---
title: "On Injuries of the Head · Περὶ τῶν ἐν κεφαλῇ τρωμάτων"
author: "Hippocrates"
translator: "Francis Adams"
languages: [grc, en]
shelf: "Classical Greek"
url: https://scriptura.si/works/hippocrates-injuries-of-the-head/
cite: "Hippocrates, tr. Francis Adams, On Injuries of the Head · Περὶ τῶν ἐν κεφαλῇ τρωμάτων. Scriptura (scriptura.si), https://scriptura.si/works/hippocrates-injuries-of-the-head/"
---

# On Injuries of the Head · Περὶ τῶν ἐν κεφαλῇ τρωμάτων

*Hippocrates, tr. Francis Adams*

Skull wounds and fractures, and when to trephine.

> Greek: ed. Émile Littré, from the Perseus Digital Library (canonical-greekLit, tlg0627.tlg007, CC BY-SA 4.0).

> English: Francis Adams, from the Perseus Digital Library (tlg0627.tlg007.perseus-eng2). Notes are not included.

> Rows follow the references the two texts share (chapters and sections), cut where both reach the end of a sentence.

## Contents

1. [Sections 1–12](https://scriptura.si/works/hippocrates-injuries-of-the-head/1.md)
2. [Sections 13–21](https://scriptura.si/works/hippocrates-injuries-of-the-head/2.md)

## 1. Sections 1–12

Source: https://scriptura.si/works/hippocrates-injuries-of-the-head/1/ · cite a paragraph as https://scriptura.si/works/hippocrates-injuries-of-the-head/1/#p-N

[¶0] 1. MEN’S heads are by no means all like to one another, nor are the sutures of the head of all men constructed in the same form. Thus, whoever has a prominence in the anterior part of the head (by prominence is meant the round protuberant part of the bone which projects beyond the rest of it), in him the sutures of the head take the form of the Greek letter tau, T; for the head has the shorter line running transverse before the prominence, while the other line runs through the middle of the head, all the way to the neck. But whoever has the prominence in the back part of the head, in him the sutures are constructed in quite the opposite form to the former; for in this case the shorter line runs in front of the prominence, while the longer runs through the middle all along to the forehead. But whoever has a prominence of the head both before and behind, in him the sutures resemble the Greek letter eta E; for the long lines of the letter run transverse before each prominence while the short one runs through the middle and terminates in the long lines. But whoever has no prominence on either part he has the sutures of the head resembling the Greek letter chi; for the one line comes transverse to the temple while the other passes along the middle of the head. The bone at the middle of the head is double, the hardest and most compact part being the upper portion, where it is connected with the skin, and the lowest, where it is connected with the meninx (dura mater); and from the uppermost and lowermost parts the bone gradually becomes softer and less compact, till you come to the diploe. The diploe is the most porous, the softest, and most cavernous part. But the whole bone of the head, with the, exception of a small portion of the uppermost and lowermost portions of it, is like a sponge; and the bone has in it many juicy substances, like caruncles; and if one will rub them with the fingers, some blood will issue from them. There are also in the bone certain very slender and hollow vessels full of blood. So it is with regard to hardness, softness, and porosity.

> Greek: 1. 1. τῶν ἀνθρώπων αἱ κεφαλαὶ οὐδὲν ὁμοίως σφίσιν αὐταῖς, οὐδὲ αἱ ῤαφαὶ τῆς κεφαλῆς πάντων κατὰ ταὐτὰ πεφύκασιν. ἀλλʼ ὅστις μὲν ἔχει ἐκ τοῦ ἔμπροσθεν τῆς κεφαλῆς προβολὴν (ἡ δὲ προβολή ἐστι τὸ τοῦ ὀστέου ἐξέχον στρογγύλον παρὰ τὸ ἄλλo), τουτέου εἰσὶν αἱ ῤαφαὶ πεφυκυῖαι ἐν τῇ κεφαλῇ, ὡς γράμμα τὸ ταῦ, Τ, γράφεται· τὴν μὲν γὰρ βραχυτέρην γραμμὴν ἔχει πρὸ τῆς προβολῆς ἐπικαρσίην πεφυκυῖαν· τὴν δʼ ἑτέρην γραμμὴν ἔχει διὰ μέσης τῆς κεφαλῆς κατὰ μῆκος πεφυκυῖαν ἐς τὸν τράχηλον αἰεί. ὅστις δʼ ὄπισθεν τῆς κεφαλῆς τὴν προβολὴν ἔχει, αἱ ῤαφαὶ τουτέῳ πεφύκασι τἀναντία ἢ τῷ προτέρῳ· ἡ μὲν γὰρ βραχυτέρη γραμμὴ πρὸ τῆς προβολῆς πέφυκεν ἐπικαρσίη· ἡ δὲ μακροτέρη διὰ μέσης τῇς κεφαλῆς πέφυκε κατὰ μῆκος ἐς τὸ μέτωπον αἰεί. ὅστις δὲ ἀμφοτέρωθεν τῆς κεφαλῆς προβολὴν ἔχει, ἐκ τε τοῦ ἔμπροσθεν καὶ ἐκ τοῦ ὄπισθεν, τουτέῳ αἱ ῤαφαί εἰσιν ὁμοίως πεφυκυῖαι ὡς γράμμα τὸ ἦτα,, γράφεται· πεφύκασι δὲ τῶν γραμμέων αἱ μὲν μακραὶ, πρὸ τῆς προβολῆς ἑκατέρης ἐπικάρσιαι πεφυκυῖαι· ἡ δὲ βραχείη διὰ μέσης τῆς κεφαλῆς κατὰ μῆκος πρὸς ἑκατέρην τελευτῶσα τὴν μακρὴν γραμμήν. ὅστις δὲ μηδʼ ἑτέρωθι μηδεμίαν προβολὴν ἔχει, οὗτος ἔχει τὰς ῤαφὰς τῆς κεφαλῆς, ὡς γράμμα τὸ χῖ, Χ, γράφεται· πεφύκασι δὲ αἱ γραμμαὶ, ἡ μὲν ἑτέρη ἐπικαρσίη πρὸς τὸν κρόταφον ἀφίκουσα· ἡ δὲ ἑτέρη, κατὰ μῆκος διὰ μέσης τῆς κεφαλῆς. Δίπλοον δʼ ἐστὶ τὸ ὀστέον κατὰ μέσην τὴν κεφαλήν· σκληρότατον δὲ καὶ πυκνότατον αὐτέου πέφυκεν τό τε ἀνώτατον, ᾗ ἡ ὁμοχροίη τοῦ ὀστέου ἡ ὑπὸ τῇ σαρκὶ, καὶ τὸ κατώτατον τὸ πρὸς τῇ μήνιγγι, ᾗ ἡ ὁμοχροίη τοῦ ὀστέου ἡ κάτω· ἀποχωρέον δὲ ἀπὸ τοῦ ἀνωτάτου ὀστέου καὶ τοῦ κατωτάτου, ἀπὸ τῶν σκληροτάτων καὶ πυκνοτάτων ἐπὶ τὸ μαλθακώτερον καὶ ἧσσον πυκνὸν καὶ ἐπικοιλότερον ἐς τὴν διπλόην αἰεί. ἡ δὲ διπλόη κοιλότατον καὶ μαλθακώτατον καὶ μάλιστα σηραγγῶδές ἐστιν. ἔστι δὲ καὶ πᾶν τὸ ὀστέον τῆς κεφαλῆς, πλὴν κάρτα ὀλίγου τοῦ τε ἀνωτάτου καὶ τοῦ κατωτάτου, σπόγγῳ ὅμοιον· καὶ ἔχει τὸ ὀστέον ἐν ἑωυτῷ ὁκοῖα σαρκία πολλὰ καὶ ὑγρὰ, καὶ εἴ τις αὐτὰ διατρίβοι τοῖσι δακτύλοισιν, αἷμα ἂν διαγίγνοιτο ἐξ αὐτέων. ἔνι δʼ ἐν τῷ ὀστέῳ καὶ φλέβια λεπτότερα καὶ κοιλότερα, αἵματος πλέα. σκληρότητος μὲν οὖν καὶ μαλθακότητος καὶ κοιλότητος ὧδε ἔχει.

[¶1] 2. In respect to thickness and thinness; the thinnest and weakest part of the whole head is the part about the bregma; and the bone there has the smallest and thinnest covering of flesh upon it, and the largest proportion of brain is situated in that region of the head. And hence it happens that from similar or even smaller wounds and instruments, when a person is wounded to the same or a less degree, the bone of the head there is more contused, fractured, and depressed; and that injuries there are more deadly and more difficult to cure; and it is more difficult to save one’s life in injuries there than in any other part of the head; that from having sustained a similar or even a less wound a man will die, and that, too, in a shorter space of time than from a wound in any other part of the head. For the brain about the bregma feels more quickly and strongly any mischief that may occur to the flesh or the bone; for the brain about the bregma is in largest quantity, and is covered by the thinnest bone and the least flesh. Of the other portions, the weakest is that about the temples; for it is the conjunction of the lower jaw with the cranium, and there is motion there up and down as at a joint; and the organ of hearing is near it; and further, a hollow and important vein runs along the temple. But the whole bone of the head behind the vertex and the ear is stronger than the whole anterior part, and the bone itself has a larger and deeper covering of flesh upon it. And hence it follows, that when exposed to the same or even greater injuries from instruments of the same or greater size, the bone is less liable to be fractured and depressed than elsewhere; and that in a fatal accident the patient will live longer when the wound is in the posterior part of the head than when elsewhere; and that pus takes longer time to form and penetrate through the bone to the brain, owing to the thickness of the bone; and moreover, as there is less brain in that part of the head, more persons who are wounded in the back part of the head escape than of those who wounded in the anterior part. And in fatal cases, a man will survive longer in winter than in summer, whatever be the part of the head in which the wound is situated.

> Greek: 2. 2. παχύτητι δὲ καὶ λεπτότητι, ξυμπάσης τῆς κεφαλῆς τὸ ὀστέον λεπτότατόν ἐστιν καὶ ἀσθενέστατον τὸ κατὰ βρέγμα, καὶ σάρκα ὀλιγίστην καὶ λεπτοτάτην ἔχει ἐφʼ ἑωυτέῳ ταύτῃ τῆς κεφαλῆς τὸ ὀστέον, καὶ ὁ ἐγκέφαλος κατὰ τοῦτο τῆς κεφαλῆς πλεῖστος ὕπεστιν. καὶ δὴ, ὅτι οὕτω ταῦτα ἔχει, τῶν τε τρωσίων καὶ τῶν βελέων ἴσων τε ἐόντων κατὰ μεγέθος, καὶ ἐλασσόνων, καὶ ὁμοίως τε τρωθεὶς καὶ ἧσσον, τὸ ὀστέον ταύτῃ τῆς κεφαλῆς φλᾶταί τε μᾶλλον καὶ ῤήγνυται, καὶ ἔσω ἐσφλᾶται, καὶ θανασιμώτερά ἐστι καὶ χαλεπώτερα ἰητρεύεσθαί τε καὶ ἐκφυγγάνειν τὸν θάνατον ταύτῃ ἤπου ἄλλοθι τῆς κεφαλῆς· ἐξίσων τε ἐόντων τῶν τρωμάτων καὶ ἡσσόνων, καὶ ὁμοίως τε τρωθεὶς καὶ ἧσσον, ἀποθνήσκει ὁ ἄνθρωπος, ὅταν καὶ ἄλλως μέλλῃ ἀποθανεῖσθαι ἐκ τοῦ τρώματος, ἐν ἐλάσσονι χρόνῳ ὁ ταύτῃ ἔχων τὸ τρῶμα τῆς κεφαλῆς, ἤπου ἄλλοθι. ὁ γὰρ ἐγκέφαλος τάχιστά τε καὶ μάλιστα κατὰ τὸ βρέγμα αἰσθάνεται τῶν κακῶν τῶν γιγνομένων ἔν τε τῇ σαρκὶ καὶ τῷ ὀστέῳ· ὑπὸ λεπτοτάτῳ γὰρ ὀστέῳ ἐστὶ ταύτῃ ὁ ἐγκέφαλος καὶ ὀλιγίστῃ σαρκὶ, καὶ ὁ πλεῖστος ἐγκέφαλος ὑπὸ τῷ βρέγματι κεῖται. τῶν δὲ ἄλλων τὸ κατὰ τοὺς κροτάφους ἀσθενέστατόν ἐστιν· ξυμβολή τε γὰρ τῆς κάτω γνάθου πρὸς τὸ κρανίον, καὶ κίνησις ἔνεστιν ἐν τῷ κροτάφῳ ἄνω καὶ κάτω ὥσπερ ἄρθρου· καὶ ἡ ἀκοὴ πλησίον γίγνεται αὐτέου, καὶ φλὲψ διὰ τοῦ κροτάφου τέταται κοίλη τε καὶ ἰσχυρή. ἰσχυρότερον δʼ ἐστὶ τῆς κεφαλῆς τὸ ὀστέον ἅπαν τὸ ὄπισθεν τῆς κορυφῆς καὶ τῶν οὐάτων, ἢ ἅπαν τὸ πρόσθεν, καὶ σάρκα πλέονα καὶ βαθυτέρην ἐφʼ ἑωυτέῳ ἔχει τοῦτο τὸ ὀστέον. καὶ δὴ, τουτέων οὕτως ἐχόντων ὑπὸ τῶν τε τρωσίων καὶ τῶν βελέων ἴσων ἐόντων καὶ ὁμοίων, καὶ μεζόνων, καὶ ὁμοίως τιτρωσκόμενος καὶ μᾶλλον, ταύτῃ τῆς κεφαλῆς τὸ ὀστέον ἧσσον ῤήγνυται καὶ φλᾶται ἔσω· κἢν μέλλῃ ὥνθρωπος ἀποθνήσκειν καὶ ἄλλως ἐκ τοῦ τρώματος, ἐν τῷ ὄπισθεν τῆς κεφαλῆς ἔχων τὸ τρῶμα, ἐν πλέονι χρόνῳ ἀποθανεῖται· ἐν πλέονι γὰρ χρόνῳ τὸ ὀστέον ἐμπυΐσκεταί τε καὶ διαπυΐσκεται κάτω ἐπὶ τὸν ἐγκέφαλον διὰ τὴν παχύτητα τοῦ ὀστέου, καὶ ἐλάσσων ταύτῃ τῆς κεφαλῆς ὁ ἐγκέφαλος ὕπεστι, καὶ πλέονες ἐκφυγγάνουσι τὸν θάνατον τῶν ὄπισθεν τιτρωσκομένων τῆς κεφαλῆς ὡς ἐπιτοπολὺ, ἢ τῶν ἔμπροσθεν. καὶ ἐν χειμῶνι πλέονα χρόνον ζῇ ὥνθρωπος ἢ ἐν θέρει, ὅστις καὶ ἄλλως μέλλει ἀποθανεῖσθαι ἐκ τοῦ τρώματος, ὁκουοῦν τῆς κεφαλῆς ἔχων τὸ τρῶμα.

