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Show , 150 rascfinc or THE me. not to risk the weight of the body on the limb, but the limb is to be lifted and carried ; so in fracture of the tibia, the corn finement, or at least the precaution against resting on the limb, must be continued as long as in the instance of fracturs ed thigh bone. A difference may be observed in the time of the knitting of the fractured bones, ascribable to the state of the patient's health, and of course this will depend on air, diet, and consti- tution. When there is pain in the attempt to use the limb, it in- dicates, that the inflammation has not subsided, or that the r can natural action is not yet established. make us cautious of using the limb. It ought, therefore, to OP I‘RACTURES OF THE RIBS, S'l‘L‘IiSUM, AND PELVIS. 'l‘nc cases of fractured ribs, sternum, or pelvis, form a distinct class, because they resemble injuries of the skull more than the fracture of the bones of the extremity, in this, that they are dangerous only in so far as they do mischief to the contained viscera. OT A I‘R‘ACIL‘I‘LLD RIB. THE principal security of the bones of the chest is their elasticity. While the perfect elasticity of the cartilaginous joinings of the ribs remains, they are much protected, because they yield, and by that means are saved from shocks , r» W" 57* 0"".4gn'uw awrcum . which would break them; therefore, men are more liable to have fractured ribs in mature years. The ribs are often fractured by the person falling on a projecting corner, as of a table or chair. If he be reaching to take down something above him, and, stepping on a chair, he falls and strikes his side upon the corner of the chair, he will probably break his ribs. But I have had strong grounds of suspicion that patients have been braced up for weeks without any necessity, and that both surgeon and pits FRACTURE OF THE RIB. tient have mistaken the pain of the bruised muscles, which lie on the side of the chest for the effect of fractured bone. To find whether the rib be broken or not, we must feel along its Whole course : but if there be a particular spot very painful, and yet we do not distinguish the fracture, we must press in the rib at a part remote from this; when, if it be fractured, it will yield, and produce the same pain as before; but if the bone be entire, there will be no pain, because the bruised integuments are not affected by the pressure. When the patient insists that there is something particularly wrong, because he finds a sharp pain when he moves, it should still be considered whether this be not owing to the bruised flesh of the dcsccndcns abdominis or scrratus magmas. You make him breathe, and there is no pain nor crepitation while you place the fingers on the part; you make him exert those mus cles while the breathing is suspended, and then he feels the sharp pain caused by the action of the bruised muscles. 'When a rib is broken, we have only to keep it from moving by preventing the motion of the chest in respiration; for it is unnecessary to attempt to keep the rib in its place, this being already accomplished by the neighbouring ribs, and by the connexion of the rib with the intercostal muscles. It is to be remarked, that the lower ribs have so free a motion. and so much elasticity, that they are not apt to be broken; while the upper one is defended by the clavicle. If a fractured rib be neglected, there is much pain, and much danger of inflammation in the chest, and, in the end, of caries of the rib; for, by the motion of respiration, there is an incessant rubbing and grating of the broken ends. of the ribs which prevents their union. I have dissected the body of a man who died in conse quence of the fracture of two ribs; or rather, I ought to say, in consequence of their being neglected, the nature of the case having been misunderstood. There was an abscess under the pectoral muscle, and a caries of the ribs ; and, from the irritation spreading within the chest, much matter had beer; formed in the cavity, and even the pericardium container}. "Adam /" .. . m ‘3?!" I . 7,, W .. .. I ..,, WON! "MD 'i " I , , |