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Show rmcrunn or THE ans. 152 pus. It will be said, that this extensive mischief could not. have proceeded from the fracture of two ribs had not the con. stitution been bad. This may be true, but from this we can only infer, that we should be more careful of such accidents where there is constitutional weakness. The mention of this terrible consequence of neglected fracture, reminds me of the necessity of cautioning my reader against the consequence of a mere BRUISE or run cunsr. For, if abscess form under the broad muscles of the side, ca- ries of the bones and abscess within, may be the consequence. It becomes our duty, therefore, to take precautions that matter do not collect under the pectoralis major or serratus muscles, I 350W m and still more, that disease of the sternum does not follow con~ tusion of that bone. A compound fracture of the ribs will not readily happen in consequence of the ribs projecting, for the ribs are, in truth, beaten in when fractured. But owing to this latter circumstance, the fracture of the rib is often complicated with a puncture of the lungs, or the rupture of the intercostal artery. If the lungs be wounded by the end of the ribs,»we know it from the frothy blood spit up. If a man dies from the ribs .s‘... being beaten in upon the lungs, after surviving the immediate effect of the accident, the chest of that side is found full of bloody serum, and the lungs are compressed. 153 If, after the patient is put to bed, there should come on a difficulty of breathing, with oppression in the chest, the end of the rib has probably pierced the pleura and penetrated the lungs, and the cavity of the chest contains air which has escaped from the lungs. If a tumour on the broken rib suc~ ceeds to this, which crackles under the finger, it is the emphysematous tumour, so peculiarly characteristic of this accident. The air has been forced from the cavity of the chest into the cellular membrane by the compressson of the chest, and it may be forced from the cellular membrane, which covers the wounded rib, over the whole body, until it closes the eyelids and distends the scrotum and integuments of the penis ! When the tumour merely betrays its nature, without much inconvenience, we need not mind it ; but if it increas- es rapidly, and is attended with much oppression, punctures must be made in it with the lancet and the air pressed out, that both the cellular membrane may be freed from air, and the breathing from great oppression. While, in consequence of the accidental puncture of the lungs by the rib, the air distends the cavity and compresses the lungs on one side, the breathing and circulation may be oppressed and difficult ; but still there is no interruption of the function of respiration: at last, however, by the great When one or more of the ribs are fractured, a broad roll~ distension of one side, the mediastinum suffers, and the ca- er is put about the chest, and a split cloth is laid over the shoulders, to the ends of which the roller is pinned. This rity of the other side is eneroached -upon ; and both the diaphragm and the external muscles of respiration are 11111)ch ed in their action. There is a sympathy which pervades all the muscles of respiration, and even if the cavity of one side bandaging forces the patient to breathe by the diaphragm and muscles of the belly, while the chest is relieved from motion. The patient is then to be bled and put to bed. Bleeding, in this case, not only prevents the membranes of the chest from inflaming, but, by diminishing the quantity r N"' "‘." "*waaun-‘m-a.‘ .. m, _ e murmur or Inn ms. of circulating blood, it relieves the respiration, because the extent and frequency of the distension of the lungs is pro- portioned to the quantity and velocity of the circulating bleed. If there be. a tickling cough, after the bleeding, or?! ates may be given. he distended, the muscles of that side cannot act, and their impeded action prevents the free motion of those of the other side. Therefore it is that in emphysema there is, in the end, great anxiety and oppression, and the heart partaking of the influence, there is a feeble pulse and cold extremities. When the emphysema has proved the nature of the case, and the symptoms are thus pressing, we have to make an in- cision through the integuments and intercostal muscle, and vor. 17. w ‘ _‘| ‘ Halli". r up 3?- Jib "I ‘ It; a... main-nu vmm "Wflfi |