[¶2] 3. As to the haedrae (dints or marks?) of sharp and light weapons, when they take place in the bone without fissure, contusion, or depression inwards (and these take place equally in the anterior and posterior part of the head), death, when it does occur, does not properly result from them. A suture appearing in a wound, when the bone is laid bare, on whatever part of the head the wound may have been inflicted, is the weakest point of the head to resist a blow or a weapon, when the weapon happens to be impinged into the suture itself; but more especially when this occurs in the bregma at the weakest part of the head, and the sutures happen to be situated near the wound, and the weapon has hit the sutures themselves.

> Greek: 3. 3. αἱ δὲ ἕδραι τῶν βελέων τῶν ὀξέων καὶ κουφοτέρων, αὐταὶ ἐπὶ σφῶν αὐτέων γινόμεναι ἐν τῷ ὀστέῳ, ἄνευ ῤωγμῆς τε καὶ φλάσιος, ἢ ἔσω ἐσφλάσιος (αὗται δὲ γίνονται ὁμοίως ἔν τε τῷ ἔμπροσθεν τῆς κεφαλῆς, καὶ ἐν τῷ ὄπισθεν), ἐκ τουτέων ὁ θάνατος οὐ γίνεται κατά γε δίκην, οὐδʼ ἢν γένηται. Ῥαφὴ δὲ ἐν ἕλκει φανεῖσα, ὀστέου ψιλωθέντος, πανταχοῦ τῆς κεφαλῆς τοῦ ἕλκεος γενομένου, ἀσθενέστατον γίγνεται τῇ τρώσει καὶ τῷ βέλει ἀντέχειν, εἰ τύχοι τὸ βέλος ἐς αὐτὴν τὴν ῤαφὴν στηριχθέν· πάντων δὲ μάλιστα ἐν τῷ βρέγματι γενόμενον κατὰ τὸ ἀσθενέστατον τῆς κεφαλῆς, καὶ αἱ ῤαφαὶ εἰ τύχοιεν ἐοῦσαι περὶ τὸ ἕλκος, καὶ τὸ βέλος αὐτέων τύχοι τῶν ῤαφῶν.

[¶3] 4. The bone in the head is liable to be wounded in the following modes, and there are many varieties in each of these modes of fracture: When a wounded bone breaks, in the bone comprehending the fissure, contusion necessarily takes place where the bone is broken; for an instrument that breaks the bone occasions a contusion thereof more or less, both at the fracture and in the parts of the bone surrounding the fracture. This is the first mode. But there are all possible varieties of fissures; for some of them are fine, and so very fine that they cannot be discovered, either immediately after the injury, or during the period in which it would be of use to the patient if this could be ascertained. And some of these fissures are thicker and wider, certain of them being very wide. And some of them extend to a greater, and some to a smaller, distance. And some are more straight, nay, completely straight; and some are more curved, and that in a remarkable degree. And some are deep, so as to extend downwards and through the whole bone; and some are less so, and do not penetrate through the whole bone.

> Greek: 4. 4. τιτρώσκεται δὲ ὀστέον τὸ ἐν τῇ κεφαλῇ τοσούσδε τρόπους· τῶν δὲ τρόπων ἑκάστου πλέονες ἰδέαι γίγνονται τοῦ κατήγματος ἐν τῇ τρώσει. ὀστέον ῤήγνυται τιτρωσκόμενον, καὶ τῷ περιέχοντι ὀστέῳ τὴν ῤωγμὴν, ἀνάγκη φλάσιν προσγίγνεσθαι, ἤνπερ ῤαγῇ· τῶν γὰρ βελέων ὅ τι περ ῤήγνυσι τὸ ὀστέον, τὸ αὐτὸ τοῦτο καὶ φλᾷ τὸ ὀστέον ἢ μᾶλλον, ἢ ἧσσον, αὐτό τε ἐν ᾧπερ καὶ ῤήγνυσι τὴν ῤωγμὴν, καὶ τὰ περιέχοντα ὀστέα τὴν ῤώγμήν· εἷς οὗτος τρόπος. ἰδέαι δὲ ῤωγμέων παντοῖαι γίγνονται· καὶ γὰρ λεπτότεραί τε καὶ λεπταὶ πάνυ, ὥστε οὐ καταφανέες γίγνονται ἔστιν αἳ τῶν ῤωγμέων, οὔτε αὐτίκα μετὰ τὴν τρῶσιν, οὔτʼ ἐν τῇσιν ἡμέρῃσιν, ἐν ᾗσιν ἂν καὶ πλέον ὄφελος γένοιτο ἐκ τούτου τῷ ἀνθρώπῳ· αἱ δʼ αὖ παχύτεραί τε καὶ εὐρύτεραι ῤήγνυνται τῶν ῤωγμέων· ἔνιαι δὲ καὶ πάνυ εὐρέαι. ἔστι δὲ αὐτέων καὶ αἳ μὲν ἐπὶ μακρότερον ῤήγνυνται, αἳ δὲ ἐπὶ βραχύτερον. καὶ αἱ μὲν ἰθύτεραί τε καὶ ἰθεῖαι πάνυ, αἱ δὲ καμπυλώτεραί τε καὶ καμπύλαι· καὶ βαθύτεραί τε ἐς τὸ κάτω καὶ διὰ παντὸς τοῦ ὀστέου, καὶ ἧσσον βαθεῖαι ἐς τὸ κάτω, καὶ οὐ διὰ παντὸς τοῦ ὀστέου.

[¶4] 5. But a bone may be contused, and yet remain in its natural condition without any fracture in it; this is the second mode. And there are many varieties of contusion; for they occur to a greater or less degree, and to a greater depth, so as sometimes to extend through the whole bone; or to a less depth, so as not to extend through the whole bone; and to a greater and smaller length and breadth. But it is not possible to recognize any of these varieties by the sight, so as to determine their form and extent; neither, indeed, is it visible to the eyes when any mischief of this kind takes place, and immediately after the injury, whether or not the bone has been actually bruised, as is likewise the case with certain fractures at a distance from the seat of injury.

> Greek: 5. 5. Φλασθείη δʼ ἂν τὸ ὀστέον μένον ἐν τῇ ἑωυτοῦ φύσει, καὶ ῤωγμὴ τῇ φλάσει οὐκ ἂν προσγένοιτο ἐν τῷ ὀστέῳ οὐδεμία· δεύτερος οὗτος τρόπος. ἰδέαι δὲ τῆς φλάσιος πλείους γίγνονται· καὶ γὰρ μᾶλλόν τε καὶ ἧσσον φλᾶται, καὶ ἐς βαθύτερόν τε καὶ διὰ παντὸς τοῦ ὀστέου, καὶ ἧσσον ἐς βαθὺ, καὶ οὐ διὰ παντὸς τοῦ ὀστέου, καὶ ἐπὶ πλέον τε καὶ ἔλασσον μήκεός τε καὶ πλατύτητος. ἀλλʼ οὐ τουτέων τῶν ἰδεῶν οὐδεμίαν ἐστὶν ἰδόντα τοῖσιν ὀφθαλμοῖσι γνῶναι, ὁκοίη τίς ἐστι τὴν ἰδέην, καὶ ὁκόσητις τις τὸ μέγεθος· οὐδὲ γὰρ εἰ πέφλασται, ἢ μὴ πέφλασται, ἐόντων πεφλασμένων καὶ τοῦ κακοῦ γεγενημένου, γίγνεται τοῖσιν ὀφθαλμοῖσι καταφανὲς ἰδεῖν αὐτίκα μετὰ τὴν τρῶσιν, ὥσπερ οὐδὲ τῶν ῤωγμέων ἔνιαι ἑκὰς ἐοῦσαι.

[¶5] 6. And the bone being fractured, is sometimes depressed inwards from its natural level along with the fractures, otherwise there would be no depression; for the depressed portion being fractured and broken off, is pushed inwards, while the rest of the bone remains in its natural position; and in this manner a fracture is combined with the depression. This is the third mode. There are many varieties of depression, for it may comprehend a greater and a small extent of bone, and may either be to a greater depth, or less so, and more superficial.

> Greek: 6. 6. καὶ ἐῤῥωγότος τοῦ ὀστέου, ἐσφλᾶται τὸ ὀστέον ἐκ τῆς φύσιος τῆς ἑωυτοῦ ἔσω σὺν ῤωγμῇσιν· ἄλλως γὰρ οὐκ ἂν ἐσφλασθείη· τὸ γὰρ ἐσφλώμενον, ἀποῤῥηγνύμενόν τε καὶ καταγνύμενον, ἐσφλᾶται ἔσω ἀπὸ τοῦ ἄλλου ὀστέου μένοντος ἐν τῇ φύσει τῇ ἑωυτοῦ· καὶ δὴ οὕτω ῤωγμὴ ἂν προσείη τῇ ἐσφλάσει· τρίτος οὗτος τρόπος. ἐσφλᾶται δὲ τὸ ὀστέον πολλὰς ἰδέας· καὶ γὰρ ἐπὶ πλέον τοῦ ὀστέου καὶ ἐπʼ ἔλασσον, καὶ μᾶλλόν τε καὶ ἐς βαθύτερον κάτω, καὶ ἧσσόν τε καὶ ἐπιπολαιότερον.

[¶6] 7. When a hedra, or dint of a weapon, takes place in a bone, there may be a fracture combined with it; and provided there be a fracture, contusion must necessarily be joined, to a greater or less extent, in the seat of the dint and fracture, and in the bone which comprehends them. This is the fourth mode. And there may be a hedra, or indentation of the bone, along with contusion of the surrounding bone, but without any fracture either in the hedra or in the contusion inflicted by the weapon. But the indentation of a weapon takes place in a bone, and is called hedra, when the bone remaining in its natural state, the weapon which struck against the bone leaves its impression on the part which it struck. In each of these modes there are many varieties, with regard to the contusion and fracture, if both these be combined with the hedra, or if contusion alone, as it has been already stated that there are many varieties of contusion and fracture. And the hedra, or dint, of itself may be longer and shorter, crooked, straight, and circular; and there are many varieties of this mode, according to the shape of the weapon; and they may be more or less deep, and narrower or broader, and extremely broad. When a part is cleft, the cleft or notch which occurs in the bone, to whatever length or breadth, is a hedra, if the other bones comprehending the cleft remain in their natural position, and be not driven inwards; for in this case it would be a depression, and no longer a hedra.

