--- title: "Instruments of Reduction · Μοχλικός" author: "Hippocrates" translator: "Francis Adams" languages: [grc, en] shelf: "Classical Greek" section: 2 of 2 url: https://scriptura.si/works/hippocrates-instruments-of-reduction/2/ cite: "Hippocrates, tr. Francis Adams, Instruments of Reduction · Μοχλικός, section 2. Scriptura (scriptura.si), https://scriptura.si/works/hippocrates-instruments-of-reduction/2/" --- # Instruments of Reduction · Μοχλικός *Hippocrates, tr. Francis Adams* A summary of the treatment of fractures and dislocations. > Greek: ed. Émile Littré, from the Perseus Digital Library (canonical-greekLit, tlg0627.tlg011, CC BY-SA 4.0). > English: Francis Adams, from the Perseus Digital Library (tlg0627.tlg011.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. ## 2. Sections 25–42 Source: https://scriptura.si/works/hippocrates-instruments-of-reduction/2/ · cite a paragraph as https://scriptura.si/works/hippocrates-instruments-of-reduction/2/#p-N [¶0] 25. In reduction-the extension of the thigh is to be powerful, and the adjustment what is common in all such cases, with the hands, or a board, or a lever, which, in dislocations inward, should be round, and in dislocations outward, flat; but it is mostly applicable in dislocations outward. Dislocations inward are to be remedied by means of bladders, extending to the bare part of the thigh, along with extension and binding together of the limbs. The patient may be suspended, with his feet a little separated from one another, and then a person inserting his arm within the affected limb, is to suspend himself from it, and perform extension and readjustment at the same time; and this method is sufficient in dislocations forward and the others, but least of all in dislocations backward. A board fastened under the limb, like the board fastened below the arm in dislocations at the shoulder, answers in dislocations inward, but less so in the other varieties. Along with extension you will use pressure either with the foot, the hand, or a board, especially in dislocations forward and backward. > Greek: 25. 25. μηροῦ δὲ κατάτασις μὲν ἰσχυρή· καὶ ἡ διόρθωσις κοινὴ, ἢ χερσὶν, ἢ σανίδι, ἢ μοχλῷ, τὰ μὲν ἔσω στρογγύλῳ, τὰ δὲ ἔξω πλατεῖ, μάλιστα δὲ τὰ ἔξω. καὶ τὰ μὲν ἔσω, ἀσκοῖσιν ἀκεσάμενον, ἐς τὸ ὑπόξηρον τοῦ μηροῦ, κατατάσιος δὲ καὶ ξυνδέσιος σκελέων· κρεμάσαι διαλείποντα σμικρὸν τοὺς πόδας, ἔπειτα πλέξαντα ἐκκρεμασθῆναί τινα, ἐν τῆ διορθώσει ἀμφότερα ἅμα ποιεῦντα. καὶ τῷ ἔμπροσθεν τοῦτο ἱκανὸν καὶ τοῖσιν ἑτέροισιν, ἥκιστα δὲ τῷ ἔξω. ἡ τοῦ ξύλου ὑπόστασις, ὥσπερ ὤμῳ ὑπὸ τὴν χεῖρα, οἷς ἔσω· τοῖσι γὰρ ἄλλοισιν ἧσσον. Καταναγκάσεις δὲ μετὰ διατάσιος, μάλιστα τῶν ἔμπροσθεν ἢ ὄπισθεν, ἢ ποδὶ ἢ χειρὶ ἐφίζεσθαι ἢ σανίδι. [¶1] 26. Dislocations at the knee are of a milder character than those of the elbow, owing to the compactness and regularity of the joint; and hence it is more readily dislocated and reduced. Dislocation generally takes place inward, but also outward and backward. The methods of reduction are-by circumflexion, or by rapid excalcitration, or by rolling a fillet into a ball, placing it in the ham, and then letting the patient’s body suddenly drop down on his knees: this mode applies best in dislocations backward. Dislocations backward, like those of the elbows, may also be reduced by moderate extension. Lateral dislocations may be reduced by circumflexion or excalcitration, or by extension (but this is most applicable in dislocation backward), but also by moderate extension. The adjustment is what is common in all. If not reduced, in dislocations backward, they cannot bend the leg and thigh upon one another, but neither can they do this in the others except to a small extent; and the fore parts of the thigh and leg are wasted. In dislocations inward they are bandy-legged, and the external parts are atrophied. But, in dislocations outward, they incline more outward, but are less lame, for the body is supported on the thicker bone, and the inner parts are wasted. The consequences of a congenital dislocation, or one occurring during adolescence, are analogous to the rule formerly laid down. > Greek: 26. 26. γόνυ δὲ εὐηθέστερον ἀγκῶνος, διὰ τὴν εὐσταλίην καὶ εὐφυΐην· διὸ καὶ ἐκπίπτει καὶ ἐμπίπτει ῥᾷον. ἐκπίπτει δὲ πλειστάκις ἐσω, ἀτὰρ καὶ ἔξω, καὶ ὄπισθεν. ἐμβολαὶ δὲ, ἢ ἐκ τοῦ ξυγκεκάμφθαι, ἢ ἐκλακτίσαι ὀξέως, ἢ ξυνελίξας ταινίης ὄγκον, ἐν ἰγνύῃ θεὶς, ἀμφὶ τοῦτον ἐξαίφνης ἐς ὄκλασιν ἀφεῖναι τὸ σῶμα, μάλιστα ἐν τῇ τῶν ὄπισθεν· δύναται δὲ καὶ κατατεινόμενα μετρίως, ὥσπερ ἀγκὼν, ἐμπίπτειν τὰ ὄπισθεν. τὰ δὲ ἔνθα, ἢ ἔνθα, ἐκ τοῦ ξυγκεκάμφθαι, ἢ ἐκλακτίσαι, [ἢ] ἐν καταστάσει, μάλιστα δὲ αὐτὴ τὸ ὄπισθεν· ἀτὰρ καὶ ἐκ κατατάσιος μετρίης. ἡ διόρθωσις ἅπασι κοινή. ἢν δὲ μὴ ἐμπέσῃ, τοῖσι μὲν ὄπισθεν ξυγκάμπτειν οὐ δύνανται, ἀτὰρ οὐδὲ τοῖσιν ἄλλοισι πάνυ τι· μινύθει δὲ μηροῦ καὶ κνήμης τὸ ἔμπροσθεν. ἢν δὲ ἐς τὸ ἔσω, βλαισότεροι, μινύθει δὲ τὰ ἔξω. ἢν δὲ ἐς τὰ ἔξω, γαυσότεροι, χωλοὶ δὲ ἧσσον, κατὰ γὰρ τὸ παχύτερον ὀστέον ὀχέει, μινύθει δὲ τὰ ἔσω. ἐκ γενεῆς δὲ ἢ ἐν αὐξήσει, κατὰ λόγον τὸν πρόσθεν. [¶2] 27. Dislocations at the ankle-joint require strong extension, either with the hands or some such means, and adjustment, which at the same time effects both acts; this is common in all cases. > Greek: 27. 