,transcrib]'s ,note ,italic text display$ z3 italic ,bold text display$ z3 bold ,,! ,,ess5tials ,,( ,,b&ag+2 ,,includ+ ,,! ,,managem5t ,,( ,,fractures ,,& ,,dislocations1 ,,) ,,directions ,,= ,,us+ ,,o!r ,,surgical ,,app>atus4 ,,illu/rat$ ,,by #abb ,,engrav+s ,,on ,,wood4 ,,by ,,b]keley ,,hill1 ,m4,b4 ,,lond41 ,f4,r4,c4,s41 ,in/ructor 9 ,b&ag+1 c41 9 ,univ]sity ,college1 ,assi/ant ,surgeon to ,univ]sity ,college ,hospital1 & ,surgeon to ,out-pati5ts at ! ,lock ,hospital4 ,,second ,,edition1 ,,revis$ ,,& ,,enl>g$4 ,,london3 ,,james ,,walton1 ,,booksell] ,,& ,,publi%] ,,to ,,univ]sity ,,college1 #acg1 ,,g[] ,,/reet4 #ahfi4 ,,london3 ,,bradbury1 ,,evans1 ,,& ,,co41 ,,pr9t]s1 ,,:itefri>s4 ,,preface ,,to ,,! ,,second ,,edition4 ,9 lay+ a ,second ,edition be=e ! public1 ,i h decid$ n to alt] ! scope ( ?is little "w1 b simply to endeav\r to increase its usefulness1 by rem$y+ omissions1 & by add+ new in/ructions :]e su* appe>$ desirable4 ,i h v5tur$ to ins]t1 z an ,app5dix1 li/s ( ! prep>ations requisite = ! sick room & = ! op]at+ room be=e ! ord9>y op]ations ( surg]y are p]=m$2 also1 li/s ( ! in/rum5ts & appliances requisite1 or possibly useful1 9 p]=m+ =ty-n9e diff]5t op]ations on ! human body4 ,x is hop$ t1 by giv+ ! surgeon a li/1 su* z mo/ op]ators draw up 9 manuscript = _! private use1 :]eby !y may *eck _! prep>ations be=e proce$+ to op]ate1 "s tr\ble may be sav$4 #ad1 ,,weym\? ,,/reet1 ,w4 ,novemb]1 #ahfi4 ,,preface ,,to ,,! ,,fir/ ,,edition4 ,! descriptions & directions = us+ surgical app>atus 9 ! foll[+ pages1 are ^? orig9ally prep>$ = oral deliv]y 9 a %ort c\rse ( practical lessons 9 b&ag+ & ! application ( surgical app>atus1 giv5 by me 9 ,univ]sity ,college ,hospital4 ,no attempt is made to include all effici5t modes ( treat+ surgical injuries3 x is m]ely propos$ to supply ! /ud5t or practition] ) in/ructions by :i* he may refre% 8 memory :5 ab\t to employ ! ord9>y surgical appliances4 ,! draw+s are by ,mr4 ,r4 ,w4 ,%]w91 :o has tak5 mu* pa9s to furni% exact repres5tations ( ! app>atus1 z x 0 appli$ by myself = 8 del9eation4 ,! directions = giv+ *lor(orm h _h ! advantage ( ,mr4 ,clov]'s revision be=e publication4 #ad1 ,,weym\? ,,/reet1 ,w4 ,octob]1 #ahfg4 ,,cont5ts4 ,,*apt] ,i4 ,,b&ag+4 ,,page ,g5]al rules4--,diff]5t mat]ials ( b&ages4--,position ( ! op]ator4--,mode ( hold+ ! b&age4--,v>ieties ( turns2 ! simple spiral2 ! rev]se2 ! figure ( #h4 #a-c ,b&ag+ ! head4--,! common roll]4--,! knott$ b&age4--,! ,capell9e b&age4--,! %awl cap4--,! f\r-tail b&age4--,fa/5+ ice bladd]s to ! head4--,compress+ ! jugul> ve9 #c-h ,b&ag+ ! trunk4--,! brea/4--,! gro94--,aft] op]ation = h]nia4--,= tapp+ ! belly4--,! ,t-b&age4--,! /rait jacket4--,manacles = deliri\s pati5ts4--,to susp5d ! te/icles #h-ac ,b&ag+ ! upp] extremity4--,! f+]s4--,! ?umb4--,! h&4--,! =e-arm4--,! elb[4--,! %\ld]4--,! axilla4--,w\nd ( ! palm> ar*4--,ble$+ at ! elb[ #ad-bj ,b&ag+ ! l[] extremity4--,! foot4--,! leg4--,! ?igh4--,! heel4--,! toe4--,! knee4--,a /ump4--,ext5d+ a /ump4--,! _m-tail$ b&age4--,ela/ic socks #ba-bd ,,*apt] ,,ii4 ,,/rapp+4 ,g5]al rules4--,/rapp+ ! brea/4--,! te/es4--,jo9ts4--,ulc]at$ legs4--,scott's m]curial dress+ #be-bi ,,*apt] ,,iii4 ,,treatm5t ,,( ,,fractures4 ,! head & trunk4--,( ! l[] jaw2 by ! ext]nal spl9t & b&age2 by int]d5tal spl9ts1 ,morell ,lavalle's plan2 fitt+ a cap to ! tee?4--,( ! ribs2 by pla/]2 by a body roll]4--,( ! pelvis #cj-cg ,! upp] extremity4--,( metac>pal bones2 by a gutta-p]*a glove2 by a ball ( t[4--,( phalanges4--,( ! l[] end ( ! radius2 by ! pi/ol spl9t2 by ! gutta-p]*a gauntlet4--,( bo? bones ( ! =e>m4--,( ! olecranon2 by figures ( #h & an inside spl9t2 by ,hamilton's plan4--,( ! hum]us ne> ! elb[2 by lat]al holl[$ spl9ts2 by a gutta-p]*a ,l-%ap$ spl9t4--,( ! %aft ( ! hum]us4--,( ! anatomical or surgical neck1 & ( ! great tub]osity ( ! hum]us1 by a cap = ! %\ld]4--,( ! acromion4--,( ! clavicle2 by an axill>y pad & elevation ( ! elb[2 by a figure ( #h beh9d ! back2 ! ,am]ican r+ pad #cg-ei ,! l[] extremity4--,rupture ( ! t5do ,a*illis4--,sep>ation ( ! epiphysis ( ! os calcis4--,fracture ( ! fibula1 by ,dupuytr5's spl9t4--,( ! tibia1 by ,mc,intyre's spl9t2 sl++ ! spl9t2 elevat+ x on a block4--,transv]se fracture ( ! tibia1 by lat]al spl9ts2 9 ! flex$ position4--,( ! patella2 by back spl9t & figures ( #h2 by ,malgaigne's hooks2 by /rapp+ pla/] & /ick4--,( ! %aft ( ! femur2 by ,li/on's me?od ( us+ ! long spl9t2 by us+ ela/ic ext5sion2 ,coxet]'s ela/ic p]9eal b&2 ela/ic /irrup4 ,by cont9u\s ext5sion ) ! limb b5t2 t5d5cy to angul> union2 d\ble incl9e planes2 sl++ ! d\ble incl9e planes 9 fracture ( ! neck ( ! femur2 by cont9u\s ext5sion ( weight & pulley #ei-hj ,! />* b&age4--,! pla/] ( p>is b&age4--,pla/] ( p>is spl9t4--,gum & *alk & o!r /iff5+ mixtures4 --,s&-bags4--,cradles2 ,salt]'s sw+ cradle #ha-ij ,lea!r spl9ts2 ,spl9t = ! hip #ij-id ,,*apt] ,,iv4 ,,dislocations4 ,g5]al rules4--,( ! l[] jaw4--,( ! clavicle4--,( ! %\ld]2 signs ( dislocation into ! axilla2 :5 b5ea? ! clavicle2 :5 beh9d ! scapula4 ,modes ( r$uction2 by ! heel 9 ! axilla2 by simple ext5sion4 ,! clove-hit* knot4--,( ! elb[1 signs :5 bo? bones g backw>ds2 di/9ctions betwe5 dislocation & fracture ne> ! elb[2 ! mode ( r$uction by ! knee inside ! =e-arm2 by ext5sion at ! wri/4--,( ! radius1 only1 by ext5sion at ! wri/4--,( ! ?umb & f+]s2 h&le = comm&+ ! phalanx4--,at ! hip2 signs ( dislocation backw>ds1 r$uction by ext5sion2 by manipulation or lev]age2 signs ( dislocation d[nw>ds1 mode ( r$uction2 signs ( dislocation on to ! pubes1 mode ( r$uction4--,( ! knee2 incomplete1 lat]al1 & po/]ior2 mode ( r$uction4--,( ! patella1 mode ( r$uction4--,( ! foot1 mode ( r$uction #id-aaj ,sc>pa's %oes4--,v>ieties ( talipes2 equ9us1 v>us1 valgus2 po9ts to be att5d$ to 9 fitt+ ! %oe4--,ca/+ 9 pla/] ( p>is #aaa-aad ,,*apt] ,v4 ,,miscellane\s4 ,! ,hair suture4--,! eye d\*e1 drops = ! eye4--,syr++ ! e>s4--,epi/axis2 ,ice-cold injection2 ,plugg+ ! n>es2 ,belloc's s\nd4--,draw+ tee?2 v>ieties ( =ceps2 extract+ incisors & can9es1 bicuspids1 upp] mol>s1 l[] mol>s1 wisdom mol>s1 roots2 ! elevator4--,/opp+ ble$+ aft] extraction4--,sore nipples2 nipple %ields4--,plugg+ ! vag9a2 ,kite's tail plug = vag9a4--,inject+ ! ure?ra4 ,ca!t]s1 silv]2 diff]5t k9ds ( flexible ca!t]s & b\gies2 con=mation ( ! ure?ra4--,pass+ ca!t]s & b\gies2 difficulties 9 do+ s2 pass+ ! female ca!t]4--,wa%+ out ! bladd]4--,ty+ 9 ca!t]s4--,position = li?otomy4--,b$-sores1 applications to prev5t ! =mation ( b$-sores2 ! float+ b$2 ! wat]-cu%ion4--,! /oma*-pump1 :5 us$ to empty ! /oma* or to inject food4--,transfusion ( blood2 precautions2 mode ( us+ ! app>atus4--,t\rniquets2 ! ,r+2 ,petit's2 ,signoroni's2 ,c>te's2 ,li/]'s2 ! make-%ift4--,m]curial fumigation2 g5]al2 local4--,hot air ba?s4--,vap\r ba?s4--,sick c>riage4--,cupp+4--,junod's boot4--,lee*es4--,/opp+ lee* bites4--,t5ts4--,setons4--,dra9age tubes4--,issues4--,trusses1 requirem5ts (1 +u9al1 femoral1 umbilical1 ,salmon & ,ody's4--,caut]ies1 iron2 gas2 galvanic4 ,cau/ics4--,vesicants1 mu/>d1 can?>ides1 iod9e4--,corrigan's hamm]4--,p\ltices & fom5tations4--,li/]'s mode ( dress+ ) c>bolic acid4--,irrigation2 ,esm>*'s irrigator4--,adm9i/ration ( *lor(orm1 precautions2 dang]s2 me?ods2 ,clov]'s inhal]4--,artificial respiration4--,local an/hesia4--,e!r spray1 pulv]is$ fluids4--,*lor(orm vap\r to ! ut]us4--,subcutane\s injection4--,collodion4 --,vacc9ation #aaf-aib ,,li/ ,,( ,,appliances ,,= ,,! ,,op]at+ ,,room ,,& ,,! ,,sick ,,room4--,,li/ ,,( ,,s$atives ,,& ,,re/oratives4--,,= ,,! ,,arre/ ,,( ,h,,morrhage #aie-aig ,,li/ ,,( ,,in/rum5ts ,,employ$ ,,9 ,,op]ations-- ,,on ,,! ,,head ,,& ,,neck4 ,treph9+ ! skull4--,op]ations on ! eye4--,h>e-lip4--,resection ( ! jaw4--,excision ( ! tongue4--,cleft palate4--,excision ( tonsils4--,l>yngotomy4--,tra*eotomy #aih-bjb ,,on ,,! ,,trunk4 ,removal ( brea/ or tum\rs4--,nvus4--,tapp+ ! pleura4--,tapp+ ! belly4--,colotomy4--,ov>iotomy4--,cs>ian section4--,/rangulat$ h]nia4--,radical cure ( h]nia4--,hmorrhoids4--,fi/ula 9 ano4--,cleft p]9um4--,extirpation ( ! c]vix ut]i4--,amputation ( ! p5is4--,circumcision4--,excision ( te/is4--,tapp+ a hydrocele4--,vesico-vag9al fi/ula4--,ret5tion ( ur9e4--,ext]nal ure?rotomy4--,li?otomy4--,li?otrity4--,= remov+ =eign bodies f ! ure?ra & bladd] #bjc-baj ,,on ,,! ,,limbs4 ,ligature ( ! l>g] art]ies4--,resections3 ( ! head ( ! hum]us1 ! elb[1 ! hip1 ! knee4--,removal ( necros$ bone4--,amputations3 at ! %\ld]-jo9t2 arm2 =e-arm & wri/2 metac>pus2 hip2 ?igh & leg2 ,syme & ,*op>t's op]ation2 metat>sus & toes #baa-bae ,,! ,,ess5tials ,,( ,,b&ag+1 c4 ,,*apt] ,i4 ,,b&ag+4 ,,g5]al ,,rules4--,ord9>y b&ages are /rips ( unblea*$ calico #f or #h y>ds long1 hav+ a bread? ( in* = ! f+]s & toes1 #b in*es = ! head & upp] limb1 #c in*es = ! l[] limb1 & #f in*es = ! body4 ,^!1 :5 tightly roll$ = use1 are t]m$ roll]s4 ,besides ^! roll]s = g5]al use !re are special b&ages1 su* z roll]s ( musl9 = us+ ) pla/] ( p>is1 ( /ock+-webb+ :5 ela/icity is ne$$2 f\r- & _m-tail$ b&ages = p>ticul> fractures1 c4 ,messrs4 ,j4 ,j4 ,ca%1 ! cambric frill+ mak]s ( ,cov5try1 n[ make a v firm light b&age ( unblea*$ cambric wov5 9 ! necess>y wid?s & l5g?s = use2 ^! are v cool & pleasant1 & a decid$ improvem5t on ! ord9>y calico /rips g5]ally us$4 ,position ( ! ,op]ator4--,he %\ld place himself opposite 8 pati5t1 n at ! side ( ! limb to be b&ag$2 ! limb too %\ld be b5t to ! position x w occupy :5 ! b&age is complet$4 ,be=e apply+ any k9d ( app>atus1 ! surgeon %\ld see t ! limb is c>efully wa%$ & dri$4 ,h[ to hold a ,roll]4--,:5 apply+ a roll] x is be/ to beg9 by plac+ ! out] surface ( ! roll] next ! sk9 7see fig4 #a1 page #c71 = x !n unw9ds m readily1 & ! fir/ turns are m easily secur$2 moreov] ! b&age %\ld be c>ri$ f ! inn] side ( ! limb by ! front to ! out] side1 = ! muscles are ?us m firmly & pleasantly conf9$ ?an by turns pass+ 9 ! opposite direction2 ( c\rse ?is obs]vation supposes ! h& & =e>m to be 9 _! usual position ( semi-pronation4 ,v>ieties ( ,turns4--,9 c>ry+ a b&age up a limb1 x is necess>y1 9 ord] to support ! p>ts ev5ly1 to employ a comb9ation ( ?ree diff]5t turns4 ,! simple spiral1 rev]se1 & ! figure ( #h4 ,! simple spiral turn is us$ only :]e ! circumf]5ce ( ! "p increases slightly1 z ! wri/2 b :5 ! limb enl>ges too fa/ to all[ ! fre% turn to ov]lap ! previ\s "o regul>ly1 ! turn mu/ be int]rupt$1 & ! b&age br\ght back aga9 by rev]se1 or by figure ( #h4 ,to rev]se ! b&age1 ! ?umb ( ! unoccupi$ h& is plac$ on ! l[] bord] ( ! b&age :ile ! roll] is turn$ ov] 9 ! o!r1 & !n pass$ d[nw>ds to ov]lap & fix ! previ\s turn ev5ly4 ,at ! mom5t ( rev]s+1 ! b&age %\ld be held q slack1 & n unroll$ m ?an is necess>y to make ! rev]se4 ,all ! rev]ses mu/ be c>ri$ "o above ! o!r along ! out] side ( ! limb1 & only employ$ :]e really necess>y4 ,figures ( #h are made1 z _! "n implies1 by pass+ ! roll] alt]nately upw>ds & d[nw>ds z x enwraps ! limb 7see fig4 #a74 ,!y are adopt$ :]e ! enl>gem5t is too great & irregul> = rev]ses to sit ev5ly1 ov] ! ankle & elb[ jo9t = in/ance4 ,illu/ration3 ,fig4 #a4--;,figure ( #h turn4 ,,! ,,head4 ,b&ages = ! ,head4--,a roll] is commonly appli$ 9 ?ree diff]5t ways to ! head4 #a/4 ,= keep+ simple dress+s 9 place4 ,app>atus4--#a4 ,a roll] #b in*es wide1 & ( ! usual l5g?4 #b4 ,"s p9s4 ,a turn is fir/ c>ri$ r\nd ! head1 ov] ! br[s & bel[ ! occipital protub]ance1 & fa/5$ by a p92 ?is be+ done1 ! roll] is c>ri$ across ! dress+1 & gett+ into ! l9e ( ! fir/ turn1 is pass$ r\nd ! head aga91 !n across ! dress+1 & r\nd ! head by horizontal & oblique turns alt]nately1 ! =m] to fix ! latt]1 & prev5t _! slipp+ (f ! dress+ 7see fig4 #b74 ,9 ! figure ! oblique turns h be5 d\bl$1 & w\ld fix dress+s on ea* side ( ! head4 ,knott$ ,b&age4--,?is is us$ :5 pressure on ! sup]ficial temporal art]y is requir$4 ,app>atus4--#a4 ,a roll] #h y>ds long1 #b in*es wide1 "o-?ird be+ roll$ into "o head1 ! re/ into ano!r head4 #b4 ,"s l9t4 #c4 ,a piece ( a w9e cork "o-?ird ( an in* ?ick4 #d4 ,ne$le1 ?read1 & p9s4 ,illu/ration3 ,fig4 #b4--;,b&age = reta9+ dress+s 9 position1 %[+ two sets ( oblique turns4 ,! cork is fold$ 9 a d\ble ?ickness ( l9t2 ov] ?is are plac$ six or eight m folds ( l9t ( gradually increas+ size1 & ! :ole are kept 9 %ape by a /it* pass$ ?r\gh !m & ?r\gh ! cork4 ,?is =ms a graduat$ compress1 & is !n laid on ! w\nd small end d[nw>ds4 ,"o head ( ! roll] is tak5 9 ea* h&1 its middle laid ov] ! compress on ! injur$ temple1 say ! "r2 ! ends are c>ri$ r\nd ! head1 "o j above ! eyebr[s to ! left temple1 & ! o!r backw>ds bel[ ! occipital protub]ance1 to ! same po9t2 ! ends are !n cross$ & *ang$ f "o h& to ! o!r to be br\ght to ! w\nd$ temple4 ,"h !y are aga9 tightly cross$1 "o end be+ c>ri$ "u ! *9 & by ! left side to ! v]tex1 !re meet+ ! o!r end1 :i* has pass$ ov] ! head1 9 ! opposite direction 7see fig4 #c72 at ! "r temple ! ends are aga9 cross$ or 8knott$10 b ?is "t !y are pass$ horizontally r\nd ! head4 ,hav+ done ?is ! ends are p9n$ & cut (f1 or if necess>y ! knots repeat$ be=e fa/5+2 ! fir/ pair1 if tightly drawn1 usually suffice z well z sev]al4 ,illu/ration3 ,fig4 #c4--,knott$ ,b&age4 ,! ,capell9e ,b&age is r>ely requir$1 b is us$ :5 ! re/lessness ( ! pati5t r5d]s x difficult to keep dress+s or ice-bags 9 place4 ,app>atus4--#a4 ,a d\ble-head$ roll]1 #b in*es wide & #ab y>ds long4 #b4 ,"s p9s4 ,illu/ration3 ,fig4 #d4--;,capell9e ,b&age4 ,! middle ( ! roll] is laid aga9/ ! =ehead j above ! br[s1 & ! ends pass$ beh9d ! occiput1 :]e !y are cross$1 & :ile "o cont9ues ! circul> turns r\nd ! head1 ! o!r head ( ! b&age is br\ght ov] ! top along ! middle to ! front1 pass+ "u ! encircl+ turn1 :i* fixes x4 ,x is !n c>ri$ back to ! occiput1 on "o side ( ! fir/ transv]se b&1 :5 aga9 fix$ beh9d by ! circul> b& x is br\ght =w>d on ! opposite side ( ! fir/1 & fix$ 9 front4 ,?is arrangem5t is repeat$ until ! head is cov]$ 9 a closely fitt+ cap 7see fig4 #d74 ,9 beg9n+ ?is b&age1 x is necess>y to keep ! fir/ circle l[ d[n1 close to ! br[s 9 front1 & bel[ ! occipital protub]ance beh9d1 or ! cap w n fit firmly ov] ! skull4 ,a ,%awl ,cap is readily improvis$ ) a silk or cambric h&k]*ief fold$ diagonally into a triangle2 ! base ( ! triangle is !n c>ri$ ov] ! br[1 ! apex let fall beh9d ! occiput1 :]e ! ends cross1 & cat*+ 9 ! apex1 come r\nd to ! front to be ti$ on ! =ehead4 ,illu/ration3 ,fig4 #e4--,%awl ,cap4 ,! ,f\r-tail ,b&age4--,in/ead ( apply+ ! h&k]*ief 9 ! mann] j describ$1 x may be split f ea* end to )9 six in*es ( ! middle1 & s conv]t$ into a broad f\r-tail b&age2 ! middle is laid on ! top ( ! head1 ! h9d] ends ti$ "u ! *91 & ! =w>d ones beh9d ! nape ( ! neck 7see fig4 #f74 ,or a piece ( calico1 #a y>ds long & #d or #f in*es wide1 is split f ea* end #c in*es %ort ( ! c5tre--"o pair ( tails be+ r wid] ?an ! o!r4 ,if us$ on ! face1 ! middle is put aga9/ ! po9t ( ! *91 ! two n>r[ tails are c>ri$ backw>ds to ! nape1 cross$1 & p9n$ toge!r on ! =ehead above ! br[s4 ,! two broad] tails are c>ri$ upw>ds 9 front ( ! e>s1 :]e !y turn r\nd ! two n>r[ tails1 to be ei!r ti$ or p9n$ at ! v]tex4 ,f\r-tail b&ages are us$ else:]e1 z 9 ! axilla1 to keep p\ltices 9 place1 c4 ,illu/ration3 ,fig4 #f4--;,f\r-tail ,b&age4 ,to reta9 ,ice ,bladd]s on ! ,head4--,?is is done by fold+ a ?9 napk9 ov] ! bladd]1 :i* is !n laid aga9/ ! head or "p to be kept cool1 & ! ends ( ! napk9 are p9n$ tightly d[n to ! pill[ at ea* side4 ,9 ?is way ! bag _c slip1 & its weight is at ! same "t prev5t$ f press+ on ! head4 ,to compress ! ,jugul> ,ve9 aft] ble$+4--,aft] v5section ( ! ext]nal jugul> ve9 x is requisite to keep a compress ( l9t on ! w\nd4 ,?is is done by fa/5+ ! b&age on ! neck ) two simple turns1 !n c>ry+ x 9 a figure ( #h r\nd ! neck1 ov] ! compress & "u ! axilla ( ! opposite side1 !n r\nd ! neck aga92 if ! figure ( #h is pass$ pretty firmly1 suffici5t pressure is made 9 ?is way )\t int]f]+ ) ! circulation ?r\gh ! vessels1 & ! turns r\nd ! neck ( c\rse mu/ n be tight4 ,,! ,,trunk4 ,to b&age ! ,brea/4 ,app>atus4--#a4 ,a roll] #c in*es wide & #h y>ds long4 ,! roll] is fir/ c>ri$ once r\nd ! body bel[ ! brea/1 beg9n+ 9 front & pass+ t[>ds ! s\nd side4 ,:5 ! b&age is fix$1 ! roll] asc5ds ov] ! l[] "p ( ! diseas$ brea/1 to ! opposite %\ld]1 & comes back by ! arm-pit to ! horizontal turn2 x is !n pass$ r\nd ! *e/ to fix ! oblique turn4 ,hav+ done ?is1 x aga9 is c>ri$ up ov] ! brea/ & %\ld]1 & r\nd ! body 9 alt]nate turns until ! brea/ is fully compress$1 ea* turn ov] ! brea/ be+ c>ri$ high] ?an ! prec$+ "o1 & ea* turn r\nd ! body ov]lapp+ ! oblique turn to keep x 9 place 7see fig4 #g74 ,illu/ration3 ,fig4 #g4--;,b&age = a ,brea/4 ,to b&age bo? ,brea/s4--,?is is readily done by fir/ b&ag+ "o brea/ & !n1 c>ry+ ! roll] ov] ! %\ld] ( ! side already b&ag$1 br++ x across ! /]num & "u ! second brea/ on to ! horizontal turns1 :i* x foll[s alt]nately ) ! oblique ones1 z 0 done 9 b&ag+ ! fir/ brea/4 ,! only diff]5ce is1 t 9 compress+ ! fir/ brea/ ! b&age 0 pass$ obliquely upw>ds1 = ! second x is c>ri$ obliquely d[nw>ds ov] ! brea/4 ,spica ,b&age4 ,app>atus4--#a4 ,a roll] or #b or #c in*es wide4 #b4 ,"s p9s4 ,lay ! end on ! gro9 to be b&ag$1 c>ry ! roll] betwe5 ! great tro*ant] & ! cri/a ilii r\nd ! pelvis to ! o!r side1 pass+ !re also betwe5 ! cri/a ilii & tro*ant]2 next take ! roll] d[nw>ds 9 front ( ! pubes to ! injur$ gro91 !n outw>ds r\nd ! ?igh bel[ ! tro*ant] to ! gluteal fold1 & pass x up betwe5 ! ?ighs to ! gro91 :]e ! figure ( #h is complet$4 ,a second & a ?ird are to be pass$ 9 ! same way1 c>ry+ !m exactly "o ov] ! o!r1 r\nd ! body & bel[ ! buttock 7see fig4 #h72 at ! gro9 !y %\ld ov]lap1 ea* ly+ a little above ! prec$+ turn4 ,a p91 :5 ! necess>y numb] ( turns is complet$1 fa/5s d[n ! end4 ,illu/ration3 ,fig4 #h4--,spica = ! ,gro94 ,h]nia ,spica4--,! spica b&age is usually requir$ to keep dress+s & compresses 9 place ov] w\nds aft] op]ation = /rangulat$ h]nia1 s9uses1 c41 9 ! gro92 :5 ! figure ( #h has be5 put on ! fir/ "t x may be cut across 9 front2 &1 ! dress+s be+ *ang$1 ! ends may be fa/5$ toge!r by p9s4 ,if additional /rips are laid across & fa/5$ to ! figure ( #h und]nea?1 ! requir$ pressure is obta9$1 & mu* t$i\s lift+ ( ! pati5t is sav$ 7see fig4 #i47 ,illu/ration3 ,fig4 #i4--;,h]nia ,spica4 ,body b&age = tapp+ ! ,belly 9 ,ascites4--,?is is made ( two ?icknesses ( /\t flannel1 #b feet wide 9 ! middle1 :]e x =ms a cont9u\s %eet = #ah in*es1 b beyond t x is split into #c tails1 #f in*es wide & #c feet long4 ,9 ! middle l9e1 #d in*es bel[ ! c5tre1 is a r\nd hole #b in*es across1 ?r\gh :i* ! surgeon rea*es ! sk9 to ins]t ! troc>4 ,:5 9 use1 ! middle ( ! b&age is plac$ 9 front ) ! hole 9 ! mesial l9e ( ! body1 & midway betwe5 ! umbilicus & pubes2 ! ends ( ! "r side are pass$ beh9d ! back to ! left1 int]lac+ ) ^? f ! left side4 ,:5 all is ready1 an assi/ant /&+ on ea* side ( ! b$ pulls /eadily on ! ends to keep up cont9u\s pressure on ! abdom9al visc]a z ! fluid escapes4 ,aft] ! fluid is evacuat$ ! ends are w\nd firmly r\nd ! body 9 front1 :ile ! puncture 9 ! wall ( ! belly is clos$ by a fold ( l9t atta*$ ) a /rip ( pla/]4 ,! ,t ,b&age is us$ to apply dress+s1 compresses1 c41 to ! anus or p]9um4 ,a roll] #c in*es wide is fa/5$ by a c\ple ( turns r\nd ! pelvis1 & !n fix$ by a p9 at ! middle l9e 9 front4 ,f ?is po9t ! roll] is c>ri$ tightly ov] ! dress+s to ! correspond+ po9t beh9d1 & return$ once or twice m until suffici5t pressure is ga9$1 :5 x is fa/5$ (f4 ,! ,/rait ,jacket is made ( jean or /\t canvas4 ,x is cut long en\gh to rea* bel[ ! wai/1 ar\nd :i* a /rong tape is c>ri$ to be drawn tight & ti$ aft] ! jacket is put on4 ,! sleeves are sev]al in*es long] ?an ! arms1 & _! ends c be drawn close by a tape :i* runs 9 ! ga!rs2 a simil> tape conf9es ! g>m5t r\nd ! neck1 & x is ti$ beh9d by tapes d[n ! sides4 ,:5 ! jacket is to be put on a pati5t x is fir/ turn$ inside out1 !n "o ( ! nurses or assi/ants ?ru/s 8 own arms ?r\gh ! sleeves1 & fac+ ! pati5t1 invites him to %ake h&s2 hav+ ?us obta9$ possession ( ! pati5t's h&s he holds !m fa/ :ile a second assi/ant1 /&+ beh9d ! pati5t1 pulls ! jacket (f ! fir/ assi/ant on to ! pati5t1 ^: h&s are ?us drawn ?r\gh ! sleeves be=e he p]ceives ! object ( ! manuvre2 ! jacket is next ti$ r\nd ! neck & beh9d1 ! tapes ( ! sleeves are c>ri$ r\nd ! body1 drawn tight till ! arms are fold$ across ! *e/1 & fa/5$ to ! b$ on ea* side1 or ti$ r\nd ! body4 ,manacles = ,deliri\s ,pati5ts4--,in/ead ( ! /rait jacket a d\ble lea!rn muff is n[ g5]ally us$ to re/ra9 unruly pati5ts4 ,x irritates !m less1 & is f> m easily appli$4 ,illu/ration3 ,fig4 #aj4--,manacles = conf9+ ! arms ( deliri\s pati5ts4 ,9 we>+ x ! arms are cross$ 9 front1 & a /rap drawn tight r\nd bo? wri/s4 ,ea* h& is ?ru/ into a /\t lea!rn glove1 or muff1 connect$ ) ! wri/-/rap1 & capable ( be+ tight5$ ov] ! f+]s by a /rap & buckle across ! glove4 ,to susp5d ! ,te/icles4--,susp5sories are made specially = ?is purpose4 ,! be/ are fa/5$ r\nd ! neck by a loop ( ela/ic tape1 b a v effici5t "o c be improvis$ ) a pocket h&k]*ief & a piece ( b&age4 ,! b&age is ti$ tightly r\nd ! hips = a girdle1 ! h&k]*ief is fold$ ?ree-corn] wise1 & its longe/ side slipp$ beh9d ! te/es1 ! ends be+ pass$ ov] ! girdle 7see fig4 #aa71 & ti$ aga9 beh9d ! scrotum4 ,! loose apex ( ! h&k]*ief is drawn up 9 front ov] ! girdle & p9n$ to x1 :i* is all t is requir$ 7see fig4 #ab74 ,illu/ration3 ,fig4 #aa4--,%awl ,susp5sory = ! ,te/es1 9 ! fir/ /age ( application4 ,illu/ration3 ,fig4 #ab4--,susp5sory = ,te/es complet$4 ,:5 ! pati5t is recumb5t1 ! te/es may be support$ by a /rip ( dia*ylon pla/] #b feet long & #d in*es wide1 pass$ across f hip to hip und]nea? ! scrotum & te/es1 :i* lie support$ on a %elf4 ,ano!r way ( rais+ ! te/es is to place a s(t p9cu%ion betwe5 ! ?ighs1 & all[ ! swoll5 gl& to re/ on ! cu%ion4 ,,upp] ,,extremity4 ,b&age = ! ,f+]s & ,?umb4 ,app>atus4--,a -in* wide roll]4 ,! f+]s are b&ag$ to prev5t dema :5 spl9ts are tightly atta*$ to ! =e or upp] arm4 ,a roll] in* wide is pass$ once r\nd ! wri/ & !n c>ri$ ov] ! back ( ! h& to ! little f+]2 !n w\nd 9 spirals r\nd x to ! tip & return$ up ! f+]1 complet$ by a figure ( #h r\nd ! wri/ & ! root ( ! f+]1 & return$ to ! wri/ be=e be+ br\ght across ! back ( ! h& to ! next f+]1 to :i* x is appli$ 9 ! same mann] till ! f\r f+]s are cov]$4 ,x is a good precaution to place a %r$ ( cotton wool betwe5 ea* f+] be=e c>ry+ ! figure ( #h turn r\nd ! root2 x prev5ts ! b&ages f *af+ ! t5d] sk94 ,! ?umb is b&ag$ r diff]5tly3 ! roll] is comm5c$ 9 ! same way r\nd ! wri/1 b ! fir/ turn is c>ri$ at once beyond ! la/ jo9t1 turn$ once or twice r\nd ! la/ phalanx1 & cont9u$ by rev]ses to ! metac>po-phalangeal jo9t2 ! ball ( ! ?umb is !n cov]$ by figures ( #h r\nd ! ?umb & wri/4 ,?is is call$ ! spica = ! ?umb4 ,illu/ration3 ,fig4 #ac4--,spica = ! ,?umb4 ,?is plan is sometimes employ$ to compress ble$+ w\nds ( ! ball ( ! ?umb1 & is appli$ )\t previ\sly cov]+ ! phalanges1 z 9 fig4 #ac4 ,! ,h& & ,arm4 ,app>atus4--#a4 ,a roll] #b in*es wide = an adult1 b n>r[] = a *ild4 #b4 ,"s cotton wool4 ,a little cotton wool %\ld fill ! palm be=e apply+ ! roll]4 ,! b&age comm5ces ) figures ( #h c>ri$ r\nd ! h& & wri/4 ,! roll] is fir/ pass$ across ! back ( ! h& f ! radial bord] ( ! ?umb to ! root ( ! little f+] 7see fig4 #ad71 & !n across ! palm1 rea*+ ! back ( ! h& betwe5 ! ?umb & =ef+]4 ,illu/ration3 ,fig4 #ad4--;,comm5c+ to b&age ! h&4 ,:5 ! h& is cov]$ by ^! figures ( #h ! b&age is pass$ up ! =e>m by rev]ses plac$ ov] ! ext5sor muscles till ! elb[ is ne>ly rea*$4 ,be=e go+ fur!r a dossil ( cotton wool is plac$ 9 ! b5d ( ! elb[1 & on ! inn] condyle2 ! jo9t is b5t to ! degree t w be requir$ by ! spl9t1 & ! pati5t told to grasp "s "p ( 8 dress1 or ! sleeve ( ! o!r arm1 t he may n unconsci\sly ext5d ! jo9t aga9 :ile ! b&age is be+ roll$ r\nd x4 ,! elb[ is cov]$ by fir/ c>ry+ ! roll] r\nd ! jo9t1 s t ! po9t ( ! olecranon re/s on ! c5tre ( ! turn 7see dott$ l9es1 fig4 #ae74 ,! b&age is !n cont9u$ 9 figures ( #h1 pass+ above & bel[ ! fir/ turn until ! elb[ is cov]$ 9 & ! b&age ( ! =e>m is complet$4 ,illu/ration3 ,fig4 #ae4--;,b&age cov]+ ! elb[4 ,! fir/ turn ov] ! po9t ( ! elb[ is %[n by ! dott$ l9es4 ,illu/ration3 ,fig4 #af4--,spica ,b&age = ! %\ld]4 ,! arm is cov]$ by spirals & rev]ses till ! armpit is rea*$4 ,be=e b&ag+ ! %\ld] ! armpit is protect$ by cotton wool or a d\ble fold ( s(t blanket2 ! roll] is !n c>ri$ 9 front ( & ov] ! %\ld]1 across ! back to ! opposite axilla1 :]e also "s wool %\ld be plac$1 !n across ! *e/ to ! top ( ! %\ld] aga91 & "u ! armpit to ! front 7see fig4 #af74 ,^! figures ( #h are repeat$ z (t5 z necess>y to complete ! cov]+4 ,! b&age is appli$ 9 ?is me?od = dress+s2 b :5 pressure is ne$$ ! fir/ turn may be c>ri$ at once to ! root ( ! neck1 & ea* succe$+ turn made to ov]lap bel[ ! la/1 until ! po9t ( ! %\ld] is ga9$1 z 9 fig4 #cg1 p4 #ee4 ,^! are call$ ! spica = ! %\ld]4 ,w\nd ( ! ,palm> ar*4--,ble$+ f ?is w\nd c usually be /opp$ by pressure on ! ble$+ po9t1 :5 ?is fails an attempt %\ld be made to tie ! vessel at ! w\nd1 & if ?is be impracticable ! art]ies ( ! =e>m mu/ be deligat$4 ,= compression ! foll[+ is necess>y3-- ,app>atus4--#a4 ,petit's t\rniquet4 #b4 ,/raight wood5 spl9t4 #c4 ,roll]s #b in*es wide1 & in* wide = f+]s4 #d4 ,pad & cotton wool4 #e4 ,l9t4 #f4 ,a slip ( a w9e cork4 #g4 ,scissors & ne$le & ?read4 #h4 ,lun> cau/ic4 ,/ep #a4 ,fir/ apply ! t\rniquet to ! bra*ial art]y1 to control ! hmorrhage :ile ! app>atus is be+ adju/$4 ,/ep #b4 ,make a graduat$ compress by fold+ a sixp5ce or slip ( a cork 9 two or ?ree ?icknesses ( l9t1 trim ! l9t into circul> disks & prep>e a doz5 simil> disks ( increas+ size2 lay ^! "o on ea* o!r to =m a r\nd cone ab\t "o in* high ) ! piece ( cork at ! apex1 & fa/5 !m toge!r by a ?read4 ,/ep #c4 ,clean & dry ! w\nd1 !n rub its surface c>efully ) nitrate ( silv]1 to less5 ! suppuration4 ,/ep #d4 ,b&age ! f+]s & ?umb1 & prep>e ! spl9t1 :i* %\ld be /raight1 z broad z ! =e>m1 & long en\gh to rea* f ! elb[ to ! tips ( ! f+]s2 x %\ld be lightly padd$4 ,/ep #e4 ,envelope ! wri/ ) a little wool2 next lay ! graduat$ compress on ! w\nd1 ! small end d[nw>ds1 & press x firmly 9 ) ! left ?umb1 :ile ! spl9t is appli$ to ! back ( ! h& & =e>m4 ,^! are !n fix$ by a roll] c>ri$ 9 figures ( #h r\nd ! h& & wri/ across ! compress until t is tightly press$ into ! w\nd & ! spl9t fix$ to ! limb4 ,! roll] is !n c>ri$ along ! =e>m1 a fold ( wool laid 9 front ( ! elb[1 ! t\rniquet remov$ & ! roll] c>ri$ to ! axilla :ile ! =e>m is rais$1 flex$ across ! *e/1 & fa/5$ to ! side4 ,?is app>atus is worn )\t be+ di/urb$ = ?ree or f\r days if ble$+ d n return2 b at ! end ( ?is "t x %\ld be exam9$2 if pa9ful or if dis*>ge ooze out at ! w\nd1 ! b&age %\ld be remov$ & readju/$ less firmly ?an be=e1 a piece ( wet l9t replac+ ! graduat$ compress4 ,v5section4--,b&age & ble$+ at ! b5d ( ! elb[4 ,app>atus4--#a4 ,lancet4 #b4 ,tape4 #c4 ,pl$get ( l9t4 #d4 ,di%4 #e4 ,/aff4 ,9 op5+ a ve9 at ! b5d ( ! elb[1 ! m$ian basilic is select$1 simply because x is usually ! l>ge/1 b any bran* t is sup]ficial1 & well fill$ ) blood1 may be op5$4 ,! pati5t %\ld sit or /&1 9 :i* positions1 syncope1 "o ( ! objects ( ble$+1 is atta9$ by ! ab/raction ( a less am\nt ( blood ?an 9 ! horizontal po/ure4 ,! surgeon places a graduat$ ble$+ di% on a *air or /ool )9 8 rea*1 & a pl$get ( l9t 9 8 wai/coat pocket2 he next gives ! pati5t a heavy book1 or /aff to grasp 9 8 h&4 ,! arm be+ b>e to ! %\ld]1 a tape1 in* broad & #a y>d long1 is ti$ r\nd ! arm tight en\gh to imp$e ! v5\s1 b n ! art]ial fl[4 ,! surgeon /&+ opposite 8 pati5t & grasp+ ! arm to be bl$ ) 8 left h&1 s t 8 ?umb controls & /eadies ! swoll5 ve91 takes 8 lancet betwe5 ! "r =ef+] & ?umb2 !n go+ ?r\gh sk9 & ve9 at "o /roke1 c>ries ! lancet upw>ds = ab\t in* along ! ve94 ,! puncture ( ! lancet %\ld be q v]tical1 & ! extraction also made q v]tically1 t ! slit 9 ! ve9 may correspond to ! slit 9 ! sk94 ,?is be+ done1 ! op]ator lays aside 8 lancet1 & takes up ! di%1 hold+ x s t ! blood %all fl[ into x3 :5 ! di% is plac$1 he lifts 8 left ?umb f ! ve9 cauti\sly or ! sudd5 spirt ( blood w fall outside ! di% & be lo/4 ,:5 ! desir$ am\nt is drawn1 ! op]ator compresses ! ve9 aga9 ) ! left ?umb1 & sett+ d[n ! di%1 puts ! pl$get ( l9t ov] ! w\nd4 ,he keeps ! pl$get 9 place ) 8 left ?umb1 :ile he releases ! tape r\nd ! arm & places its middle obliquely across ! pl$get4 ,8 left ?umb presses ! pl$get on ! w\nd1 :ile ! "r h& takes ! end ( ! tape :i* is f>!/ f 8 left1 & passes x "u ! =e>m bel[ ! elb[ to 8 left f+]s1 :i* grasp x tightly4 ,he !n takes ! o!r end ) 8 "r h& 7see fig4 #ag71 & br++ x r\nd ! arm above ! elb[1 c>ries x across ! pl$get3 z he does ?is1 he replaces 8 left ?umb on ! compress ) 8 "r =ef+]1 :i* he keeps !re :ile he br+s up ! end ( ! tape he has already 9 8 left f+]s1 & ?r[s x ov] ! arm above 8 "r =ef+]1 !n pass+ 8 left h& bel[ ! "r =ef+]1 he cat*es ! same end ( ! tape aga9 & draws x back4 ,! two ends ?us lock$ 9 a loop ov] ! compress1 are secur$ by ty+ !m 9 a b[ outside ! elb[ & ! op]ation is f9i%$ 7see fig4 #ah74 ,illu/ration3 ,fig4 #ag4--;,adju/+ ! tape aft] ble$+4 ,illu/ration3 ,fig4 #ah4--,! b&age complet$4 ,,! ,,l[] ,,extremity4 ,= adults ! mo/ useful wid? = ! roll]s is #c in*es1 & ! l5g? ! ord9>y "o ( #h y>ds4 ,! ,foot is usually b&ag$ )\t cov]+ ! heel1 & ! b&age is begun z foll[s3-- ,! roll] be+ held 9 ! "r h& = ! "r foot1 or 9 ! left h& = ! left foot2 ! unoccupi$ h& takes ! end1 & pass+ x "u ! sole1 br+s x up on ! back ( ! foot j beh9d ! toes1 :]e x is made fa/ by c>ry+ ! roll] outw>ds ov] ! back4 ,:5 "o turn is complet$1 ! b&ag+ is cont9u$ by rev]ses until ! metat>sus is cov]$1 !n "o or two figures ( #h r\nd ! foot & ankle c>ry ! b&age to ! leg1 :]e x proce$s upw>ds by spiral turns r\nd ! small ( ! leg1 & by rev]ses up ! calf4 ,! rev]ses lie at equal di/ance up ! leg1 on ! muscles1 n ov] ! bone1 t ! sk9 be n p9*$ betwe5 ! crease ( ! b&age & ! bone4 ,:5 ! calf is pass$1 ! roll] is cont9u$ by figures ( #h above & bel[ ! knee1 until t jo9t is cov]$ 91 !n by rev]ses up ! ?igh to ! gro91 :]e ! b&age t]m9ates by a spica r\nd ! body 7see page #i74 ,?is is ! ord9>y b&age = ! l[] limb4 ,!re are "s v>ieties = p>ticul> p>ts1 ^! are3-- ,to cov] ! ,heel4--,hold+ ! roll] z = ! foot1 pass ! end beh9d ! heel1 br+ x out by ! outside ov] ! front ( ! ankle-jo9t1 & complete ! turn ) ! roll]4 ,9 do+ ?is1 ! po9t ( ! heel mu/ cat* ! middle ( ! b&age4 ,if ! foot is a long "o1 ! roll] %\ld be ?ree in*es broad2 b a n>r[] b&age is m easily fitt$ on a small foot4 ,aft] ! fir/ turn1 ! b&ag+ is cont9u$ by c>ry+ ! roll] 9 figures ( #h r\nd ! foot & ankle1 pass+ alt]nately above & bel[ ! fir/ turn until ! ankle is cov]$ z 9 fig4 #ai4 ,illu/ration3 ,fig4 #ai4--;,cov]+ ! ,heel4 ,to b&age a ,toe4--,take two turns r\nd ! foot1 ) a b&age "o in* wide1 !n g r\nd ! toe to be rais$1 & back aga9 r\nd ! foot4 ,?is figure ( #h lifts a toe above ! re/ if tak5 f ! dorsal1 & depresses x if tak5 f ! plant> surface4 ,! ,knee is b&ag$ by beg9n+ ) a simple turn r\nd ! leg above ! calf1 !n c>ry+ ! roll] across ! patella to ! ?igh above ! knee3 & next entw9+ x 9 a circul> turn r\nd ! ?igh be=e desc5d+ ov] ! patella to ! leg bel[ ! knee1 :]e ?is is repeat$ until ! knee is cov]$4 ,to b&age a ,/ump4--,! flaps are fir/ support$ by two or m /rips ( pla/]1 "o in* wide & t5 or twelve long1 c>ri$ f ! "u surface ( ! limb ov] ! face ( ! /ump1 & a slip ( wet l9t & oilsk9 is appli$ to ! w\nd4 ,! muscles & s(t p>ts are next conf9$ by a b&age4 ,?is is fir/ fix$ by simple turns bel[ ! ne>e/ jo9t1 & br\ght d[nw>ds 9 figures ( #h r\nd ! limb till ! end ( ! /ump is rea*$1 :i* is next cov]$ 9 by oblique & circul> turns c>ri$ alt]nately ov] ! face ( ! /ump & r\nd ! limb1 z is %[n 9 fig4 #b = b&ag+ ! head4 ,or1 if a d\ble-head$ roll] be us$1 9 ! mann] direct$ = ! capell9e b&age on page #e4 ,ext5d+ a ,/ump4--,:5 ! s(t p>ts fall away f ! bone !y may be drawn d[n by atta*+ a weight by cord & pulley1 z describ$ = ext5d+ ! hip-jo9t 7see fig4 #hj74 ,! /ump %\ld be lightly b&ag$ & ! cord fa/5$ to its upp] & "u surface4 ,! weight is v small at fir/1 & %\ld be increas$ f "t to "t z requir$4 ,_m-tail1 or #ah-tail ,b&age1 or b&age ( ,scultetus4--,a roll] is cut into %ort l5g?s long en\gh to encircle ! limb & to let ! ends ov]lap #b or #c in*es2 ^! are appli$ sep>ately1 ! l[e/ fir/1 ! next ov]lapp+ x1 & ! next ov]lapp+ ! second until ! requisite numb] are appli$4 ,sometimes ! tails are atta*$ to ea* o!r be=e !y are appli$4 ,to d ?is1 ! tails are laid out on a table1 s t ! second ov]laps "o-?ird ( ! wid? ( ! fir/ /rip1 & ! ?ird /rip ov]laps ! second1 & s on4 ,:5 all ! tails are arrang$1 a /rip is laid across _! middle & fa/5$ to ea* tail by a /it*2 b ?is is n a necess>y "p ( ! b&age1 & x prev5ts s+le tails f be+ remov$4 ,?is b&age is us$ 9 comp\nd fractures & o!r w\nds1 z ! soil$ /rips c be replac$ )\t rais+ ! limb to pass ! roll] "u x4 ,ela/ic ,socks & ,/ock+s are made to support v>icose ve9s ( ! legs4 ,!y are wov5 ( india-rubb] webb+ ) silk or cotton4 ,! latt] are ! l[e/ pric$ & (t5 ev5 ! mo/ com=table to we>4 ,! /ock+s %\ld fit c>efully ev]y:]e1 especially at ! small ( ! leg1 :]e !y g5]ally are too slack1 :ile !y cut at ! upp] end bel[ ! knee4 ,,*apt] ,,ii4 ,,/rapp+4 ,/rapp+ is a me?od ( support+ weak or swoll5 jo9ts & o!r p>ts4 ,%eets ( calico1 wa%-lea!r1 or :ite bucksk91 spread ) lead or soap pla/]1 are prep>$ = ?is purpose4 ,a %eet %\ld be rubb$ ) a dry clo? be=e us+1 to remove adh]5t du/1 c4 ,x is !n cut into /rips v>y+ 9 wid? betwe5 in* & #b in*es1 accord+ to ! ev5ness ( ! surface to be cov]$3 n>r[ /rips fit be/ ov] jo9ts & irregul> surfaces4 ,:5 appli$ to a limb1 ! /rips %\ld be ab\t "o-?ird long] ?an its circumf]5ce4 ,ea* /rip or /rap is fir/ w>m$ by hold+ x to a fire1 or by apply+ its unpla/]$ side to a c ( boil+ wat]2 :5 hot1 ! /rip is !n drawn tightly & ev5ly ov] ! "p4 ,if ! surface to be /rapp$ be irregul>1 x is be/ to dip ea* /rip ( pla/] 9 hot wat] be=e apply+ x1 be+ ?us q supple ! /rap fits ! limb m exactly4 ,:5 ! limb is ?ickly beset ) hairs1 x is a good plan to %ave ! "p :]e ! pla/] w lie be=e putt+ on ! /raps4 ,/rapp+ ! ,brea/4--,/rapp+ is put on ! brea/ 9 ! same way z ! b&age 7page #h74 ,! /raps %\ld be n m ?an #b in*es wide1 & long en\gh to pass =w>d "u ! axilla & brea/ f ! l[] angle ( ! scapula on ! same side z ! injur$ brea/1 across ! *e/ z f> z ! sp9e ( ! o!r scapula4 ,! /rips are !n w>m$ & laid on alt]nately ov] ! brea/ & across ! *e/1 until ! =m] is fairly support$4 ,/rapp+ has ?is advantage ov] a b&age--its circul> /rips d n pass r\nd ! *e/ completely & !reby hamp] ! brea?