> Greek: 7. 7. καὶ ἕδρης γενομένης ἐν τῷ ὀστέῳ βέλεος, προσγένοιτο ἂν ῤωγμὴ τῇ ἑδραίῃ· φλάσιν προσγενέσθαι ἀναγκαῖόν ἐστιν, ἢ μᾶλλον, ἢ ἧσσον, ἤνπερ καὶ ῤωγμὴ προσγένηται, ἐνθάπερ ἡ ἕδρη ἐγένετο καὶ ἡ ῤωγμὴ, καὶ ἐν τῷ ὀστέῳ τῷ περιέχοντι τήν τε ἕδρην καὶ τὴν ῤωγμήν· τέταρτος οὗτος τρόπος. καὶ ἕδρη μὲν ἂν γένοιτο, φλάσιν ἔχουσα τοῦ ὀστέου περὶ αὐτὴν, ῤωγμὴ δὲ οὐκ ἂν προσγένοιτο τῇ ἕδρῃ καὶ τῇ φλάσει ὑπὸ τοῦ βέλεος. καὶ ἕδρη δὲ τοῦ βέλεος γίγνεται ἐν τῷ ὀστέῳ· ἕδρη δὲ καλέεται, ὅταν, μένον τὸ ὀστέον ἐν τῇ ἑωυτοῦ φύσει, τὸ βέλος στηρίξαν ἐς τὸ ὀστέον δῆλον ποιήσῃ ὅκου ἐστήριξεν. ἐν δὲ τῷ τρόπῳ ἑκάστῳ πλέονες ἰδέαι γίγνονται· καὶ περὶ μὲν φλάσιός τε καὶ ῤωγμῆς, ἢν ἄμφω ταῦτα προσγένηται τῇ ἕδρῃ, καὶ ἢν φλάσις μούνη γένηται, ἤδη πέφρασται, ὅτι πολλαὶ ἰδέαι γίνονται καὶ τῆς φλάσιος καὶ τῆς ῤωγμῆς. ἡ δὲ ἕδρη αὐτὴ ἐφʼ ἑωυτῆς γίνεται, μακροτέρη καὶ βραχυτέρη ἐοῦσα, καὶ καμπυλωτέρη, καὶ ἰθυτέρη, καὶ κυκλοτερής· καὶ πολλαὶ ἄλλαι ἰδέαι τοῦ τοιουτέου τρόπου, ὁκοῖον ἄν τι καὶ τὸ σχῆμα τοῦ βέλεος ᾖ· αὐταὶ δὲ καὶ βαθύτεραι τὸ κάτω καὶ μᾶλλον καὶ ἧσσον, καὶ στενότεραι, καὶ εὐρύτεραι, καὶ πάνυ εὐρέαι. Ἣ διακέκοπται διακοπὴ δʼ, ὁκοσητισοῦν γιγνομένη μήκεός τε καὶ εὐρύτητος ἐν τῷ ὀστέῳ, ἕδρη ἐστὶν, ἢν τὰ ἄλλα ὀστέα τὰ περιέχοντα τὴν διακοπὴν μένῃ ἐν τῇ φύσει τῇ ἑωυτέων, καὶ μὴ ξυνεσφλᾶται τῇ διακοπῇ ἔσω ἐκ τῆς φύσιος τῆς ἑωυτέων· οὕτω δʼ ἔσφλασις ἂν εἴη, καὶ οὐκ ἔτι ἕδρη.

[¶7] 8. A bone may be injured in a different part of the head from that on which the person has received the wound, and the bone has been laid bare. This is the fifth mode. And for this misfortune, when it occurs, there is no remedy; for when this mischief takes place, there is no means of ascertaining by any examination whether or not it has occurred, or on what part of the head.

> Greek: 8. 8. ὀστέον τιτρώσκεται ἄλλῃ τῆς κεφαλῆς, ἢ ᾗ τὸ ἕλκος ἔχει ὥνθρωπος, καὶ τὸ ὀστέον ἐψιλώθη τῆς σαρκός· πέμπτος οὗτος τρόπος. καὶ ταύτην τὴν ξυμφορὴν, ὅταν γένηται, οὐκ ἂν ἔχοις ὠφελῆσαι οὐδέν. οὐδὲ γὰρ, εἰ πέπονθε τὸ κακὸν τοῦτο, οὐκ ἔστιν ὅκως χρὴ αὐτὸν ἐξελέγξαντα εἰδέναι εἰ πέπονθε τὸ κακὸν τοῦτο ὥνθρωπος, οὐδʼ ὅκοι τῆς κεφαλῆς.

[¶8] 9. Of these modes of fracture, the following require trepanning: the contusion, whether the bone be laid bare or not; and the fissure, whether apparent or not. And if, when an indentation (hedra) by a weapon takes place in a bone it be attended with fracture and contusion, and even if contusion alone, without fracture, be combined with the indentation, it requires trepanning. A bone depressed from position rarely requires trepanning; and those which are most pressed and broken require trepanning the least; neither does an indentation (hedra) without fracture and contusion require trepanning; nor does a notch, provided it is large and wide; for a notch and a hedra are the same.

> Greek: 9. 9. τούτων τῶν τρόπων τῆς κατήξιος ἐς πρίσιν ἀφήκει, ἥ τε φλάσις ἡ ἀφανὴς ἰδεῖν, καὶ ἤν πως τύχῃ φανερὴ γενομένη, καὶ ἡ ῤωγμὴ ἡ ἀφανὴς ἰδεῖν, καὶ ἢν φανερὴ ᾖ. καὶ ἢν, ἕδρης γενομένης τοῦ βέλεος ἐν τῷ ὀστέῳ, προσγένηται ῤωγμὴ καὶ φλάσις τῇ ἕδρῃ, καὶ ἢν φλάσις μοῦνον προσγένηται ἄνευ ῤωγμῆς τῇ ἕδρῃ, καὶ αὕτη ἐς πρίσιν ἀφήκει. τὸ δʼ ἔσω ἐσφλώμενον ὀστέον ἐκ τῆς φύσιος τῆς ἑωυτοῦ, ὀλίγα τῶν πολλῶν πρίσιος προσδεῖται· καὶ τὰ μάλιστα ἐσφλασθέντα καὶ μάλιστα καταῤῥαγέντα, ταῦτα πρίσιος ἥκιστα κέχρηται· οὐδὲ ἕδρη αὐτὴ ἐφʼ ἑωυτῆς γενομένη ἄτερ ῤωγμῆς καὶ φλάσιος, οὐδὲ αὐτὴ πρίσιος δεῖται· οὐδʼ ἡ διακοπὴ, ἢν μεγάλη καὶ εὐρέη, οὐδʼ αὐτή· διακοπὴ γὰρ καὶ ἕδρη τωὐτόν ἐστιν.

[¶9] 10. In the first place, one must examine the wounded person, in what part of the head the wound is situated, whether in the stronger or weaker parts; and ascertain respecting the hairs about the wound, whether they have been cut off by the instrument, and have gone into the wound; and if so, one should declare that the bone runs the risk of being denuded of flesh, and of having sustained some injury from the weapon. These things one should say from a distant inspection, and before laying a hand on the man; but on a close examination one should endeavor to ascertain clearly whether the bone be denuded of flesh or not; and if the denuded bone be visible to the eyes, this will be enough; but otherwise an examination must be made with the sound. And if you find the bone denuded of the flesh, and not safe from the wound, you must first ascertain the state of the bone, and the extent of the mischief, and of what assistance it stands in need. One should also inquire of the wounded person how and in what way he sustained the injury; and if it be not apparent whether the bone has sustained an injury or not, it will be still more necessary, provided the bone be denuded, to make inquiry how the wound occurred, and in what manner; for when contusions and fractures existin the bone, but are not apparent, we must ascertain, in the first place from the patient’s answers, whether or not the bone has sustained any such injuries, and then find out the nature of the case by word and deed, with the exception of sounding. For sounding does not discover to us whether the bone has sustained any of these injuries or not; but sounding discovers to us an indentation inflicted by a weapon, and whether a bone be depressed from its natural position, and whether the bone be strongly fractured; all which may also be ascertained visibly with the eyes.

> Greek: 10. 10. πρῶτον δὲ χρὴ τὸν τρωματίην σποπεῖσθαι, ὅπη ἔχει τὸ τρῶμα τῆς κεφαλῆς, ἐἴτʼ ἐν τοῖσιν ἰσχυροτέροισιν, εἴτʼ ἐν τοῖσιν ἀσθενεστέροισι, καὶ τὰς τρίχας καταμανθάνειν τὰς περὶ τὸ ἕλκος, εἰ διακεκόφαται ὑπὸ τοῦ βέλεος, καὶ εἰ ἔσω ἤϊσαν ἐς τὸ τρῶμα· καὶ ἢν τοῦτο ᾖ, φάναι κινδυνεύειν τὸ ὀστέον ψιλὸν εἶναι τῆς σαρκὸς, καὶ ἔχειν τι σίνος τὸ ὀστέον ὑπὸ τοῦ βέλεος. ταῦτα μὲν οὖν χρὴ ἀπόπροσθεν σκεψάμενον λέξαι, μὴ ἁπτόμενον τοῦ ἀνθρώπου· ἁπτόμενον δʼ ἤδη πειρᾶσθαι εἰδέναι σάφα, εἴ ἐστι ψιλὸν τὸ ὀστέον τῆς σαρκὸς, ἢ οὔ· καὶ ἢν μὲν καταφανὲς ᾖ τοῖσιν ὀφθαλμοῖσι τὸ ὀστέον ψιλόν· εἰ δὲ μὴ, τῇ μήλῃ σκέπτεσθαι. καὶ ἢν μὲν εὕρῃς ψιλὸν ἐὸν τὸ ὀστέον τῆς σαρκὸς, καὶ μὴ ὑγιὲς ἀπὸ τοῦ τρώματος, χρὴ τοῦ ἐν τῷ ὀστέῳ ἐόντος τὴν διάγνωσιν πρῶτα ποιέεσθαι, ὁρέοντα ὅσον τέ ἐστι τὸ κακὸν, καὶ τίνος δεῖται ἔργου. χρὴ δὲ καὶ ἐρωτᾷν τὸν τετρωμένον, ὅκως ἔπαθε καὶ τίνα τρόπον. ἢν δὲ μὴ καταφανὲς ᾖ τὸ ὀστέον, εἰ ἔχει τι κακὸν ἢ μὴ ἔχει, πολλῷ ἔτι χρὴ μᾶλλον τὴν ἐρώτησιν ποιέεσθαι, ψιλοῦ ἐόντος τοῦ ὀστέου, τὸ τρῶμα ὅκως ἐγένετο, καὶ ὅντινα τρόπον· τὰς γὰρ φλάσιας καὶ τὰς ῤωγμὰς τὰς οὐ φαινομένας ἐν τῷ ὀστέῳ, ἐνεούσας δὲ, ἐκ τῆς ὑποκρίσιος τοῦ τετρωμένου πρῶτον διαγινώσκειν πειρῆσθαι, εἴ τι πέπονθε τουτέων τὸ ὀστέον ἢ οὐ πέπονθεν, ἔπειτα δὲ καὶ λόγῳ καὶ ἔργῳ ἐξελέγχειν πλὴν μηλώσιος. Μήλωσις γὰρ οὐκ ἐξελέγχει, εἰ πέπονθέ τι τουτέων τῶν κακῶν τὸ ὀστέον, καὶ εἴ τι ἔχει ἐν ἑωυτέῳ, ἢ οὐ πέπονθεν· ἀλλʼ ἕδρην τε τοῦ βέλεος ἐξελέγχει μήλωσις, καὶ ἢν ἐμφλασθῇ τὸ ὀστέον ἔσω ἐκ τῆς φύσιος τῆς ἑωυτέου, καὶ ἢν ἰσχυρῶς ῤαγῇ τὸ ὀστέον, ἅπερ καὶ τοῖσιν ὀφθαλμοῖσι καταφανέα ἐστὶν ὁρῶντα γιγνώσκειν.

