Commentary. Hippocrates gives a full and accurate account of this accident. He remarks that when the broken ends of the bone are not pushed inwards, it seldom happens that fever or any unpleasant symptoms supervene. When fever is not present he thinks that abstinence by occasioning an emptiness of the belly, proves rather prejudicial by removing what otherwise tends to support the part affected, which is thereby made to hang unsupported. In this case a slight bandage will be sufficient. The ribs, he says, become united in about twenty days. When the skin about the ribs is bruised by a blow or any other such cause, much blood, he says, is often vomited up. Galen, in his commentary on this passage, states that when the vessels of the pleura are wounded and blood effused into its cavity, a spitting of blood may take place although the lungs themselves have not been injured. The treatment recommended by Hippocrates consists of bleeding at the elbow, enjoining silence, applying folded compresses with broad bandages, neither too tight nor too loose. He directs us to use a double-headed bandage, and to commence at the seat of the fracture. He approves of gentle aperients and restricted diet for ten days, after which period nourishing food is to be given. He adds, that when the proper treatment is neglected, even if no other inconvenience should result from it, a viscid collection is sure to form in the part. When, in addition to this swelling, a chronic pain gets seated in the part, he advises the actual cautery to be applied. (De Articulis.)
Celsus, with his characteristic elegance and terseness, expounds the rules of practice delivered by Hippocrates. He directs us to apply a bandage, to bleed from the arm, to open the belly; to avoid noise, speaking, tumultuous passions, smoke, dust, and whatever is calculated to excite coughing and sneezing. Gruels only are to be taken before the seventh day, after which bread may be used. When the pain is violent he directs us to apply a cataplasm made from darnel, or barley with fat figs. Should a collection of matter take place it is to be opened with a red-hot iron. When mucus forms about the fracture, he recommends the application of the cautery. The above is but an imperfect outline of his admirable chapter on fractures of the ribs.
Avicenna professedly copies from our author. Haly Abbas, Rhases, and Albucasis give nearly the same account, without the slightest addition of any importance. They all approve of making an incision and extracting the pieces of bones which may happen to be irritating the pleura. Albucasis gives a drawing of the meningophylax, or instrument for protecting membranes during the sawing of bones.
SECT. XCVII.—ON THE BONES OF THE HIPS AND PUBES.
The bones of the ischium or hips are rarely fractured indeed, but admit of the same varieties as those of the scapula. Their extremities, then, are sometimes broken off; there may be fracture along their length, and the middle may be fractured by expression. They are attended with a local pain, a pungent and throbbing sensation, and torpor of the leg on that side if from expression. It is to be set in the same way as that of the scapula, only it does not admit of the extraction of broken pieces by an operation on account of the external parts. If necessary, it is to be set by the fingers, and afterwards we must apply the other convenient treatment, using embrocations, and filling up the hollows of the loins with compresses, in order that the circular bandages which are put on may lie even. The same things may be said with respect to the bones of the pubes, for we have nothing more particular to say of them.
Commentary. The other authorities do not treat of these cases so minutely as our author, whose account of them is sufficiently accurate.
Celsus merely directs us to treat them upon general principles.
Albucasis recommends the same plan of treatment as our author, with the addition of splints made of wood or leather. These, however, cannot be very much required. He directs the patient to lie on his back or on the sound side.
Avicenna does not treat of these cases of fracture. Haly Abbas and Rhases abridge our author’s account.