever。Forthispurposeitwillbesufficienttopossessaboardinlength，breadth，andthickness，resemblingthequadrangularthreshing-boardsmadeofoak。
14。Whenyouhavemadeproperextension，itiseasyreducethejoint，forthedisplacedboneisthusraisedintoalinewiththeother。Andthebonesaretobeadjustedwiththepalmsofthehands，pressingupontheprojectingbonewiththeone，andmakingcounter-pressurebelowtheanklewiththeother。Whenyouhavereplacedthebones，youmustapplythebandageswhilethepartsareuponthestretch，ifyoupossiblycan；butifpreventedbythethongs，youmustloosethem，andmakecounter-extensionuntilyougetthebandagesapplied。Thebandageistobeappliedinthemannerformerlydescribed，theheadsofthebandagesbeingplacedontheprojectingpart，andthefirstturnsmadeinlikemanner，andsoalsowithregardtothenumberofcompressesandthecompression；
andturnsofthebandagesaretobebroughtfrequentlyroundonthisandonthatsideoftheankle。Butthisjointmustbeboundmoretightatthefirstdressingthaninthecaseofthehand。Butwhenyouhaveappliedthebandage，youmustplacethebandagedpartsomewhathigherthantherestofthebody，andinsuchapositionthatthefootmayhangaslittleaspossible。Theattenuationofthebodyistobemadeproportionatetothemagnitudeoftheluxation，foroneluxationistobeasmall，andanothertoagreatextent。Butingeneralwemustreducemore，andforalongertime，ininjuriesaboutthelegs，thaninthoseaboutthehands；fortheformerpartsarelargerandthickerthanthelatter，anditisnecessarythatthebodyshouldbekeptinastateofrest，andinarecumbentposition。
Thereisnothingtopreventorrequirethelimbtobebandagedanewonthethirdday。Andallthetreatmentotherwiseistobeconductedinlikemanner，asintheprecedingcases。Andifthepatienthaveresolutiontoliequiet，fortydayswillbesufficientforthispurpose，ifonlythebonesbeproperlyreduced，butifhewillnotliequiet，hewillnotbeabletousethelimbwithease，andhewillfinditnecessarytowearabandageforalongtime。Whenthebonesarenotproperlyreplaced，buttherehasbeensomedefectinthisrespect，thehip，thethigh，andthelegbecomewasted，andifthedislocationbeinward，theexternalpartofthethighiswasted，andviceversa。
Butforthemostpartthedislocationisinward。
15。Andwhenbothbonesofthelegarebrokenwithoutawoundoftheskin，strongerextensionisrequired。Wemaymakeextensionbysomeofthemethodsformerlydescribed，providedthebonesrideoveroneanothertoaconsiderabledegree。Butextensionbymenisalsosufficient，andforthemostparttwostrongmenwillsuffice，bymakingextensionandcounterextension。Extensionmustnaturallybemadestraightinalinewiththelegandthigh，whetheronaccountofafractureofthebonesofthelegorofthethigh。Andinbothcasestheyaretobebandagedwhileinastateofextension，forthesamepositiondoesnotsuitwiththelegandthearm。Forwhenthefracturedbonesofthearmorfore-armarebandaged，thefore-armissuspendedinasling，andifyoubindthemupwhileextended，thefiguresofthefleshypartswillbechangedinbendingthearmattheelbow，fortheelbowcannotbekeptlongextended，sincepersonsarenotinthecustomofkeepingthejointlonginthisform，butinabentposition，andpersonswhohavebeenwoundedinthearm，andarestillabletowalkabout，requiretohavethearmbentattheelbow-joint。Buttheleg，bothinwalkingandstanding，ishabituallyextended，eithercompletelyornearlyso，andisusuallyinadependingpositionfromitsconstruction，andinorderthatitmaybeartheweightoftherestofthebody。Whereforeitreadilybearstobeextendedwhennecessary，andevenwheninbedthelimbisofteninthisposition。