[¶10] 11. And a bone sustains fractures, either so fine as to escape the sight, or such as are apparent, and contusions which are not apparent, and depression from its natural position, especially when one person is intentionally wounded by another, or when, whether intentionally or not, a blow or stroke is received from an elevated place, and if the instrument in the hand, whether used in throwing or striking, be of a powerful nature, and if a stronger person wound a weaker. Of those who are wounded in the parts about the bone, or in the bone itself, by a fall, he who falls from a very high place upon a very hard and blunt object is in most danger of sustaining a fracture and contusion of the bone, and of having it depressed from its natural position; whereas he that falls upon more level ground, and upon a softer object, is likely to suffer less injury in the bone, or it may not be injured at all. Of those instruments which, falling upon the head, wound the parts about the bone, or the bone itself, that which falls from a very high place, and the least on a level with the person struck, and which is at the same time very hard, very blunt, and very heavy, and which is the least light, sharp, and soft, such an instrument would occasion a fracture and contusion of the bone. And there is most danger that the bone may sustain these injuries, under such circumstances, when the wound is direct and perpendicular to the bone, whether struck from the hand or from a throw, or when any object falls upon the person, or when he is wounded by falling, or in whatever way the bone sustains a direct wound from this instrument. Those weapons which graze the bone obliquely are less apt to fracture, contuse, or depress the bone, even when the bone is denuded of flesh; for in some of those wounds thus inflicted the bone is not laid bare of the flesh. Those instruments more especially produce fractures in the bone, whether apparent or not, and contusions, and inward depression of the bone, which are rounded, globular, smooth on all sides, blunt, heavy, and hard; and such weapons bruise, compress, and pound the flesh; and the wounds inflicted by such instruments, whether obliquely or circularly, are round, and are more disposed to suppurate, and to have a discharge, and take longer time to become clean; for the flesh which has been bruised and pounded must necessarily suppurate and slough away. But weapons of an oblong form, being, for the most part, slender, sharp, and light, penetrate the flesh rather than bruise it, and the bone in like manner; and such an instrument may occasion a hedra and a cut (for a hedra and a cut are same thing); but weapons of this description do not produce contusions, nor fractures, nor depressions inwardly. And in addition the appearances in the bone, which you call detect by the sight, you should make inquiry as to all these particulars (for they are symptoms of a greater or less injury), whether the wounded person was stunned, and whether darkness was diffused over his eyes, and whether he had vertigo, and fell to the ground.

> Greek: 11. 11. ῥήγνυται δὲ τὸ ὀστέον τάς τε ἀφανέας ῤωγμὰς καὶ τὰς φανερὰς, καὶ φλᾶται τὰς ἀφανέας φλάσιας, καὶ ἐσφλᾶται ἔσω ἐκ τῆς φύσιος τῆς ἑωυτέου, μάλιστα ὅταν ἕτερος ὑφʼ ἑτέρου τιτρωσκόμενος ἐπίτηδες τρωθῇ, ἢ ὁκόταν, ἐπίτηδες τρῶσαι βουλόμενος ἢ ἀέκων, ἐξ ὑψηλοτέρου γίγνηται ἡ βολὴ ἢ ἡ πληγὴ, ὁκοτέρη ἂν ᾖ μᾶλλον, ἢ ὅταν ἐξ ἰσοπέδου τοῦ χωρίου, καὶ ἢν περικρατέῃ τῇ χειρὶ τὸ βέλος, ἤν τε βάλλῃ, ἤν τε τύπτῃ, καὶ ἰσχυρότερος ἐὼν ἀσθενέστερον τιτρώσκῃ. ὅσοι δὲ πίπτοντες τιτρώσκονται πρός τε τὸ ὀστέον καὶ αὐτὸ τὸ ὀστέον, ὁ ἀπὸ ὑψηλοτάτου πίπτων καὶ ἐπὶ σκληρότατον καὶ ἀμβλύτατον, τουτέῳ κίνδυνος τὸ ὀστέον ῤαγῆναι καὶ φλασθῆναι, καὶ ἔσω ἑσφλασθῆναι ἐκ τῆς φύσιος τῆς ἑωυτέου· τῷ δʼ ἐξ ἰσοπέδου μᾶλλον χωρίου πίπτοντι καὶ ἐπὶ μαλθακώτερον, ἧσσον ταῦτα πάσχει τὸ ὀστέον, ἢ οὐκ ἂν πάθοι. ὅσα δὲ ἐσπίπτοντα ἐς τὴν κεφαλὴν βέλεα τιτρώσκει πρὸς τὸ ὀστέον καὶ αὐτὸ τὸ ὀστέον, τὸ ἀπὸ ὑψηλοτάτου ἐμπεσὸν καὶ ἥκιστα ἐξ ἰσοπέδου, καὶ σκληρότατόν τε ἅμα καὶ ἀμβλύτατον καὶ βαρύτατον, καὶ ἥκιστα κοῦφον καὶ ἥκιστα ὀξὺ καὶ μαλθακὸν, τοῦτο ἂν ῤήξειε τὸ ὀστέον καὶ φλάσειεν. καὶ μάλιστά γε ταῦτα πάσχειν τὸ ὀστέον κίνδυνος, ὅταν ταῦτά τε γίνηται, καὶ ἐς ἰθὺ τρωθῇ, καὶ κατʼ ἀντίον γένηται τὸ ὀστέον τοῦ βέλεος, ἤν τε πληγῇ ἐκ χειρὸς, ἤν τε βληθῇ, ἤν τέ τι ἐμπέσῃ αὐτέῳ, καὶ ἢν αὐτὸς καταπεσὼν τρωθῇ, καὶ ὁκωσοῦν τρωθεὶς κατʼ ἀντίον γενομένου τοῦ ὀστέου τῷ βέλει. τὰ δʼ ἐς πλάγιον τοῦ ὀστέου παρασύραντα βέλεα ἧσσον καὶ ῤήγνυσι τὸ ὀστέον, καὶ φλᾷ, καὶ ἔσω ἐσφλᾷ, κἢν ψιλωθῇ τὸ ὀστέον τῆς σαρκός· ἔνια γὰρ τῶν τρωμάτων τῶν οὕτω τρωθέντων οὐδὲ ψιλοῦται τὸ ὀστέον τῆς σαρκός. τῶν δὲ βελέων ῤήγνυσι μάλιστα τὸ ὀστέον τάς τε φανερὰς ῤωγμὰς καὶ τὰς ἀφανέας, καὶ φλᾶται καὶ ἐσφλᾷ ἔσω ἐκ τῆς φύσιος τῆς ἑωυτέου τὸ ὀστέον, τὰ στρογγύλα τε καὶ περιφερέα, καὶ ἀρτίστομα, ἀμβλέα τε ἐόντα καὶ βαρέα καὶ σκληρά· καὶ τὴν σάρκα ταῦτα φλᾶται, καὶ πέπειρον ποιέει, καὶ κόπτει· καὶ τὰ ἕλκεα γίνεται ὑπὸ τῶν τοιουτέων βελέων, ἔς τε πλάγιον καὶ ἐν κύκλῳ, ὑπόκοιλα, καὶ διάπυά τε μᾶλλον γίγνεται, καὶ ὑγρά ἐστι, καὶ ἐπὶ πλέονα χρόνον καθαίρεται· ἀνάγκη γὰρ τὰς σάρκας τὰς φλασθείσας καὶ κοπείσας πῦον γενομένας ἐκτακῆναι. τὰ δὲ βέλεα τὰ προμήκεα, ἐπιπολὺ λεπτὰ ἐόντα καὶ ὀξέα καὶ κοῦφα, τήν τε σάρκα διατάμνει μᾶλλον ἢ φλᾷ, καὶ τὸ ὀστέον ὡσαύτως· καὶ ἕδρην μὲν ἐμποιέει αὐτὸ καὶ διακόψαν (διακοπὴ γὰρ καὶ ἕδρη τωὐτόν ἐστι), φλᾷ δὲ οὐ μάλα τὸ ὀστέον τὰ τοιαῦτα βέλεα, οὐδὲ ῤήγνυσιν, οὐδʼ ἐκ τῆς φύσιος ἔσω ἐσφλᾷ. ἀλλὰ χρὴ πρὸς τῇ ὄψει τῇ ἑωυτέου, ὅ τι ἄν σοι φαίνηται ἐν τῷ ὀστέῳ, καὶ ἐρώτησιν ποιέεσθαι πάντων τουτέων (τοῦ γὰρ μᾶλλόν τε καὶ ἧσσον τρωθέντος ταῦτʼ ἐστὶ σημήϊα), καὶ ἢν ὁ τρωθεὶς καρωθῇ, καὶ σκότος περιχυθῇ, καὶ δῖνος ἔχῃ, καὶ πέσῃ.

[¶11] 12. When the bone happens to be denuded of flesh by the weapon, and when the wound occurs upon the sutures, it is difficult to distinguish the indentation (hedra) of a weapon which is clearly recognized in other parts of the bone, whether it exist or not, and especially if the hedra be seated in the sutures themselves. For the suture being rougher than the rest of the bone occasions confusion, and it is not clear which is the suture, and which the mark inflicted by the instrument, unless the latter (hedra) be large. Fracture also for the most part is combined with the indentation when it occurs in the sutures; and this fracture is more difficult to discern when the bone is broken, on this account, that if there be a fracture, it is situated for the most part in the suture. For the bone is liable to be broken and slackened there, owing to the natural weakness of the bone there, and to its porosity, and from the suture being readily ruptured and slackened: but the other bones which surround the suture remain unbroken, because they are stronger than the suture. For the fracture which occurs at the suture is also a slackening of the suture, and it is not easy to detect whether the bone be broken and slackened by the indentation of a weapon occurring in the suture, or from a contusion of the bone at the sutures; but it is still more difficult to detect a fracture connected with contusion. For the sutures, having the appearance of fissures, elude the discernment and sight of the physician, as being rougher than the rest of the bone, unless the bone be strongly cut and slackened (for a cut and a hedra are the same thing). But it is necessary, if the wound has occurred at the sutures, and the weapon has impinged on the bone or the parts about it, to pay attention and find out what injury the bone has sustained. For a person wounded to the same, or a much smaller, extent, and by weapons of the same size and quality, and even much less, will sustain a much greater injury, provided he has received the blow at the sutures, than if it was elsewhere. And many of these require trepanning, but you must not apply the trepan to the sutures themselves, but on the adjoining bone.

