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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.