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On The Articulations   

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

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