on the articulations-第11章

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the　hole　made　in　the　wall；　so　that　the　board　introduced　into　it　may
make　pressure　more　especially　at　that　especially　at　that　spot。　When
matters　are　thus　adjusted；　one　person；　or　two　if　necessary；　must　press
down　the　end　of　the　board；　whilst　others　at　the　same　time　make
extension　and　counter…extension　as　along　the　body；　as　formerly
described。　Extension　may　also　be　made　with　axles；　which　may　either
be　fastened　in　the　ground　beside　the　bench；　or　the　post　of　the　axles
may　be　attached　to　the　bench　itself；　if　you　will　make　them
perpendicular　and　overtopping　（the　bench？）　a　little　at　both　ends；　or
at　either　end　of　the　bench。　These　powers　are　easily　regulated；　so　as
to　be　made　stronger　or　weaker；　and　they　are　of　such　force；　that　if　one
were　to　have　recourse　to　them　for　a　mischievous　purpose；　and　not　as
a　remedy；　they　would　operate　strongly　in　this　way　also；　for　by
making　merely　extension　and　counter…extension　longitudinally；
without　any　additional　force；　one　might　make　sufficient　extension；　and
if；　without　making　extension　at　all；　one　were　only　to　press　down
properly　with　the　board；　sufficient　force　might　be　applied　in　this
way。　Such　powers；　then；　are　excellent　which　admit　of　being　so
regulated；　that　they　can　be　made　weaker　and　stronger　as　required。
And　the　forces　are　applied　in　the　natural　way；　for　the　pressure
above　forces　the　displaced　parts　into　their　place。　Natural　extension
restores　parts　which　have　come　too　near　one　another　to　their　natural
position。　I；　then；　am　acquainted　with　no　powers　which　are　better　or
more　appropriate　than　these；　for　extension　along　the　spine　downward
has　no　proper　hold　at　the　bone　called　the　os　sacrum；　and　extension
upward；　along　the　neck　and　head；　has　indeed　a　hold；　but　extension　thus
made　is　unseemly　to　behold；　and；　besides；　if　increased；　may　occasion
much　mischief　otherwise。　I　once　made　trial　of　the　following　plan。
Having　placed　the　patient　on　his　back；　I　put　below　the　hump　a　bladder；
not　inflated；　and　afterward　introduced　air　into　the　bladder　by　means
of　a　brass　pipe　connected　with　it。　But　the　experiment　did　not　succeed；
for；　when　the　man　was　fairly　extended；　the　bladder　yielded；　and　the
air　could　not　be　forced　into　it；　and；　besides；　the　hump　of　the　patient
was　apt　to　slip　off　the　distended　bladder　when　they　were　pressed
together。　But　when　I　did　not　extend　the　man　strongly；　the　bladder
was　swelled　up　by　the　air；　and　the　man　became　more　bent　forward　than
proper。　I　have　written　this　expressly；　for　it　is　a　valuable　piece　of
knowledge　to　learn　what　things　have　been　tried　and　have　proved
ineffectual；　and　wherefore　they　did　not　succeed。

　　48。　In　curvatures　forward　of　the　vertebrae　from　a　fall；　or　from　some
heavy　body　falling　upon　them；　in　general　no　one　of　them　is　displaced
far　beyond　the　others；　but　if　one　or　more　be　so　displaced；　the　case
proves　fatal；　but；　not　withstanding；　as　formerly　stated；　the
displacement　is　circular；　and　not　angular。　In　such　cases；　then；　the
urine　and　faeces　are　more　apt　to　be　retained　than　in　displacement
outward；　the　feet　and　the　whole　inferior　extremities　are　colder；　and
the　symptoms　are　more　fatal　than　in　the　former　case；　and　if　they　do
survive；　they　are　more　subject　to　retention　of　the　urine；　and　to
loss　of　strength；　and　to　torpor　in　their　legs。　But　if　the　displacement
be　in　the　upper　part；　they　experience　loss　of　strength　and　torpor　of
the　whole　body。　I　know　no　mechanical　contrivance　by　which　such　a
displacement　could　be　reduced；　unless　that　one　might　be　benefited　by
succussion　on　a　bladder；　or　any　other　similar　plan　of　treatment；
such　as　extension；　as　formerly　described。　I　am　not　aware　of　any　mode
of　pressure　which　might　be　applied　along　with　the　extension；　like　that
of　the　board　in　displacement　backward；　for　how　could　one　apply
pressure　from　before　through　the　belly？　（internal　cavity？）　The　thing
is　impossible。　But　neither　coughing　nor　sneezing　has　any　power　so　as
to　cooperate　with　the　extension；　nor　would　the　injection　of　air　into
the　bowels　have　any　effect。　And　to　apply　large　cupping　instruments
with　the　view　of　drawing　back　the　vertebrae　which　have　protruded
forward；　shows　a　great　error　of　judgment；　for　they　rather　propel
than　attract；　and　those　who　apply　them　are　not　aware　even　of　this
fact；　for　the　greater　will　be　the　inclination　forward　the　greater
the　instrument　applied；　the　skin　being　forcibly　drawn　into　the
cupping…instrument。　I　could　tell　of　other　modes　of　succussion　than
those　formerly　described；　which　one　might　fancy　would　be　more
applicable　in　such　an　affection；　but　I　have　no　great　confidence　in
them；　and　therefore　I　do　not　describe　them。　On　the　main；　it　should
be　known；　respecting　the　accidents　which　I　have　briefly　described；
that　displacements　forward　are　of　a　fatal　and　injurious　nature；　but
that　displacements　backward；　for　the　most　part；　do　not　prove　fatal；
nor　occasion　retention　of　urine　nor　torpor　of　the　limbs；　for　they　do
not　stretch　the　ducts　leading　toward　the　intestines；　nor　occasion
obstruction　of　the　same；　but　displacements　forward　produce　both
these　bad　effects；　and　many　others　in　addition。　And　truly　they　are
more　apt　to　lose　the　power　of　their　legs　and　arms；　to　have　torpor　of
the　body；　and　retention　of　urine；　who　experience　no　displacement
either　forward　or　backward；　but　merely　a　violent　concussion　along
the　spine；　while　those　who　have　displacement　backward　are　least
subject　to　these　symptoms。

