Instruments of Reduction   

animi. Treatment:-As in injuries of the head; warmth.


PART 35
Sphacelus of the fleshy parts is produced by the tight compression
of bleeding wounds, and by pressure in the fractures of bones, and
by blackening, arising from bandages. And in those cases in which
a portion of the thigh or arm, both the bones and the flesh drop off,
many recover, the case being less dangerous than many others. In cases,
then, connected with fracture of the bones, the separation of the
flesh quickly takes place, but the separation of the bone, at the
boundary of its denuded part, is slower in taking place. But the parts
below the seat of the injury, and the sound portion of the body, are
to be previously taken away (for they die previously), taking care
to avoid producing pain, for deliquium animi may occasion death. The
bone of the thigh in such a case came away on the eightieth day, but
the leg was removed on the twentieth day. The bones of the leg, in
a certain case, came away at the middle of the sixtieth day. In these
cases the separation is quick or slow, according to the compression
applied by the physician. When the compression is gently applied the
bones do not drop off at all, neither are they denuded of flesh, but
the gangrene is confined in the more superficial parts. The treatment
of such cases must be undertaken; for most of them are more formidable
in appearance than in reality. The treatment should be mild, but,
not withstanding, with a restricted diet; hemorrhages and cold are
to be dreaded; the position, so as that the limb may be inclined upward,
and afterward, on account of the purulent abscess, horizontally, or
such as may suit with it. In such cases, and in mortifications, there
are usually, about the crisis, hemorrhages and crisis, hemorrhages
and violent diarrhoeas, which, however, only last for a few days;
the patients do not lose their appetite, neither are they feverish,
nor should they be put upon a reduced diet.


PART 36
Displacement of the spine, if inward, threatens immediate death, attended
with retention of urine and loss of sensibility. Outward, the accident
is free from most of these bad effects, much more so than where there
is merely concussion without displacement; the effects in the former
case being confined to the spot affected, whereas in the latter they
are further communicated to the whole body, and are of a mortal character.
In like manner, when the ribs are fractured, whether one or more,
provided there be no splinters, there is rarely fever, spitting of
blood, and sphacelus, and ordinary treatment without evacuation will
suffice, provided there be no fever;-bandaging, according to rule;
and the callus forms in twenty days, the 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.