1. 1 The remaining part of my work relates to the bones; and to make this more easily understood, I will begin by pointing out their positions and shapes.
1. Superest ea pars, quae ad OSSA pertinet; quae quo facilius accipi possit, prius positus figurasque eorum indicabo.
First then comes the skull, concave internally, convex externally, on both aspects smooth, where it covers the cerebral membrane as well as where it is covered by the skin bearing hair; and it is in one layer from the back of the head to the temples, in two layers from the forehead to the vertex. Its bones are hard externally, but the inner parts which connect them together are softer, and between these run large blood-vessels which probably supply their nutrition. It is rare for the skull to be solid without sutures; in hot countries, however, this is more easily found; and that kind of head is the firmest and safest from headaches. As for the rest, the fewer the sutures, the better for the heads; and there is no certainty as to the number, or even as to the position of the sutures. Generally, however, there are two above the ears separating the temples from the upper part of the head: a third stretches to the ears across the vertex and separates the occiput from the top of the head. A fourth runs likewise from the vertex over the middle of the head to the forehead, sometimes ending at the hairy margin, sometimes dividing the forehead itself and ending between the eyebrows. Most of these are dovetailed, but those which cross over above the ears are bevelled off a little all along their margin so that the lower bones smoothly overlap the upper. Now the thickest bone in the head is behind the ear, where hair does not grow, probably on that very account. Under the muscles covering the temples is situated the middle bone which slopes outwards. But the face has the largest suture; it begins at one temple, passes across the middle of the orbits and nose to the other temple. From this suture two short sutures are directed downwards from the inner corners of the eyes; and the cheeks at their upper parts also have transverse sutures. From the middle of the nostrils or of the gums of the upper teeth, one suture runs back through the middle of the palate, another cuts the same palate transversely. These are the sutures found in most skulls.
Igitur caluaria incipit, ex interiore parte concaua, extrinsecus gibba, utrimque leuis, et qua cerebri membranam contegit et qua cute capillum gignente contegitur; eaque simplex ab occipitio et temporibus, duplex usque in uerticem a fronte. Ossaque eius ab exterioribus partibus dura, ab interioribus, quibus inter se conectuntur, molliora sunt; interque ea uenae discurrunt, quas his alimentum subministrare credibile est. Rara autem caluaria solida sine suturis est; locis tamen aestuosis facilius inuenitur; et id caput firmissimum atque a dolore tutissimum est. Ex ceteris, quo suturae pauciores sunt, eo capitis ualetudo commodior est: neque enim certus earum numerus est, sicut ne locus quidem. Fere tamen duae ⟨in⟩super aures tempora a superiore capitis parte discernunt; tertia ad aures per uerticem tendens occipitium a summo capite diducit. Quarta ab eodem uertice per medium caput ad frontem procedit; eaque modo sub imo capillo desinit, modo frontem ipsam secans inter supercilia finit * * * Ex his ceterae quidem suturae in unguem committuntur: eae uero, quae super aures trauersae sunt, totis oris paulatim extenua⟨n⟩tur atque ita inferiora ossa superioribus leniter insidunt. Crassissimum uero in capite os post aurem est, qua capillus, ut ⟨u⟩erisimile est, ob id ipsum non gignitur. Sub is [quo]que musculis, qui tempora conectunt, os medium in exteriorem partem inclinatum positum est. At facies suturam habet maximam, quae a tempore incipiens per medios oculos naresque transuersa peruenit ad alterum tempus. A qua breue⟨s⟩ duae sub interioribus angulis deorsum spectant; et malae quoque in summa parte singulas transuersas suturas habent.
Now the largest passages leading into the head are those of the eyes, next the nostrils, then those of the ears. Those of the eyes lead direct and without branching into the brain. The two nasal passages are separated by an intermediate bone. These begin at the eyebrows and eye-corners, and their structure is for almost a third part bony, then changes into cartilage, and the nearer they get to the mouth the more soft and fleshy their structure becomes. Now these passages are single between the highest and lowest part of the nostrils, but there they each break up into two branches, one set from the nostrils to the throat for expiration and inspiration, the other leading to the brain and split up in its last part into numerous small channels through which we get our sense of smell. In the ear the passage is also at first straight and single, but as it goes further becomes tortuous. And close to the brain this too is divided into numerous fine passages which give the faculty of hearing. Adjacent to the passages there are two little pits, as it were, above which ends the bones which stretches across from the cheek, supported by deeper-seated bones: it may be called the yoke, from the same resemblance which led the Greeks to call it zygodes. But the lower jaw is a soft bone and a single one, of which the chin forms the middle and lowest portion, whence it is continued on the two sides to the temples; and it alone is movable, for the cheek-bones with all that bone which produces the upper teeth are immobile. Now the ends of the lower jaw itself form, as it were, two horns. One process broader below tapers to its tip, and as it passes higher, goes under the zygoma, and is fastened to the temporal muscles above it. The other is shorter and more rounded off, and in that pit which is adjacent to the auditory passages, it is set in a sort of hinge, and as it bends there forwards backwards supplies the power of movement to the lower jaw.
