Bract

“ Old braces were braces, these are mere sources of weakness, they do not brace; when weight is applied to the seat the tendency is to drive the legs apart, then out falls the brace. No mortice holds it, it has no function to fulfil. In the old chair how firm all the joints are made! Stout oak pegs are driven through every mortice, and every precaution is taken to prevent gaping at the joints, to resist strain put on them. ”

“ The cutaneus brachii superior is a small nerve which springs from the last brachial plexus root and passes between the skin and the triceps brachii muscle on the dorsal surface of the upper arm, or brachial, region. It extends down over the elbow region, where it gives off numerous branches to the skin of these regions, to the meta-patagium and to the extensor muscles of the upper arm. ”

“ But most braces, you may not be aware, slip down unpleasantly on the shoulder-blade, and so lead to an awkward habit of hitching them up by the sleeve-hole of the waistcoat at frequent intervals. Such a habit must be felt to be ungraceful. ”

“ Straining pieces are secured to the upper and lower faces of the shore to serve as abutments for the ends of the braces. The best angle for these braces is one of 45°, but a smaller inclination than this is frequently adopted. Wedges are inserted, usually at the end of the flyer so as to tighten this up between the wall-plates, and sometimes between the braces and the straining piece, and carefully driven to tighten up the whole and cause each timber to find a close bearing. ”

“ It can thus very well happen that the upper or the middle braces may receive more stress in the end, than the lower braces. In fact, this was asserted to be generally true, for well-drained material, by many engineers in the valuable discussion on Mr. Meem’s paper referred to. Other engineers advised caution in accepting this view, and asserted that in wet or saturated ground the lower braces were most severely stressed. ”

“ When we view the relative position of the subclavian vessels, A B, Plate 11, to the clavicle, R, we can readily understand why a fracture of the middle of this bone through that arch which it forms over the vessels, should interfere with the free circulation of the blood which these vessels supply to the arm. When the clavicle is severed at its middle, the natural arch which the bone forms over the vessels and nerves is lost, and the free moving broken ends of the bone will be acted on in opposing directions by the various muscles attached to its sternal and scapular extremities. ”

“ It may for the present suffice to say, that, in crossing the direction of the sterno-mastoid muscle, it furnishes the subdividing line of the great triangles of the neck; that its posterior belly lies parallel to and just above the subclavian artery and brachial plexus, is covered by the platysma and partly by the trapezius, clavicle and subclavius, and crosses the scaleni and phrenic nerve: that its looped tendon is covered by the sterno-mastoid, and lies on the sheath of the carotid vessels, across which its anterior belly continues obliquely to run. ”

“ The Brachial Plexus.—Lesions of the brachial plexus may be divided into those above the clavicle and those below that bone.
In the supra-clavicular injuries, the violence applied to the head or shoulder causes over-stretching of the anterior branches (primary divisions) of the cervical nerves, the fifth, or the fifth and sixth being those most liable to suffer. Sometimes the traction is exerted upon the plexus from below, as when a man in falling from a height endeavours to save himself by clutching at some projection, and the lesion then mainly affects the first dorsal nerve. ”

“ While we view the general lateral outline of the neck, we find that, in the same measure as the blood vessels ascend from the thorax to the skull, they recede from the fore-part of the root of the neck to the angle of the jaw, whereby a much greater interval occurs between them and the mental symphysis, or the apex of the thyroid cartilage, than happens between them and the top of the sternum, as they lie at the root of the neck. ”

“ It is true that to stop the circulation through the main vessel of the limb, is always attended with danger, and that such a proceeding is never to be adopted but as the lesser one of two great hazards. It is also true that to tie the main brachial artery for a haemorrhage of anyone of its terminal branches, may be doing too much, while a milder course may serve; or else that even our tying the brachial may not suffice, owing to a high distribution of the vessels of the arm, in the axilla, above the place of the ligature. ”