> Greek: 12. 12. ὅταν δὲ τύχῃ ψιλωθὲν τὸ ὀστέον τῆς σαρκὸς ὑπὸ τοῦ βέλεος, καὶ τύχῃ κατʼ αὐτὰς τὰς ῤαφὰς γενόμενον τὸ ἕλκος, χαλεπὸν γίγνεται καὶ τὴν ἕδρην τοῦ βέλεος φράσασθαι τὴν ἐν τῷ ἄλλῳ ὀστέῳ φανερὴν γιγνομένην, εἴτʼ ἔνεστιν ἐν τῷ ὀστέῳ, εἴτε μὴ ἔνεστιν, καὶ ἢν τύχῃ γενομένη ἡ ἕδρη ἐν αὐτέῃσι τῇσι ῤαφῇσιν. Ξυγκλέπτεται γὰρ αὐτὴ ἡ ῤαφὴ τρηχυτέρη ἐοῦσα τοῦ ἄλλου ὀστέου, καὶ οὐ διάδηλον ὅ τι τε αὐτοῦ ῤαφή ἐιν, καὶ ὅ τι τοῦ βέλεος ἕδρη, ἢν μὴ κάρτα μεγάλη γένηται ἡ ἕδρη. προσγίνεται δὲ καὶ ῤῆξις τῇ ἕδρῃ ὡς ἐπὶ τὸ πουλὺ, τῇ ἐν τῇσι ῤαφῇσι γιγνομένῃ, καὶ γίνεται καὶ αὐτὴ ἡ ῤήξις χαλεπωτέρη φράσασθαι, ἐῤῥωγότος τοῦ ὀστέου, διὰ τοῦτο, ὅτι κατʼ αὐτὴν τὴν ῤαφὴν ἡ ῤῆξις γίνεται ἢν ῤηγνύηται, ὡς ἐπὶ τὸ πουλύ. ἕτοιμον γὰρ ταύτῃ ῤήγνυσθαι τὸ ὀστέον καὶ διαχαλᾷν, διὰ τὴν ἀσθένείην τῆς φύσιος τοῦ ὀστέου ταύτῃ καὶ διὰ τὴν ἀραιότητα, καὶ δὴ ἅτε τῆς ῤαφῆς ἑτοίμης ἐούσης ῤήγνυσθαι καὶ διαχαλᾷν· τὰ δʼ ἄλλα ὀστέα, τὰ περιέχοντα τὴν ῤαφὴν, μένει ἀῤῥαγέα, ὅτι ἰσχυρότερά ἐστι τῆς ῤαφῆς. ἡ δὲ ῤῆξις ἡ κατὰ τὴν ῤαφὴν γινομένη καὶ διαχάλασίς ἐστι τῆς ῤαφῆς, καὶ φράσασθαι οὐκ εὐμαρὴς, οὔτε ἢν ὑπὸ ἕδρης τοῦ βέλεος γενομένης ἐν τῇ ῤαφῇ ῤαγῇ καὶ διαχαλάσῃ, οὔτε ἢν, φλασθέντος τοῦ ὀστέου κατὰ τὰς ῤαφὰς, ῤαγῇ καὶ διαχαλάσῃ· ἀλλʼ ἔτι χαλεπώτερον φράσασθαι τὴν ἀπὸ τῆς φλάσιος ῤωγμήν. Ξυγκλέπτουσι γὰρ τὴν γνώμην καὶ τὴν ὄψιν τοῦ ἰητροῦ αὗται αἱ ῤαφαὶ ῤωγμοειδέες φαινόμεναι, καὶ τρηχύτεραι ἐοῦσαι τοῦ ἄλλου ὀστέου, ὅτι μὴ ἰσχυρῶς διεκόπη, καὶ διεχάλασεν· διακοπὴ δὲ καὶ ἕδρη τωὐτόν ἐστιν. ἀλλὰ χρὴ, εἰ κατὰ τὰς ῤαφὰς τὸ τρῶμα γένοιτο καὶ πρός γε τὸ ὀστέον καὶ ἐς τὸ ὀστέον στηρίξειε τὸ βέλος, προσέχοντα τὸν νόον, ἀνευρίσκειν ὅ τι πέπονθε τὸ ὀστέον. ἀπὸ γὰρ ἴσων τε βελέων τὸ μέγεθος καὶ ὁμοίων, καὶ πολλὸν ἐλασσόνων, καὶ ὁμοίως τρωθεὶς καὶ πολὺ ἧσσον, πολλῷ μέζον ἐκτήσατο τὸ κακὸν ἐν τῷ ὀστέῳ ὁ ἐς τὰς ῤαφὰς δεξάμενος τὸ βέλος, ἢ ὁ μὴ ἐς τὰς ῤαφὰς δεξάμενος. καὶ τουτέων τὰ πολλὰ πρίεσθαι δεῖ· ἀλλʼ οὐ χρὴ αὐτὰς τὰς ῤαφὰς πρίειν, ἀλλʼ ἀποχωρήσαντα ἐν τῷ πλησίον ὀστέῳ τὴν πρίσιν ποιέεσθαι, ἢν πρίῃς.

## 2. Sections 13–21

Source: https://scriptura.si/works/hippocrates-injuries-of-the-head/2/ · cite a paragraph as https://scriptura.si/works/hippocrates-injuries-of-the-head/2/#p-N

[¶0] 13. And with regard to the cure of wounds in the head, and the mode of detecting injuries in the bone which are not apparent, the following is my opinion:— In a wound of the head, you must not apply anything liquid, not even wine, but as little as possible, nor a cataplasm, nor conduct the treatment with tents, nor apply a bandage to an ulcer on the head, unless it be situated on the forehead, in the part which is bare of hairs, or about the eyebrow and eye, for wounds occurring there require cataplasms and bandages more than upon any other part of the head. For the rest of the head surrounds the whole forehead, and the wounds wherever situated become inflamed and swelled, owing to an influx of blood from surrounding parts. And neither must you apply cataplasms and bandages to the forehead at all times; but when the inflammation is stopped and the swelling has subsided, you must give up the cataplasms and bandages. A wound in any other part of the head must not be treated with tents, bandages, or cataplasms, unless it also requires incision. You must perform incision on wounds situated on the head and forehead, whenever the bone is denuded of flesh, and appears to have sustained some injury from the blow, but the wound has not sufficient length and breadth for the inspection of the bone, so that it may be seen whether it has received any mischief from the blow, and of what nature the injury is, and to what extent the flesh has been contused, and whether the bone has sustained any injury, or whether it be uninjured by the blow, and has suffered no mischief; and with regard to the treatment, what the wound, and the flesh, and the injury of the bone stand in need of. Ulcers of this description stand in need of incision; and, if the bone be denuded of the flesh, and if it be hollow, and extend far obliquely, we cut up the cavity wherever the medicine cannot penetrate readily, whatever medicine it may be; and wounds which are more inclined to be circular and hollow, and for the most part others of the like shape, are cut up by making double incision in the circle lengthways, according to the figure of the man, so as to make the wound of a long form. Incisions may be practiced with impunity on other parts of the head, with the exception of the temple and the parts above it, where there is a vein that runs across the temple, in which region an incision is not to be made. For convulsions seize on a person who has been thus treated; and if the incision be on the left temple, the convulsions seize on the right side; and if the incision be on the right side, the convulsions take place on the left side.

> Greek: 13. 13. περὶ δὲ ἰήσιος τρωσίων τῶν ἐν τῇ κεφαλῇ, καὶ ὡς χρὴ ἐξελέγχειν τὰς πάθας τὰς ἐν τῷ ὀστέῳ γινομένας τὰς μὴ φανερὰς, ὧδέ μοι δοκέει. ἕλκος ἐν τῇ κεφαλῇ οὐ χρὴ τέγγειν οὐδενὶ, οὐδὲ οἴνῳ, ἀλλʼ ὡς ἥκιστα· οὐδὲ καταπλάσσειν, οὐδὲ μοτῷ τὴν ἴησιν ποιέεσθαι, οὐδʼ ἐπιδεῖν χρὴ ἕλκος ἐν κεφαλῇ, ἢν μὴ ἐν τῷ μετώπῳ ᾖ τὸ ἕλκος, ἐν τῷ ψιλῷ τῶν τριχῶν, ἢ περὶ τὴν ὀφρὺν καὶ τὸν ὀφθαλμόν. ἐνταῦθα δὲ γινόμενα τὰ ἕλκεα καταπλάσιος καὶ ἐπιδέσιος μᾶλλον κέχρηται ἤ κου ἄλλοθι τῆς κεφαλῆς τῆς ἄλλης. περιέχει γὰρ ἡ κεφαλὴ ἡ ἄλλη τὸ μέτωπον πᾶν· ἐκ δὲ τῶν περιεχόντων τὰ ἕλκεα, καὶ ἐν ὅτῳ ἂν ᾖ τὰ ἕλκεα, φλεγμαίνει καὶ ἐπανοιδίσκεται διʼ αἵματος ἐπιῤῥοήν. χρὴ δὲ οὐδὲ τὰ ἐν τῷ μετώπῳ διὰ παντὸς τοῦ χρόνου καταπλάσσειν καὶ ἐπιδεῖν, ἀλλʼ ἐπειδὰν παύσηται φλεγμαίνοντα, καὶ τὸ οἴδημα καταστῇ, παύσασθαι καταπλάσσοντα καὶ ἐπιδέοντα. ἐν δὲ τῇ ἄλλῃ κεφαλῇ ἕλκος οὔτε μοτοῦν χρὴ, οὔτε καταπλάσσειν, οὔτʼ ἐπιδεῖν, εἰ μὴ καὶ τομῆς δέοιτο. τάμνειν δὲ χρὴ τῶν ἑλκέων τῶν ἐν τῇ κεφαλῇ γινομένων, καὶ ἐν τῷ μετώπῳ, ὅκου ἂν τὸ μὲν ὀστέον ψιλὸν ᾖ τῆς σαρκὸς, καὶ δοκέῃ τι σίνος ἔχειν ὑπὸ τοῦ βέλεος, τὰ ἕλκεα μὴ ἱκανὰ τὸ μέγεθος τοῦ μήκεος καὶ τῆς εὐρύτητος ἐς τὴν σκέψιν τοῦ ὀστέου, εἴ τι πέπονθεν ὑπὸ τοῦ βέλεος κακὸν, καὶ ὁκοῖόν τι πέπονθε, καὶ ὅσον μὲν ἡ σὰρξ πέφλασται, καὶ τὸ ὀστέον ἔχει τὸ σίνος, καὶ δʼ αὖ εἰ ἀσινές τέ ἐστι τὸ ὀστέον ὑπὸ τοῦ βέλεος, καὶ μηδὲν πέπονθε κακὸν, καὶ ἐς τὴν ἴησιν, ὁκοίης τινὸς δεῖται τό τε ἕλκος, ἥ τε σὰρξ, καὶ ἡ πάθη τοῦ ὀστέου. τὰ δὴ τοιαῦτα τῶν ἑλκέων τομῆς δεῖται. καὶ ἂν μὲν τὸ ὀστέον ψιλωθῇ τῆς σαρκὸς, ὑπόκοιλα δὲ ᾖ ἐς πλάγιον ἐπιπολὺ, ἐπανατάμνειν τὸ κοῖλον, ὅκου μὴ εὐχερὲς τῷ φαρμάκῳ ἐφικέσθαι, ὁκοίῳ ἄν τινι χρῇ· καὶ τὰ κυκλοτερέα τῶν ἑλκέων καὶ ὑπόκοιλα ἐπὶ πουλὺ καὶ τὰ τοιαῦτα, ἐπανατάμνων τὸν κύκλον διχῆ κατὰ μῆκος, ὡς πέφυκεν ὥνθρωπος, μακρὸν ποιέειν τὸ ἕλκος. Τάμνοντι δὲ κεφαλὴν, τὰ μὲν ἄλλα τῆς κεφαλῆς ἀσφαλείην ἔχει ταμνόμενα· ὁ δὲ κρόταφος, καὶ ἄνωθεν ἔτι τοῦ κροτάφου, κατὰ τὴν φλέβα τὴν διὰ τοῦ κροτάφου φερομένην, τοῦτο δὲ τὸ χωρίον μὴ τάμνειν. σπασμὸς γὰρ ἐπιλαμβάνει τὸν τμηθέντα· καὶ ἢν μὲν ἐπʼ ἀριστερὰ τμηθῇ κροτάφου, τὰ ἐπὶ δεξιὰ ὁ σπασμὸς ἐπιλαμβάνει· ἢν δʼ ἐπὶ τὰ δεξιὰ τμηθῇ κροτάφου, τὰ ἐπʼ ἀριστερὰ ὁ σπασμὸς ἐπιλαμβάνει.

[¶1] 14. When, then, you lay open a wound in the head on account of the bones having been denuded of the flesh, as wishing to ascertain whether or not the bone has received an injury from the blow, you must make an incision proportionate to the size of the wound, and as much as shall be judged necessary. And in making the incision you must separate the flesh from the bone where it is united to the membrane (pericranium?) and to the bone, and then fill the whole wound with a tent, which will expand the wound very wide next day with as little pain as possible; and along with the tents apply a cataplasm, consisting of a mass (maza) of fine flour pounded in vinegar, or boiled so as to render it as glutinous as possible. On the next day, when you remove the tent, having examined the bone to see what injury it has sustained, if the wound in the bone be not right seen by you, nor can you discover what mischief the bone itself has sustained, but the instrument seems to have penetrated to the bone so as to have injured it, you must scrape the bone with a raspatory to a depth and length proportionate to the suture of the patient, and again in a transverse direction, for the sake of the fractures which are not seen, and of the contusions which are not discovered, as not being accompanied with depression of the bone from its natural position. For the scraping discovers the mischief, if the injuries in the bone be not otherwise manifest. And if you perceive an indentation (hedra) left in the bone by the blow, you must scrape the dint itself and the surrounding bones, lest, as often happens, there should be a fracture and contusion, or a contusion alone, combined with the dint, and escape observation. And when you scrape the bone with the raspatory, and it appears that the wound in the bone requires the operation, you must not postpone it for three days, but do it during this period, more especially if the weather be hot, and you have had the management of the treatment from commencement. If you suspect that the bone is broken or contused, or has sustained both these injuries, having formed your judgement from the severity of the wound, and from the information of the patient, as that the person who inflicted the wound, provided it was done by another person, was remarkably strong, and that the weapon by which he was wounded was of a dangerous description, and then that the man had been seized with vertigo, dimness of vision, and stupor, and fell to the ground,—under these circumstances, if you cannot discover whether the bone be broken, contused, or both the one and the other, nor can see the truth of the matter, you must dissolve the jet-black ointment, and fill the wound with it when this dissolved, and apply a linen rag smeared with oil, and then a cataplasm of the maza with a bandage; and on the next day, having cleaned out the wound, scrape the bone with the raspatory. And if the bone is not sound, but fractured and contused, the rest of it which is scraped will be white; but the fracture and contusion, having imbibed the preparation, will appear black, while the rest of the bone is white. And you must again scrape more deeply the fracture where it appears black; and, if you thus remove the fissure, and cause it to disappear, you may conclude that there has been a contusion of the bone to a greater or less extent, which has occasioned the fracture that has disappeared under the raspatory; but it is less dangerous, and a matter of less consequence, when the fissure has been effaced. But if the fracture extend deep, and do not seem likely to disappear when scraped, such an accident requires trepanning. But having performed this operation, you must apply the other treatment to the wound.