A mediisque naribus ⟨aut⟩ superiorum dentium gingiuis per medium palatum una procedit, aliaque transuersa idem palatum secat. Et suturae quidem in plurimis hae sunt. Foramina autem intra caput maxima oculorum sunt, ⟨deinde narium, tum quae in auribus habemus. Ex his quae oculorum sunt,⟩ recta simplicia ad cerebrum tendunt. Narium duo foramina osse medio discernuntur: siquidem ha⟨e⟩ primum ⟨a⟩ superciliis angulisque oculorum osse inchoantur ad tertiam fere partem; deinde in cartilaginem uersae, quo propius ori descendunt, eo magis caruncula quoque molliuntur. Sed ea foramina, quae a summis ad imas nares simplicia sunt, ibi rursum in bina itinera diuiduntur; aliaque ex his ad fauces peruia spiritum et reddunt et accipiunt, alia ad cerebrum tendenti⟨a⟩ ultima parte in multa et tenu⟨i⟩a foramina dissipantur, per quae sensus odoris nobis datur. In aure quoque primum rectum et simplex iter; procedendo flexuosum ⟨fit. Quod ipsum⟩ iuxta cerebrum in multa et tenuia foramina diducitur, per quae facultas audiendi est. Iu⟨xt⟩aque ea duo paruuli quasi sinus sunt; superque eos finitur os, quod transuersum a genis tendens ab inferioribus ossibus sustinetur: iugale appellari potest, ab eadem similitudine, a qua id Graeci zygodes appellant. Maxilla uero est molle os; eaque una est, cuius eadem et media et ima pars mentum est, a quo utrimque procedit ad tempora; solaque ea mouetur: nam malae cum toto osse, quod superiores dentes exigit, immobiles sunt. Verum ipsius maxillae partes extremae quasi bicornes sunt. Alter processus in⟨f⟩ra latior uertice ipso tenuatur, longiusque procedens sub osse iugali subit, et ⟨super⟩ id temporum musculis inligatur.
The teeth are harder than bone, some are fixed in the lower jaw, some in the cheek-bones. Of the teeth, the four in front are named by the Greeks tomis because they cut. These are flanked at each side by four canine teeth. Behind these on either side is generally a set of four molars, except in those who have five one tooth on each side coming through later. There are some in whom the four last, which generally come through late, do not make their appearance. Of these teeth the front ones are fixed by single roots, the molars at least by two, sometimes even by three or four; and generally the longer root produces the shorter teeth; the straight tooth has a straight root; a crooked tooth a crooked root. From the same root in children a new tooth grows which general pushes out the former one, but sometimes shows itself behind or in front of it.
Alter breuior et rotundior et in eo sinu, qui iuxta foramina auris est, cardinis modo †fit; ibique huc et illuc se inclinans maxillae facultatem motus praestat. Duriores osse dentes sunt, quorum pars maxillae, pars superior⟨i⟩ ossi malarum haeret. Ex his quaterni primi, quia secant, tomis a Graecis nominantur; hi deinde quattuor caninis dentibus ex omni parte cinguntur; ultra quos utrimque fere maxillares quaterni sunt, praeterquam in is * * Sunt, quibus ⟨IV⟩ ultimi, qui sero gigni solent, non increuerunt. Ex his priores singulis radicibus, maxillares utique binis, quidam etiam ternis quaternisue nituntur; fereque longior radix breuiorem dentem edit;
Now the spine is the support of the head. It is composed of twenty-four vertebrae, seven in the neck, twelve belonging to the ribs; the remaining five are below the ribs. The vertebrae are bones rounded off and short; from each side they thrust out a transverse process; they are perforated in the middle where the spinal marrow which is connected with the brain passes downwards, and at the sides also through the two transverse processes they are traversed by fine channels, through which little membranes pass down resembling the cerebral membrane; with the exception of the three highest all the vertebrae have slight depressions in their articular processes on the upper side, on the lower side other articular processes grow downwards. The highest vertebra is therefore the immediate support of the head, receiving its small processes into two depressions, and this enables the head to move up and down. The second vertebra is made irregular by a protuberance and is attached to the lower side of the one above. To secure the rotation of the head the top of it ends in a narrower round process, so that the first vertebra encircling the top of this allows the head to turn sideways as well. After the same fashion the third vertebra supports the second, hence there is easy movement in the neck. And the neck could not even hold up the head were it not supported on each side by straight and powerful sinews which the Greeks call te/nontej; since whenever the head bends one of the sinews is always tense, and does not allow what is above to slip too far over. From the third vertebra in turn grow little protuberances which are inserted into the vertebra below; the remaining vertebrae are fastened into the ones below them by processes directed downwards and support the ones above them in the depression which they have on either side, and they are held together by many ligaments and cartilages. Thus by bending once in the required direction and avoiding moving in other directions man stands upright, or bends somewhat, to do anything that is required.
