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anew； for spasms do not arise from relaxation； but from
tension of the
parts。
Part 34
Excision； either of articular bones or of pieces of bones； when
not high up in the body； but about the foot or the hand； is
generally followed by recovery； unless the patient die at once from
deliquium 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。
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