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 should commence at the seat of the injury； and be made
more particularly tight there； and the bandaging should be conducted
as is done with a double…headed roller； so that the skin about the
ribs may not be ruffled； but may lie smooth； and the bandaging
should be renewed every day； or every alternate day。 It is better also
to open the bowels with some gentle medicine； so as just to produce an
evacuation of the food； and the diet is to be restricted for ten days；
and then the body is to be recruited and filled up； while you are upon
the reducing system； the bandaging should be tighter； but when you are
making him up again； it must be looser； and； if he spit blood from the
commencement； the treatment and bandaging should be continued for
forty days； but if there be no haemoptysis； treatment for twenty
days will generally be sufficient； but the length of time must be
regulated by the magnitude of the injury。 When such contusions are
neglected； if no greater mischief result there from； at all events the
bruised part has its flesh more pulpy than it had formerly。 When；
therefore； any such thing is left behind； and is not properly
dissipated by the treatment； it will be worse if the mucosity be
lodged near the bone； for the flesh no longer adheres to the bone as
formerly； the bone becomes diseased； and chronic sloughings of the
bone in many cases arise from such causes。 But if the mischief be
not upon the bone； but it is the flesh itself which is pulpy； relapses
and pains will return from time to time； if there happen to be any
disorder in the body； wherefore proper bandaging； and for a
considerable time； must be had recourse to； until the extravasated
blood forming in the bruise be dried up and absorbed； and the part
be made up with sound flesh； and the flesh adhere to the bone。 The
best cure is the cautery in those cases which； from neglect； have
become chronic； and the place turns painful； and the flesh is pulpy。
And when the flesh itself is pulpy； the burning should be carried as
far as the