rectique dentis recta etiam radix, curui flexa est. Exque eadem radice in pueris nouus dens subit, qui multo saepius priorem expelli⟨t⟩, interdum tamen supra infraue eum se ostendit. Caput autem spina excipit. Ea constat ex uertebri⟨s⟩ quattuor et uiginti: septem in ceruice sunt, duodecim ad costas, reliquae quinque sunt proximae costis. Eae teretes breuesque; ab utroque latere processus duos exigunt; mediae perforatae, qua spinae medulla cerebro commissa descendit, circa quoque per duos processus tenuibus cauis peruiae, per quae membrana cerebri similes membranulae deducuntur; omnesque uertebrae exceptis tribus summis a superiore parte in ipsis processibus paulum desidentis sinus habent; ab inferiore alios deorsum uersus processus exigunt. Summa igitur protinus caput sustinet, per duos sinus receptis exiguis eius processibus; quo fit, ut caput susum deorsum uersum * Tuber⟨i⟩ exasperatur secunda, superiori parte * inferiore. Quod ad circuitum pertinet, pars summa angustiore orbe finitur; ita superior ei summae circumdata in latera quoque caput moueri sinit. Tertia eodem modo secundam excipit; ex quo facilis ceruici mobilitas est. Ac ne sustineri quidem caput posset, nisi utrimque rect⟨i⟩ ualentesque nerui collum continerent, quos ΤΕΝΟΝΤΑΣ Graeci appellant; siquidem horum inter omnes flexus alter semper intentus ultra prolabi superiora non patitur. Iamque uertebra tertia tubercula, quae inferiori inserantur, exigit: ceterae process⟨ib⟩us deorsum spectantibus in inferiores ⟨in⟩sinuantur, ac per sinus, quos utrimque habent, superiores accipiunt, multisque neruis et multa cartilagine continentur. Ac sic, uno flexu modico in promptum dato, ceteris negatis, homo e⟨t⟩ rectus insistit, et aliquid ad necessaria opera curuatur.
Below the neck the highest rib is placed on a level with the shoulders; after that there are six lower ribs, reaching as far as the bottom of the thorax; the ribs, which in their first part are rounded and end in small heads, as it were, are lightly fixed to the transverse processes of the vertebrae, which themselves have slight depressions; then the ribs flatten out and after curving outwards gradually degenerate into cartilage, and here, after again bending slightly inwards, they become united to the breast-bone. This, a strong and hard bone, begins below the throat, is lunated on each side, and, when it becomes itself softened into cartilage, is bounded by the praecordia. Below the upper ribs, there are five called by the Greeks nothae; they are short, thinner, and after changing gradually into cartilage, they are embedded in the highest part of the abdomen. The lowest of these consists for the most part only of cartilage. Again, from the neck two wide bones extend to the shoulders on each side; we call them scutula operta, the Greeks omoplatae. These bones are curved at their highest point, and below these they are triangular, and become gradually wider as they approach the spine. As they become wider, they become blunter. And they too at the lowest part soften into cartilage at the back and float, as it were, since they are unconnected with any other bone except at the top, but there they held in place by very strong muscles and sinews. Now at the level of the first rib, and a little behind its middle, a bone grows out which at first is slight but as it comes nearer the broad bone of the shoulder-blades becomes thicker and broader, and curves slightly outwards; and this at its other upper end is enlarged somewhat to support the root of the neck. But this bone itself is curved, and must not be reckoned among the hardest or most solid, and it lies with one head fixed as just stated, the other in a small depression of the breast-bone; it moves a little with the movement of the arm, and is connected with the flat bone of the shoulder-blades by sinews and cartilage.
Infra ceruicem uero summa costa contra umerum sita est; inde ⟨VI⟩ inferiores usque ad imum pectus perueniunt; ea⟨e⟩que primis partibus rotundae et leniter quasi capitulatae uertebrarum transuerseis processibus et i⟨ps⟩i⟨s⟩ quoque paulum sinuatis inhaerent; inde ⟨l⟩atescunt et in exteriorem partem recuruatae paulatim in cartilaginem degenerant; eaque parte rursus ⟨in⟩ interiora leniter flexa⟨e⟩ committuntur cum osse pectoris. Quod ualens et durum a faucibus incipit, ab utroque latere lunatum et a praecordiis iam ipsum quoque cartilagine mollitum terminatur; sub costis uero prioribus, quinque, quas ΝΟ⟨Θ⟩ΑΣ Graeci nominant, breues tenuioresque atque ipsae quoque paulatim in cartilaginem uersae extremis abdominis partibus inhaerescunt; imaque ex his maiore iam parte nihil nisi cartilago est. Rursus a ceruice duo lata ossa utrimque ad scapulas tendunt: nostri scutula operta, omoplatas Graeci nominant. Ea summis uerticibus sinuata, ab his triangula, paulatimque latescentia ad spinam tendunt; et quo latiora qu⟨a⟩que parte sunt, hoc hebetiora. Atque ipsa quoque in imo cartilag⟨in⟩osa posteriore parte uelut innatant, quoniam nisi †uel in summo nulli ossi inhaerescunt, ibi uero ualidis musculis neruisque constricta sunt. At a summa costa paulo interius quam ubi ⟨ea⟩ media est os excrescit, ibi quidem tenue, procedens uero, quo propius lato scapularum ossi fit, eo plenius latiusque et paulum in exteriora curuatum; quod altera uerticis parte modice intumescens sustinet iugulum. Id autem ipsum recuruum ac neque inter * * * durissima ossa numerandum, altero capite in eo, quod posui, altero in exiguo sinu pectoralis ossis insidit, paulumque motu bracchi mouetur, et cum lato osse scapularum infra caput eius neruis et cartilagin⟨e⟩ conectitur.