+ z ! roll] does4 ,to /rap ! ,te/icle4 ,app>atus4--#a4 ,/rips ( soap pla/] spread on calico1 or bett]1 on wa%-lea!r1 in* wide & #ab in*es long4 #b4 ,a c ( boil+ wat]4 #c4 ,razor & soap4 ,illu/ration3 ,fig4 #bj4--,/rapp+ ! ,te/is4 ,fir/1 %ave ! scrotum2 !n tight5 ! sk9 ov] ! te/is ) ! left ?umb & =ef+] pass$ above x2 take a /rip ( pla/] #f in*es long & in* wide1 & encircle ! cord tightly ) x2 next pass ano!r /rap ( ! same wid?1 #i or #aj in*es long1 f ! back ( ?is r+1 ov] ! te/icle to ! front1 draw+ x tight also 7see fig4 #bj74 ,! /rapp+ is cont9u$ by lay+ fre% /raps ov] ea* o!r until ! :ole te/is is cov]$ 94 ,la/ly1 take a /rip #ae or #bj in*es long1 &1 beg9n+ at ! r+ above1 w9d x r\nd & r\nd ! te/icle until all ! v]tical /rips are conf9$ 9 place by ?is spiral /rip4 ,! /rapp+ %\ld be re-appli$ ! second or ?ird day1 z ! te/icle by t "t w h %runk )9 its case4 ,illu/ration3 ,fig4 #ba4--,/rapp+ an ,ulc]4 ,illu/ration3 ,fig4 #bb4--,/rapp+ ! ,ankle4 ,/rapp+ ,ulc]s & ,jo9ts4--,cut /rips ( pla/] "o-?ird long] ?an ! circumf]5ce ( ! "p to be /rapp$2 if t is irregul>1 z ! ankle or wri/1 !y mu/ be n>r[3 commonly ! wid? v>ies betwe5 in* & #a in*4 ,! /rips are w>m$1 ! middle pass$ beh9d ! limb1 ! ends cross$ 9 front 7see fig4 #ba7 & drawn tight1 b ) suffici5t obliquity = ! m>g9s ( ! /rip to lie ev5ly4 ,! /rapp+ is begun z l[ d[n ! limb z requisite1 & cont9u$ upw>ds by lay+ on m /rips1 ea* ov]lapp+ ab\t two-?irds ( ! prec$+ /rap4 ,:5 ! process is f9i%$1 ! ends %\ld meet along ! same l9e1 & all ! upp]mo/ ones be on ! same side4 ,! ankle is /rapp$ diff]5tly4 ,/rips are prep>$ ab\t in* wide2 "o is c>ri$ beh9d ! heel & its ends br\ght =w>d till !y meet on ! dorsum ( ! foot2 a second1 encircl+ ! foot at ! toes1 secures ! fir/2 a ?ird is aga9 c>ri$ beh9d ! heel above ! fir/1 & is fix$ by a f\r? r\nd ! foot4 ,?is is cont9u$ until ! foot & ankle are firmly support$ 7see fig #bb74 ,/rapp+ a ,jo9t ) ,m]curial ,o9tm5t4 7,scott's ,b&age47 ,app>atus4--#a4 ,m]curial o9tm5t4 #b4 ,dia*ylon pla/]4 #c4 ,l9t4 #d4 ,_s ( camphor4 #e4 ,cotton wool4 #f4 ,fre%ly scald$ />*1 or solution ( gum4 #g4 ,b9d]'s millbo>d4 ,spread ! o9tm5t on a piece ( l9t l>ge en\gh to cov] ! jo9t1 & to ext5d f\r or six in*es above & bel[ x2 !n wa% ! jo9t ) w>m wat] & soap & dry x c>efully2 next sponge x well ) ! _s ( camphor = five m9utes4 ,te> ! l9t into /rips & wrap x r\nd ! jo9t2 !n /rap ! "p firmly f bel[ upw>ds ov] ! l9t ) /rips ( dia*ylon pla/]1 ea* ov]lapp+ ! prec$+4 ,la/ly1 envelope ! jo9t 9 a ?9 lay] ( cotton wool1 & roll a b&age soak$ 9 />* ov] all4 ,if ! pati5t we>s no o!r k9d ( spl9t ! b&age may be /r5g!n$ by lay+ a piece ( millbo>d well s(t5$ 9 boil+ wat] along ea* side ( ! jo9t be=e ! />* b&age is appli$4 ,z ! enl>gem5t ( ! jo9t %r9ks1 ?is application mu/ be r5ew$1 usually e =tnight is (t5 en\gh4 ,,*apt] ,,iii4 ,,fractures4 ,,head ,,& ,,trunk4 ,fracture ( ! l[] ,jaw4--,! ,ext]nal ,spl9t & ,b&age4--,a me?od requir+ ! l[] jaw to be firmly fix$ aga9/ ! upp] "o :ile ! brok5 bone knits4 ,app>atus4--#a4 ,"o & a half y>ds ( b&age f\r in*es wide4 #b4 ,a piece ( gutta-p]*a1 sole lea!r1 or b9d]'s millbo>d4 #c4 ,d5ti/s' silk or wire4 #d4 ,boil+ hot1 & cold wat]4 ,/ep #a4 ,! fracture is fir/ r$uc$4 ,:ile ! app>atus is be+ fitt$1 ! recurr5ce ( ! displacem5t is prev5t$ by ! h&s ( an assi/ant1 or by lac+ ! tee? toge!r ) /\t silk or wire4 ,x is well also to wet ! pati5t's *9 ) a sponge & cold wat]1 to prev5t ! gutta-p]*a f /ick+ to 8 be>d :ile x is s(t4 ,/ep #b4 ,a piece ( gutta-p]*a is prep>$ #b in*es wide & long en\gh to rea* f "o angle ( ! jaw to ! o!r :5 pass+ 9 front ( ! *94 ,?is is s(t5$ ?or\ghly by imm]sion 9 boil+ wat]1 & :5 q pliable %\ld be quickly remov$ f ! hot & plung$ = a mom5t into cold wat]3 if a t[el be previ\sly laid 9 ! hot bas91 ! gutta-p]*a c be lift$ on x )\t /ret*+4 ,x %\ld be laid on a table1 & its surface spong$ ) cold wat] to prev5t x /ick+ to ! sk91 x is !n slit f ea* end into tails #a in* & #a in* wide1 leav+ #b in*es uncut at ! c5tre4 ,s prep>$1 ! spl9t is appli$ to ! jaw ) ! middle press+ aga9/ ! *91 ! n>r[] ends be+ c>ri$ horizontally backw>ds to ! angles ( ! jaw2 ! broad] "p is next b5t up b5ea? ! *91 its ends ov]lapp+ ! horizontal ones4 ,:ile ! spl9t is /ill s(t1 ! surgeon presses x firmly upw>ds t ! gutta-p]*a may m\ld itself accurately to ! *94 ,:5 set1 ! spl9t is remov$1 trimm$1 & pun*$ ) holes "h & !re = evaporation4 ,a cov]+ ( wa%-lea!r may be add$1 if desir$4 ,:5 ! spl9t is f9i%$1 x is replac$ on ! *94 ,if sole lea!r or pa/ebo>d be us$ in/ead ( gutta-p]*a1 !y mu/ be prep>$ 9 ! same way1 b all[$ to rema9 on ! *9 tw5ty-f\r h\rs t !y may set be=e ! f9al trimm+ & adju/m5t4 ,/ep #c4 ,a b&age1 #d in*es wide & #a y>d long1 & slit f ea* end to ab\t #b in*es f ! c5tre1 is !n appli$ to ! spl9t1 & a small pad ( fold$ flannel %\ld be plac$ at ! nape ( ! neck to protect ! sk9 f ! cross$ b&age4 ,:5 all is ready1 ! two upp] ends are c>ri$ beh9d ! neck1 cross$1 drawn tight1 & ti$ or p9n$ on ! =ehead2 ! l[] ends are c>ri$ upw>ds1 tak+ a turn r\nd ! fir/ pair at ! temples1 & fa/5$ at ! v]tex 7see fig4 #bc74 ,illu/ration3 ,fig4 #bc4--,outside spl9t = fracture ( ! l[] jaw4 ,! ligatures t may h be5 us$ on ! tee? c n[ be remov$1 or if !y cause no pa91 !y may be left = a week or two4 ,x is a useful precaution to place a piece ( soap pla/] spread on s(t lea!r1 "u ! *9 & along ! ?roat1 to protect ! sk9 f ! *af+ ( ! spl9t :ile x is worn4 ,sometimes ! jaws close too ne>ly to all[ food to be tak5 betwe5 !m4 ,x is !n necess>y to place a ?9 w$ge ( s(t5$ gutta-p]*a1 #a in* long1 in* wide1 & ab\t in* ?ick1 betwe5 ! mol>s on ea* side4 ,! gutta-p]*a mu/ n be s(t5$ mu*1 or :5 ! bite is tak5 ! tee? w pass ?r\gh x4 ,^! plugs %\ld be omitt$ unless absolutely requir$1 z ! fragm5ts keep a bett] position )\t !m4 ,on em]g5cy1 :5 gutta-p]*a1 lea!r1 or pa/ebo>d are n at h&1 ! jaw may be set1 & !n kept 9 position by a f\r-tail b&age1 made f a pocket-h&k]*ief1 until m complicat$ app>atus c be prep>$4 ,! app>atus mu/ be worn five weeks be=e x is laid aside & ma/ication p]mitt$4 ,int]d5tal ,spl9ts4--,9 cases ( unusual difficulty1 int]d5tal spl9ts may be employ$4 ,to fa%ion "s ( ^!1 ! me*anical skill ( a d5ti/ is requisite1 unless ,morel ,lavalle's plan is resort$ to4 ,he appli$ a m\ld or socket to ! l9e ( ! tee?1 & kept x 9 place by pressure und]nea? ! jaw4 ,he fir/ br\ght ! fragm5ts into apposition by means ( ?reads & wire4 ,!n he took a piece ( gutta-p]*a1 ab\t in* ?ick & in* broad1 & long en\gh to ext5d1 :5 b5t along ! l[] jaw1 f "o wisdom mol> to ! o!r4 ,?is 0 s(t5$ 9 wat]1 & press$ on ! tee?2 next a well-padd$ horse-%oe plate 0 plac$ "u ! *91 rea*+ f "o angle ( ! jaw to ! o!r1 & two wires 7 pass$ ?r\gh ! side ( ?is plate opposite ! angle ( ! m\?2 ^! 7 drawn ?r\gh ! plate by a screw nut2 _! upp] ends be+ curv$ into hooks ) %>p5$ po9ts4 ,! po9ts cat* into ! gutta-p]*a2 by screw+ up ! nuts1 ! *9plate 0 rais$1 & ! tee? driv5 up & b$d$ into ! spl9t4 ,?is me?od1 h[ev]1 has its disadvantages4 ,if ! fracture take place beh9d ! fir/ mol>1 ! be>+ on ! upp] fragm5t is too slight to keep x d[n 9 its place4 ,9 ! ,new ,york ,m$ical ,j\rnal = ,septemb] & ,octob]1 #ahff1 ,mr4 ,gunn+1 ( t city1 has publi%$ a mode ( apply+ caps fitt$ to ! tee? = fracture ( ! jaw-bone4 ,ext]nal support is ab&on$ :]ev] x is possible4 ,9 simple fractures1 ! caps or int]d5tal spl9ts1 be+ accurately fitt$1 require no fa/5+ to ! tee?4 ,! jaw %\ld be adju/$ 9 its spl9t z quickly z possible aft] ! accid5t4 ,! fragm5ts are fir/ br\ght into _! true position4 ,gaps ?r\gh loss ( tee? at ! l9e ( fracture1 are fill$ by plugs ( h>d wood1 & ! fragm5ts kept 9 place by wir+ ! tee? toge!r tightly4 ,cont9u$ /ra9 on ! tee? causes mu* pa92 h5ce all means = keep+ ! fragm5ts 9 place :ile ! spl9t is be+ fitt$ %\ld be remov$ :5 t is accompli%$1 ?\gh ligatures us$ solely to support loos5$ tee? may be left1 z !re is no traction ^u !m4 ,/umps1 & tee? loose be=e ! accid5t are be/ tak5 out1 if !y int]f]e ) ! arrangem5t ( ! spl9t4 ,illu/ration3 ,fig4 #bd4--,vulcanite ,int]d5tal ,spl9t to fit ! ar* ( ! tee? ( ! l[] jaw1 se5 upside d[n4 ,! holes m>k$ a pass ?r\gh to ! upp] surface1 to all[ wat] to be inject$ betwe5 ! spl9t & ! tee?1 :ile x is worn1 = clean+4 ,! next ?+ is to take a m\ld ( ! l[] jaw 9 wax s(t5$ by heat1 hold+ ! wax 9 an ord9>y d5ti/'s tray4 ,f ?is m\ld a pla/] ca/ ( ! jaw is made4 ,if ! l9e ( tee? be unev5 9 ! ca/1 x is to be sawn ?r\gh1 ! pieces rais$ to ! "r level1 & ca/ aga94 ,9 ?is ca/ a vulcanite plate is made exactly fitt+ ! tee? 7see fig4 #bd74 ,! m>g9s ( ! m\ld or spl9t %\ld be c>ri$ d[n bel[ ! l9e ( ! gums1 to grasp ! jaw beyond ! alveol> bord]2 & :5 ! fracture takes place beh9d ! tee?1 its out] side %\ld be prolong$ backw>ds z f> z ! muscles w all[1 to prev5t ! displacem5t ( ! ant]ior fragm5t outw>ds :i* muscul> action produces 9 ^! fractures4 ,holes %\ld be made 9 ! top ( ! spl9t1 to p]mit a /ream ( wat] to be s5t betwe5 ! spl9t & ! tee? daily1 = cleanl9ess4 ,also1 9 difficult cases1 a hole %\ld be cut opposite a too? 9 ea* fragm5t1 = asc]ta9+ f "t to "t t ea* "p cont9ues 9 its prop] position :ile ! spl9t is worn4 ,metal is us$ = ! plate by ,engli% d5ti/s1 in/ead ( vulcanite4 ,x c be made ?9n]1 & is less brittle ?an ! latt]4 ,! p]fect fit ?us secur$ suffices1 9 simple fracture1 to keep ! p>ts 9 close apposition2 :ile ! movem5ts ( eat+ & speak+ are v little int]f]$ )4 ,illu/ration3 ,fig4 #be4--,%[+ ! me?od = support+ ext]nally ! jaws 9 ! spl9t1 :5 ! tee? are n fa/5$ to x by screws1 ,e4 ,upp] w+2 ,g4 ,l[] w+2 ,h4 ,m5tal b& to keep ! jaw up 9 ! spl9t2 ,i4 ,neck-/rap to keep ! b& back2 ,k4 ,balance-/rap to hold skull-cap 9 place4 ,! upp] w+s are ( c\rse disp5s$ )1 :5 a s+le spl9t only is us$4 ,:5 ! displacem5t is consid]able ! fragm5ts are held 9 place by rivet+ "o or m tee? to ! cap1 or1 :5 circum/ances prev5t support be+ obta9$ 9 ?is way1 ext]nal support is suppli$ to ! spl9t by /eel w+s1 fix$ into ! spl9t at ! angles ( ! m\? 7see fig4 #be71 & c>ri$ outside ! *eek to ! angles ( ! jaw4 ,a piece ( /\t jean or canvas1 cut to fit "u ! *91 is !n connect$ ) ^! w+s1 & also fa/5$ by a tape beh9d ! neck4 ,if ! case require t a be>+ be made on ! upp] jaw z well z ! l[] "o1 z 9 fracture ( bo? jaws 9 ed5tul\s p]sons1 ! two spl9ts are articulat$ beh9d1 s t !y may op5 & %ut ) ! l[] jaw4 ,ea* piece !n c>ries a w+1 ! l[] "o support+ a *9-piece1 & ! upp] "o be+ connect$ by /r+s atta*$ at ! temples to a close-fitt+ skull-cap4 ,! skull-cap is prev5t$ f slipp+ =w>d by connexion ) a /rap fa/5$ to bo? %\ld]s4 ,a fractur$ ,rib is v well treat$ by /rapp+ ! injur$ side alone1 )\t enroll+ ! *e/ 9 a tight b&age1 :i* h>asses ! pati5t by imp$+ respiration4 ,app>atus4--#a4 ,dia*ylon pla/]4 #b4 ,c ( boil+ wat]4 ,illu/ration3 ,fig4 #bf4--,/rapp+ a brok5 ,rib4 ,/rips ( pla/] long en\gh to rea* f ! sp9al column to ! /]num1 & #b in*es wide1 are to be firmly drawn r\nd ! injur$ side4 ,! fir/ /rip %\ld be c>ri$ z high z c be manag$ "u ! arm-pit4 ,! next /rip ov]laps x ab\t an in* 7fig4 #bf71 ea* succe$+ /rip ov]lapp+ & fix+ ! prec$+ "o until ! l[] ribs are cov]$ 94 ,! arm %\ld !n be b&ag$ to ! side1 & support$ 9 a sl+4 ,a second mode ( treat+ fractur$ ribs1 is to take a flannel roll] #f in*es wide1 & #h y>ds long1 & c>ry x firmly r\nd ! *e/ 9 successive spirals1 beg9n+ at ! armpits1 & pass+ d[n till ! wai/ is rea*$4 ,! turns ( ! roll] may be kept f slipp+ d[n by ?r[+ across ! %\ld]s two /rips ( b&age l a pair ( braces1 & /it*+ ea* turn to ! brace 9 front & beh9d4 ,! arm %\ld be conf9$ to ! side z 9 ! o!r me?od4 ,?is plan has ! inconv5i5ce be=e m5tion$ ( int]f]+ ) respiration4 ,9 ,fracture ( ! ,pelvis1 ! fragm5ts are kept 9 position by a broad roll] c>ri$ sev]al times r\nd ! pelvis & fa/5$4 ,,! ,,upp] ,,extremity4 ,fracture ( ! ,metac>pal ,bones4 ,app>atus4--#a4 ,a piece ( gutta-p]*a4 #b4 ,a roll] #b in*es wide4 ,9 treat+ ?is fracture x is important to keep ! brok5 bone 9 place )\t conf9+ ! wri/ or f+]s4 ,a patt]n ( ! palm & dorsum ( ! h& is cut out ( pap]1 :i* is d\bl$ r\nd ! radial side1 lett+ ! ?umb out ?r\gh a hole ( conv5i5t size to cle> x 7see fig4 #bg74 ,! piece ( pap] is !n laid on a %eet ( gutta-p]*a in* ?ick1 & ! requisite quantity cut (f2 a hole z big z a pea is next pun*$ 9 ! gutta-p]*a 9 ! middle1 ab\t #a in* f ! l[] bord]1 or at a po9t correspond+ to ! hole 9 ! pap] = ! ?umb4 ,! fragm5ts are !n pu%$ into place & held s by an assi/ant1 :ile ! surgeon s(t5s ! gutta-p]*a 9 boil+ wat]2 :5 ?or\ghly s(t1 he draws ! ?umb ?r\gh ! little hole pun*$ 9 ! gutta-p]*a1 & m\lds ! spl9t to ! palm & back ( ! h&1 br++ ! ends ( ! gutta-p]*a toge!r at ! uln> side ( ! h&2 ! fragm5ts are held c>efully 9 position till ! spl9t is set4 ,! spl9t is aft]w>ds remov$ & trimm$4 ,a few holes %\ld be pun*$ 9 x aft] x is m\ld$ to all[ p]spiration to escape4 ,! spl9t may !n be cov]$ ) wa%-lea!r1 & a pair ( /raps ) buckles /it*$ on to keep x 9 place4 ,x is worn = ?ree or f\r weeks1 or until ! fragm5ts are unit$4 ,illu/ration3 ,fig4 #bg4--;,gutta-p]*a ,glove = fractur$ ,metac>pal ,bone4 ,%\ld gutta-p]*a n be at h&1 ano!r plan is effectual4 ,app>atus4--#a4 ,a firm ball ( t[ l>ge en\gh to fill ! palm1 /it*$ 9 old l954 #b4 ,a roll] #b in*es wide4 ,! brok5 bone is fir/ replac$2 !n ! h& & f+]s b\nd on to ! ball by c>ry+ ! roll] ar\nd !m until !y are all immoveably conf9$4 ,?is plan has ! disadvantage ( conf9+ ! :ole h& = ! fracture ( "o metac>pal bone2 ! gutta-p]*a all[s free use ( all b ! metac>pal bones4 ,brok5 phalanges are treat$ by b&ag+ !m on to a slip ( wood long en\gh to rea* into ! palm2 ! slip mu/ be well padd$1 t ! some:at concave ant]ior surface ( ! digit may accommodate itself on ! flat spl9t4 ,if m ?an "o f+] be injur$1 & ! fracture be comp\nd1 ! spl9t %\ld !n rea* up ! palm> aspect ( ! =e>m & h&4 ,f+]s %\ld be cut 9 x to correspond ) ! f+]s to be fa/5$ to ! spl9t4 ,fracture ( ! l[] end ( ! ,radius4--,colles' ,fracture4--,! displacem5t 9 ?is fracture is ma9ly due to ! l[] end ( ! radius & ! c>pus be+ c>ri$ backw>ds :ile ! %aft projects 9 front4 ,app>atus4--#a4 ,a /raight spl9t ( wood4 ,a second spl9t1 curv$ at its l[] end4 #b4 ,pads & cotton wool4 #c4 ,a roll] #b in*es wide4 #d4 ,a sl+4 #e4 ,a /rip ( pla/]4 ,! objects to be atta9$ 9 treat+ ?is fracture are to press ! l[] fragm5t =w>ds & to draw 7adduct7 ! h& t[>ds ! uln> side ( ! limb4 ,= ?is purpose a /raight & a curv$ spl9t are us$4 ,no b&age %\ld be plac$ "u ! spl9ts 9 treat+ any fracture ( ! %aft ( ! radius or ulna1 le/ ! brok5 ends be press$ into ! int]osse\s space4 ,/ep #a4 ,prep>e ! spl9ts4 ,! /raight spl9t %\ld rea*1 :5 ! arm is b5t1 to a "r angle ) ! ?umb upw>ds1 f a little bel[ ! inn] condyle to ! l[] end ( ! upp] fragm5t or %aft2 ! curv$ or pi/ol spl9t ext5ds f ! out] condyle to ! jo9t ( ! fir/ & second phalanges4 ,! wid? ( bo? spl9ts %\ld slightly exce$ t ( ! =e>m4 ,! b5d ( ! l[] end ( ! pi/ol spl9t %\ld be abrupt1 & direct$ t[>ds ! uln> bord] opposite ! wri/1 :]e ! m>g9 ( ! spl9t %\ld make an obtuse angle ( ab\t #a "r angles 7see fig4 #bh74 ,illu/ration3 ,fig4 #bh4--,pi/ol ,spl9t = fracture ( ! ,radius ne> ! l[] end4 ,pads us$ ) ^! & o!r wood5 spl9ts are made ( lay]s ( cotton wool1 c>d$ %eep's wool1 t[1 or folds ( old blanket4 ,^! mat]ials %\ld be /it*$ 9 old l95 or calico1 & cov]$ outside ) oil$ silk :]e likely to be /a9$ ) ! dis*>ge f w\nds4 ,! pads mu/ be ?ick] bel[ ?an above1 to keep ! spl9ts p>allel along ! =e>m2 & t ( ! pi/ol spl9t is ?icke/ opposite ! c>pus1 to pu% ! l[] fragm5t =w>ds4 ,fix$ de=mity opposite ! wri/ is usually pres5t f impaction ( ! fragm5ts2 mod]ate ext5sion may be employ$ to remove ?is1 b =cible or cont9u$ ef=ts give great pa9 & d h>m1 by fur!r /ra9+ ! already wr5*$ ligam5ts4 ,aft] ^! prep>ations ! spl9ts are appli$4 ,/ep #b4 ,put a v little cotton wool 9 ! palm & across ! root ( ! ?umb1 be=e ! roll] is begun1 le/ x *afe ! c>pus 9 front4 ,! curv$ spl9t1 ) ! b>rel or long] "p incl9$ d[nw>ds bel[ ! =e>m1 is next atta*$ to ! back ( ! h& by a roll] c>ri$ 9 figures ( #h r\nd ! h& & root ( ! ?umb1 b n above ! wri/ 7see fig4 #bi74 ,?is is made fa/ by a p94 ,illu/ration3 ,fig4 #bi4--;,fracture ( ! ,radius4 ,/ep #c4 ,raise ! /raight "p ( ! outside spl9t till p>allel to ! =e>m1 ?us adduct+ ! h& to ! uln> side2 & fix ! spl9t by a /rap ( pla/] an in* wide c>ri$ r\nd x & ! =e>m bel[ ! elb[4 ,/ep #d4 ,apply ! inside /raight spl9t next1 keep+ ! front ( ! c>pus & ( ! l[] fragm5t expos$4 ,draw ! two spl9ts toge!r by simple spiral turns ( a roll]1 begun j bel[ ! elb[ & c>ri$ d[n to ! l[] end ( ! inside spl9t1 !re fa/5 x (f4 ,/ep #e4 ,put a n>r[ sl+ "u ! =e>m betwe5 ! elb[ & ! wri/ to support ! limb com=tably4 ,:5 ! app>atus is f9i%$ ! position ( ! brok5 fragm5ts %\ld be visible 7see fig4 #bi7 & n conceal$ by b&age4 ,! h& %\ld also be q free ( ! sl+1 le/ x be drawn f its prop] adduct$ position4 ,! fragm5ts are 9 good position :5 ! holl[ on ! ant]ior aspect ( ! wri/ & ! prom95ce on ! correspond+ po/]ior surface are remov$4 ,! ,gutta-p]*a ,gauntlet is ano!r plan ( treat+ fracture ( ! l[] end ( ! radius t may (t5 be adopt$ f ! fir/1 & may always replace ! wood5 spl9ts & b&age :5 ! swell+ has subsid$4 ,x 0 contriv$ by ,mr4 ,hea!r ,bigg1 & p]mits ! pati5t to use 8 h& to "s ext5t :ile ! bone is unit+4 ,app>atus4--#a4 ,a piece ( gutta-p]*a in* ?ick1 wide en\gh to enwrap ! metac>pus & wri/1 & long en\gh to rea* up ! l[] half ( ! =e>m4 ,two ?irds across ! wid?1 & ab\t #a in* f ! l[] end1 a small r\nd hole is pun*$4 ,! %eet is !n s(t5$ 9 hot wat]1 & appli$ to ! h&1 ! ?umb be+ ?ru/ ?r\gh ! hole pun*$ to receive x1 :i* rapidly enl>ges :5 s(t4 ,! gutta-p]*a is !n adju/$ to ! h& & =e>m1 its bord]s meet+ at ! uln> side ( ! limb1 r ne>] ! inn] bord] ( ! arm ?an is depict$ 9 fig4 #cj4 ,illu/ration3 ,fig4 #cj4--;,gutta-p]*a ,gauntlet = ,colles' ,fracture4 ,if ! fracture is rec5t1 x mu/ be r$uc$ :ile ! spl9t is s(t by ext5d+ ! h& & hold+ ! p>ts 9 ! requir$ position until ! gutta-p]*a is set4 ,be=e remov+ ! spl9ts sup]flu\s edges %\ld be m>k$1 &1 :5 ! spl9t is (f1 trimm$ away ) a knife4 ,holes mu/ also be pun*$ at frequ5t int]vals t ! p]spiration may escape4 ,! spl9t is next l9$ ) wa%-lea!r1 & fitt$ ) a pair ( /raps & buckles to keep x 9 place4 ,by ?is plan ! f+]s are left free1 & "s motion all[$ also to ! ?umb4 ,! only jo9ts kept immoveable are ^? ( ! c>pus & wri/4 ,app>atus ( "s k9d mu/ be worn ?ree weeks cont9u\sly2 !n = a =tnight long]1 :ile x is remov$ e day to all[ passive motion ( ! f+]s & gradually ( ! wri/ also to be practis$4 ,c>e %\ld be tak5 to w>n ! pati5t t pa9 & /iffness la/ long 9 ^! fractures1 le/ he blame ! surgeon because he does n quickly recov] full use ( 8 arm4 ,fracture ( ! ,%aft ( "o or bo? ,bones ( ! ,=e>m4 ,app>atus4--#a4 ,two /raight wood5 spl9ts4 #b4 ,pads & wool4 #c4 #b-;in* wide roll]4 #d4 ,sl+4 ,! treatm5t is ! same :e!r "o or bo? bones are brok54 ,caution has be5 already giv5 aga9/ b&ag+ ! =e>m und]nea? ! spl9ts4 ,/ep #a4 ,prep>e two /raight wood5 spl9ts2 "o to g 9 front (1 & "o beh9d ! =e>m4 ,! po/]ior or outside rea*es f ! ext]nal condyle to ! end ( ! metac>pus2 ! ant]ior or inside spl9t f a little bel[ ! int]nal condyle only z f> z ! wri/1 keep+ cle> ( ! ball ( ! ?umb4 ,! spl9ts %\ld be slightly broad] ?an ! =e>m1 & well padd$2 t[>ds ! l[] end ! padd+ %\ld be ?ick] ?an above4 ,! =e>m is b5t to a "r angle & ! ?umb put upw>ds4 ,/ep #b4 ,r$uce ! fracture by g5tle sl[ ext5sion at ! wri/2 ?is be+ effect$1 apply ! spl9ts to ! =e>m1 & let an assi/ant hold !m :ile ! b&age is roll$ on4 ,/ep #c4 ,:5 a little wool has be5 wrapp$ r\nd ! h& & wri/1 fa/5 ! dorsal spl9t by figures ( #h c>ri$ r\nd ^? p>ts2 !n draw ! two spl9ts toge!r by simple spirals cont9u$ to ! elb[ 7see fig4 #ca74 ,illu/ration3 ,fig4 #ca4--;,fracture ( bo? ,bones ( ! ,=e>m4 ,/ep #d4 ,support ! =e>m 9 a sl+1 to complete ! app>atus4 ,! spl9ts are worn ?ree weeks2 aft] ?is1 passive motion may be practis$ daily1 & ! spl9ts f9ally ab&on$ t5 days lat]4 ,b a sl+ is /ill requir$ "s t5 days aft] ! spl9ts are laid aside4 ,:5 ! ulna alone is brok51 an ant]ior spl9t rea*+ f ! inn] condyle to ! tips ( ! f+]s (t5 suffices )\t a second "o4 ,:5 ! %aft ( ! radius is brok5 high up 7a r>e accid5t7 ! displacem5t is sometimes v difficult ( r$uction unless ! wri/ be well sup9at$4 ,to pres]ve ?is position x may be necess>y to use a wood5 angul> spl9t1 & to fix ! v]tical "p to ! arm beh9d ! elb[1 :ile ! horizontal "p is c>ri$ along ! back ( ! =e>m4 ,fracture ( ! ,olecranon4--,?is fracture1 if se5 e>ly be=e effusion takes place1 may be put up at once1 b if delay till ! jo9t is swoll5 has occurr$1 ! limb mu/ be kept quiet on a pill[1 or on a spl9t 9 an easy position ) evaporat+ lotions1 until ! effusion is absorb$1 be=e any means c be tak5 to re/ore ! position ( ! olecranon4 ,?\gh ! /raight position ( ! elb[ is usually employ$1 x is n ess5tial = ev5 v close union ( ! fragm5ts4 ,9 treat+ ?is fracture ! foll[+ plan is useful4 ,app>atus4--#a4 ,/raight holl[ spl9t4 #b4 #b-;in* roll]s & f+] roll]s4 #c4 ,pad1 wool1 & l9t4 #d4 ,/rapp+ pla/]4 #e4 ,p9s4 ,/ep #a4 ,b&age ! f+]s2 wrap ! h& 9 cotton wool & b&age x4 ,:5 ! wri/ is pass$1 fa/5 ! b&age = a "t by a p91 & /raight5 ! arm4 ,/ep #b4 ,pu% ! olecranon d[n z close z possible to ! re/ ( ! ulna1 & put a dossil ( l9t ov] x4 ,place ! middle ( a /rap ( pla/] an in* wide & #af in*es long1 on ! l9t1 & c>ry its ends r\nd ! =e>m 9 a figure ( #h2 to "s ext5t ?is alone fixes ! fragm5t4 ,/ep #c4 ,cont9ue ! b&age up ! =e>m by rev]ses1 keep+ ! elb[ /raight2 & pass ! jo9t by figures ( #h c>ri$ ov] ! compress ( l9t & ! =e>m1 to draw d[n ! olecranon 7see fig4 #cb74 ,:5 ?is is secur$1 prolong ! b&age to ! deltoid1 to conf9e ! action ( ! triceps muscle4 ,/ep #d4 ,pad lightly a holl[ spl9t ab\t #b in*es wide1 rea*+ f ! axilla ne>ly to ! wri/1 & apply x along ! ant]ior aspect ( ! limb1 !n fix x by a second roll]4 ,?is completes ! app>atus4 ,illu/ration3 ,fig4 #cb4--;,br++ d[n ! ,olecranon ) ,figures ( #h4 ,! spl9ts & roll]s %\ld be remov$ on ! f\r? or fif? day1 t ! positions ( ! fragm5ts may be exam9$ & ! roll] aga9 appli$ to draw !m clos] toge!r4 ,aft] t5 or twelve days1 passive motion ( ! wri/ & f+]s1 ) pronation & sup9ation ( ! radius1 %\ld be adopt$1 b great c>e is to be tak5 t ! pati5t does n inadv]t5tly b5d ! elb[ jo9t :ile free ( ! spl9t4 ,! spl9t mu/ be worn1 ) ! frequ5t removals direct$ above1 = five weeks1 by :i* "t g5tle flexion ( ! elb[ may be practis$4 ,hamilton not*es 8 spl9t at ea* bord] ab\t its middle s t ! not*es %all be #c in*es bel[ ! tip ( ! olecranon 7see fig4 #cc74 ,he beg9s ! b&ag+ by fa/5+ 8 spl9t on to ! h& & =e>m1 z high z ! not*es2 "h ! roll] is c>ri$ above ! olecranon & aga9 d[n to ! not*es2 ?is is repeat$ aga9 & aga91 ea* turn bel[ ! la/1 until ! not*es are all cov]$1 he !n cont9ues ! b&age upw>ds by circul> turns until ! top ( ! spl9t is rea*$4 ,illu/ration3 ,fig4 #cc4--;,hamilton's ,spl9t = fracture ( ,olecranon4 ,fractures ( ! ,hum]us ne> ! ,elb[4--,^! resemble dislocations ( ! ulna & radius backw>ds1 b are di/+ui%$ f !m by ! ease ) :i* ! bones slip into place & aga9 slip back f x :5 left to !mselves2 by crepitus2 &1 :5 ! fracture is above ! condyles1 ! common accid5t1 by ^? projections reta9+ _! natural relation to ! olecranon4 ,9 *ildr5 & y\?s ! articulat+ surface ( ! hum]us may sep>ate f ! %aft )\t c>ry+ ! re/ ( ! l[] epiphysis ) !m4 ,9 ?is r>e accid5t ! ma9 di/9ctions f ! usual fracture are1 ! projection ( ! olecranon beh9d ! condyles2 f dislocation1 ! abs5ce ( ! holl[ ( ! sigmoid not*1 & facility ( r$uction4 ,9 ord9>y cases1 :]e ! de=mity is r$uc$ )\t mu* difficulty1 & ! injury to ! jo9t is n sev]e1 lat]al rectangul> spl9ts ( lea!r1 holl[$ wood1 or wire gauze1 answ] v well4 ,^! are plac$ bo? inside & outside ! limb1 & rea* f ! axilla & %\ld] to ! wri/4 ,!y are appli$ 9 ! foll[+ mann]3-- ,app>atus4--#a4 ,lat]al holl[$ angul> spl9ts4 #b4 ,pads & wool4 #c4 ,roll]s #b in*es wide = ! arm1 & #a in* wide = ! f+]s4 #d4 ,sl+4 ,/ep #a4 ,! spl9ts mu/ be prep>$4 ,wood5 & wire gauze spl9ts are d\ble4 ,"o1 inside ! arm1 rea*es f ! axilla to ! wri/1 ! =e>m be+ b5t to a "r angle4 ,! o!r ext5ds1 on ! outside1 f ! deltoid to ! wri/4 ,!y are bett] if provid$ ) h+es opposite ! elb[1 s t _! angle c be alt]$1 if desir$1 9 ! lat] /age ( ! treatm5t4 ,spl9ts ( wood or wire gauze mu/ be ev5ly & lightly padd$ be=e application4 ,/ep #b4 ,b5d ! arm to a "r angle ) ! ?umb upw>ds4 ,an assi/ant next r$uces ! fracture1 & holds x 9 position4 ,!n apply ! spl9ts4 ,:5 adju/+ ! inside spl9t1 c>e mu/ be tak5 t ! int]nal condyle is eas$ f pressure by suffici5t padd+ above & bel[ x4 ,next fa/5 on ! spl9ts by a roll] begun at _! l[] end1 leav+ ! h& free1 & c>ri$ up to ! elb[4 ,be=e turn+ r\nd t jo9t a s(t pad mu/ be plac$ 9 ! holl[ ( ! elb[ to pu% ! l[] end ( ! hum]us back1 & ! l5g? ( ! arm %\ld be measur$ aga9/ ! unbrok5 "o to make sure t ! %ort5+ is r$uc$4 ,ext5sion is kept up ! :ole "t ! spl9t is be+ fix$ to ! arm1 :i* is done by c>ry+ ! roll] r\nd ! elb[ ) figures ( #h & simple spirals up to ! axilla1 :]e x is f9i%$ (f4 ,/ep #c4 ,la/ly1 ! =e>m is support$ 9 a sl+ "u ! wri/1 leav+ ! elb[ free 7z 9 fig4 #ce1 page #eb74 ,aft] ?ree weeks ( complete immobility1 passive motion %\ld be appli$ to ! elb[ daily1 dur+ a =tnight or ?ree weeks m 9 :i* ! spl9t is /ill worn4 ,if ! displacem5t returns v easily1 x is bett] to use an ,l-%ap$ spl9t pass+ beh9d ! arm & bel[ ! =e>m4 ,?is may be made ( wood1 or ( lea!r1 or ( gutta-p]*a1 9 ! mode ab\t to be describ$4 ,! ,l-%ap$ spl9t ( gutta-p]*a1 or lea!r1 is made z foll[s3-- ,app>atus4--#a4 ,%eet gutta-p]*a in* ?ick4 #b4 ,a tray or wide wa%-h& bas94 #c4 ,a bas9 ( cold wat]4 #d4 ,a kettle ( boil+ wat]4 #e4 ,a t[el4 #f4 ,a knife4 #g4 ,a %eet ( newspap]4 ,cut a patt]n ( pap] rea*+1 :ile ! elb[ is b5t & ! ?umb upw>ds1 f ! arm-pit d[n ! back ( ! arm & "u ! elb[ & =e>m to ! wri/4 ,! sides mu/ be br\ght =w>d to ! biceps & front ( ! =e>m z se5 9 fig4 #cd4 ,next cut f ! %eet ( gutta-p]*a a piece to mat* ! patt]n4 ,prep>e ! tray ) ! hot wat]1 lay 9 x ! t[el1 & !n s(t5 ! gutta-p]*a by lay+ x 9 ! tray & cov]+ x ) almo/ boil+ wat]1 add+ m wat] z ! fir/ cools2 ?is may be done by an assi/ant1 :ile ! surgeon directs ano!r assi/ant to grasp ! =e>m & r$uce ! fracture4 ,! assi/ant keep ext5sion :ile ! surgeon lifts ! s(t5$ gutta-p]*a ) ! t[el f ! hot & plunges x a mom5t into cold wat]1 !n lays x on ! limb1 :i* ! assi/ant keeps at a "r angle1 & ! bone 9 place1 :ile ! spl9t is sett+ to ! limb4 ,?is done1 ! spl9t is remov$ to be trimm$1 p]=at$1 & cov]$ ) wa%-lea!r4 ,x is !n ready = use4 ,illu/ration3 ,fig4 #cd4--;,gutta-p]*a ,spl9t = fracture at ! l[] end ( ,hum]us4 ,lea!r takes s mu* "t to set t x %\ld n be us$ 9 rec5t fractures4 ,:5 ! bone is p>tly set1 lea!r is a useful sub/itute = wood4 ,x is prep>$ f a patt]n 9 ! same mann] z ! gutta-p]*a1 b is trimm$ be=e soak+1 n aft] x is m\ld$1 l gutta-p]*a4 ,if possible x %\ld h tw5ty-f\r h\rs soak+ 9 wat] be=e be+ fitt$ to ! limb2 b :5 ?is _c be done1 imm]sion 9 hot wat]1 into :i* a teacupful ( v9eg> has be5 ?r[n1 w make ! lea!r q supple 9 a qu>t] ( an h\r4 ,! lea!r spl9t mu/ be worn tw5ty-f\r h\rs :ile x sets1 & !n be remov$ = cov]+ 7see ,lea!r ,spl9ts74 ,fractur$ ,%aft ( ! ,hum]us4 ,app>atus4--#a4 ,f\r /raight holl[ spl9ts4 #b4 ,roll]s #b in*es wide1 & #a in* = ! f+]s1 or /raps & buckles4 #c4 ,pads & wool4 #d4 ,sl+4 ,:5 brok5 bel[ ! atta*m5t ( ! deltoid & coraco-bra*ialis muscles ! displacem5t ( ! bone is commonly prev5t$ ) ease2 nei!r %\ld] nor elb[-jo9t ne$ be fix$1 & x is n necess>y to apply ! spl9ts s tightly z to risk int]f]5ce ) ! v5\s circulation4 ,if ! pectoral muscles or deltoid be connect$ ) ! l[] fragm5t1 ! displacem5t is sometimes ob/9ate2 9 su* cases x is necess>y to buckle ! spl9ts lightly4 ,= ?is to be done1 ! f+]s1 h&1 & =e>m mu/ be previ\sly b&ag$ to prev5t dema2 ) ?is addition1 ! me?od ( treatm5t is ! same 9 bo? v>ieties ( fracture4 ,/ep #a4 ,select ! spl9ts2 !y %\ld be holl[$1 ( wood1 p]=at$ %eet z9c1 or wire gauze1 ab\t #b in*es broad1 lightly padd$1 & provid$ ) /raps & buckles4 ,! ext]nal "o rea*es f ! acromion to ! out] condyle2 ! inn] "o f ! axilla to ! inn] condyle2 a ?ird %ort] "o is plac$ beh9d ! arm1 & if !re is mu* projection =w>ds ( ! l[] fragm5t1 a f\r? v %ort "o is add$ 9 front4 ,! pati5t %\ld sit on a *air :ile ! app>atus is be+ put on4 ,/ep #b4 ,! f+]s & ?umb are b&ag$2 !n1 ! h& & =e>m1 fir/ padd$ ) a little wool 9 ! palm & ov] ! wri/1 are ev5ly b&ag$ to ! elb[1 r\nd :i* ! roll] is c>ri$ :ile ! jo9t is well flex$2 ?is be+ cov]$ 91 ! roll] is made fa/4 ,! fir/ /ep ( b&ag+ ! h& & =e>m be=e apply+ ! spl9ts is bett] omitt$ if ! compression requisite to procure ! natural position ( ! bone does n int]f]e ) ! circulation4 ,/ep #c4 ,an assi/ant grasp+ ! elb[ 9 "o h&1 pulls d[n ! l[] fragm5t1 :ile he /eadies ! %\ld] ) ! o!r4 ,! displacem5t ?us r$uc$1 ! surgeon applies ! spl9ts1 tak+ c>e t ! inside spl9t does n rea* too high into ! axilla1 le/ x compress ! axill>y ve94 ,9 simple cases1 ! spl9ts %\ld be drawn close by /raps & buckles2 :]e ! muscles are p[]ful1 a roll] %\ld be w\nd r\nd ! spl9ts in/ead ( /raps4 ,illu/ration3 ,fig4 #ce4--;,fractur$ ,%aft ( ! ,hum]us4 ,/ep #d4 ,a #b in* wide roll] is fa/5$ to ! arm above ! elb[1 & !n c>ri$ r\nd ! trunk to ! arm aga91 to /eady ! limb aga9/ ! body4 ,/ep #e4 ,! h& & wri/ are support$ by a sl+ ov] ! %\ld]s1 ! elb[ be+ all[$ to hang 7see fig4 #ce74 ,?is app>atus is worn ?ree weeks1 :5 ! b&ages are remov$ f ! =e>m1 & ! spl9ts replac$ less tightly ?an be=e4 ,!y may be sub/itut$ by a %ea? ( gutta-p]*a m\ld$ to ! arm f ! acromion to ! elb[1 & buckl$ on to ! limb4 ,! arm mu/ be support$ by spl9ts = five weeks1 b passive motion ( ! elb[ & wri/ %\ld be adopt$ aft] ! ?ird week4 ,! wri/ especially %\ld be set at lib]ty z soon z possible4 ,9 treat+ ?is fracture great c>e is necess>y t ! bone be kept 9 accurate & close position1 z ! hum]us is specially prone to rema9 un-unit$ = _m mon?s4 ,fracture ( ! ,anatomical or ,surgical ,neck ( ! ,hum]us1 ( ! ,great ,tub]osity1 & ( ! ,neck ( ! ,scapula4 ,^! fractures are simil>ly treat$4 ,app>atus4--#a4 ,pap] = patt]n4 #b4 ,gutta-p]*a1 lea!r1 or millbo>d4 #c4 ,pads4 ,a s(t ?9 pad1 #aj in*es long1 #e in*es wide 7a d\ble fold ( ?ick flannel or blanket answ]s v well71 is want$ to l9e ! axilla4 ,if ! cap is ( lea!r or gutta-p]*a1 a l9+ ( wa%-lea!r %\ld be add$ aft] ! spl9t is made4 #d4 ,roll]s1 #b in*es & #a in* wide = ! f+]s4 #e4 ,scissors4 #f4 ,a tray1 & kettle ( hot wat]4 #g4 ,a t[el1 & bas9 ( cold wat]4 #h4 ,sl+4 #i4 ,cotton wool4 ,/ep #a4 ,cut out a pap] patt]n ( ! spl9t on ! limb to be fitt$4 ,! patt]n %\ld rea* along ! clavicle to ! root ( ! neck1 & ov] ! scapula to its po/]ior bord]1 & be cont9u$ d[n ! arm to ! elb[1 tap]+ z x goes1 b hav+ its ant]ior & po/]ior m>g9s br\ght suffici5tly to ! inn] side ( ! arm to give ! spl9t a good grasp ( ! limb 9 desc5d+4 ,! end %\ld be left long en\gh to turn a c\ple ( in*es r\nd ! po9t ( ! elb[ 7see fig4 #cf74 ,a not* mu/ be cut at ! upp] end ( ! pap] patt]n to make x fit on ! %\ld] betwe5 ! clavicle & ! sp9e ( ! scapula2 ?is %\ld n be repeat$ 9 ! gutta-p]*a1 z t c be m\ld$ on )\t2 & = t reason ! cap is mu* m s]viceable :5 made ( gutta-p]*a ?an ( lea!r1 :]e a not* mu/ be cut & /it*$ toge!r :5 ! lea!r is set4 ,! gutta-p]*a1 :5 cut to patt]n1 mu/ be s(t5$ 9 ! mann] describ$ 9 mak+ ! spl9t = ! elb[ at page #ej1 fig4 #cd2 !n accurately adju/$ to ! %\ld] z high z ! root ( ! neck1 & turn$ "u ! po9t ( ! elb[ a c\ple ( in*es 7see fig4 #cf71 :ile ! =e>m is well rais$ across ! *e/4 ,illu/ration3 ,fig4 #cf4--;,cap = fracture ne> ! ,%\ld]4 ,:5 set1 ! spl9t mu/ be remov$ t x may be trimm$ & l9$ ) wa%-lea!r4 ,if ( gutta-p]*a1 x mu/ be p]=at$ ) small holes2 if ( lea!r1 ! not* at ! %\ld] mu/ be /it*$ toge!r4 ,next prep>e a s(t ?9 pad1 #e or #f in*es broad1 & #h or #aj in*es long1 to fill ! axilla4 ,/ep #b4 ,b&age ! f+]s & ?umb sep>ately1 !n1 putt+ a little wool 9 ! palm & r\nd ! wri/1 b&age ! h& & =e>m to ! elb[1 :]e ! b&age is fa/5$4 ,/ep #c4 ,apply ! spl9t4 ,fir/ get on ! cap2 !n put ! s(t pad 9 ! axilla1 fill+ x out if ! arm-pit is v holl[ ) cotton wool1 & b5d ! elb[ till ! h& lies on ! brea/ ( ! opposite side4 ,!n1 :ile an assi/ant holds ! limb & app>atus 9 position1 fa/5 !m all 9 place by cont9u+ ! roll] ( ! =e>m 9 figures ( #h r\nd ! elb[ until ! spl9t is well fix$ to x2 & c>ry ! roll] up ! arm by rev]ses to ! axilla4 ,/ep #d4 ,a little wool or piece ( flannel hav+ be5 plac$ 9 ! opposite arm-pit to prev5t *af+1 a spica = ! %\ld] is !n appli$ 7see page #af71 beg9n+ at ! root ( ! neck & work+ d[nw>ds4 ,c>eful ext5sion is cont9u$ by ! assi/ant all ! "t ?is b&age is be+ put on1 until ! head ( ! bone is well drawn into ! cap4 ,illu/ration3 ,fig4 #cg4--;,fracture at ! upp] end ( ,hum]us4 ,! app>atus complet$4 ,/ep #e4 ,! arm is drawn to ! side1 & ! =e>m fix$ aga9/ ! *e/ by a roll] c>ri$ r\nd ! arm & trunk & ov] ! %\ld] 7see fig4 #cg74 ,aft] ?ree weeks ! =e>m may be releas$1 b ! cap & axill>y pad mu/ be cont9u$ to be worn two or ?ree weeks long] :ile ! arm is well drawn to ! side1 & ! wri/ c>ri$ 9 a sl+4 ,fracture ( ! ,great ,tub]osity ( ! hum]us is difficult to treat1 on acc\nt ( ! tub]osity be+ c>ri$ backw>ds by ! muscles & ! hum]us be+ rotat$ =w>ds4 ,h5ce ! p>ts mu/ be brac$ toge!r ) a firm cap ( gutta-p]*a m\ld$ on to ! %\ld] :ile s(t1 & :ile ! fractur$ p>ts are held 9 apposition1 :i* may be done by ! f+]s1 or by putt+ on a wet roll] firmly ov] ! %\ld] z a spica be=e ! spl9t is set4 ,:5 ! spl9t is h>d ! b&age may be tak5 (f1 & ! spl9t remov$ & f9i%$ ready = application4 ,9 do+ ?is1 ! /eps are ! same z = fracture ( ! surgical neck ( ! hum]us1 & ! necessity = fix+ ! arm well to ! side ( ! body z great z 9 t fracture4 ,fracture ( ! ,acromion is treat$ v mu* l fracture ( ! clavicle1 t is1 ! arm is well rais$ by a sl+ "u ! elb[1 & !n fa/5$ to ! side4 ,x is n necess>y to fill ! axilla ) a pad1 z 9 fracture ( ! clavicle1 = 9 ?is case ! %\ld] is n drawn inw>ds4 ,fracture ( ! ,clavicle4 ,app>atus4--#a4 ,axill>y pad4 #b4 ,roll]1 #c in*es wide4 #c4 ,sl+4 #d4 ,wool4 ,fractures ( ! clavicle ne>ly always leave "s de=mity aft] union2 ?is is be/ avoid$ by keep+ ! pati5t on 8 back on a flat c\* ) ! head alone support$ by a cu%ion1 & ! arm fix$ to ! side until union has tak5 place4 ,z mo/ p]sons w n submit to a =tnight or ?ree weeks' conf9em5t 9 b$ = ?is accid5t1 ! fragm5ts mu/ be kept 9 position z ne>ly z possible by app>atus :ile ! pati5t goes ab\t4 ,! displacem5t ( ! out] fragm5t is inw>ds1 d[nw>ds1 & =w>ds4 ,_m v>ieties ( app>atus are employ$ to prev5t ?is displacem5t dur+ union2 ! foll[+ mode is p]haps z effectual z any o!r 9 accompli%+ ?is object4 ,/ep #a4 ,fix 9 ! arm-pit a firm w$ge-%ap$ pad ( b$tick fill$ ) *aff2 #e in*es broad1 #f in*es long1 & #a or #b in*es ?ick at ! ?ick end1 or j en\gh to fill ! axilla & ?r[ out ! hum]us )\t compress+ ! axill>y ve91 h5ce ! ?ickness v>ies ) ! holl[ness ( ! axilla 7see fig4 #ch74 ,a b& & buckle are /it*$ to ! ?ick end1 :i* is upp]mo/4 ,:5 9 use1 ?is b& is pass$ ov] ! opposite %\ld] & keeps ! pad 9 place4 ,a little wool %\ld be put "u ! b&1 :]e x crosses ! root ( ! neck1 to prev5t *af+4 ,illu/ration3 ,fig4 #ch4--,w$ge-%ape pad = brok5 ,coll>-bone1 atta*$ to ! ,am]ican r+-pad4 ,/ep #b4 ,! elb[ is elevat$ by an assi/ant1 :o keeps ! arm v]tical & lays ! f+]s on ! brea/ bone4 ,a roll] atta*$ to ! arm by a c\ple ( turns is c>ri$ beh9d ! back r\nd ! trunk1 & ov] ! arm above ! elb[1 draw+ t close to ! side4 ,/ep #c4 ,to support ! elb[1 ! longe/ bord] or base ( a ?ree-corn]$ h&k]*ief is c>ri$ "u x1 "o end passes 9 front1 ! o!r beh9d ! body2 bo? are !n drawn tightly & cross$ ov] ! opposite %\ld]1 :]e "o end is tak5 "u ! axilla1 & ti$ 9 front4 ,9 giv+ ?is direction ! r+-pads %[n 9 ! figures are suppos$ n to be at h&4 ,la/ly1 ! loose corn] at ! wri/ is fold$ neatly & p9n$ up 7see fig4 #ci74 ,illu/ration3 ,fig4 #ci4--;,app>atus = brok5 ,clavicle f9i%$4 ,?is app>atus mu/ be wat*$ f "t to "t1 & re-adju/$ if any "p slips4 ,! sl+ & pad are to be worn = f\r weeks4 ,union sometimes takes place 9 ?ree weeks or less1 9 :i* case ! pad may be remov$ s mu* ! e>li]2 b a sl+ %\ld be worn = a =tnight aft] ! b&age & pad are laid aside4 ,9 *ildr5 ! pad mu/ be v mu* ?9n] & %ort] ?an t describ$2 ! sl+ %\ld be replac$ by a b&age c>ri$ alt]nately r\nd ! body1 & ov] ! opposite %\ld]4 ,aft] x is put on ! turns %\ld be well /it*$ toge!r1 & sme>$ ov] ) /iff />*4 ,9 b&ag+ *ildr51 great c>e mu/ be tak5 to protect ) wool ! p>ts likely to be *af$4 ,figure-(-#h b&age4--,_m surgeons /ill employ a figure-(-#h b&age c>ri$ "u ea* axilla & cross$ beh9d ! back4 ,"u any circum/ances ?is is exce$+ly irksome to ! pati5t1 b is lea/ s if two silk h&k]*iefs be sub/itut$ = ! b&age1 "o be+ pass$ r\nd ea* %\ld] & ! ends ( bo? brac$ tightly toge!r beh9d ! back4 ,! w$ge-%ap$ pad may be disp5s$ ) if ! %\ld]s are brac$ back1 b ! elb[ mu/ /ill be rais$ & drawn to ! side4 ,! ,am]ican surgeons h a v good plan = atta*+ ! sl+ to ! s\nd %\ld]4 ,in/ead ( c>ry+ ! ends ( ! sl+ r\nd ! %\ld] & "u ! axilla1 !y pass ov] ! %\ld] a loose b well-/uff$ coll> or r+-pad 7see fig4 #ch71 to :i* !y fa/5 ! ends ( ! sl+ 9 front & beh9d2 ?is prev5ts all cutt+ or *af+ "u ! armpit1 & di/ributes ! /ra9 ev5ly4 ,,l[] ,,extremity4 ,ruptur$ t5do ,a*illis is treat$ by ext5d+ ! foot & flex+ ! knee2 = ?is purpose ! pati5t we>s a high-heel$ slipp]4 ,a b& is sewn to ! heel1 drawn tight1 & fa/5$ to a buckle & /rap r\nd ! ?igh1 j above ! knee4 ,! pati5t %\ld n walk = a mon? unless he w use a wood5 leg on :i* he c kneel1 ) ! knee b5t4 ,sep>ation ( ! ,epiphysis ( ! ,calcaneum1 :i* sometimes occurs in/ead ( rupture ( ! t5do ,a*illis1 is treat$ 9 ! same way4 ,fracture ( ! ,fibula4--,dupuytr5's ,spl9t4--,:5 ! fibula only is brok51 x may be treat$ 9 sev]al ways2 ?is1 h[ev]1 is ! common plan3-- ,app>atus4--#a4 ,/raight wood5 spl9t4 #b4 ,pad & wool4 #c4 ,a roll]4 ,/ep #a4 ,! spl9t %\ld be ab\t #c in*es broad1 & long en\gh to rea* f ! head ( ! tibia to #d in*es beyond ! sole ( ! foot4 ,a not* #a or #b in*es deep is g5]ally cut at ! l[] end ( ! spl9t to cat* ! b&age 94 ,! spl9t is !n padd$1 c>e be+ tak5 t ! padd+ is suffici5tly ?ick to prev5t gall+ at ! upp] end aga9/ ! inn] condyle ( ! tibia1 & t x becomes ?ick] z x desc5ds along ! leg1 = t to re/ easily aga9/ ! spl9t2 la/ly1 ! pad %\ld end 9 a ?ick boss or projection opposite ! int]nal malleolus1 beyond :i* x %\ld n rea*1 le/ x int]f]e ) ! rotation & adduction ( ! foot inw>ds4 ,/ep #b4 ,! spl9t1 :5 ?us prep>$1 is appli$ along ! inn] side ( ! leg1 tak+ c>e 9 do+ ?is t ! int]nal malleolus is aga9/ ! middle ( ! spl9t1 & n all[$ by ! assi/ant to slip t[>ds ! ant]ior or po/]ior bord]4 ,/ep #c4 ,a roll] is !n c>ri$ r\nd ! limb & spl9t1 beg9n+ bel[ ! knee & cont9u+ 9 simple spirals = ?ree or f\r turns1 :5 x is fa/5$ & cut (f4 ,/ep #d4 ,a light lay] ( wool is wrapp$ r\nd ! outside ( ! ankle1 heel1 & dorsum ( ! foot4 ,!n a roll]1 beg9n+ at ! spl9t1 passes outw>ds 9 front ( ! ankle ov] ! ext]nal malleolus1 beh9d ! heel & ! spl9t2 !n ov] ! dorsum to ! out] m>g9 ( ! foot1 next "u ! sole ?r\gh ! not* ( ! spl9t to ! front ( ! ankle jo9t aga91 :]e x repeats ! same c\rse ?ree or f\r times4 ,ea* turn mu/ be tightly appli$ & made to draw ! foot well inw>ds to ! spl9t1 & 9 do+ s to tilt outw>ds ! brok5 "p ( ! fibula 7see fig4 #dj74 ,?is spl9t is cumb]some1 h5ce aft] two or ?ree weeks1 %\ld be replac$ by a light />* or gum cas+ = ! foot & leg1 leav+ ! knee free4 ,illu/ration3 ,fig4 #dj4--;,dupuytr5's ,spl9t = fracture ( ! ,fibula4 ,fractures ( ! ,tibia ) or )\t ! fibula1 & fractures at ! ankle jo9t4 ,^! fractures are (t5 f _! obliquity difficult to keep 9 good position2 9 su* cases ,mc,intyre's ,spl9t is v g5]ally us$ 9 ! e>ly "p ( ! treatm5t4 ,= ?is spl9t ! foll[+ app>atus is requir$3-- #a4 ,mc,intyre's spl9t4 #b4 ,pads = ! d\ble incl9e plane & foot-piece4 #c4 ,sock ( flannel = ! foot4 #d4 ,roll]s1 #c in*es wide4 #e4 ,wool1 p9s1 ne$le & ?read1 /rapp+ pla/]4 #f;a4 ,a sl+-cradle1 or #f;b4 ,bo>d1 block1 gimlet1 screws & screw-driv]4 ,! ,mc,intyre's ,spl9t may be us$ ei!r b5t or /raight1 :i*ev] position ( ! knee mo/ relaxes ! t5sion ( ! muscles on ! fragm5ts4 ,z a g5]al rule ! /raight position is be/ if ! fracture is high up1 & ! b5t "o1 :5 ne> ! ankle jo9t4 ,/ep #a4 ,a spl9t ( suitable l5g? is select$1 by measur+ ! s\nd leg4 ,! jo9t ( ! spl9t %\ld be put opposite ! patella1 & space be left bel[ ! foot = ! foot-piece to slide along ! slot :5 ext5sion is made4 ,! spl9t is next padd$1 ! holl[ :]e ! l[] "p ( ! calf & small ( ! leg w come be+ well fill$1 t ! leg may be ?or\ghly support$2 b ! space beh9d ! heel & t5do ,a*illis mu/ be left q cle>4 ,a small pad is !n fa/5$ by a /rip ( /rapp+ or by ne$le & ?read to ! foot-piece4 ,/ep #b4 ,! limb hav+ be5 fir/ clean$ & dri$1 ! dorsum ( ! foot & ankle are wrapp$ 9 an ev5 lay] ( cotton wool4 ,a sock or boot made ( flannel is next put on ! foot4 ,?is may be readily extemporis$ by cutt+ (f ! foot ( an angola /ock+1 slitt+ x up along ! back to ! toes1 & sew+ on to ! sole1 "o in* 9 front ( ! heel1 ! middle ( a piece ( tape in* wide & #ah in*es long4 ,! foot is !n wrapp$ 9 ! sock1 ! edges drawn toge!r by a ne$le & ?read1 c>e be+ tak5 t ! sock fits closely r\nd ! ankle & dorsum ( ! foot4 ,a little wool hav+ be5 wrapp$ r\nd ! knee1 ! limb is next rais$1 :ile ! spl9t is plac$ "u x2 ! screw is turn$ until ! incl9$ planes are at an angle suit$ = ! ma9t5ance ( ! fragm5ts 9 position1 & ! foot-piece is pu%$ up to ! foot ) its screw-p9 loose1 t x may be adju/$ to ! am\nt ( flexion or ext5sion necess>y = ! foot2 ?is be+ asc]ta9$1 ! screw is tight5$ to keep x s :ile ! foot is fa/5$ to ! foot-piece4 ,= ?is ! /r+s ( ! sock are br\ght ov] ! top ( ! foot-piece1 & drawn tight be=e ty+ !m4 ,illu/ration3 ,fig4 #da4--,mc,intyre's ,spl9t4 ,! ?igh fix$ ready = ext5sion ( ! leg4 ,! position ( ! heel is v important4 ,x %\ld n s9k bel[ ! spl9t1 or x w re/ on ! b&age2 nei!r %\ld x be drawn up too high1 or ! weight ( ! leg w hang on ! sock1 in/ead ( re/+ on ! pad2 bo? frequ5t causes ( pa9 at ! heel4 ,:5 ! prop] position is obta9$1 ! /r+s are made fa/ to ! p9 beh9d ! foot-piece1 & ! foot is /eadi$ by two or ?ree turns ( a roll] c>ri$ r\nd x & ! foot-piece 7fig4 #da74 ,/ep #c4 ,! ?igh is next fa/5$ to ! ?igh-piece by a roll] c>ri$ f ! top ( ! spl9t d[nw>ds along ! ?igh to ! knee1 or bel[ t jo9t if ! fracture is ne> ! ankle4 ,9 do+ ?is ! roll] is pass$ inside ! screw1 %\ld t be plac$ und]nea? ! spl9t1 z 9 fig4 #dc page #fe1 & n at ! side z 9 fig4 #da1 = ! screw w be want$ free = fur!r adju/m5t4 ,illu/ration3 ,fig4 #db4--,mc,intyre's ,spl9t slung 9 ,salt]'s ,cradle4 ,/ep #d4 ,an assi/ant grasps ) bo? h&s ! foot & foot-piece1 & pulls !m d[nw>ds until ! %ort5+ is remov$4 ,:ile do+ ?is1 he tilts ! foot up or d[n z ! surgeon f9ds necess>y = adju/+ ! fragm5ts1 :o also b5ds ! knee & raises or l[]s ! foot until a good position is atta9$4 ,! g5]al rule is to keep ! great toe 9 a l9e ) ! patella4 ,?is done1 ! surgeon tight5s up ! screw-p9 ( ! foot-piece1 & completes ! atta*m5t ( ! foot by cont9u+ 8 roll] ) figures ( #h r\nd ! foot & ankle2 ^! turns %\ld n h[ev] pass above ! fracture1 & be no m ?an suffici5t to secure ! position ( ! foot & ( ! l[] fragm5ts 7see fig4 #db74 ,/ep #e4 ,! b&ag+ usually ceases ) :at has be5 already done2 b if ! limb swell1 a sep>ate roll] may be c>ri$ along ! leg to support ! muscles & re/ra9 dema1 o!rwise ! leg is be/ left b>e1 t ! position ( ! fragm5ts may be wat*$1 & evaporat+ lotions appli$4 ,illu/ration3 ,fig4 #dc4--,mc,intyre's ,spl9t rais$ on a ,block4 ,/ep #f;a4 ,?is consi/s 9 sl++ ! limb1 = :i* ,salt]'s ,cradle is v conv5i5t 7see fig4 #db71 or an ord9>y b$ cradle answ]s v well1 f :i* ! limb c be slung on pieces ( b&age c>ri$ und]nea? ! spl9t at ! knee & ankle4 b4 ,in/ead ( elevat+ ! limb by a sl+1 x is also cu/om>y to raise & fix ! spl9t on a block 7fig4 #dc71 #f1 #h1 #aj1 or ev5 #ab in*es high1 z may be necess>y2 ?is block slides 9 a groove on a bo>d #c feet squ>e1 put betwe5 ! mattress & b$/ead1 to af=d a firm support = ! block4 ,9 ord9>y cases ! limb is kept on ! spl9t ?ree weeks1 until ! irritation has subsid$1 & p>tial union is atta9$2 ! spl9t may !n be replac$ by a />* b&age1 & ! pati5t may leave 8 b$4 ,transv]se ,fracture ( ! tibia alone1 or ev5 ( bo? bones1 :5 ! displacem5t is small1 is v well treat$ by a holl[ spl9t on ea* side4 ,bo? spl9ts are cut away opposite ! malleoli1 & ! foot-piece ( ! inside "o %\ld n ext5d beyond ! t>sus2 t ( ! outside passes to ! toes4 ,! spl9ts rea* on ea* side to ! head ( ! tibia1 b ought n to ext5d above ! knee-jo9t 7see fig4 #dd74 ,illu/ration3 ,fig4 #dd4--,outside lat]al ,spl9t = ! ,tibia4 ,/ep #a4 ,!y are padd$ lightly & ev5ly along _! :ole l5g?1 & appli$ to ! limb on ea* side4 ,/ep #b4 ,!y %\ld !n be fa/5$ by figure ( #h r\nd ! foot & ankle until ! foot is securely fix$ 9 !m4 ,! b&age %\ld !n be fa/5$ (f1 & ext5sion made by an assi/ant1 :o grasps ! foot & ankle ) bo? h&s :ile ! surgeon fixes ! spl9ts to ! limb above ! fracture1 beg9n+ 8 roll] at ! top j bel[ ! knee1 & cont9u+ x d[nw>ds ) spiral turns until ! fracture is rea*$1 above :i* x %\ld t]m9ate 7fig4 #de74 ,aft] ! app>atus is appli$1 ! limb may be ei!r support$ upright by s&-bags1 or slung 9 a cradle1 = ?ree weeks1 aft] :i* ! spl9ts are advantage\sly replac$ by a />* b&age = ?ree weeks long]4 ,illu/ration3 ,fig4 #de4--,lat]al ,spl9ts = simple transv]se fracture ( ! ,tibia4 ,flex+ ! ,leg = ,fracture ( ! ,tibia4 ,sometimes1 :5 !re is unusual difficulty 9 prev5t+ displacem5t ( ! fragm5ts :ile ! limb is ne>ly /raight1 ! bones c be readily kept 9 position if ! pati5t lies on ! same side z ! injur$ limb & ! knee is well flex$4 ,= su* cases ^! spl9ts are v suitable2 !y %\ld be appli$ aft] ! limb has be5 b5t & ! fragm5ts br\ght into apposition4 ,:5 ! spl9ts h be5 put on1 a roll] may be c>ri$ r\nd ! leg & ?igh to keep ! limb 9 its b5t position4 ,fracture ( ! ,patella4--,:5 ?is bone is brok5 !re is usually mu* swell+ f effusion into ! knee-jo9t2 :ile ?is is pres5t1 re/1 ) cold lotions1 & elevation ( ! foot1 are alone applicable4 ,:5 ! effusion has subsid$1 ! upp] fragm5t mu/ be br\ght d[n to ! l[] "o1 by "s means l ! foll[+4 ,app>atus4--#a4 ,/raight wood5 spl9t ) a foot-piece4 #b4 ,pads4 #c4 ,dia*ylon pla/]4 #d4 ,roll]4 #e4 ,l9t & wool4 #f4 ,two hooks or screws1 gimlet1 & screw-driv]4 ,/ep #a4 ,! spl9t is fir/ fitt$2 x %\ld rea* f ! buttock to ! heel1 at :i* po9t a foot-piece rises = ! foot to re/ aga9/2 at ! back ( ! spl9t a l9e %\ld be m>k$ #c in*es above1 & ano!r #c in*es bel[ ! knee-cap1 into :i* a /\t screw or hook is ins]t$ be=e ! spl9t is put on4 ,x is !n well padd$1 to support ! calf & leg1 :ile ! heel is left free1 & a pad is put betwe5 ! sole & ! foot-piece4 ,a firm cresc5t-%ap$ pad is prep>$ to sit l a saddle above ! upp] fragm5t4 ,/ep #b4 ,! limb is laid on ! spl9t2 an assi/ant draws ! patella z ne>ly z possible into its place1 & ! surgeon lays ! cresc5tic pad on ! ?igh above ! patella1 & takes a /rap ( pla/] #b in*es broad & #bj long1 w>ms x1 & lays ! middle across ! compress1 draw+ ea* end tightly ar\nd ! limb1 & !n d[nw>ds & =w>ds 9 a figure ( #h2 a simil> /rap is !n fix$ bel[ ! l[] fragm5t4 ,! knee1 %91 ankle1 & foot are !n protect$ by a lay] ( cotton wool1 & ! b&ag+ beg9s4 ,/ep #c4 ,! roll] fir/ fa/5s ! foot aga9/ ! foot-piece by figures ( #h1 !n passes up ! leg by rev]ses until opposite ! l[] hook1 :]e x is fa/5$4 ,illu/ration3 ,fig4 #df4--;,fractur$ ,patella1 draw+ d[n ! upp] fragm5t4 ,/ep #d4 ,a second roll] is !n begun at ! top ( ! ?igh & br\ght d[n ! limb till x rea*es ! compress ov] ! patella2 f ?is po9t x passes bel[ ! l[] screw at ! back ( ! spl9t & makes "o circul> turn r\nd ! limb2 ! roll] is !n tak5 upw>ds across ! compress 7z %[n 9 fig4 #df7 to ! upp] screw1 :]e x also makes a circul> turn2 hav+ done ?is x aga9 desc5ds to rea* ! l[] screw1 & is return$ z be=e4 ,ea* ( ^! turns %\ld be drawn tightly to br+ ! upp] fragm5t z ne> ! l[] "o z possible2 :5 ?is is done ! b&age is complet$ ov] ! knee by figures ( #h4 ,x suffices to fix ! l[] fragm5t1 :i* _c be drawn up to meet ! upp] "o2 ! latt] mu/ desc5d to x4 ,/ep #e4 ,! limb is la/ly put into position by elevat+ ! heel & by rais+ ! body ) pill[s till x is 9 a half-sitt+ position4 ,! pati5t we>s ?is spl9t f\r weeks1 dur+ ! fir/ =tnight ( :i* ! b&age %\ld be p]sev]+ly re-appli$ e ?ree or f\r days until ! upp] fragm5t is br\ght into apposition ) ! l[] "o4 ,aft] ?is ! spl9t may be *ang$ = a light />* or gutta-p]*a case1 to be worn = six weeks m1 & !n replac$ by a back spl9t ( lea!r & knee-cap1 t mu/ n be laid aside = ano!r p]iod ( ?ree or f\r weeks4 ,if ! pati5t c be p]suad$ n to b5d 8 knee = f\r mon?s1 ! union ( ! fragm5ts w be less likely to yield aft]w>ds4 ,he %\ld be also w>n$ t mu* /iffness w result f ! long fix$ position necess>y to procure good union betwe5 ! fragm5ts2 b ! /iffness w all subside 9 "t1 not)/&+ ! long-en=c$ rigidity4 ,/rap & ,spiral ,b&age4 ,e4 ,k4 ,samborne's ,plan ( draw+ ,patella ,fragm5ts toge!r4--,a /rip ( dia*ylon pla/] #d feet long & #b 94 wide is appli$ to ! front ( ! limb f #b 94 bel[ ! gro9 to ! small ( ! leg1 leav+ a free loop or d\bl+ opposite ! patella4 ,b5ea? ?is loop a firm compress or horse%oe pad is plac$ above ! upp] fragm5t4 ,a roll] is !n c>ri$ r\nd ! limb to keep ! /rap 9 place1 b leav+ ! loop at ! knee expos$4 ,?is done1 ! body is propp$ up 9 a half-sitt+ position1 & ! limb elevat$ on an incl9e4 ,a /ick1 #f in*es long & in* ?ick1 is ins]t$ into ! loop ( pla/]1 & !n twi/$ r\nd & r\nd till1 by %ort5+ ! loop1 ! loose tissues ( ! ?igh1 & ) !m ! upp] fragm5t ( ! patella1 are drawn d[n to ! knee4 ,! /ick is prev5t$ f untwi/+ by a roll] lightly c>ri$ r\nd ! knee4 ,z ! pla/] slack5s1 ! /ick may be tight5$ f "t to "t & ! fragm5t br\ght 9 a few days into its prop] place4 ,illu/ration3 ,fig4 #dg4--,malgaigne's ,hooks4 ,malgaigne's ,hooks 7fig4 #dg71 = draw+ closely & hold+ toge!r ! fragm5ts 9 transv]se fracture ( ! patella1 or ( ! olecranon1 (t5 procure a clos] union ?an any o!r me?od4 ,!y %\ld n be ins]t$ until effusion is absorb$ & ! sor5ess has subsid$4 ,to ins]t !m1 "o pair ( hooks %\ld be b$d$ 9 ! ligam5tum patell1 & cat* aga9/ ! l[] edge ( ! bone2 ! sk9 is !n drawn up ! limb1 :ile ! upp] pair ( hooks is pass$ ?r\gh x & beh9d ! upp] fragm5t2 ! two ends are !n approximat$ by turn+ ! screw4 ,! fragm5ts usually d n come q close ! fir/ day1 b ! next !y c be drawn s firmly toge!r t if "o is mov$ ! o!r goes ) x4 ,9 apply+ ! hooks c>e %\ld be tak5 t ! upp] pair g well ?r\gh ! sk9 & fascia beh9d ! bone1 or :5 !y are screw$ up ! upp] fragm5t is apt to ride unev5ly ov] ! o!r1 & exact junction is lo/4 ,! pa9 ( ! ins]tion soon passes (f1 & ! hooks c commonly be worn )\t annoyance = five or six weeks1 until union is secur$4 ,fracture ( ! ,%aft ( ! ,?igh-bone4--,! long ,spl9t4 ,app>atus4--#a4 ,a wood5 spl9t4 #b4 ,roll]s1 #c in*es wide4 #c4 ,p]9eal b&4 #d4 ,/rapp+1 ne$le1 & ?read4 #e4 ,pad & wool4 ,! spl9t = an adult %\ld be #b or #c in*es wide1 & long en\gh to rea* f ! nipple to #d or #e in*es beyond ! heel2 two r\nd holes in* diamet] are cut at its upp] end1 & at ! l[] "o two not*es #b in*es deep4 ,li/on's ,mode ( apply+ ! ,long ,spl9t4 ,/ep #a4 ,! end ( a roll] is split = a few in*es1 & ti$ 9 ! holes at ! upp] end4 ,! roll] itself is c>ri$ d[n ! inside ( ! spl9t & atta*$ tempor>ily to ! not*es at ! o!r end2 a pad is !n fa/5$ on1 by draw+ ! m>g9s toge!r ) ne$le & ?read across ! outside ( ! spl9t1 or by ty+ /rips ( b&age r\nd ! pad & spl9t at %ort di/ances4 ,/ep #b4 ,! limb hav+ be5 wa%$ ) soap & wat]1 well dri$1 & aft]w>ds du/$ ) />* p[d]1 especially at ! p]9um1 ! ankle & dorsum ( ! foot are wrapp$ 9 a lay] ( cotton wool1 & ! spl9t appli$ along ! outside ( ! body4 ,! b&age :i* 0 fa/5$ to ! spl9t is n[ releas$ f ! not*2 &1 tak+ ) x ! end ( ! pad1 is c>ri$ "u ! sole1 !n ov] ! ankle jo9t to ! spl9t1 & beh9d ! ankle r\nd ! int]nal malleolus to ! dorsum ( ! foot1 !n ?r\gh ! l[] not* ( ! spl9t to ! inside ( ! foot aga94 ,?is figure ( #h is c>ri$ f\r times ov] ! dorsum ( ! foot1 twice ?r\gh ea* not* ( ! spl9t1 & is made fa/ by a p9 or a /it*4 ,9 do+ ?is1 c>e mu/ be tak5 to keep ! leg & spl9t p>allel1 & t ! spl9t does n ride ov] ! back ( ! foot2 ! ext]nal malleolus %\ld be midway betwe5 ! m>g9s2 moreov]1 ! b&age mu/ fit firmly r\nd ! ankle & spl9t1 n spread+ ov] ! dorsum m ?an c be help$1 to avoid /ra9+ ! front ( ! ankle4 ,means = m effectually prev5t+ ?is w be aft]w>ds detail$4 ,/ep #c4 ,next apply c\nt]-ext5sion2 = ?is1 ! p]9eal b& is us$4 ,! b& consi/s ( a silk h&k]*ief or napk9 fold$ into a flat ribbon1 #a in* wide & cov]$ = ab\t #a foot ( its l5g? ) oil$ silk4 ,a piece ( smoo? br[n pap]1 #a foot long & #d in*es wide1 fold$ into a ribbon "o in* wide1 makes an excell5t f\ndation = ! silk h&k]*ief to be fold$ ^u4 ,a b& ?us prep>$ is too /iff to become a cord aft] x has be5 worn a few days1 :i* a simple h&k]*ief is apt to d4 ,"o end ( ! b& is pass$ 9 front 9 ! gro91 & "o beh9d ! buttock1 s t x be>s on ! tub] is*ii 9 ! p]9um2 ! ends are !n drawn sep>ately ?r\gh ! holes 9 ! spl9t4 ,all be+ ready = ext5sion1 an assi/ant1 grasp+ ! leg & spl9t above ! ankle1 pulls out ! %ort5+ till ! brok5 bone is 9 a good position2 ! ends ( ! b& are !n tight5$ & made fa/ 9 a knot4 ,/ep #d4 ,fir/ protect+ ! bony po9ts ) cotton wool1 ! muscles ab\t ! hip are conf9$ by a spica c>ri$ r\nd ! body & ! spl9t1 n m]ely a simple figure ( #h z depict$ 9 ! figure1 b a s]ies ( ov]lapp+ turns :i* asc5d & cov] 9 ! hips well4 ,aft]w>ds ! upp] end ( ! spl9t is drawn close to ! body by a few turns ( a broad roll] c>ri$ r\nd ! *e/ f above d[nw>ds 7see fig4 #dh74 ,illu/ration3 ,fig4 #dh4--,! long spl9t1 ) ela/ic /irrup ext5sion at ! foot4 ,b&age c>ri$ up to ! seat ( fracture4 ,/ep #e4 ,x is cu/om>y to c>ry ! b&age fur!r ?an ! ankle1 b ?is is n an ess5tial "p ( ! app>atus1 :i* is simply to keep up ! ext5sion 9 ! direction ( ! axis ( ! limb4 ,?is subsidi>y b&age has ! disadvantage ( conceal+ ! limb1 & ! position ( ! brok5 ends ( ! bone2 b x /eadies ! limb on ! spl9t1 & conf9es ! muscles1 !reby prev5t+ pa9 & p]haps h9d]+ rotation outw>ds ( ! upp] fragm5t4 ,be=e putt+ x on1 "s cotton wool is wrapp$ r\nd ! knee1 & laid along ! %92 ! application ( ! roll] is !n begun at ! ankle :]e x fir/ t]m9at$1 & is c>ri$ up ! leg1 ov] ! knee1 & along ! ?igh by rev]ses until ! gro9 is rea*$1 :]e x f9i%es4 ,! p]9eal b& mu/ be *ang$ :5ev] x gets soil$1 & ! sk9 wa%$ be=e a clean "o is adju/$4 ,aft] ! fir/ few days ! b& ne$ n be v tight2 x suffices if n slack or loose4 ,mr4 ,coxet] makes india-rubb] tubes 9 ! %ape ( a p]9eal b&2 ^! are fill$ ) wat] :5 9 use 7see fig4 #di74 ,illu/ration3 ,fig4 #di4--;,coxet]'s ela/ic p]9eal b&4 ,/irrup ext5sion is a mode ( reliev+ ! /ra9 on ! front ( ! ankle1 caus$ by ! l[] end ( ! spl9t be+ atta*$ to x4 ,a #c-;in* wide roll] or bit ( wood ( ! same bread? is laid aga9/ ! sole ( ! foot1 & a /\t india-rubb] r+ #b in*es 9 diamet] is slipp$ ov] x4 ,a piece ( /rapp+ pla/]1 #b feet long & #b in*es wide1 is pass$ half-way ?r\gh ! r+1 & its ends c>ri$ up ! leg inside & outside2 ! pla/] is kept 9 place by a roll] or second /rip laid on 9 spirals up ! limb z 9 fig4 #ej1 & ! india-rubb] r+ is hit*$ aga9/ a hook at ! end ( ! spl9t4 ,by ?is means ! /ra9 is transf]r$ to ! leg1 & ! ankle is q free4 ,x is p]fectly successful1 & v easy to ! pati5t4 ,! long spl9t is to be worn cont9u\sly = six weeks2 or1 :at is bett]1 aft] ! fir/ ?ree weeks x may be replac$ by a />* b&age1 & ! pati5t all[$ to get ab\t on crut*es ) 8 leg slung f 8 neck4 ,illu/ration3 ,fig4 #ej4--,mode ( fa/5+ ! /irrup to ! leg1 to avoid /ra9+ ! ankle4 ,cont9u\s ,ext5sion ) ! ,limb flex$4--,! muscles atta*$ to ! upp] end ( ! femur sometimes cause s mu* flexion & rotation outw>ds ( ! upp] fragm5t t union ( ! bones 9 ?is position produces a result approa*+ t 9 fig4 #ea1 drawn f a prep>ation 9 ! museum ( ,univ]sity ,college4 ,?is crook$ union is prev5t$ by b5d+ ! ?igh & relax+ ! muscles ( ! hip4 ,?is object is accompli%$ by us+ ! d\ble incl9e planes or ! d\ble incl9e planes1 slung1 %[n 9 figs4 #eb & #ec4 ,illu/ration3 ,fig4 #ea4--;,fracture bel[ ! tro*ant]s2 bone 9 angul> union4 ,d\ble incl9e planes are sometimes employ$ alone4 ,! limb is rais$ ov] a wood5 frame ab\t #h in*es broad1 ) a d\ble slope high en\gh at ! apex = ! leg & foot to hang unsupport$ d[n ! fur!r side 7fig4 #eb74 ,x is well padd$ be=e be+ appli$1 & ! leg & ?igh secur$ to x by a roll] pass$ r\nd ! limb & plane1 or bett]1 a tr\gh ( gutta-p]*a may be m\ld$ to ! limb :ile x is on ! plane1 & :5 set1 screw$ d[n to ! wood at "o or two po9ts2 9 ?is ! limb re/s securely4 ,illu/ration3 ,fig4 #eb4--;,d\ble incl9e planes4 ,sl++ ! d\ble incl9e planes 0 practis$ _m ye>s ago by ,mayor ( ,lausanne1 & has be5 mu* us$ rec5tly4 ,x is an app>atus v easy = ! pati5t1 & p>ticul>ly well suit$ = comp\nd fractures ( ! ?igh1 = fractures ne> ! tro*ant]s t require a flex$ position1 or = fractures ( ! neck ( ! femur :]e ! pati5t's feebl5ess does n p]mit ! con/ra9t ( ! long spl9t4 ,app>atus4--#a4 ,a b5t wire frame 7see fig4 #ec7 ) a sep>ate foot-piece4 #b4 ,two pulleys1 a rope ) t5t /ret*]s pass+ up to hooks 9 ! ceil+1 or "s suitable support4 #c4 ,"o long & "o %ort s(t pad4 #d4 ,/rapp+ pla/]1 & "s ends ( b&age4 ,/ep #a4 ,! limb is wa%$ & dri$1 & ! %ort pad fitt$ to ! foot-piece1 :i* is furni%$ ) "s hooks at its l[] surface1 :]e ends ( b&age or tape c be fa/5$1 = fix+ x to ! wire frame4 ,! frame is next prep>$ by pass+ /rips ( b&age across x f side to side at %ort int]vals1 to make a support on :i* ! limb is laid2 if !re is no w\nd1 a s(t pad may be put on ! frame fir/1 b if "o be pres5t1 ! limb %\ld re/ imm$iately on ! /rips ( b&age1 :i* c be *ang$ :5ev] soil$1 & replac$ by clean ones )\t di/urb+ ! limb4 ,^! /rips %\ld be tack$ on ) a ne$le & ?read1 t1 :5 ! limb is plac$ on ! app>atus1 !y c be %ort5$ or l5g!n$ till ! leg be>s ev5ly on !m 7see fig4 #ec74 ,illu/ration3 ,fig4 #ec4--;,d\ble incl9e plane1 slung4 ,/ep #b4 ,! foot-piece is adju/$ & fa/5$ to ! foot by /raps ( pla/] c>ri$ r\nd x & up ea* side ( ! leg1 z 0 done = ! /irrup ext5sion 9 ! 8long spl9t0 7p4 #gf74 ,/ep #c4 ,! limb is next plac$ 9 ! cradle =m$ = x1 to ! l[] end ( :i* ! foot-piece is ti$ securely2 ! ropes are rove ?r\gh ! pulleys & tight5$ till ! limb sw+s easily4 ,! po9t ( atta*m5t ( ! ropes mu/ n be j above ! limb1 b beyond x1 t ! leg may be drawn away f ! body along its own axis4 ,! weight ( ! body makes c\nt]-ext5sion suffici5t to remove all %ort5+ 9 a few days4 ,! relief f ! con/ra9t att5d+ ! absolute immobility ( ! long spl9t1 r5d]s ?is app>atus a p>ticul>ly easy "o = ! pati5t2 & union is f\nd to take place )\t any %ort5+ ( ! limb4 ,:]e !re is no w\nd1 ! limb & frame may be kept toge!r by a roll] b&age c>ri$ r\nd !m f ! toes to ! knee1 aft] ! limb has be5 adju/$ 9 ! spl9t4 ,cont9u\s ,ext5sion 9 ! /raight position is employ$ = fractures ( ! femur & 9 hip-disease4 ,x is procur$ z foll[s4 ,a /irrup is fa/5$ to ! leg 9 ! way describ$ at page #gf2 to ?is a cord & weight are atta*$ bel[ ! sole ( ! foot1 & pass$ ov] a pulley fix$ to a tripod frame 7fig4 #ed71 or any conv5i5t object bel[ ! b$1 9 a l9e ) ! axis ( ! limb4 ,! weight %\ld balance ! contraction ( ! muscles1 & usually v>ies betwe5 #b & #f lbs4 ,a p]9eal b& fa/5$ beh9d ! pati5t's head keeps ! body f foll[+ ! limb4 ,! weight may be a common scale weight1 or a bag ) a hole at ! bottom clos$ by a /r+1 & fill$ ) %ot or s&1 or a c ) a tap at ! bottom fill$ ) wat]3 ^! arrangem5ts all[ increase or less5+ ( ! weight1 )\t slack5+ ! cord & mov+ ! limb4 ,?is app>atus requires no b&ages1 :i* are s difficult to keep clean 9 *ildr51 & ex]ts a v ev5 & cont9u\s /ra9 on ! limb4 ,illu/ration3 ,fig4 #ed4--;,fracture ( ! femur4 ,ext5sion by weight & pulley4 ,! p]9eal b& may be (t5 disp5s$ )1 by lay+ ! pati5t on a flat mattress & rais+ ! foot ( ! b$/ead a few in*es high] ?an ! head2 ! body !n s9ks t[>ds ! head ( ! b$ & resi/s ! ext5sion ( ! leg4 ,/>* ,b&age4--,! foll[+ mode ( apply+ ! />* b&age & pa/ebo>d spl9ts may be us$ 9 all v>ieties ( fracture2 ! l5g? ( ! spl9ts & ! numb] ( jo9ts t %\ld be includ$ dep5d on ! bone t is brok54 ,"s surgeons apply ! />* app>atus imm$iately aft] ! fracture has happ5$1 o!rs wait until p>tial union is procur$ & ! irritability ( ! muscles has subsid$4 ,app>atus4--#a4 ,%eets ( bookb9d]'s millbo>d4 #b4 ,roll]s suitable = ! size ( ! limb4 #c4 ,cotton wool4 #d4 ,a bas9 ( fre%ly scald$ />*4 #e4 ,a long /rip ( pla/]1 to rea* z high z ! b&age w ext5d up ! limb4 #f4 ,if ! fracture be rec5t1 a wood5 spl9t w g5]ally be necess>y to keep up ext5sion :ile ! />* is dry+4 ,z a g5]al rule1 ! jo9t at ! l[] end ( ! fractur$ bone %\ld always be fix$1 & t at ! upp] end also1 if ! fracture is ne> t po9t4 ,= an example ( ! mode ( fitt+1 let u suppose ! femur is brok5 betwe5 ! middle & l[] ?irds z 9 fig4 #ef4 ,/ep #a4 ,! limb is fir/ measur$ = ! spl9ts4 ,! l5g? f ! top ( ! sacrum to ! heel1 f ! tub] is*ii to ! inside ( ! foot1 & f ! iliac cre/ to ! outside ( ! foot1 %\ld be tak51 & ?ree /rips ( millbo>d prep>$ ( correspond+ l5g?s2 ! po/]ior "o be+ #c in*es wide above & #b in*es1 or1 if ! limb is small1 #a in*es wide at ! heel4 ,! inn] & out] /rips ( simil> wid? mu/ be cut ) side pieces = ! foot1 & ^! side-pieces /op %ort ( ! roots ( ! toes4 ,= a *ild's ?igh1 ! foot ne$ n be includ$1 x suffices = ! spl9ts to rea* ! small ( ! leg1 ?