FRACTURE 
Scalp, and, then . ay we inftrument called an elevator, 
the fame way a ‘ufed on the fkull.: Se 
Eipvazon and ‘ThePax NNING 
duty of a ea oh aaa to remo ve, with a pair of: ae 
agments, which,’ if left: in the wound, 
id not — to the reft of the bone; but only‘act as 
extraneous bod 
ere a peoraher ee of = or a colleion of purulent 
matter, thdere fractured fter are known to exift, an 
be the caufe of urgent and ners fymptoms, the furgeon 
SS be called ears to make a perforation in the bone with 
{mall trephine. wever, before a recourfe to this 
proceeding, he oie ta be te a the bad fymptoms: do 
depend on the prefence of a fluid in the anterior mediaftinum, 
o 
° 
and are not cael the ofee of inflammation confequent 
to. the violen 
We 
fhall ands thefe 1 on lass of the fter - 
h 
in oracic Rie the rere ‘objects in te 
treatment: are, to pre the broken pieces of bone fr: 
hurting the pleura, iets and lungs, by proedting 
inward, and to avert inflammation in thé cheft, as m 
poi ible, by aes venefeétions, low mes, guietude, 
rient medicines, 
QO 
“ 
Frattures of the Ribs. 
The ribs.are. broken almoft as ‘fre quently as any bones of 
the human body. The peas who feces from. a feaffold, 
the poor fellow who is run ya carriage, the man of 
.pleafure who is thrown from! his horfe, “he bara who tum- 
bles from aloft, and dalld f perfons fubje@ to falls 
in running up and down Le and ae are often ‘ under 
the. furgeon’s care for fractured ribs. thefe 
bones may be broken, but in many cafes the accident befals 
feveral at the fametime. T of the'ribs ‘wl fra 
tures are moft co 
which. .muft epee be the moft expofec 
een violen 
The falfe ee are not fo apt to be fractured as thofe which 
have the epithet true given to them. The reafon of this cir- 
cumftance is owing to the moveable nature of the former, a 
quality = io to elude the confequences of ex- 
ternal for ed fituation of the firit true rib 
‘beneath ie aan is ral a caufe why it is very feldom 
mmonly fituated is their greateft convexity, 
to the effects of 
roken 
The diagnofis of fraGtures of the ribs is eat fiffi- 
ciently plain, but in numerous eo the moit difcerning 
can obtain no y ee patient: is ‘thin, 
“Fax 
Ho owever, a obfeurity. Stan sre when the patient 
“3s-fat, when only a fingle rib is broken, and when‘the ends 
of the fra€ture are undifplaced. Py pricking fenfation in 
the fide; ee ta on the.motion of t sin ‘refpiration, « 
is frequen a juit ground of aes that. one of reed 
‘bones is featured eal at hen the natire of the fall, j 
ow, ma accident not improbable. ce all cafes of 
doubt, the sce furgeon makes it an invariable maxim 
to a& in the fame ‘hile | as he would do were he certain that 
a ribs are bro Thi 
ment, are o 
e pra ractice, in cafes of Fractured ribs, confifts in. dini 
nifhing the motion of thefe boncs as much as poffible, ae 
meafures for the hindrance and a of inflammation 
of the pleura and lungs.; and, in particular, in ee 
any cough under which’ the pat ct a happen to be fut- 
"The firft of thefe indications is fulfilled by means of ‘a 
thorax as 
roller applied round the thorax as tightly as the patient?s 
feelings will permit. Inftead of a roller, thre Agere of 
furgeons rightly prefer employing a ftrong piece of linen, 
ale enough | to furround . the c oa an ice ith du 
tightnefs in front of the body. an apparatus is not fo 
pt to bec m flack as a roller, ine it has. this ee 
at the patient himfelf, in the abfence .of the furgeon, _c 
eafily ee a or diminifh the Fe a of the odin as cir- 
cumitances:.. may require. Before putting on ‘kind of 
bandage, how wer the furgeon hould examine. the fituation 
of: the fracture, and put the. ends a the bon 
nearly as poflible into a ca e ofiti 
effected by making - fkilful p 
injured ribs. It is ufual allo t apply a pi 
after to th i 
. Whether .the bandage co onfilt ‘of a common roller,’ or 
a broad piece of cloth [ ced in front, a fcapulary muft be 
employed for the purpofe of preventing the apparatus from 
flipping downward. 
One of the Gane dangers arifing from fratures: of the 
ribs, is inflammation of the pleura a, or 
lines the cheft. Hen 
pecified, and which is fulfilled by ftri& attention to the 
— fyftem 7 ae 
or not, a 
flee a, vee yas 
sad 3 
— mes si point of ’ esa rib, by being beaten 
1 In 
shat it i is fae to difpenfe with 
ra 
etira coftalis every time that the cavity a the- 
nalis and p 
heft is enlarged i in infpiration, and thence partly efcapes 
into thé common cellul mbrane of the body through 
the deme in the pleura aes on every diminution of = 
— The fw hei: of the parts w 
i demphyfema, and-fréquen aii 
ae place ih a egies almoft incredible, the celhilar fub- 
Rance becomin 
i “che 
quickly, t than can efcape te e laceration in the 
pleura, and ae aie uch a degree of preffure: 
on the mediaftinum, diaphragm, and. oppofite lung,, ar - 