From this point begins the humerus, which at both ends is swollen out, and is there soft, without marrow and cartilaginous; in the middle cylindrical, hard, contain in marrow; and slightly curved both forwards and outwards. Now its front part is that on the side of the chest, its back, that on the side of the shoulder-blades; its inner part that which faces the side, its outer away from the side. It will be clear in later chapters that this applies to all joints. Now the upper head of the humerus is more rounded than any other bone hitherto described and is inserted by a small excrescence into the top of the wide bone of the shoulder-blades, and the greater part of it is held fast by sinews outside its socket.
Hinc umerus incipit, extremis utrimque capitibus tumidus, mollis, sine medulla, cartilaginosus: medius teres, durus, medullosus; leniter gibbus et in priorem et in exteriorem partem. Prior autem pars e⟨s⟩t, quae a pectore est, posterior, quae a scapulis; ⟨interior, quae ad latus⟩ tendit, exterior, quae ab eo recedit; quod ad omnes articulos pertinere in ulterioribus patebit. Superius autem umeri caput rotundius quam cetera ossa, de quibus adhuc dixi, paruo excessu uertici lati scapularum ossis inseritur, ac maiore parte extra situm neruis deligatur.
The humerus at its lower end has two processes, between which the bone is hollowed out even more than at its extremities. This furnishes a seat for the forearm, which consists of two bones. The radius, which the Greeks call cercis, is the uppermost and shorter; at its beginning it is thinner, with a round and slightly hollowed head which receives a small protuberance of the humerus; and it is kept in place there by sinews and cartilage. The ulna is further back and longer and at first larger, and at its upper extremity is inserted by two outstanding prominences into the hollow of the humerus, which, as I said above, is between the two processes. At their upper ends the two bones of the forearm are bound together, then they gradually separate, to come together again at the wrist, but with an alteration in size; since there the radius is the larger whilst the ulna is quite small. Further, the radius as it enlarges into its cartilaginous extremity is hollowed out at its tip. The ulna is rounded at the extremity, and projects a little at one part. And, to avoid repetition, it should not be overlooked that most bones turn into cartilage at their ends, and that all joints are bounded by it, for movement would be impossible unless apposition were smooth, nor could they be united with flesh and sinews unless some such intermediary material formed the connection.
At inferius duos processus habet, inter quos quod medium est magis etiam extremis partibus sinuatur. Quae res sedem brachio praestat, quod constat ex ossibus duobus. Radius, quam cercida Graeci appellant, superior breuiorque, et primo tenuior, rotundo et leniter cauo capite exiguum umeri tuberculum recipit, atque ibi neruis et cartilagine continetur. Cubitus inferior longiorque et primo plenior, in summo capite duobus quasi uerticibus extantibus in sinum umeri, quem inter duos processus eius esse proposui, se inserit. Primo uero du⟨o⟩ brachii ossa uincta paulatim dirimuntur, rursusque ad manum coeunt modo crassitudinum mutato, siquidem ibi radius plenior, cubitus admodum tenuis est. Dein radius in caput cartilaginosum consurgens in uertice eius sinuatur. Cubitus rotundus in extremo parte altera paulum procedit. Ac ne saepius dicendum sit, illud ignorari non oportet, plurima ossa in cartilaginem desinere, nullum articulum non sic finiri: neque enim aut moueri posset, nisi leui inniteretur, aut cum carne neruisque coniungi, nisi ea media ⟨quaedam⟩ materia committeret.
Turning to the hand, the first part of the palm consists of many minute bones of which the number is uncertain, but all are oblong and triangular, and are connected together on some plan since the upper angle of one alternates with the base of another; therefore they appear like one bone which is slightly concave. Now two small bones project from the hand and are fitted into the hollow of the radius; and at the other end five straight bones directed towards the fingers complete the palm; from these spring the fingers themselves, each composed of three bones; and all are similarly formed. A lower bone is hollowed out at its top to admit a small protuberance from an upper bone, and sinews keep them in place; from them grow nails which become hard, and thus these adhere by their roots to flesh rather than to bone.
In manu uero prima palmae pars ex multis minutisque ossibus constat, quorum numerus incertus est, sed oblonga omnia et triangula, structura quadam inter se conectuntur, cum inuicem superior alterius angulus, alterius planities sit; eoque fit ex his unius ossis paulum in interiora concaui species. Verum ex manu duo exigui processus in sinus radi coiciuntur; tum ex altera parte recta quinque ossa ad digitos tendentia palmam explent; a quibus ipsi digiti oriuntur, qui ex ossibus ternis constant; omniumque eadem ratio est. Interius ⟨os⟩ in uertic⟨e⟩ sinuatur, recipitque exterioris exiguum tuberculum, neruique ea continent; a quibus orti ungues indurescunt, ideoque non ossi sed carni magis radicibus suis inhaerent.
And such are the arrangements for the upper limbs. Now the bottom of the spine is fixed between the bone of the hips, which lies crosswise and is very strong and so protects the womb, bladder and rectum; and the bone bulges out externally, is bent up towards the spin, and on the sides that is, the hips proper, it has rounded hollows; and from these start the bone they call the comb, situated crosswise above the intestines below the pubes, and this supports the belly; in men the bone is straight, in women more curved outwards so as not to hinder parturition.
