Part 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
[p. 248]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
[p. 249]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 bone, but the bone
itself should not be heated; but if it be in the intercostal space,
you need not make the burning so superficial, only you must take care
not to burn quite through. But if the contusion appear to be at the
bone, if it be still recent, and the bone has not yet become necrosed,
if it be very small, it is to be burned as has been described; but
if the rising along the bone be oblong, several eschars are to be
burned over it. Necrosis of the rib will be described along with the
treatment of suppurating sores.