27. τὰ δὲ κατὰ τὰ σφυρὰ κατατάσιος ἰσχυρῆς δεῖται, ἢ τῇσι χερσὶν ἢ ἄλλοισι τοιούτοισι, κατορθώσιος δὲ ἅμα ἀμφότερα ποιεύσης· κοινὸν δὲ πᾶσιν. [¶3] 28. Dislocations of the bones of the foot are to be treated like those of the hand. > Greek: 28. 28. τὰ δὲ ἐν ποδὶ, ὡς τὰ ἐν χειρὶ, ὑγιῆ. [¶4] 29. Dislocations of the bones connected with the leg, if not reduced, whether occurring at birth or during adolescence, are of the same character as those in the hand. > Greek: 29. 29. τὰ δὲ ἐν τῇ κνήμῃ συγκοινωνέοντα καὶ μὴ ἐμπεσόντα, ἐκ γενεῆς καὶ ἐν αὐξήσει ἐξαρθρήσαντα, ταῦτα ἃ καὶ ἐν χειρί. [¶5] 30. Persons who, in jumping from a height, have pitched on the heel, so as to occasion diastasis (separation) of the bones, ecchymosis of the veins, and contusion of the nerves,-when these symptoms are very violent, there is danger that the parts may sphacelate, and give trouble to the patient during the remainder of his life; for these bones are so constructed as to slip past one another, and the nerves communicate together. And, likewise in cases of fracture, either from an injury in the leg or thigh, or in paralysis of the nerves connected with these parts, or, when in any other case of confinement to bed the heel, from neglect, becomes blackened, in all these cases serious effects result therefrom. Sometimes, in addition to the sphacelus, very acute fevers supervene, attended with hiccup, tumors, aberration of intellect, and speedy death, along with lividity of the large bloodvessels, and gangrene. The symptoms of the exacerbations are these: if the ecchymosis, the blackened parts, and those around them, be somewhat hard and red, and if lividity be combined with the hardness, there is danger of mortification; but, not withstanding, if the parts are sublivid, or even very livid and diffused, or greenish and soft, these symptoms, in all such cases, are favorable. The treatment consists in the administration of hellebore, if they be free from fever, but otherwise, they are to have oxyglyky for drink, if required. Bandaging,-agreeably to the rule in other joints; but this is to be attended to also,-the bandages should be numerous, and softer than usual; compression less; more water than usual to be used in the allusions; to be applied especially to the heel. The same object should be sought after in the position as in the bandaging, namely, that the humors may not be determined to the heel; the limb to be well laid should have the heel higher than the knee. Splints not to be used. > Greek: 30. 30. ὅσοι δὲ πηδήσαντες ἄνωθεν ἐστηρίξαντο τῇ πτέρνῃ, ὥστε διαστῆναι τὰ ὀστέα, καὶ φλέβας ἐκχυμωθῆναι, καὶ νεῦρα ἀμφιθλασθῆναι, ὅταν γένηται οἷα τὰ δεινότατα, κίνδυνος μὲν σφακελίσαντα τὸν αἰῶνα πρήγματα παρασχεῖν. καὶ ῥοικώδη μὲν τὰ ὀστέα, τὰ δὲ νεῦρα ἀλλήλοισι κοινωνέοντα. ἐπεὶ καὶ οἷσιν ἂν καταγεῖσιν, ἢ ὑπὸ τρώματος οἷα ἐν κνήμῃ, ἢ μηρῷ, νεύρων ἀπολυθέντων, ἃ κοινωνέει τουτέοισιν, ἢ ἐξ ἄλλης κατακλίσιος ἀμελέος ἐμελάνθη ἡ πτέρνη, καὶ τουτέοισι παλίγκοτα ἐκ τοιουτέων. ἔστιν ὅτε πρὸς σφακελισμῷ γίνονται πυρετοὶ ὑπεροξέες, λυγγώδεες, τρομώδεες, γνώμης ἁπτόμενοι, ταχυθάνατοι, καὶ ἔτι φλεβῶν αἱμοῤῥόων πελιώσιες, καὶ γαγγραινώσιες. σημεῖα τῶν παλιγκοτησάντων· ἢν τὰ ἐκχυμώματα, καὶ τὰ μελάσματα, καὶ τὰ περὶ ταῦτα ὑπόσκληρα καὶ ὑπέρυθρα ᾖ· ἢν γὰρ ξὺν σκληρύσματι πελιωθῇ, κίνδυνος μελανθῆναι· ἢν δʼ ὑποπέλια ἢ καὶ πέλια μάλα, καὶ κεχυμένα, ἢ ὑπόχλωρα καὶ μαλθακὰ, ταῦτα ἐν πᾶσι τοῖσι τοιούτοισιν ἀγαθά. ἴησις δὲ, ἢν μὲν ἀπύρετοι ἔωσιν, ἐλλεβορίζειν· ἢν δὲ μὴ, μή· ἀλλὰ ποτὸν διδόναι ὀξύγλυκυ, εἰ δέοι. ἐπίδεσις δὲ, ἡ ἄρθρων σύνδεσις· ἔτι δὲ ταῦτα· μᾶλλον τοῖσι φλάσμασι, καὶ ὀθονίοισι πλέοσι καὶ μαλθακωτέροισι χρῆσθαι· πίεξις ἧσσον· ὕδωρ πλέον· προσπεριβάλλειν τὰ πλεῖστα τῇ πτέρνῃ. τὸ σχῆμα, ὅπερ ἡ ἐπίδεσις, ὡς μὴ ἐς την πτέρνην ἀποπιέζηται· ἀνωτέρω γούνατος· ἔστω εὔθετος· νάρθηξι μὴ χρήσασθαι. [¶6] 31. When the foot is dislocated, either alone, or with the epiphysis, the displacement is more apt to be inward. If not reduced, in the course of time the parts of the hips, thigh, and leg, opposite the dislocation, become attenuated. Reduction:—As in dislocation at the wrist; but the extension requires to be very powerful. Treatment:—Agreeably to the rule laid down for the other joints. Less apt to be followed by serious consequences than the wrist, if kept quiet. Diet restricted, as being in an inactive state. Those occurring at birth, or during adolescence, observe the rule formerly stated. > Greek: 31. 