Ac superiores quidem partes sic ordinatae sunt. Ima uero spina in coxarum osse desidit, quod transuersum longeque ualentissimum uoluam, uesicam, rectum intestinum tuetur; idque ab exteriore parte gibbum, ad spinam resupinatum, a lateribus [id est ipsis coxis] sinus rotundos habet; a quibus oritur os, quod pectinem uocant, idque super intestina sub pube transuersum uentrem firmat;
Next in order are the thigh-bones, the heads of which are even more globular than those of the arm-bones, although those are the most globular of the other bones; below there are two processes, one directed forward, the other backward; after this the bones are hard and marrowy and convex on the outer side, and they are again enlarged at their lower ends also. The upper ends are inserted into hollows of the hip-bones, as the arm-bones into the shoulder-bones; then these tend gently downwards and inwards in order that they may support the upper parts of the body more evenly. But the heads at the lower end have a hollow in between, that the leg-bones may be more easily fixed into them. Their juncture is covered by a small, soft, cartilaginous bone, called the knee-cap. This bone, which floats freely and is not attached to any other bone, but held in place by flesh and sinews, is turned slightly towards the thigh-bone and protects the joint in all movements of the legs.
rectius in uiris, recuruatum magis in exteriora in feminis, ne partum prohibeat. Inde femina ordiuntur, quorum capita rotundiora etiam quam umerorum sunt, cum illa ex ceteris rotundissima sint: infra uero duos processus a priore et a posteriore parte habent; dein dura et medullossa et ab exteriore parte gibba, rursus inferioribus quoque capitibus intumescunt. Superiora in sinus coxae, sicut umeri in ea ossa, quae scapularum sunt, coiciuntur; tum infra introrsum leniter intendunt, quo aequalius superiora membra sustineant. At inferiora capita media sinuantur; quo facilius excipi cruribus possint. Quae commissura osse paruo, molli, cartilaginoso tegitur: patellam uocant. Haec super innatans, neque ulli ossi inhaerens, sed carne et neruis deligata, pauloque magis ad femoris os tendens inter omnes crurum flexus iuncturam tuetur.
The leg itself is made up of two bones; for as the thigh-bone is throughout similar to the humerus, so is the leg like the forearm, hence the form and appearance of the one can be learnt from the other: and what holds good for the bones holds also for the soft parts. One bone lies outside, and this too itself is called the calf. It is the shorter, and is smaller in its upper part, but swells out just at the ankles. The other is placed more in front and is named tibia; it is the longer, and is larger at the upper end, and it alone joins with the lower head of the thigh-bone, as the ulna does with the humerus. These two bones, moreover, are joined together at the lower and upper ends, but in the middle as in the forearm they are separated. The leg below is received by the transverse bone of the ankles, which itself is set upon the heel-bone; the heel-bone is hollowed out in one part, and has excrescences at another part, so that it receives the excrescences of the ankle and is received itself into the hollow of the ankle. The heel-bone is without marrow, is hard, and projects somewhat backwards where it presents a rounded outline. The other bones of feet are constructed in a similar way to the bones of the hand; the sole corresponds to the palm, digits to digits, nails to nails.
Ipsum autem crus est ex ossibus duobus: etenim per omnia femur umero, crus ⟨uero⟩ brachio simile est, adeo ut habitus quoque et decor alterius ex altero cognoscatur: quod ab ossibus incipiens etiam in carne respondet. Verum alterum os ab exteriore parte [id est supra] positum est, quod ipsum quoque su⟨r⟩a nominatur. Id breuius supraque tenuius ad ipsos talos intumescit. Alterum a priore parte positum, cui tibiae nomen est, longius et in superiore parte plenius, solum cum femoris inferiore capite committitur, sicut ⟨cum umero cubitus. Atque ea quoque⟩ ossa, infra supraque coniuncta, media ut in bracchio dehiscunt. Excipitur autem crus infra osse transuerso talorum; idque ipsum super os calcis situm est, quod quadam parte sinuatur, quadam excessus habet, et procedentia ex talo recipit et in sinum eius inseritur. Idque sine medulla durum magisque in posteriorem partem proiectum teretem ibi figuram repraesentat. Cetera pedis ossa ad eorum, quae in manu sunt, similitudinem structa sunt: plant⟨a⟩ palmae, digiti digitis, ungues unguibus respondent.
