第 10 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  if; without making extension at all; one were only to press down
  properly with the board; sufficient force might be applied in this
  way。 Such powers; then; are excellent which admit of being so
  regulated; that they can be made weaker and stronger as required。
  And the forces are applied in the natural way; for the pressure
  above forces the displaced parts into their place。 Natural extension
  restores parts which have come too near one another to their natural
  position。 I; then; am acquainted with no powers which are better or
  more appropriate than these; for extension along the spine downward
  has no proper hold at the bone called the os sacrum; and extension
  upward; along the neck and head; has indeed a hold; but extension thus
  made is unseemly to behold; and; besides; if increased; may occasion
  much mischief otherwise。 I once made trial of the following plan。
  Having placed the patient on his back; I put below the hump a bladder;
  not inflated; and afterward introduced air into the bladder by means
  of a brass pipe connected with it。 But the experiment did not succeed;
  for; when the man was fairly extended; the bladder yielded; and the
  air could not be forced into it; and; besides; the hump of the patient
  was apt to slip off the distended bladder when they were pressed
  together。 But when I did not extend the man strongly; the bladder
  was swelled up by the air; and the man became more bent forward than
  proper。 I have written this expressly; for it is a valuable piece of
  knowledge to learn what things have been tried and have proved
  ineffectual; and wherefore they did not succeed。
  48。 In curvatures forward of the vertebrae from a fall; or from some
  heavy body falling upon them; in general no one of them is displaced
  far beyond the others; but if one or more be so displaced; the case
  proves fatal; but; not withstanding; as formerly stated; the
  displacement is circular; and not angular。 In such cases; then; the
  urine and faeces are more apt to be retained than in displacement
  outward; the feet and the whole inferior extremities are colder; and
  the symptoms are more fatal than in the former case; and if they do
  survive; they are more subject to retention of the urine; and to
  loss of strength; and to torpor in their legs。 But if the displacement
  be in the upper part; they experience loss of strength and torpor of
  the whole body。 I know no mechanical contrivance by which such a
  displacement could be reduced; unless that one might be benefited by
  succussion on a bladder; or any other similar plan of treatment;
  such as extension; as formerly described。 I am not aware of any mode
  of pressure which might be applied along with the extension; like that
  of the board in displacement backward; for how could one apply
  pressure from before through the belly? (internal cavity?) The thing
  is impossible。 But neither coughing nor sneezing has any power so as
  to cooperate with the extension; nor would the injection of air into
  the bowels have any effect。 And to apply large cupping instruments
  with the view of drawing back the vertebrae which have protruded
  forward; shows a great error of judgment; for they rather propel
  than attract; and those who apply them are not aware even of this
  fact; for the greater will be the inclination forward the greater
  the instrument applied; the skin being forcibly drawn into the
  cupping…instrument。 I could tell of other modes of succussion than
  those formerly described; which one might fancy would be more
  applicable in such an affection; but I have no great confidence in
  them; and therefore I do not describe them。 On the main; it should
  be known; respecting the accidents which I have briefly described;
  that displacements forward are of a fatal and injurious nature; but
  that displacements backward; for the most part; do not prove fatal;
  nor occasion retention of urine nor torpor of the limbs; for they do
  not stretch the ducts leading toward the intestines; nor occasion
  obstruction of the same; but displacements forward produce both
  these bad effects; and many others in addition。 And truly they are
  more apt to lose the power of their legs and arms; to have torpor of
  the body; and retention of urine; who experience no displacement
  either forward or backward; but merely a violent concussion along
  the spine; while those who have displacement backward are least
  subject to these symptoms。
  49。 And one might observe many other instances in medicine; of
  considerable injuries not proving serious; but producing a crisis in
  some affection; while less considerable injuries prove more serious;