31. ὅταν δὲ ἐκστῇ ὁ ποὺς, ἢ μοῦνος, ἢ ξὺν τῇ ἐπιφύσει, ἐκπίπτει μᾶλλον ἐς τὸ ἔσω. εἰ δὲ μὴ ἐμπέσοι, λεπτύνεται ἀνὰ χρόνον ἰσχίου καὶ μηροῦ καὶ κνήμης τὸ ἀντίον τοῦ ὀλισθήματος. ἐμβολὴ, ὡς ἡ καρποῦ, κατάτασις δὲ ἰσχυροτέρη. ἴησις, νόμος ἄρθρων. Παλιγκοτέει ἧσσον καρποῦ, ἢν ἡσυχάσῃ. δίαιτα μείων, ἐλινύουσι γάρ. τὰ δὲ ἐκ γενεῆς μὲν ἢ ἐν αὐξήσει, κατὰ λόγον τὸν πρότερον. [¶7] 32. With regard to slight congenital dislocations, some of them can be rectified, especially club-foot. There is more than one variety of club-foot. The treatment consists in modeling the foot like a piece of wax; applying resinous cerate, and numerous bandages; or a sole, or a piece of lead is to be bound on, but not upon the bare skin; the adjustment and attitudes to correspond. > Greek: 32. 32. ἐπεὶ τὰ σμικρὸν ὠλισθηκότα ἐκ γενεῆς, ἔνια οἷά τε διορθοῦσθαι· μάλιστα δὲ ποδὸς κύλλωσις· κυλλώσιος γὰρ οὐχ εἷς ἐστι τρόπος. ἡ δὲ ἴησις τουτέου· κηροπλαστεῖν· κηρωτὴ ῥητινώδης, ὀθόνια συχνὰ, ἢ πέλμα, ἢ μολύβδιον προσεπιδεῖν, μὴ χρωτί· ἀνάληψις, τά τε σχήματα ὁμολογείτω. [¶8] 33. If the dislocated bones cause a wound in the skin, and protrude, it is better to let them alone, provided only they are not allowed to hang, nor are compressed. The treatment consists in applying pitched cerate, or compresses dipped in hot wine (for cold is bad in all such cases), and certain leaves; but in winter unwashed wool may be applied as a cover to the part; neither cataplasms nor bandaging; restricted diet. Cold, great weight, compression, violence, restricted position, all such are to be accounted as fatal measures. When treated moderately (they escape), maimed and deformed; for, if the dislocation be at the ankle, the foot is drawn upward, and, if elsewhere, according to the same rule. The bones do not readily exfoliate; for only small portions of them are denuded, and they heal by narrow cicatrices. The danger is greatest in the greatest joints, and those highest up. The only chance of recovery is, if they are not reduced, except at the fingers and hand, and in these cases the danger should be announced beforehand. Attempts at reduction to be made on the first or second day; or, if not accomplished then, on the tenth, by no means on the fourth. Reduction by levers. Treatment:—As in injuries of the bones of the head, and the part is to be kept hot; and it is better to give hellebore immediately after the parts have been reduced. With regard to the other bones, it should be well known, that, if replaced, death will be the consequence; the more surely and expeditiously, the greater the articulation, and the more high its situation. Dislocation of the foot is attended with spasm (tetanus) and gangrene; and if, upon its being replaced, any of these symptoms come on, the chance of recovery, if there be any chance, is in displacing it anew; for spasms do not arise from relaxation, but from tension of the parts. > Greek: 33. 33. ἢν δὲ ἐξαρθρήσαντα ἕλκος ποιησάμενα ἐξίσχῃ, ἐώμενα ἀμείνω, ὥστε δὴ μὴ ἀπκιωρέεσθαι, μηδʼ ἀπαναγκάζεσθαι. ἴησις δὲ, πισσηρῇ, ἢ σπλήνεσιν οἰνηροῖσι θερμοῖσιν (ἅπασι γὰρ τουτέοισι τὸ ψυχρὸν κακὸν), καὶ φύλλοισιν· χειμῶνος δὲ, εἰρίοισι ῥερυπωμένοισι τῆς σκέπης εἵνεκα· μὴ καταπλάσσειν, μηδὲ ἐπιδεῖν· δίαιτα λεπτή. ψῦχος, ἄχθος πουλὺ, πίεξις, ἀνάγκη, σχήματος τάξις· εἰδέναι μὲν οὖν ταῦτα πάντα ὀλέθρια. μετρίως δὲ θεραπευθέντες, χωλοὶ αἰσχρῶς· ἢν γὰρ παρὰ πόδας γένηται, ποὺς ἀνασπᾶται καὶ ἤν πη ἄλλῃ, κατὰ λόγον. ὀστέα οὐ μάλα ἀφίστανται· μικρὰ γὰρ ψιλοῦται, περιωτειλοῦται λεπτῶς. τουτέων τὰ μέγιστα κινδυνωδέστατα, καὶ τὰ ἀνωτάτω. ἐλπὶς δὲ μούνη σωτηρίης, ἐὰν μὴ ἐμβάλλῃ, πλὴν τὰ κατὰ δακτύλους, καὶ χεῖρα ἄκρην· ταῦτα δὲ, προειπέτω τοὺς κινδύνους· ἐγχειρέειν ἐμβάλλειν ἢ τῇ πρώτῂ, ἢ τῇ δευτέρῃ· ἢν δὲ μὴ, πρὸς τὰς δέκα· ἥκιστα τεταρταῖα· ἐμβολὴ δὲ, οἱ μοχλίσκοι· ἴησις δὲ, ὡς κεφαλῆς ὀστέων, καὶ θέρμη· ἐλλεβόρῳ δὲ καὶ αὐτίκα ἐπὶ τοῖσιν ἐμβαλλομένοισι βέλτιον χρῆσθαι. τὰ δʼ ἄλλα, εὖ εἰδέναι δεῖ, ὅτι, ἐμβαλλομένων, θάνατοι· τὰ μέγιστα καὶ τὰ ἀνωτάτω μάλιστα καὶ τάχιστα. ποὺς δὲ ἐκβὰς, σπασμὸς, γάγγραινα· καὶ ἢν ἐμβληθέντι ἐπιγένηταί τι τουτέων, ἐκβάλλοντι ἐλπὶς, εἴ τις ἄρα ἐλπίς· οὐ γὰρ ἀπὸ τῶν χαλώντων οἱ σπασμοὶ, ἀλλʼ ἀπὸ τῶν ἐντεινόντων. [¶9] 34. Excision, either of articular bones or of pieces of bones, when not high up in the body, but about the foot or the hand, is generally followed by recovery, unless the patient die at once from deliquium animi. Treatment:—As in injuries of the head; warmth. > Greek: 34. 