2. 2 Now when any bone has been injured, it either becomes diseased or splits or is broken or perforated or crushed or displaced. A diseased bone generally first becomes fatty, next either blackened or rotten; and this occurs in cases of severe ulceration or fistula, when these have become chronic or even gangrenous. And it is necessary in the first place to expose the diseased bone by cutting out the ulcer, and if the bone disease extends beyond the margins of the ulcer to cut away the flesh until sound bone is exposed all round. Then if the diseased bone appears merely fatty, it is enough to apply a cautery once or twice until a scale of Boeotian comes away; or to scrape it away until there is bleeding, which is a sign of sound bone; for diseased bone is necessarily dry. The same is also to be done for diseased cartilage; it too must be scraped away with a scalpel until what remains is sound. Then, whether bone or cartilage has been scraped, finely powdered soda must be dusted on; and nothing different is to be done when the surface of the bone is black or carious, except that the treatment by cautery or scraping must be continued for a longer time. In these cases if the surgeon scrapes he should press boldly upon the instrument that he may effect more and finish sooner. The end is when white or hard bone is reached. White bone instead of black, or hard bone instead of carious clearly indicates the end of the diseased part. I have already stated that sound bone also bleeds to some extent. But if in either case it is doubtful how deep the disease has reached, in the case of carious bone, this is readily ascertained. A fine probe is introduced into the hole, and according as it enters to a less or greater extent, it shows either that the caries is superficial or that it has penetrated more deeply, With black bone it is possible to form some opinion also from the pain and fever; when these are moderate in degree, the disease cannot have penetrated deeply. This becomes more obvious, however, when a trepan is used; for the limit of disease is reached when the bone dust ceases to be black. Therefore, if caries has penetrated deeply, by means of the trepan holes are bored in the bone at frequent intervals, equal in depth to the extent of the disease; next cautery points are passed into these holes, until the bone becomes entirely dry. For after such applications, simultaneously the diseased part separates off from the bone underneath, and the cavity will make flesh, and no humour or very little will be subsequently discharged. If on the other hand the disease, whether blackness or caries, has extended to the other side of the bone as well, excision is required; and the same can be done when caries has penetrated right through a bone. But whatever is wholly diseased is to be wholly removed; if the lower part is sound, only that which is corrupt should be excised. Further, if there is caries of the skull or breast-bone or rib, the cautery is useless, and excision is necessary. Nor are we to listen to those who await the third day after the bone has been laid bare before excising; for all cases are treated more safely before the inflammatory reaction. Therefore, whenever possible at the same sitting, the skin is to be incised, and the bone exposed, and freed from a that is diseased. And much the most dangerous case is in the breast-bone, for even if the operation has been successful, complete healing scarcely ever results.
2. Omne autem os, ubi iniuria accessit, aut uitiatur aut finditur aut frangitur aut foratur aut conliditur aut loco mouetur. Id quod VITIATVM est, primo fere pingue fit, deinde uel nigrum uel cariosum; quae supernatis grauibus ulceribus aut fistulis, hisque uel longa uetustate uel etiam cancro occupatis, eueniunt.—Oportet autem ante omnia os nudare ulcere exciso, et, si latius est eius uitium quam ulcus fuit, carnem subsecare, donec undique os integrum pateat; tum id, quod pingue est, semel iterumue satis est admoto ferramento adurere, ut ex eo ⟨squama⟩ secedat; aut radere, donec iam aliquid cruoris ostendatur, quae integri ossis nota est: nam necessum est aridum sit id, quod uitiatum est. Idem in cartilagine quoque laesa faciendum est: siquidem ea quoque scalpello radenda est, donec integrum id sit, quod relinquatur; deinde si⟨ue os siue⟩ cartilago rasa est, nitro bene trito respergendum est: neque alia facienda sunt, ubi caries nigritiesue in summo osse est: siquidem id uel paulo diutius eodem ferramento adurendum, uel radendum est. Qui radit haec, audacter inprimere ferramentum debet, ut et agat aliquid et maturius desinat. Finis est, cum ⟨uel⟩ ad album os uel ad solidum uentum est. Albo finiri ex nigritie ⟨uitium⟩, soliditate quadam ex carie manifestum est; accedere etiam cruoris aliquid integro supra dictum est. Si quando autem an altius descenderit utrumlibet, dubium est, in carie quidem expedita cognitio est. Specillum tenue in foramina demittitur, quod magis minusue intrando uel in summo cariem esse uel altius descendisse testatur. Nigrities colligi quidem potest etiam ex dolore et ex febre; quae ubi mediocria sunt, illa alte descendisse non potest. Manifestior tamen adacta terebra fit: nam finis uitii est, ubi scobis nigra esse desit. Igitur si caries alte descendit, per terebram ⟨os p⟩ung⟨e⟩nd⟨u⟩m creb⟨r⟩is foraminibus est, quae altitudine uitium aequent; tum in ea foramina demittenda candentia ferramenta sunt, donec i⟨d⟩ siccum os ex toto fiat. Simul enim post haec et soluetur ab inferiore osse, quodcumque uitiatum est, et is sinus carne replebitur, et umor aut nullus postea feretur aut mediocris. Sin autem nigrities [est] aut si caries ad alteram quoque partem ossis transit, oportet excidi; atque idem in †carie quoque ad alteram partem ossis penetrante fieri potest. Sed quod totum ⟨uitiatum est, totum⟩ eximendum est: si inferior pars integra est, eatenus, quod corruptum est, excidi debet. Item, siue capitis siue ⟨pectoris os siue⟩ costa cariosa e⟨s⟩t, inutilis u⟨s⟩tio est, et excidendi necessitas est. Neque audiendi sunt qui osse nudato diem tertium expectant, ut tum excidant: ante inflammationem enim tutius ⟨omnia⟩ tractantur. Itaque, quantum fieri potest, eodem momento et cutis incidenda est, et os detegendum et omni uitio liberandum est. Longeque pernici⟨oss⟩issimum est, quod in osse pectoris est, quia uix, etiam si recte cessit curatio, ueram sanitatem reddit.