> Greek: 14. 14. ὅταν οὖν τάμνῃς ἕλκος ἐν κεφαλῇ ὀστέων εἵνεκα τῆς σαρκὸς ἐψιλωμένων, θέλων εἰδέναι εἴ τι ἔχει τὸ ὀστέον κακὸν ὑπὸ τοῦ βέλεος, ἢ καὶ οὐκ ἔχει, τάμνειν χρὴ τὸ μέγεθος τὴν ὠτειλὴν, ὅση ἂν δοκέῃ ἀποχρῆναι. τάμνοντα δὲ χρὴ ἀναστεῖλαι τὴν σάρκα ἀπὸ τοῦ ὀστέου, ᾗ πρὸς τῇ μήνιγγι καὶ πρὸς τῷ ὀστέῳ πέφυκεν· ἔπειτα διαμοτῶσαι τὸ ἕλκος πᾶν μοτῷ, ὅστις εὐρύτατον τὸ ἕλκος παρέξει ἐς τὴν ὑστεραίην ξὺν ἐλαχίστῳ πόνῳ· μοτώσαντα δὲ καταπλάσματι χρῆσθαι, ὅσον ἂν χρόνον καὶ τῷ μοτῷ, μάζην ἐκ λεπτῶν ἀλφίτων ἐν ὄξει διαμάσσειν, ἢ ἕψειν καὶ γλίσχρην ποιέειν ὡς μάλιστα. τῇ δʼ ὑστεραίῃ ἡμέρῃ, ἐπειδὰν ἐξέλῃς τὸν μοτὸν, κατιδὼν τὸ ὀστέον ὅ τι πέπονθεν, ἐὰν μή σοι καταφανὴς ᾖ ἡ τρῶσις, ὁκοίη τίς ἐστιν ἐν τῷ ὀστέῳ, μηδὲ διαγινώσκῃς εἴ τέ τι ἔχει τὸ ὀστέον κακὸν ἐν ἑωυτέῳ, ἢ καὶ οὐκ ἔχει, τὸ δὲ βέλος δοκέῃ ἀφικέσθαι ἐς τὸ ὀστέον καὶ σίνασθαι, ἐπιξύειν χρὴ τῷ ξυστῆρι κατὰ βάθος καὶ κατὰ μῆκος τοῦ ἀνθρώπου ὡς πέφυκε, καὶ αὖθις ἐπικάρσιον τὸ ὀστέον, τῶν ῤηξίων εἵνεκα τῶν ἀφανέων ἰδεῖν, καὶ τῆς φλάσιος εἵνεκα τῆς ἀφανέος, τῆς οὐκ ἐσφλωμένης ἔσω ἐκ τῆς φύσιος τῆς κεφαλῆς τοῦ ἄλλου ὀστέου. ἐξελέγχει γὰρ ἡ ξύσις μάλα τὸ κακὸν, ἢν μὴ καὶ ἄλλως καταφανέες ἔωσιν αὗται αἱ πάθαι ἐοῦσαι ἐν τῷ ὀστέῳ. καὶ ἢν ἕδρην ἴδῃς ἐν τῷ ὀστέῳ τοῦ βέλεος, ἐπιξύειν χρὴ αὐτήν τε τὴν ἕδρην, καὶ τὰ περιέχοντα αὐτὴν ὀστέα, μὴ πολλάκις τῇ ἕδρῃ προσγένηται ῤῆξις καὶ φλάσις, ἢ μούνη φλάσις, ἔπειτα λανθάνῃ οὐ καταφανέα ἐόντα. ἐπειδὰν δὲ ξύσῃς τὸ ὀστέον τῷ ξυστῆρι, ἢν μὲν δοκέῃ ἐς πρίσιν ἀφίκειν ἡ τρῶσις τοῦ ὀστέου, πρίειν χρὴ, καὶ οὐ δεῖ τὰς τρεῖς ἡμέρας μὴ ὑπερβάλλειν ἀπρίωτον, ἀλλʼ ἐν ταύτῃσι πρίειν, ἄλλως τε καὶ τῆς θερμῆς ὥρης, ἢν ἐξ ἀρχῆς λαμβάνῃς τὸ ἴημα. ἢν δὲ ὑποπτεύσῃς μὲν τὸ ὀστέον ἐῤῥωγέναι, ἢ πεφλάσθαι, ἢ ἀμφότερα ταῦτα, τεκμαιρόμενος, ὅτι ἰσχυρῶς τέτρωται, ἐκ τῶν λόγων τοῦ τρωματίου, καὶ ὅτι ὑπὸ ἰσχυροτέρου τοῦ τρώσαντος, ἢν ἕτερος ὑφʼ ἑτέρου τρωθῇ, καὶ τὸ βέλος ὅτῳ ἐτρώθη, ὅτι τῶν κακούργων βελέων ἦν, ἔπειτα τὸν ἄνθρωπον ὅτι δῖνός τε ἔλαβε καὶ σκότος, καὶ ἐκαρώθη καὶ κατέπεσεν· τούτων δὲ οὕτω γιγνομένων, ἢν μὴ διαγινώσκῃς εἰ ἔῤῥωγε τὸ ὀστέον, ἢ πέφλασται, ἢ καὶ ἀμφότερα ταῦτα, μήτε ὅλως ὁρᾷν δύνῃ, δεῖ δὴ, ἐπὶ τὸ ὀστέον τὸ τηκτὸν τὸ μελάντατον δεύσαντα, τῷ μέλανι φαρμάκῳ τῷ τηκομένῳ στεῖλαι τὸ ἕλκος, ὑποτείναντα ὀθόνιον, ἐλαίῳ τέγξαντα, εἶτα καταπλάσαντα τῇ μάζῃ ἐπιδῆσαι· τῇ δʼ ὑστεραίῃ, ἀπολύσαντα, ἐκκαθήραντα τὸ ἕλκος, ἐπιξῦσαι. καὶ ἢν μὴ ᾖ ὑγιὲς, ἀλλʼ ἐῤῥώγῃ καὶ πεφλασμένον ᾖ, τὸ μὲν ἄλλο ἔσται ὀστέον λευκὸν ἐπιξυόμενον· ἡ δὲ ῤωγμὴ καὶ ἡ φλάσις, κατατακέντος τοῦ φαρμάκου, δεξαμένη τὸ φάρμακον ἐς ἑωυτὴν μέλαν ἐὸν, ἔσται μέλαινα ἐν λευκῷ τῷ ὀστέῳ τῷ ἄλλῳ. ἀλλὰ χρὴ αὖθις τὴν ῤωγμὴν ταύτην φανεῖσαν μέλαιναν ἐπιξέειν κατὰ βάθος· καὶ ἢν μὲν ἐπιξύων τὴν ῤωγμὴν ἐξέλῃς καὶ ἀφανέα ποιήσῃς, φλάσις μὲν γεγένηται τοῦ ὀστέου ἢ μᾶλλον ἢ ἧσσον, ἥτις περιέῤῥηξε καὶ τὴν ῤωγμὴν τὴν ἀφανισθεῖσαν ὑπὸ τοῦ ξυστῆρος· ἧσσον δὲ φοβερὸν καὶ ἧσσον ἂν πρῆγμα ἀπʼ αὐτέης γένοιτο ἀφανισθείσης τῆς ῤωγμῆς. ἢν δὲ κατὰ βάθος ᾖ καὶ μὴ ἐθέλῃ ἐξιέναι ἐπιξυομένη, ἀφίκει ἐς πρίσιν ἡ τοιαύτη ξυμφορή. ἀλλὰ χρὴ πρίσαντα τὰ λοιπὰ ἰητρεύειν τὸ ἔλκος.

[¶2] 15. You must be upon your guard lest the bone sustain any injury from the fleshy parts if not properly treated. When the bone has been sawed and otherwise denuded, whether it be actually sound, or only appears to be so, but has sustained some injury from the blow, there may be danger of its suppurating (although it would not otherwise have done so), if the flesh which surrounds the bone be ill cured, and become inflamed and strangled; for it gets into a febrile state, and becomes much inflamed. For the bone acquires heat and inflammation from the surrounding flesh, along with irritation and throbbing, and the other mischiefs which are in the flesh itself, and from these it gets into a state of suppuration. It is a bad thing for the flesh (granulations?) in an ulcer to be moist and mouldy, and to require a long time to become clean. But the wound should be made to suppurate as quickly as possible; for, thus the parts surrounding the wound would be the least disposed to inflammation, and would become the soonest clean; for the flesh which has been chopped and bruised by the blow, must necessarily suppurate and slough away. But when cleaned the wound must be dried, for thus the wound will most speedily become whole, when flesh devoid of humors grows up, and thus there will be no fungous flesh in the sore. The same thing applies to the membrane which surrounds the brain: for when, by sawing the bone, and removing it from the meninx, you lay the latter bare, you must make it clean and dry as quickly as possible, lest being in a moist state for a considerable time, it become soaked therewith and swelled; for when these things occur, there is danger of its mortifying.

> Greek: 15. 15. φυλάσσεσθαι δὲ χρὴ, ὅκως μή τι κακὸν ἀπολαύσῃ τὸ ὀστέον ἀπὸ τῆς σαρκὸς, ἢν κακῶς ἰητρεύηται. ὀστέῳ γὰρ καὶ πεπρισμένῳ, καὶ ἄλλως ἐψιλωμένῳ, ὑγιεῖ δὲ ἐόντι, καὶ ἔχοντί τι σίνος ὑπὸ τοῦ βέλεος, δοκέοντι δὲ ὑγιεῖ εἶναι, κίνδυνός ἐστι μᾶλλον ὑπόπυον γενέσθαι (ἢν καὶ ἄλλως μὴ μέλλᾐ, ἢν καὶ ἡ σὰρξ ἡ περιέχουσα τὸ ὀστέον κακῶς θεραπεύηται, καὶ φλεγμαίνηται, καὶ περισφίγγηται· πυρετῶδες γὰρ γίγνεται, καὶ πολλοῦ φλογμοῦ πλέον. καὶ δὴ τὸ ὀστέον ἐκ τῶν περιεχουσῶν σαρκέων ἐς ἑωυτὸ θέρμην τε καὶ φλογμὸν καὶ ἄραδον ἐμποιέει καὶ σφυγμὸν, καὶ ὅσα περ ἡ σὰρξ ἔχει κακὰ ἐν ἑωυτέῃ, καὶ ἐκ τουτέων ὧδε ὑπόπυον γίνεται. κακὸν δὲ καὶ ὑγρήν τε εἶναι τὴν σάρκα ἐν τῷ ἕλκει καὶ μυδῶσαν, καὶ ἐπὶ πολλὸν χρόνον καθαίρεσθαι. ἀλλὰ χρὴ διάπυον μὲν ποιῆσαι τὸ ἕλκος ὡς τάχιστα· οὕτω γὰρ ἂν ἥκιστα φλεγμαίνοι τὰ περιέχοντα τὸ ἕλκος, καὶ τάχιστα καθαρὸν εἴη· ἀνάγκη γὰρ ἔχει τὰς σάρκας τὰς κοπείσας καὶ φλασθείσας ὑπὸ τοῦ βέλεος, ὑποπύους γενομένας, ἐκτακῆναι. ἐπειδὰν δὲ καθαρθῇ, ξηρότερον χρὴ γίγνεσθαι τὸ ἕλκος· οὕτω γὰρ ἂν τάχιστα ὑγιὲς γένοιτο, ξηρῆς σαρκὸς βλαστούσης καὶ μὴ ὑγρῆς, καὶ οὕτως οὐκ ἂν ὑπερσαρκήσειε τὸ ἕλκος. ὁ δʼ αὐτὸς λόγος καὶ ὑπὲρ τῆς μήνιγγος τῆς περὶ τὸν ἐγκέφαλον· ἢν γὰρ αὐτίκα ἐκπρίσας τὸ ὀστέον καὶ ἀφελὼν ἀπὸ τῆς μήνιγγος ψιλώσῃς, αὐτὴν καθαρὴν χρὴ ποιῆσαι ὡς τάχιστα καὶ ξηρὴν, ὡς μὴ ἐπὶ πουλὺν χρόνον ὑγρὴ ἐοῦσα μυδήῃ τε καὶ ἐξαίρηται· τούτων γὰρ οὕτω γιγνομένων, σαπῆναι αὐτὴν κίνδυνος.