34. αἱ δὲ ἀποκοπαὶ ἢ ἐν ἄρθρῳ, ἢ κατὰ τὰ ὀστέα, μὴ ἄνω, ἀλλʼ ἢ παρὰ τῷ ποδὶ, ἢ παρὰ τῇ χειρὶ, ἐγγὺς περιγίνονται, ἢν μὴ αὐτίκα μάλα λειποθυμίῃ ἀπόλωνται. ἴησις, ὡς κεφαλῆς, θέρμη. [¶10] 35. Sphacelus of the fleshy parts is produced by the tight compression of bleeding wounds, and by pressure in the fractures of bones, and by blackening, arising from bandages. And in those cases in which a portion of the thigh or arm, both the bones and the flesh drop off, many recover, the case being less dangerous than many others. In cases, then, connected with fracture of the bones, the separation of the flesh quickly takes place, but the separation of the bone, at the boundary of its denuded part, is slower in taking place. But the parts below the seat of the injury, and the sound portion of the body, are to be previously taken away (for they die previously), taking care to avoid producing pain, for deliquium animi may occasion death. The bone of the thigh in such a case came away on the eightieth day, but the leg was removed on the twentieth day. The bones of the leg, in a certain case, came away at the middle of the sixtieth day. In these cases the separation is quick or slow, according to the compression applied by the physician. When the compression is gently applied the bones do not drop off at all, neither are they denuded of flesh, but the gangrene is confined in the more superficial parts. The treatment of such cases must be undertaken; for most of them are more formidable in appearance than in reality. The treatment should be mild, but, not withstanding, with a restricted diet; hemorrhages and cold are to be dreaded; the position, so as that the limb may be inclined upward, and afterward, on account of the purulent abscess, horizontally, or such as may suit with it. In such cases, and in mortifications, there are usually, about the crisis, hemorrhages and crisis, hemorrhages and violent diarrhoeas, which, however, only last for a few days; the patients do not lose their appetite, neither are they feverish, nor should they be put upon a reduced diet. > Greek: 35. 35. Ἀποσφακελίσιος μέντοι σαρκῶν, καὶ ἐν τρώμασιν αἱμοῤῥόοις ἀποσφιγχθὲν, καὶ ἐν ὀστέων κατήγμασί πιεχθὲν, καὶ ἐν δεσμοῖς ἀπομελανθέν. καὶ οἷσι μηροῦ μέρος ἀποπίπτει καὶ βραχίονος, ὀστέα τε καὶ σάρκες [ἀποπίπτουσι], πολλοὶ περιγίνονται, ὡς τά γε ἄλλα εὐφορώτερα. οἷσι μὲν οὖν καταγέντων ὀστέων, αἱ μὲν περιῤῥήξιες ταχεῖαι, αἱ δὲ τῶν ὀστέων ἀποπτώσιες, ᾗ ἂν τὰ ὅρια τῇς ψιλώσιος ᾖ, ταύτῃ ἀποπίπτουσι, βραδύτερον δέ. δεῖ δὲ τὰ κατωτέρω τοῦ τρώματος προσαφαιρέειν καὶ τοῦ σώματος τοῦ ὑγιέος (προθνήσκει γὰρ), φυλασσόμενον ὀδύνην· ἅμα γὰρ λειποθυμίῃ θνήσκουσιν. μηροῦ ὀστέον ἀπελύθη ἐκ τοιούτου ὀγδοηκοσταῖον, ἡ δὲ κνήμη ἀφῃρέθη εἰκοσταίη· κνήμης δὲ ὀστέα κατὰ μέσην, ἑξηκοσταῖα ἀπελύθη. ἐκ τοιουτέων ταχὺ καὶ βραδέως, αἱ πιέξιες αἱ ἰητρικαί. τὰ δʼ ἄλλα ὅσα ἡσυχαίως, τὰ μὲν ὀστέα οὐκ ἀποπίπτει, οὐδὲ σαρκῶν ψιλοῦται, ἀλλʼ ἐπιπολαιότερον. προσδέχεσθαι ταῦτα χρή· τὰ γὰρ πλεῖστα φοβερώτερα ἢ κακίω. ἡ ἴησις πραεῖα· θέρμῃ, διαίτῃ ἀκριβεῖ· κίνδυνος αἱμοῤῥαγιῶν, ψύχεος· σχήματα δὲ, ὡς μὲν ἀνάῤῥοπα, ἔπειτα ὑποστάσιος πύου εἵνεκα ἐξ ἴσου ἢ ὅσα ξυμφέρει. ἐπὶ τοῖσι τοιουτέοισι καὶ ἐπὶ τοῖσι μελασμοῖσιν, αἱμοῤῥαγίαι· δυσεντερίαι, περὶ κρίσιν, λαῦροι μὲν, ὀλιγήμεροι δέ· οὐκ ἀπόσιτοι δὲ πάνυ, οὐδὲ πυρετώδεες, οὐδέ τι κενεαγγητέον. [¶11] 36. Displacement of the spine, if inward, threatens immediate death, attended with retention of urine and loss of sensibility. Outward, the accident is free from most of these bad effects, much more so than where there is merely concussion without displacement; the effects in the former case being confined to the spot affected, whereas in the latter they are further communicated to the whole body, and are of a mortal character. In like manner, when the ribs are fractured, whether one or more, provided there be no splinters, there is rarely fever, spitting of blood, and sphacelus, and ordinary treatment without evacuation will suffice, provided there be no fever;-bandaging, according to rule; and the callus forms in twenty days, the bone being of a porous nature. But in cases of contusion, tubercles form, along with cough, suppurating sores, and sphacelus of the ribs, for nerves from all the parts run along each rib. In many of these cases haemoptysis and empyema also take place. The management of this case consists in careful treatment, bandaging according to rule, diet at first restricted, but afterward more liberal, quiet, silence, position, bowels, and venereal matters regulated. Even when there is no spitting of blood, these contusions are more painful than fractures, and are more subject in time to relapses; and when any mucous collection is left in the part, it makes itself be felt in disorders of the body. Treatment:—burning, when the bone is affected, down to the bone, but not touching the bone itself; if in the intercostal space, the burning must not extend through it, nor be too superficial. In sphacelus of the ribs, tents are to be tried, all other particulars will be stated afterward: but they should be learned by sight rather than by words, namely, food, drink, heat, cold, attitude; medicines, dry, liquid, red, dark, white, sour, for the ulcers, and so with regard to the diet. > Greek: 36. 