　　49。　And　one　might　observe　many　other　instances　in　medicine；　of
considerable　injuries　not　proving　serious；　but　producing　a　crisis　in
some　affection；　while　less　considerable　injuries　prove　more　serious；
give　rise　to　chronic　diseases；　and　extend　their　effects　to　the　whole
system。　Now　something　similar　may　happen　in　fracture　of　the　ribs；
for　in　fracture　of　one　or　more　ribs；　in　general；　if　the　fractured
bones　are　not　driven　inward；　nor　are　laid　bare；　fever　rarely
supervenes；　neither　does　it　often　happen　that　there　is　haemoptysis；
empyema；　and　suppurating　sores；　which　require　treatment　with　pledgets；
nor　necrosis　of　the　bones；　and　in　these　cases　the　ordinary　regimen
is　sufficient。　For；　unless　they　be　seized　with　continual　fever；　a
strict　diet　does　more　harm　than　good；　by　inducing　inanition；　and
increasing　the　pain；　fever；　and　cough；　for　moderate　fullness　of　the
intestines　has　a　tendency　to　replace　the　ribs；　while　evacuation
leads　to　suspension　of　the　ribs；　and　suspension　induces　pain。　Ordinary
bandaging；　externally；　is　sufficient　in　such　cases；　the　bandages
should　be　applied　moderately　tight；　along　with　cerate　and
compresses；　or　a　pad　of　wool　may　be　applied。　The　rib　is　consolidated
in　twenty　days；　for　callus　soon　forms　in　such　bones。

　　50。　But　when　there　is　contusion　of　the　flesh　about　the　ribs；
either　from　a　blow；　or　a　fall；　or　a　bruise；　or　any　like　cause；　there
is　often　copious　vomiting　of　blood；　for　there　are　canals　stretched
along　the　vacuity　of　each　rib　（intercostal　space？）；　and　nerves
proceeding　from　the　most　important　parts　of　the　body　have　their　origin
there。　Many　of　these；　therefore；　are　troubled　with　coughs；
tubercles；　empyema；　external　suppurations；　and　sphacelus　of　the
ribs。　And　even　when　no　such　symptoms　supervene　from　contusion　of　the
skin　about　the　ribs；　still　in　such　cases　there　is；　generally；　more
combined　pain　than　in　fractures　of　the　ribs；　and　relapses　of　pain　in
the　seat　of　the　injury　are　more　apt　to　occur。　Wherefore　some
physicians　pay　much　less　attention　to　such　injuries；　than　where　the
rib　is　fractured；　whereas；　if　they　were　wise；　they　would　treat　such
cases　with　far　greater　care　than　the　other；　for　it　is　proper　that
the　diet　should　be　restricted；　that　the　patients　should　remain　at　rest
as　much　as　possible；　and　abstain　from　venery；　from　fat　articles　of
food；　from　such　as　excite　cough；　and　from　everything　strong；　they
should　be　bled　in　the　arm；　speak　as　little　as　possible；　should　have
the　contused　part　bound　round　with　folded　compresses；　plenty　of
bandages；　broader　than　the　contusion；　and　which　should　be　smeared　with
cerate；　in　applying　the　bandages；　broad　and　soft　shawls　should　be
used；　and　they　should　be　put　on　moderately　firm；　so　that　the　patient
will　say　that　they　are　neither　too　tight　nor　loose；　and　the
bandaging　shoul