Now we shall discourse on the measures to be adopted in fractures occurring in each particular limb. In the case of a nail-joint, being in any way crushed or swollen by the accumulation of the deranged blood (in the locality), the incarcerated blood should be first let out with the help of an awl (Ará) and the part should be plastered with a paste of Sáli-rice. A finger or phalanx bone put out of joint or fractured should be first set in its natural position and bandaged with a piece of thin linen and should be then sprinkled over with clarified butter. In the case of a fracture in the foot the fractured part should be first lubricated with clarified butter, then duly splinted up, and bandaged with linen. Such a patient should forego all kinds of locomotion. In the case of a fracture of the knee-joint or thigh-bone the affected part should be lubricated with clarified butter and carefully pulled straight, after which it should be splinted with barks (of Nyagrodha, etc.) and bandaged with clean linen. In case of the fracture projecting out a thigh-bone should be reset with the help of a circular splint and bandaged. In the case of Sphutita (cracked) or Pichchita (bruised) thigh-bone, the part should be also bandaged in the aforesaid manner. 20-24. In a case of a fracture in the Kati (Ilium-bone), it should be reduced by the fractured bone being raised up or pressed down (as the case may be) and the patient should then be treated with Vasti (enematas of medicated oils or Ghritas*). In the case of a fracture of one of the rib-bones (Párs'aka), the patient should be lubricated with clarified butter. He should then be lifted up (in a standing posture) and the fractured rib (bone), whether left or right, should be relaxed by being rubbed with clarified butter. Strips of bamboo or pad (Kavalika) should be placed over it and the patient should be carefully laid in a tank or cauldron full of oil with the bamboo splint duly tied up with straps of hide. In the case of a dislocation of the Amsa-Sandhi (shoulder-joint), the region of the Kaksha (arm-pit) should be raised up with an iron-rod (Mushala) and the wise physician should bandage the part, thus reduced, in the shape of a Svastika (8-shaped) bandage. A dislocated elbow-joint should be first rubbed with the thumb, after which it should be pressed with a view to set it in its right place by fixing and expanding the same. After that the affected part should be sprinkled over with any oleaginous substance. The same measures should be adopted in the case of a dislocation of the knee-joint (Jánu-sandhi), the wrist-joint (Gulpha-sandhi) and the ankle-joint (Mani-vandha). 25-29.
* In the Nidána-Sthána - Chap. XV., 9 - it is stated that a case of fracture in the Kati should be given up (Varjjayet). Jejjata, however, explains "Varjjayet" as "hard to cure."
In the case of fractured bones in the palms of the hands, the two palms * should be made even and opposed, and then bandaged together and the affected parts should be sprinkled with raw and unmedicated oil (Ama-taila).
The patient should be made later first to hold a ball of cow-dung, then a ball of clay and then a piece of stone in his palms and so on, with the progressive return of strength (to the affected parts). In a case of a fracture of the Akshaka, the affected part should be first fomented and then reduced by raising it up with a Mushala (iron-rod) in the arm-pit or by pressing it down (as the case may be) and should be firmly bandaged. A case of fractured arm-bone should be treated according to the directions given in the case of a fractured thigh-bone. 30-32:
* The text has "Ubhe tale same kritvá." Jejjata explains "Ubhe tale" to mean "palms of the hands and soles of the feet;" Gayá Dása explains it to mean "the palms of both the hands."
In the case of a bending (twisting) or intussusception of the neck downward, the head should be lifted up by putting the ringers into the hollow (Avatu) above the nape of the neck and at the roots of the jaw-bones (Hanu) *. Then the part should be bandaged with a piece of linen after having evenly put the splint (Kus'a round the neck). The patient should be caused to lie constantly on his back for a week. In a case of a dislocation of the joints of the jaw-bones (Hanu) the jaw-bones should be fomented and duly set in their right position, bandaged in the manner of a Panchángi-vandha, and a Ghrita boiled and prepared with (the Kalka and a decoction of) the Madhura (Kákolyádi) and Váyu-subduing (Chavyádi) groups should be used as errhines by the patient. 33-34. A tooth of a young person, not broken but loose, should be plastered with a cooling paste on its outside after having pressed out the accumulated blood at the root. The tooth should be sprinkled or washed with cold water and treated with drugs having Sandhániya (adhesive) properties † The patient should be caused to drink milk with the help of a lotus stem. The loose tooth of an old man should be drawn. A nose sunk down or depressed (by a blow) should be raised up with the help of a rod or director, while it should be straightened in a case of simple bending. Then two tubes, open at both ends, should be inserted into the nostrils (to facilitate the process of breathing) and the organ should be bandaged and sprinkled with clarified butter. In the case of (the cartilage of) the ear being broken, the organ should be rubbed with clarified butter straightened, and evenly set in its right position and bandaged. Measures and remedial agents mentioned in connection with Sadyo-vrana, should be likewise adopted and employed in the present instance. 37.
* According to Gayi, the lifting up of the head by putting fingers in the Avatu and in the Hanus should be made in cases of bending and intussusception of the neck respectively.
† Honey, clarified butter, and drugs of the Nyagrodhádi group.
In a case of a fracture of the bone of the forehead unattended by any oozing out of brain matter, the affected part should be simply rubbed with honey and clarified butter and then duly bandaged. The patient should take clarified butter for a week * 38.
Cooling plasters and washes should be applied to a part of the body, swollen but not in any way ulcerated on account of a fall or a blow. In the case of a fracture of the bone in the leg and in the thigh, the patient should be laid down on a plank or board and bound to five stakes or pegs in five different places for the purpose of preventing any movements of his limbs. The distribution of the (bindings) pegs in each case should be as follows. In the first case (fractured leg-bone), two on each side of the two thighs making four and one on the exterior side of the enguinal region of the affected side. In the second case (fracture of knee-joint) two on each side of the ankle-joints making four and one on the side of the sole of the affected leg. The same sort of bed and fastenings should be used in cases of fractures and dislocations of the pelvic-joint, the spinal columu, the chest and the shoulders †. In cases of long-standing dislocations, the joint should be lubricated with oily or lardaceous applications, fomented and softened (with proper medicinal drugs) in the manner mentioned above in order to reduce it to its natural state. 39-40.
' In the case of such an emission or oozing out a plug of bristles or hair as described in the preceding chapter and remedial agents laid down in connection therewith, should be used.
† The principle of splintering and bandaging may be profitably compared with those followed in Agnur's splint.
In the case of a faulty union of a (fractured) bone lying between two joints (Kánda-bhagna), the union should be again disjointed, and the fractured bone should again be set right and treated as a case of ordinary fracture. In the case where a fractured bone would be found to have protruded out of the ulcerated part and dried, it should be carefully cut off near the margin of the (incidental) ulcer, (so as not to create a fresh ulcer on any other spot of the affected part) and subsequently treated as a case of fractural ulcer. A fracture occurring in the upper part of the body should be treated with applications of Mastikya-Sirovasti [oil-soaked pads on the head] and pourings of oil into the cavity of the ears. Potions of clarified butter, * errhines and Anuvásana (enematas) should be prescribed in cases of fractures in the extremeties. 41-43.