36. Υβωσις, ἡ μὲν εἴσω, ἐπιθάνατος, οὔρων σχέσιος, ἀποναρκώσιος· τὰ δὲ ἔξω, τουτέων ἀσινέα τὰ πλεῖστα, πουλὺ μᾶλλον, ἢ ὅσα σεισθέντα μὴ ἐξέστη· αὐτὰ μὲν ἑωυτοῖσι κρίσιν ποιησάμενα, κεῖνα δὲ ἐπὶ πλέον τῷ σώματι ἐπιδιδόντα, καὶ ἐν ἐπικαίροις ἔοντα. οἷον πλευραὶ κατεαγεῖσαι μὲν, ὀλίγαι πυρετώδεες, καὶ αἵματος πτύσιος, καὶ σφακελισμοῦ, ἤν τε μία, ἤν τε πλείους, μὴ κατασχισθεῖσαι δέ· καὶ ἴησις φαύλη, μὴ κενεαγγοῦντα, ἢν ἀπύρετος ἔῃ· ἐπίδεσις, ὡς νόμος· ἡ δὲ πώρωσις, ἐν εἴκοσιν ἡμέρῃσι, χαῦνον γάρ. ἢν δʼ ἀμφιφλασθῇ, φυματίαι, καὶ βηχώδεες, καὶ ἔμμοτοι, καὶ πλευρὰς ἐσφακέλισαν· παρὰ γὰρ πλευρὴν ἑκάστην, ἀπὸ πάντων τόνοι εἰσίν. πολλοὶ δὲ καὶ αἷμα ἔπτυσαν, καὶ ἔμπυοι ἐγένοντο. ἡ δὲ μελέτη, ἴησις, ἐτίδεσις, ὡς νόμος· διαίτης τὰ πρῶτα ἀτρεκέως, ἔπειτα ἁπαλύνειν· ἡσυχίῃ, σιγῇ· σχήματα, κοιλίη, ἀφροδίσια. ἀτὰρ οἷς ἄναιμα, ἐπωδυνώτερα τῶν καταγνυμένων, καὶ φιλυποστροφώτερα χρόνουιν· οἷσι δὲ καταλείπεται μυξῶδες, ὑπομιμνήσκει ἐν πόνοισιν. ἴησις, καῦσις, τοῖσι μὲν ἀπʼ ὀστέου, μέχρις ὀστέου, μὴ αὐτὸ δέ· ἢν δὲ μεταξὺ, μὴ πέρην, μηδὲ ἐπιπολῆς. Σφακελισμός· καὶ τὰ ἔμμοτα πειρᾶσθαι· εἰρήσεται ἅπαντα τὰ ἐπεσιόντα. ὁρατὰ, λόγοις δʼ οὐ μὴ, βρώματα, πόματα, θάλπος, ψῦχος, σχῆμα, ὅτι καὶ φάρμακα, τὰ μὲν ξηρὰ, τὰ δὲ ὑγρὰ, τὰ δὲ πυῤῥὰ, τὰ δὲ μέλανα, τὰ δὲ λευκὰ, τὰ δὲ στρυφνὰ, ἐπὶ ἕλκη, οὕτω καὶ δίαιται. [¶12] 37. Displacements (of the vertebrae) from a fall rarely admit of being rectified, and those above the diaphragm are most difficult to rectify. When the accident happens to children, the body does not grow, with the exception of the legs, the arms, and head. Excurvation, in adults, speedily relieves the individual from the disease he is laboring under, but in time it renews its attack, with the same symptoms as in children, but of a less serious nature. Some individuals have borne this affection well, and have turned out to be brawny and fat. But few of them have lived to the age of sixty. Lateral curvatures also occur, the proximate cause of which is the attitudes in which these persons lie. These cases have their prognostics accordingly. > Greek: 37. 37. τὰ δʼ ἀπὸ καταπτώσιος ἧσσον δύναται ἐξιθύνεσθαι· χαλεπώτερα δὲ τὰ ἄνω φρενῶν ἐξιθύνεσθαι. οἷσι δὲ παισὶν, οὐ συναύξεται, ἀλλʼ ἢ σκέλη καὶ χεῖρες καὶ κεφαλή. ηὐξημένοισιν ὕβωσις, παραχρῆμα μὲν τῆς νούσου ῥύεται, ἀνὰ χρόνον δʼ ἐπισημαίνεται, διʼ ὧνπερ καὶ τοῖσι νεωτέροισιν, ἧσσον δὲ κακοήθως. εἰσὶ δὲ οἳ εὐφόρως ἤνεγκαν, οσιν ἂν ἐς εὔσαρκον καὶ πιμελῶδες τράπηται. ὀλίγοι δὲ τουτέων περὶ ἑξήκοντα ἔτεα ἐβίωσαν. ἀτὰρ καὶ ἐς τὰ πλάγια ιαστρέμματα γίνεται· συναίτια δὲ καὶ τὰ σχήματα, ἐν οἷσιν ἂν καακέωνται· καὶ ἔχει προγνώσιας. [¶13] 38. The rule for the reduction and adjustment:—The axle, the lever, the wedge, pressure above; the axle to separate, the lever to push aside. Reduction and adjustment are to be accomplished by forcible extension, the parts being placed in such a position as will facilitate the conveying of the displaced bone over the extremity of the bone from which it was displaced: this is to be accomplished either with the hands, or by suspension, or axles, or turned round something. With the hands this is to be effected properly, according to the structure of the parts. In the case of the wrist and elbow, the parts are to be forced asunder, at the wrist in the line of the elbow, and the elbow with the fore-arm at a right angle with the arm, as when it is suspended in a sling. When we want to separate the protruding bones, and force them into place, in the case of the fingers, the toes, or the wrist, the proper separation may be made by hands, while the projecting part is forced into its place by pressing down with the heel or the palm of the hand upon some resisting object, while something moderately soft is laid under the projecting part, but nothing such under the other, and then pressure is to be made backward and downward, whether the dislocation be inward or outward. In lateral displacement, pressure and counter-pressure must be made on the opposite sides. Displacements forward can be reduced neither by sneezing, nor coughing, nor by the injection of air, nor by the cupping-instrument; and if anything can do good in such a case, it is extension. People are deceived in fractures of the spinal processes, the pain of which causing the patient to stoop forward, the case is taken for dislocation inward; these fractures heal speedily and easily. Dislocation outward is to be remedied by succussion, when high up, toward the feet; and when situated low down, in the contrary direction; the part is to be pressed back into its place, either with the foot or a board. Dislocations to either side, if they admit of any remedy, are to be treated by extension, and suitable attitudes, with regimen. The whole apparatus should be broad, soft, and strong; or otherwise, they should be wrapped in rags; before being used, they should all be prepared proportionately to the length, height, and breadth. In applying extension to the thigh, for example, the bands should be fastened at the ankle and above the knee, these stretching in the same direction, another band to be passed by the loins, and around the armpits, and by the perineum and thigh, one