第 6 节
作者:没事找事      更新:2021-10-16 18:43      字数:9321
  distorted; the absence of distortion may be recognized by comparing
  the corresponding rows of the teeth in the upper and lower jaws。 In
  such cases reduction should be performed as quickly as possible; the
  method of reduction has been described above。 If not reduced; the
  patient's life will be in danger from continual fevers; coma
  attended with stupor (for these muscles; when disordered and stretched
  preternaturally; induce coma); and there is usually diarrhea
  attended with billous; unmixed; and scanty dejections; and the
  vomitings; if any; consist of pure bile; and the patients commonly die
  on the tenth day。
  32。 In fracture of the lower jaw; when the bone is not fairly broken
  across; and is still partially retained; but displaced; it should be
  adjusted by introducing the fingers at the side of the tongue; and
  making suitable counter…pressure on the outside; and if the teeth at
  the wound be distorted and loosened; when the bone is adjusted; they
  should be connected together; not only two; but more of them; with a
  gold thread; if possible; but otherwise; with a linen thread; until
  the bone be consolidated; and then the part is to be dressed with
  cerate; a few compresses; and a few bandages; which should not be very
  tight; but rather loose。 For it should be well known that in
  fracture of the jaw; dressing with bandages; if properly performed; is
  of little advantage; but occasions great mischief if improperly
  done。 Frequent examinations should be made about the tongue; and
  prolonged pressure should be applied with the fingers; in order to
  rectify the displaced bone。 It would be best if one could do so
  constantly; but that is impossible。
  33。 But if the bone be fairly broken across (this; however; rarely
  happens); it is to be set in the manner now described。 When
  adjusted; the teeth are to be fastened together as formerly described;
  for this will contribute much toward keeping the parts at rest;
  especially if properly fastened; and the ends of the thread secured
  with knots。 But it is not easy to describe exactly in writing the
  whole manipulation of the case; but the reader must figure the thing
  to himself from the description given。 Then one must take a piece of
  Carthaginian leather; if the patient be a younger person; it will be
  sufficient to use the outer skin; but if an adult the whole
  thickness of the hide will be required; it is to be cut to the breadth
  of about three inches; or as much as will be required; and having
  smeared the jaw with a little gum (for thus it sticks more
  pleasantly); the end of the skin is to be fastened with the glue
  near the fractured part of the jaw; at the distance of an inch or a
  little more; from the wound。 This piece is to be applied below the
  jaw; but the thong should have a cut in it; in the direction of the
  chin; so that it may go over the sharp point of the chin。 Another
  piece of thong like this; or somewhat broader; is to be glued to the
  upper part of the jaw; at about the same distance from the wound as
  the other thong; this thong should be so cut as to encircle the ear。
  The thongs should be sharp…pointed at the part where they unite; and
  in gluing them; the flesh of the thong should be turned to the
  patient's skin; for in this way it will be more tenacious; then we
  must stretch this thong; but still more so the one at the chin; in
  order to prevent the fragments of the jaw from riding over each other;
  and the thongs are to be fastened at the vertex; and then a bandage is
  to be bound round the forehead; and a proper apparatus is to be put
  over all; to prevent the bandages from being displaced。 The patient
  should lie upon the sound side of the jaw; not resting upon the jaw;
  but upon the head。 He is to be kept on a spare diet for ten days;
  and then nourished without delay。 If there be no inflammation during
  the first days; the jaw is consolidated in twenty days; for callus
  quickly forms in this; as in all the other porous bones; provided
  there be no sphacelus (exfoliation?)。 But much remains to be said on
  the sphacelus of bones in another place。 This method of distention
  with glued substances is mild; of easy application; and is useful
  for many dislocations in many parts of the body。 Those physicians
  who have not judgment combined with their dexterity; expose themselves
  in fractures of the jaws; as in other cases; for they apply a
  variety of bandages to a fractured jaw…bone; sometimes properly; and
  sometimes improperly。 For all such bandaging of a fractured jawbone
  has a tendency rather to derange the bones connected with the
