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bone being
of a porous nature。 But in cases of contusion； tubercles form； along
with cough； suppurating sores； and sphacelus of the ribs； for nerves
from all the parts run along each rib。 In many of these cases
haemoptysis and empyema also take place。 The management of this case
consists in careful treatment； bandaging according to rule； diet at
first restricted； but afterward more liberal； quiet； silence；
position； bowels； and venereal matters regulated。 Even when there is
no spitting of blood； these contusions are more painful than
fractures； and are more subject in time to relapses； and when any
mucous collection is left in the part； it makes itself be felt in
disorders of the body。 Treatment：…burning； when the bone is
affected； down to the bone； but not touching the bone itself； if in
the intercostal space； the burning must not extend through it； nor
be too superficial。 In sphacelus of the ribs； tents are to be tried；
all other particulars will be stated afterward： but they should be
learned by sight rather than by words； namely； food； drink； heat；
cold； attitude； medicines； dry； liquid； red； dark； white； sour； for
the ulcers； and so with regard to the diet。
Part 37
Displacements （of the vertebrae） from a fall rarely admit of
being rectified； and those above the diaphragm are most difficult to
rectify。 When the accident happens to children； the body does not
grow； with the exception of the legs； the arms； and head。
Excurvation；
in adults； speedily relieves the individual from the disease he is
laboring under； but in time it renews its attack； with the same
symptoms as in children； but of a less serious nature。 Some
individuals have borne this affection well； and have turned out to
be brawny and fat。 But few of them have lived to the age of sixty。
Lateral curvatures also occur； the proximate cause of which is the
attitudes in which these persons lie。 These cases have their
prognostics accordingly。
Part 38
The rule for the reduction and adjustment：…The axle； the
lever； the wedge； pressure above； the axle to separate； the lever to
push aside。 Reduction and adjustment are to be accomplished by
forcible extension； the parts being placed in such a position as
will facilitate the conveying of the displaced bone over the
extremity
of the bone from which it was displaced： this is to be accomplished
either with the hands； or by suspension； or axles； or turned round
something。 With the hands this is to be effected properly； according
to the structure of the parts。 In the case of the wrist and
elbow； the
parts are to be forced asunder； at the wrist in the line of
the elbow；
and the elbow with the fore…arm at a right angle with the
arm； as when
it is suspended in a sling。 When we want to separate the protruding
bones； and force them into place； in the case of the fingers； the
toes； or the wrist； the proper separation may be made by hands；
while the projecting part is forced into its place by pressing down
with the heel or the palm of the hand upon some resisting object；
while something moderately soft is laid under the projecting
part； but
nothing such under the other； and then pressure is to be
made backward
and downward； whether the dislocation be inward or outward。
In lateral
displacement； pressure and counter…pressure must be made on the
opposite sides。 Displacements forward can be reduced neither by
sneezing； nor coughing； nor by the injection of air； nor by the
cupping…instrument； and if anything can do good in such a case； it
is extension。 People are deceived in fractures of the spinal
processes； the pain of which causing the patient to stoop
forward； the
case is taken for dislocation inward； these fractures heal speedily
and easily。 Dislocation outward is to be remedied by succussion；
when high up； toward the feet； and when situated low down； in the
contrary direction； the part is to be pressed back into its place；
either with the foot or a board。 Dislocations to either side； if
they admit of any remedy； are to be treated by extension；
and suitable
attitudes； with regimen。 The whole apparatus should be broad； soft；
and strong； or otherwise； they should be wrapped in rags；
before being
used； they should all be prepared proportionately to the length；
height； and breadth。 In applying extension to the thigh； for
example； the bands should be fastened at the ankle and above
the knee；
these stretching in the same direction； another band to be passed by
the loins； and around the armpits； and by the perineum and thigh；
one end passing up the breast and the other along the back； these
all stretching in the same direction and being fastened either to a
piece of wood resembling a pestle or to an axle。 When this is done
on a couch； either of its feet is to be fastened to the
threshold； and
a strong block of wood is to be laid across the other； and the
pieces of wood resembling a pestle are to be raised on these； to
make extension and counter…extension； the naves of a wheel are to be
fastened in the floor； or a ladder is to be adjusted； so that
extension may be made in both directions。 The thing commonly
used is a
bench six cubits long； two cubits broad； one fathom in thickness；
having two low axles at this end and that； and having at its middle
two moderate sized pillars； to which is to be adjusted a transverse
piece of wood like the step of a ladder； which is to receive
the piece
of wood tied below the limb； as is done in dislocation at the
shoulder； and the bench is to have excavations like trays； smooth；
four inches in breadth and depth； and at such an interval as to
leave room for the lever used to reduce the limb。 In the
middle of the
bench a square hole is to be scooped out to receive a small pillar；
which； being adjusted to the perineum； will obviate the tendency of
the body to slip downward； and being rather loose may act somewhat
as a lever。 In certain occasions a piece of wood is
required； which is
inserted into a hole scooped out of the wall； the other end of it is
then to be pressed down； something moderately soft being placed
under it。
Part 39
In those cases where the bone of the palate has exfoliated；
the nose sinks in its middle。 In contusions of the head without a
wound； either from a fall； a fracture； or pressure； in certain of
these cases acrid humors descend from the head to the
throat； and from
the wound in the head to the liver and thigh。
Part 40
The symptoms of subluxations and luxations； and where； and
how； and how much these differ from one another。 And the cases in
which the articular cavity has been broke off； and in which the
ligament has been torn； and in which the epiphysis has broken in
which； and how； when the limb consists of two bones； one or both are
broken： in consequence of these the dangers； chances in
which bad； and
when the injuries will result in death； and when in recovery。 What
cases are to be reduced or attempted； and when； and which； and when
not； the hopes and dangers in these cases。 Which and when congenital
dislocations are to be undertaken： the parts in a state of
growth； the
parts fully grown； and why sooner； or slower： and why a part