end passing up the breast and the other along the back, these all stretching in the same direction and being fastened either to a piece of wood resembling a pestle or to an axle. When this is done on a couch, either of its feet is to be fastened to the threshold, and a strong block of wood is to be laid across the other, and the pieces of wood resembling a pestle are to be raised on these, to make extension and counter-extension; the naves of a wheel are to be fastened in the floor, or a ladder is to be adjusted, so that extension may be made in both directions. The thing commonly used is a bench six cubits long, two cubits broad, one fathom in thickness, having two low axles at this end and that, and having at its middle two moderate sized pillars, to which is to be adjusted a transverse piece of wood like the step of a ladder, which is to receive the piece of wood tied below the limb, as is done in dislocation at the shoulder; and the bench is to have excavations like trays, smooth, four inches in breadth and depth, and at such an interval as to leave room for the lever used to reduce the limb. In the middle of the bench a square hole is to be scooped out to receive a small pillar, which, being adjusted to the perineum, will obviate the tendency of the body to slip downward, and being rather loose may act somewhat as a lever. In certain occasions a piece of wood is required, which is inserted into a hole scooped out of the wall; the other end of it is then to be pressed down, something moderately soft being placed under it. > Greek: 38. 38. Νόμα ἐμβολῆς καὶ διορθώσιος, ὄνος, μοχλὸς, σφηνίσκος, ἴπο ὄνος μὲν ἀπάγειν, μοχλὸς δὲ παράγειν. τὰ δὲ ἐμβλητέα ἢ δυρθωτέα διαναγκάσαι δεῖ ἐκτείνοντα, ἐν ᾧ ἂν ἕκαστα σχήματι μέλῃ ὑπεραιωρηθήσεσθαι· τὸ δʼ ἐκβὰν, ὑπὲρ τούτου ὅθεν ἐξέβη· τοῦτι δὲ, ἢ χερσὶν, ἢ κρεμασμῷ, ἢ ὄνοισιν, ἢ περί τι. χερσὶ μὲν ον ὀρθῶς κατὰ μέρεα· καρπὸν δὲ καὶ ἀγκῶνα ἀπόχρη διαναγκάζε, καρπὸν μὲν ἐς ἰθὺ ἀγκῶνος, ἀγκῶνα δὲ ἐγγώνιον πρὸς βροχίονα ἔχοντα, οἷον παρὰ τῷ βραχίονι τὸ ὑπὸ τὴν χεῖρα ὑποτεινόμεον. ἐν οἷσι δὲ δακτύλου ποδὸς, χειρὸς, καρποῦ, ὑβώματος τὸ ἴξω διαναγκάσαι δεῖ καὶ καταναγκάσαι, τὰ μὲν ἄλλα ὑπὸ χειῶν αἱ διαναγκάσεις ἱκαναὶ, καταναγκάσαι δὲ τὰ ὑπερέχοντα ἕδρην πτέρνῃ ἢ θέναρι ἐπί τινος· ὥστε κατὰ μὲν τὸ ἐξέχον ὑπκέεσθαι ὄγκον σύμμετρον μαλθακόν· κατὰ δὲ τὸ ἕτερον μὴ στοσαντα χρὴ ὠθέειν ὀπίσω καὶ κάτω, ἤν τε ἔσω, ἤν τε ἔξω ἐκπεπώκῃ· τὰ δʼ ἐκ πλαγίων, τὰ μὲν ἀπωθέειν, τὰ δὲ ἀντωθέειν ὀπίσο ἀμφότερα κατὰ τὸ ἕτερον. τὰ δὲ ὑβώματα, τὰ μὲν ἔσω οὔτε πταρμῷ, οὔτε βηχὶ, οὔτε φύσης ἐνέσει, οὔτε σικύῃ· εἰ δέ τι, ἡ κατάτασις. ἡ δὲ ἀπάτη, ὅτι οἴονταί ποτε καταγέντων σπονδύλων, καὶ τὰ λορδώματα διὰ τὴν ὀδύνην δοκέει ἔσω ὠλισθηκέναι· ταῦτα δὲ ταχύφυα καὶ ῥᾴδια. τὰ δὲ ἔξω, κατάσεισις, τὰ μὲν ἄνω ἐπὶ πόδας, τὰ δὲ κάτω τἀναντία· κατανάγκασις δὲ σὺν κατατάσει, ἢ ἕδρῃ, ἢ ποδὶ, ἢ σανίδι. τὰ δʼ ἔνθα ἢ ἔνθα, εἴ τι, ἡ κατάτασις, καὶ ἔτι τὰ σχήματα ἐν τῇ διαίτῃ. τὰ ἄρμενα πάντα εἶναι πλατέα, προσηνέα, ἰσχυρά· εἰ δὲ μὴ, δεῖ ῥάκεσι προκατειλίχθαι· ἐσκευάσθαι πρὶν ἢ ἐν τῇσιν ἀνάγκῃσι, πάντα συμμεμετρημένως τὰ μήκεα, καὶ ὕψεα, καὶ εὔρεα. διάτασις οἷον μηροῦ, τὸ παρὰ σφυρὸν δεδέσθαι, καὶ ἄνω τοῦ γούνατος, ταῦτα μὲν ἐς τὸ αὐτὸ τείνοντα· παρὰ δʼ ἰξύϊ, καὶ περὶ μασχάλας, καὶ κατὰ περίνεον, καὶ μηρὸν, τὰ μεταξὺ, τῆς ἀρχῆς τὸ μὲν ἐπὶ τὸ στῆθος, τὸ δʼ ἐπὶ νῶτον τείνοντα, ταῦτα δʼ ἐς τὸ αὐτὸ ἅπαντα τείνοντα, προσδεθέντα ἢ πρὸς ὑπεροειδέα, ἢ πρὸς ὄνον. ἐπὶ μὲν οὖν κλίνης ποιέοντι, τοῦτο μὲν τῶν ποδῶν πρὸς οὐδὸν χρὴ ἐρεῖσαι, πρὸς δὲ τὸ ἕτερον, ξύλον ἰσχυρὸν πλάγιον παραβεβλῆσθαι, τὰ δὲ ὕπερθεν ὑπεροειδέα πρὸς ταῦτα ἀντιστηρίζοντα διατείνειν, ἢ πλήμνας κατορύξαντα, ἢ κλίμακα διαθέντα, ἀμφωτέρωθεν ὠθέειν. τὸ δὲ κοινὸν, σανὶς ἑξάπηχυς, εὖρος δίπηχυς, πάχος σπιθαμῆς, ἔχουσα ὄνους δύο ταπεινοὺς ἔνθεν καὶ ἔνθεν, ἔχουσα δὲ καὶ κατὰ μέσον στυλίσκους ξυμμέτρους, ἐξ ὧν ὡς κλιμακτὴρ ἥρμοσται ἐς τὴν ὑπόστασιν τῷ ξύλῳ, ὥσπερ τῷ κατʼ ὦμον· καταγλύφους δὲ, ὥσπερ ληνοὺς, λείας ἔχειν, τετραδακτύλους εὖρος καὶ βάθος, καὶ διαλιπεῖν τοσοῦτον, ὅσον αὐτῇ τῇ μοχλεύσει ἐς διόρθωσιν· ἐν μέσῳ δὲ τετράγωνον καταγλυφὴν, ὥστε στυλίσκον ἐνεῖναι, ὃς παρὰ περίνεον ἐὼν περιῤῥέπειν τε κωλύσει, ἐών τε ὑποχάλαρος ὑπομοχλεύσει. χρὴ δὲ, τῆς σανίδος [ἢ] ἐν τῷ τοίχῳ [τὸ ἄκρον] καταγεγλυμμένον τι ἐχούσης, τοῦ ξύλου ὦσαι τὸ ἄκρον, ἐπὶ δὲ θάτερα καταναγκάζειν, ὑποτιθέντα μαλθακά τινα σύμμετρα. [¶14] 39. In those cases where the bone of the palate has exfoliated, the nose sinks in its middle. In contusions of the head without a wound, either from a fall, a fracture, or pressure, in certain of these cases acrid humors descend from the head to the throat, and from the wound in the head to the liver and thigh. > Greek: 39. 