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Show 1.544 rnacrunu or run srnnsunr. FRACTURE or THE BONES or THE FACE. then puncture the pleura; by this means, the lungs of the wounded side will not be restored, but the play of the chest will become free, and the lungs of the other side will resume their action. When a rib is fractured, the intercostal artery may be torn; and should it happen that the artery is opened, and yet not torn across, it will bleed until the lungs are oppress ed. Then with the common marks of lizemorrhagy, the patient finds himself greatly oppressed. He has a sense of suflocation, and cannot lie down; and he breathes with con- i can mom ii" t it tortion of the body, to allow the side of the chest opposite to that which contains the accumulated blood, to expand in respiration. It is, in this case, the business of the surgeon to make an incision on the lower edge of the rib fractured, and a little further back than the broken point of the rib, taking care not to cut the artery which lies just under the rib ; and, having cut through the integuments and intercestal muscles, he ought to puncture the pleura. If he finds coagulated blood, he will be tempted to enlarge the wound, and introduce his finger to give vent to the blood and coagulum. If, after this, the blood accumulate again, it must be again evacuated, and a compress of Sponge put into the wound, so as to press the artery against the rib. Should there be bloody froth discharged from the mouth, the lungs are wounded, and then probably emphysema will unequivocally betray the nature of the case. t FRAC'I'URE OF THE STERNL‘M. the sternum, being attached to the of; longer ribs, moves through a larger space than the upper portion. This rub- bing and grating of the fractured bones will produce inflam~ mation and suppuration under the bone, viz. in the interior mediastinum. The danger from the mere motion of ordinary respiration is, of course, much increased when the almost inevitable con- sequences of the accident supervene-irritation and inflammation in the chest, and a troublesome cough. From these considerations it will be understood how the patient, having happily escaped the immediate shock and injury to the thoracic viscera, is in danger of caries of the bone, and abscess under it ; and it will be seen too, that the swathing, or bandaging of the chest is equally necessary here as in the fracture of the ribs, and that bleeding must be oftener repeated, and every possible cause of irritation avoided. It may happen that we require to draw out and pick away broken pieces of the sternum ; but fracture of the sternum, I am inclined to hope, does not ever require the trephine. We have however observed that the sternum is a very spongy bone, and therefore a part that is not always secure from scrophulous action when it is bruised. The ca‘ ries of the sternum does, in some measure, hold analogy with the caries of the skull: it is the communication of the disease to the contained parts which we have to dread in both; and here it may be necessary, in some cases to apply the trephine to allow the free discharge of matter, or to take away a dead piece of bone which is the source of irritation, A The fracture of the sternum is a very alarming accident, both from the parts contained under it, and from the spongy FRACTURE OF THE BONES OF THE FACE. rm‘r'fi‘ -'vv"177.~w h "‘4‘. nature of the bone. Like the ribs, during reSpiration, the sternum is in incessant motion; and the thorax being of a conical form, and the lower part admitting of a much great- er extent of motion than the upper part, it follows, that when the sternum is fractured across, there is a perpetual grating of the broken parts of the bone; the lower part of THE lower jaw bone, being much exposed and moveable, is very often fractured. It is fractured by blows and falls, and is often found to be broken in two places. The reason of this complicated fracture we may see in the arched form of the bone, and the support it has at the condyles; for it. T'til; ‘. - ' : ' wow M692 |