\gh to prev5t %ort5+ 9 an adult x is usually necess>y to include ! :ole limb4 ,! spl9ts are readily cut1 by fir/ m>k+ on ! %eet ( millbo>d1 ! requir$ wid? & l5g? ( ! /rips1 !n b5d+ ! %eet ov] ! edge ( a table along ^! l9es4 ,! two lat]al spl9ts may be fir/ tak5 f ! %eet 9 "o wide /rip1 aft] all[+ = ! foot-piece2 ! two /rips are sep>at$ ?r\gh a diagonal l9e1 s t ! broad end ( "o spl9t is tak5 f ! o!r 7see fig4 #ee74 ,illu/ration3 ,fig4 #ee4--;,diagram %[+ ! mode ( cutt+ out spl9ts f a %eet ( millbo>d4 ,:5 ! /rips are cut !y %\ld be laid on a l>ge tea-tray1 boil+ wat] p\r$ ov] !m1 & a m9ute or two lat]1 "s boil+ hot ?9 />*2 ?is soon soaks into & s(t5s ! millbo>d till x is ?or\ghly pliant4 ,:5 some:at s(t5$1 ! edges %\ld be ?9n$ by peel+ (f little /rips along !m1 aft] :i* "s m boil+ wat] may be p\r$ on & all[$ to soak 9 :ile ! limb is prep>$4 ,two or ?ree roll]s %\ld !n be unw\nd1 & pass$ z !y are roll$ up aga9 ?r\gh ! bas9 ( />*2 ^!1 ?or\ghly soak$ 9 />*1 are us$ = ! fir/ lay]1 dry roll]s s]ve v well = ! second lay]4 ,/ep #b4 ,! limb is wa%$ & dri$2 a /rip ( dia*ylon pla/] "o in* wide is laid along ! front to protect ! sk9 :5 ! case is be+ cut op5 aft] x is dry2 ! limb is next wrapp$ ev5ly 9 cotton wool1 putt+ a scrap betwe5 ea* toe4 ,?is is be/ done by unroll+ a %eet ( wadd+1 splitt+ ! %eet into a lay] ( suitable ?ickness1 :i* is torn into /rips ab\t ?ree in*es broad1 t are !n w\nd ev5ly r\nd ! limb z high z ! spl9ts w rea*4 ,/ep #c4 ,! spl9ts are next adju/$ & m\ld$ to ! limb1 be+ tempor>ily secur$ by a few ends ( b&age ti$ r\nd !m4 ,"o assi/ant grasps ! spl9ts & foot at ! ankle & keeps up ext5sion1 :ile ano!r holds ! ?igh4 ,! surgeon !n proce$s to roll ! b&ages1 fir/ r\nd ! foot & ankle1 & !n up ! leg1 rubb+ 9 ! w>m />* z he proce$s4 ,ea* turn ( ! roll] %\ld be made z tightly z possible1 = :5 ! case dries x always gr[s loose by ! evaporation ( ! wat] x holds4 ,z rev]ses are always difficult to cut ?r\gh aft]w>ds1 !y %\ld be avoid$1 & ! b&age laid on 9 simple spiral or figure ( #h turns4 ,:5 ! p]9um is rea*$1 ! surgeon wraps r\nd ! pelvis a broad /rip ( cotton wool1 :ile an assi/ant on ea* side ( ! pati5t supports 8 body on a fold$ %eet or jack-t[el1 & a ?ird holds ! brok5 limb4 ,! b&ag+ is !n cont9u$ 9 a well-fitt+ spica1 & end$ by a few circul> turns r\nd ! body4 ,if ! spl9t t\*es ! cre/ ( ! ilium x %\ld be %ort5$ till x cle>s t po9t1 or x w gall ! pati5t aft]w>ds4 ,a fold ( s(t l9t 9 addition to ! cotton wool %\ld l9e ! spl9t at ! p]9um1 or ! %>p edge ( ! b&age1 :5 x is dry1 w *afe !re also4 ,:5 ! fir/ b&age is complete1 ! limb %\ld be sme>$ aga9 ) />*1 & a dry b&age roll$ ov] x f bel[ upw>ds1 :i* mu/ be simil>ly saturat$ ) />* z x is laid on ! limb1 & :5 f9i%$ ! :ole is well cov]$ ) />*4 ,if ! fracture is rec5t1 & no union has tak5 place1 a long spl9t %\ld be put on outside ! case1 fa/5$ to ! foot & ext5d$ by a p]9eal b&1 :ile ! />* is dry+1 t ! limb may n %ort54 ,) *ildr5 x is be/ to apply ! wood5 spl9t 9 all cases1 z !y are apt to wriggle ab\t1 or sit up 9 b$ & dis>range ! case :ile x is 9 a pliant condition4 ,if ! wood spl9t is n us$1 ! limb %\ld be support$ 9 a good position by s&-bags laid along its sides4 ,illu/ration3 ,fig4 #ef4--,/>* ,b&age4 ,9 ?ree days ! />* is q dry1 b ! dry+ may be ha/5$ by hot-wat] bottles or hot s&-bags laid 9 ! b$4 ,x mu/ !n be cut up along ! front f bottom to top2 x w (t5 be f\nd loose1 especially :]e swell+ _h exi/$ be=e2 ?is is be/ rem$i$ by p>+ ! ov]lapp+ edges ) scissors4 ,if any project+ "p is *af$1 an accid5t t ought n to happ51 ! case may be lift$ f ! sore "p by a little m wool laid ar\nd1 n on ! "p p9*$4 ,! limb be+ 9 a satisfactory position1 & ! case fitt+ prop]ly1 a roll] is c>ri$ up ov] ! :ole to keep x 9 place :ile x is worn 7fig4 #ef74 ,! pati5t ne$ n n[ be conf9$ to b$2 on ! contr>y1 ! limb %\ld be support$ by a sl+ r\nd 8 neck1 :ile he gets ab\t ) crut*es1 if 8 leg be ! "p injur$4 ,! fracture %\ld be exam9$ f "t to "t1 & at ! end ( ?ree weeks "s ( ! jo9ts previ\sly conf9$ 9 ! spl9t may be releas$ by cutt+ (f ! "p cov]+ !m2 b if ! "p is a dep5d5t "o1 su* z ! leg1 x %\ld be support$ by a b&age aft] ! spl9t has be5 remov$4 ,! limb may also be wa%$ ) soap & wat]1 & !n ano9t$ ) simple o9tm5t1 if ! sk9 be r\gh5$ or irritat$ by long conf9em5t4 ,9 six weeks ! />* spl9t may usually be disc>d$1 & a roll] alone worn = a few weeks long]4 ,pla/] ( ,p>is ,b&age4 ,app>atus4--#a4 ,fre%ly burn$ :ite pla/] ( ,p>is4 ,if ! pla/] h become /ale by keep+ 9 improp]ly clos$ vessels1 & x be impossible to obta9 fre% pla/]1 ! wat] ! pla/] has absorb$ f ! atmosph]e c be driv5 (f by heat+ ! p[d] 9 a dry ov5 to ab\t #bjj ,f4 to #bfj ,f41 b n high]1 z great] heat de/roys ! p[] ( 8sett+40 #b4 ,roll]s1 ab\t #b in*es wide1 ( musl9 ) a co>se op5 texture4 #c4 ,a roll] ( ,wel% flannel #c in*es wide & #f y>ds long4 #d4 ,bas9 ( cold wat]1 sponge1 & a kit*5 spoon4 #e4 ,s(t l>d or sp]maceti o9tm5t4 ,/ep #a4 ,! musl9 roll]s are prep>$ by be+ load$ ) dry p[d] j be=e !y are us$4 ,to d ?is ! roll] %\ld be gradually unroll$ on a table :ile "o p]son rubs 9 ! p[d]1 & a second rolls ! load$ b&age up aga94 ,:5 ?ree or f\r are load$ !y %\ld be plung$ = a m9ute into cold wat]1 & !n are ready = use4 ,:ile ?is is be+ done ! limb %\ld be ?or\ghly wa%$ & dri$1 support$1 if ! fracture be rec5t1 by s&-bags4 ,illu/ration3 ,fig4 #eg4--,pla/] ( ,p>is ,b&age1 = simple fracture ( ! tibia1 & common b$ cradle4 ,/ep #b4 ,! surgeon c>efully greases ! limb :]ev] ! pla/] w rea*1 & rolls a ,wel% flannel roll] r\nd x = ab\t #c in*es at ! po9t :]e ! pla/] roll] w cease4 ,?is protects ! sk9 f ! r\gh edge ( ! pla/] spl9t :5 ! app>atus is set & h>d4 ,inde$1 if ! :ole ( ! surface to be cov]$ ) pla/] be envelop$ 9 a flannel roll]1 ! app>atus is m com=table to ! pati5t1 & 9 ?is case ! grease may be disp5s$ )4 ,:5 ! limb is prep>$ ! surgeon intru/s x to assi/ants1 :o w ma9ta9 r$uction :ile he lays on ! pla/] roll]s1 wett+ !m freely z !y are laid on1 ) a sponge at h& 9 a bas9 ( cold wat]4 ,usually two lay]s ( roll] give suffici5t rigidity to ! app>atus2 b if ! limb is heavy1 ! case %\ld be /r5g!n$1 by sme>+ ov] x a coat+ ( pla/]1 prep>$ by %ak+ ! p[d] into a bas9 ( wat] kept con/antly /irr$1 till x has ! consi/5ce ( cream4 ,! surgeon mu/ wat* t ! fractur$ bones are kept 9 position till ! pla/] is set1 a process suffici5tly advanc$ 9 five m9utes1 :5 ! b&age1 support$ by s&-bags1 may be left to dry4 ,:5 ! pla/] is q set ! bone is immoveable & may be c>ri$ ab\t )\t risk ( displacem5t4 ,9 decid+ :at jo9ts %\ld be includ$ 9 ! b&age1 ! same rules obta9 9 ?is z = ! />* b&age2 no m jo9ts %\ld be r5d]$ immoveable ?an are necess>y to obta9 comm& ( ! brok5 bone2 :5 ! fracture is ne> a jo9t1 t mu/ be conf9$ to prev5t ! bones be+ mov$ ) ! movem5ts ( ! jo9t2 :5 ! fracture is f> away f x1 suffici5t control c be ex]cis$ ov] ! bone to prev5t ! brok5 ends mov+1 & ! jo9t may rema9 free4 ,if ! pla/] app>atus is appli$ ov] a w\nd1 ! latt] %\ld be cov]$ ) greas$ l9t1 & its position not$ be=e ! roll]s are appli$2 :5 ! app>atus is set1 ! pla/] mu/ be dissolv$ ar\nd ! w\nd by t\*+ x ) /rong nitro-hydro*loric acid2 :5 ?is is c>ri$ completely r\nd1 ! isolat$ fragm5t ( pla/] may be remov$1 & ! w\nd expos$4 ,= removal1 ! roll] c be unw\nd aga9 readily1 or x c be s(t5$ by acid along a l9e1 & slit up ) scissors1 :5 ! app>atus comes (f 9 a piece4 ,%\ld b&ages ( loose texture n be at h&1 common roll]s c be made to answ] ! purpose tol]ably well 9 ! foll[+ way4 ,hav+ wa%$ & dri$ ! limb1 & r$uc$ ! fracture2 ! bones are held 9 position by assi/ants1 :ile ! limb is greas$ & envelop$ 9 a dry roll] by simple turns & figures ( #h4 ,a bas9 ( pla/] is prep>$ by %ak+ ! p[d] into wat] till a ?9 cream is =m$1 :i* is laid on ! b&age ) a spoon1 or ! h&s4 ,!n a second b wett$ roll] is put on 9 ! same way quickly be=e ! pla/] has set1 & cov]$ 9 its turn1 until a case ( suffici5t ?ickness is procur$4 ,?is b&age is mu* improv$ if ! fir/ roll] be ( flannel in/ead ( calico4 ,! flannel roll] may be unroll$ & load$ ) dry pla/]1 l ! musl91 & wett$ be=e us+2 9 ?is way x conta9s ne>ly z mu* pla/] z ! loose webb+ roll]s ( musl94 ,9 ! ,army ,m$ical ,reports = #ahfe 7#ahfg71 ,mr4 ,m(fitt describes a v ready me?od ( employ+ ! pla/] spl9ts = rec5t fractures4 ,in/ead ( b&ag+ ! limb1 an envelope ( ,wel% flannel is fitt$ to ! "p to be support$4 ,! flannel %\ld envelope ! limb1 except = a longitud9al space ab\t in* 9 wid? betwe5 ! edges ( ! flannel4 ,! dott$ l9es 9 ! accompany+ figure %[ ! %ape ( ! flannel :5 fitt$ to ! leg4 ,! limb be+ ?or\ghly greas$1 ! flannel is well soak$ 9 ?9 pla/] cream1 & laid on a table :ile ! creases are smoo!d out ( x4 ,:5 ready x is appli$ accurately to ! limb1 s z to fit ev]y:]e1 b leav+ a n>r[ op5 space along ! :ole l5g? ( ! limb4 ,! flannel mu/ be held /eadily till ! pla/] is set1 :i* takes place 9 ab\t five m9utes1 & ! spl9t is complete4 ,if "o lay] is n /iff en\gh1 a second may be laid ov] ! fir/ 9 ! same way4 ,:5 ! spl9ts are fitt$1 !y are kept 9 place by a roll] appli$ lightly ov] !m4 ,if in/ead ( soak+ ! second lay] ( flannel 9 pla/]1 x be ?ickly spread ) /rong solution ( ,briti% gum 7dextr9e71 & ! gumm$ side laid next ! fir/ flannel1 ! spl9t is t\gh en\gh to /& any ord9>y /ra9 )\t break+4 ,illu/ration3 ,fig4 #eh4--,m(fitt's me?od ( apply+ pla/] ( ,p>is spl9ts4 ,copi$ f ,army ,m$ical ,reports = #ahfe4 ,gum ?ick5$ ) p[d]$ *alk1 glue1 silicate ( soda1 ,hides' lea!r felt & /iff5+ solution1 p>aff9e1 c41 are also employ$ = /iff5+ b&ages & flexible spl9ts1 aft] !y are m\ld$ to a limb1 b none ( !m are z readily procur$ or h mu* advantage ov] />* & pla/] ( ,p>is4 ,a detail$ description ( ! mode ( us+ !m is unnecess>y4 ,s&-bags are v useful1 :5 laid along an injur$ limb1 to prop x up on ei!r side4 ,= ?is purpose !y are bett] ?an pill[s1 z _! weight prev5ts _! slipp+ f "u ! "p !y support4 ,!y %\ld be made ( mac9to% clo? ab\t #d or #f in*es diamet]1 & 9 l5g?s v>y+ f #a to #d feet1 well clos$ t ! s& may n escape ?r\gh ! seams2 ! mac9to% %\ld be cov]$ ) flannel1 r5ew$ f "t to "t4 ,! s& %\ld be wa%$ & well dri$ be=e ! bags are fill$1 t x may n rot ! clo? conta9+ x4 ,moreov]1 ! bags %\ld be only ?ree qu>t]s full1 or !y w be too h>d to adapt !mselves to ! limb :5 9 use4 ,cradles are light ar*$ frames ( wire or cane to support ! b$clo!s ov] an injur$ limb4 ,on em]g5cy an effici5t cradle c be con/ruct$ f a b&-box1 by knock+ out ! bottom & putt+ ! leg ?r\gh x4 ,if us$ to protect a foot1 a not* may be cut ) /rong scissors1 n a knife1 = t splits ! wood4 ,if ! cradle is /\t en\gh1 x is useful to sl+ a brok5 limb 9 its spl9t1 & (t5 great relief is ?us giv5 to ! pati5t4 ,dr4 ,salt]'s ,sw+ ,cradle is specially contriv$ = ! purpose1 & is %[n1 fig4 #db1 page #fd4 ,lea!r ,spl9ts4--,= ^! sole lea!r1 to be pur*as$ at any lea!r deal]'s1 is us$4 ,9 prep>+ !m1 ! requir$ l5g? %\ld be fir/ not$ d[n1 !n a s]ies ( transv]se measurem5ts tak5 at ! wide/ & n>r[e/ p>ts ( ! limb & ov] ! projections ( jo9ts1 c41 or a patt]n may be fir/ cut 9 pap] & laid on ! %eet ( lea!r f :i* a correspond+ piece is cut4 ,! spl9t %\ld always be s arrang$ t its edges d n be> on any bony po9t1 ! %91 or malleoli1 = example1 b ei!r fall %ort ( or pass beyond !m4 ,! hair side ( ! lea!r %\ld g next ! sk91 z x is ! smoo!/ & lea/ irritat+4 ,! edges ( ! spl9t mu/ be ?9n$ by bevell+ (f ! outside = ab\t an in* all r\nd1 & no %>p corn]s %\ld be left4 ,:5 ! lea!r is prep>$ x %\ld be soak$1 if ! "t c be sp>$1 = tw5ty-f\r h\rs 9 cold wat]1 b :5 want$ quickly x c be s(t5$ 9 a few m9utes by soak+ x 9 w>m wat] to :i* a little v9eg> is add$--?is1 h[ev]1 r5d]s ! lea!r brittle :5 dry1 & apt to curl at ! edges4 ,:5 ! lea!r is s(t5$1 a v ?9 ev5 lay] ( cotton wadd+ or ( l9t is laid on next ! sk92 ! spl9t is !n m\ld$ to ! limb ) ! h&s1 & b&ag$ firmly2 9 twelve h\rs x w be dry & rigid4 ,! roll] is !n unw\nd1 & any p>ts ( ! spl9t press+ on bony projections are m>k$ be=e removal4 ,x is !n trimm$1 & laid betwe5 two lay]s ( wa%-lea!r /it*$ toge!r r\nd ! edges4 ,! spl9t is n[ f9i%$1 & c be ei!r fa/5$ on by a roll] or by two or m /raps & buckles /it*$ to x4 ,:5 support is requir$ = a jo9t1 ! spl9t %\ld be fitt$ on ! sides1 :]e ! lea!r may h ! rigidity ( its wid? r ?an only t ( its ?ickness to prev5t b5d+4 ,lea!r ,spl9t = ! ,hip4--,?is jo9t is by f> ! mo/ difficult to fit4 ,! hip spl9t %\ld obta9 a good grasp ( its fix$ po9t1 ! pelvis1 & a /iff be>+ on ! front ( ! ?igh :]e its pressure is to be ex]t$4 ,!re are _m plans ( procur+ a satisfactory fit2 ! foll[+ is "o ( ! be/4 ,fir/ cut a patt]n on a %eet ( pap] f :i* to %ape ! lea!r4 ,if possible ! pati5t %\ld /& :ile ! patt]n is fitt+4 ,take a %eet ( pap] l>ge en\gh to rea* r\nd ! body1 & long en\gh to ext5d f ! wai/ to ! leg bel[ ! knee4 ,lay x aga9/ ! diseas$ hip1 c>ry its v]tical m>g9 a little beyond ! middle l9e 9 front t[>ds ! s\nd side1 & ! o!r "p r\nd ! body beh9d1 till ! front is rea*$ on ! s\nd side4 ,feel = ! ant]ior iliac sp9e1 & m>k ) a p5cil ! po9t midway betwe5 x & ! pubis2 f ?is draw "o horizontal l9e inw>ds to ! bord] ( ! pap]1 & a second obliquely to ! p]9um4 ,!n seek = ! junction ( ! sacrum & iliac bone beh9d1 :i* corresponds pretty ne>ly to ! po9t fir/ f\nd 9 front2 f ?is m>k ! gluteal fold4 ,next c>ry a l9e v]tically f ! upp] bord] ( ! %eet ( pap] to ! great tro*ant]2 & la/ly1 m>k ! level ( ! pelvis4 ,lay ! %eet on a table & slit x ) scissors along ! l9es m>k$1 apply x a second "t to ! body & b5d ! ?igh "p r\nd ! ?igh1 mak+ its ant]ior m>g9 rea* well to ! inside ( ! limb1 :ile ! po/]ior "p %\ld almo/ meet x f beh9d4 ,! spl9t %\ld also rea* d[nw>ds to ! back ( ! knee4 ,! pap] is !n trimm$ d[n to ^! dim5sions4 ,! hip "p is next trimm$ s t x cle>s ! buttock on ! s\nd side & passes r\nd to ! ant]ior iliac sp9e ( t side4 ,! patt]n be+ complete1 cut a piece ( sole-lea!r to correspond1 arrang+ t ! hair or %ort side ( ! lea!r w lie next ! sk92 bevel (f ! out] edge all r\nd1 & soak ! lea!r till ?or\ghly s(t 9 wat]1 wipe x dry1 & b&age x c>efully fir/ to ! trunk & next to ! ?igh4 ,:5 x is set1 sup]flu\s & ov]lapp+ edges mu/ be m>k$ be=e removal2 la/ly1 ! sides ( ! v]tical not*1 betwe5 ! hip & tro*ant]1 are /it*$ toge!r1 & ! spl9t is cov]$ ) wa%-lea!r4 ,illu/ration3 ,fig4 #ei4--,lea!r spl9t = ! hip4 ,:5 ext5sion ( ! hip is requir$ 7see page #hj71 x c be appli$ to ! leg bel[ ! spl9t )\t less5+ ! support t af=ds4 ,! accompany+ figure1 #ei1 is drawn f a spl9t fitt$ by ,mr4 ,hea!r ,bigg on ! plan j describ$4 ,gutta-,p]*a may always be sub/itut$ = lea!r 9 ^! spl9ts1 & ! same plan ( fitt+ is us$1 except t ! not*+ requisite 9 lea!r is n necess>y 9 us+ gutta-p]*a2 = ! directions to use ?is mat]ial see page #ej4 ,,*apt] ,,iv4 ,,dislocations4 ,! ma9 ob/acles 9 r$uc+ dislocations are entanglem5t toge!r ( ! displac$ bones & contraction ( ! muscles2 ! entanglem5t ( ! bones det]m9es ! direction 9 :i* ext5sion mu/ be made1 & also ( ! c\nt] ext5sion1 or po9t at :i* ! body is fix$ to resi/ ! traction practis$ on ! limb2 ?is %\ld be exactly opposite ! direction 9 :i* ! limb w be drawn4 ,! muscles c always be relax$ by *lor(orm1 h5ce x is bett] :5 !y are p[]ful1 n to use ! limb z a lev] to prize ! head ( ! bone into its place4 ,/eady ext5sion in/ead is bett]1 to dis5gage ! bone f ! p>ts aga9/ :i* x is caught1 & to br+ x opposite its socket1 into :i* ! h&s ( ! surgeon guide x ) less risk ( lac]ation ( ! s(t p>ts ?an att5ds =cible lev]age4 ,l[] ,jaw4--,?is bone is dislocat$ on "o or bo? sides2 :5 ! condyle has slipp$ =w>d f ! gl5oid fossa1 ! contract$ temporal muscle keeps ! bone f rega9+ its prop] position1 & causes ! coronoid process to hit* aga9/ ! mal> bone4 ,treatm5t4--,app>atus4--#a4 ,a t[el4 #b4 ,a f\r-tail b&age4 ,illu/ration3 ,fig4 #fj4--;,dislocation ( ! jaw4 ,! pati5t %\ld be seat$ 9 a high-back$ *air1 re/+ 8 head aga9/ ! back4 ,! surgeon w9ds ! t[el r\nd bo? ?umbs1 & /&+ imm$iately 9 front ( 8 pati5t1 places a ?umb on ! second mol> ( bo? sides1 if ! dislocation be d\ble1 or on "o side only1 if t be alone displac$ 7see fig4 #fj74 ,he !n presses /eadily d[nw>ds until ! condyle is releas$1 :5 x slips back to its place4 ,! return ( ! bone may be aid$ by pu%+ up ! *9 ) ! f+]s aft] ! ramus ( ! jaw has be5 l[]$4 ,:5 ! jaw is replac$1 a f\r-tail b&age or split h&k]*ief %\ld be ti$ ov] ! nu*a & v]tex ( ! head1 to keep ! jaw clos$ 7see fig4 #bc1 page #cb74 ,bit+ or *ew+ %\ld n be attempt$ = t5 days or a =tnight4 ,! pati5t %\ld be w>n$ also t :5 ! jaw has be5 once dislocat$ x v readily slips out ( place aga92 he mu/ !nce=? avoid gap+ or op5+ ! jaw v widely4 ,! ,clavicle is r>ely dislocat$1 nev]!less bo? ! inn] & ! out] end may be displac$4 ,! signs are obvi\s--! end ( ! bone is felt 9 its new position4 ,! treatm5t = all is ! same4 ,app>atus4--#a4 ,roll]1 #b in*es wide4 #b4 ,a piece ( old blanket4 ,! blanket %\ld be torn into /rips ab\t a foot squ>e1 & fold$ ?rice1 ?us mak+ a long s(t pad to l9e ! axilla1 "o = ea* armpit4 ,! pati5t is next seat$ on a /ool2 an assi/ant /&+ beh9d1 draws back ! %\ld] :ile he presses on ! sp9e ) 8 knee2 ! dislocation be+ r$uc$1 ! surgeon fixes ! bone by a figure ( #h c>ri$ r\nd ! %\ld]s & across ! back4 ,! =e>m is !n b5t & fa/5$ to ! body by a few turns ( ! roll] r\nd x & ! *e/4 ,?is prev5ts ! pectorals f act+ on ! bone4 ,! app>atus may be laid aside at ! end ( a week1 b ! arm mu/ be fix$ to ! trunk = a =tnight long]4 ,?is bone is (t5 difficult to keep 9 place aft] dislocation1 & ev5 ! mo/ accurately fitt$ app>atus sometimes fails to effect its object1 h5ce _m v>ieties ( coll> & yoke h be5 devis$ by diff]5t surgeons to accompli% ?is purpose4 ,! ,%\ld] is dislocat$ 9 ?ree directions1 d[nw>ds1 inw>ds1 & backw>ds4 ,^! h subord9ate v>ieties1 b ! signs dep5d *iefly on ! direction ( ! greate/ displacem5t4 ,signs ( dislocation into ! axilla4 ,:5 ! bone is displac$ bel[ ! gl5oid fossa ! acromion is prom95t2 und]nea? x1 ! surgeon feels a holl[ in/ead ( ! head ( ! hum]us1 :i* ! f+] detects 9 ! axilla4 ,movem5t ( ! %\ld] is v limit$ & pa9ful ,if ! elb[ is rotat$ :ile ! f+] is 9 ! armpit1 ! head w be f\nd to move ) ! re/ ( ! bone4 ,if ! head ( ! bone is c>ri$ m inw>ds on to ! ribs1 x c be se5 & felt ne> ! clavicle2 ! holl[ is aga9 readily detect$ bel[ ! acromion1 :ile ! axis ( ! arm is alt]$1 be+ direct$ inside its prop] position4 ,:5 ! bone is c>ri$ backw>ds ! head is pla9ly felt on ! scapula bel[ ! sp9e4 ,= ! r$uction ( ^! dislocations sev]al plans are employ$4 ,:5 rec5t ! two fir/ displacem5ts c g5]ally be re/or$ )\t *lor(orm1 b if ! pati5t is muscul> x (t5 saves "t & pa9 to produce ane/hesia be=e attempt+ to replace ! bone4 ,illu/ration3 ,fig4 #fa4--,r$uc+ a dislocat$ %\ld] by ! heel 9 ! armpit4 ,by ! heel 9 ! axilla 7fig4 #fa74--,! pati5t lies flat on a c\*2 ! surgeon pull+ (f 8 boot f ! left foot if he has to r$uce a left dislocation1 & vice v]s ! "r boot1 seats himself on ! c\* fac+ ! pati5t4 ,putt+ 8 unboot$ foot into ! armpit1 he grasps ! =e>m ) bo? h&s & pulls /eadily d[nw>ds4 ,:5 ! head ( ! bone is dis5gag$ ! muscles draw x into ! socket1 & ! movem5ts ( ! limb become at once easy & natural4 ,! arm mu/ !n be fix$ to ! side by a roll] = a =tnight1 & ! %\ld] is wett$ ) an evaporat+ lotion to allay ! pa9 & inflammation result+ f ! lac]ation ( ! s(t p>ts4 ,%\ld ! surgeon's /r5g? be insuffici5t = ! requisite ext5sion1 a jack t[el may be atta*$ 9 a clove hit* r\nd ! wri/ & held by an assi/ant1 :o /&+ beh9d ! surgeon draws /eadily 9 ! same direction4 ,to make a clove hit*4--,grasp ! t[el 9 ! left h&1 ! little f+] be+ d[nw>ds1 !n pronat+ ! "r h& till ! little f+] is upmo/1 seize ! t[el bel[ ! left h&2 if ! wri/s are !n rotat$ 9 opposite directions ! t[el w be drawn into two loops1 ( :i* ! ends cross above ! connect+ "p betwe5 ! loops 7see fig4 #fb72 if "o h& holds ! loops & ! o!r pulls ! ends1 ! loops w be f\nd n to slip1 h[ev] tight ! ends are pull$4 ,illu/ration3 ,fig4 #fb4--,! ,clove-hit* knot4 ,r$uction by simple ext5sion4--,! pati5t aga9 lies flat on 8 back1 a jack t[el is pass$ r\nd 8 body & fa/5$ beh9d ! opposite %\ld] = c\nt]-ext5sion1 :ile a second t[el is atta*$ to ! wri/ by a clove hit* & intru/$ to two or ?ree assi/ants1 :o are desir$ to pull quietly & /eadily directly away f ! pati5t's body4 ,! surgeon mean:ile wat*es ! progress ( ! ext5sion1 alt]+ its direction z he f9ds ! head m or less engag$ aga9/ ! scapula1 & f9ally ) 8 h&s ?ru/s ! head into its socket4 ,sometimes !re is mu* difficulty 9 gett+ ! head back to ! gl5oid fossa1 ev5 :5 ! hum]us is completely dis5gag$ f ! scapula2 ?is difficulty is (t5 ov]come if an assi/ant rotates ! hum]us backw>ds & =w>ds1 :ile ! ext5sion at ! wri/ & ! pressure on ! head ( ! hum]us is /eadily ma9ta9$4 ,:5 ! limb is replac$ x is fix$ to ! side z be=e direct$4 ,illu/ration3 ,fig4 #fc4--;,dislocation ( ! %\ld] r$uc$ by simple ext5sion4 ,if ! dislocation has exi/$ m ?an a few h\rs1 relaxation ( ! muscles by *lor(orm & ext5sion ( ! limb c>ri$ directly away f ! body are m sure ( success ?an ! heel 9 ! axilla1 because !y all[ great] p[] to be ex]t$ 9 a /eadi] mann] ?an is possible by ! o!r mode4 ,! ,elb[4--,! signs ( dislocation at ?is jo9t are tol]ably evid5t1 b !re is (t5 coexi/5t fracture ( ! coronoid or olecranon processes4 ,sep>ation ( ! articulat+ surfaces ( ! hum]us f ! %aft is sometimes mi/ak5 = dislocation ( ! =e>m backw>ds4 ,9 dislocation ( bo? bones backw>ds ! olecranon is v pla9ly felt beh9d ! l[] end ( ! hum]us2 ! sigmoid not* is g5]ally to be made out1 & ! =e>m is fix$ at a "r angle4 ,! alt]$ relation ( ! olecranon to ! condyles suffices to di/+ui% dislocation f fracture ( ! hum]us at its l[] end1 :]e ! olecranon also goes backw>ds1 b ! condyles g ) x4 ,! immobility ( ! jo9t di/+ui%es x f sep>ation ( ! l[] articul> surfaces ( ! hum]us f ! %aft1 an accid5t1 moreov]1 only met ) 9 *ildr54 ,o!r subord9ate di/9ctions betwe5 dislocation & fracture are1 ! limit$ movem5t1 ! difficulty ( re/or+ ! bones to _! natural position1 & ! abs5ce ( crepitus2 la/ly1 ! peculi> =m ( ! articul> surfaces c sometimes be made out4 ,9 r$uc+ ! backw>d dislocations ! pati5t sits on a *air on :i* ! surgeon re/s 8 foot1 press+ 8 knee aga9/ ! =e>m at ! elb[ = a fulcrum2 !n1 grasp+ ! wri/ ) "o h&1 & /eady+ ! arm ) ! o!r1 he flexes ! elb[ to dislodge ! coronoid process f ! fossa at ! back ( ! hum]us2 :5 ?is is done1 ! articulat+ surfaces slip into place4 ,?is plan is commonly adopt$ :5 ! olecranon is displac$1 b if x fails to r$uce ! dislocation1 direct ext5sion at ! wri/ mu/ be employ$1 z = ! foll[+ dislocation4 ,:5 ! radius only is displac$1 ! body %\ld be fix$ by a jack t[el c>ri$ "u ! armpit ( ! injur$ side1 & ov] ! %\ld] ( ! s\nd side4 ,a wett$ b&age is roll$ r\nd ! =e>m1 & a second t[el is atta*$ by a clove-hit* 7see fig4 #fb1 page #ii7 to ! wri/ = ext5sion1 :i* is made 9 ! axis ( ! limb until ! radius c be slipp$ into its place on ! out] condyle4 ,illu/ration3 ,fig4 #fd4--,r$uc+ dislocation ( ! elb[ r\nd ! knee4 ,9 all dislocations ( ! elb[1 :5 ! bones are return$ ! limb %\ld be b5t to a "r angle & put on a lat]al angul> spl9t = a week or t5 days1 aft] :i* "t x %\ld be worn 9 a sl+ a =tnight long]4 ,illu/ration3 ,fig4 #fe4--;,h&le = obta9+ grasp ( ! ?umb 9 dislocation4 ,! ,?umb & ,f+]s4--,:5 ! fir/ phalanx is dislocat$ f ! head ( ! metac>pal bone x is sometimes v difficult ( r$uction4 ,! mo/ effectual mode is /eady ext5sion1 :i* is procur$ by fa/5+ ! ?umb to a piece ( wood1 :i* s]ves z a h&le to give comm& ( ! phalanx1 & is contriv$ z foll[s3 ! ?umb is fir/ b&ag$ ) a n>r[ wett$ roll] ov] ! two phalanges1 & a ?ick lay] ( cotton wool is roll$ r\nd x2 a piece ( /iff wood1 #a in* wide1 in* ?ick1 & #ab long1 is p]=at$ at "o end ) ?ree pairs ( holes in* di/ant f ea* o!r & f ! end2 ?r\gh ^!1 ?ree /\t tapes1 in* wide & #b feet long1 are ?read$1 leav+ ?ree loops on "o side ( ! piece ( wood 7fig4 #fe74 ,! wood is !n appli$ to ! palm> aspect ( ! phalanges1 ! loops pass$ ov] ! ?umb1 _! ends drawn tight1 & ti$1 n 9 a b[ z ! figure repres5ts1 b w\nd r\nd ! end ( ! /ick4 ,! /ick ?us atta*$ becomes a good h&le = ext5d+ ! digit1 & also a long lev] = alt]+ ! direction ( ! phalanx if desir$4 ,lang5beck ( ,b]l9 employs a pair ( =ceps to seize ! ?umb1 in/ead ( ! wood5 h&le j describ$4 ,b ) ! greate/ c>e & p]sev]ance x is sometimes impossible to replace ! bone unless ! con/rict+ b&s be divid$ ) a t5otome4 ,hip-jo9t4--,!re are ?ree *ief directions 9 :i* ! hip is dislocat$4 ,fir/ backw>ds on ! dorsum ilii1 or fur!r on to ! sciatic not*4 ,9 ?is dislocation ! limb is %ort5$1 mov$ ) difficulty1 drawn inw>ds ov] ! o!r1 & its great toe t\*es "s "p ( ! back ( ! o!r foot4 ,! hip itself is alt]$1 ! great tro*ant] be+ ne>] to ! cri/a ilii1 & m prom95t ?an on ! un9jur$ side1 & ! head is (t5 pla9ly felt 9 its new position4 ,resi/ance to ext5sion ( ! limb1 limit$ movem5t ( ! hip1 ) rotation inw>ds1 are ! di/+ui%+ po9ts betwe5 ?is dislocation & fracture at ! neck ( ! femur4 ,treatm5t4--,app>atus4--,a complete app>atus = ?is purpose is contriv$ & sold by in/rum5t mak]s1 b a suffici5tly s]viceable "o c be extemporis$ :5 ! =m] is n at h&2 x consi/s (3-- #a4 ,a rope runn+ 9 two pulley blocks4 #b4 ,?ree jack t[els4 #c4 ,two /\t hooks to screw into ! wall1 or "s firm object1 to obta9 fix$ atta*m5t4 #d4 ,a wett$ roll] #c in*es wide4 ,! complete app>atus is z foll[s3-- ,app>atus4--#a4 ,a set ( multiply+ pulleys4 #b4 ,a lea!rn padd$ gir?1 #b in*es wide & #c feet long1 hav+ at ea* end an iron r+4 #c4 ,a /\t lea!rn belt ab\t #f in*es broad1 furni%$ ) buckles1 /raps1 & r+s to fa/5 on to ! ?igh above ! knee2 a rope is run ?r\gh ! r+s to connect ! hook ( ! pulleys ) ! ?igh4 #d4 ,two /rong iron hooks to screw into ! wall1 = fix+ ! app>atus4 #e4 ,half-a-doz5 y>ds ( /\t cord4 #f4 ,a hook1 fitt$ ) a buckle & /rap1 & h+$ s t1 by turn+ a p91 x at once dis5gages itself4 ,if ?is is int]pos$ betwe5 ! pulleys & ! hook fix$ 9 ! wall1 ! limb may be in/antane\sly releas$ if desir$4 ,illu/ration3 ,fig4 #ff4--;,dislocation ( ! dorsum ilii4 ,treatm5t4--,/ep #a4 ,! pati5t is laid on a flat c\*1 & put "u ! influ5ce ( *lor(orm4 ,:5 he is n>cotis$1 a jack t[el1 or if x be at h& ! pelvic girdle1 is c>ri$ across ! p]9um1 arrang+ x to be> on ! tub] is*ii beh9d & ! pubes 9 front1 its ends be+ atta*$ to "o ( ! hooks screw$ into ! wall beh9d1 & ab\t six in*es bel[ ! level ( ! pati5t4 ,?is t[el %\ld be put slightly on ! /ret*1 t ! pelvis may be kept 9 ! position fir/ assign$ to x :5 ! pulleys beg9 to draw4 ,a wet roll] is put on ! l[] ?ird ( ! ?igh1 ! jack t[el slipp$ up ! leg to ! b&age1 & fa/5$ 9 a clove hit*4 ,ano!r jack t[el is !n d\bl$ & pass$ up ! limb to ! p]9um4 ,! pati5t is next turn$ on to 8 s\nd side1 & ! belt ( ! ?igh connect$ by ! dis5gag+ hook to ! pulleys1 :i* are drawn out f ea* o!r z f> z _! cord w all[1 & atta*$ to a hook fix$ a little above ! level ( ! pati5t1 on a l9e c>ri$ f ! hip across ! junction ( ! middle & l[] ?irds ( ! un9jur$ ?igh 7see fig4 #ff74 ,/ep #b4 ,! surgeon be+ ready1 an assi/ant draws on ! pulley cord1 gett+ gradual ext5sion ( ! limb z requir$ by ! surgeon1 :o1 keep+ 8 h&s on ! hip & great tro*ant]1 wat*es ! progress ( ! head ( ! bone t[>ds ! acetabulum4 ,/ep #c4 ,:5 ! bone has rea*$ ! edge ( ! acetabulum1 a second assi/ant slips ! d\bl$ jack-t[el ov] 8 %\ld]s1 & by rais+ 8 body1 lifts ! femur away f ! brim ( ! acetabulum1 :ile ! surgeon1 grasp+ ! foot & knee1 makes a few movem5ts ( rotation backw>ds & =w>ds to ease ! head into its socket4 ,:5 a r$uction is effect$1 ! limb %\ld be put 9 a long spl9t or />* b&age = ?ree weeks1 & ! pati5t n all[$ to ex]cise ! limb freely or viol5tly = a mon? aft]w>ds4 ,r$uction by ,manipulation4--,:5 ! pati5t is n v muscul>1 & ! dislocation rec5t1 ! bone c (t5 be spe$ily return$ by movem5ts ( flexion & rotation4 ,! pati5t is put fully "u *lor(orm & br\ght to ! foot ( ! b$2 ! surgeon grasps ! ankle 9 "o h&1 & ! knee 9 ! o!r1 b5d+ t jo9t till ! heel rea*es ! ?igh2 he next flexes ! ?igh on ! abdom51 9 do+ ?is he c>ries ! knee outw>ds away f ! body1 & !n rotates ! limb by pu%+ ! foot outw>ds1 on :i* ! head (t5 slips into ! acetabulum4 ,if ?is plan d n quickly succe$ x is bett] to h rec\rse to ext5sion1 by assi/ants if pulleys are n at h&1 b ! irregul>ity ( ! =ce :5 assi/ants are employ$ r5d]s ! traction ( pulleys mu* pref]able to manual /r5g?4 ,dislocation d[nw>ds into ! is*iatic =am54 ,! limb is l5g!n$1 capable ( little motion2 ! knee is b5t2 ! toe po9ts =w>ds1 & away f ! o!r foot4 ,"h ! r$uction is be/ manag$ by ext5sion2 ! app>atus requir$ be+ ! same z t employ$ 9 dislocation backw>ds1 b x is diff]5tly arrang$4 ,/ep #a4 ,! pati5t lies on 8 back1 ! pelvic gir?1 or t[el1 is c>ri$ r\nd ! pelvis & fa/5$ to ! wall on a level ) 8 body1 opposite ! un9jur$ side4 ,a jack t[el is put r\nd ! upp] "p ( ! dislocat$ ?igh1 & atta*$ to ! pulleys outside1 :i* are fa/5$ to ! wall opposite 7see fig4 #fg74 ,illu/ration3 ,fig4 #fg4--;,dislocation into ! =am5 ovale4 ,/ep #b4 ,ext5sion is !n made by an assi/ant1 ! surgeon grasps ! leg above ! ankle1 & rotat+ ! limb inw>ds & outw>ds1 b )\t lift+ x f ! b$1 guides ! head into ! acetabulum4 ,"h1 z aft] dislocation backw>ds1 a long spl9t %\ld be worn on ! limb = ?ree weeks be=e ! pati5t is all[$ to move ab\t at all4 ,dislocation on to ! ,pubes4--,! limb is easily mov$ at ! hip1 %ort5$1 rotat$ outw>ds1 & ! head ( ! bone is felt 9 ! gro94 ,! same app>atus is us$ 9 ?is z 9 ! dislocation on ! dorsum ilii4 ,x is appli$ z foll[s3-- ,/ep #a4 ,! pati5t lies on 8 back 7fig4 #fh71 ) 8 legs sep>at$4 ,! pelvic b& is pass$ ov] ! p]9um & pubes1 & atta*$ above ! pati5t1 9 a l9e pass+ f ! pelvis a little to 8 s\nd side4 ,a d\ble jack t[el is slipp$ up ! limb to ! p]9um2 ! pulleys are fa/5$ to ! ?igh above ! knee & fix$1 9 ! mann] direct$ on page #ajf1 to ! wall bel[ & ext]nal to ! injur$ side ( ! body4 ,illu/ration3 ,fig4 #fh4--;,dislocation on to ! pubes4 ,/ep #b4 ,ext5sion is !n /eadily made1 :ile ! surgeon wat*es ! head gett+ free f ! pubes1 ov] ! edge ( :i* a second assi/ant slipp+ 8 neck ?r\gh ! d\bl$ t[el1 raises ! bone a little outw>ds4 ,! surgeon 9 ! meantime enc\rages ! bone by rotation to ent] ! socket4 ,a spl9t is necess>y "h also aft] r$uction4 ,! ,knee4--,^! dislocations are r>ely complete1 & are easily r$uc$2 ! lat]al ones by flex+ ! ?igh on ! belly1 /raight5+ ! leg1 & rotat+ x a little f side to side4 ,ano!r ,plan4--,app>atus4--,two jack t[els4 ,?is is m useful :5 ! tibia is c>ri$ backw>ds4 ,lay ! pati5t on 8 back1 & slip a jack t[el 9 a clove hit* up ! leg to ! ham1 & ano!r r\nd ! small ( ! leg2 ! ?igh is b5t & reta9$ 9 a semiflex$ position by an assi/ant hold+ ! jack t[el at ! ham1 :ile a second pulls on ! "o at ! ankle & s dis5gages ! bones f ea* o!r1 :5 ! surgeon readily slips !m into place4 ,aft] r$uction is accompli%$1 ! limb %\ld be fix$ 9 a lea!rn back spl9t until ! inflammation subsides4 ,dislocation ( ! ,patella4--,! displacem5t ( ?is bone on to ! out] or inn] condyle is g5]ally easily r$uc$ if ! knee is /raight5$ & ! va/i relax$ by b5d+ ! ?igh on ! belly4 ,:5 ! patella is turn$ on its own axis1 ! side1 n ! "u surface1 is lock$ aga9/ ! condyle1 & r$uction is sometimes extremely difficult or impossible4 ,! same movem5ts mu/ be adopt$ z = simple lat]al displacem5t1 & ! surgeon mu/ endeav\r to release ! bone by press+ its upp] edge d[nw>ds ) 8 ?umbs4 ,aft] _! r$uction1 all dislocations ab\t ! knee-jo9t mu/ be treat$ by re/1 /raight spl9ts1 & evaporat+ lotions4 ,! ,foot is v r>ely dislocat$ f ! leg )\t fracture ( ! malleoli4 ,its r$uction requires simple ext5sion ( ! foot on ! leg1 ) ! knee b5t2 ! surgeon grasps ! heel 9 "o h&1 ! foot 9 ! o!r1 :ile an assi/ant fixes ! ?igh 9 ! half-b5t position4 ,! foot is fir/ drawn d[nw>ds to dis5gage x f ! tibia1 & !n direct$ into its place4 ,aft] r$uction ! limb %\ld be put 9 a ,mc,intyre's spl9t1 9 ! way describ$ = fracture ( ! tibia ne> ! ankle-jo9t4 ,sc>pa's ,%oes are in/rum5ts = re/or+ de=m$ feet to _! natural %ape4 ,! %oe 7fig4 #fi7 consi/s ( a flat metal sole broad] & long] ?an ! foot1 furni%$ ) a re/ = ! heel4 ,a rod1 atta*$ to ! side ( ! sole b5ea? ! ankle1 rea*es up ! limb1 to :i* x is secur$ by "o broad b& & buckle bel[1 & by a second above ! knee1 opposite :i* jo9t ! iron /em moves on a free jo9t backw>ds & =w>ds4 ,opposite ! malleoli are set ! c5tres ( movem5t requir$ = ! re/oration ( ! de=mity2 !y are mov$ by a key4 ,! foot is fa/5$ to ! sole by /raps across ! in/ep & ankle2 ! toes are re/ra9$ by a /rap pass+ r\nd !m & fix$ to a horizontal toe-b> by ! side ( ! foot4 ,9 fitt+ "o ( ^! %oes1 :i* ( c\rse mu/ always be made specially = ! limb x is to control1 ! po9ts to be att5d$ to are--#a/1 ! c5tres ( ! jo9ts mu/ be s arrang$ t1 :5 traction is made1 ! foot %all revolve back aga9 r\nd ! same c5tres x has pass$ 9 rea*+ its di/ortion4 ,= example1 if ! heel is rais$1 z 9 talipes equ9us1 ! =e "p ( ! sole ( ! %oe mu/ be capable ( elevation1 by mov+ a jo9t t rotates 9 a plane p>allel to ! rotation ( ! a/ragalus on ! tibia4 ,9 mo/ cases ( talipes1 ! bones ( ! foot h be5 displac$ r\nd sev]al c5tres2 h5ce1 ! app>atus mu/ be furni%$ ) p[] ( traction along all ( ^!1 or along ! l9es result+ f ^! diff]5t directions act+ simultane\sly4 #bnd4 ,! heel mu/ be got ?or\ghly into its place at ! back ( ! sole to ensure t ! foot w foll[ ! %oe 9 all its movem5ts4 ,! treatm5t ( talipes frequ5tly requires division ( t5dons be=e ext5sion is attempt$1 if !y are too firmly contract$ to p]mit ! bones to rega9 _! prop] position until !y are l5g!n$ by division4 ,?us1 9 v>us1 ! tibiales & t5do a*illis2 9 valgus1 ! p]onci2 9 equ9us1 ! t5do a*illis2 are (t5 divid$4 ,! limb mu/ n be v tightly brac$ into ! %oe1 slight t5sion1 if cont9u\s1 suffices to ov]come ! resi/ance2 & 9 *ildr5 if ! /raps are drawn tight ! sk9 almo/ inv>iably inflames1 & ev5 sl\ghs :]e x is compress$4 ,be=e ! in/rum5t is appli$1 ! limb %\ld be b&ag$ ) a s(t cotton1 or ,domett's flannel roll]4 ,! foot is fir/ fix$ to ! sole or %oe1 & !n ! leg to ! rod4 ,traction is increas$ gradually ) frequ5t small alt]ations1 z ! foot yields to ! t5sion & rega9s its natural position4 ,! accompany+ figure 7,no4 #fi7 repres5ts an in/rum5t made by ,mr4 ,hea!r ,bigg4 ,x %[s ! %oe re/or+ a mu* elevat$ heel to its prop] position aft] division ( ! t5do a*illis4 ,!re are ?ree common v>ieties ( talipes--equ9us1 or horse-heel1 :]e ! heel is drawn up & ! toes only t\* ! gr\nd2 v>us1 club-foot prop]1 :]e ! foot is twi/$ inw>ds2 & valgus1 splay-foot1 9 :i* ! foot is drawn outw>ds4 ,equ9us is (t5 associat$ ) v>us1 & sometimes also ) valgus1 & consequ5tly = su* cases ! in/rum5t mu/ provide ! me*anism prop] to ea* direction ( displacem5t4 ,9 ,equ9us ! heel is rais$ by ! extreme ext5sion ( ! ankle1 & ! sole ( ! foot is %ort5$ by ! metat>sus be+ drawn backw>ds4 ,9 ?is k9d ( de=mity ! %oe mu/ h a jo9t to br+ ! a/ragalus =w>ds on ! tibia1 & ! sole ( ! %oe mu/ be well padd$ b5ea? ! scaphoid & metat>sal bones1 t1 z ! foot is releas$ f its position ( extreme ext5sion at ! ankle-jo9t1 ! ant]ior p>ts ( ! foot may be ?ru/ upw>ds into _! prop] relation to ! a/ragalus & os calcis4 ,illu/ration3 ,fig4 #fi--,%oe = r$uc+ talipes equ9us4 ,9 ,v>us1 or r ,equ9o-v>us1 = v>us )\t elevation ( ! heel is r>e1 ! displacem5t is comp\nd1 ! ankle is ext5d$1 ! heel rais$1 ! scaphoid & metat>sus are drawn inw>ds & d[nw>ds1 s t ! scaphoid lies imm$iately b5ea?1 sometimes ev5 9 contact ) ! int]nal malleolus4 ,! a/ragalus & cuboid are drawn =w>ds s z to lie 9 front ( _! natural position aga9/ ! tibia & os calcis4 ,to br+ d[n ! heel ! upright /em passes outside ! limb1 ! toe ( ! %oe c be rais$ by a circul> jo9t on ! /em opposite ! malleolus1 :i* by its revolution raises ! toes & depresses ! heel4 ,a second jo9t work+ outw>ds & upw>ds elevates ! out] bord] ( ! foot1 & re/ores ! scaphoid to ! front ( ! head ( ! a/ragalus4 ,la/ly1 ! metat>sus is drawn outw>ds by a horizontal spr+ toe-b> along ! out] bord] ( ! foot1 to :i* ! toes are fa/5$4 ,9 ,valgus1 ! plant> ar* is flatt5$ or ev5 r5d]$ convex d[nw>ds by ! s9k+ ( ! scaphoid1 & 9 extreme cases1 by rotation outw>ds & upw>ds ( ! t>sus4 ,! %oe "h has ! v]tical rod inside ! limb1 & if necess>y1 an axis = rotation bel[ ! inn] malleolus1 & an ela/ic ar*$ pad "u ! scaphoid to lift x into its natural position4 ,ca/+ 9 ,pla/] ( ,p>is4--,x is (t5 conv5i5t1 :5 ord]+ an app>atus = de=mity1 to s5d ! in/rum5t-mak] a ca/ ( ! de=m$ "p4 ,?is is readily made 9 ! foll[+ way3-- ,app>atus4--#a4 ,two packets ( fre%ly burn$ pla/] ( ,p>is4 #b4 ,"s pa/ebo>d1 an old b&box1 or sev]al newspap]s4 #c4 ,olive oil4 #d4 ,a bas9 ( cold wat]4 ,/ep #a4 ,! "p to be modell$ %\ld be laid 9 an easy position1 ?or\ghly oil$1 & a %ell or tr\gh ( pa/ebo>d r\ghly built r\nd x to conta9 ! pla/] till x sets4 ,/ep #b4 ,! pla/] is !n prep>$ by %ak+ ! p[d] into cold wat]1 till a ?ick cream )\t lumps is =m$2 ?is is secur$ by con/antly /irr+ ! wat] z ! pla/] is %ak5 94 ,! cream is !n p\r$ into ! tr\gh1 little by little1 t x may make its way into ! inequalities & recesses "u ! limb1 until ! limb is half imm]s$1 leav+ ! project+ p>ts1 su* z jo9ts1 half expos$1 s t ! halves ( ! m\ld may sep>ate opposite !m4 ,?is fir/ in/alm5t is !n all[$ to set1 & a fre% supply ( pla/] is prep>$4 ,/ep #c4 ,! surface ( ! h>d5$ m\ld is oil$1 t ! fre% cream may n /ick to x1 & ! :ole ( ! limb is !n cov]$ by p\r+ ! cream on a second "t4 ,pl5ty ( pla/] %\ld be laid ov] ! project+ p>ts t ! m\ld may be /rong en\gh = use4 ,x %\ld be in* ?ick ev]y:]e1 & #a in* ?ick along ! sides4 ,:5 ! second half is set1 ! tr\gh or %ell is cle>$ away1 & ! two halves ( ! m\ld remov$ f ! limb sep>ately4 ,= ca/+1 ! m\ld is well oil$ inside & fill$ ) cream1 :i* sets into ! ca/ requir$4 ,:ile ! pla/] is liquid1 ! m\ld %\ld be well %ak51 t ! air-bubbles may be all driv5 f ! surface ( ! ca/4 ,,*apt] ,v4 ,,miscellane\s4 ,hair ,suture4--,?is is useful to br+ ! m>g9s ( small scalp w\nds toge!r1 :]e pla/]s are n employ$4 ,x consi/s 9 tak+ a lock ( hair or ( an in* on ea* side ( ! w\nd1 & ty+ !m toge!r ov] a d\ble ?ickness ( l9t2 by ?is means ! m>g9s ( ! w\nd are kept toge!r1 & ! dress+ 9 place4 ,! slits left aft] ! removal ( small sebace\s tum\rs are v conv5i5tly treat$ 9 ?is way4 ,illu/ration3 ,fig #gj4--;,eye ,d\*e4 ,! ,eye ,d\*e is a small ela/ic bottle fitt$ ) a nozzle & flexible tube1 end+ 9 a rose1 ?r\gh :i*1 by means ( a valve1 ! wat] is drawn f a vessel & driv5 9 a f9e spray ov] ! eye held op5 to receive x 7see fig4 #gj74 ,! syr+e 9 fig4 #gj is v useful = a v>iety ( purposes4 ,eye-,drops4--,little bottles are sold by *emi/s = ?is purpose1 ) a tubul> /opp]2 at "o end ( ! /opp] is a f9e jet1 ! o!r is clos$ by a piece ( indian rubb] /ret*$ ov] x2 on press+ ?is a drop escapes f ! jet4 ,9 dropp+ a/r+5ts into ! eye ! pati5t %\ld put 8 head well back2 :ile ! surgeon raises "o lid f ! eye1 drops 9 ! lotion1 & !n raises ! o!r & drops x 9 aga91 & tells ! pati5t to move 8 eyelids ab\t a little to =ce ! lotion ov] ! :ole conjunctiva4 ,illu/ration3 ,fig4 #ga4--,syr+e = s5d+ a cont9u\s curr5t into ! nose or e>1 c4 ,syr++ ! ,e>s is be/ p]=m$ by a syr+e hav+ a long nozzle to direct ! curr5t ( soap & wat] d[n ! meatus on to ! wax4 ,figure #ga consi/s ( a syr+e ) d\ble op5+ & air *amb]2 :5 9 action x supplies a cont9u\s g5tle curr5t1 :i* breaks up ! concretions m spe$ily & ) less discom=t to ! pati5t ?an ! int]mitt+ jet ( a common syr+e2 b an important "p ( ! app>atus is ! long sl5d] nozzle to direct ! /ream well into ! meatus4 ,! in/rum5t-mak]s supply a little sp\t or %oot to hang "u ! e>1 to turn (f ! wat] into a bas9 cle> ( ! neck4 ,if "t p]mit1 ! pati5t %\ld keep ! e> *>g$ ) olive oil = a few days be=e syr++1 t ! wax may be s(t5$4 ,aft] ! wax is remov$1 ! irritation ( ! canal is be/ allay$ by a little glyc]9e or olive oil put into ! meatus1 & cov]$ by a pl$get ( cotton wool1 l>ge en\gh to fill ! con*a & too l>ge to ent] ! passage1 :]e x may be lo/ sight (4 ,ice-,cold ,injection4--,9 ob/9ate epi/axis ! n>es are sometimes plugg$1 b1 be=e proce$+ to ?is pa9ful mode ( treatm5t1 a simpl] plan %\ld fir/ be tri$2 namely1 ! injection ( ice-cold wat] into ! no/ril along :i* ! blood fl[s4 ,! /ream %\ld be direct$ upw>ds t ! wat] may fir/ dislodge ! clots entangl$ 9 ! meatuses1 & !n fl[ ov] ! ble$+ surface4 ,?is is be/ done by employ+ a cly/] or d\*e bottle 7see fig4 #ga71 "o tube ( :i* lies 9 a vessel ( ice-cold wat] 7conta9+ solution ( gallic acid or o!r /yptic if desir$1 ?\gh cold wat] alone usually suffices71 ! o!r tube1 hav+ a long n>r[ nozzle1 is pass$ up ! no/ril & direct$ upw>ds among ! spongy bones4 ,) ?is app>atus ! wat] is inject$ /eadily = half an h\r1 be=e be+ ab&on$ z unsuccessful4 ,! pati5t is kept /ill1 sitt+ upright 9 a cool room4 ,if ^! means fail to *eck ! fl[ ( blood1 ! n>es may !n be plugg$4 ,plugg+ ! ,n>es4 ,app>atus4--#a4 ,a flexible ca!t]1 ,no4 #g1 or ,belloc's s\nd4 #b4 ,:ipcord4 #c4 ,l9t4 #d4 ,scissors4 ,/ep #a4 ,roll up a /rip ( l9t tightly into a mass1 #a in* broad & an in* ?ick1 trim ! ends away ) scissors till ! mass is ( a size to ent] a po/]ior n>is1 !n tie ! w$ge 9 ! middle ( a y>d ( d\bl$ :ipcord4 ,if blood trickle d[n bo? no/rils bo? mu/ be plugg$1 & two su* plugs mu/ be prep>$2 next1 make two simil> rolls ( l9t1 & tie ^! up ) a %ort piece ( silk or tw9e to prev5t _! unroll+4 ,/ep #b4 ,pass along ! int]ior ( ! ca!t] a y>d ( tw9e1 & draw its end ?r\gh ! eye ( ! ca!t] a few in*es1 !n introduce ! ca!t] ?r\gh ! n>is directly backw>ds1 n upw>ds nor d[nw>ds1 because1 :5 ! pati5t is upright1 ! floor ( ! nose is ne>ly horizontal4 ,:5 ! ca!t] has rea*$ ! ph>ynx1 ! f+]1 or a =ceps1 mu/ be pass$ ?r\gh ! m\? to cat* ! /r+ hang+ f ! end ( ! ca!t] & br+ x out ( ! m\?1 :]e x is held :ile ! in/rum5t is )drawn f ! nose4 ,! /ep is repeat$ 9 ! o!r no/ril if requir$4 ,/ep #c4 ,next wa% out ! no/rils ) a few syr+efuls ( ice-cold wat]1 9 :i* "s tann9 is susp5d$4 ,/ep #d4 ,fa/5 ! d\ble /r+ ( ! plug to ! end ( tw9e hang+ out ( ! m\? 7see fig4 #gb71 & !n draw out ! o!r end ?r\gh ! nose2 ?is w c>ry ! plug to ! ph>ynx1 :]e ! f+] guides x ov] ! s(t palate & ?ru/s "o ( its ends into ! n>is1 :]e ! /r+s draw x tight4 ,! plug = ! ant]ior no/ril is !n put 9 place1 & ! /r+s ti$ tightly ov] x 7see fig4 #gc74 ,?us ! plug 9 front keeps ! plug beh9d 9 place & vice v]s4 ,! end ( /r+ f ! po/]ior n>es1 left hang+ out ( ! m\?1 mu/ next be ti$ to ! /r+ ( ! ant]ior plug to keep x out ( ! pati5t's way1 till want$ to )draw ! po/]ior plug1 :5 t is to be remov$4 ,if blood run f bo? sides1 ! o!r n>es are /opp$ by a repetition ( ?is op]ation4 ,illu/ration3 ,fig4 #gb4--,plugg+ ! n>es4 ,belloc's s\nd pass$ ?r\gh ! n>es1 & project+ at ! m\?4 ,?is app>atus is v pa9ful1 &1 if borne s long z a c\ple ( days1 %\ld always be tak5 out !n4 ,if ble$+ recur1 :i* is v unlikely1 fre% plugs mu/ be introduc$4 ,sometimes ! po/]ior plugs are soak$ 9 /yptic solutions2 ?is is bad1 because ! ble$+ "p is n at ! po/]ior n>es1 & ! /yptics increase ! sor5ess ! plugs !mselves produce4 ,illu/ration3 ,fig4 #gc4--,plugg+ ! n>es2 ! /r+s f ! po/]ior plug ti$ ov] ! ant]ior plug4 ,illu/ration3 ,fig4 #gd4--;,belloc's ,s\nd1 = draw+ a ?read f ! m\? along ! n>es4 ,belloc's ,s\nd4--,fig4 #gd is a curv$ silv] cannula l a female ca!t]1 furni%$ ) a long spr+ /ylet1 t ar*es r\nd 9 a circle :5 ?ru/ out ( ! cannula1 & has a hole at ! end to c>ry a ?read4 ,! long /ylet c be unscrew$ into two p>ts1 :5 n 9 use4 ,! figure repres5ts ! in/rum5t ) ! /ylet ready = protrusion1 & ! same ar*+ =w>ds aft] x is protrud$4 ,! cannula is pass$ along ! n>es till ! end rea*es ! ph>ynx1 !n ! /ylet is protrud$ & ar*es =w>d till x rea*es ! tee?1 :5 a ?read is pass$ ?r\gh ! hole1 & ! /ylet be+ )drawn1 ! ?read is c>ri$ ) x into ! ph>ynx & ?r\gh ! no/ril1 :]e x c be us$ to draw ! plug into its place at ! po/]ior n>es4 ,too? ,draw+4--,a surgeon is frequ5tly requir$ to draw a too? on em]g5cy1 & %\ld be provid$ ) in/rum5ts 7see fig4 #ge74 ,sev5 pairs ( =ceps & an elevator are suffici5t = all he is likely to deal )4 ,!y are diff]5tly %ap$ = ! diff]5t tee?1 :i* v>y mu* at ! neck1 ! "p grasp$ 9 ! =ceps4 ,illu/ration3 ,fig4 #ge4--,too? ,=ceps4 ,= ! op]ation ! pati5t %\ld be seat$ 9 a high-back$ *air2 ! surgeon /&s at 8 "r side1 holds ! jaw ) 8 left h&1 :ile ) ! "r he ?ru/s ! beaks ( ! =ceps betwe5 ! gum & ! too? on its l+ual & buccal aspects2 hav+ rea*$ ! neck1 he holds ! too? firmly1 pu%+ x inw>ds & outw>ds ) a rot>y motion ( ! wri/ 7except = ! mol> tee?74 ,sudd5 tugs break ! too? & leave ! fang beh9d2 :5 loos5$ by rotation & lat]al motion1 ! =ceps readily lift ! too? out ( its socket4 ,= ! upp] incisors ! beaks ( ! =ceps are /raight1 slightly holl[$ inside1 to give !m hold ( ! tee?1 & h cresc5tic edges 7see fig4 #gf74 ,! upp] incisors & can9es c be drawn by ! same pair1 z ! %ape ( ^! tee? at ! neck v>ies to a small ext5t4 ,= ! l[] incisors a v n>r[ =ceps is necess>y4 ,! beaks 7fig4 #gg7 %\ld be curv$ at ! jo9t suffici5tly to =m an angle ( #be ) ! h&les1 t ! latt] may cle> ! upp] jaw4 ,! edge ( ! beaks is cresc5tic1 simil> to t ( ! upp] incisors4 ,^! =ceps are also v useful = remov+ roots1 z _! f95ess enables !m to s9k betwe5 ! /ump & ! alveolus ) ease4 ,illu/ration3 ,fig4 #gf4--,upp] incisor too? & =ceps4 ,illu/ration3 ,fig4 #gg4--,l[] c5tral incisor & =ceps4 ,illu/ration3 ,fig4 #gh4--;,ext]nal aspect ( upp] bicuspid too?1 & bicuspid =ceps4 ,= ! bicuspids1 beaks ) cresc5tic edges also are us$1 b ! inside ( ! beak is m holl[$ to fit ! r\nd neck ( ^! tee? 7see fig4 #gh74 ,all ! bicuspids c be drawn ) ! same pair1 b x is conv5i5t to h =ceps b5t at ! jo9t to cle> ! upp] jaw :5 extract+ a l[] bicuspid 7see fig4 #gi74 ,illu/ration3 ,fig4 #gi4--,l[] bicuspid =ceps4 ,= ! upp] mol>s two =ceps are requir$1 "o = ea* side ( ! jaw2 ! beaks ( ^! are well holl[$ to admit ! cr[n ( ! too?4 ,! inn] beak t]m9ates 9 a cresc5tic bord] to fit ! l>ge int]nal fang 7see figs4 #hj #ha72 ! out] beak has two small] grooves sep>at$ by a po9t1 t passes betwe5 ! two ext]nal fangs4 ,9 draw+ ^! tee? ! =ceps %\ld be ?ru/ z high z possible & held firmly1 :ile ! fangs are loos5$ by mov+ ! too? f side to side1 b f ! multiplicity ( fangs1 rot>y motion is n available4 ,illu/ration3 ,fig4 #hj4--,left upp] mol> too? & =ceps4 ,illu/ration3 ,fig4 #ha4--,"r upp] mol> =ceps4 ,! wisdom mol>s are (t5 difficult to seize f be+ almo/ buri$ 9 ! jaw2 z !y resemble a bicuspid 9 %ape1 bicuspid =ceps 7fig4 #gh7 %\ld be employ$2 if ?is fails to p5etrate betwe5 ! too? & ! alveolus1 ! n>r[ incisor =ceps 7fig4 #gg7 c be driv5 up till x grasps ! too?4 ,n unfrequ5tly ! fang ( ?is too? 9 ! l[] jaw is curv$ backw>ds & prev5ts extraction :5 ! too? has be5 loos5$2 ?is difficulty may be ov]come by pu%+ ! cr[n ( ! too? a little backw>ds s z to tilt ! fang =w>ds out ( place4 ,:5 ! mol>s are closely set1 or ! too? to be extract$ is ov]hung by its neighb\r1 x is (t5 difficult to avoid te>+ ! gum ext5sively & ev5 c>ry+ away m ?an "o too?2 te>+ ! gum is easily avoid$ by lanc+ x be=e apply+ ! =ceps1 & sl[ & /eady movem5ts ( ! wri/ usually prev5t ! latt] accid5t1 or ! ov]hang+ too? may be fil$ away be=e ! =ceps are appli$4 ,! inf]ior mol>s 7fig4 #hb7 h =ceps1 ^: beaks are d\bly groov$ & po9t$1 to enable !m to seize ! neck on ea* side betwe5 ! two fangs4 ,illu/ration3 ,fig4 #hb4--;,inf]ior mol> too? & =ceps4 ,illu/ration3 ,fig4 #hc4--;,elevator4 ,9 rais+ /umps1 s mu* decay$ t ! =ceps w n hold !m1 ! elevator mu/ be employ$2 ?is in/rum5t 7fig4 #hc71 /raight1 po9t$1 & a little groov$ at ! po9t1 is ?ru/ d[n betwe5 ! alveolus & ! too?2 ! jaw be+ !n ! fulcrum1 ! elevator is ! lev] to pu% =w>ds ! fang2 :5 ?us loos5$ x is easily lift$ out4 ,9 work+ ) an elevator !re is "s risk ( ?ru/+ ! po9t ?r\gh ! alveolus1 & w\nd+ ! tongue or floor ( ! m\?1 h5ce x %\ld always be guid$ & cov]$ by ! left =ef+]4 ,9 remov+ ! fangs ( incisors ! n>r[ =ceps are mo/ useful1 & %\ld x n be possible to p5etrate betwe5 ! fang & ! alveolus1 ! alveol> bord] may be includ$ 9 ! grasp ( ! =ceps & br\ght away ) ! too?4 ,! injury ?us inflict$ is v unimportant & mu* pa9 is sav$4 ,aft] ! too? is extract$ ! m\? %\ld be well wa%$ ) w>m wat] a few times1 ! att5d+ ble$+ be+ ( no importance1 except 9 individuals ( hmorrhagic dia!sis1 9 :om measures %\ld be at once tak5 to arre/ ! fl[4 ,to /op a ble$+ socket ! alveolus mu/ be well cle>$ ( clots1 & fragm5ts ( sponge1 soak$ 9 a solution ( p]*loride ( iron1 "o "p ( ! salt to ?ree ( wat]1 pack$ into ! cavity4 ,a plug ( cork is plac$ betwe5 ! jaws1 & a f\r-tail$ b&age 7see page #cb7 c>ri$ r\nd ! head to keep !m firmly clos$4 ,%\ld ?is plan fail1 ! socket mu/ be cle>$ aga91 & ! wire ( ! galvanic caut]y pu%$ well d[n to ! bottom & !n heat$ till x has caut]is$ ! cavity 7see page #afh74 ,nipple ,%ields & ,artificial ,nipples made ( flexible ivory1 vulcaniz$ india-rubb]1 c41 are requir$ :5 ! nipple is *af$ & excoriat$ by ! *ild's suck+1 especially if 8 m\? be attack$ by ?ru%1 z is usually ! case4 ,:5 ! nipple is sore x %\ld be well wa%$ & dri$ aft] suckl+1 cov]$ ) glyc]9e ( />* or pla/ic collodion & protect$ by a %ield4 ,if mu* inflam$ x may be wrapp$ 9 l9t dipp$ 9 alum wat] or solution ( sulphate ( z9c 7"o gra9 to ! ounce71 & deep *9ks %\ld be freely rubb$ ) lun> cau/ic4 ,! brea/ %\ld be regul>ly empti$ by ! brea/-pump if ! *ild's suck+ gives mu* pa91 le/ ! accumulation ( milk 9 ! ducts cause milk abscess4 ,plugg+ ! ,vag9a is employ$ 9 cases ( rapid hmorrhage f ! womb1 c4 ,app>atus4--#a4 ,a silk pocket-h&k]*ief4 #b4 ,a dry new f9e sponge or pellets ( cotton wool4 #c4 ,silk ?read4 #d4 ,a body roll] or fold$ %eet4 ,! sponge %\ld be cut into pieces ! size ( nuts2 if ! sponge is compress$ x answ]s bett]4 ,:5 prep>$1 ! vag9a %\ld be cle>$ ( coagula by a syr+eful ( ice-cold wat]2 ! h&k]*ief1 unfold$ & ?r[n ov] ! "r h&1 is pass$ up ! vag9a till its c5tre rea*es ! os ut]i1 ! bord]s & ends !n project f ! vag9a4 ,! int]ior ( ! h&k]*ief is next fill$ by firmly pack+ ! sponge 9 bit by bit until ! vag9a is di/5d$ by ! mass2 ! ends ( ! h&k]*ief are !n ti$ toge!r4 ,! sponge swells z x absorbs ! blood1 & compresses ! ble$+ vessels by its di/5tion4 ,! abdom5 & ut]us are !n support$ by a body roll]1 or fold$ %eet1 wrapp$ tightly r\nd ! hips & wai/1 :ile ! pati5t1 lightly clad1 is kept quiet 9 a cool *amb]4 ,:5 ! plug has answ]$ its purpose x is remov$1 by )draw+ ! sponge bit by bit1 & ! vag9a is wa%$ ) tepid wat]4 ,! kite's-tail plug4--,masses ( cotton wool ! size ( a h5's egg are ti$ at two in*es di/ance f ea* o!r along a long /r+4 ,:5 ab\t a doz5 are ti$ on1 a speculum is introduc$1 & ! fir/ ball ( wool is pass$ to ! ble$+ po9t & pu%$ firmly aga9/ x1 & !n ano!r1 & s on1 until ! vag9a is firmly pack$4 ,an end ( /r+ is left hang+ out ( ! vulva1 :]eby ! plug may be remov$ :5 necess>y4 ,ea* mass comes away successively ) ease z ! /r+ is pull$ out ( ! vag9a4 ,inject+ ! ,ure?ra (t5 fails f ! ineffici5t mode 9 :i* x is done4 ,! syr+e employ$ %\ld be %ort en\gh to be work$ easily ) "o h&1 & ne$ n conta9 m ?an "o or two tea-spoonfuls1 z ! capacity ( ! ure?ra does n exce$ t am\nt4 ,"o ( su* a size is j #b in*es 9 l5g?1 & easily work$ by "o h&4 ,! op5+ ?r\gh ! nozzle %\ld also be wide1 t a =cible /ream may be inject$ into ! ure?ra4 ,! pati5t %\ld fill ! syr+e1 !n place on a *air or /ool be=e him a *amb] pot1 &1 hav+ j made wat] to cle> out ! dis*>ge collect$ 9 ! ure?ra1 he ins]ts ! slightly bulb\s nozzle into ! meatus ur9>ius4 ,he !n grasps ! sides ( ! glans ) ! left =ef+] & ?umb to close ! m\? ( ! passage4 ,! "r =ef+] next presses d[n ! pi/on sl[ly1 s t ! :ole ( ! injection passes into ! canal & di/5ds x2 keep+ ! meatus %ut ) 8 left f+] & ?umb1 ! pati5t lays d[n ! syr+e & rubs ! "u "p ( ! p5is backw>ds & =w>ds1 t ! injection may be =c$ into any folds or follicles ( ! muc\s membrane4 ,hav+ ?us occupi$ ab\t ?irty seconds1 he releases ! m\? ( ! passage1 :5 ! fluid is eject$ %>ply into ! vessel plac$ ready to receive x4 ,?is rapid ejection is a te/ ( ! prop] p]=mance ( ! op]ation4 ,9 c\nsell+ ! use ( a/r+5t solutions1 ! surgeon %\ld always caution ! pati5t n to employ "o t produces sev]e sm>t+1 :i* la/s m ?an a few m9utes aft] injection4 ,if x causes mu* pa91 ! solution is too /rong4 ,ca!t]s & ,b\gies4--,silv] ca!t]s are made 9 sizes1 increas+ f ,no4 to ,no4 #ab1 ! fir/ hav+ a diamet] ( #jfd in*1 ! latt] #jbe in*4 ,l>g] ones ?an ^! are seldom employ$4 ,illu/ration3 ,fig4 #hd4--,silv] ca!t]4 ,illu/ration3 ,fig4 #he4--;,engli% ,flexible ca!t]4 ,! curve pref]r$ by diff]5t surgeons v>ies mu*2 t depict$ 9 fig4 #hd is ! "o us$ by ,sir ,h5ry ,?ompson2 x beg9s at #c in*es f ! po9t1 & ends :5 ! po9t is at "r angles ) ! /em4 ,ea* ca!t] is fitt$ ) a wire /ylet4 ,! flexible ca!t]s are ( _m k9ds2 ! ,engli% gum-ela/ic 7fig4 #he71 ! ,fr5* black flexible 7fig4 #hf71 & ! vulcanis$ india-rubb] 7fig4 #hg71 ca!t]s1 be+ ! ?ree v>ieties mo/ g5]ally employ$4 ,engli% flexible ca!t]s %\ld be kept on /ylets well curv$ at ! la/ #c in*es1 t1 :5 ! /ylet is )drawn1 = ! ca!t] to be pass$1 ! latt] may reta9 suffici5t curve to pass ov] ! neck ( ! bladd] easily4 ,illu/ration3 ,fig4 #hf4--;,fr5* bulb\s-end$ ca!t]4 ,illu/ration3 ,fig4 #hg4--,vulcanis$ india-rubb] ca!t]4 ,s\nds are solid1 be+ ( /eel1 plat$ or gilt4 ,_! curve v>ies1 & is g5]ally #bj or #cj degrees m obtuse ?an t ( ! ca!t]s4 ,b\gies are made ( ! same mat]ials z ! flexible ca!t]s2 !y are kept /raight1 & ! m supple !y are ! bett]1 ! black bulb\s-end$ b\gies be+ ! mo/ useful v>iety = dilat+ ! ure?ra4 ,illu/ration3 ,fig4 #hh4--,! ,olive-head$ b\gie4 ,olive-head$ ,b\gies 7,b\gies olivaires7 are us$ = explor+ ! ure?ra 9 cases ( gleet1 :]e ! dis*>ge is (t5 kept up by a /ricture or a t5d] pat* ( *ronic inflammation ( ! muc\s membrane4 ,!y are made ( metal1 or ( black gum m\nt$ on a v flexible lead5 wire2 ! latt] k9d are f> pref]able4 ,! /em ( ! in/rum5t is sl5d]1 no bigg] ?an a ,no4 #c or ,no4 #d b\gie2 ! end t]m9ates 9 a conical po9t ab\t or ( an in* long1 exp&+ at its base to any requir$ size4 ,^! b\gies are mo/ useful f ,no4 #d to ,no4 #af ( ! ,engli% scale1 or f ,no4 #aj to ,no4 #bd ( ! millimetrical scale4 ,! /em %\ld be m>k$ ) :ite r+s an in* ap>t1 s t :5 ! in/rum5t is pass+ ov] a t5d] "p1 or is arre/$ by a /ricture1 ! di/ance ( ! imp$im5t d[n ! ure?ra c be at once e/imat$4 ,9 )draw+ ! in/rum5t1 ! wide base ( ! olive %[s ! exact position & l5g? ( ^? /rictures :i* are n too n>r[ = ! olive-head to slip by1 = x is nipp$ by ! /ricture & releas$ z soon z ! n>r[+ is pass$4 ,by us+ in/rum5ts l>ge en\gh to fill ! normal ure?ra1 an induration b5ea? ! muc\s membrane c be detect$ 9 its e>lie/ /age be=e x has produc$ symptoms diagno/ic ( /ricture4 ,rigid in/rum5ts h "o advantage ov] flexible ones1 9 t _! po9ts c be guid$ by ! surgeon2 ! po9ts ( flexible in/rum5ts _c be direct$1 h5ce ! introduction ( ! latt] into a /ricture is less easily manag$1 consequ5tly b\gies ) v>i\s k9ds ( po9ts %\ld be kept4 ,b flexible in/rum5ts cause f> less irritation ?an rigid ones1 & %\ld always be employ$ in/ead ( ! latt] :5 possible3 ) pati5ce & practice mu* ( ! difficulty att5d+ _! introduction is ov]come4 ,! ,fr5* b\gies1 ) tap]+ ends & bulb\s po9ts1 slip m easily ?r\gh a /ricture ?an in/rum5ts hav+ ! same diamet] ?r\gh\t1 & b\gies ) f9e tap]+ po9ts c sometimes be introduc$ :]e o!rs fail4 ,pass+ ,ca!t]s4--,9 pass+ in/rum5ts along ! ure?ra ! con=mation ( its int]ior %\ld be borne 9 m9d4 ,f ! meatus to ! triangul> ligam5t1 ! normal ure?ra1 :5 g5tly /ret*$1 becomes a /raight tube2 hav+1 nev]!less1 j )9 ! meatus1 a p\* 9 ! ro(1 ! lacuna magna1 :]e ! po9t ( ! in/rum5t may cat* if n turn$ d[nw>ds4 ,at ! bulb\s "p ! ure?ra enl>ges 9 capacity by hav+ a slight d[nw>d curve 9 its floor1 j be=e ! triangul> ligam5t is rea*$4 ,9 ?is depression1 ! beak ( ! ca!t] is apt to s9k bel[ ! level ( ! passage ?r\gh ! ligam5t1 :i* is always a fix$ po9t4 ,beyond ! triangul> ligam5t ! ure?ra curves g5tly upw>ds1 has a floor beset ) irregul>ities1 9 :i* ! po9t ( ! in/rum5t easily cat*es1 if n rais$ z x passes along ! curve4 ,a ,silv] ,ca!t] is pass$ mo/ easily :ile ! pati5t is 9 a horizontal position1 ) ! %\ld]s l[ & ! ?ighs sep>at$4 ,! surgeon /&s on ! left side ( ! pati5t1 & holds ! ca!t]1 previ\sly w>m$ & lubricat$ ) oil or l>d1 lightly betwe5 ! ?umb & two fir/ f+]s ( ! "r h&1 ! beak d[nw>ds & ! /em across ! pati5t's left gro94 ,!n tak+ ! p5is betwe5 ! middle & r+ f+]s ( ! left h&1 ! palm be+ upw>ds1 he pu%es back ! =esk9 ) ! ?umb & =ef+]1 & /eadies ! meatus :ile introduc+ ! beak ( ! ca!t]4 ,?is done1 he draws ! p5is g5tly along ! ca!t] z ! po9t is l[]$ to ! p]9um1 b )\t rais+ 8 "r wri/ until ! in/rum5t has travell$ #e or #f in*es along ! passage & rea*$ ! triangul> ligam5t4 ,! surgeon !n c>ries 8 "r wri/ to ! middle l9e ( ! pati5t's body1 & :ile pu%+ ! po9t onw>ds1 raises ! h& r\nd a curve till x aga9 s9ks betwe5 ! pati5t's ?ighs4 ,:5 ! bladd] is rea*$ he )draws ! /ylet t ! ur9e may escape4 ,?ree po9ts ( difficulty are usual 9 pass+ ca!t]s2 ! lacuna magna j )9 ! meatus1 ! triangul> ligam5t1 & ! pro/atic "p ( ! ure?ra j be=e ! bladd] is rea*$4 ,! fir/ is escap$ by keep+ ! beak along ! floor ( ! ure?ra = ! fir/ two in*es2 ! second is be/ avoid$ by rais+ ! wri/ z ! in/rum5t passes ! triangul> ligam5t1 & direct+ ! beak aga9/ ! upp] surface ( ! ure?ra1 le/1 be+ 9 ! enl>g$ bulb\s "p1 x s9k bel[ ! op5+ 9 ! ligam5t2 ! ?ird difficulty is ov]come by depress+ ! h& well z ! po9t approa*es ! bladd]4 ,to pass ! ca!t] 9 ! upright position1 ! pati5t is plac$ aga9/ a wall or firm object1 ) 8 heels eight or t5 in*es ap>t & five f ! wall1 t he may re/ easily dur+ ! op]ation4 ,! surgeon sets himself opposite ! pati5t & grasps ! p5is ) ! two middle f+]s ( ! left h&1 ! palm upw>ds2 he next exposes ! meatus ) ! ?umb & =ef+]1 & 8 "r h& hold+ ! ca!t] by its middle obliquely across ! left side ( ! pati5t1 he draws ! p5is on to ! in/rum5t till ! triangul> ligam5t is ga9$4 ,he !n c>ries ! %aft ( ! ca!t] to ! middle l9e &1 hold+ x by its end1 br+s ! "r h& d[nw>ds & =w>ds1 to c>ry ! po9t upw>ds ov] ! ob/ruction at ! neck ( ! bladd]4 ,! op]ation %\ld be done sl[ly & ) great g5tl5ess1 giv+ ! ure?ra "t 8to swall[ ! in/rum5t10 z ! ,fr5* surgeons express x4 ,ha/y or =cible movem5ts t5d to ?ru/ ! po9t aga9/ ! wall ( ! ure?ra1 :]e x hit*es1 if x does n p5etrate & make a false passage4 ,h[ev] easy ! introduction may h be51 ! )drawal ( ! ca!t] %\ld be always done sl[ly to avoid giv+ pa9 to ! pati5t4 ,:5 ! canal sudd5ly contracts1 z f a /ricture1 ! po9t ( ! s\nd (t5 /ops at ! ob/ruction2 by )draw+ ! in/rum5t a little1 & div]t+ its po9t to ano!r side or along ! upp] "p ( ! ure?ra1 a "p :]e ! ob/ruction is less abrupt w (t5 be f\nd to let ! ca!t] glide into ! /ricture4 ,! floor ( ! ure?ra %\ld always be avoid$1 z false passages ne>ly always bran* (f f ! floor close to ! /ricture4 ,difficult n>r[ /rictures are mo/ easily ov]come by inject+ a dra*m ( w>m olive oil into ! ure?ra1 & !n pass+ f9e black gum or :alebone b\gies 7b\gies fili=mes7 along ! ure?ra4 ,^!1 f _! f95ess 7_! diamet] is only or ( a millimetre1 ab\t #a_/ajj in*71 are v apt to cat* 9 false passages2 if s1 ! b\gie %\ld be left engag$ 9 ! false passage1 & held 9 ! left h& :ile ano!r b\gie is pass$ along ! ure?ra2 if1 9 its turn1 ?is "o gets into a false passage1 x also %\ld be left1 & a ?ird pass$2 & s on till all ! false r\tes are occupi$1 or a b\gie ent]s ! /ricture & rea*es ! bladd]1 :i* is kn[n by ! read9ess ) :i* x w pass backw>ds & =w>ds4 ,! o!r b\gies %\ld !n be )drawn1 & ! b\gie :i* has pass$ ! /ricture be ti$ 9 = tw5ty-f\r h\rs1 until ! passage is suffici5tly dilat$ to all[ a small ca!t] to replace x4 ,if ! pati5t is n suff]+ f ret5tion ( ur9e1 !re ne$ be no anxiety ab\t evacuat+ 8 bladd]1 z ur9e w f9d its way alongside ! b\gie :5 he attempts to make wat]4 ,9 pass+ to relieve ret5tion1 ,no4 ,engli% flexible ca!t] %\ld be us$ in/ead ( b\gies2 b :5 ! /ricture is too n>r[ = ^!1 a b\gie may /ill be tri$1 z ! ur9e w g5]ally dribble alongside ! b\gie ) suffici5t rapidity to relieve ! pati5t4 ,engli% flexible ,ca!t]s %\ld be kept on /ylets curv$ z repres5t$ 9 fig4 #he1 t ! fir/ #c in*es ( ! in/rum5t1 :5 ! /ylet is )drawn1 may reta9 suffici5t curve to ride ov] ! imp$im5t at ! neck ( ! bladd]4 ,9 w>m wea!r1 aft] be+ oil$1 !y %\ld be dipp$ 9 cold wat] j be=e us+1 to r5d] !m a little /iff]1 & less likely to lose _! curve :ile trav]s+ ! ure?ra4 ,!y may also be pass$ :ile ! pati5t lies or /&s1 & ! movem5ts are ! same z = ! silv] ca!t]4 ,bulb\s-end$ or probe-end$ ,ca!t]s & ,b\gies 7,b\gies b\le7 are always /raight2 _! suppl5ess1 _! tap]+ ends1 & _! smoo? r\nd$ po9t enable !m to glide along ! ure?ra1 & to accommodate !mselves readily to ! w9d+s ( ! passage2 = :i* reason !y are ! easie/ to pass bo? = ! pati5t & ! surgeon4 ,9 pass+ !m !y are slightly w>m$1 if ! wea!r is cold1 to re/ore _! flexibility1 & g5tly pu%$ along ! canal till ! bladd] is rea*$4 ,vulcanis$ ,india-,rubb] ,ca!t]s 7fig4 #hg7 are us$ :5 ! bladd] is to be kept empty2 _! suppl5ess r5d]s !m v unirritat+1 & z phosphates cru/ on !m v sl[ly1 !y may be worn = a week )\t be+ *ang$4 ,!y are easily pass$ by ?read+ !m on a /ylet ) ! appropriate curve1 & lubricat+ !m ) :ite ( egg or wat]1 n ) grease1 :i* injures !m4 ,! /ylet is )drawn aft] !y are pass$4 ,to pass a ,ca!t] 9 ! ,female4--,! pati5t may lie on "o side or on h] back2 if on h] side ! knees %\ld be well drawn up2 if on h] back1 ! ?ighs mu/ be some:at sep>at$4 ,be=e introduc+ ! ca!t]1 a w9e bottle or n>r[-neck$ b$ ur9al %\ld be plac$ 9 ! b$ ready to receive ! ur9e4 ,if ! ord9>y slightly curv$ female ca!t] be n at h&1 a ,no4 #g or #h flexible "o does j z well4 ,hav+ oil$ ! in/rum5t1 g to ! pati5t's back1 & take ! ca!t] 9 ! "r h& if ! pati5t lies on h] "r side1 & 9 ! left h& if %e lies on h] left side2 if %e lies on h] back1 g to ei!r side & take ! ca!t] 9 ! h& ne>e/ h] feet4 ,hold ! /em ( ! ca!t] 9 ! palm1 s t ! beak lies aga9/ ! tip ( ! =ef+]1 :ile ! ?umb & second & ?ird f+]s grasp ! /em4 ,!n pass+ ! h& "u ! b$-clo!s1 seek ! buttock2 f t pass ! =ef+] to ! p]9um1 & let x ent] ! vulva1 keep+ ! back ( ! f+] aga9/ ! po/]ior "p1 !n pass x betwe5 ! nymph to ! entry ( ! vag9a4 ,?is is kn[n by ! tip ( ! =ef+] be+ lightly grasp$1 unless ! vag9a is v wide4 ,keep+ ! f+] j )9 ! entry1 feel = ! ar* ( ! pubes 9 front2 hav+ f\nd ?is1 )draw ! tip ( ! f+] slightly f ! vag9a3 9 do+ ?is1 x w /rike a small projection ( muc\s membrane hang+ j at ! ant]ior m>g9 ( ! entry4 ,keep ! f+] /eady aga9/ ?is1 :ile ! o!r h& pu%es ! ca!t] g5tly onw>ds1 :i* !n r>ely fails to ent] ! ure?ral op5+ close above ! projection ( muc\s membrane4 ,hav+ p5etrat$ ! ure?ra1 arrange ! ca!t] 9 ! receptacle = ! ur9e1 & pu% ! in/rum5t into ! bladd]4 ,to ,wa% out ! ,bladd]4 ,app>atus4--#a4 ,a flexible ca!t]2 ,nos4 #h or #i are conv5i5t sizes2 b a small] "o c be employ$4 #b4 ,a ca\t*\c bottle1 hold+ six ounces1 & fitt$ ) a tap]+ nozzle & /op-cock4 7,fig4 #hi47 ,illu/ration3 ,fig4 #hi4--;,ela/ic india-rubb] bottle = inject+4 ,dur+ ! op]ation ! pati5t %\ld /&1 if possible1 z ! mucus is ?us m easily cle>$ f ! bladd]4 ,! surgeon fir/ fills 8 bottle completely ) tepid wat]1 t no air may rema92 !n direct+ 8 pati5t to /& aga9/ a wall or "s firm object1 passes ! ca!t] & draws (f ! ur9e4 ,he next ins]ts ! nozzle into ! ca!t]1 &1 turn+ ! cock1 compresses ! bottle sl[ly until two or ?ree ounces ( wat] h run into ! bladd]2 ?is he lets escape by remov+ ! bottle = a m9ute1 & !n repeats 8 op]ation till ! wat] returns cle>1 )\t exhau/+ ! pati5t's /r5g?4 ,?ree or f\r small injections wa% ! s$im5t & mucus f ! bladd] z quickly1 & ) f> less fatigue or risk ( spasm ?an a prolong$ fl[ ( wat] ?r\gh a /iff d\ble curr5t ca!t]4 ,9 ?is way ! bladd] may be wa%$ twice or ?rice daily to ! great com=t ( ! pati5t4 ,injections ( solutions ( nitrate ( silv]1 c>bolic acid1 alum1 c41 9 ! proportion ( #a "p to #ajj1 or to #ej ( wat]1 c be us$ in/ead ( wat] = ?is purpose4 ,to ,tie 9 a ,silv] ,ca!t]4 ,app>atus4--#a4 ,a few y>ds ( tape in* wide4 #b4 ,a roll]4 #c4 ,a spigot ( wood2 or1 #d4 ,a y>d & a half ( f9e india-rubb] tub+4 ,illu/ration3 ,fig4 #ij4--;,a silv] ca!t] ti$ 9 ! ure?ra4 ,a n>r[ roll] is ti$ r\nd ! hips2 f ?is1 on ea* side1 a tape is pass$ r\nd ! ?igh at ! gro91 & fa/5$ be=e & beh9d to ! roll] r\nd ! hips 7see fig4 #ij72 a n>r[ tape run ?r\gh ! r+s ( ! ca!t] connects !m ) ! loops 9 ! gro9s4 ,! tapes are ti$ %ort en\gh to prev5t ! ca!t] slipp+ out2 a y>d or two ( n>r[ india-rubb] tub+1 fix$ on to ! end ( ! ca!t]1 conveys ! ur9e to a pan "u ! b$1 & keeps ! b$ dry1 or a spigot ( wood fitt$ to ! ca!t] may be ins]t$1 = ! pati5t to draw out :5 he desires to void 8 ur9e4 ,to ,tie 9 a ,flexible ,ca!t]4 7,fig4 #ia47 ,app>atus4--#a4 ,a piece ( s(t tw9e1 or ,b]l9 wool1 ab\t #ae in*es long4 ,illu/ration3 ,fig4 #ia4--;,a flexible ca!t] ti$ 9 ! ure?ra2 ! /r+ fa/5$ beh9d ! corona gl&is1 & conceal$ by ! =esk94 ,a ca!t] is fir/ pass$ into ! bladd]1 & ! ur9e runs (f4 ,! ca!t] is !n g5tly )drawn1 till ! /ream ceases1 t ! end ( ! in/rum5t may rema9 j )\t ! neck ( ! bladd]4 ,! /r+ %\ld be ti$ r\nd ! ca!t] an in* f ! meatus1 its ends ga!r$ toge!r & ti$ 9 a knot ab\t #a in* f>!r on4 ,! =esk9 is !n drawn back1 ! ends pass$ b5ea? ! glans & ti$ r\nd ! p5is beh9d ! corona2 ! sup]flu\s /r+ is snipp$ (f1 & ! =esk9 br\ght =w>d4 ,! ca!t] is cut (f obliquely an in* beyond ! /r+ & !n /opp$ ) a spigot1 direction be+ giv5 to ! pati5t to )draw ! spigot1 & pu% ! ca!t] a little fur!r 9 :5 he wants to make wat]4 ,to ,tie a ,pati5t 9 ,position = ,li?otomy4 ,app>atus4 ,two b&ages1 ea* #c y>ds long & #b in*es wide1 ( calico or saddle-gir?1 ) tapes sew$ on ! ends4 ,illu/ration3 ,fig4 #ib4--,ty+ = li?otomy4 ,! pati5t is laid on 8 back1 a slip-knot made 9 ! middle ( ! b&age & pass$ ov] ! wri/2 ! h& is !n made to grasp ! foot1 ! ?umb above1 ! f+]s "u ! sole 7fig4 #ib72 "o end ( ! b&age is c>ri$ beh9d & inside ! ankle to ! dorsum ( ! foot1 :]e x meets ! o!r end pass+ 9 front ( ! ankle4 ,! ends are !n c>ri$ "u ! sole1 br\ght up & ti$ 9 a d\ble b[ ov] ! back ( ! h&4 ,b$sores are be/ treat$ by great cleanl9ess1 & by wa%+ ! sk9 expos$ to ! dis*>ges ) _s ( w9e e day4 ,br[n-,sequ>d recomm5ds cold & heat to be appli$ daily1 by means ( an ice bag = t5 m9utes1 foll[$ by a w>m p\ltice = an h\r4 ,! pressure ( ! sk9 ov] ! sacrum or tro*ant]s is prev5t$ by a r+ ( s(t ?ick felt1 cov]$ on "o side ) adhesive pla/]1 & appli$ l a corn pla/] ar\nd ! prom95t bone4 ,9 addition to ^! local applications1 ! pressure ( ! body %\ld be ev5ly di/ribut$ ov] its "u surface by plac+ ! pati5t on a wat] cu%ion1 or1 bett]1 on ,arnott's wat]-b$4 ,illu/ration3 ,fig4 #ic4--,wat]-b$4 ,arnott's ,float+ ,b$4--,9 ! hydro/atic or float+ b$ ( ,dr4 ,arnott1 ! pati5t floats on ! surface ( a tr\gh ( wat]1 into :i* he s9ks until he has displac$ 8 own weight ( wat]2 8 float+ app>atus1 or raft1 s to speak1 be+ a %eet ( wat]pro(+1 & a ?9 mattress or fold$ blanket1 on :i* he lies4 ,! b$ consi/s ( a tr\gh runn+ on l>ge ca/ors1 ab\t #h feet long1 #b feet #h in*es wide1 & #a deep1 ) a tap at ! bottom = lett+ out ! wat]1 & a sp\t 9 "o corn] to fill x by4 ,ov] ! top a mac9to% clo? is spread1 its edges be+ firmly nail$ to ! m>g9 ( ! tr\gh1 b ! clo? is left slack en\gh to float easily on ! surface ( ! wat] :5 ! tr\gh is p>tly fill$4 ,?is slackness is requisite to all[ ! wat] displac$ by ! weight ( ! pati5t's body to rise up ar\nd him )\t tight5+ ! clo?1 or ! float+ pr9ciple ( ! b$ is n c>ri$ out1 & ! pressure ( ! pati5t's weight n ev5ly di/ribut$ ov] 8 body 7see fig4 #ic74 ,?ree or f\r blankets are laid ev5ly ov] ! mac9to%1 & ^! aga9 protect$ f ! moi/ure ( ! pati5t by a mac9to% "u-%eet4 ,if a mattress is us$1 x mu/ be v ?91 & supple en\gh to let ! surface ( ! wat] adju/ itself to ! pati5t's body & receive ! pressure ev5ly4 ,! wat] employ$ to fill ! ba? %\ld be ab\t #ej4 ,illu/ration3 ,fig4 #id4--,wat]-cu%ion4 ,wat] ,cu%ions are flat cu%ions ( /\t mac9to% clo?1 half or two-?irds full ( wat]1 & laid on ! mattress b5ea? ! blanket & %eet 7see fig4 #id74 ,!y are m portable ?an ! wat]-b$1 b !y are simply s(t pill[s1 & d n c\nt]-balance ! weight ( ! pati5t 9 ! mann] ( ! float+ b$4 ,! ,/oma*-,pump is us$ = empty+ ! /oma*1 or = inject+ fluid food :5 pati5ts refuse to swall[4 ,x consi/s ( a brass syr+e hold+ #d ounces1 ( :i* ! nozzle is connect$ ) two tubes1 "o at ! end1 ! o!r at ! side4 ,! passage ?r\gh ^! is direct$ by a valve :i* is gov]n$ by a lev] ly+ on ! b>rel 7see fig4 #ie74 ,:5 ! lev] is at re/1 ! curr5t passes 9 & out ( ! syr+e by ! lat]al tube2 :5 depress$1 by ! direct tube4 ,! ela/ic tubes ) smoo? nozzles1 ab\t #b feet long1 are fitt$ to ! syr+e4 ,!re is also a gag ( h>d wood1 hav+ a hole 9 ! middle1 ?r\gh :i* ! tube passes on its way to ! /oma*1 to protect x f ! pati5t's tee?4 ,illu/ration3 ,fig4 #ie4--,! /oma*-pump4 ,:5 ! pump is employ$ to remove ! cont5ts ( ! /oma*1 two wa%h&-bas9s are plac$ at h&1 "o empty1 "o full ( tepid wat]4 ,! pati5t is seat$ 9 a high-back$ *air to /eady 8 head2 "o assi/ant holds 8 h&s1 :ile a second screws ! small end ( ! gag betwe5 ! tee? & =ces op5 ! m\?1 across :i* x is !n easily fix$4 ,! flexible tube1 be+ well oil$1 is next pass$ across ! ph>ynx & d[n ! gullet sl[ly & cauti\sly1 )\t /ay+ = any ef=t ( vomit+ x may induce2 :5 ab\t #bj in*es are pass$ ?r\gh ! gag ! nozzle has rea*$ ! /oma*4 ,fir/1 two or ?ree syr+efuls ( wat] are inject$ into ! /oma*2 !n1 remov+ ! second tube f ! bas9 ( wat] to ! empty bas91 ! action ( ! syr+e is rev]s$1 by press+ on ! lev] z ! pi/on is rais$1 & lett+ x fly up :5 ! pi/on is depress$4 ,?us two syr+efuls may be )drawn1 !n fre% wat] is aga9 inject$ & )drawn1 until ! cont5ts ( ! /oma* are remov$ & ! wat] returns cle>4 ,precaution mu/ be always tak5 n to exhau/ f ! /oma* be=e wat] is inject$1 le/ ! coats ( t organ be injur$ by be+ suck$ aga9/ ! nozzle ( ! tube4 ,if desirable1 antidotes may be dissolv$ or susp5d$ 9 ! wat] inject$4 ,:5 ! pump is us$ = fe$+ pati5ts1 "o or two p9ts ( beef tea1 eggs beat5 ) milk or w9e1 ,liebig's s\p1 c41 are ! k9ds ( food suit$ = ! purpose4 ,ea* "t ! pump is us$1 x %\ld be ?or\ghly clean$ by syr++ ?r\gh x pl5ty ( w>m wat]1 & ! tubes mu/ be unscrew$ to wipe ! jo9ts c>efully4 ,transfusion ( ,blood4--,! po9ts ( greate/ importance 9 p]=m+ ?is op]ation are3-- #a4 ,t ! supply ( blood come f a vigor\s adult4 #b4 ,t ! transf] be made )9 two m9utes ( ! blood's escape f ! ve9 ( ! suppli]4 #c4 ,t1 to prev5t coagulation1 ! blood %\ld pass ov] z small a surface1 & suff] z little exposure z possible 9 transit4 #d4 ,c>e mu/ be tak5 to prev5t air ent]+ ! ve9 ) ! blood4 ,! app>atus describ$ bel[ is t devis$ by ,dr4 ,graily ,hewitt1 & depict$ 9 ! ,ob/etrical ,society's ,transactions = #ahfd1 page #acg4 ,x consi/s ( a glass syr+e hold+ two ounces 7fig4 #if71 ) a pi/on easily atta*$ & remov$2 its nozzle is curv$ & fits ! m\? ( a cannula ( silv]4 ,! nozzle ( ! syr+e is provid$ ) a little /opp] atta*$ by a *a92 a /ylet likewise fills ! cannula1 to be )drawn :5 ! blood is inject$ ?r\gh ! latt]4 ,illu/ration3 ,fig4 #if4--;,graily ,hewitt's syr+e = transfusion ( blood4 ,! success ( ! op]ation dep5ds 9 great measure on ! rapidity ) :i* x is p]=m$1 & requires ! aid ( two assi/ants t ! v>i\s /eps may foll[ ea* o!r z quickly z possible4 ,app>atus4--#a4 ,syr+e1 cannula & /ylet4 #b4 ,lancet4 #c4 ,scalpel4 #d4 ,=ceps4 #e4 ,?ree y>ds ( tape1 "o in* wide1 & l9t4 #f4 ,a silv] wire suture4 #g4 ,a bas9 ( cold wat]4 #h4 ,br&y & ,sal ,volatile4 ,/ep #a4 ,see t ! pi/on-rod works prop]ly 9 ! syr+e1 & t ! in/rum5t is fit = use2 !n place x 9 ! bas9 ( cold wat] ) ! cannula to lie till want$4 ,/ep #b4 ,place ! p]son supply+ ! blood on a c\* or easy *air 9 ! same *amb]1 b s t he _c see ! recipi5t1 le/ he fa9t & 8 blood consequ5tly fl[ feebly4 ,tie up ! arm z = v5esection2 lay ready ! lancet1 & direct ! assi/ant1 9 *>ge ( ! suppli] ( blood1 to keep 8 ?umb on ! ve9 :5 x is op5$1 t ! fl[ may be *eck$ :5 blood is n requir$4 ,/ep #c4 ,place a tape r\nd ! arm ( ! recipi5t1 above ! po9t = injection1 & ano!r bel[ x at a conv5i5t di/ance1 & lay b>e a ve9 7usually ! m$ian basilic7 = an in* & a half ( its c\rse2 hold+ ! ve9 by ! =ceps1 make a slit ) ! scalpel & introduce ! cannula1 :i* is !n intru/$ to ! second assi/ant4 ,! /ylet is )drawn1 & a m9ute drop ( blood escapes ?r\gh ! cannula1 %[+ t ! po9t has be5 prop]ly introduc$ into ! ve94 ,! assi/ant replaces ! /ylet & slack5s ! ligature1 :ile ! surgeon proce$s to fill 8 syr+e4 ,/ep #d4 ,! surgeon1 go+ to ! suppli] ( blood1 makes a l>ge op5+ 9 ! ve9 ) a lancet1 or if ! fir/ assi/ant be a surgeon also1 he may d ?is :ile ! *ief op]ator is prep>+ ! ve9 ( ! recipi5t4 ,:5 ! ve9 is op5 & ! blood fl[+ freely1 ! b>rel ( ! syr+e is inv]t$ ov] x & fill$ ) blood2 :5 full1 ! nozzle is /opp$ by ! plug & ! pi/on atta*$ :ile ! syr+e is c>ri$ to ! recipi5t4 ,/ep #e4 ,?is be+ rea*$1 ! plug is pull$ out1 ! nozzle ins]t$ into ! cannula1 & ! blood sl[ly inject$ by depress+ ! pi/on g5tly1 b )\t q empty+ ! syr+e4 ,a m9ute %\ld be sp5t 9 inject+ "o ounce & a half1 & a pause ( five m9utes ensue be=e a second supply is introduc$4 ,?is int]val may be employ$ 9 clean+ ! syr+e1 c41 & procur+ a fre% supply ( blood2 #c-d ounces ( blood are usually suffici5t1 b #aj ounces h be5 inject$ on "s occasions4 ,! p]turbation ( ! suppli] 7g5]ally a ne> fri5d ( ! recipi5t71 r5d]s x necess>y he %\ld dr9k freely ( br&y & wat]1 t ! blood fl[ =cibly :5 requir$4 ,/ep #f4 ,:5 suffici5t blood has be5 introduc$1 bo? pati5ts' w\nds are dress$1 z aft] v5esection 7see page #bj71 ! long incision ( ! recipi5t be+ clos$ by a po9t ( suture "u ! pad4 ,t\rniquets4--,t\rniquets are ( sev]al k9ds4 ,! ,r+ ,t\rniquet 7fig4 #ig7 is us$ :5 pressure is desir$ on ! ma9 art]y ( su* a limb z ! arm4 ,x is less easily displac$ ?an ! ,signoroni1 b1 l t1 soon becomes irksome by its cont9ual pressure4 ,illu/ration3 ,fig4 #ig4--,r+ t\rniquet4 ,:5 hmorrhage has to be tempor>ily arre/$1 t ( ,petit 7fig4 #ih7 is g5]ally us$4 ,x consi/s ( a /rap ( /\t webb+ & buckle1 t c be rapidly tight5$ by a few turns ( a screw4 ,to use ?is t\rniquet1 lay a roll] ov] ! art]y & c>ry ! end once or twice r\nd ! limb to /eady ! roll]1 !n pass ! /rap ov] ! roll]1 keep+ ! buckle ab\t two in*es away f ! screw & ! screw on ! ant]ior or out] aspect ( ! limb1 n ov] ! pad1 le/ t be displac$ :5 ! screw is tight5$4 ,! t\rniquet %\ld be screw$ up z quickly z possible1 t ! limb be n *>g$ ) blood by ob/ruct+ ! v5\s1 be=e ! art]ial fl[ is *eck$4 ,illu/ration3 ,fig4 #ih4--,petit's t\rniquet appli$ to ! popliteal art]y4 ,illu/ration3 ,fig4 #ii4--,! horse-%oe t\rniquet4 ,9 ,signoroni's ,horse-%oe t\rniquet 7fig4 #ii7 ! extremities ( ! %oe c be approximat$ to ea* o!r by a rack screw work+ a h+e4 ,! ends are furni%$ ) pads1 "o broad & flat to be> on ! limb away f ! art]y1 ! o!r r\nd$ to compress ! vessel itself4 ,?is t\rniquet does n arre/ ! :ole circulation 9 ! limb4 ,x c !re=e be appli$ = a long] "t ?an ,petit's4 ,h[ev]1 x easily slips out ( place1 & soon becomes v irksome & pa9ful4 ,illu/ration3 ,fig4 #ajj4--,li/]'s t\rniquet = compress+ ! aorta4 ,! ,abdom9al ,t\rniquet ( ,pr(essor ,li/] is a v effectual contrivance = compress+ ! aorta dur+ amputation ?r\gh ! hip jo9t1 & op]ations :]e a t\rniquet _c be plac$ on ! limb4 ,x consi/s 7see fig4 #ajj7 ( a semicircul> b>1 ) a broad pad to fit on ! lumb> v]tebr beh9d1 :ile 9 front x holds a long screw-p9 c>ry+ a pad4 ,?is in/rum5t passes r\nd ! left side1 & its pad is =c$ d[n into ! abdom51 "o in* to ! left ( ! umbilicus1 until ! aorta is compress$ aga9/ ! sp9e4 ,illu/ration3 ,fig4 #aja4--;,c>te's t\rniquets = femoral aneurism4 ,c>te's ,t\rniquets 7fig4 #aja7 are employ$ to control & dim9i% ! fl[ ( blood ?r\gh an aneurism4 ,!y are int5d$ to be worn = sev]al days1 & are fitt$ ) _m contrivances = obta9+ a cont9u\s pressure on ! art]y )\t completely arre/+ ! fl[ ( blood4 ,!y are always us$ 9 pairs2 9 ! figure1 "o presses ! ext]nal iliac on ! pubes1 ! o!r ! femoral art]y4 ,! fir/ is fa/5$ to ! body r\nd ! hips1 ! second r\nd ! ?igh4 ,!y are con/ruct$ z foll[s3 an arm atta*$ to a pad rea*es r\nd ! limb to ! art]y1 ov] :i* x supports a ball & socket jo9t turn+ 9 any direction1 b fix$ by a screw clamp4 ,?is jo9t has a long screw c>ry+ ! compress d[n to ! art]y4 ,!re is a little play ( ! screw 9 ! ball ( ! jo9t1 controll$ by india-rubb] b&s1 t ! compress may yield slightly be=e ! art]ial pulse4 ,9 ! solidification ( an aneurism by ?is means1 ! fl[ ( ! blood is int5d$ to cont9ue2 h5ce ! curr5t ?r\gh ! vessel ne$ n be completely ob/ruct$ by ! pressure ( ! t\rniquet1 & ! ela/ic b&s prev5t t pressure f becom+ insupportable4 ,:5 ! t\rniquets are appli$1 ! pati5t mu/ lie on a flat hair mattress1 h 8 limb well wa%$ & dri$1 lightly b ev5ly b&ag$1 & some:at rais$4 ,if ! ?igh is hairy x %\ld be %av$ :]e ! pads w press1 & du/$ ) p[d]$ ,fr5* *alk4 ,! t\rniquets are next adju/$1 z se5 9 fig4 #aja2 ! pati5t is taught to *ange ! pressure :5 x gr[s irksome1 by screw+ d[n ! second pad1 & !n releas+ ! fir/4 ,to improvise a ,t\rniquet4--,a t\rniquet may readily be =m$ on em]g5cy f a h&k]*ief1 a /one1 & a /ick4 ,fold a /one ! size ( an egg 9 ! middle ( a h&k]*ief1 lay x ov] ! ma9 art]y1 tie ! ends ( ! h&k]*ief r\nd ! limb1 slip ! /ick und]nea? & twi/ x r\nd1 till ! tight5$ h&k]*ief draws ! /one on to ! art]y & arre/s ! fl[ ( blood 7see fig4 #ajb74 ,illu/ration3 ,fig4 #ajb4--;,an improvis$ t\rniquet4 ,fumigation4--,m]curial vap\r ba?s are contriv$ 9 v>i\s ways4 ,! foll[+ plan succe$s p]fectly well :5 ! :ole surface ( ! body is to be expos$ to ! vap\r 7fig4 #ajc74 ,illu/ration3 ,fig4 #ajc4--,m]curial fumigation4 ,illu/ration3 ,fig4 #ajd4--,lamp = fumigat+4 ,app>atus4--,a ,lang/on ,p>k]'s lamp made by ,savigny & o!r in/rum5t mak]s4 ,9 ?is a _s lamp1 hold+ ! requir$ am\nt ( _s is protect$ 9 a cage1 on ! top ( :i* is a receptacle = ! calomel1 & a small sauc] = wat] 7fig4 #ajd74 ,! flame b5ea? boils ! wat] & volatilises ! calomel4 ,wat] is add$1 because ! calomel vap\r1 :5 associat$ ) /eam1 acts m effici5tly ?an ) dry air4 ,! lamp is plac$ "u a high wick] *air1 on :i* ! pati5t sits undress$1 & r\nd 8 neck1 a frame is ti$1 made ( cane hoops1 ) a calico cov] sewn ov] !m2 ?is falls to ! gr\nd & encloses 8 body 9 a *amb]1 :]e ! vap\r is conf9$ :ile absorb$ into ! sk94 ,a blanket ?r[n ov] ! frame completes ! prep>ation4 ,if a hoop frame be n at h& a lady's wire-hoop$ petticoat answ]s ! purpose q z well4 ,illu/ration3 ,fig4 #aje4--,lamp = local fumigation4 ,! pati5t1 9 f\r or five m9utes1 usually breaks into a viol5t p]spiration1 8 pulse quick5s mu*1 sometimes ev5 syncope occurs2 h5ce1 he %\ld n be left alone until ! ba? is ov]4 ,?is1 if ! flame is /rong & ! quantity ( calomel n v great--"o or two scruples be+ a common dose--occupies a qu>t] ( an h\r4 ,:5 ! ba? is ov] ! pati5t %\ld at once get into b$1 & lie !re a few h\rs2 !n he may rise & be well spong$ ) tepid wat]4 ,mod]ate b tol]ably spe$y m]curialisation ( ! sy/em is ?us induc$4 ,local ,fumigation is employ$ :5 ! disease is conf9$ to a few ob/9ate pat*es ( eruption4 ,= ?is purpose an e>!nw>e alembic 7fig4 #aje7 is fitt$ to ! lamp us$ = g5]al fumigation2 ! calomel is ?r[n into ! bottom ( ! alembic4 ,! flame plays ov] ! outside1 & heat+ x1 sublimes ! calomel2 :i* rea*es ! m\? ( ! alembic & cond5ses on any "p to :i* x is appli$4 ,! ?roat may be fumigat$ by inhal+ ! vap\r z x escapes f ?is alembic1 or by suck+ air ?r\gh ! sp\t ( an e>!nw>e teapot 9 :i* ! calomel has be5 plac$1 & heat$ by a _s lamp und]nea?4 ,! ,hot ,air-,ba? is easily obta9$ by undress+ ! pati5t1 putt+ him to b$ on a mattress1 & fa/5+ across ! b$ two or ?ree l5g?s ( cane or /\t wire1 ov] :i* a blanket is next ?r[n4 ,! pati5t's body is ?us enclos$ 9 a small *amb]1 ! air ( :i* is !n heat$ by putt+ inside1 on an e>!nw>e plate1 a _s lamp1 surr\nd$ by a kit*5 lemon-grat] to protect ! b$ clo!s f its flame4 ,%eets %\ld be disp5s$ ) :ile ! lamp is alight1 le/ !y cat* fire4 ,! temp]ature ( ! air %\ld be wat*$1 le/ x gr[ hot en\gh to scor*1 b x mu/ be kept up till ! pati5t breaks into a %>p p]spiration1 :5 ! lamp may be remov$ & ! pati5t all[$ to cool sl[ly d[n4 ,! action ( ! ba? is greatly accel]at$ by spong+ ! pati5t all ov] z he lies 9 b$ ) tepid wat]1 :5 ! air gr[s w>m4 ,lamps protect$ ) wire gauze1 & furni%$ ) a cradle to keep ! b$ clo!s up1 are sold at ! in/rum5t-mak]s1 b ! above arrangem5t answ]s j z well z m elaborate app>atus4 ,! ,vap\r ,ba?4--,! pati5t is put to b$ z 9 ! hot-air ba?1 & a few feet ( vulcanis$ india-rubb] tub+1 fa/5$ to ! sp\t ( a tea-kettle on ! fire1 br+ a supply ( vap\r into ! b$4 ,! vap\r ba? may prec$e ! hot-air ba?1 & w quick5 ! action ( ! latt] v greatly4 ,illu/ration3 ,fig4 #ajf4--;,dr4 ,horace ,swete's village ambulance or sick c>riage4 ,c>riage = transport+ ! ,sick4 ,! army ambulance & ! c>riage ( ! ,invalid ,c>riage ,society are excell5t means = transport+ sick f _! homes1 or w\nd$ p]sons f ! sc5e ( injury to ! hospital4 ,z _! co/ is some:at consid]able1 a *eap c>riage 7see fig4 #ajf7 has be5 devis$ by ,dr4 ,horace ,swete1 ( ,we/on-sup]-,m>e1 = ! use ( ! di/rict 9 :i* he is resid+1 & :i* may be kept = use at workh\ses1 hospitals1 & 9 remote di/ricts4 ,x is con/ruct$ ( v>ni%$ wood & iron1 & 9 ! foll[+ mann]4 ,! dim5sions ( ! c>riage are--l5g?1 #g feet #f in*es2 bread?1 #c feet #i in*es2 height1 #d feet #i in*es4 ,its weight is "u #c cwt41 & its total co/ #bal4 ,! body is l a skeleton he>se1 )\t fix$ floor or sides4 ,! sides are clos$ by vulcanis$ india-rubb] curta9s1 or by glass slid+ panels4 ,! back1 a wood5 panel1 op5s l a door4 ,a wood5 tray slides on ?ree roll]s at ! bottom1 & on ?is a mattress cov]$ ) vulcanis$ india-rubb] is plac$ to receive ! pati5t4 ,= infecti\s cases /raw %\ld be us$ in/ead ( ! mattress1 z x may be burnt :5 ! pati5t is remov$4 ,! tray is n>r[1 & fitt$ ) h&les1 t x may be c>ri$ up a n>r[ /aircase4 ,! vehicle runs on f\r :eels1 is fitt$ ) lamp1 h&le1 %afts1 & driv+ box1 & is well hung on good spr+s4 ,! mat]ial ( ! c>riage admits ( be+ wa%$1 & ?us readily purifi$1 aft] convey+ an infecti\s case4 ,cupp+--,dry1 & ,ble$+ ,cupp+4 ,app>atus4--#a4 ,a s]ies or ne/ ( exhau/+ glasses4 #b4 ,diff]5t siz$ boxes ( lancets = incis+ ! sk91 call$ sc>ificators4 #c4 ,a _s lamp 7fig4 #ajg74 ,! glasses are #f oz41 #d oz41 #b oz41 & #a oz4 9 size1 ( r\nd$ %ape1 ) ?ick smoo? edges4 ,9 dry cupp+ ! object is to relieve int]nal conge/ion by draw+ ! blood into ! subcutane\s cellul> tissue4 ,! back & lo9s1 :]e ! sk9 is tol]ably loose1 are mo/ suitable places = ?is proce$+4 ,illu/ration3 ,fig4 #ajg4--;,cupp+ glasses1 lamp1 sc>ificator1 & _s bottle4 ,! ,op]ation4 ,/ep #a4 ,light ! _s lamp1 direct ! pati5t to sit =w>ds1 & lay b>e ! back ready = ! glasses1 :i* %\ld be plac$ on ! b$ )9 rea* ( ! op]ator's "r h&4 ,/ep #b4 ,r>ify ! air 9 a glass by plung+ ! flame into x a few mom5ts1 & !n quickly clap ! m\? ( ! glass on ! sk92 leave x !re :ile a second & ?ird glass are heat$ & appli$1 :5 ! fir/ %\ld be remov$ & its vacuum re/or$ be=e x is replac$4 ,9 putt+ ! glasses on aga91 _! rims %\ld n lie exactly 9 ! r+s m>k$ on ! sk9 by previ\s applications1 or ! bruises may inflame & sl\gh aft]w>ds at ^! p>ts4 ,! application & removal ( ! glasses %\ld be done z lightly z possible to prev5t all unnecess>y pa94 ,a few repetitions ( ?is incomplete vacuum causes ! sk9 to puff up readily into ! glasses1 & mu* blood is !reby attract$ into ! cellul> tissue4 ,ble$+ or ,bloody ,cupp+4--,:5 x is desir$ to take blood f ! body ! sk9 is punctur$ or sc>ifi$ by ! sc>ificators1 half a doz5 incisions be+ made at a bl[ by z _m lancets protrud+ f a box1 :5 a spr+ x holds is t\*$2 ! glasses are !n laid ov] ^! incisions1 & ! necess>y am\nt ( blood remov$ by _! exhau/+ p[]4 ,illu/ration3 ,fig4 #ajh4--;,junod's vacuum boot = attract+ ! blood to ! l[] extremities4 ,junod's ,boot is a t9 case1 %ap$ l a boot 7see fig4 #ajh71 b capaci\s en\gh to all[ a limb :5 plac$ )9 x to swell freely4 ,x is sometimes employ$ to draw blood & s]um into ! l[] extremities dur+ conge/ion ( int]nal organs4 ,:5 us$1 ! leg is pass$ into ! boot1 & ! m\? ( ! boot clos$ r\nd ! limb by a pack+ ( india-rubb] ti$ firmly r\nd ! boot & limb1 & well sme>$ ) simple o9tm5t4 ,! air is !n exhau/$ f ! inside ( ! boot by a small brass syr+e1 :i* screws into a hole 9 ! leg ( ! boot1 z depict$ 9 ! figure4 ,! pati5t %\ld we> ! boot "s two or ?ree h\rs1 :ile ! vacuum is kept up by an occasional exhau/ion ( ! syr+e4 ,bo? limbs may be subject$ to exhau/ion1 b ! pati5t mu/ rema9 9 b$ = tw5ty-f\r h\rs aft] ! op]ation2 ?is is g5]ally necess>y = o!r reasons1 & he mu/ we> a b&age = a few days :5 he gets ab\t4 ,lee*es4--,ea* lee* %\ld draw ab\t #b dra*ms ( blood1 & if ! bite is well fom5t$1 ano!r dra*m w escape f ! w\nd aft]w>ds4 ,be=e ! lee*es are appli$1 ! sk9 %\ld be well wa%$ ) soap & w>m wat]1 & c>efully dri$4 ,! lee*es %\ld n be tak5 f _! box1 b ! box inv]t$ ov] ! "p1 :5 !y w quickly fa/5 !mselves4 ,if ! lee*es are appli$ 9 a dep5d5t position1 a s(t napk9 may be p9n$ r\nd ! box to support !m z !y gr[ heavy1 & to enable !m to suck z long z possible4 ,!y %\ld be all[$ to drop (f2 if pull$ (f !y are apt to te> ! w\nd1 or leave "p ( _! suck]s 9 x1 :i* causes mu* irritation aft]w>ds4 ,! lee* is put 9 a little glass :5 appli$ to ! gums or ! c]vix ut]i1 & held aga9/ ! "p he is to suck4 ,if ! lee*es d n bite readily ! "p %\ld be sme>$ ) blood or w>m milk1 & ! lee*es put into lukew>m wat] a few m9utes2 imm]sion 9 small be] is also said to /imulate !m to bite4 ,if ! bites ble$ long] ?an is desir$1 !y may be /opp$ by p9*+ ! sk9 betwe5 ! f+] & ?umb1 wip+ ! bite ?or\ghly dry1 & fill+ x ) a little bit ( amad\ or f9e sponge1 soak$ 9 solution ( p]*loride ( iron2 a l>g] piece ( amad\ is plac$ ov] ! fir/1 & ! :ole compress$ ) a turn ( a b&age or long /rip ( pla/]4 ,if ?is fails1 a sew+ ne$le may be pass$ ?r\gh ! sk9 b5ea? ! floor ( ! bite1 & ! ble$+ surface con/rict$ by twi/+ a ?read r\nd x "u ! ne$le4 ,lee*-bites %\ld nev] be left ble$+1 especially 9 *ildr51 = a dang]\s am\nt ( blood may be lo/ f !m 9 a few h\rs4 ,t5ts are in/rum5ts made ( "s sub/ance t enl>ges z x absorbs liquid2 !y are employ$ to dilate ap]tures ( s9uses or natural passages1 z ! c]vix ut]i1 c41 & are g5]ally %ort rods #b to #c in*es long1 & #a_/aj to in* 9 ?ickness1 made ( a :alebone /em1 w\nd r\nd ) compress$ sponge1 :i* is sme>$ ) wax to keep x 9 %ape4 ,slips ( g5tian root1 or ( lam9>ia digitata1 :i* rapidly enl>ge z !y imbibe moi/ure1 are also employ$ = ?is purpose4 ,setons are /rips ( v>ni%$ calico1 #f or #h in*es long & broad2 a ?read is fa/5$ to ea* end1 :i* are ti$ toge!r :ile ! seton is worn4 ,x is employ$ to excite irritation ei!r along ! c\rse ( a s9us1 or 9 "s sup]ficial situation1 z ! nape ( ! neck1 to relieve conge/ion ( int]nal p>ts4 ,9 s9uses1 a few ?reads ( silk usually produce ! requir$ am\nt ( irritation4 ,*assaignac's ,dra9age-tubes are a =m ( seton2 !y are india-rubb] tubes ( ! calibre ( a :eat /raw1 ( any requisite l5g?1 & p]=at$ ) holes at frequ5t int]vals2 !y are c>ri$ into ! cavity to be dra9$1 by hit*+ ! prong ( a =k$ probe1 made = ! purpose1 ?r\gh "o end ( ! tube & ?ru/+ x along ! s9us1 or across ! abscess4 ,! sk9 is !n incis$ ov] ! fur!r end ( ! s9us to br+ ! probe out1 & ! ends ( ! tube are ti$ toge!r4 ,! advantages ( ^! tubes are1 ! small am\nt ( irritation !y provoke1 & ! ready exit furni%$ = ! matt] along _! int]ior4 ,issues are a contrivance = keep+ up irritation ( ! surface4 ,a piece ( dia*ylon pla/] ! size ( a half-cr[n1 ) a hole 9 ! c5tre z l>ge z a pea1 is laid ov] ! sk9 :]e ! issue is to be =m$4 ,a bit ( potassa fusa is laid 9 ! hole & kept 9 sit by a second pla/]1 = an h\r or till ! sk9 is de/roy$ "u ! hole4 ,! pla/]s are !n remov$1 ! w\nd wa%$1 & a fre% piece ( ! same size put on1 hav+ at its c5tre a slit in* long1 "u :i* a pea is slipp$ into ! sore & cov]$ ov] by ano!r small] piece ( pla/]4 ,! dis*>ge t soon sets up mu/ be wa%$ away twice daily1 & ! pla/] & pea r5ew$ f "t to "t z !y become soil$4 ,trusses = ruptures4 ,^! are v>i\s1 9 %ape1 /r5g? ( spr+1 c4 ,:atev] v>iety ( truss is employ$1 c>e %\ld be tak5 t ! pressure is made 9 ! "r direction1 & t x is suffici5t1 b n too great = ! /ra9 x has to support4 ,9 r$ucible h]nia ! pressure = +u9al rupture %\ld be ex]t$ on ! +u9al canal & directly backw>ds 7see fig4 #aji74 ,= umbilical rupture1 ! pressure %\ld be also backw>ds1 & conf9$ z mu* z possible to ! ap]ture 9 ! wall ( ! belly4 ,9 femoral rupture ! pressure %\ld be direct$ upw>ds z well z backw>ds into ! femoral r+ 7see fig4 #aaj74 ,! pad 9 all %\ld be l>ge en\gh to well cov] ! passage ?r\gh :i* ! rupture passes4 ,! ease & com=t ( a truss mu* dep5d on ! complet5ess ) :i* x fulfils ^! conditions4 ,illu/ration3 ,fig4 #aji4--;,+u9al truss4 ,illu/ration3 ,fig4 #aaj4--;,femoral truss4 ,! adequacy ( a truss %\ld always be te/$ by direct+ ! pati5t to sep>ate 8 legs1 lean =w>d ov] ! back ( a *air1 & c\gh or /ra9 deeply4 ,if ! truss support ! rupture dur+ ?is ex]tion x fits satisfactorily4 ,= irr$ucible h]nia l>ge air-1 or spr+-padd$ trusses are made1 :i* prev5t fur!r desc5t ( ! visc]a1 b !y are exce$+ly difficult to fit & (t5 unsatisfactory 9 use4 ,9 +u9al h]nia ! truss consi/s ( a pad1 a spr+1 & a neck1 ) guide /raps4 ,! pad is made ( v>i\s mat]ials1 f9e c>d$ wool is among ! be/ :5 well /uff$ into a prop] %ap$ lea!r pad1 & 9 mo/ cases a fix$ pad is bett] ?an a moveable "o4 ,! pad %\ld compress ! canal & be convex if ! pati5t is /\t4 ,its size ought to be suffici5t to compress ! canal & ! m>g9s = a %ort di/ance on ea* side1 b ! pad %\ld be z small z w ensure fair compression4 ,a v flaccid bellywall1 & a l>ge gap or protrusion require a l>ge surface on ! pad4 ,! spr+ %\ld be supple & padd$ beh9d to re/ on ! two sacro-iliac syn*ondroses1 )\t be>+ on ! sp9e4 ,! spr+1 n>r[+ z x comes =w>d1 embraces ! pelvis2 & opposite ! ant]ior iliac sp9e incl9es d[nw>ds1 because ! h]nia is a little l[] ?an ! re/+-place ( ! spr+ beh9d4 ,:5 ! rupture is almo/ rea*$1 ! spr+ takes a slight elb[ or b5d 7! neck71 t its pressure may be direct$ aga9/ ! h]nia m fully4 ,und]/raps1 g5]ally n necess>y1 %\ld be omitt$ if possible4 ,9 trusses = *ildr5 :5 ! te/is is n desc5d$1 ! pad %\ld h a not* at its l[] bord] 9 :i* ! te/is may re/ uncompress$4 ,9 ! truss = femoral h]nia1 ! spr+ be>s beh9d ! body & encircles ! hips 9 ! same mann] z 9 ! +u9al truss1 b :5 opposite ! femoral art]y x turns abruptly d[nw>ds to rea* ! saph5\s op5+4 ,! pad %\ld fit ! holl[ :]e ! rupture issues & be n oval1 b r\nd$4 ,! "u-/rap %\ld be atta*$ to ! /ud at ! l[] end ( ! pad1 & pass r\nd ! p]9um & fold ( ! buttock1 & be atta*$ to ! neck ( ! spr+ close to ! pad4 ,x %\ld be made ( knitt$ b&age t x may be *ang$ & wa%$ frequ5tly4 ,:5 measur+ a pati5t = an +u9al truss1 ! circumf]5ce ( ! body r\nd ! hips 7betwe5 ! cri/a ilii & ! great tro*ant]7 %\ld be fir/ tak51 & !n t betwe5 ! symphysis pubis & ! ant]ior iliac sp9e1 half ( :i* di/ance d5otes ! position ( ! int]nal abdom9al r+1 :i* ) ! +u9al canal has to be support$ by ! pad ( ! truss4 ,= a femoral h]nia ! same measurem5t %\ld be tak5 r\nd ! body1 & also ! di/ance ( ! saph5\s op5+ f ! symphysis pubis & f ! ant]ior sup]ior iliac sp9e4 ,?is w enable ! mak] to put ! pad at ! prop] angle ) ! spr+1 s t x compresses ! saph5\s op5+1 & cle>s ! cre/ ( ! pubes4 ,e pati5t %\ld1 :ile he we>s a truss1 %[ himself f "t to "t to ! surgeon to see t any defect 9 8 app>atus may be quickly rem$i$4 ,x is a useful precaution also to keep two trusses at h&1 s t if "o breaks1 ! pati5t may at once apply ! o!r4 ,salmon & ,ody's truss consi/s ( a spr+ pass+ r\nd ! hip f a circul> pad b1 :i* be>s on ! sacrum to a second oval pad a4 ,bo? pads are atta*$ to ! spr+ by a ball & socket jo9t4 ,!re is also a slide = %ort5+ or l5g!n+ ! spr+ if desir$ 7fig4 #aaa74 ,?is truss is worn r\nd ! s\nd side ( ! body & rea*es beyond ! middle l9e to ! h]nial op5+1 ) ! object ( direct+ ! pressure ( ! spr+ outw>ds & backw>ds1 or exactly c\nt] to ! c\rse ( ! h]nia inw>ds4 ,illu/ration3 ,fig4 #aaa4--,salmon ,ody's truss4 ,umbilical h]nia4--,spr+ trusses are n adapt$ = re/ra9+ umbilical h]nia4 ,! support consi/s ( a broad belt fitt$ to ! belly1 made 9 front ( ela/ic webb+1 & on ea* flank1 ( :ite jean4 ,beh9d1 ! belt is fa/5$ by /raps & buckles1 or by lac+1 ! bett] plan4 ,9 ! c5tre1 ! ela/ic "p c>ries a ne>ly flat air-cu%ion1 measur+ ab\t #c in*es transv]sely & #b v]tically4 ,?is cu%ion is plac$ aga9/ ! ap]ture ( ! belly1 & presses back ! protrusion4 ,! size ( ! pad v>ies ) ! size ( ! h]nia1 b x %\ld always l>gely exce$ ! ext5t ( ! gap 9 ! abdom9al wall4 ,! pad1 :5 ! app>atus is us$ = an infant1 %\ld n be too prom95t1 z x is !n m difficult to keep 9 place1 & also by press+ into ! ap]ture h9d]s x f clos+4 ,! pad = an infant is be/ made ( a disc ( ivory1 #a in* broad & an in* to #a in* ?ick1 /it*$ 9 a little case 9 ! c5tre ( ! girdle4 ,! quantity ( ela/ic tissue %\ld be mu* less 9 ! infant's belt ?an 9 ^? = adults t ! belt may be frequ5tly wa%$4 ,! difficulty ( keep+ ! belt 9 place is obviat$ by atta*+ two b&s to ! upp] bord]1 to pass ov] ! %\ld]s & cross beh9d be=e fa/5+ to ! belt1 l braces4 ,two simil> ones may be fa/5$ to ! l[] bord] & c>ri$ "u ! ?ighs4 ,^! b&s %\ld be ( s(t webb+1 & sev]al pairs kept 9 /ore1 t !y may be frequ5tly *ang$ & wa%$4 ,caut]ies4 ,caut]y irons4--,^! are masses ( iron ( diff]5t %apes2 "s po9t$1 o!rs r\nd$ l buttons1 c41 set 9 a /em a foot long1 fix$ 9 a ?ick wood5 h&le4 ,!y are heat$ 9 a *>coal brazi] or common fire to bright r$ness if requir$ to de/roy deeply1 b %ort ( r$ness if int5d$ only to scor* ! surface4 ,z ^! irons are inconv5i5t = _m cases f _! bulk1 & yet soon lose _! heat if made small1 o!r caut]ies h be5 devis$ to :i* ! heat c be quickly r5ew$4 ,illu/ration3 ,fig4 #aab4--;,gas caut]y = l>ge surfaces4 ,gas ,caut]y4--,! late ,mr4 ,alex&] ,bruce p]fect$ an in/rum5t :i* employs ! gas flame z a s\rce ( heat 7see figs4 #aab1 #aac74 ,a bl[pipe flame plays on plat9um discs ( v>i\s sizes1 & keeps !m at a gl[+ heat4 ,?is hot solid po9t c be ?ru/ into ! tissue :]ev] x is desir$4 ,a l>g] =m is also made = caut]is+ ! p$icle 9 ,ov>iotomy1 c4 ,9 ?is a l>ge flame is bl[n on a w$ge-%ap$ surface ( plat9um1 #a in* long & in* broad1 & cont9u$ backw>ds = #b in*es by wire gauze to conf9e ! flame aga9/ ! plat9um4 ,! flame beh9d ^! plat9um discs quickly heats !m aga9 if cool$ by ! blood4 ,?is caut]y is v portable1 & easily made ready = use4 ,illu/ration3 ,fig4 #aac4--;,gas caut]y4 ,a4 ,ela/ic gas res]voir4 ,b4 ,gas jet4 ,c4 ,tube = convoy+ air to ! flame4 #c4 ,plat9um disc to be heat$ by ! flame4 ,mr4 ,clov] has also devis$ a caut]y1 v useful = small gr[?s4 ,a silv] bead1 ! size ( a pea1 is set at ea* end ( a horizontal metal rod #d in*es long1 :i* rotates on a v]tical pivot half a circle backw>ds & =w>ds1 s t "o or o!r bead is ?r[n into ! flame ( a _s lamp plac$ at a prop] di/ance2 :5 ! bead is heat$1 a t\* ( ! f+] causes ! c5tral pivot to rotate1 :i* br+s ! hot bead away f ! lamp1 & c>ries ! cold "o into ! flame1 to be heat$ :ile ! fir/ is us$4 ,galvanic ,caut]y4--,! in/rum5t consi/s ( a plat9um wire1 made to gl[ by pass+ ?r\gh x a p[]ful galvanic curr5t4 ,! wire %\ld be ?ick 7ab\t #a_/ab ( an in*71 & all ! o!r conduct+ surfaces suffici5tly l>ge to (f] no imp$im5t to ! curr5t :]e heat is n desir$4 ,! batt]y be/ adapt$ = ?is purpose is a ,grove's batt]y4 ,! ma9 advantage ( a galvanic caut]y is t ! wire c be pass$ :ile cold exactly :]e x is requir$1 & !n heat$ :5 x is 9 place4 ,x is exce$+ly useful 9 fi/ul betwe5 ! ure?ra & rectum1 or 9 de/roy+ vascul> gr[?s1 nvi1 c41 :]e x is desirable n to de/roy all ! sk9 cov]+ ! tum\r4 ,aga91 by ?is means1 an int5se heat c be appli$ to a v limit$ area1 & m quickly r5ew$ ?an by any o!r plan1 = ! wire1 ev5 :5 plung$ 9 ! tissue1 is nev] f> bel[ a r$ heat4 ,( *emical cau/ics a ho/ exi/2 ^? mo/ commonly employ$ are3--nitrate ( silv]1 solid1 or 9 saturat$ solutions 7#b dra*ms to ! oz4 ( wat]1 c472 fum+ nitric acid2 solution ( nitrate ( m]cury 9 nitric acid2 oil ( vitriol made into a pa/e ) p[d]$ *>coal2 *loride ( z9c mix$ ) dry />*1 !n roll$ into cakes & cut 9 slices2 ,vi5na pa/e1 t is1 equal p>ts ( potassa fusa & quick lime work$ into a pa/e ) spirits ( w9e2 potassa fusa itself2 solution ( *romic acid4 ,"s surgeons pref] "o1 "s ano!r2 z a rule1 ! liquid cau/ics are employ$ :]e ! surface to be de/roy$ is unev5 & spongy1 & solid cau/ics :]e ! surface is smoo?1 & a long cont9u$ action is desir$4 ,vesicants & irritants4--,( ! commone/ are mu/>d p\ltices1 made by mix+ mu/>d fl\r 9 a bas9 ) luke-w>m wat]1 i4e4 ab\t #ajj ,f41 to a pa/e & spread+ x on musl91 :i* is aga9 fold$ ov] ! expos$ surface ( ! mu/>d4 ,boil+ wat] & v9eg> %\ld n be us$1 = !y less5 ! pung5cy ( ! p\ltice4 ,if ! full effect be desir$ ! p\ltice %\ld rema9 on ! sk9 fifte5 or tw5ty m9utes4 ,if only slight r$d5+ is want$1 ! mu/>d fl\r %\ld be dilut$ ) its bulk ( l9se$ meal be=e mix+ x ) wat]4 ,a /rong] vesicant is ,corrigan's hamm]1 a button ( poli%$ /eel ) a flat surface1 fix$ to a h&le2 :5 us$ x %\ld be plung$ = a c\ple ( m9utes 9 boil+ wat]1 or heat$ ov] a _s lamp1 b c>e mu/ be tak5 n to ov]heat x1 or x w br+ ! cuticle away ) x4 ,x is press$ on ! sk9 = t5 or fifte5 seconds2 ?is is suffici5t to cause r$d5+ & vesication4 ,bli/]s are rais$ by ! empla/rum lytt1 l94 can?>idis1 or pte epispa/ique1 :i* is mild] 9 its effect ?an ! two prec$+ prep>ations ( ,spani% fly4 ,solution ( iod9e & iodide ( pota%1 9 ?ree times _! bulk ( _s ( w9e1 also produces a bli/] :5 laid on freely4 ,p\ltices are made ( l9se$ meal1 bread1 or />*1 & are means = apply+ w>m? & moi/ure )\t absolutely wett+4 ,bread p\ltices sodd5 ! p>ts to :i* !y are appli$ mo/1 & />* lea/1 ( ! ?ree k9ds4 ,be=e mak+ a p\ltice all ! mat]ials %\ld be at h& & ?or\ghly w>m$ be=e a good fire4 ,!y are--boil+ wat]1 a broad knife or spatula1 s(t old l95 or musl91 oil silk1 tapes1 /rapp+ pla/]1 b&ages1 a piece ( old blanket1 flannel or cotton wadd+1 safety p9s1 or ne$le & ?read4 ,! l95 on :i* ! p\ltice is to be spread %\ld be cut ( ! int5d$ size1 & :5 = use ab\t ! neck or %\ld] %\ld h "s tapes sewn on to x to tie x on to ! body4 ,! oil silk %\ld be l>ge en\gh to cov] ! p\ltice next :i* x is laid to keep 9 ! moi/ure4 ,! flannel or wadd+ are us$ to wrap ov] & keep 9 ! heat ( ! p\ltice2 ! /rapp+ or b&age to fix e ?+ 9 situ z requir$4 ,:5 p\ltices are cont9u$ long1 _! surfaces %\ld be sme>$ ) l>d be=e application2 ?is protects ! sk9 some:at f ! irritation t arises2 also :5 ! p\ltice is to be laid betwe5 folds ( sk9 or on hairy situations1 z ! buttocks & p]9um1 x is bett] to cov] ! p\ltice ) a ?9 cambric h&k]*ief le/ "s ( ! meal /ick to ! p>ts4 ,! ,l9se$ ,p\ltice is made z foll[s3 p\r boil+ wat] into a well-heat$ bas9 till ! bas9 is half full1 !n scatt] meal ) ! left h& on ! wat] :ile t is kept cont9ually /irr$ ) a broad knife1 add+ m & m meal until ! mass becomes q s(t & gelat9\s1 b too /iff to cl+ to ! knife2 !n turn x out on ! l951 also well heat$ at ! fire1 & spread x 9 a lay] ab\t an in* ?ick1 turn up ! edge ( ! l95 = an in* all r\nd1 & c>ry ! p\ltice at once to ! pati5t4 ,if x has to be c>ri$ f> ! p\ltice %\ld be laid betwe5 two v hot plates2 apply x to ! "p to be p\ltic$1 lay on ! oil silk1 & cov] t ) ! hot flannel or cotton wadd+1 & fa/5 ^! 