“ In a steel structure, a can very easily be made a tension member by anchoring its lower end to a heavy [Pg 35] foundation. This resists the tendency to overturn and makes a very stable structure. In practice, braces can generally be located parallel to the line of resultant strain, Fig. 29, or outside this line, as shown in Fig. 30, so that the strain due to the pull of the rope will come mainly on the inclined brace and not on the upright. ”

“ The anatomical neck may be fractured in an old person by a direct blow on the shoulder. In a few cases the fracture is entirely intra-capsular, the head of the bone remaining loose in the cavity of the joint. As a rule, however, the fracture passes laterally and implicates the tuberosities. In some cases there is impaction, and in others comminution of the fragments. The use of the X-rays has shown that in many cases in which prolonged stiffness has followed a severe blow of the shoulder, there has been a fracture of the anatomical neck. ”

“ The theory of the invention is that, as the collar at the bottom of the standard is raised, the braces will force the ribs to expand to the circumference limited by the tape or elastic affixed to the lower extremities of the ribs. Should the collar be pushed above the mean center of expansion, which is attained when the braces are at right angles with the standard, the tendency to expand would cease, and contraction would begin. ”

“ But the limb they carry is heavy, so they rapidly become overstretched and it is difficult to keep them properly adjusted.
b. The stretching is naturally diminished if the upper part of the brace is not elastic but an elastic section is inserted in its lower third, in front and behind.
c. But the patients almost always say that better command of the limb is obtained with inelastic braces. If the strap is wide on the shoulder, the pressure is well borne, and the lower attachment may be made narrower, consisting of a leather thong (Fig. 64) . ”

“ In cutting braces always allow in length from a sixteenth to an eighth of an inch more than the exact measurement calls for.
Directly under the half-inch marks on the outer edge of the back of the tongue will be noticed two figures, one above the other. These represent the run of the brace, or the length of two sides of a right-angled triangle; the 62 figures immediately to the right represent the length of the brace or the hypothenuse. For instance, the figures 36-36 59-91 show that the run on the post and beam is 36 inches, and the length of the brace is 50.91 inches. ”

“ The fracture is exposed, the joint cavity opened up and cleared of clots, and silver-wire sutures passed through the fragments without encroaching upon the articular cartilage. The limb is fixed with the elbow-joint in the position of almost complete extension. Movement may be commenced at the end of a week, the angle at which the joint is fixed being changed morning and evening. During the day the flexed position should be maintained and the arm carried in a sling; during the night the limb is fixed to a pillow in the extended position. ”

“ If at both ends, the whole chin projects outwards, the lower teeth are more prominent, and the muscles appear stretched. The patient being properly seated, and his head held by an assistant, the surgeon having wrapped his thumbs with linen cloths, is to put them into the patient’s mouth, while the fingers are applied externally. The jaw being firmly grasped, the chin is to be shaken, and then, at one and the same instant, the head is to be seized, the chin moved, the jaw forced into its place, and the mouth shut. ”

“ Diagonal bracing in the frame-work of a building is never seen. Sometimes, however, the uprights in a weak frame are supported by braces running from the ground at an acute angle, and held in place by wooden pins (fig. 13) . Outside diagonal braces are sometimes met with as an ornamental feature. In the province of Ise one often sees a brace or bracket made out of an unhewn piece of timber, generally the proximal portion of some big branch. This is fastened to an upright, and appears to be a brace to hold up the end of a horizontal beam that projects beyond the eaves. ”

“ This notch is frequently invaded by the knife of the suicide; and there is perhaps no part of the neck on which a gash may be inflicted with less serious injury: the large vessels are far removed, and the larynx lies below the blade, which may, if near to the hyoid bone, enter the pharynx above the epiglottidean fold of mucous membrane, leaving the epiglottis unhurt, or, if more nearly approached to the thyroid border of the space, may partly or entirely sever that cartilage from its inferior attachments. No special surgical operation belongs to the space ”

“ One wooden brace and two iron braces are to be put in, as shown upon the plan hereto annexed. The wooden brace is to be of one piece, or of two pieces well bolted together, of selected lumber, free from knots and other imperfections, squared, and measuring 6 by 8 inches in 337 cross section. The iron braces are to be of 1 inch diameter, best quality wrought-iron rods. The bearing plates, four to each rod, are to be not less than 10 inches in diameter, of sufficient strength, and securely and permanently fastened to the braces. ”