Andwhenwounded，necessitysubduestheunderstanding，sincethepatientsbecomeincapableofraisingthemselvesup，sothattheyneitherthinkofbendingthelimbnorofgettinguperect，butremainlyinginthesameposition。Forthesereasons，neitherthesamepositionnorthesamemodeofbandagingappliestothearmandtotheleg。If，then，extensionbymeansofmenbesufficient，weshouldnothaverecoursetoanyuselesscontrivances，foritanyuselesscontrivances，foritisabsurdtoemploymechanicalmeanswhennotrequired；butifextensionbymenbenotsufficient，youmayuseanyofthemechanicalpowerswhichissuitable。Whensufficientlyextended，itwillbeeasytoadjustthebonesandbringthemintotheirnaturalposition，bystraighteningandarrangingthemwiththepalmsofthehand。
16。Whenthepartsareadjusted，youshouldapplythebandageswhilethelimbisinastretchedposition，makingthefirstturnstotherightortotheleft，asmaybemostsuitable；andtheendofthebandageshouldbeplacedoverthefracture，andthefirstturnsmadeatthatplace；andthenthebandageshouldbecarrieduptheleg，asdescribedwithregardtotheotherfractures。Butthebandagesshouldbebroaderandlonger，andmorenumerous，inthecaseofthelegthaninthatofthearm。Andwhenitisbandageditshouldbelaiduponsomesmoothandsoftobject，sothatitmaynotbedistortedtotheonesideortheother，andthattheremaybenoprotrusionoftheboneseitherforwardorbackward；forthispurposenothingismoreconvenientthanacushion，orsomethingsimilar，eitheroflinenorwool，andnothard；itistobemadehollowalongitsmiddle，andplacedbelowthelimb。Withregardtothecanals（gutters？）usuallyplacedbelowfracturedlegs，Iamatalosswhethertoadvisethattheyshouldbeusedornot。Fortheycertainlyarebeneficial，butnottotheextentwhichthosewhousethemsuppose。Forthecanalsdonotpreservethelegatrestastheysuppose；nor，whentherestofthebodyisturnedtotheonesideortheother，doesthecanalpreventthelegfromfollowing，unlessthepatienthimselfpayattention；neitherdoesthecanalpreventthelimbfrombeingmovedwithoutthebodytotheonesideortheother。Andaboardisanuncomfortablethingtohavethelimblaidupon，unlesssomethingsoftbeplacedaboveit。Butitisaveryusefulthinginmakinganysubsequentarrangementsofthebedandingoingtostool。Alimbthenmaybewellorillarrangedwithorwithoutthecanal。Butthecommonpeoplehavemoreconfidence，andthesurgeonismorelikelytoescapeblame，whenthecanalisplacedunderthelimb，althoughitisnotsecundumartem。Forthelimbshouldbyallmeansliestraightuponsomelevelandsoftobject，sincethebandagingmustnecessarilybeovercomebyanydistortionintheplacingoftheleg，wheneverortowhateverextentitmaybeinclined。Thepatient，whenbandaged，shouldreturnthesameanswersasformerlystated，forthebandagingshouldbethesame，andthesameswellingsshouldariseintheextremities，andtheslackeningofthebandagesinlikemanner，andthenewbandagingonthethirdday；andthebandagedpartshouldbefoundreducedinswelling；andthenewbandagingsshouldbemoretightlyputon，andmorepiecesofclothshouldbeused；andthebandagesshouldbecarriedlooselyaboutthefoot，unlessthewoundbeneartheknee。Extensionshouldbemadeandthebonesadjustedateverynewbandaging；for，ifproperlytreated，andiftheswellingprogressinasuitablemanner，thebandagedlimbwillhavebecomemoreslenderandattenuated，andtheboneswillbemoremobile，andyieldmorereadilytoextension。Ontheseventh，theninth，ortheeleventhday，thesplintsshouldbeappliedasdescribedintreatingoftheotherfractures。Attentionshouldbepaidtothepositionofthesplintsabouttheanklesandalongthetendonofthefootwhichrunsuptheleg。Thebonesoftheleggetconsolidatedinfortydays，ifproperlytreated。Butifyoususpectthatanythingiswantingtotheproperarrangementofthelimb，ordreadanyulceration，youshouldloosethebandagesintheinterval，andhavingputeverythingright，applythemagain。