9 place ) p9s or a /it*4 ,wadd+ is put :]e ! "p is irregul>1 z ! neck or axilla2 unless ! wadd+ is well plac$ & ! p\ltice is fa/5$ by /r+s1 x w soon fall into a n>r[ b& leav+ ! "p expos$ t x %\ld w>m & moi/54 ,! ,bread ,p\ltice is made z foll[s3 ! mat]ials be+ all at h&1 z detail$ 9 ! directions = mak+ a l9se$ p\ltice1 crumble ! inside ( a mod]ately /ale loaf until ab\t half a p9t or a p9t ( crumbs are prep>$2 !n p\r boil+ wat] into a bas91 & ?r[ 9 crumbs gradually 9 ! same mann] z ! l9se$ meal1 until a s(t por\s mass is prep>$4 ,! rema9+ /eps are ! same z ^? = mak+ ! l9se$ p\ltice4 ,! p\ltice c be made to hold m wat] if x is turn$ into a saucepan aft] mix+1 & a little m wat] add$ :ile x simm]s = half an h\r at a sl[ fire4 ,any sup]flu\s wat] mu/ be dra9$ (f1 & ! p\ltice cov]$ ) musl9 :5 x is made 9 ?is way4 ,! ,/>* ,p\ltice is made z foll[s3 rub a little />* 9 a bas9 ) cold wat] till x has ! consi/5ce ( cream1 !n mix 9 boil+ wat] till ! />* is a ?ick jelly1 & spread x on ! l95 :ile hot4 ,/>* p\ltices reta9 _! heat a long "t1 b yield v little moi/ure to ! "p4 ,!y are *iefly us$ z emolli5ts to inflam$ affections ( ! sk91 c4 ,hot fom5tations are a means = apply+ heat :5 moi/ure is n desir$4 ,a ready mode is to take a piece ( blanket or ?ick flannel1 soak x 9 boil+ wat] & dry x by wr++ 9 a fold$ t[el1 & !n wrap x ov] ! "p to be fom5t$ ) a piece ( oil silk or a hot dry flannel ov] x4 ,laudanum1 turp5t9e1 & o!r applications are spr9kl$ ov] ! flannel1 :5 soo?+ or c\nt]-irritat+ effects are requir$ 9 addition to ! w>m?4 ,a bag ( bran makes a light w>m fom5tation if heat$ 9 a /eam kit*51 or /eam] = boil+ potatoes4 ,:5 absolutely dry heat is desir$1 *amomile fl[]s1 bran1 or s&1 may be heat$ 9 an ov51 & p\r$ into hot flannel bags4 ,dry heat is also v agreeably obta9$ by fill+ india-rubb] bags & cu%ions ) hot wat]3 !y are r heavy1 b reta9 _! heat _m h\rs4 ,li/]'s ,me?od ( ,dress+ ,w\nds ) ,c>bolic ,acid4--,! prop]ties ( c>bolic acid :i* conc]n ! surgeon may be briefly recapitulat$ z foll[3-- ,x is highly volatile1 & ! putrefaction ( organic fluids is indef9itely po/pon$ :]e its vap\r is pres5t4 ,c>bolic acid is soluble 9 diff]5t degrees 9 wat]1 alcohol1 e!r1 glyc]9e1 fix$ oils1 gutta p]*a1 india-rubb]1 & %ell-lac4 ,its v>y+ aff9ity = ^! sub/ances enables ! surgeon to modify ! application ( c>bolic acid 9 v>i\s ways2 ^! modifications are necess>y to fully utilise its prop]ties4 ,wat] dissolves ! cry/allis$ acid b sp>+ly1 #a "p 9 #bj be+ a conc5trat$ solution1 & all[s x to escape readily4 ,! aque\s solution is !re=e useful :]e ! effects ( ! acid are requir$ copi\sly1 b only tempor>ily4 ,glyc]9e & ! fix$ oils dissolve a f> great] am\nt ( ! acid1 & "p ) x unwill+ly4 ,_! solutions are adapt$ = ! cont9u\s b abundant application ( ! antiseptic4 ,%ell-lac1 & "s o!r sub/ances1 hold ! c>bolic acid /ill m t5aci\sly1 & are valuable z solid /oreh\ses :i* yield up ! antiseptic 9 small quantity = a consid]able p]iod4 ,c>bolic acid /imulates raw surfaces1 & :5 conc5trat$ ev5 de/roys animal tissues4 ,x is a local an/hetic2 ) mod]ate doses1 w\nds lose _! s5sibility aft] ! fir/ sm>t+ ( ! application has pass$ (f4 ,:5 giv5 9 l>ge quantities ! acid produces a peculi> k9d ( delirium1 & tempor>y p>alysis ( s5se & motion3 fatal results h foll[$ its int]nal application4 ,x is rapidly absorb$ into ! blood f w\nd$ surfaces1 & ?r\gh ! sk91 :5ce x is dis*>g$ f ! body by ! lungs & kidneys4 ,! ur9e ( pati5ts dress$ ) c>bolic acid1 ?\gh ( normal col\r :5 pass$1 assumes a d>k gre5i%-br[n hue aft] a few h\rs' exposure to ! air & light4 ,h[ mu* ( ! antiseptic mu/ float 9 ! atmosph]e to prev5t f]m5tative *anges has n yet be5 det]m9$2 ,bu*oltz f\nd t #a "p ( c>bolic acid 9 #fjj ( milk almo/ entirely prev5t$ lactic f]m5tation1 :ile #a 9 #bhe did s altoge!r4 ,alcoholic f]m5tation 9 sug>y fluids 0 arre/$ by a simil> quantity4 ,:5 us+ ! acid 9 dress+ w\nds1 ! wat]y solution1 ! solid mixture1 & ! oily solution are necess>y4 ,! fir/ to neutralise ! effects ( exposure to ! atmosph]e & wat] be=e ! w\nd is clos$2 ! second solid mixture 9 ! =m ( pla/] to provide a v scanty b cont9u\s supply ( c>bolic vap\r close to ! w\nd3 too scanty to irritate ! raw surface1 yet en\gh to *eck putrifaction 9 ! dis*>ge ooz+ f x4 ,! ?ird1 or oily solution1 is to supply ! c>bolic vap\r abundantly to ! l95 dress+s1 appo9t$ to receive ! dis*>ge :5 x has pass$ f ! vic9ity ( ! w\nd4 ,! t9 is us$ to af=d z close a cov] z possible to ! brea* ( surface2 = ?is purpose x mu/ be z flexible z possible t x may fit ! w\nd exactly4 ,! c>bolic pla/] is made ( #c p>ts ( %ell-lac & #a "p ( c>bolic acid cry/als melt$ toge!r & spread on calico4 ,to r5d] ! lac pla/] non-adhesive t x may n /ick to ! t5d] w\nd1 x is pa9t$ ) solution ( gutta p]*a1 :i* dries & leaves a ?9 film ( t sub/ance cov]+ ! pla/]4 ,?is film is easily remov$ by rubb+ ! surface ) a r\gh t[el %\ld an adhesive quality be desir$4 ,9 ei!r /ate ! c>bolic acid cont9ues to volatilise sl[ly :5 ! pla/] is laid ov] ! w\nd4 ,:5 adopt+ ?is me?od ( treat+ w\nds ! foll[+ mat]ials are necess>y3-- #a4 ,aque\s solution ( cry/allis$ c>bolic acid 7#a "p 9 #bj74 #b4 ,c>bolic oil3 #a "p ( c>bolic acid 9 #e ( olive oil4 #c4 ,li/]'s %ell-lac pla/]4#a #d4 ,%eet t94 #e4 ,l9t2 old l954 #f4 ,dia*ylon pla/]4 #g4 ,glass syr+e4 #h4 ,scissors4 #i4 ,?9 calico or musl94 #aj4 ,b&age4 #aa4 ,a wood5 spl9t to re/ ! limb ^u4 ,to ,dress rec5t ,w\nds4--,:5 ! app>atus is ready1 ! piece ( t9 is cut & fitt$ to ! w\nd1 s t x %all ov]lap ! w\nd to a small ext5t on all sides2 !n a piece ( lac pla/]1 l>ge en\gh to ov]lap ! t9 "o or two in*es all r\nd2 ?is pla/] may be cut & not*$ :5 ! surface is irregul> to make x lie pretty closely2 !n /rips ( dia*ylon1 ab\t two in*es broad1 are cut ready4 ,! p>ts ar\nd ! w\nd are well clean$2 dirt & clots cle>$ f ! w\nd ) cold wat]1 conta9+ ab\t #a ( c>bolic acid to #dj ( wat]1 & ! int]ior ( ! w\nd is freely syr+$ ) wat] conta9+ #a ( acid 9 #cj or ev5 #a 9 #bj p>ts4 ,! sides are br\ght toge!r ) sutures1 if necess>y1 9 ! ord9>y way1 & ! t9 laid on ! w\nd2 ! t9 is freely wett$ ) c>bolic wat]1 & ! lac pla/] laid ov] x & kept 9 situ by /rips ( dia*ylon pla/]4 ,9 dress+ rec5t w\nds ! mo/ dep5d5t side ( ! lac pla/] is left unatta*$1 t ! s]\s dis*>ge1 :i* is (t5 copi\s1 may readily escape4 ,to receive ?is dis*>ge1 a piece ( calico1 soak$ 9 c>bolic oil1 is laid ov] ! w\nd n[ cov]$ 91 & all kept 9 place by a fold$ t[el or a roll] b&age4 ,?is oily clo? is to be *ang$ f "t to "t z x gets soak$ ) dis*>ge3 at fir/ ?is *ange is necess>y e night & morn+1 b aft] ?ree or f\r days once a day is (t5 en\gh4 ,! %ell-lac pla/] & t9 ne$ n be remov$ = a week unless ! w\nd gr[ hot & pa9ful1 :5 !y c be remov$ at any "t if ! surface ( ! w\nd is imm$iately sme>$ ) c>bolic oil1 & kept well imbu$ ) ! antiseptic :ile x is be+ exam9$4 ,%\ld x conta9 p5t-up dis*>ge1 ! sutures mu/ be loos5$ & ! dis*>ge wa%$ out by inject+ ! #a 9 #cj aque\s solution4 ,! t9 & lac pla/] may be !n replac$1 & ! dress+ r5ew$4 ,! same precaution mu/ be foll[$ :5 ! sutures h to be remov$4 ,usually !re is v little swell+ & no pa91 & ! heal+ process goes on tranquilly if undi/urb$4 ,%\ld bruis$ p>ts sl\gh1 !y may be trimm$ away ) scissors dipp$ 9 c>bolic oil4 ,:5 ! w\nd has once be5 wa%$ ) c>bolic acid1 ! antiseptic %\ld n ent] ! w\nd a second "t1 z its irritant qualities excite inflammation 9 ! w\nd4 ,*ronic abscesses1 besides rec5t w\nds1 are treat$ ) c>bolic acid4 ,! surface to be punctur$ is cov]$ ) a piece ( ?9 musl9 soak$ 9 c>bolic oil1 & ! knife to be us$ is dipp$ 9 ! oil also4 ,!n1 a second piece ( musl9 be+ ready1 ! surgeon op5s ! abscess ?r\gh ! musl91 & z he )draws ! knife an assi/ant lays on ! second piece ( musl9 ov] ! w\nd4 ,! matt] dra9s away f "u ?is curta91 & ! access ( atmosph]ic air is prev5t$4 ,:5 ! matt] ceases to fl[1 ! lac pla/] is laid on1 & ! oily clo? outside1 :i* c be *ang$ z (t5 z is requisite4 ,abscesses s treat$ usually soon cease to secrete matt]1 %r9k1 & fill up )\t delay4 ,if ! abscess has bur/ or _h communication ) ! ext]nal air1 ! int]ior mu/ be fill$ ) wat]y solution #a to #bj be=e x is dress$1 t f]m5tation 9 ! cavity may be prev5t$2 ! fur!r treatm5t is ! same z = a rec5t w\nd4 ,illu/ration3 ,fig4 #aad4--;,irrigat+ a w\nd4 ,irrigation4--,! cont9ual fl[ ( ice-cold wat] is us$ to prev5t inflammation ( c]ta9 w\nds4 ,9 us+ cold1 x is p>ticul>ly necess>y t ! temp]ature ( ! wat] rema9 /eady1 = alt]ations ( temp]ature cause alt]ations 9 ! capacity ( ! blood vessels1 & promote conge/ion r ?an dim9i% x2 h5ce irrigation1 badly att5d$ to1 becomes an evil in/ead ( a b5efit4 ,! simple/ way 7see fig4 #aad7 ( contriv+ irrigation is to lay ! limb 9 an easy position on pill[s1 protect$ by a %eet ( india-rubb] clo?1 weight$ at "o corn] to draw ! clo? into a *annel1 d[n :i* ! wat] trickles into a receiv] "u ! b$2 ov] ! limb a j>1 wrapp$ 9 blanket1 is susp5d$4 ,?is is fill$ ) wat] f "t to "t1 & kept *>g$ ) lumps ( ice4 ,a syphon is made by a few feet ( f9e india-rubb] tub+ rea*+ f ! bottom ( ! j> to ! w\nd1 ! escape ( wat] ?r\gh ! tube be+ mod]at$ by draw+ ! end m or less tightly ?r\gh a bit ( cleft /ick4 ,x is suffici5t t ! w\nd %\ld be kept con/antly & ?or\ghly wett$2 m ?an t is wa/e ( cool+ p[]4 ,esm>*'s ,irrigator4--,?is is a simple contrivance = wa%+ out w\nds & s9uses ) a /ream ( wat]4 ,x consi/s ( a tall c ( block t9 7see fig4 #aae71 ) an orifice at ! l[] end1 to :i* a c\ple ( feet ( india-rubb] tub+ are atta*$4 ,! tube is fitt$ ) an ivory nozzle & a hook1 s t :5 ! /ream is n want$ ! fl[ ( wat] is /opp$ by hang+ ! nozzle on ! upp] edge ( ! c4 ,! /ream c be made m or less =cible by rais+ or l[]+ ! c above ! w\nd4 ,illu/ration3 ,fig4 #aae4--;,esm>*'s ,irrigator4 ,! ,adm9i/ration ( ,*lor(orm4--,9 adm9i/]+ *lor(orm ! ma9 po9ts to be borne 9 m9d are--#a4 ,if ! pati5t is fit to und]go an op]ation at all he may inhale *lor(orm4 #b4 ,! pati5t %\ld be fa/+2 ?is is ! mo/ effectual prev5tive ( sickness4 #c4 ,he %\ld be 9 an easy position1 clad 9 a loose b w>m night-dress1 :i* does n int]f]e ) ord9>y or artificial respiration1 %\ld t be sudd5ly requir$4 #d4 ,! pati5t mu/ nev] inhale m ?an #d p] c5t4 ( *lor(orm vap\r 9 ! air he respires2 on ! o!r h&1 ! vap\r may circulate 9 ! blood )\t h>m = an indef9ite "t1 provid$ x nev] pass beyond a c]ta9 conc5tration4 #e4 ,*lor(orm is a s$ative & depressant2 ! pulse gives ! e>lie/ indication ( syncope1 & ! respiration %\ld be con/antly wat*$ ! :ole "t *lor(orm is inhal$4 ,x %\ld be not$ t ! pulse (t5 fails sudd5ly at ! fir/ fl[ ( blood 9 an op]ation4 ,aga91 :5 ! pati5t is deeply n>cotis$1 ! jaw may gape & ! tongue s9k back till x closes ! glottis4 ,f ?is cause respiration sometimes ceases1 & dang] quickly arises if ! *9 is n drawn up to raise ! epiglottis4 ,9 beg9n+ to inhale1 ! quantity ( vap\r %\ld be small1 & gradually increas$4 ,! pati5t mu/ be caution$ n to talk1 to avoid ! irritation & c\gh+ *lor(orm sometimes excites :ile he is speak+4 ,he %\ld also %ut 8 eyes le/ ! vap\r make !m sm>t4 ,aft] inhalation has be5 cont9u$ a few m9utes ! pati5t is (t5 quiet & inatt5tive1 ?\gh easily r\s$ by pa94 ,8 condition at ?is /age %\ld be te/$ by ask+ him to give 8 h&1 or by p9*+ him g5tly2 if no notice be tak5 ( ^!1 ! conjunctiva %\ld be t\*$1 & ! am\nt ( w9k+ ?us excit$ w enable ! *lor(ormi/ to judge if ! pati5t w resi/ :5 ! knife is appli$4 ,pati5ts v>y mu* 9 ! "t pass$ be=e recov]+ consci\sness2 if !y rema9 s\ndly asleep1 brea?+ freely & ) good pulse1 x is bett] to avoid r\s+ or mov+ !m until !y wake spontane\sly2 su* pati5ts suff] less confusion & vomit+ ?an ^? :o are quickly alive to :at is go+ on ar\nd !m4 ,signs ( ,dang]4--,sudd5 failure or irregul>ity ( ! pulse1 ) pallor & arre/$ brea?+1 are ( great importance2 if ^! occur1 ! *lor(orm mu/ be at once remov$1 a free supply ( fre% air ensur$1 ! tongue drawn g5tly =w>d1 & if ! brea?+ d n quickly beg91 x mu/ be set up artificially 7see p4 #ahc7 )\t loss ( "t1 & cont9u$1 if necess>y1 = at lea/ an h\r be=e recov]y is despair$ (4 ,/]tor\s brea?+ is n al>m+ unless accompani$ by feeble pulse1 %all[ respiration1 & dilatation ( ! pupils2 ) ^! x becomes a sign ( a comatose condition4 ,z subord9ate adjuvants = fa9tness ! foll[+ are useful3--moi/5+ ! tongue & lips ) br&y f "t to "t1 or lett+ ! pati5t sip a small quantity f ! sp\t ( a fe$+ cup4 ,9 complete syncope1 galvanism to ! epiga/rium1 a hot iron or scald+ wat] to ! prcordia may be employ$1 b %\ld nev] int]f]e ) ! ma9t5ance ( artificial respiration1 :i* is ( f> great] efficacy 9 re/or+ susp5d$ animation ?an any?+ else4 ,*lor(orm is safely giv5 on a h&k]*ief1 or 9 v>i\s ways1 if ! adm9i/rator is c>eful to wat* ! pulse & respiration1 & to gu>d aga9/ ! pati5t1 by a sudd5 deep inspiration1 tak+ too l>ge a dose ( vap\r at once4 ,exact measurem5t ( ! quantity ( liquid p\r$ on ! h&k]*ief at a "t is ( no value1 z x is no index ( ! conc5tration ( ! air respir$ by ! pati5t4 ,( f> great] consequ5ce is x to insure a free supply ( atmosph]ic air1 by keep+ ! evaporat+ surface a few in*es f ! m\? & no/rils4 ,illu/ration3 ,fig4 #aaf4--;,clov]'s app>atus = adm9i/]+ *lor(orm4 ,! safe/ mode ( giv+ *lor(orm is by ,clov]'s ,inhal] 7fig4 #aaf71 n[ us$ 9 _m ,london hospitals & else:]e4 ,x r5d]s x impossible to give ! pati5t too /rong a dose1 by prep>+ an atmosph]e ( kn[n /r5g? = him to brea!4 ,clov]'s app>atus consi/s ( a bag ( #h1jjj or #aj1jjj cubic in*es capacity1 susp5d$ by a loop beh9d ! *lor(ormi/'s back1 f ?is a flexible tube br+s ! vaporis$ air to a mask1 fitt+ ov] ! nose & m\? ( ! pati5t4 ,?is mask has a flexible metal bord] = adju/+ x to diff]5t faces2 & a valve t op5s & closes1 to all[ m or less common air to be respir$ ) t drawn f ! res]voir if desir$4 ,! res]voir is suppli$ by inject+ into x1 f a bell[s1 #a1jjj cubic in*es ( air1 drawn ?r\gh an evaporat+ box heat$ by hot wat]1 into :i* #cb m9ims ( *lor(orm are inject$ f a graduat$ syr+e ea* "t ! bell[s are fill$4 ,by ^! means1 an atmosph]e ( kn[n /r5g? is prep>$ = ! inhalation2 t is "o conta9+ ab\t #d ( vap\r4 ,?is app>atus is v easy to use1 & ! mo/ effici5t 9 produc+ an/hesia quickly & pleasantly4 ,artificial ,respiration4--,_m plans are employ$2 b ! two mo/ effici5t are ^? to be describ$4 ,illu/ration3 ,fig4 #aag4--;,artificial ,respiration4 ,m>%all ,hall's me?od4 #a/ position4 ,m>%all ,hall's ,me?od4--,lay ! pati5t on ! floor1 ) ! clo?+ r\nd 8 neck1 *e/1 & abdom5 loose2 if wet1 remove x1 & ?r[ ov] 8 body a w>m blanket4 ,cle> out ! m\?1 & turn ! pati5t on 8 face1 "o arm be+ fold$ "u 8 =ehead 7see fig4 #aag71 & ! *e/ rais$ on a fold$ coat or firm cu%ion4 ,next1 turn ! pati5t well on 8 side1 :ile an assi/ant supports ! head & arm d\bl$ und]nea? x 7see fig4 #aah71 & conf9es 8 att5tion to keep+ ! head =w>d & ! m\? op5 dur+ ! movem5ts to & fro4 ,:5 two seconds h elaps$ turn ! body aga9 face d[nw>ds1 & all[ x to rema9 s = two seconds1 & !n raise x z be=e4 ,?is s]ies ( movem5ts1 occasionally v>y+ ! side1 %\ld be repeat$ ab\t fifte5 times a m9ute1 & cont9u$ until spontane\s respiration is re/or$1 or1 until two h\rs h be5 ?us sp5t 9 va94 ,illu/ration3 ,fig4 #aah4--;,artificial ,respiration4 ,m>%all ,hall's me?od4 #bnd position4 ,illu/ration3 ,fig4 #aai4--;,artificial ,respiration4 ,silve/]'s ,me?od4 ,exp&+ ! ,*e/4 ,illu/ration3 ,fig4 #abj4--;,artificial ,respiration4 ,silve/]'s me?od4 ,compress+ ! ,*e/4 ,silve/]'s ,me?od4--,lay ! pati5t on a flat surface1 ! head & %\ld]s support$ on 8 coat fold$ into a firm cu%ion4 ,loos5 all tight clo?+1 & if wet replace x by a w>m dry blanket1 8 arms be+ outside ! blanket4 ,cle> ! m\? ( dirt1 blood1 c41 draw ! tongue =w>ds1 & fa/5 x to ! *9 by a piece ( /r+ or tape ti$ r\nd x & ! l[] jaw4 ,next1 /&+ at ! pati5t's head1 grasp ! arms at ! elb[s1 & draw !m g5tly & /eadily upw>ds till ! h&s meet above ! head 7see fig4 #aai72 keep !m s /ret*$ = two seconds4 ,!n sl[ly replace ! elb[s by ! sides1 & press g5tly inw>ds = two seconds 7see fig4 #abj74 ,^! movem5ts are repeat$ )\t hurry ab\t fifte5 times 9 a m9ute1 until a spontane\s ef=t to brea! is made1 :5 ex]tion %\ld be direct$ to re/or+ ! circulation by rubb+ ! limbs upw>ds t[>ds ! body1 & by plac+ hot bottles at ! pit ( ! /oma*1 to ! armpits1 betwe5 ! ?ighs1 & to ! feet4 ,%\ld natural brea?+ n comm5ce1 artificial respiration %\ld be cont9u$ = two h\rs be=e success is despair$ (4 ,illu/ration3 ,fig4 #aba4--,! ,spray-produc]4 ,ri*>dson's ,e!r ,spray-,produc] 7fig4 #aba7 consi/s ( a tube on :i* two india-rubb] bags are plac$2 "o1 protect$ by a silk net1 acts z a res]voir2 ! o!r1 furni%$ ) a valve1 is ! pump2 ^! drive a con/ant /ream ( air ov] ! tip ( a f9e tube project+ f a flask ( e!r2 ?is sucks up ! e!r & ?r[s x 9 f9e spray on ! surface to be *ill$ by its evaporation4 ,! e!r = ?is purpose mu/ be v pure & dry1 hav+ a specific gravity ( #gbj1 or ! evaporation w n be suffici5tly rapid to produce congelation4 ,! fir/ effect ( ! spray is a numb+ a*+ pa9 ) r$d5+ ( ! surface4 ,?is is succe$$ by a prick+ pa94 ,9 t5 seconds1 if ! e!r be good1 a dead :ite hue spreads rapidly ov] ! sk91 & :5 ?is appe>s ! surface is q ins5sible4 ,! bottle & ela/ic air-pump may be atta*$ to ! glass jet se5 9 ! corn] ( fig4 #aba1 :i* !n makes an app>atus = inject+ a/r+5t solutions 9 spray ov] ! nasal passages1 ! ?roat1 & air-tubes2 b ! tubes us$ = wat]y fluids are mu* wid] ?an t = pulv]is+ e!r into spray4 ,tann9 9 solution ( #c-aj gra9s to ! ounce ( wat]1 sulphate ( z9c1 or alum 9 simil> quantity1 may be ?us inhal$ ) mu* b5efit by p]sons suff]+ f *ronic conge/ion ( ! muc\s membranes4 ,inject+ ,*lor(orm ,vap\r into ! ,ut]us is a ready means ( reliev+ pa9 9 canc] ( t organ2 special app>atus is made = ! purpose1 b an ord9>y ela/ic cly/] syr+e w answ] ! purpose1 if ! flask is unscrew$ & a few drops ( *lor(orm are p\r$ into x1 f "t to "t1 :ile air is pump$ ?r\gh ! deliv]y tube1 :i* is pass$ up ! vag9a to ! ulc]at$ c]vix-ut]i4 ,subcutane\s ,injection4--,! syr+e = ?is op]ation 7fig4 #abb7 consi/s ( a graduat$ glass tube hold+ six m9ims4 ,! pi/on works 9 a silv] cont9uation ( ! graduat$ tube1 & is ?us kept cle> ( ! solutions us$ = injection4 ,to ! nozzle ( ! syr+e f9e %>p-po9t$ cannul are screw$ on2 !y are ( diff]5t l5g?s1 "s ( /eel1 o!rs ( /eel gilt2 ! gild+ r5d]s ! po9ts v blunt1 & consequ5tly mu* m pa9ful to ins]t4 ,9 fill+ ! syr+e1 c>e %\ld be tak5 n to draw ! fluid above ! level ( ! graduation on ! tube1 t ! exact am\nt inject$ may be read (f z ! liquid s9ks 9 ! tube4 ,! f9] ! cannula1 & ! %>p] its po9t1 ! less pa9 is caus$ by its introduction4 ,illu/ration3 ,fig4 #abb4--,subcutane\s ,injection4 ,! solution ( morphia %\ld conta9 a gra9 9 six drops & be z little acid z possible4 ,9 inject+ morphia1 x %\ld be recollect$ t gra9 is ! usual dose to allay pa91 & produce sleep2 doses ev5 f> small] (t5 suffice = ?is purpose1 ?\gh v mu* great] quantities c be adm9i/]$ by injection1 :]e long use has r5d]$ ! pati5t tol]ant ( ! drug4 ,"s p]sons dread ! puncture consid]ably2 = !m ! pa9 may be entirely prev5t$ by numb+ ! surface ) e!r-spray 7see page #ahf7 be=e ins]t+ ! syr+e1 ?\gh usually ! prick is ( s little consequ5ce t any precaution ( ?is k9d is unnecess>y4 ,! cannula %\ld be ?ru/ completely ?r\gh ! sk9 into ! subcutane\s cellul> tissue2 if ! fluid is inject$ into ! sk9 itself1 inflammation & suppuration ( ! puncture sometimes ensues4 ,aft] ! cannula is )drawn1 ! f+] %\ld be plac$ = a few seconds ov] ! puncture1 or mu* ( ! fluid w leak out aga94 ,:5 l>ge quantities ( solution 7"o or two syr+efuls7 are inject$ ! cannula ne$ n always be )drawn1 ! nozzle c be unscrew$ & ! syr+e *>g$ aga92 b m ?an t5 or twelve drops inject$ into "o place g5]ally causes mu* pa91 ev5 :]e ! cellul> tissue is v loose4 ,! syr+e & cannula %\ld be c>efully clean$1 by s5d+ pl5ty ( cold wat] ?r\gh !m ea* "t !y are us$1 or ! cannula w ru/ & become unfit = use4 ,collodion is mu* us$ 9 draw+ ! edges ( small w\nds toge!r1 c4 ,pre/on's pla/ic collodion1 or ! flexible collodion ( ! ,briti% ,ph>macopia1 #ahfg1 h advantages ov] ! common =m by furni%+ a t\gh] pellicle1 yield+ to ! movem5ts ( ! sk9 b5ea? )\t crack+4 ,collodion %\ld be kept = use 9 a small wide-m\!d bottle1 ) /opp] & bru%1 & :5 employ$ %\ld be laid on quickly 9 a ?ick mass1 s t ! cru/ x leaves %all be ( "o lay]4 ,a t\gh] cru/ is obta9$ if a piece ( musl9 is soak$ 9 ! collodion & !n laid on ! w\nd1 ?an if ! collodion is us$ alone4 ,vacc9ation4--,! lymph ( ! vacc9e vesicle1 tak5 betwe5 ! sev5? & t5? days1 is pres]v$ = use on lancet-%ap$ slips ( bone #a in* long1 call$ po9ts4 ,^! are dipp$ 9 ! lymph z x exudes f ! vesicle1 & expos$ to ! air till dry2 !y are !n wrapp$ 9 pap] ready = use4 ,:5 us$1 ! lymph %\ld be moi/5$1 by hold+ !m ov] a vessel ( /eam+ wat] a few seconds be=e ins]t+ !m 9 ! w\nd made to receive ! lymph4 ,! po9ts (t5 lose ! virus 9 a few days1 & %\ld1 if possible1 be us$ ! same day !y are *>g$4 ,! lymph may be mu* long] pres]v$ if h]metically seal$ 9 glass tubes4 ,^! are ab\t ! ?ickness ( a d>n+-ne$le1 #c in*es long1 & op5 at bo? ends4 ,:5 ! tube is to be *>g$1 "o end is ins]t$ 9 ! lymph exud+ f a punctur$ vesicle2 a drop !n ent]s ! tube by capill>y attraction1 b fill+ n m ?an half its int]ior3 a few %akes ( ! h& w s5d ! drop a little fur!r 94 ,! lymph end ( ! tube is !n tak5 9 ! ?umb & =ef+]1 :ile ! unoccupi$ "p ( ! tube is pass$ once or twice quickly ?r\gh ! flame ( a c&le4 ,?is r>ifies ! air1 & :ile x is w>m ! end is clos$ by melt+ x at ! edge ( ! flame4 ,! second end is !n clos$ 9 ! same way z ! fir/4 ,:5 ! lymph is want$ = use1 ! ends ( ! tube are brok51 & ! lymph bl[n out on ! po9t ( a lancet4 ,lymph pres]v$ 9 ^! tubes reta9s its efficacy an indef9ite "t4 ,! ,national ,vacc9e ,in/itution1 ,russell ,place1 ,fitzroy ,squ>e1 ,london1 ,w41 supplies to m$ical practition]s bo? po9ts & tubes gratis on application4 ,9 p]=m+ ! op]ation ! common lancet does v well2 b two or ?ree =ms ( n>r[-groov$ lancets are employ$ by surgeons = ?is purpose4 ,! op]ation is mo/ successful :5 ! lymph is transf]r$ direct f arm to arm2 ! lancet mak+ ! puncture is !n *>g$ at ! vesicle ( a *ild vacc9at$ a week be=e1 & po9ts are unnecess>y4 ,:5 mak+ ! puncture ! surgeon grasps ! *ild's arm 9 8 left h&1 puts ! sk9 on ! /ret* ov] ! ins]tion ( ! deltoid ) 8 left =ef+] & ?umb1 pu%es ! lancet d[nw>ds betwe5 ! cutis & cuticle1 ab\t #a-aj? ( an in*1 to raise ! latt] 9 a little pocket2 he !n *>ges 8 lancet ) lymph & ins]ts x 9 ! pocket1 or if us+ po9ts1 ins]ts ! moi/5$ po9t = a m9ute1 tak+ c>e z he )draws ! po9t to press ! sk9 d[n on ! po9t ) 8 left ?umb1 t ! lymph may be well wip$ (f ! po9t & left 9 ! w\nd4 ,?is process is repeat$ f\r or five times & ! op]ation is complete4 ,! corium %\ld n be p5etrat$1 or x w ble$ freely & ! blood w wa% away ! lymph2 "o drop ( blood is ( little consequ5ce2 inde$1 x %[s t an absorb+ surface has be5 rea*$4 ,! ph5om5a foll[+ ! ins]tion ( ! vacc9e virus 9 an infant's arm are z foll[s3--,on ! second day ! puncture is slightly elevat$2 on ! ?ird x beg9s to gr[ r$2 on ! fif? x is m>k$ by a di/9ct vesicle ) a depress$ c5tre & r$ areola2 on ! eigh? ! vesicle is p]fect1 ( pe>l-l aspect1 full ( cle> lymph2 ! areola1 (t5 little m>k$ by ! eigh? day1 rapidly increases on ! n9? & t5? days1 & rea*es an in* or m 9 diamet]4 ,?is bright-r$ inflammatory action 9 ! sk9 is ess5tial to %[ ! sy/em is prop]ly infect$ ) ! vacc9e disease2 by ! twelf? day ! areola has less5$1 ! lymph is yell[1 & (t5 escapes by rupture ( ! vesicle2 on ! f\rte5? day ! vesicle has dri$ to a scab1 t falls on ! tw5ty-fir/ day1 leav+ a dott$ cicatrix1 ! ve/ige ( ! multilocul> /ructure ( ! vesicle4 ,! ?ree important m>ks diagno/ic ( ! vacc9ation be+ satisfactory1 are--#a1 ! pe>ly multilocul> vesicle ( ! #h?-#i? day2 #b1 ! widely-spread areola on ! #i?-#ab? day2 #c1 ! well-m>k$ foveat$ cicatrix aft] ! scab has fall54 ,obs]vation %[s t ! numb] ( p :o take small-pox aft] vacc9ation is v small inde$1 :5 m ?an ?ree well-m>k$ sc>s exi/2 & ?is numb] at lea/ %\ld be secur$ by mak+ five ins]tions ( lymph at ! "t ( vacc9ation4 ,,footnotes3 #a ,li/]'s %ell-lac pla/] c be obta9$ ( ! ,glasg[ ,g5]al ,apo!c>ies' ,company1 & ! %eet t9 ( ,messrs4 ,compton ,co41 #adh1 ,f5*ur* ,/reet1 ,e4,c4 ,,li/ ,,( ,,! ,,in/rum5ts ,,& ,,appliances ,,requisite1 ,,or ,,occasionally ,,useful1 ,,9 ,,mo/ ,,( ,,! ,,important ,,& ,,ord9>y ,,op]ations ,,9 ,,surg]y4 ,,prep>ations ,,& ,,requisites ,,= ,,op]ations ,,9 ,,g5]al4 ,,! ,,op]at+ ,,room4 ,,! ,,sick ,,b$ ,,& ,,b$-,,room4 ,,s$atives ,,& ,,re/oratives4 ,,! ,,arre/ ,,( ,h,,morrhage4 ,,op]at+ ,,room4 ,hav+ a good ,light & ,w9d[s t op5 readily1 & a ,fire 9 ,w9t]4 #a4 ,firm table1 #d feet long1 #b feet wide1 & #c feet high4 #b4 ,pill[s4 #c4 ,blankets4 #d4 ,t[els4 #e4 ,old l954 #f4 ,mack9to% %eets4 #g4 ,old c>pet1 or old %eet to cov] ! floor4 #h4 ,tray ( sawdu/ or s&4 #i4 ,b&ages4 #aj4 ,/rapp+ plai/]4 #aa4 ,l9t4 #ab4 ,oil$ silk4 #ac4 ,cotton wool4 #ad4 ,t[4 #ae4 ,p]*loride ( iron4 #af4 ,bas9s1 l>ge & small4 #ag4 ,hot & cold wat]1 ice4 #ah4 ,bucket & slop-j>4 #ai4 ,sponges4 #bj4 ,*lor(orm & inhal]4 #ba4 ,oil4 #bb4 ,p9s4 #bc4 ,scissors4 #bd4 ,br&y4 #be4 ,ammonia4 #bf4 ,fire = heat+ caut]ies4 ,,sick ,,room ,,& ,,b$4 #a4 ,iron b$/ead4 #b4 ,wool & hair mattress4 #c4 ,sev]al pill[s1 s(t & ( diff]5t sizes4 #d4 ,air & wat] cu%ions4 #e4 ,blankets1 small s+le ones4 #f4 ,pieces ( s(t flannel4 #g4 ,six sets ( %eets & pill[cases4 #h4 ,old s(t l954 #i4 ,cotton-wool4 #aj4 ,t[els4 #aa4 ,s(t pocket-h&k]*iefs4 #ab4 ,?ree pieces ( ,mack9to%1 #b feet #f in*es squ>e4 #ac4 ,b$ cradle4 #ad4 ,light b$g[ns4 #ae4 ,flannel jacket1 & flannel ,z\ave draw]s4 #af4 ,hot-wat] bottle4 #ag4 ,b$-pan4 #ah4 ,b$-ur9al & b$-/ool4 #ai4 ,bas9s4 #bj4 ,cold wat]4 #ba4 ,condy's fluid4 #bb4 ,sir ,w4 ,burnett's fluid4 #bc4 ,a b$-re/ *air4 #bd4 ,night lights4 #be4 ,a fire1 or 9 summ] a lamp to burn 9 ! fireplace1 to create a draught ( air4 #bf4 ,enamell$ saucepan4 #bg4 ,two fe$+ cups4 #bh4 ,spittoon4 #bi4 ,tea-equipage4 #cj4 ,tea-kettle4 #ca4 ,m$ic9e measure4 #cb4 ,app>atus = keep+ food w>m1 ) lamp4 #cc4 ,fl[]s4 ,be=e a room is occupi$ by a pati5t :o has be5 op]at$ on1 x %\ld be ?or\ghly clean$2 ! walls & ceil+ %\ld be well bru%$1 ! c>pet tak5 away & ! floor ?or\ghly scrubb$ ) soda4 ,all curta9s & *9tz furniture %\ld be remov$1 old w9d[-bl9ds replac$ by new gre5 ones1 & ! w9d[ made to op5 readily at ! top & bottom4 ,a fire or oil-lamp %\ld be light$ 9 ! fireplace to ma9ta9 a circulation ( air4 ,if ! season require a fire1 ! iron f5d] %\ld be remov$ & replac$ by a wood5 tray ( s& or a%es1 to prev5t ! noise ( c9d]s & fire-irons fall+ on ! f5d] & he>?4 ,x is well also to flu% all ! dra9s1 wat]-closets & s9ks 9 ! h\se ) dis9fect+ fluid "o or two days be=e ! op]ation1 & a /ore ( ,sir ,william ,burnett's1 or simil> dis9fect+ fluid1 %\ld be made ready to cle> away ! ftid od\rs ( dis*>ges z !y arise4 ,:5 possible1 x is a great advantage to h two b$s ( simil> height & size1 t ! pati5t may occupy !m alt]nately4 ,! cool b$ refre%es ! pati5t greatly1 & ! vacat$ b$ is easily clean$ & air$ )\t fatigue to ! sick p]son4 ,,s$atives4 #a4 ,t9cture ( opium4 #b4 ,solution ( morphia & hypod]mic syr+e4 #c4 ,morphia suppository4 #d4 ,ice4 ,,re/oratives4 #a4 ,br&y1 *ampagne1 %]ry4 #b4 ,eau-de-cologne4 #c4 ,liquor ammoni4 #d4 ,smell+ salts4 #e4 ,_s ( *lor(orm4 #f4 ,a fan4 #g4 ,a ,rimmel's p]fume vaporis]4 #h4 ,beef-tea4 #i4 ,*ick5-bro?4 #aj4 ,milk4 #aa4 ,lime-wat]4 #ab4 ,soda-wat]4 #ac4 ,eggs4 #ad4 ,fr5* bread4 #ae4 ,biscuits4 #af4 ,arr[-root4 #ag4 ,liebig's extract ( meat4 ,,! ,,arre/ ,,( ,h,,morrhage4 #a4 ,art]y =ceps4 #b4 ,torsion =ceps4 #c4 ,t\rniquet4 #d4 ,t5aculum4 #e4 ,h>e-lip p9s4 #f4 ,acupressure ne$les4 #g4 ,nvus ne$le4 #h4 ,wire nipp]s4 #i4 ,solution ( p]*loride ( iron 7equal p>ts ( ! salt & wat]74 #aj4 ,solid p]*loride ( iron4 #aa4 ,ri*>dson's /yptic colloid4 #ab4 ,ice1 ice-cold wat]4 #ac4 ,caut]y irons4 #ad4 ,galvanic caut]y wire4 #ae4 ,ligatures1 silk1 f9e hemp1 & :ipcord4 #af4 ,l9t4 #ag4 ,amad\4 #ah4 ,b&ages4 #ai4 ,compress$ sponge4 #bj4 ,scissors4 7,see ,li/ = ! ,ligature ( ,art]ies47 ,,in/rum5ts ,,& ,,appliances ,,= ,,op]ations ,,ab\t ,,! ,,head ,,& ,,neck4 ,,treph9+ ,,! ,,skull4 ,,op]ations ,,on ,,! ,,eye4 ,,h>e-,,lip4 ,,resection ,,( ,,! ,,jaw4 ,,excision ,,( ,,! ,,:ole ,,tongue4 ,,cleft ,,palate4 ,,excision ,,( ,,tonsils4 ,,l>yngotomy4 ,,tra*eotomy4 ,,treph9+ ,,! ,,skull4 #a4 ,scalpel4 #b4 ,treph9es--sev]al cr[ns4 #c4 ,hey's saw4 #d4 ,elevator4 #e4 ,/\t dissect+ =ceps4 #f4 ,bru% to clean away ! bone-du/4 #g4 ,probe4 #h4 ,quill1 cut l a too?