Albucasis and Avicenna, as usual, copy from our author. The former states that fractures of the scapula are healed in twenty or twenty-five days. Haly Abbas, like the others, directs us to remove any spiculæ which occasion irritation, to apply soothing cataplasms, and suitable bandages. Rhases remarks that the body of the bone is little subject to fractures, but that its extremities may be broken off. A fracture of the hollow portion of it is ascertained by a rising in the part; fissures are recognized only by the local pain.
SECT. XCV.—ON THE BREAST-BONE.
The middle of the sternum is fractured by simple division and by expression, and the extremity of it is broken off. When, therefore, the fracture is deranged, pain and inequality of the place follow, and there is crepitus upon pressure with the fingers. When by expression, there is violent pain, dyspnœa, and cough, owing to the pleura being irritated; and rarely there is vomiting of blood, a hollow in the fractured place, and yielding thereof. The same treatment is to be applied as that recommended for the scapula. When the fracture is by expression, we may practise Hippocrates’s mode of setting which he recommended for the clavicle when it inclines inwards, having recourse to the supine posture, the application of a cushion upon the back, pressing down the shoulders, and drawing the sides together with the hands. The sides being covered with wool, we apply a circular bandage, having first put on two thongs straight from the shoulders, so that afterwards the two ends may be united in a proper manner, and prevent the circular bandage from falling off.
Commentary. Hippocrates holds injuries of the sternum to be more dangerous than those of the ribs. He recommends in this case a light diet, rest, silence, bleeding at the arm, and so forth. (De Artic. 50.)
Celsus directs this fracture to be treated upon general principles, as explained in [the preceding section].
The Arabians evidently follow our author. Albucasis speaks of applying thin splints.
The reader will find, upon reference to [the ninetieth section], that a fracture by expression is a comminuted fracture with depression.
SECT. XCVI.—ON THE RIBS.
Of the ribs, called also spathæ, those which are long admit of a fracture in any part, but the false only at the spine, because there only they are of a bony nature; for at their anterior part they are cartilaginous, and are liable to be crushed, but not fractured. The diagnosis is not difficult, for an inequality presents itself to the fingers of the examiner, and there is crepitus with derangement at the fractured part. When the fractured parts incline inwards there is a violent pungent pain, more severe than that in pleurisy, from the pleura being wounded as with a sharp instrument; there is difficulty of breathing, cough, and often vomiting of blood. The other modes of displacement, then, may be rectified by the fingers, but in that inwards this cannot be done, owing to the difficulty of applying distension. Wherefore, some direct us to give much flatulent food, in order that by the inflation and distension occasioned by it the fracture may be propelled outwards. But this is not necessary, for there is no communication between the chest and the organs of nutrition, and besides, the inflammation will be augmented by repletion. Others apply a cupping instrument, which is not amiss, unless a collection of humours should be occasioned by the suction, and the fracture be thereby pushed more inwardly. Wherefore, Soranus says, “Let the parts be covered with wool dipped in hot oil, and let the intercostal space be filled with compresses, in order that the circular bandage applied, as in the case of the sternum, may lie smooth. And let everything be done, as in pleurisy, according to the degree of accident. But if any great necessity compel us, owing to the pleura being irritated, we must divide the skin and lay bare the broken part of the rib; and then putting the instrument for protecting membranes under, to prevent the pleura from being wounded, cut off properly, and remove the irritating pieces of bone. After this the parts which are not inflamed are to be united and cured as recent wounds; but such as are inflamed are to be covered with pledgets dipped in oil. The diet and treatment must be anti-inflammatory, and the patient is to be laid in the easiest posture.”