3. 3 Now bone is excised in two ways; if the damaged part is very small, with the modiolus, which the Greeks call xoineiki/j; if more extensive by means of trepans. I will describe the use of both. The modiolus is a hollow cylindrical iron instrument with its lower edges serrated; in the middle of which is fixed a pin which is itself surrounded by an inner disc. The trepans are of two kinds; one like that used by smiths, the other longer in the blade, which begins in a sharp point, suddenly becomes larger, and again towards the other end becomes even smaller than just above the point. When the disease is so limited that the modiolus can include it, this is more serviceable; and if the bone is carious, the central pin is inserted into the hole; if there is black bone, a small pit is made with the angle of a chisel for the reception of the pin, so that, the pin being fixed, the modiolus when rotated cannot slip; it is then rotated like a trepan by means of a strap. The pressure must be such that it both bores and rotates; for if pressed lightly it makes little advance, if heavily it does not rotate. It is a good plan to drop in a little rose oil or milk, so that it may rotate more smoothly; but if too much is used the keenness of the instrument is blunted. When a way has been cut by the modiolus, the central pin is taken out, and the modiolus worked by itself; then, when the bone dust shows that underlying bone is sound, the modiolus is laid aside. But if disease is too extensive for the modiolus to cover, the operation must be carried out by the trepan. With this a hole is made exactly at the margin of the diseased and sound bone, then not very far off a second, and a third, until the whole area to be excised is ringed round by these holes; and here also the bone dust shows how deep the trepan is to go. Next the excising chisel is driven through from one hole to the other by striking it with a mallet, and cuts out the intervening bone, and so a ring is made like the smaller one cut by the modiolus. And in whichever way the circle has been made, the same excising chisel should cut away from the corrupted bone every scale-like layer until sound bone is left. Black bone hardly ever penetrates the whole thickness of the bone, but caries sometimes does so, and especially when the cranium is diseased. A test of this is also made by means of the probe, which when inserted into a cavity which has solid bone underneath finds some resistance because of this and is wet when it comes up. If it finds a clear way, as it goes deeper between bone and membrane, it encounters no resistance and comes up dry; not because there is no harmful sanies within, but because this is spread over a wider area. If bone is diseased right through, whether it be black bone exposed by the trepan, or caries discovered by a probe, the use of the modiolus is generally out of place, because what goes down so deep must be more widely opened up. Then the trepan which I described second is to be used; and in order that it may not get too hot, it should be dipped repeatedly in cold water. But particular care must be taken when we have bored half through a bone consisting of a single layer, or through the upper layer of a bone of two layers; in the former the actual distance bored, in the latter the appearance of blood is the indication. Therefore the strap is then worked more gently and the left hand held up and moved away more often, and the depth of the borehole is to be examined in order that we may perceive just when the bone is being broken through anywhere, and not run the risk of injuring the cerebral membrane by the point; which causes severe inflammation with danger of death. When boreholes have been made, the intervening partitions are to be excised in the same way but much more carefully, lest the corner of the chisel injure the aforesaid membrane; until a sufficient opening has been made to insert a guard of the membrane which the Greeks call meningophylax. This consists of a plate of bronze, its end slightly concave, smooth on the outer side; this is so inserted that the smooth side is next the brain, and is gradually pushed in under the part where the bone is being cut through by the chisel; and if it is knocked by the corner of the chisel it stops the chisel going further in; and so the surgeon goes on striking the chisel with the mallet more boldly and more safely, until the bone, having been divided all round, is lifted by the same plate, and can be removed without any injury to the brain. When all this bone has been removed, the margins of the opening must be filed down smooth, and if any bone dust is sticking to the membrane it is to be removed. When the outer table has been removed, and the inner table left, it is not only the margins but also all the bone which is to be smoothed down, in order that skin may grow over it subsequently without harm; for when it grows over rough bone there is never sound healing, but it causes new pains. What is to be done when the bain is exposed, I will describe when I come to fractures. If some of the inner table has been preserved, medicaments which are not greasy, such as are fitted for recent wounds, are to be applied, and over that, unscoured wool soaked in oil and vinegar. In course of time flesh grows up from the bone and fills up the hollow made by the surgery. Also if any bone has been cauterized it separates from the healthy part, and between the sound and dead bone granulations form to throw off what has separated; and this is usually a thin and small splinter, which the Greeks call a scale. It may possibly even happen as the result of an injury, that bone, although neither fissured nor fractured, yet has its surface indented and roughened; when this happens scraping and smoothing suffice. These conditions, although mostly occurring in the head, are found also in the other bones, so that whenever the same thing happens the same procedure is to be followed. But for bones which are fractured, fissured, perforated or crushed, some special treatment is required, suited for particular cases, and some general measures which apply to the majority; of these I will proceed to treat, beginning with the said cranium.