  give rise to chronic diseases; and extend their effects to the whole
  system。 Now something similar may happen in fracture of the ribs;
  for in fracture of one or more ribs; in general; if the fractured
  bones are not driven inward; nor are laid bare; fever rarely
  supervenes; neither does it often happen that there is haemoptysis;
  empyema; and suppurating sores; which require treatment with pledgets;
  nor necrosis of the bones; and in these cases the ordinary regimen
  is sufficient。 For; unless they be seized with continual fever; a
  strict diet does more harm than good; by inducing inanition; and
  increasing the pain; fever; and cough; for moderate fullness of the
  intestines has a tendency to replace the ribs; while evacuation
  leads to suspension of the ribs; and suspension induces pain。 Ordinary
  bandaging; externally; is sufficient in such cases; the bandages
  should be applied moderately tight; along with cerate and
  compresses; or a pad of wool may be applied。 The rib is consolidated
  in twenty days; for callus soon forms in such bones。
  50。 But when there is contusion of the flesh about the ribs;
  either from a blow; or a fall; or a bruise; or any like cause; there
  is often copious vomiting of blood; for there are canals stretched
  along the vacuity of each rib (intercostal space?); and nerves
  proceeding from the most important parts of the body have their origin
  there。 Many of these; therefore; are troubled with coughs;
  tubercles; empyema; external suppurations; and sphacelus of the
  ribs。 And even when no such symptoms supervene from contusion of the
  skin about the ribs; still in such cases there is; generally; more
  combined pain than in fractures of the ribs; and relapses of pain in
  the seat of the injury are more apt to occur。 Wherefore some
  physicians pay much less attention to such injuries; than where the
  rib is fractured; whereas; if they were wise; they would treat such
  cases with far greater care than the other; for it is proper that
  the diet should be restricted; that the patients should remain at rest
  as much as possible; and abstain from venery; from fat articles of
  food; from such as excite cough; and from everything strong; they
  should be bled in the arm; speak as little as possible; should have
  the contused part bound round with folded compresses; plenty of
  bandages; broader than the contusion; and which should be smeared with
  cerate; in applying the bandages; broad and soft shawls should be
  used; and they should be put on moderately firm; so that the patient
  will say that they are neither too tight nor loose; and the
  bandaging should commence at the seat of the injury; and be made
  more particularly tight there; and the bandaging should be conducted
  as is done with a double…headed roller; so that the skin about the
  ribs may not be ruffled; but may lie smooth; and the bandaging
  should be renewed every day; or every alternate day。 It is better also
  to open the bowels with some gentle medicine; so as just to produce an
  evacuation of the food; and the diet is to be restricted for ten days;
  and then the body is to be recruited and filled up; while you are upon
  the reducing system; the bandaging should be tighter; but when you are
  making him up again; it must be looser; and; if he spit blood from the
  commencement; the treatment and bandaging should be continued for
  forty days; but if there be no haemoptysis; treatment for twenty
  days will generally be sufficient; but the length of time must be
  regulated by the magnitude of the injury。 When such contusions are
  neglected; if no greater mischief result there from; at all events the
  bruised part has its flesh more pulpy than it had formerly。 When;
  therefore; any such thing is left behind; and is not properly
  dissipated by the treatment; it will be worse if the mucosity be
  lodged near the bone; for the flesh no longer adheres to the bone as
  formerly; the bone becomes diseased; and chronic sloughings of the
  bone in many cases arise from such causes。 But if the mischief be
  not upon the bone; but it is the flesh itself which is pulpy; relapses
  and pains will return from time to time; if there happen to be any
  disorder in the body; wherefore proper bandaging; and for a
  considerable time; must be had recourse to; until the extravasated
  blood forming in the bruise be dried up and absorbed; and the part
  be made up with sound flesh; and the flesh adhere to the bone。 The
  best cure is the cautery in those cases which; from neglect; have
  become chronic; and the place turns painful; and the flesh is pulpy。
  And when the flesh itself is pulpy; the burning should be carried as
  fa