39. οἷσιν ὀστέον ἀπὸ ὑπερῴης ἀπῆλθε, μέση ἵζει ἡ ῥὶς τουτέοισιν. οἱ δὲ φλώμενοι κεφαλὰς ἄνευ ἕλκεος, ἢ πεσόντος, ἢ κατάξαντος, ἢ πιέσαντος, τουτέων ἐνίοισι τὰ δριμέα ἔρχεται ἀπὸ κεφαλῆς κατὰ τὰς φάρυγγας, καὶ ἀπὸ τρώματος ἐν τῇ κεφαλῇ, καὶ ἐς τὸ ἧπαρ, καὶ ἐς τὸν μηρόν. [¶15] 40. The symptoms of subluxations and luxations, and where, and how, and how much these differ from one another. And the cases in which the articular cavity has been broke off, and in which the ligament has been torn, and in which the epiphysis has broken in which, and how, when the limb consists of two bones, one or both are broken: in consequence of these the dangers, chances in which bad, and when the injuries will result in death, and when in recovery. What cases are to be reduced or attempted, and when, and which, and when not; the hopes and dangers in these cases. Which and when congenital dislocations are to be undertaken: the parts in a state of growth, the parts fully grown, and why sooner, or slower: and why a part becomes maimed, and how, and how not: and why a certain part is atrophied, and where, and how, and in what cases to a less extent. And why fractured parts unite sooner or slower, how distortions and callosities form, and the remedy for them. In what cases there are external wounds, either at first or afterwards: in what fractures the bones are shortened, and in what not: in what cases the fractured bones protrude, and when they protrude most: in what cases dislocated bones protrude. That physicians are deceived, and by what means, in what they see, and in what they devise, regarding affections, and regarding cures. Established rules with regard to bandaging: preparation, presentation of the part, extension, adjustment, friction, bandaging, suspension and placing of the limb, attitude, seasons, diet. The more porous parts heal fastest, and vice versa. Distortions, where the bones are crooked. Flesh and tendons wasted on the side of the dislocation. The force used in reduction to be applied at as great a distance as possible from the seat of the displacement. Of nerves (ligaments?), those which are in motion and in humidity (flabby?) are of a yielding nature; those that are not, less so. In every dislocation the most speedy reduction is best. Reduction not to be made while the patient is in a febrile state, nor on the fourth or fifth day; and least of all, in those of the elbow, and all cases which induce torpor; the soonest the best, provided the inflammatory stage be avoided. Parts torn asunder, whether nerves, or cartilages, or epiphyses, or parts separated at symphyses, cannot possibly be restored to their former state; but callus is quickly formed in most cases, yet the use of the limb is preserved. Of luxations, those nearest the extremities are least dangerous. Those joints which are most easily dislocated are the least subject to inflammation. Those which have been least inflamed, and have not been subjected to after-treatment, are most liable to be dislocated anew. Extension should be made in the position most calculated to enable the one bone to clear the extremity of the other, attention being paid to configuration and place. Adjustment to be made in the direction of the displacement; to push the displaced limb straight backward and sideways. Parts suddenly drawn aside are to be suddenly drawn back by a rotatory motion. Articulations which have been oftenest dislocated are the most easily reduced; the cause is the conformation of the nerves (ligaments?) or of the bones; of the ligaments that they are long and yielding; and of the bones, the shallowness of the articular cavity, and roundness of the head [of the bone that enters it]. Usage, by its friction, forms a new socket. The cause-the disposition, and habit, and age. A part somewhat mucous is not subject to inflammation. > Greek: 40. 40. Ση μεῖα παραλλαγμάτων καὶ ἐκπτωμάτων, καὶ ᾗ, καὶ ὅκως, καὶ ὅσον διαφέρει ταῦτα πρὸς ἄλληλα. καὶ οἷσιν ἡ κοτύλη παρέαγε, καὶ οἷσι νευρίον ἀπεσπάσθη, καὶ οἷσιν ἐπίφυσις ἀπέαγε, καὶ οἷσι, καὶ ὡς, καὶ ἓν ἢ δύο, ὧν δύο ἐστίν· ἐπὶ τουτέοισι κίνδυνοι, ἐλπίδες, οἷσι κακαὶ, καὶ ὅτε κακώσιες θανάτου, ὑγιείης ἀσφαλείης. καὶ ἃ ἐμβλητέα, ἢ χειριστέα, καὶ ὅτε, καὶ ἃ οὒ, ἢ ὅτε οὔ· ἐπὶ τουτέοισιν ἐλπίδες, κίνδυνοι. οἷα καὶ ὅτε χειριστέα καὶ τὰ ἐκ γενεῆς ἔξα ρθρα, τὰ αὐξανόμενα, τὰ ηὐξημένα, καὶ ὅ τι θᾶσσον, καὶ ὅ τι βραδύτερον, καὶ ὅ τι χωλὸν, καὶ ὡς, καὶ οὔ· καὶ διότι καὶ ὅ τι μινυθήσει, καὶ ᾗ, καὶ ὡς, καὶ οἷσιν ἧσσον. καὶ ὅτι τὰ καταγέντα θᾶσσον καὶ βραδύτερον φυόμενα, ᾗ αἱ διαστροφαὶ καὶ ἐπιπωρώσιες γίνονται, καὶ ἄκη τουτέων. οἷσιν ἕλκεα αὐτίκα ἢ ὕστερον γίνονται· οἷσι καὶ ὀστέα καταγεῖσι, μείω, οἷσιν οὔ· οἷσι καταγέντα ἐξέσχεν, καὶ ᾗ ἐξίσχει μᾶλλον· οἷσιν ἐκβάντα [ἢ] ἄρθρα ἐξίσχει. ἀπατῶνται, καὶ διʼ ἃ, ἐν οἷσιν ὁρῶσιν, ἐν οἷσι διανοεῦνται ἀμφὶ τὰ παθήματα, ἀμφὶ τὰ θεραπεύματα. νόμοισι τοῖσι νομίμοισι, περὶ ἐπιδέσιος· παρασκευὴ, πάρεξις, κατάτασις, διόρθωσις, ἀνάτριψις, ἐπίδεσις, ἀνάληψις, θέσις, σχῆμα, χρόνοι, δίαιται. τὰ χαυνότατα τάχιστα φύεται, τά δʼ ἐναντία ἐναντίως. διαστροφαὶ, ᾗ κυρτοί· ἄσαρκοι, ἄνευροι, ᾗ τὸ ἐκπεσόν. τὸ ἐμπεσὸν ὡς προσωτάτω ἔσται τοῦ χωρίου, οὗ ἐξέπεσεν. νεύρων, τὰ μὲν ἐν