17。Butiftheotherbone（fibula？）ofthelegbebroken，lesspowerfulextensionisrequired，andyetitmustnotbeneglected，norbeperformedslovenly，moreespeciallyatthefirstbandaging。Forinallcasesoffracturethisobjectshouldbeattainedthenasquicklyaspossible。Forwhenthebandageisappliedtightwhilethebonesarenotproperlyarranged，theproperlyarranged，thepartbecomesmorepainful。Thetreatmentotherwiseisthesame。
18。Ofthebonesoftheleg，theinnerone，calledthetibia，isthemoretroublesometomanage，andrequiresthegreaterextension；andifthebrokenbonesarenotproperlyarranged，itisimpossibletoconcealthedistortion，fortheboneisexposedandwhollyuncoveredwithflesh；anditismuchlongerbeforepatientscanwalkonthelegwhenthisboneisbroken。Butiftheouterbonebebroken，itcausesmuchlesstrouble，andthedeformity，whenthebonesarenotproperlyset，ismuchmoreeasilyconcealed，thebonebeingwellcoveredwithflesh；andthepatientsspeedilygetonfoot，foritistheinnerboneofthelegwhichsupportsthemostoftheweightofthebody。Foralongwiththethigh，asbeinginalinewithweightthrownuponthethigh，theinnerbonehasmoreworktosustain；
inasmuchasitistheheadofthethigh-bonewhichsustainstheupperpartofthebody，anditisontheinnerandnotontheoutersideofthethigh，beinginalinewiththetibia；andtheotherhalfofthebodyapproximatesmoretothislinethantotheexternalone；andatthesametimetheinnerboneislargerthantheouter，asinthefore-armtheboneinthelineofthelittlefingeristheslendererandlonger。Butinthejointoftheinferiorextremity，thedispositionofthelongerboneisnotalike，fortheelbowandthehamarebentdifferently。Forthesereasonswhentheexternalboneisbroken，thepatientscansoonwalkabout；butinfracturesoftheinner，itisalongtimebeforetheycanwalk。
19。Whenthethigh-boneisbroken，particularpainsshouldbetakenwithregardtotheextensionthatitmaynotbeinsufficient，forwhenexcessive，nogreatharmresultsfromit。For，ifoneshouldbandagealimbwhiletheextremitiesoftheboneareseparatedtoadistancefromoneanotherbytheforceoftheextension，thebandagingwillnotkeepthemseparate，andsotheboneswillcometogetheragainassoonasthepersonsstretchingitletgotheirhold；forthefleshyparts（muscles？）beingthickandstrong，aremorepowerfulthanthebandaging，insteadofbeinglessso。Inthecasethenwhichwearenowtreatingof，nothingshouldbeomittedinorderthatthepartsmaybeproperlydistendedandputinastraightline；foritisagreatdisgraceandaninjurytoexhibitashortenedthigh。Forthearm，whenshortened，mightbeconcealed，andthemistakewouldnotbegreat；butashortenedthigh-bonewouldexhibitthemanmaimed。Forwhenthesoundlimbisplacedbesideit，beinglongerthantheother，itexposesthemistake，andthereforeitwouldbetotheadvantageofapersonwhowouldbeimproperlytreatedthatbothhislegsshouldbebroken，ratherthaneitherofthem；forinthiscasetheonewouldbeofthesamelengthastheother。When，then，properextensionhasbeenmade，youmustadjustthepartswiththepalmsofthehands，andbandagethelimbinthemannerformerlydescribed，placingthehandsofthebandagesaswasdirected，andmakingtheturnsupward。Andthepatientshouldreturnthesameanswerstothesamequestionsasformerly，shouldbepainedandrecoverinlikemanner，andshouldhavethebandagingrenewedinthesameway；andtheapplicationofthesplintsshouldbethesame。