CHAP. XI. Of the fracture of the ribs.
THe true ribs, for that they are bonie, may be broken in any part of them. But the bastard ribs cannot be truly broken unlesse at the backe bone, * 1.1 because they are onely bonie in that part, but gristly of the foreside to∣wards the breast-bone; wherefore there they can only be folded or croo∣ked in. These which are subject to fractures, may be broken inwards and outwards. But oft times it comes to passe, that they are not absolutely broken, but cleft into splinters, and that sometimes inwards, but not outwards. Thus the fissure doth oft-times not exceede the middle substance of the rib; but sometimes it so breakes through it all, that the fragments and splinters do prick and wound the membrane, which invests and lines them on the inside, and then there is great danger. But when the fracture is simple without a wound, compression, puncture of the mem∣brane, and lastly, without any other symptome; then the danger is lesse. There∣fore Hippocrates wisheth, that these, who are thus affected, fill themselves more free∣ly * 1.2 with meat; for that moderate repletion of the belly, is (as it were) a certaine prop or stay for the ribs, keeping them well in their place and state: which rule chiefly takes place in fractures of the bastard ribs. For such as have them broken, usually feele themselves better after, than before meat. For emptinesse of meat, or of the stomack, makes a suspension of the ribs, as not underpropped by the meat. Now that fracture which is outwardly, is farre more easie to heale, than that which * 1.3 is inwardly; for that this pricketh the membrane or Pleura, and causeth inflamma∣tion, which may easily end in an Empyema. Adde hereunto, that this is not so easi∣ly to be handled or dealt withall, as the other: whereby it commeth to passe, that it cannot be so easily restored; for that these things cannot bee so fully and freely performed in this kinde of fracture, which are necessary to the setting of the bone, as to draw it out, hold it and joyne it together. It is therefore healed within twenty dayes, if nothing else hinder. The signes of fractured ribs are not obscure; for by * 1.4 feeling the grieved part with your fingers, you may easily perceive the fracture by the inequalitie of the bones, and their noyse or crackling, especially, if they bee quite broke asunder. But if a rib be broken on the inside, a pricking paine, far more grievous than in a Pleurisie, troubles the Patient; because the sharp splinters pricke the Costall membrane: whence great difficulty in breathing, a cough and spitting of blood ensue. For blood, flowing from the vessels broken by the vio∣lence * 1.5 of the thing causing the fracture, is (as it were) sucked up by the lungs, and so by a dry cough carried into the weazond, and at length spit out of the mouth. Some, to pull up the bone that is quite broken and deprest, apply a cupping glasse, and that is ill done: for there is caused greater attraction of humors, and excesse of paine by the pressure and contraction of the adjacent parts, by the cupping-glasse; wherefore Hippocrates also forbids it. Therefore it is better to endeavour to re∣store * 1.6 it after this following manner. Let the Patient lye upon his sound fide, and let there be layd upon the fractured side an emplaister made of Turpentine, rosin, black pitch, wheat floure, mastick and aloes, and spread upon a strong and new cloath. When it hath stucke there some time, then plucke it suddenly with great violence from below upwards: for so the rib will follow together therewith, and bee plucked and drawne upwards. It is not sufficient to have done this once, but you