第 6 节
作者:
没事找事 更新:2021-10-16 18:43 字数:9321
distorted; the absence of distortion may be recognized by comparing
the corresponding rows of the teeth in the upper and lower jaws。 In
such cases reduction should be performed as quickly as possible; the
method of reduction has been described above。 If not reduced; the
patient's life will be in danger from continual fevers; coma
attended with stupor (for these muscles; when disordered and stretched
preternaturally; induce coma); and there is usually diarrhea
attended with billous; unmixed; and scanty dejections; and the
vomitings; if any; consist of pure bile; and the patients commonly die
on the tenth day。
32。 In fracture of the lower jaw; when the bone is not fairly broken
across; and is still partially retained; but displaced; it should be
adjusted by introducing the fingers at the side of the tongue; and
making suitable counter…pressure on the outside; and if the teeth at
the wound be distorted and loosened; when the bone is adjusted; they
should be connected together; not only two; but more of them; with a
gold thread; if possible; but otherwise; with a linen thread; until
the bone be consolidated; and then the part is to be dressed with
cerate; a few compresses; and a few bandages; which should not be very
tight; but rather loose。 For it should be well known that in
fracture of the jaw; dressing with bandages; if properly performed; is
of little advantage; but occasions great mischief if improperly
done。 Frequent examinations should be made about the tongue; and
prolonged pressure should be applied with the fingers; in order to
rectify the displaced bone。 It would be best if one could do so
constantly; but that is impossible。
33。 But if the bone be fairly broken across (this; however; rarely
happens); it is to be set in the manner now described。 When
adjusted; the teeth are to be fastened together as formerly described;
for this will contribute much toward keeping the parts at rest;
especially if properly fastened; and the ends of the thread secured
with knots。 But it is not easy to describe exactly in writing the
whole manipulation of the case; but the reader must figure the thing
to himself from the description given。 Then one must take a piece of
Carthaginian leather; if the patient be a younger person; it will be
sufficient to use the outer skin; but if an adult the whole
thickness of the hide will be required; it is to be cut to the breadth
of about three inches; or as much as will be required; and having
smeared the jaw with a little gum (for thus it sticks more
pleasantly); the end of the skin is to be fastened with the glue
near the fractured part of the jaw; at the distance of an inch or a
little more; from the wound。 This piece is to be applied below the
jaw; but the thong should have a cut in it; in the direction of the
chin; so that it may go over the sharp point of the chin。 Another
piece of thong like this; or somewhat broader; is to be glued to the
upper part of the jaw; at about the same distance from the wound as
the other thong; this thong should be so cut as to encircle the ear。
The thongs should be sharp…pointed at the part where they unite; and
in gluing them; the flesh of the thong should be turned to the
patient's skin; for in this way it will be more tenacious; then we
must stretch this thong; but still more so the one at the chin; in
order to prevent the fragments of the jaw from riding over each other;
and the thongs are to be fastened at the vertex; and then a bandage is
to be bound round the forehead; and a proper apparatus is to be put
over all; to prevent the bandages from being displaced。 The patient
should lie upon the sound side of the jaw; not resting upon the jaw;
but upon the head。 He is to be kept on a spare diet for ten days;
and then nourished without delay。 If there be no inflammation during
the first days; the jaw is consolidated in twenty days; for callus
quickly forms in this; as in all the other porous bones; provided
there be no sphacelus (exfoliation?)。 But much remains to be said on
the sphacelus of bones in another place。 This method of distention
with glued substances is mild; of easy application; and is useful
for many dislocations in many parts of the body。 Those physicians
who have not judgment combined with their dexterity; expose themselves
in fractures of the jaws; as in other cases; for they apply a
variety of bandages to a fractured jaw…bone; sometimes properly; and
sometimes improperly。 For all such bandaging of a fractured jawbone
has a tendency rather to derange the bones connected with the
fracture; than to bring them into their natural position。
34。 But if the lower jaw be disjointed at its symphysis in the
chin (there is but one symphysis in the lower jaw; but there are
several in the upper; but I am unwilling to digress from the
subject; as these matters will have to be touched upon in other
kinds of disease)…if; then; the symphysis be separated at the chin; it
is the work which anybody can perform; to rectify it; for the part
which protrudes is to be pushed inward by pressure with the fingers;
and the part that inclines inward is to forced outward by pushing with
the fingers from within。 It is after having applied extension to
separate the fragments that this is to be done; for they will thus
be more easily restored to their natural position; than if one
should bring them together by using force。 This is proper to be
known as applying to all such cases。 When you have set the parts;
you must fasten the teeth on both sides to one another; as formerly
directed。 The treatment is to be accomplished with cerate; a few
compresses; and bandages。 This part; in particular; requires a short
but complex (?) bandaging; for it is nearly cylindrical; though not
exactly so; but the turn of the bandage is to be made; if the right
jaw was dislocated; to the right hand (that is said to be to the right
hand when the right hand conducts the bandaging); but if the other jaw
be the seat of the dislocation; the bandaging is to be made in the
other direction。 And if matters be properly adjusted; and the
patient keep quiet; there will be a speedy recovery; and the teeth
will be uninjured; but if not; the recovery will be more protracted;
the teeth will be distorted; will give trouble; and become useless。
35。 Of fractures of the nose there are more than one variety; but
those who; without judgment; delight in fine bandagings; do much
mischief; most especially in injuries about the nose。 For this is
the most complex of all the forms of bandaging; having most of the
turns of the bandage called 〃ascia;〃 and rhomboidal intervals and
uncovered spaces of the skin。 As has been said; those who practice
manipulation without judgment are fond of meeting with a case of
fractured nose; that they may apply the bandage。 For a day or two;
then; the physician glories in his performance; and the patient who
has been bandaged is well pleased; but speedily the patient
complains of the incumbrance of the bandage; and the physician is
satisfied; because he has had an opportunity of showing his skill in
applying a complex bandage to the nose。 Such a bandaging does
everything the very reverse of what is proper; for; in the first
place; those who have their nose flattened by the fracture; will
clearly have the part rendered still more flat; if pressure above be
applied to it; and further; those cases in which the nose is distorted
to either side; whether at the cartilage or higher up; will
evidently derive no benefit from bandaging above it; but will rather
be injured; for it will not admit of having compresses properly
arranged on either side of the nose; and indeed; persons applying this
bandage do not seek to do this。
36。 This bandaging would appear to me to answer best when the skin
surrounding the bone is contused on its ridge near the middle; or if
the bone itself have sustained some injury; but not a great one; in
such cases; redundant callus forms in the nose; and the part becomes a
little too prominent; and yet; even in these cases; the bandaging need
not require much trouble; if; indeed; any bandage be applied at all;
for it is enough if one lay a waxed compress on the contusion; and
then apply the double…headed bandage; thus taking one turn with it。
The best application to such accidents is a small cataplasm of wheaten
flour; washed; and mixed up into a viscid mass。 If the flour be made
from good wheat; and if it be glutinous; it should be used alone for
all such cases; but if it be not very glutinous; a little of the manna
of frankincense; well pulverized; is to be moistened with water; and
the flour is to be mixed up with it; or a very little gum may be mixed
in like manner。
37。 In those cases in which the fractured portions are depressed and
flattened; if it is depressed in front at the cartilage; something may
be introduced into the nostrils to rectify the parts。 If not; all such
deformities may be restored by introducing the fingers into the
nostrils; if this can be managed; but if not; a thick spatula is to be
introduced with the fingers; not to the fore part of the nose; but
to the depressed portion; and the physician is to take hold of the