3. Exciditur uero os duobus modis: si paruulum est, quod laesum est, modiolo, quam ΧΟΙΝΕΙΚΙΔΑ Graeci uocant; si spatios⟨i⟩us, terebris. Vtriusque rationem proponam. Modiolus ferramentum concauum, teres est, imis oris serratum, per quod medium clauus ipse quoque interiore orbe cinctus demittitur. Terebrarum autem duo genera sunt: alterum simile ei, quo fabri utuntur, alterum capituli ⟨longioris; quod ab⟩ acuto mucrone incipit, dein subito latius fit, atque iterum ab alio principio paulo minus quam aequaliter sursum procedit. Si uitium in angusto est, quod conprehendere modiolus possit, ille potius aptatur; et, si caries subest, medius clauus in foramen demittitur; si nigrities, angulo scalpri sinus exiguus fit, qui clauom recipiat, ut eo insistente circumactus modiolus delabi non possit; deinde is habena quasi terebra conuertitur. Estque quidam premendi modus, ut et foretur ⟨et circ⟩umagatur; quia si leuiter inprimitur, parum proficit; si grauiter, non mouet⟨ur⟩. Neque alienum est instillare paulum rosae uel lactis, quo magis lubrico circumagatur; quod ipsum tamen, si copiosius est, aciem ferramenti hebetat. Vbi iam iter modiolo pressum est, medius clauus educitur, et ille per se agitur; dein cum sanitas inferioris partis scobe cognita est, modiolus remouetur. At si latius uitium est quam ut illo conprehendatur, terebra res agenda est. Ea foramen fit in ipso fine uitiosi ossis atque integri; deinde alterum non ita longe, tertiumque; donec totus is locus, qui excidendus est, his cauis cinctu⟨s sit⟩; atque ibi quoque quatenus terebra agenda sit, scobis significat. Tum excissorius scalper ab altero foramine ad alterum malleolo adactus id, quod inter utrumque medium est, excidit; ac sic ambitus similis ei fit, qui in angustiore⟨m⟩ orbe⟨m⟩ modio⟨lo⟩ inprimitur. Vtr⟨o⟩ modo uero id circumductum est, idem excissorius scalper in osse corrupto planissumam quamque testam †laesit, donec integrum os relinquatur. Vix umquam nigrities, inte⟨rd⟩um caries per totum os perrumpit, maximeque ubi uitiata caluaria est. Id quoque signi specillo significatur, qu⟨od⟩ depressu⟨m⟩ in id foramen, quod infra solidam sedem habet, [et] ob id re⟨nit⟩ens aliquid inuenit, et madens exit. Si peruium inuenit, altius descendens inter os et membranam nihil oppositum inuenit, educiturque siccu⟨m⟩: non quo non subsit aliqua uitiosa sanies, sed quo[niam] ibi ut in latiore sede diffusa sit. Siue autem nigrities, quam terebra detexit, siue caries, quam specillum ostendit, os transit, modioli quidem usus fere superuacuus est, quia latius pateat necesse est, quod ⟨t⟩am alte processit. Terebra uero ea, quam secundo loco posui, utendum; eaque ne nimis incalescat, subinde in aquam frigidam demittenda est. Sed tum maiore cura agendum est, cum iam aut simplex os dimidium perforatum est, aut in duplici superius: illud spatium ipsum, hoc sanguis significat. Ergo tum lentius ducenda habena suspendendaque manus sinistra est et saepius attollenda, et foraminis altitudo consideranda, ut, quandoque qui perrumpatur, sentiamus, neque periclitemur, ne mucrone cerebri membrana laedatur; ex quo graues inflammationes cum periculo mortis oriuntur. Facti⟨s⟩ foraminibus, eodem modo media ⟨saepta⟩, sed multo circumspectius, excidenda sunt, ne forte angulus scalpri eandem membranam uiolet; donec fiat aditus, per quem membranae custos inmittatur: menin⟨go⟩phylaca Graeci uocant. Lammina aenea est, prima paulum resima, ab exteriore parte leuis; quae demissa sic, ut exterior pars ⟨eius⟩ cerebro propior sit, subinde ei subicitur quod scalpro discutiendum est; ac, si excipit eius angulum, ultra transire non patitur; eoque et audacius et tutius scalprum malleolo medicus subinde ferit, donec undique excisum os eadem lammina leuatur, tollique sine ulla noxa cerebri potest. Vbi totum os eiectum est, circumradendae leuandaeque orae sunt, et, si quid scobis membranae insedit, colligendum. Vbi superiore parte sublata relicta inferior est, non orae tantum sed os quoque totum leuandum est, ut sine noxa postea cutis increscat, quae aspero osse nascens protinus non sanitatem, sed nouos dolores mouet. Patefacto cerebro qua ratione agendum sit, dicam, cum ad fracta ossa uenero. Si bas⟨s⟩is aliqua seruata est, superinponenda sunt medicamenta non pinguia, quae recentibus uulneribus ac⟨c⟩ommodantur; supraque inponenda lana sucida oleo atque aceto madens. Vbi tempus processit, ab ipso o⟨ss⟩e caro increscit, eaque factum manu sinum complet. Si quod etiam ⟨os⟩ adustum est, a parte sana recedit, subi⟨t⟩que inter integram atque ⟨e⟩mortuam partem caruncula, quae quod apscessit expellat; eaque fere, quia testa tenuis et angusta est, squama [id est lepis] a Graecis nominatur. Potest etiam euenire, ut ex ictu neque findatur os neque perfringatur, sed summum tamen collidatur exaspereturque; quod ubi incidit, radi et leuari satis est. Haec quamuis maxime fiunt in capite, tamen ceteris quoque ossibus communia sunt, ut ubicumque idem incidit, eodem remedio sit utendum. At quae FRACTA, fissa, forata, collisa sunt, quasdam proprias in singulis generibus, quas⟨dam⟩ communes in pluribus curationes requirunt; de quibus protinus dicam, initio ab eadem caluaria accepto.