-pick1 to cle> ! groove ( bone-du/4 #i4 ,l5ticul> knife4 #aj4 ,small polypus =ceps4 #aa4 ,sponges4 #ab4 ,l9t4 #ac4 ,ice4 ,,op]ations ,,on ,,! ,,eye4 ,/rabismus4 #a4 ,*lor(orm1 if us$4 #b4 ,laur5ce's1 or o!r head-fix]4 #c4 ,specula ( diff]5t sizes4 #d4 ,too!d =ceps4 #e4 ,/rabismus scissors & hooks4 #f4 ,f9e curv$ ne$les1 & f9e/ ?read4 #g4 ,l9t4 #h4 ,ice1 or cold wat]4 ,extirpation ( ! ,eyeball4 #a4 ,*lor(orm4 #b4 ,head-fix]4 #c4 ,speculum4 #d4 ,too!d =ceps4 #e4 ,curv$ scissors4 #f4 ,/rabismus hook4 #g4 ,small & l>ge sponges4 #h4 ,dissect+ =ceps4 #i4 ,ice-cold wat]4 #aj4 ,p]*loride ( iron4 #aa4 ,f9e curv$ ne$les1 & f9e/ silk ?read4 #ab4 ,l9t4 #ac4 ,pull$ l9t4 #ad4 ,bas94 #ae4 ,b&age4 ,cat>act 7,cong5ital74 #a4 ,atrop9e drops4 #b4 ,*lor(orm4 #c4 ,head-fix]4 #d4 ,speculum4 #e4 ,lac]at+ ne$les4 #f4 ,too!d =ceps1 to fix eyeball4 #g4 ,l9t4 #h4 ,cold wat]4 #i4 ,gelat9e pla/]4 ,cat>act 7,s5ile74 #a4 ,atrop9e drops4 #b4 ,*lor(orm4 #c4 ,head-fix]4 #d4 ,speculum4 #e4 ,lac]at+ ne$les4 #f4 ,too!d =ceps4 #g4 ,cat>act knives4 #h4 ,scoop4 #i4 ,plat9um spatula1 to adju/ edges ( w\nd4 #aj4 ,small sponges4 #aa4 ,bas9 & wat]4 #ab4 ,gelat9e pla/]4 #ac4 ,wool & b&age4 #ad4 ,l9t4 ,iridectomy4 #a4 ,*lor(orm1 if us$4 #b4 ,head-fix]4 #c4 ,specula4 #d4 ,too!d =ceps4 #e4 ,"r-angl$ knives4 #f4 ,iris =ceps4 #g4 ,iris hooks4 #h4 ,capsule scissors1 if requir$4 #i4 ,light curv$ scissors4 #aj4 ,l9t4 #aa4 ,gelat9e pla/]4 #ab4 ,wool & b&age4 #ac4 ,atrop9e drops4 #ad4 ,small sponges & bas94 #ae4 ,hot & cold wat]4 ,,h>e-,,lip4 #a4 ,scalpel4 #b4 ,art]y =ceps1 or %>p hook4 #c4 ,h>e-lip p9s4 #d4 ,wire nipp]s4 #e4 ,d5ti/'s silk twi/4 #f4 ,/rapp+ pla/]4 #g4 ,silv] suture4 #h4 ,collodion4 #i4 ,scissors4 #aj4 ,*eek compressor4 #aa4 ,sponges4 #ab4 ,l>ge t[el to wrap ! *ild 94 #ac4 ,*lor(orm & inhal]4 ,:5 ! bone has also to be b5t back-- #ad4 ,bone nipp]s4 #ae4 ,seque/rum =ceps4 #af4 ,a knitt+ ne$le2 & #ag4 ,_s lamp to *eck deep hmorrhage by ! actual caut]y4 ,,resection ,,( ,,! ,,jaw1 ,,& ,,tum\rs ,,connect$ ,,) ,,x4 #a4 ,scalpels4 #b4 ,art]y =ceps4 #c4 ,torsion =ceps4 #d4 ,ligatures4 #e4 ,retractors4 #f4 ,too? =ceps4 #g4 ,n>r[ saw4 #h4 ,hey's saw4 #i4 ,bone-cutt+ =ceps4 #aj4 ,lion's-too? =ceps4 #aa4 ,seque/rum =ceps4 #ab4 ,g\ges4 #ac4 ,*isel4 #ad4 ,gag4 #ae4 ,h>e-lip p9s4 #af4 ,wire nipp]s4 #ag4 ,actual caut]y4 #ah4 ,p]*loride ( iron4 #ai4 ,ice4 #bj4 ,sutures1 silk & wire4 #ba4 ,solution ( *loride ( z9c4 #bb4 ,l9t4 #bc4 ,b&ages4 #bd4 ,pla/]4 #be4 ,collodion4 #bf4 ,mack9to% %eet4 #bg4 ,small sponges ti$ on /icks4 #bh4 ,l>g] sponges4 #bi4 ,*lor(orm & inhal]4 ,,excision ,,on ,,! ,,:ole ,,tongue4 #a4 ,scalpel4 #b4 ,torsion =ceps4 #c4 ,art]y =ceps4 #d4 ,gag4 #e4 ,ar*im$ian bone-drill4 #f4 ,*eek retractors4 #g4 ,incisor too? =ceps4 #h4 ,n>r[ saw4 #i4 ,nvus ne$le1 & #aj4 ,half a y>d ( ?ick :ipcord4 #aa4 ,/\t copp] wire4 #ab4 ,key = twi/+ ! wire tight4 #ac4 ,wire cutt]s4 #ad4 ,/\t acupressure ne$le4 #ae4 ,h>e-lip p9s4 #af4 ,two ecraseurs4 #ag4 ,ne$le = pass+ ! *a94 #ah4 ,%>p & blunt hooks4 #ai4 ,/\t silk4 #bj4 ,metallic sutures4 #ba4 ,ligatures4 #bb4 ,ice4 #bc4 ,p]*loride ( iron4 #bd4 ,caut]y iron4 #be4 ,solution ( *loride ( z9c4 #bf4 ,collodion4 #bg4 ,small sponges m\nt$ on /icks4 #bh4 ,br&y4 #bi4 ,*lor(orm & inhal]4 #cj4 ,l9t4 #ca4 ,mack9to% %eet4 ,,cleft ,,palate4 #a4 ,long-h&l$1 n>r[-blad$ knife1 = divid+ ! palat9e muscles4 #b4 ,long-h&l$ curv$ scissors4 #c4 ,sl5d] hook$ =ceps1 to seize s(t palate4 #d4 ,long-h&l$ small bi/\ry1 = p>+ edges ( fissure4 #e4 ,long-h&l$ ne$les1 ) ! eye at ! po9t = pass+ sutures4 #f4 ,f9e blue silk1 or catgut4 #g4 ,blunt & %>p hooks4 #h4 ,scissors4 #i4 ,ice1 ice-cold wat]4 #aj4 ,mack9to% %eet4 #aa4 ,sponges set on /icks4 #ab4 ,glass syr+e = wa%+ ! m\?4 #ac4 ,smi?'s gag4 #ad4 ,*lor(orm & inhal]4 ,,excision ,,( ,,tonsils4 #a4 ,long vulsellum4 #b4 ,tonsil guillot9es2 or1 probe-po9t$ bi/\ry1 ! po/]ior two-?irds ( ! blade cov]$ ) l9t or pla/]2 or1 tonsil excisors ( v>i\s k9ds4 #c4 ,ice1 ice-cold wat]4 ,to repress ,hmorrhage f ! ,tonsils4 #a4 ,a small lump ( ice held 9 a long vulsellum aga9/ ! tonsil4 #b4 ,small sponge on ! end ( a /ick1 dipp$ 9 ice-cold solution ( p]*loride ( iron1 or o!r /yptic4 #c4 ,long /raight polypus or gullet =ceps ) padd$ ends1 to compress ! tonsil2 "o blade be+ pass$ )9 ! m\?1 ! o!r outside aga9/ ! neck4 ,,l>yngotomy ,,9 ,,! ,,crico-,,?yroid ,,space4 #a4 ,scalpel4 #b4 ,art]y =ceps & ligature silk4 #c4 ,torsion =ceps4 #d4 ,silv] tube1 curv$ on ! flat4 #e4 ,tapes4 #f4 ,%>p & blunt hooks4 #g4 ,two hook$ =ceps4 #h4 ,sponges4 ,,tra*eotomy4 #a4 ,scalpel4 #b4 ,dissect+ =ceps4 #c4 ,blunt hooks = ve9s4 #d4 ,%>p hook to draw =w>d tra*ea4 #e4 ,d\ble silv] tube & tapes4 #f4 ,torsion =ceps4 #g4 ,art]y =ceps4 #h4 ,ligatures4 #i4 ,tra*ea-dilator1 to assi/ introduction ( tube4 #aj4 ,sponges4 #aa4 ,br&y4 #ab4 ,ammonia4 #ac4 ,if a =eign body is lodg$ 9 ! l>ynx1 =ceps ( v>i\s k9ds to extract )4 #ad4 ,/rapp+ plai/]4 #ae4 ,silv] suture4 ,,in/rum5ts1 c41 ,,= ,,op]ations ,,ab\t ,,! ,,trunk4 ,,removal ,,( ,,! ,,brea/ ,,or ,,tum\rs4 ,n,,vus4 ,,tapp+ ,,! ,,pleura4 ,,tapp+ ,,! ,,belly4 ,,colotomy4 ,,ov>iotomy4 ,c,,s>ian ,,section4 ,,/rangulat$ ,,h]nia4 ,,radical ,,cure ,,( ,,h]nia4 ,h,,morrhoids4 ,,fi/ula ,,9 ,,ano4 ,,cleft ,,p]9,,um4 ,,extirpation ,,( ,,! ,,c]vix ,,ut]i4 ,,amputation ,,( ,,! ,,p5is4 ,,circumcision4 ,,excision ,,( ,,te/is4 ,,tapp+ ,a ,,hydrocele4 ,,vesico-,,vag9al ,,fi/ula4 ,,ret5tion ,,( ,,ur9e4 ,,ext]nal ,,ure?rotomy4 ,,li?otomy4 ,,li?otrity4 ,,remov+ ,,=eign ,,bodies ,,f ,,! ,,ure?ra ,,& ,,bladd]4 ,,removal ,,( ,,! ,,brea/ ,,or ,,tum\rs4 #a4 ,scalpel4 #b4 ,art]y =ceps4 #c4 ,torsion =ceps4 #d4 ,dissect+ =ceps4 #e4 ,d\ble hook4 #f4 ,blunt hooks4 #g4 ,t5aculum4 #h4 ,f9e ligatures4 #i4 ,half-y>d ( /\t :ipcord1 = irremovable gl&s4 #aj4 ,wire or silk sutures4 #aa4 ,l9t4 #ab4 ,dia*ylon pla/]4 #ac4 ,sponges4 #ad4 ,scissors4 #ae4 ,?ree-in* wide roll]s4 #af4 ,fold$ t[el compress4 #ag4 ,*lor(orm & inhal]4 #ah4 ,wat]pro( %eet4 ,n,,vus4 ,= ,ligature4 #a4 ,nvus ne$les1 /raight & curv$4 #b4 ,suture silk1 /\t compress$ :ipcord4 #c4 ,scalpel4 #d4 ,scissors4 #e4 ,l9t4 #f4 ,*lor(orm & inhal]4 #g4 ,sponge & wat]4 ,= ,caut]is+4 #a4 ,acupressure ne$les4 #b4 ,_s lamp4 #c4 ,galvanic caut]y4 #d4 ,gas caut]y4 ,= ,excis+4 #a4 ,scalpel4 #b4 ,dissect+ =ceps4 #c4 ,blunt hooks4 #d4 ,art]y =ceps4 #e4 ,%>p hooks4 #f4 ,ligature4 #g4 ,l9t4 #h4 ,b&age4 #i4 ,sponge4 #aj4 ,sutures4 ,= ,inject+4 #a4 ,subcutane\s inject+ syr+e4 #b4 ,solution ( p]*loride ( iron4 ,= ,pass+ ,setons4 #a4 ,small f9e suture ne$les4 #b4 ,f9e silk suture4 ,,tapp+ ,,! ,,pleura4 #a4 ,small scalpel4 #b4 ,troc>1 fitt$ ) india-rubb] tube4 #c4 ,bucket4 #d4 ,l9t4 #e4 ,collodion4 #f4 ,/rapp+4 #g4 ,scissors4 #h4 ,br&y4 ,,tapp+ ,,! ,,belly4 #a4 ,body b&age 7see p4 #aj74 #b4 ,scalpel4 #c4 ,troc>4 #d4 ,suture4 #e4 ,collodion4 #f4 ,scissors4 #g4 ,l9t4 #h4 ,bucket4 #i4 ,dia*ylon pla/]4 #aj4 ,br&y4 ,,amussat',s ,,op]ation ,,( ,,colotomy ,,& ,,ga/rotomy4 #a4 ,scalpel4 #b4 ,probe-po9t$ bi/\ry4 #c4 ,director4 #d4 ,dissect+ =ceps4 #e4 ,nvus ne$le1 ?read$ ) ?ick :ipcord4 #f4 ,silv] sutures4 #g4 ,art]y =ceps4 #h4 ,f9e ligatures4 #i4 ,retractors4 #aj4 ,sponges4 #aa4 ,l>ge troc>4 #ab4 ,t[4 #ac4 ,sponges4 #ad4 ,l>ge syr+e full ( w>m wat]4 #ae4 ,*lor(orm & inhal]4 ,,ov>iotomy4 #a4 ,room rais$ to temp]ature ( #gj ,f4 #b4 ,scalpel4 #c4 ,clamp4 #d4 ,vulcanis$ india-rubb] tub+1 to fix on cannula4 #e4 ,torsion =ceps4 #f4 ,art]y =ceps & ligatures4 #g4 ,f9e ligatures4 #h4 ,broad retractors4 #i4 ,blunt hooks4 #aj4 ,ov>iotomy troc>4 #aa4 ,nvus ne$les1 ?read$4 #ab4 ,h>e-lip p9s4 #ac4 ,wire nipp]s4 #ad4 ,/rong :ipcord4 #ae4 ,silk sutures & silv] wire4 #af4 ,dia*ylon pla/]4 #ag4 ,ca!t] = empty+ ! bladd]4 #ah4 ,s(t napk9s4 #ai4 ,b&age or lac$ napk94 #bj4 ,*lor(orm & inhal]4 #ba4 ,caut]y iron4 #bb4 ,silv] p9s4 #bc4 ,sponges4 ,c,,s>ian ,,section4 #a4 ,room ma9ta9$ at temp]ature ( #gj ,f4 #b4 ,ca!t] to empty bladd]4 #c4 ,l>ge scalpel4 #d4 ,/raight probe-po9t$ bi/\ry4 #e4 ,director4 #f4 ,l>ge blunt hooks4 #g4 ,l>ge syr+e & vag9al tube1 = wa%+ out ut]us p] vag9am4 #h4 ,art]y =ceps4 #i4 ,ligatures1 f9e & /\t :ipcord4 #aj4 ,torsion =ceps4 #aa4 ,h>e-lip p9s1 /\t & long4 #ab4 ,suture silk4 #ac4 ,f9e sutures4 #ad4 ,fold$ l95 compress4 #ae4 ,broad body roll]4 #af4 ,flannel4 #ag4 ,cotton wool4 #ah4 ,w>m flannels4 #ai4 ,*lor(orm & inhal]4 ,,/rangulat$ ,,h]nia4 #a4 ,scalpel4 #b4 ,/raight bi/\ry4 #c4 ,probe-po9t$ bi/\ry4 #d4 ,h]nia knife4 #e4 ,n>r[ director4 #f4 ,broad director4 #g4 ,dissect+ =ceps4 #h4 ,blunt hooks4 #i4 ,f9e hook1 9 case ! sac is v t5se4 #aj4 ,art]y =ceps4 #aa4 ,torsion =ceps4 #ab4 ,ligatures4 #ac4 ,sutures4 #ad4 ,l9t4 #ae4 ,dia*ylon pla/]4 #af4 ,?ree-in* wide roll]4 #ag4 ,compress4 #ah4 ,razor4 #ai4 ,sponges4 #bj4 ,half gra9 ( morphia suppository4 #ba4 ,*lor(orm & inhal]4 #bb4 ,scissors4 ,,wood',s ,,op]ation ,,= ,,radical ,,cure ,,( ,,h]nia4 #a4 ,razor1 or scalpel1 = %av+ ! gro94 #b4 ,t5otomy knife4 #c4 ,ne$le4 #d4 ,compress$ :ipcord1 well wax$ & soap$4 #e4 ,glass or box-wood compress4 #f4 ,two pads ( l9t4 #g4 ,l9t4 #h4 ,b&age4 #i4 ,scissors4 #aj4 ,suture4 #aa4 ,collodion4 ,h,,morrhoids4 ,ext]nal1--,excision (4 #a4 ,vulsellum1 or hook1 or r+$ =ceps4 #b4 ,knife-edg$ scissors curv$ on ! flat4 #c4 ,torsion =ceps4 #d4 ,l9t & ,t-b&age4 #e4 ,smi?'s clamp4 #f4 ,caut]y iron4 ,int]nal4 #a4 ,enema ( w>m wat]4 #b4 ,hook1 vulsellum1 or r+-=ceps4 #c4 ,?9 compress$ :ipcord4 #d4 ,nvus ne$les ?read$1 to transfix ! base ( ! pile4 #e4 ,scissors4 #f4 ,smi?'s clamp4 #g4 ,ice4 #h4 ,solid p]*loride ( iron4 #i4 ,l9t & cotton wool4 #aj4 ,opium suppository4 ,,prolapsus ,,ani4 ,! same4 ,,fi/ula ,,9 ,,ano4 #a4 ,probes ( v>i\s sizes1 "s groov$4 #b4 ,groov$ director4 #c4 ,probe-po9t$ curv$ bi/\ry4 #d4 ,/raight %>p-po9t$ bi/\ry4 #e4 ,t5aculum4 #f4 ,?read$ curv$ ne$le set 9 a h&le4 #g4 ,torsion =ceps4 #h4 ,art]y =ceps4 #i4 ,/\t ligature4 #aj4 ,caut]y iron4 #aa4 ,l9t1 cotton wool4 #ab4 ,sponges4 #ac4 ,compress4 #ad4 ,?ree-in* wide roll]4 #ae4 ,oil4 #af4 ,*lor(orm & inhal]4 ,,cleft ,,p]9,,um4 #a4 ,scalpel4 #b4 ,hook =ceps4 #c4 ,curv$ nvus ne$les1 ?read$4 #d4 ,/\t :ipcord4 #e4 ,suture silk4 #f4 ,wire suture4 #g4 ,glass rods1 or ,no4 #ab b\gies4 #h4 ,collodion4 #i4 ,l9t4 #aj4 ,sponges on h&les4 #aa4 ,oil4 #ab4 ,*lor(orm & inhal]4 ,,extirpation ,,( ,,! ,,c]vix ,,ut]i4 #a4 ,two hook$ =ceps1 or long vulsella4 #b4 ,specula 7bivalve & duckbill74 #c4 ,ecraseur4 #d4 ,two wool hold]s4 #e4 ,small sponges on /icks4 #f4 ,scalpel4 #g4 ,/raight probe-po9t$ bi/\ry4 #h4 ,bi/\ry curv$ on ! flat4 #i4 ,long-h&l$ /raight scissors4 #aj4 ,long-h&l$ curv$ scissors4 #aa4 ,art]y =ceps4 #ab4 ,ligatures4 #ac4 ,h>e-lip p9s4 #ad4 ,d5ti/s' silk4 #ae4 ,caut]y irons4 #af4 ,p]*loride ( iron4 #ag4 ,solution ( *loride ( z9c4 #ah4 ,ice4 #ai4 ,l9t 7if plugg+ necess>y1 see pp4 #abg1 #abh74 #bj4 ,compress$ sponge 9 pieces4 #ba4 ,s(t silk h&k]*ief4 #bb4 ,cotton wool4 #bc4 ,suppository4 ,,amputation ,,( ,,! ,,p5is4 #a4 ,tape to tie r\nd ! root ( p5is4 #b4 ,/raight bi/\ry4 #c4 ,scalpel4 #d4 ,art]y =ceps4 #e4 ,torsion =ceps4 #f4 ,dissect+ =ceps4 #g4 ,scissors4 #h4 ,f9e ligatures4 #i4 ,f9e suture1 to fix ! flap ( muc\s membrane ( ! ure?ra4 #aj4 ,flexible ca!t]4 #aa4 ,l9t4 #ab4 ,tape4 #ac4 ,ice4 #ad4 ,*lor(orm & inhal]4 ,,circumcision4 #a4 ,small /raight bi/\ry4 #b4 ,polypus =ceps4 #c4 ,half-in* wide tape4 #d4 ,art]y =ceps4 #e4 ,f9e ligatures4 #f4 ,silk suture4 #g4 ,torsion =ceps4 #h4 ,scissors4 #i4 ,l9t4 #aj4 ,ice4 #aa4 ,*lor(orm & inhal]4 ,,excision ,,( ,,te/is4 #a4 ,scalpel4 #b4 ,l>ge %>p hook4 #c4 ,blunt hooks4 #d4 ,/\t :ipcord4 #e4 ,f9e ligature4 #f4 ,art]y =ceps4 #g4 ,sutures1 silk or wire4 #h4 ,scissors4 #i4 ,*lor(orm & inhal]4 #aj4 ,l9t4 ,,tapp+ ,,& ,,inject+ ,a ,,hydrocele4 #a4 ,troc>4 #b4 ,vulcanite syr+e1 ) nozzle to fit cannula4 #c4 ,t9cture ( iod9e4 #d4 ,susp5d] = ! te/icles4 #e4 ,l9t4 #f4 ,collodion4 #g4 ,plai/]4 ,,vesico-,,vag9al ,,fi/ula4 #a4 ,duckbill speculum4 #b4 ,scalpels set 9 long h&les1 curv$ blades4 #c4 ,long-h&l$ curv$ scissors4 #d4 ,long-h&l$ =ceps4 #e4 ,long-h&l$ hook$ =ceps4 #f4 ,long-h&l$ %>p hook4 #g4 ,n>r[ curv$ spatula4 #h4 ,ne$les to c>ry silv] wire suture4 #i4 ,silv] wire4 #aj4 ,probes4 #aa4 ,%ort curv$ ne$les1 to c>ry f9e silk suture4 #ab4 ,ne$le hold]4 #ac4 ,suture tight5]4 #ad4 ,lead clamp4 #ae4 ,awl = p]=at+ ! clamp4 #af4 ,clamp adju/]4 #ag4 ,split %ot4 #ah4 ,=ceps = plac+ & p9*+ ! %ot4 #ai4 ,small sponges set on slips ( wood4 #bj4 ,l>ge sponges4 #ba4 ,sims' ca!t]4 #bb4 ,ice-cold wat]4 #bc4 ,syr+e & flexible ca!t] = inject+ ! bladd]1 to te/ ! p]fect closure ( ! fissure4 #bd4 ,*lor(orm & inhal]4 #be4 ,oil4 ,,ret5tion ,,( ,,ur9e4 #a4 ,flexible ca!t]s 7,nos4 #h to 7 7,engli% & ,fr5*74 #b4 ,f9e/ gum b\gies 7,no4 74 #c4 ,silv] ca!t]s4 #d4 ,long pro/atic ca!t]4 #e4 ,oil4 #f4 ,glass syr+e4 #g4 ,inject+ bottle4 #h4 ,tapes & /r+4 #i4 ,/rapp+ plai/]4 #aj4 ,scissors4 #aa4 ,troc> = tapp+ p] rectum4 #ab4 ,t9cture ( opium4 #ac4 ,morphia suppository4 #ad4 ,*lor(orm & inhal]4 ,,ext]nal ,,ure?rotomy4 #a4 ,scalpels4 #b4 ,ca!t]s1 silv]4 #c4 ,ca!t]s1 flexible4 #d4 ,f\r feet ( india-rubb] tub+ to fit ca!t]4 #e4 ,probes1 /raight & groov$1 ) flat h&les4 #f4 ,syme's %\ld]$ n>r[ groov$ /aff4 #g4 ,m>%all's long jo9t$ groov$ s\nd1 ) flexible ca!t] slid+ on x4 #h4 ,curv$ director4 #i4 ,li?otomy tapes or anklets4 #aj4 ,tapes4 #aa4 ,sponges4 #ab4 ,t5aculum4 #ac4 ,art]y =ceps4 #ad4 ,ligatures4 #ae4 ,oil4 #af4 ,ice4 #ag4 ,*lor(orm & inhal]4 ,,li?otomy4 #a4 ,firm table1 ( conv5i5t height4 #b4 ,fold$ blankets4 #c4 ,mack9to% %eet4 #d4 ,tray ( s&1 or saw-du/4 #e4 ,pair ( li?otomy tapes1 or anklets4 #f4 ,l9t4 #g4 ,s\nd4 #h4 ,/aff4 #i4 ,ca!t] to fit syr+e1 = inject+ ! bladd]4 #aj4 ,li?otomy scalpels4 #aa4 ,=ceps4 #ab4 ,scoops4 #ac4 ,se>*]4 #ad4 ,bi/\ri ca*4 #ae4 ,syr+e1 v>i\s nozzles4 #af4 ,gorget4 #ag4 ,tubes1 ) & )\t petticoats4 #ah4 ,li?otrite4 #ai4 ,ca!t] to fit syr+e4 #bj4 ,art]y =ceps4 #ba4 ,t5aculum4 #bb4 ,ligatures4 #bc4 ,half gra9 morphia suppository4 #bd4 ,*lor(orm & inhal]4 #be4 ,oil4 #bf4 ,sponges4 #bg4 ,b&ages & tape4 #bh4 ,br&y1 ammonia4 ,,li?otrity4 #a4 ,li?otrites1 f5e/rat$ & flat4 #b4 ,holl[ s\nd1 ) %ort beak4 #c4 ,clov]'s app>atus = wa%+ out ! bladd]4 #d4 ,oil4 #e4 ,li?otrite ca!t]s4 #f4 ,ure?ral =ceps4 #g4 ,inject+ bottle1 ) nozzle to fit ! holl[ s\nd4 #h4 ,half gra9 morphia suppository4 #i4 ,hot l9se$ p\ltice4 #aj4 ,firm bol/] or pill[4 ,,remov+ ,,=eign ,,bodies ,,f ,,! ,,ure?ra ,,& ,,bladd]4 #a4 ,ca!t]s1 silv]1 gum1 ela/ic4 #b4 ,s\nds ( diff]5t curves4 #c4 ,b\gies olivaires4 #d4 ,ure?ral =ceps ) long blades4 #e4 ,f9e dress+ =ceps4 #f4 ,f9e polypus =ceps4 #g4 ,coxet]'s ure?ral =ceps4 #h4 ,ure?ral li?otrite =ceps4 #i4 ,hunt]'s tube =ceps4 #aj4 ,loop ( wire set 9 long h&le4 #aa4 ,l]oy d',etiolles' jo9t$ scoop4 #ab4 ,l]oy's tube1 & slid+ hook4 #ac4 ,*>rire's hair-p9 retractor4 #ad4 ,*>rire's b\gie retractor4 #ae4 ,?ree-bran*$ =ceps4 #af4 ,endoscope4 #ag4 ,oil4 #ah4 ,glass syr+e4 #ai4 ,scalpel4 #bj4 ,dissect+ =ceps4 #ba4 ,hook4 #bb4 ,art]y =ceps4 #bc4 ,ligature4 #bd4 ,sutures4 #be4 ,tapes4 #bf4 ,sponges4 #bg4 ,*lor(orm & inhal]4 ,,in/rum5ts ,,= ,,op]ations ,,on ,,! ,,limbs4 ,,ligature ,,( ,,! ,,l>g] ,,art]ies4 ,,resections1 ,,( ,,! ,,head ,,( ,,! ,,hum]us1 ,,elb[1 ,,hip1 ,,& ,,knee4 ,,removal ,,( ,,necros$ ,,bone4 ,,amputations ,,at ,,! ,,%\ld]-,,jo9t1 ,,jo9t1 ,,arm1 ,,=e>m ,,& ,,wri/2 ,,metac>pus1 ,,hip1 ,,?igh ,,& ,,leg2 ,,by ,,syme',s ,,& ,,*op>t',s ,,op]ations2 ,,metat>sus4 ,,ligature ,,( ,,! ,,l>ge ,,art]ies4 #a4 ,scalpel4 #b4 ,groov$ director4 #c4 ,dissect+ =ceps4 #d4 ,broad groov$ director4 #e4 ,probe4 #f4 ,blunt hooks4 #g4 ,metallic retractors4 #h4 ,aneurism ne$le4 #i4 ,ditto1 helix curve4 #aj4 ,wax$ compress$ :ipcord4 #aa4 ,art]y =ceps4 #ab4 ,f9e ligatures4 #ac4 ,sutures4 #ad4 ,scissors4 #ae4 ,sponges on /icks4 #af4 ,l>g] sponges4 #ag4 ,/rapp+4 #ah4 ,l9t4 #ai4 ,b&age4 #bj4 ,*lor(orm & inhal]4 ,,resection ,,( ,,! ,,%\ld]4 #a4 ,scalpels4 #b4 ,saw 7,iri% b[-saw74 #c4 ,retractors4 #d4 ,lion's-too? =ceps4 #e4 ,blunt hooks4 #f4 ,art]y =ceps4 #g4 ,torsion =ceps4 #h4 ,t5acula4 #i4 ,acupressure ne$les4 #aj4 ,l95 retractors4 #aa4 ,ligatures4 #ab4 ,sutures4 #ac4 ,key to compress ! subclavian art]y4 #ad4 ,caut]y iron4 #ae4 ,wire nipp]s4 #af4 ,l9t4 #ag4 ,b&ages4 #ah4 ,/rapp+4 #ai4 ,oil$ silk4 #bj4 ,sponges4 #ba4 ,mack9to% %eet4 #bb4 ,*lor(orm & inhal]4 ,,resection ,,( ,,! ,,elb[4 #a4 ,/raight bi/\ry4 #b4 ,retractors4 #c4 ,blunt hooks4 #d4 ,b[-saw4 #e4 ,probes4 #f4 ,g\ges4 #g4 ,torsion =ceps4 #h4 ,art]y =ceps4 #i4 ,lion's-too? =ceps4 #aj4 ,bone =ceps4 #aa4 ,ligatures4 #ab4 ,sutures4 #ac4 ,l9t4 #ad4 ,oil$ silk4 #ae4 ,b&ages4 #af4 ,/rapp+4 #ag4 ,sponges4 #ah4 ,mack9to% %eet4 #ai4 ,angul> spl9t to support ! arm4 #bj4 ,*lor(orm & inhal]4 ,,resection ,,( ,,! ,,upp] ,,end ,,( ,,! ,,femur4 #a4 ,/rong bi/\ry4 #b4 ,probe-po9t$ bi/\ry4 #c4 ,long probes4 #d4 ,b[-saw4 #e4 ,retractor4 #f4 ,blunt hooks4 #g4 ,n>r[ l95 retractor4 #h4 ,g\ges & *isels4 #i4 ,bone =ceps4 #aj4 ,art]y =ceps4 #aa4 ,torsion =ceps4 #ab4 ,t5aculum4 #ac4 ,ligatures4 #ad4 ,sutures4 #ae4 ,b&ages4 #af4 ,l9t4 #ag4 ,sponges4 #ah4 ,/raight bracket$ long spl9t & pads4 #ai4 ,*lor(orm & inhal]4 #bj4 ,mack9to% %eet4 ,,resection ,,( ,,! ,,knee4 #a4 ,/raight bi/\ry4 #b4 ,scalpels4 #c4 ,metallic retractors4 #d4 ,b[-saw4 #e4 ,g\ge4 #f4 ,*isel4 #g4 ,art]y =ceps4 #h4 ,torsion =ceps4 #i4 ,acupressure ne$le4 #aj4 ,t5aculum4 #aa4 ,ligatures4 #ab4 ,sutures4 #ac4 ,t\rniquet4 #ad4 ,sponges4 #ae4 ,l9t4 #af4 ,b&ages4 #ag4 ,oil$ silk4 #ah4 ,mc,intyre's spl9t & pads4 #ai4 ,*lor(orm & inhal]4 #bj4 ,mack9to% %eet4 ,,remov+ ,,necros$ ,,bone4 #a4 ,scalpels4 #b4 ,/raight & curv$ bi/\ries1 ) %>p & probe po9ts4 #c4 ,long & %ort probes4 #d4 ,directors4 #e4 ,retractors4 #f4 ,g\ges4 #g4 ,*isels4 #h4 ,bone =ceps 7v>i\s74 #i4 ,g\ge =ceps4 #aj4 ,seque/rum =ceps4 #aa4 ,lion's-too? =ceps4 #ab4 ,o/eotrites4 #ac4 ,art]y =ceps4 #ad4 ,t5aculum4 #ae4 ,torsion =ceps4 #af4 ,acupressure ne$les4 #ag4 ,ligatures4 #ah4 ,sutures4 #ai4 ,l9t4 #bj4 ,b&ages4 #ba4 ,oil$ silk4 #bb4 ,mack9to% %eet4 #bc4 ,*lor(orm & inhal]4 ,,amputation ,,at ,,! ,,%\ld] ,,jo9t4 #a4 ,t\rniquet4 #b4 ,long amputat+ knife4 #c4 ,art]y =ceps4 #d4 ,f9e ligatures1 /\t ligatures4 #e4 ,t5aculum4 #f4 ,acupressure ne$les4 #g4 ,ne$le nipp]s4 #h4 ,key to compress subclavian art]y4 #i4 ,sutures4 #aj4 ,/rapp+ cut into /rips4 #aa4 ,b&ages4 #ab4 ,l9t4 #ac4 ,oil$ silk4 #ad4 ,sponges4 #ae4 ,caut]y irons4 #af4 ,ice4 #ag4 ,mack9to% %eet4 #ah4 ,*lor(orm & inhal]4 ,,amputation ,,( ,,! ,,arm4 #a4 ,t\rniquet4 #b4 ,amputat+ knife4 #c4 ,saw4 #d4 ,art]y =ceps4 #e4 ,torsion =ceps4 #f4 ,ligatures4 #g4 ,sutures4 #h4 ,t5aculum4 #i4 ,acupressure ne$les4 #aj4 ,wire nipp]s4 #aa4 ,/rapp+4 #ab4 ,l9t4 #ac4 ,b&ages4 #ad4 ,wadd+4 #ae4 ,/raight spl9ts4 #af4 ,sponges4 #ag4 ,mack9to% %eet4 #ah4 ,*lor(orm & inhal]4 ,if a circul> amputation-- #ai4 ,split l95 retractor2 & #bj4 ,r\nd-po9t$ /raight-edg$ knife4 ,,amputation ,,( ,,! ,,=e>m ,,& ,,wri/4 #a4 ,t\rniquet4 #b4 ,l>ge bi/\ry1 or small amputat+ knife4 #c4 ,torsion =ceps1 art]y =ceps1 & ligature ?read4 #d4 ,art]y =ceps4 #e4 ,saw4 #f4 ,acupressure ne$les4 #g4 ,ne$le nipp]s4 #h4 ,t5aculum4 #i4 ,f9e ligatures4 #aj4 ,sutures4 #aa4 ,l9t4 #ab4 ,wool4 #ac4 ,spl9ts4 #ad4 ,b&ages4 #ae4 ,oil$ silk4 #af4 ,sponges4 #ag4 ,mack9to% %eet4 #ah4 ,*lor(orm & inhal]4 ,,amputation ,,( ,,metac>pal ,,bones ,,& ,,phalanges4 #a4 ,n>r[-blad$ bi/\ry4 #b4 ,bone =ceps4 #c4 ,torsion =ceps4 #d4 ,art]y =ceps4 #e4 ,f9e ligatures4 #f4 ,small suture4 #g4 ,/rapp+4 #h4 ,n>r[ b&age4 #i4 ,wadd+4 #aj4 ,spl9t to support ! arm & h&4 #aa4 ,b&age4 #ab4 ,l9t4 #ac4 ,oil$ silk4 #ad4 ,mack9to% %eet4 #ae4 ,sponges4 #af4 ,t\rniquet4 #ag4 ,*lor(orm & inhal]4 ,,amputation ,,at ,,! ,,hip ,,jo9t4 #a4 ,li/]'s aorta compressor4 #b4 ,long hip knife4 #c4 ,art]y =ceps4 #d4 ,/\t & f9e ligatures4 #e4 ,torsion =ceps4 #f4 ,t5aculum4 #g4 ,acupressure ne$les4 #h4 ,ne$le nipp]s4 #i4 ,silk & silv] sutures4 #aj4 ,l9t4 #aa4 ,/rapp+ plai/]4 #ab4 ,sponges4 #ac4 ,b&ages4 #ad4 ,ice4 #ae4 ,a bone-hold]1 or lion's-too? =ceps1 if ! fragm5t ( ! bone is too %ort to grasp 9 ! h&4 #af4 ,*lor(orm & inhal]4 #ag4 ,mack9to% %eet4 7,see also ! ,li/ = ! ,op]at+ ,room74 ,,amputation ,,( ,,! ,,?igh ,,& ,,leg4 #a4 ,t\rniquet4 #b4 ,amputat+ knife4 #c4 ,scalpel4 #d4 ,bone =ceps4 #e4 ,saw4 #f4 ,torsion =ceps4 #g4 ,art]y =ceps4 #h4 ,/\t & f9e ligatures4 #i4 ,sutures4 #aj4 ,t5aculum4 #aa4 ,/rapp+4 #ab4 ,h>e-lip p9s4 #ac4 ,wire nipp]s4 #ad4 ,l9t4 #ae4 ,b&ages4 #af4 ,oil$ silk4 #ag4 ,caut]y iron4 #ah4 ,ice4 #ai4 ,sponges4 #bj4 ,mack9to% %eet4 ,9 a circul> amputation-- #ba4 ,a r\nd-po9t$ knife1 & a l95 retractor split into two tongues = ! ?igh & ?ree = ! leg1 ! c5tre "o be+ well wax$4 ,,amputation ,,at ,,! ,,ankle ,,& ,,foot4 7,syme's & ,*op>t's ,op]ations47 #a4 ,t\rniquet4 #b4 ,/rong bi/\ry4 #c4 ,/rong scalpel 7,syme's74 #d4 ,saw4 #e4 ,bone =ceps4 #f4 ,art]y =ceps4 #g4 ,torsion =ceps4 #h4 ,t5aculum4 #i4 ,acupressure ne$les4 #aj4 ,wire nipp]s4 #aa4 ,/rapp+4 #ab4 ,sutures4 #ac4 ,l9t4 #ad4 ,b&ages4 #ae4 ,oil$ silk4 #af4 ,wool4 #ag4 ,sponges4 #ah4 ,*lor(orm & inhal]4 #ai4 ,mack9to% %eet4 ,,amputation ,,( ,,! ,,metat>sal ,,bones ,,& ,,toes4 #a4 ,t\rniquet4 #b4 ,/raight bi/\ry4 #c4 ,t5aculum4 #d4 ,torsion =ceps4 #e4 ,acupressure ne$les4 #f4 ,ne$le nipp]s4 #g4 ,art]y =ceps4 #h4 ,ligatures4 #i4 ,sutures4 #aj4 ,lion's-too?1 or seque/rum =ceps4 #aa4 ,/rapp+4 #ab4 ,l9t & wool4 #ac4 ,b&ages4 #ad4 ,n>r[ saw4 #ae4 ,bone =ceps4 #af4 ,mack9to% %eet4 #ag4 ,*lor(orm & inhal]4 ,,index4 ,a4 ,abdom9al support1 #afe4 ---- t\rniquet1 #adi4 ,acromion1 fracture (1 #ef4 ,adm9i/]+ *lor(orm1 #agi4 ,air-ba?1 ! hot1 #aed4 ,amputations1 #bac4 ---- ankle1 #bae4 ---- arm1 #bac4 ---- =e>m1 #bad4 ---- hip1 #bad4 ---- leg1 #bae4 ---- metac>pal bones1 #bad4 ---- metat>sal bones1 #bae4 ---- p5is1 #bjh4 ---- phalanges1 #bad4 ---- %\ld]1 #bac4 ---- ?igh1 #bae4 ,angul> spl9t1 #dh4 ---- union1 #gf4 ,ankle1 /rapp+ !1 #bg4 ,app>atus = dislocation at ! hip1 #ajd4 ,ar*1 palm>1 w\nd (1 #ag4 ,arm1 b&age =1 #af4 ,arre/ ( hmorrhage1 #aig4 ,artificial respiration1 #ahc4 ,ascites1 b&age =1 #aj4 ,b4 ,b&ages1 #a4 ---- arm1 #af4 ---- belly1 #aj4 ---- ble$+ jugul> ve91 #g4 ---- brea/1 #h4 ---- elb[1 #af4 ---- f+]s1 #ad4 ---- foot1 #ba4 ---- gro91 #i4 ---- h&1 #ae4 ---- head1 #c4 ---- heel1 #ba4 ---- h]nia1 #aj4 ---- knee1 #bb4 ---- leg1 #ba4 ---- _m-tail1 #bc4 ---- pla/] ( p>is1 #he4 ---- scultetus1 #bc4 ---- %\ld]1 #af1 #ee4 ---- spica1 #i1 #aj1 #ad1 #af1 #ee4 ---- />*1 #hj4 ---- /ump1 #bb4 ---- ?umb1 #ad4 ---- toe1 #ba4 ,b&-box cradle1 #ha4 ,ba?1 ! hot air1 #aed4 ---- ! vap\r1 #aee4 ,b$1 ! float+1 #ada4 ---- ! sick1 #aif4 ,b$sores1 #adj4 ---- r+ ( felt =1 #adj4 ---- ,br[n ,sequ>d's treatm5t1 #adj4 ,belloc's s\nd1 #aba4 ,belly1 b&age =1 #aj4 ---- tapp+ !1 #bjd4 ,bicuspid too?1 draw+ a1 #abd4 ,bladd]1 ice1 #g4 ---- wa%+ out !1 #acg4 ,blanket pad = axilla1 #ec4 ,ble$+1 cupp+1 #aeh4 ---- at elb[1 #ah4 ---- jugul> ve91 #g4 ---- lee* bites1 #afj4 ---- palm> ar*1 #ag4 ---- socket ( too?1 #abf4 ---- /aff1 #ai4 ---- tape1 #ai4 ,bli/]s1 #agj4 ,block = ,mc,intyre's spl9t1 #fe4 ,blood1 transfusion (1 #add4 ,bo? bones ( =e>m1 fracture (1 #dc4 ,b\gies1 #acj4 ---- fili=mes1 #acd4 ---- olive-head$1 #acj4 ,bread p\ltice1 #aga4 ,brea/1 b&ag+ !1 #h4 ---- remov+ !1 #bjc4 ---- /rapp+ !1 #be4 ,brok5 rib1 #cf4 ---- f+]1 #ci4 ,bruce's caut]y1 #aff4 ,bulb\s end$ ca!t]1 #acj1 #ace4 ,c4 ,cs>ian section1 #bje4 ,calcaneum1 sep>ation ( ! epiphysis (1 #fj4 ,calomel fumigation1 #aec4 ,cambric roll]s1 #a4 ,can9e too?1 draw+ a1 #abc4 ,can?>ides1 #agj4 ,cap = %\ld]1 #ed4 ,capell9e b&age1 #e4 ,c>bolic acid dress+1 #agb4 ,c>riage1 ! sick1 #aee4 ,c>te's t\rniquet1 #adi4 ,ca%'s b&ages1 #a4 ,ca/+ 9 pla/] ( p>is1 #aad4 ,cat>act1 #aii4 ,ca!t]s1 #abi4 ---- flexible1 #abi4 ---- pass+1 #acb4 ---- ---- 9 ! female1 #acf4 ---- silv]1 #abi4 ---- ty+ 91 #ach4 ---- vulcanis$ india-rubb]1 #acj1 #acf4 ,cau/ics1 #afh4 ,caut]ies1 #aff4 ,caut]y irons1 #aff4 ---- ,clov]'s1 #afh4 ---- galvanic1 #afh4 ---- gas1 #aff4 ,c]vix ut]i1 extirpation (1 #bjg4 ,*alk & gum1 #hi4 ,*assaignac's dra9age tubes1 #afa4 ,*loride ( z9c1 #afi4 ,*lor(orm1 #agi4 ---- 9 dislocations1 #ie4 ---- to ! ut]us1 #ahg4 ---- dang]s (1 #ahj4 ,*romic acid1 #afi4 ,circumcision1 #bjh4 ,clavicle1 dislocation (1 #if4 ---- fracture ( !1 #ef4 ,cleft palate1 #bja4 ---- p]9um1 #bjg4 ,clove hit*1 !1 #ii4 ,clov]'s caut]y1 #afh4 ---- inhal]1 #aha4 ,club foot1 #aac4 ,cold injection1 #aah4 ,coll> bone1 fracture (1 #ef4 ---- r+ pad =1 #ei4 ---- figure ( #h =1 #ei4 ---- dislocation (1 #if4 ,colles' fracture1 #ci4 ,collodion1 #ahi4 ,colotomy1 #bje4 ,common roll]s ) pla/] ( p>is1 #hh4 ,comp\nd fracture1 op5+s 9 spl9ts =1 #hg4 ,compress1 graduat$1 #ag4 ---- = ble$+ jugul> ve91 #g4 ,con=mation ( ure?ra1 #acb4 ,cont9u\s ext5sion1 #gh1 #hj4 ,corrigan's hamm]1 #afi4 ,c\nt] ext5sion1 #ie4 ,coxet]'s ela/ic p]9eal b&1 #ge4 ,cradles1 #ij4 ---- ,salt]'s1 #fd4 ---- ( b& box1 #ij4 ,cupp+1 ble$+1 #aeh4 ---- dry1 #aef4 ,cu%ions1 wat]1 #adb4 ,d4 ,deliri\s pati5ts1 manacles =1 #ab4 ,dia!sis1 ! hmorrhagic1 #abf4 ,difficulties 9 pass+ ca!t]s1 #acc4 ,disjunction ( articul> surfaces1 #dg4 ,dislocations1 #ie4 ---- clavicle1 #if4 ---- elb[1 #aja4 ---- ---- di/9ction f fracture1 #dg4 ---- f+]s1 #ajc4 ---- foot1 #aaj4 ---- hip1 #ajd4 ---- ---- r$uction by manipulation1 #ajg4 ---- knee1 #aji4 ---- l[] jaw1 #ie4 ---- patella1 #aaj4 ---- %\ld]1 #ig4 ---- ?umb1 #ajc4 ,domett's flannel roll]1 #aab4 ,d\ble incl9es1 #gg4 ---- slung1 #gh4 ,dra9age tubes1 #afa4 ,draw+ tee?1 #abb4 ,drops = eye1 #aag4 ,dry cupp+1 #aef4 ---- heat1 #agb4 ,dry+ />* b&ages1 #hd4 ,dupuytr5's spl9t1 #fa4 ,e4 ,e>s1 syr++ !1 #aag4 ,eight1 figure (1 #c4 ,eighte5-tail b&age1 #bc4 ,ela/ic ext5sion1 #ge4 ---- p]9eal b&1 #ge4 ---- socks1 #bd4 ---- /irrup1 #ge4 ,elb[1 b&ag+ !1 #af4 ---- dislocation at1 #aja4 ---- fracture ne>1 #dg4 ---- resect+ !1 #bab4 ,elevator1 #abe4 ,empla/rum lytt1 #agj4 ,epiphysis ( ,os ,calcis1 sep>ation ( !1 #fj4 ,epispa/ique1 pte1 #agj4 ,epi/axis1 #aah4 ,equ9us1 talipes1 #aac4 ,esm>*'s irrigator1 #agi4 ,ess5tials ( a truss1 #afb4 ,e!r spray1 #ahf4 ,ext5sion 9 fractures1 #ge1 #gf1 #gh4 ---- 9 hip disease1 #hj4 ---- simple1 9 dislocations1 #ii4 ---- 9 ! long spl9t1 #ge4 ---- by weight & pully1 #gi4 ,ext]nal spl9t = brok5 jaw1 #cb4 ,eye d\*e1 #aaf4 ---- drops1 #aag4 ---- op]ations on !1 #aih4 ,f4 ,fe$+ by ! /oma* pump1 #add4 ,female1 pass+ a ca!t] 9 !1 #acf4 ,femur1 fracture (1 #gb4 ---- resect+ !1 #bab4 ,fibula1 fracture (1 #fj4 ,figure ( #h turn1 #c4 ---- b&age1 #ei4 ,f+]s1 b&ag+1 #ad4 ---- dislocation (1 #ajc4 ---- spl9t =1 #ci4 ,fi/ula 9 ano1 #bjg4 ,flannel roll]s1 #a4 ---- ---- = pla/] ( p>is1 #hf4 ,flexible ca!t]s1 #acj4 ,float+ b$1 #ada4 ,fom5tations1 #agb4 ,foot1 b&ag+ !1 #ba4 ---- dislocation ( !1 #aaj4 ,=ceps1 too?1 #abb4 ---- ---- bicuspid1 #abc1 #abd4 ---- ---- incisor1 #abc4 ---- ---- mol>1 #abd4 ,=e>m1 b&ag+ !1 #ae4 ---- dislocation (1 #aja4 ---- fracture (1 #dc4 ,f\r-tail b&age1 #f4 ,fractures1 #cj4 ---- acromion1 #ef4 ---- at ankle1 #fa4 ---- clavicle1 #ef4 ---- ,colles'1 #ci4 ---- elb[1 #dg4 ---- femur1 %aft (1 #gb4 ---- fibula1 #fj4 ---- =e>m1 #dc4 ---- hum]us1 neck (1 #ec4 ---- ---- %aft (1 #ea4 ---- ---- l[] end (1 #dg4 ---- ---- great tub]osity (1 #ef4 ---- jaw1 #cj4 ---- metac>pal bones1 #cg4 ---- olecranon1 #de4 ---- os calcis1 #fj4 ---- patella1 #fg4 ---- pelvis1 #cg4 ---- phalanges1 #ci4 ---- radius1 #ci1 #dd4 ---- rib1 #cf4 ---- tibia1 #fa4 ---- transv]se ditto1 #ff4 ---- ulna1 #dc4 ,fr5* bulb\s end$ ca!t]s1 #acj4 ,fumigation1 #aea4 ---- g5]al1 #aeb4 ---- local1 #aed4 ,g4 ,gag1 = /oma*-pump1 #adc4 ,galvanic caut]y1 #afh4 ,gas caut]y1 #aff4 ,gauntlet = fractur$ radius1 #db4 ,gauze1 wire1 #dh4 ,g5]al rules1 #a4 ,glove = metac>pal bones1 #ch4 ,glue1 #hi4 ,graduat$ compress1 #ag4 ,gro91 spica =1 #i4 ,gum & *alk1 #hi4 ,gums1 lee*es to1 #aei4 ,gutta-p]*a1 #cj1 #ch1 #db1 #di1 #ed1 #gj1 #gg1 #id4 ,h4 ,hmorrhage1 arre/ (1 #aig4 ---- f ! tonsils1 #bja4 ,hmorrhagic dia!sis1 #abf4 ,hmorrhoids1 #bjf4 ,hair suture1 #aaf4 ,hamm]1 ,corrigan's1 #afi4 ,h&1 b&ag+ !1 #ad4 ,h&le = ext5d+ ! ?umb1 #ajc4 ,h>e-lip1 #aii4 ,head b&age1 #c4 ---- ice bladd] =1 #g4 ,heat1 dry1 #agb4 ,heel1 to b&age !1 #ba4 ,h]nia1 #afb4 ---- spica1 #i4 ---- trusses =1 #afa4 ,hewitt's transfusion app>atus1 #ade4 ,hides' lea!r felt1 #hi4 ,hip-disease1 ext5sion 91 #gi4 ---- dislocation1 #ajd4 ---- spl9t1 #ib4 ,hit*1 ! clove1 #ii4 ,hooks1 ,malgaigne's1 #ga4 ,horizontal position 9 fractur$ clavicle1 #eg4 ,horse heel1 #aac4 ,horse%oe t\rniquet1 #adh4 ,hot air ba?1 #aed4 ---- fom5tations1 #agb4 ---- wat] cu%ions1 #agb4 ,h[ to hold a roll]1 #b4 ,hum]us1 fractures at l[] end (1 #dg4 ---- great tub]osity1 #ef4 ---- neck (1 #ec4 ---- %aft (1 #ea4 ,hydrocele1 tapp+ a1 #bjh4 ,i4 ,ice bladd]s on head1 #g4 ---- cold injections1 #aah4 ,improvis$ t\rniquet1 #aea4 ,incisor too?1 to draw1 #abc4 ,incl9e1 d\ble1 #gg4 ---- ---- slung1 #gh4 ,inject+ bottle1 #acg4 ---- syr+e1 #aag4 ---- *lor(orm to ! ut]us1 #ahg4 ---- ! ure?ra1 #abh4 ,injection1 subcutane\s1 #ahg4 ,int]d5tal spl9ts1 #cc4 ,intracapsul> fracture ( neck ( femur1 #gg4 ,iod9e bli/]s1 #agj4 ,iridectomy1 #aii4 ,irons1 caut]y1 #aff4 ,irr$ucible h]nia1 #afc4 ,irrigation1 #agg4 ,irrigator1 ,esm>*'s1 #agi4 ,irritants1 #afh4 ,issues1 #afa4 ---- pea1 #afa4 ,j4 ,jacket1 /rait1 #aa4 ,jaw1 fracture (1 #cj4 ---- resection (1 #bjj4 ,jo9ts1 /rapp+1 #bg4 ---- to be includ$ 9 />* & pla/] ( p>is1 #ha1 #hg4 ,jugul> ve91 b&age =1 #g4 ,k4 ,kite's tail plug1 #abh4 ,knee1 b&age =1 #bb4 ---- resect+ !1 #bab4 ,knee-pan1 fracture (1 #fg4 ,knott$ b&age1 #d4 ,l4 ,l-%ap$ spl9t = arm1 #di4 ,lamp = air ba?1 #aed4 ,l>yngotomy1 #bja4 ,lat]al spl9ts = ! tibia1 #ff4 ,lavalle's 7,morel7 spl9ts1 #cc4 ,lea!r felt1 ,hides'1 #hi4 ---- spl9ts1 #ij4 ---- ---- = hip1 #ib4 ,lee*es1 #aei4 ---- to make !m bite1 #aei4 ---- to /op ! bites1 #afj4 ---- 9 ! m\?1 #aei4 ---- at ! c]vix ut]i1 #aei4 ,leg1 b&age =1 #ba4 ,ligature ( art]ies1 #baa4 ,l9se$ p\ltice1 #aga4 ,li/]'s dress+1 #agb4 ---- t\rniquet1 #adi4 ,li/on's long spl9t1 #gb4 ,li?otomy1 #baj4 ---- position1 #adj4 ,li?otrity1 #baj4 ,local an/hesia1 #ahf4 ,long spl9t1 #gb4 ,l[] jaw1 fracture (1 #cj4 ,m4 ,mc,intyre's spl9t1 #fc4 ,make%ift t\rniquet1 #aea4 ,malgaigne's hooks1 #ga4 ,manacles = deliri\s pati5ts1 #ab4 ,manipulation 9 dislocations1 #ajg4 ,_m-tail b&age1 #bc4 ,m>%all ,hall's me?od1 #ahc4 ,mat]ials = roll]s1 #a4 ,mayor's d\ble incl9e1 #gh4 ,m]curial fumigation1 #aeb4 ---- o9tm5t1 #bh4 ,metac>pal bones1 fracture (1 #cg4 ,millbo>d = spl9ts1 #hj4 ,mix+ pla/]1 #aae4 ,mol> =ceps1 #abd4 ---- tee?1 #abd4 ,morel ,lavalle's spl9ts1 #cc4 ,musl9 roll]s = pla/] ( p>is1 #he4 ,mu/>d p\ltices1 #afi4 ,n4 ,nvus1 op]at+ on1 #bjc4 ,n>es1 plugg+ !1 #aai4 ,neck ( hum]us1 fracture (1 #ec4 ,necros$ bone1 remov+1 #bac4 ,nipple %ields1 #abf4 ---- artificial1 #abf4 ,nitrate ( silv]1 #afh4 ---- ( m]cury1 #afi4 ,nitric acid1 fum+1 #afi4 ,o4 ,olecranon1 fracture (1 #de4 ---- ---- ,hamilton's spl9t =1 #dg4 ,op]at+ room1 !1 #aie4 ,op]ator's position1 #b4 ,ord9>y b&ages1 #a4 ,os ut]i1 lee*es to1 #aei4 ,outside spl9t = fractur$ jaw1 #cb4 ,ov>iotomy1 #bje4 ---- caut]y1 #afg4 ,p4 ,palm> ar*1 w\nd (1 #ag4 ,p>aff9e1 #hi4 ,p>is1 b&ages ( pla/] (1 #he4 ---- pla/] (1 ca/+ 91 #aad4 ---- ---- spl9ts (1 #hh4 ,pass+ ca!t]s1 #acb4 ---- ---- difficulties1 #acc4 ,pa/ebo>d spl9ts1 #hj4 ,pte epispa/ique1 #agj4 ,patella1 dislocation ( !1 #aaj4 ---- fracture ( !1 #fg4 ---- ---- ,samborne's plan1 #gj4 ---- back spl9t =1 #fi4 ,pelvis1 fracture ( !1 #cg4 ,p5is1 amputation (1 #bjh4 ,p]9eal b&1 #gc4 ,petit's t\rniquet1 #adg4 ,phalanges1 brok51 #ci4 ,pi/ol spl9t1 #dj4 ,pleura1 tapp+ !1 #bjd4 ,plugg+ n>es1 #aai4 ---- vag9a1 #abg4 ,po9ts = vacc9e1 #aij4 ,poisons1 /oma* pump 91 #adc4 ,position ( b&ag]1 #a4 ---- = li?otomy1 #adj4 ,potassa fusa1 #afi4 ,p\ltice1 #agj4 ---- bread1 #aga4 ---- l9se$1 #aga4 ---- mu/>d1 #afi4 ---- />*1 #agb4 ,prolapsus ani1 #bjg4 ,pubes1 dislocation on1 #ajh4 ,pulley1 ext5sion by weight1 #hj4 ,pulleys1 = dislocation1 #ajd4 ,pulv]is$ fluids1 #ahf4 ,pump1 ! /oma*1 #adc4 ,r4 ,radius1 fracture (1 #ci4 ---- ne> ! head1 #dd4 ---- dislocation (1 #ajb4 ,remov+ a />* b&age1 #hd4 ---- a pla/] ( p>is b&age1 #hh4 ---- =eign bodies f ure?ra1 #baj4 ,respiration1 artificial1 #ahc4 ,re/oratives1 #aig4 ,rev]se turn1 #b4 ,rib1 brok51 #cf4 ---- roll] =1 #cg4 ---- /rapp+1 #cf4 ,ri*>dson's spray produc]1 #ahf4 ,r+ pad1 #ei4 ---- t\rniquet1 #adg4 ,roll]s1 h[ to hold1 #b4 ---- v>ieties (1 #a4 ---- musl91 = pla/] ( p>is1 #he4 ,rules1 g5]al1 #a4 ,ruptur$ t5do a*illis1 #ei4 ,ruptures1 #afb4 ---- op]ation =1 #bjf4 ,s4 ,salt]'s cradle1 #fd4 ,s& bags1 #ij4 ,sc>ificator1 #aeg4 ,sc>pa's %oes1 #aaa4 ,scott's b&age1 #bh4 ,scultetus1 b&age (1 #bc4 ,s$atives1 #aig4 ,sep>ation ( epiphysis ( ! os calcis1 #fj4 ---- ( l[] end ( hum]us1 #dg4 ,setons1 #afj4 ,%aft ( hum]us1 #ea4 ,%awl cap1 #f4 ,%oes1 ,sc>pa's1 #aaa4 ,%ot-bag weight1 #hj4 ,%\ld]1 b&age =1 #af1 #ee4 ---- cap1 #ed4 ---- dislocation at1 #ig4 ---- dislocation at1 simple ext5sion 91 #ajj4 ---- fracture (1 #ec-ef4 ---- resect+ !1 #baa4 ,sick c>riage1 #aee4 ---- room & b$1 #aif4 ,signoroni's t\rniquet1 #adh4 ,silicate ( soda1 #hi4 ,silv] ca!t]s1 #abi1 #acb4 ---- ---- ty+ 91 #ach4 ---- nitrate (1 #afh4 ,silve/]'s me?od1 #ahd4 ,skull1 treph9+ !1 #aih4 ,sl+ = fracture1 #eb1 #fd4 ,sl++ a />* b&age1 #he4 ,slung d\ble incl9e1 #gh4 ,sock1 ela/ic1 #bd4 ,socket1 a ble$+1 #abf4 ,sore nipples1 #abf4 ,sores1 b$1 #adj4 ,s\nds1 #acj4 ,s\nd1 ,belloc's1 #aba4 ,spica = gro91 #i4 ---- = h]nia1 #aj4 ---- %\ld]1 #af1 #ee4 ---- = ?umb1 #ad4 ,spiral turn1 #b4 ,splay foot1 #aad4 ,spl9t1 ! long1 #gb4 ---- ! hip1 #ib4 ,spray produc]1 #ahf4 ,/>* b&age1 #hj4 ---- ---- aft] long spl9t1 #gf4 ---- ---- spl9ts =1 #hb4 ---- ---- "t ( apply+1 #ha4 ---- p\ltice1 #agb4 ---- roll]s1 #hb4 ,/irrup ext5sion1 #gf4 ,/ock+s1 ela/ic1 #bd4 ,/ock+-webb+ roll]s1 #a4 ,/oma* pump1 !1 #adb4 ,/rait jacket1 #aa4 ,/rangulat$ h]nia1 #bjf4 ,/rapp+1 #be4 ---- ankle1 #bg4 ---- ! brea/1 #be4 ---- jo9ts1 #bg4 ---- ---- ) m]curial o9tm5t1 #bh4 ---- pla/]s1 #be4 ---- ribs1 #cf4 ---- te/es1 #bf4 ---- ulc]s1 #bg4 ,/rictures ( ! ure?ra1 #acd4 ,/ump1 b&ag+ a1 #bb4 ---- ext5d+1 #bc4 ,/umps1 extract+1 #abe4 ,subcutane\s injection1 #ahg4 ,support+ int]d5tal spl9ts1 #ce4 ,susp5d+ ! te/es1 #ab4 ,swete's c>riage1 #aee4 ,syr++ ! e>s1 #aag4 ,t4 ,t-b&age1 #aa4 ,tak+ (f a />* b&age1 #hd4 ---- a pla/] ( p>is b&age1 #hh4 ,talipes1 #aac4 ---- equ9us1 #aac4 ---- valgus1 #aad4 ---- v>us1 #aac4 ,tape = ble$+1 #ah4 ,tapp+1 b&age =1 #aj4 ,t5do a*illis1 ruptur$1 #ei4 ,t5ts1 #afj4 ,te/es1 excis+1 #bjh4 ---- /rapp+1 #bf4 ---- susp5d+1 #ab4 ,te/+ a truss1 #afb4 ,?umb1 b&age =1 #ad4 ---- dislocation (1 #ajc4 ,tibia1 fractures (1 #fa-fg4 ,toe1 b&ag+ a1 #bb4 ,tongue1 excision (1 #bjj4 ,tonsils1 excision (1 #bja4 ---- ble$+1 #bja4 ,too? draw+1 #abb4 ---- bicuspid1 #abd4 ---- can9e1 #abc4 ---- incisor1 #abc4 ---- mol>1 #abd4 ---- =ceps1 #abb4 ,t\rniquets1 #adg4 ---- abdom9al1 #adi4 ---- ,c>te's1 #adi4 ---- horse%oe1 #adh4 ---- make%ift1 #aea4 ---- ,petit's1 #adh4 ---- r+1 #adg4 ---- ,signoroni's1 #adh4 ,tra*eotomy1 #bjb4 ,transfusion ( blood1 #add4 ,transport+ ! sick1 #aee4 ,transv]se fracture ( ! tibia1 #ff4 ,trunk1 b&ag+ !1 #h4 ,trusses1 #afa4 ---- femoral1 #afc4 ---- +u9al1 #afc4 ---- measur+ =1 #afd4 ---- ,salmon ,ody's1 #afe4 ---- umbilical1 #afe4 ,tubes1 dra9age1 #afa4 ,turns1 diff]5t1 #b4 ,ty+ = li?otomy1 #adj4 ---- 9 a flexible ca!t]1 #aci4 ---- 9 a silv] ca!t]1 #ach4 ,u4 ,ulc]s1 /rapp+1 #bg4 ,ulna1 fracture (1 #dc4 ,umbilical h]nia1 #afe4 ,union1 angul>1 #gf4 ,ure?ra1 con=mation (1 #acb4 ---- inject+ !1 #abh4 ,ure?ral syr+e1 #abh4 ,ure?rotomy1 #bji4 ,ur9e1 ret5tion (1 #bji4 ,v4 ,vacc9ation1 #aij4 ,vag9a1 plugg+ !1 #abg4 ,valgus1 #aad4 ,vap\r ba?1 !1 #aee4 ,v>ieties ( turns1 #b4 ---- ( spl9ts = ! elb[1 #dh4 ,v>us1 #aac4 ,v5esection1 #ah4 ,vesicants1 #afi4 ,vesicle 9 vacc9ation1 #aia4 ,vesico-vag9al fi/ula1 #bji4 ,vi5na pa/e1 #afi4 ,vitriol1 oil (1 #afi4 ,vulcanis$ india-rubb] ca!t]1 #acj1 #acf4 ,vulcanite spl9t = jaw1 #cd4 ,w4 ,wai/coat1 /rait1 #aa4 ,wa%+ out ! bladd]1 #acg4 ,wat]-b$1 #ada4 ---- c weight1 #hj4 ---- cu%ion1 #adb4 ,w$ge-pad = fractur$ clavicle1 #eg4 ,weight = pulley1 #hj4 ,wire gauze spl9ts1 #dh4 ,wood's op]ation = h]nia1 #bjf4 ,wool1 cotton1 #ad4 ,w\nd ( palm> ar*1 #ag4 ---- op5+ 9 spl9t =1 #hg4 ,z4 ,z9c1 *loride (1 #afi4 ,,! ,,end4 ,,bradbury1 ,,evans1 ,,& ,,co41 ,,pr9t]s1 ,,:itefri>s4