“ In the upper half, especially, complex injury was not rare, while in the lower third affection of individual nerves was more common. Another important difference must be mentioned in regard to the upper and lower segments of the course of the brachial nerves; they are not only more widely distributed below, but also more fixed in position, a fact antagonistic to the escape of the nerve by displacement and liable to expose it to more severe contusion. ”

“ If the Bones pass one over another, a small Extension is to be made. If the Teeth be forc'd out of their Place, they are to be reduc'd, and fasten'd to the sound Teeth with a wax'd Thread.
The Dressing and Bandage. If the Fracture be only on one side, a Bolster sow'd to a piece of Paste-board is to be laid upon the flat side of the Jaw, both being of the Figure and Size of the Jaw it self. The Bandage of this Fracture is call'd Chevestre, i.e. a Cord or Bridle, by the French Surgeons, and is made by taking a Band roll'd with one Head or End, three Ells long, and two Fingers broad ”

“ VASCULAR SYSTEM Heart and ventral aorta. Continue the longitudinal incision through the skin as far as the mandible. [1] Dissect away the sheet of muscles between the gill pouches and the mandible, exposing a slender muscle which extends from the pectoral girdle to the middle of the mandible. The thyroid gland lies dorsal to the anterior end of this muscle, close against the mandible. (The thyroid of Eugaleus is a broad, flattened structure covering the anterior ends of the coracohyoideus muscles.) ”

“ The musculo-spiral nerve, g, winds under the brachial artery at the middle of the arm, but as this nerve passes deep between the short and long heads of the triceps muscle, P, and behind the humerus to gain the outer aspect of the limb, a little care will suffice for avoiding the inclusion of it in the ligature. ”

“ The tighter the lace is drawn the more powerful will be the extending force.
Instead of attaching the extension brace to the leg piece it may be made to pass under a pulley in the interior of the knee. What actually happens is that the thigh piece drops, owing to its weight, when the limb is swung free; this throws a strain on the brace which is transmitted to the leg piece by the following mechanism. ”

“ Perhaps the order in which branches spring from the brachial plexus that is most constantly met with is the one represented at D, Plate 12, where we find, on the outer border of B, the axillary artery, a nervous chord, d, giving off a thoracic branch to pass behind H, the lesser pectoral muscle, while the main chord itself, d, soon divides into two branches, one the musculo-cutaneous, e, which pierces G, the coraco-brachialis muscle, and the other which forms one of the roots of the median nerve, h. ”

“ If we wish to lay out a brace having a three-foot run on both post and beam, the matter is quite simple, for we can take 12 inches on the tongue and 12 inches on the blade and transfer this distance three times on a straight line and we have the extreme length of the brace from point to point, and by marking along the blade at one end of this length and along the tongue at the other end we also get the bevels. ”

“ Inasmuch as the ribs, at their tops, are confined by a tape to a circumference corresponding with the size of the waist, it is reasonably clear that, if they were expanded to their utmost tension at the hip portion, a single set of braces would afford but slight resistance to contraction. ”

“ Fibers from the dorsal and dorsomedial sides of the heavy tendon run rostrad and insert on the ventral surface of the dorsal aponeurosis of pars profundus. From the ventral surface the most posterior fibers converge on an aponeurosis that inserts on a transverse crista on the dorsal surface of the mandible immediately lateral to the ventral aponeurosis of pars profundus and dorsal to the insertion of M. adductor mandibulae posterior. The more anterior fibers insert fleshily on the mandibular fossa. ”

“ Wrap both your thumbs in several layers of cloth, stand behind the patient, who should be seated, and place your thumbs thus protected, on his back teeth, grasp his jaws on either side with your fingers, press down with your thumbs, up with your fingers, at the same time drawing the jaw forward. The bones will go back with a snap and the victim will spasmodically close his mouth hard enough to draw blood unless your thumbs are well shielded. ”