[¶3] 16. A piece of bone that must separate from the rest of the bone, in consequence of a wound in the head, either from the indentation (hedra) of a blow in the bone, or from the bone being otherwise denuded for a long time, separates mostly by becoming exsanguous. For the bone becomes dried up and loses its blood by time and a multiplicity of medicines which are used; and the separation will take place most quickly, if one having cleaned the wound as quickly as possible will next dry it, and the piece of bone, whether larger or smaller. For a piece of bone which is quickly dried and converted, as it were, into a shell, is most readily separated from the rest of the bone which retains its blood and vitality; for, the part having become exsanguous and dry, more readily drops off from that which retains its blood and is alive.

> Greek: 16. 16. ὀστέον δὲ, ὅ τι δεῖ ἀποστῆναι ἀπὸ τοῦ ἄλλου ὀστέου, ἕλκεος ἐν κεφαλῇ γενομένου, ἕδρης τε ἐούσης τοῦ βέλεος ἐν τῷ ὀστέῳ, ἢ ἄλλως ἐπὶ πουλὺ ψιλωθέντος τοῦ ὀστέου, ἀφίσταται ἐπὶ πουλὺ ἔξαιμον γινόμενον. ἀναξηραίνεται γὰρ τὸ αἷμα ἐκ τοῦ ὀστέου ὑπό τε τοῦ χρόνου καὶ ὑπὸ φαρμάκων τῶν πλείστων· τάχιστα δʼ ἂν ἀποσταίη, εἴ τις τὸ ἕλκος ὡς τάχιστα καθήρας ξηραίνοι τὸ λοιπὸν τό τε ἕλκος καὶ τὸ ὀστέον, καὶ τὸ μεῖζον καὶ τὸ ἧσσον. τὸ γὰρ τάχιστα ἀποξηρανθὲν καὶ ἀποστρακωθὲν τούτῳ μάλιστα ἀφίεται ἀπὸ τοῦ ἄλλου ὀστέου τοῦ ἐναίμου τε καὶ ζῶντος αὐτέου, ἔξαιμόν τε γενόμενον καὶ ξηρὸν τῷ ἐναίμῳ καὶ ζῶντι μάλα ἐφίσταται.

[¶4] 17. Such pieces of bone as are depressed from their natural position, either being broken off or chopped off to a considerable extent, are attended with less danger, provided the membrane be safe; and bones which are broken by numerous and broader fractures are still less dangerous and more easily extracted. And you must not trepan any of them, nor run any risks in attempting to extract the pieces of bone, until they rise up of their own accord, upon the subsidence of the swelling. They rise up when the flesh (granulations) grows below, and it grows from the diploe of the bone, and from the sound portion, provided the upper table alone be in a state of necrosis. And the flesh will shoot up and grow below the more quickly, and the pieces of bone ascend, if one will get the wound to suppurate and make it clean as quickly as possible. And when both the tables of the bone are driven in upon the membrane, I mean the upper and lower, the wound, if treated in the same way, will very soon get well, and the depressed bones will quickly rise up.

> Greek: 17. 17. ὅσα δὲ τῶν ὀστέων ἐσφλᾶται ἔσω ἐκ τῆς φύσιος τῆς ἑωυτῶν, καταῤῥαγέντα ἢ καὶ διακοπέντα πάνυ εὐρέα, ἀκινδυνότερα τὰ τοιαῦτα γίνεται, ἐπὴν ἡ μῆνιγξ ὑγιὴς ᾖ· καὶ τὰ πλέοσι ῤωγμῇσιν ἐσκαταῤῥαγέντα καὶ εὐρυτέρῃσιν, ἔτι ἀκινδυνότερα καὶ εὐμαρέστερα ἐς τὴν ἀφαίρεσιν γίνεται. καὶ οὐ χρὴ πρίειν τῶν τοιούτων οὐδὲν, οὐδὲ κινδυνεύειν τὰ ὀστέα πειρώμενον ἀφαιρέειν, πρὶν ἢ αὐτόματα ἐπανίῃ, οἴδεος πρῶτον χαλάσαντος. ἐπανέρχεται δὲ τῆς σαρκὸς ὑποφυομένης· ὑποφύεται δὲ ἐκ τῆς διπλόης τοῦ ὀστέου καὶ ἐκ τοῦ ὑγιέος, ἢν ἡ ἄνωθεν μοῖρα μούνη σφακελίσῃ. οὕτω δʼ ἂν τάχιστα ἥ τε σὰρξ ὑποφύοιτο καὶ βλαστάνοι, καὶ τὰ ὀστέα ἐπανίοι, εἴ τις τὸ ἕλκος ὡς τάχιστα διάπυον ποιήσας καθαρὸν ποιήσηται. καὶ ἢν διὰ παντὸς τοῦ ὀστέου ἄμφω αἱ μοῖραι ἐσφλασθῶσιν ἔσω ἐς τὴν μήνιγγα, ἥ τε ἄνω μοίρη τοῦ ὀστέου καὶ ἡ κάτω, ἰητρεύοντι ὡσαύτως τὸ ἕλκος ὑγιὲς τάχιστα ἔσται, καὶ τὰ ὀστέα τάχιστα ἐπάνεισι, τὰ ἐσφλασθέντα ἔσω.

[¶5] 18. The bones of children are thinner and softer, for this reason, that they contain more blood [than those of adults]; and they are porous and spongy, and neither dense nor hard. And when wounded to a similar or inferior degree by weapons of the same or even of an inferior power, the bone of a young person more readily and quickly suppurates, and that in less time than the bone of an older person; and in accidents, which are to prove fatal, the younger person will die sooner than the elder. But if the bone is laid bare of flesh, one must attend and try to find out, what even is not obvious to the sight, and discover whether the bone be broken and contused, or only contused; and if, when there is an indentation in the bone, whether contusion, or fracture, or both be joined to it; and if the bone has sustained any of these injuries, we must give issue to the blood by perforating the bone with a small trepan, observing the greatest precautions, for the bone of young persons is thinner and more superficial than that of elder persons.

> Greek: 18. 18. τῶν δὲ παιδίων τὰ ὀστέα καὶ λεπτότερά ἐστι καὶ μαλθακώτερα διὰ τοῦτο, ὅτι ἐναιμότερά ἐστι, καὶ κοῖλα, καὶ σηραγγώδεα, καὶ οὔτε πυκνὰ, οὔτε στερεά. καὶ ὑπὸ τῶν βελέων ἴσων τε ἐόντων καὶ ἀσθενεστέρων, καὶ τρωθέντων ὁμοίως τε καὶ ἧσσον, τὸ τοῦ νεωτέρου παιδίου καὶ μᾶλλον καὶ θᾶσσον ὑποπυΐσκεται, ἢ τὸ τοῦ πρεσβυτέρου, καὶ ἐν ἐλάσσονι χρόνῳ· καὶ ὅσα ἂν ἄλλως μέλλῃ ἀποθανεῖσθαι ἐκ τοῦ τρώματος, ὁ νεώτερος τοῦ πρεσβυτέρου θᾶσσον ἀπόλλυται. ἀλλὰ χρὴ, ἢν ψιλωθῇ τῆς σαρκὸς τὸ ὀστέον, προσέχοντα τὸν νόον, πειρῆσθαι διαγινώσκειν ὅ τι μή ἐστι τοῖσιν ὀφθαλμοῖσιν ἰδεῖν, καὶ γνῶναι εἰ ἔῤῥωγε τὸ ὀστέον καὶ εἰ πέφλασται, ἢ μοῦνον πέφλασται, καὶ εἰ, ἕδρης γενομένης τοῦ βέλεος, πρόσεστι φλάσις, ἢ ῤωγμὴ, ἢ ἄμφω ταῦτα· καὶ ἤν τι τούτων πεπόνθῃ τὸ ὀστέον, ἀφεῖναι τοῦ αἵματος τρυπῶντα τὸ ὀστέον σμικρῷ τρυπάνῳ, φυλασσόμενον ἐπʼ ὀλίγον· λεπτότερον γὰρ τὸ ὀστέον, καὶ ἐπιπολαιότερον τῶν νέων ἢ τῶν πρεσβυτέρων.

[¶6] 19. When a person has sustained a mortal wound on the head, which cannot be cured, nor his life preserved, you may form an opinion of his approaching dissolution, and foretell what is to happen from the following symptoms which such a person experiences. When a bone is broken, or cleft, or contused, or otherwise injured, and when by mistake it has not been discovered, and neither the raspatory nor trepan has been applied as required, but the case has been neglected as if the bone were sound, fever will generally come on if in winter, and in summer the fever usually seizes after seven days. And when this happens, the wound loses its color, and the inflammation dies in it; and it becomes glutinous, and appears like a pickle, being of a tawny and somewhat livid color; and the bone then begins to sphacelate, and turns black where it was white before, and at last becomes pale and blanched. But when suppuration is fairly established in it, small blisters form on the tongue and he dies delirious. And, for the most part, convulsions seize the other side of the body; for, if the wound be situated on the left side, the convulsions will seize the right side of the body; or if the wound be on the right side of the head, the convulsion attacks the left side of the body. And some become apoplectic. And thus they die before the end of seven days, if in summer; and before fourteen, if in winter. And these symptoms indicate, in the same manner, whether the wound be older or more recent. But if you perceive that fever is coming on, and that any of these symptoms accompany it, you must not put off, but having sawed the bone to the membrane (meninx), or scraped it with a raspatory (and it is then easily sawed or scraped), you must apply the other treatment as may seem proper, attention being paid to circumstances.