  fracture; than to bring them into their natural position。
  34。 But if the lower jaw be disjointed at its symphysis in the
  chin (there is but one symphysis in the lower jaw; but there are
  several in the upper; but I am unwilling to digress from the
  subject; as these matters will have to be touched upon in other
  kinds of disease)…if; then; the symphysis be separated at the chin; it
  is the work which anybody can perform; to rectify it; for the part
  which protrudes is to be pushed inward by pressure with the fingers;
  and the part that inclines inward is to forced outward by pushing with
  the fingers from within。 It is after having applied extension to
  separate the fragments that this is to be done; for they will thus
  be more easily restored to their natural position; than if one
  should bring them together by using force。 This is proper to be
  known as applying to all such cases。 When you have set the parts;
  you must fasten the teeth on both sides to one another; as formerly
  directed。 The treatment is to be accomplished with cerate; a few
  compresses; and bandages。 This part; in particular; requires a short
  but complex (?) bandaging; for it is nearly cylindrical; though not
  exactly so; but the turn of the bandage is to be made; if the right
  jaw was dislocated; to the right hand (that is said to be to the right
  hand when the right hand conducts the bandaging); but if the other jaw
  be the seat of the dislocation; the bandaging is to be made in the
  other direction。 And if matters be properly adjusted; and the
  patient keep quiet; there will be a speedy recovery; and the teeth
  will be uninjured; but if not; the recovery will be more protracted;
  the teeth will be distorted; will give trouble; and become useless。
  35。 Of fractures of the nose there are more than one variety; but
  those who; without judgment; delight in fine bandagings; do much
  mischief; most especially in injuries about the nose。 For this is
  the most complex of all the forms of bandaging; having most of the
  turns of the bandage called 〃ascia;〃 and rhomboidal intervals and
  uncovered spaces of the skin。 As has been said; those who practice
  manipulation without judgment are fond of meeting with a case of
  fractured nose; that they may apply the bandage。 For a day or two;
  then; the physician glories in his performance; and the patient who
  has been bandaged is well pleased; but speedily the patient
  complains of the incumbrance of the bandage; and the physician is
  satisfied; because he has had an opportunity of showing his skill in
  applying a complex bandage to the nose。 Such a bandaging does
  everything the very reverse of what is proper; for; in the first
  place; those who have their nose flattened by the fracture; will
  clearly have the part rendered still more flat; if pressure above be
  applied to it; and further; those cases in which the nose is distorted
  to either side; whether at the cartilage or higher up; will
  evidently derive no benefit from bandaging above it; but will rather
  be injured; for it will not admit of having compresses properly
  arranged on either side of the nose; and indeed; persons applying this
  bandage do not seek to do this。
  36。 This bandaging would appear to me to answer best when the skin
  surrounding the bone is contused on its ridge near the middle; or if
  the bone itself have sustained some injury; but not a great one; in
  such cases; redundant callus forms in the nose; and the part becomes a
  little too prominent; and yet; even in these cases; the bandaging need
  not require much trouble; if; indeed; any bandage be applied at all;
  for it is enough if one lay a waxed compress on the contusion; and
  then apply the double…headed bandage; thus taking one turn with it。
  The best application to such accidents is a small cataplasm of wheaten
  flour; washed; and mixed up into a viscid mass。 If the flour be made
  from good wheat; and if it be glutinous; it should be used alone for
  all such cases; but if it be not very glutinous; a little of the manna
  of frankincense; well pulverized; is to be moistened with water; and
  the flour is to be mixed up with it; or a very little gum may be mixed
  in like manner。
  37。 In those cases in which the fractured portions are depressed and
  flattened; if it is depressed in front at the cartilage; something may
  be introduced into the nostrils to rectify the parts。 If not; all such
  deformities may be restored by introducing the fingers into the
  nostrils; if this can be managed; but if not; a thick spatula is to be
  introduced with the fingers; not to the fore part of the nose; but
  to the depressed portion; and the physician is to take hold of the