κινήσει καὶ ἐν πλάδῳ, ἐπιδοτικά· τὰ δὲ μὴ, ἧσσον. ἄριστον, ᾗ ἂν ἐκπέσῃ, εἰ ἐμπέσοι τάχιστα. Πυρεταίνοντι μὴ ἐμβάλλειν, μηδὲ τεταρταῖα, πεμπταῖα, ἥκιστα ἀγκῶνα, καὶ τὰ ναρκώδεα πάντα· ὡς τάχιστα ἄριστα, τὴν φλεγμονὴν παρέντα. τὰ ἀποσπώμενα, ἢ νεῦρα, ἢ χόνδρια, ἢ ἐπιφύσιες, ἢ διιστάμενα κατὰ συμφύσεις, ἀδύνατα ὁμοιωθῆναι· διαπωροῦται ταχέως τοῖσι πλείστοισιν· ἡ δὲ χρῆσις σώζεται. ἐκβάντων, τὰ ἔσχατα, ῥᾷον. τὰ ῥᾷστα ἐκπεσόντα ἥκιστα φλεγμαίνει· τὰ δὲ ἥκιστα θερμαίνοντα, καὶ μὴ ἐπιθεραπευθέντα, μάλιστα αὖθις ἐκπίπτει. κατατείνειν ἐν σχήματι τοιουτέῳ, ἐν ᾧ μάλιστα ὑπεραιωρηθήσεται, σκεπτόμενον ἐς τὴν φύσιν καὶ τὸν τόπον. ᾗ ἐξέβη, διόρθωσις· ὀπίσω ἐς ὀρθὸν καὶ ἐς πλάγιον παρωθεῖν· τὰ δὲ ταχέως ἀντισπάσαντα ἀντισπάσαι ταχέως ἤδη ἐκ περιαγωγῆς. τὰ πλειστάκις ἐκπίπτοντα ῥᾷον ἐμπίπτει· αἴτιον φύσις, ἢ νεύρων, ἢ ὀστέων, νεύρων μὲν, μῆκος ἢ ἐπίδοσις, ὀστέων δὲ, κοτύλης ὁμαλότης, κεφαλῆς φαλακρότης· τὸ ἔθος τρίβον ποιέει· αἰτίη, καὶ σχέσις, καὶ ἕξις, καὶ ἡλικίη. τὸ ὑπόμυξον, ἀφλέγμαντον. [¶16] 41. In those cases where there are wounds, either at first, or from protrusion of the bones; or afterwards, from pruritus, or irritation; in the latter case you are immediately to unloose the bandages, and having applied pitched cerate to the wound, bandage the limb, placing the head of the roller upon the wound, and proceeding otherwise as if there were no wound in the case; for thus will the swelling be reduced as much as possible, and the wound will suppurate most quickly, and the diseased parts will separate, and when it becomes clean the wound will most quickly heal. Splints are not to be applied to the place, nor is it to be bound tight. Proceed thus when no large bones exfoliate, but not in the latter case, for then there is great suppuration, and the same treatment is not applicable, but the parts require to be exposed to the air on account of the abscesses. In such cases where the bones protrude, and whether reduced or not, bandaging is not befitting, but distention is to be practiced by means of rolls of cloth, made like those used upon shackles; one of these is to be placed at the ankle, and the other at the knee; they are to be flattened toward the leg, soft, strong, and having rings; and rods made of cornel, and of a proper length and thickness are to be adjusted to them, so as to keep the parts distended; and straps, attached to both extremities, are to be inserted into the rings, so that the extremities being fixed into the rolls, may effect distention. Treatment:—Pitched cerate, in a hot state; the attitudes, position of the foot and hip; regulated diet. The bones which have protruded through the skin are to be replaced the same day, or next; not on the fourth or fifth, but when the swelling has subsided. Reduction is to be performed with levers; when the bone does not present any place upon which the lever can rest, a portion of the part which prevents this is to be sawed off. But the denuded parts will drop off, and the limb become shortened. > Greek: 41. 41. οἷσιν ἕλκεα ἐγένετο, ἢ αὐτίκα, ἢ ὀστέων ἐξισχόντων, ἢ ἔπειτα, ἢ κνησμῶν, ἢ τρηχυσμῶν, ταῦτα μὲν ἢν αἰσθῇ, εὐθέως σας, πισσηρὴν ἐπὶ τὸ ἕλκος ἐπιθεὶς, ἐπιδεῖν ὡς ἐπὶ τὸ ἕλκος πρῶτον τὴν ἀρχὴν βαλλόμενος, καὶ τἄλλα ὡς οὐ ταύτῃ τοῦ σίνεος ἐόντος· οὕτω γὰρ αὐτό τε ἰσχνότατον, καὶ ἐκπυήσει τάχιστα, καὶ περιῤῥήξεται, καὶ καθαρθέντα τάχιστα φύσεται νάρθηκας δὲ μήτε κατʼ αὐτὸ τοῦτο προσάγειν, μήτε πιέζειν· καὶ ὧν ὀστέα μὴ μεγάλα ἄπεισιν, οὕτω ποιέειν· ὧν δὲ μεγάλα, οὔ· πολλὴ γὰρ ἐμπύησις, καὶ ταῦτʼ οὐκ ἔτι οὕτως, ἀλλʼ ἀνέψυκται τῶν ὑποστασίων εἵνεκα. τὰ δὲ τοιαῦτα ὁπόσα ἐξέσχε, καὶ, εἴ τε ἐμβληθῇ, εἴ τε μὴ, ἐπίδεσις μὲν οὐκ ἐπιτήδειον, διάτασις δὲ, σφαῖραι ποιηθεῖσαι, οἷαι πέδαις, ἡ μὲν παρὰ σφυρὸν, ἡ δὲ παρὰ γόνυ, ἐς κνήμην πλατεῖαι, προσηνέες, ἰσχυραὶ, κρίκους ἔχουσαι· ῥάβδοι τε σύμμετροι κρανίης καὶ μῆκος καὶ πάχος, ὥστε διατείνειν· ἱμάντια δὲ ἐξ ἄκρων ἀμφοτέρωθεν ἔχοντα εἰς τοὺς κρίκους ἐνδεδέσθαι, ὡς τὰ ἄκρα ἐς τὰς σφαίρας ἐνστηριζόμενα διαναγκάζῃ. ἴησις δὲ, πισσηρὴ θερμή· σχήματα, καὶ ποδὸς. θέσις καὶ ἰσχίου· δίαιτα ἀτρεκής. ἐμβάλλειν τὰ ὀστέα τὰ ὑπερίσχοντα αὐθήμερα, ἢ δευτεραῖα, τεταρταῖα δὲ ἢ πεμπταῖα, μὴ, ἀλλʼ ἐπὴν ἰσχνὰ ᾖ. ἡ δʼ ἐμβολὴ τοῖσι μοχλικοῖσιν· ἢ τὸ ἐμβαλλόμενον τοῦ ὀστέου, ἢν μὴ ἔχῃ ἀποστήριξιν, ἀποπρῖσαι τῶν κωλυόντων. ἀτὰρ καὶ ὡς τὰ ψιλωθέντα ἀποπεσεῖται, καὶ βραχύτερα τὰ μέλεα. [¶17] 42. Dislocations at the joints are to a greater and less extent. Those that are to a less extent are the most easily reduced; those that are to a greater extent occasion lesions of the bones, of the ligaments, of the joints, of the fleshy parts, and of the attitudes. The thigh and arm resemble one another very much in their dislocations. > Greek: 42. 42. τὰ δὲ ἄρθρα, τὰ μὲν πλέον, τὰ δὲ μεῖον ὀλισθάνει· καὶ τὰ μὲν μεῖον, ἐμβαλεῖν ῥᾴδιον· τὰ δὲ πλέον μέζους ποιεῖ τὰς κακώσιας καὶ ὀστέων, καὶ νεύρων, καὶ ἄρθρων, καὶ σαρκῶν, καὶ σχημάτων. μηρὸς δὲ καὶ βραχίων ὁμοιότατα ἐκπίπτουσιν.