> Greek: 19. 19. ὅστις δὲ μέλλει ἐκ τρωμάτων ἐν κεφαλῇ ἀποθνήσκειν, καὶ μὴ δυνατὸν αὐτὸν ὑγιᾶ γενέσθαι, μηδὲ σωθῆναι, ἐκ τῶνδε τῶν σημείων χρὴ τὴν διάγνωσιν ποιέεσθαι τοῦ μέλλοντος ἀποθνήσκειν, καὶ προλέγειν τὸ μέλλον ἔσεσθαι. πάσχει γὰρ τάδε· ὁκόταν τις ὀστέον κατεηγὸς, ἢ ἐῤῥωγὸς, ἢ πεφλασμένον, ἢ ὅτῳ γοῦν τρόπῳ κατεηγὸς μὴ ἐννοήσας ἁμάρτῃ, καὶ μήτε ξύσῃ, μήτε πρίσῃ, δεόμενον, μεθῇ δὲ ὡς ὑγιέος ὄντος τοῦ ὀστέου, πρὸ τῶν τεσσαρεσκαίδεκα ἡμερέων πυρετὸς ἐπιλήψεται ὡς ἐπὶ πουλὺ ἐν χειμῶνι· ἐν δὲ τῷ θέρει μετὰ τὰς ἑπτὰ ἡμέρας ὁ πυρετὸς ἐπιλαμβάνει. καὶ ἐπειδὰν τοῦτο γένηται, τὸ ἕλκος ἄχροον γίνεται· καὶ ἐξ αὐτοῦ ἰχὼρ ῤέει σμικρός· καὶ τὸ φλεγμαῖνον ἐκτέθνηκεν ἐξ αὐτοῦ· καὶ γλισχρῶδες γίνεται, καὶ φαίνεται ὥσπερ τάριχος, χροιὴν πυῤῥὸν, ὑποπέλιον· καὶ τὸ ὀστέον σφακελίζειν τηνικαῦτα ἄρχεται, καὶ γίνεται περκνὸν, λευκὸν ὂν, τελευταῖον δὲ ἔπωχρον γενόμενον ἢ ἔκλευκον. ὅταν δʼ ἤδη ὑπόπυον ᾖ, ἐπὶ τῇ γλώσσῃ φλυκταῖναι γίνονται, καὶ παραφρονέων τελευτᾷ. καὶ σπασμὸς ἐπιλαμβάνει τοὺς πλείστους τὰ ἐπὶ θάτερα τοῦ σώματος· ἢν μὲν ἐν τῷ ἐπʼ ἀριστερὰ τῆς κεφαλῆς ἔχῃ τὸ ἕλκος, τὰ ἐπὶ δεξιὰ τοῦ σώματος ὁ σπασμὸς λαμβάνει· ἢν δʼ ἐν τῷ ἐπὶ δεξιὰ τῆς κεφαλῆς ἔχῃ τὸ ἕλκος, τὰ ἐπʼ ἀριστερὰ τοῦ σώματος ὁ σπασμὸς ἐπιλαμβάνει. εἰσὶ δʼ οἳ καὶ ἀπόπληκτοι γίνονται. καὶ οὕτως ἀπόλλυνται πρὸ ἑπτὰ ἡμερέων ἐν θέρει, ἢ τεσσάρων καὶ δέκα ἐν χειμῶνι. ὁμοίως δὲ τὰ σημεῖα ταῦτα σημαίνει, καὶ ἐν πρεσβυτέρῳ ἐόντι τῷ τρώματι, ἢ καὶ ἐν νεωτέρῳ. ἀλλὰ χρὴ, εἰ ἐννοοίης τὸν πυρετὸν ἐπιλαμβάνοντα, καὶ τῶν ἄλλων τι σημεῖον τούτῳ προσγενόμενον, μὴ διατρίβειν, ἀλλὰ πρίσαντα τὸ ὀστέον πρὸς τὴν μήνιγγα, ἢ καταξύσαντα τῷ ξυστῆρι (εὔπριστον δὲ γίνεται καὶ εὔξυστον), ἔπειτα τὰ λοιπὰ οὕτως ἰητρεύειν, ὅκως ἂν δοκέῃ ξυμφέρειν, πρὸς τὸ γινόμενον ὁρῶν.

[¶7] 20. When in any wound of the head, whether the man has been trepanned or not, but the bone has been laid bare, a red and erysipelatous swelling supervenes in the face, and in both eyes, or in either of them, and if the swelling be painful to the touch, and if fever and rigor come on, and if the wound look well, whether as regards the flesh or the bone, and if the parts surrounding the wound be well, except the swelling in the face, and if the swelling be not connected with any error in the regimen, you must purge the bowels in such a case with a medicine which will evacuate bile; and when thus purged the fever goes off, the swelling subsides, and the patient gets well. In giving the medicine you must pay attention to the strength of the patient.

> Greek: 20. 20. ὅταν δʼ ἐπὶ τρώματι ἐν κεφαλῇ ἀνθρώπου ἢ πεπριωμένου ἢ ἀπριώτου, ἐψιλωμένου δὲ τοῦ ὀστέου, οἴδημα ἐπιγένηται ἐρυθρὸν καὶ ἐρυσιπελατῶδες ἐν τῷ προσώπῳ, καὶ ἐν τοῖσιν ὀφθαλμοῖσιν ἀμφοτέροισιν, ἢ τῷ ἑτέρῳ, καὶ, εἴ τις ἅπτοιτο τοῦ οἴδήματος, ὀδυνῷτο, καὶ πυρετὸς ἐπιλαμβάνοι καὶ ῤῖγος, τὸ δὲ ἕλκος αὐτό τε ἀπὸ τῆς σαρκὸς καλῶς ἔχοι ἰδέσθαι, καὶ τἀπὸ τοῦ ὀστέου, καὶ τὰ περιέχοντα τὸ ἕλκος ἔχοι καλῶς, πλὴν τοῦ οἰδήματος τοῦ ἐν τῷ προσώπῳ, καὶ ἄλλην ἁμαρτάδα μηδεμίαν ἔχοι τὸ οἴδημα τῆς ἄλλης διαίτης, τούτου χρὴ τὴν κάτω κοιλίην ὑποκαθῆραι φαρμάκῳ, ὅ τι χολὴν ἄγει· καὶ οὕτω καθαρθέντος, ὅ τε πυρετὸς ἀφίησι, καὶ τὸ οἴδημα καθίσταται, καὶ ὑγιὴς γίνεται. τὸ δὲ φάρμακον χρὴ διδόναι πρὸς τὴν δύναμιν τοῦ ἀνθρώπου ὁρῶν, ὡς ἂν ἔχῃ ἰσχύος.

[¶8] 21. With regard to trepanning, when there is a necessity for it, the following particulars should be known. If you have had the management of the case from the first, you must not at once saw the bone down to the meninx; for it is not proper that the membrane should be laid bare and exposed to injuries for a length of time, as in the end it may become fungous. And there is another danger if you saw the bone down to the meninx and remove it at once, lest in the act of sawing you should wound the meninx. But in trepanning, when only a very little of the bone remains to be sawed through, and the bone can be moved, you must desist from sawing, and leave the bone to fall out of itself. For to a bone not sawed through, and where a portion is left of the sawing, no mischief can happen; for the portion now left is sufficiently thin. In other respects you must conduct the treatment as may appear suitable to the wound. And in trepanning you must frequently remove the trepan, on account of the heat in the bone, and plunge it in cold water. For the trepan being heated by running round, and heating and drying the bone, burns it and makes a larger piece of bone around the sawing to drop off, than would otherwise do. And if you wish to saw at once down to the membrane, and then remove the bone, you must also, in like manner, frequently take out the trepan and dip it in cold water. But if you have not charge of the treatment from the first, but undertake it from another after a time, you must saw the bone at once down to the meninx with a serrated trepan, and in doing so must frequently take out the trepan and examine with a sound (specillum), and otherwise along the tract of the instrument. For the bone is much sooner sawn through, provided there be matter below it and in it, and it often happens that the bone is more superficial, especially if the wound is situated in that part of the head where the bone is rather thinner than in other parts. But you must take care where you apply the trepan, and see that you do so only where it appears to be particularly thick, and having fixed the instrument there, that you frequently make examinations and endeavor by moving the bone to bring it up. Having removed it, you must apply the other suitable remedies to the wound. And if, when you have the management of the treatment from the first, you wish to saw through the bone at once, and remove it from the membrane, you must, in like manner, examine the tract of the instrument frequently with the sound, and see that it is fixed on the thickest part of the bone, and endeavor to remove the bone by moving it about. But if you use a perforator (trepan?), you must not penetrate to the membrane, if you operate on a case which you have had the charge of from the first, but must leave a thin scale of bone, as described in the process of sawing.

> Greek: 21. 21. περὶ δὲ πρίσιος, ὅταν καταλάβῃ ἀνάγκη πρίσαι ἄνθρωπον, ὧδε γινώσκειν· ἢν ἐξ ἀρχῆς λαβὼν τὸ ἴημα πρίῃς, οὐ χρὴ ἐκπρίειν τὸ ὀστέον πρὸς τὴν μήνιγγα αὐτίκα· οὐ γὰρ συμφέρει τὴν μήνιγγαψιλὴν εἶναι τοῦ ὀστέου ἐπὶ πουλὺν χρόνον κακοπαθοῦσαν, ἀλλὰ τελευτῶσά πη καὶ διεμύδησεν. ἔστι δὲ καὶ ἕτερος κίνδυνος, ἢν αὐτίκα ἀφαιρέῃς πρὸς τὴν μήνιγγα ἐκπρίσας τὸ ὀστέον, τρῶσαι ἐν τῷ ἔργῳ τῷ πρίονι τὴν μήνιγγα. ἀλλὰ χρὴ πρίοντα, ἐπειδὰν ὀλίγον πάνυ δέῃ διαπεπρίσθαι, καὶ ἤδη κινέηται τὸ ὀστέον, παύσασθαι πρίοντα, καὶ ἐᾷν ἐπὶ τὸ αὐτόματον ἀποστῆναι τὸ ὀστέον. ἐν γὰρ τῷ διαπριωτῷ ὀστέῳ καὶ ἐπιλελειμμένῳ τῆς πρίσιος οὐκ ἂν ἐπιγένοιτο κακὸν οὐδέν· λεπτὸν γὰρ τὸ λειπόμενον ἤδη γίνεται. τὰ δὲ λοιπὰ ἰῆσθαι χρὴ, ὡς ἂν δοκέῃ ξυμφέρειν τῷ ἕλκεϊ. πρίοντα δὲ χρὴ πυκινὰ ἐξαιρέειν τὸν πρίονα τῆς θερμασίης εἵνεκα τοῦ ὀστέου, καὶ ὕδατι ψυχρῷ ἐναποβάπτειν. θερμαινόμενος γὰρ ὑπὸ τῆς περιόδου ὁ πρίων, καὶ τὸ ὀστέον ἐκθερμαίνων καὶ ἀναξηραίνων, κατακαίει, καὶ μεῖζον ποιέει ἀφίστασθαι τὸ ὀστέον τὸ περιέχον τὴν πρίσιν, ἢ ὅσον μέλλει ἀφίστασθαι. καὶ ἢν αὐτίκα βούλῃ ἐκπρίσαι τὸ πρὸς τὴν μήνιγγα, ἔπειτα ἀφελέειν τὸ ὀστέον, ὡσαύτως χρὴ πυκινά τε ἐξαιρέειν τὸν πρίονα, καὶ ἐναποβάπτειν τῷ ὕδατι τῷ ψυχρῷ. ἢν δὲ μὴ ἐξ ἀρχῆς λαμβάνῃς τὸ ἴημα, ἀλλὰ παρʼ ἄλλου παραδέχῃ ὐστερίζων τῆς ἰήσιος, πρίονι χρὴ χαρακτῷ ἐκπρίειν μὲν αὐτίκα τὸ ὀστέον πρὸς τὴν μήνιγγα, θαμινὰ δὲ ἐξαιρεῦντα τὸν πρίονα σκοπεῖσθαι καὶ ἄλλως καὶ τῇ μήλῃ πέριξ κατὰ τὴν ὁδὸν τοῦ πρίονος. καὶ γὰρ πουλὺ θᾶσσον διαπρίεται τὸ ὀστέον, ἢν ὑπόπυόν τε ἐήν ἤδη καὶ διάπυον πρίῃς, καὶ πολλάκις τυγχάνει ἐπιπόλαιον ἐὸν τὸ ὀστέον, ἄλλως τε καὶ ἢν ταύτῃ τῆς κεφαλῆς ᾖ τὸ τρῶμα, ᾗ τυγχάνει λεπτότερον ἐὸν τὸ ὀστέον ἢ παχύτερον. ἀλλὰ φυλάσσεσθαι χρὴ, ὡς μὴ λάθῃς προσβαλὼν τὸν πρίονα, ἀλλʼ ὅπη δοκέῃ παχύτατον εἶναι τὸ ὀστέον, ἐς τοῦτο αἰεὶ ἐνστηρίζειν τὸν πρίονα, θαμινὰ σκοπούμενος, καὶ πειρᾶσθαι ἀνακινέων τὸ ὀστέον ἀναβάλλειν, ἀφελὼν δὲ, τὰ λοιπὰ ἰητρεύειν ὡς ἂν δοκέῃ ξυμφέρειν τῷ ἕλκεϊ. καὶ ἢν, ἐξ ἀρχῆς λαβὼν τὸ ἴημα, αὐτίκα βούλῃ ἐκπρίσας τὸ ὀστέον ἀφελεῖν ἀπὸ τῆς μήνιγγος, ὡσαύτως χρὴ πυκινά τε σκοπεῖσθαι τῇ μήλῃ τὴν περίοδον τοῦ πρίονος, καὶ ἐς τὸ παχύτατον ἀεὶ τοῦ ὀστέου τὸν πρίονα ἐνστηρίζειν, καὶ ἀνακινέων βούλεσθαι ἀφελέειν τὸ ὀστέον. ἢν δὲ τρυπάνῳ χρῇ, πρὸς δὲ τὴν μήνιγγα μὴ ἀφικνέεσθαι, ἢν ἐξ ἀρχῆς λαμβάνων τὸ ἴημα τρυπᾷς, ἀλλʼ ἐπιλιπεῖν τοῦ ὀστέου λεπτὸν, ὥσπερ καὶ ἐν τῇ πρίσει γέγραπται.