306 



a frigbtfiil spectacle, the prognosis of the case is comparatively sim- 

 pie, aud recovery usually only a question of time. Tlie severity of 

 the lesion corresponds in degree with that of the violence to which it 

 is due, the degree of simplicity or the amount of complication, and 

 with the situation of the wound. It is simple when at the symphysis, 

 but becomes more serious when it affects one of the branches, to be 

 again aggravated when both arc involved. Fractiirc of the coronoid 

 process becomes important principally as an evidence of the existence 

 of a morbid diathesis, such as osteo-porosis, or the like. 



The particular seat of the injury, v/ith its special features, will of 

 course determine the treatment. For a simple fracture without dis- 

 l^lacement, provided there is no laceration of the periosteum, an ordi- 

 nary supporting bandage will usually be sufficient. But when there is 

 displacement the reduction of the fracture must first be accomplished, 

 and for this special splints are necessary. lu a fracture of the sym- 

 physis or of the branches the adjustment of the fragments by securing 

 them with metallic sutures is the first step necessary, to be followed by 

 the application of supports, consisting of splints of leather or sheets 

 of metal, the entire front of the head being then covered with bandages 

 l)repared with adhesive mixtures. During the entire course of treat- 

 ment a special method of feeding becomes necessary. The inability of 

 the patient to appreciate the situation of course necessitates a resort 

 to an artificial mode of introducing thenecessary food into his otomach, 

 and it is accomplished by forcing between the commissures of the lips, 

 in a liquid form, by means of a syringe, the milk or nutritive gruels 

 selected for his sustenance, until the consolidation is sufficiently ad- 

 vanced to permit the ingestion of food of a more solid consistency. The 

 callus will usually be sufficiently hardened in two or three weeks to al- 

 low of a change of diet to mashes of cut hay and scalded grain, until 

 the removal of the dressing restores him to his old habit of mastication- 



FracUues ofvertehra\ — These are not very common, but when they do 

 occur the bones most frequently injured are those of the back and loins. 

 The ordinary causes of fracture are responsible here as elsewhere, such 

 as heavy blows on the spinal column, severe falls while conveying heavy 

 loads, and especially violent efforts in resisting the process of casting. 

 Although occurring more or less frequently under the latter circum- 

 stances, the accident is not always attributable to carelessness or error 

 in the management. It may, of course, sometimes result from such a 

 cause as a badly prepared bed, or the accidental presence of a hard 

 body concealed in the straw, or to a heavy fall when the movements of 

 the patient have not been sufficiently controlled by an effective appa- 

 ratus and its skillful adaptat-on, but it is quite as likely to be caused by 

 the violent resistance and the consequent powerful muscular contrac- 

 tion by the frightened patient. The simple fact of the overarching of 

 the vertebral column, with excessive pressure against it from the intes- 

 tinal mass, owing to the spasmodic action of the abdominal muscles, 



