---
title: "On Fractures · Περὶ ἀγμῶν"
author: "Hippocrates"
translator: "Francis Adams"
languages: [grc, en]
shelf: "Classical Greek"
section: 1 of 3
url: https://scriptura.si/works/hippocrates-on-fractures/1/
cite: "Hippocrates, tr. Francis Adams, On Fractures · Περὶ ἀγμῶν, section 1. Scriptura (scriptura.si), https://scriptura.si/works/hippocrates-on-fractures/1/"
---

# On Fractures · Περὶ ἀγμῶν

*Hippocrates, tr. Francis Adams*

Setting broken bones.

> Greek: ed. Émile Littré, from the Perseus Digital Library (canonical-greekLit, tlg0627.tlg009, CC BY-SA 4.0).

> English: Francis Adams, from the Perseus Digital Library (tlg0627.tlg009.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.

## 1. Sections 2–13

Source: https://scriptura.si/works/hippocrates-on-fractures/1/ · cite a paragraph as https://scriptura.si/works/hippocrates-on-fractures/1/#p-N

[¶0] In treating fractures and dislocations, the physician must make the extension as straight as possible, for this is the most natural direction. But if it incline to either side, it should rather turn to that of pronation, for there is thus less harm than if it be toward supination. Those, then, who act in such cases without deliberation, for the most part do not fall into any great mistake, for the person who is to have his arm bound, presents it in the proper position from necessity, but physicians who fancy themselves learned in these matters, are they who commit blunders. There is no necessity for much study, then, in order to set a broken arm, and in a word, any ordinary physician can perform it; but I am under the necessity of giving the longer directions on this subject, because I know physicians who have the reputation of being skilled in giving the proper positions to the arm in binding it up, while in reality they are only showing their own ignorance. But many other things in our art are judged of in this manner, for people rather admire what is new, although they do not know whether it be proper or not, than what they are accustomed to, and know already to be proper; and what is strange, they prefer to what is obvious. I must now state what the mistakes of medical men are, which I wish to unteach, and what instructions I have to give as to the management of the arm; for what I have to say regarding it, will apply to the other bones in the body.

> Greek: ΠΕΡΙ ΑΓΜΩΝ. 1. ἐχρῆν τὸν ἰητρὸν τῶν ἐκπτωσίων τε καὶ κατηγμάτων ὡς ἰθυτάτας τὰς κατατάσιας ποιέεσθαι· αὕτη γὰρ ἡ δικαιοτάτη φύσις. ἢν δέ τι ἐγκλίνῃ ἢ τῇ ἢ τῇ, ἐπὶ τὸ πρηνὲς ῤέπειν· ἐλάσσων γὰρ ἡ ἁμαρτὰς ἢ ἐπὶ τὸ ὕπτιον. οἱ μὲν οὖν μηδὲν προβουλεύσαντες οὐδὲν ἐξαμαρτάνουσιν ὡς ἐπὶ τὸ πουλύ· αὐτὸς γὰρ ὁ ἐπιδεόμενος τὴν χεῖρα ἀπορέγει, οὕτως ὑπὸ τῆς δικαίης φύσιος ἀναγκαζόμενος· οἱ δὲ ἰητροὶ σοφιζόμενοι δῆθεν ἐστὶν οἳ ἁμαρτάνουσιν. σπουδὴ μὲν οὐ πολλὴ χεῖρα κατεαγυῖαν χειρίσαι, καὶ παντὸς δὲ ἰητροῦ, ὡς ἔπος εἰπεῖν· ἀναγκάζομαι δʼ ἐγὼ πλείω γράφειν περὶ αὐτέου, ὅτι οἶδα ἰητροὺς σοφοὺς δόξαντας εἶναι ἀπὸ σχημάτων χειρὸς εν ἐπιδέσει, ἀφʼ ὧν ἀμαθέας αὐτέους ἐχρῆν δοκέειν εἶναι. ἄλλα γὰρ πολλὰ οὕτω ταύτης τῆς τέχνης κρίνεται· τὸ γὰρ ξενοπρεπὲς οὔπω ξυνιέντες εἰ χρηστὸν, μᾶλλον ἐπαινέουσιν, ἢ τὸ ξύνηθες, ὃ ἤδη οἴδασιν ὅτι χρηστὸν, καὶ τὸ ἀλλόκοτον, ἢ τὸ εὔδηλον. ῥητέον οὖν ὁκόσας ἐθέλω τῶν ἁμαρτάδων τῶν ἰητρῶν, τὰς μὲν ἀποδιδάξαι, τὰς δὲ διδάξαι περὶ τῆς φύσιος τῆς χειρός· καὶ γὰρ ἄλλων ὀστέων τῶν κατὰ τὸ σῶμα δίδαγμα ὅδε ὁ λόγος ἐστίν.

[¶1] 2. The arm, then, for that is the subject we were treating of, was presented in the prone position to be bound, but the physician forced his patient to hold it as the archers do when they project the shoulder, and in this position he bound it up, thinking within himself that he was acting according to Nature, and in proof of this he pointed out that all the bones in the fore-arm were thus in a straight line, and that the integuments both inside and outside, were also in a straight line, and that the flesh and nerves (tendons?) were thus put in their natural position, and he appealed to what happens in archery, as a proof of this. And so saying, and so doing, he is looked up to as a sage; and yet he forgets that in all the other arts and performances, whether executed by strength or dexterity, what is reckoned the natural position is not the same, and that in the same piece of work it may happen that the natural position of the right arm is not the same as that of the left. For there is one attitude in throwing the javelin, and another in slinging, another in casting stones, another in boxing, and another in a state of repose. And whatever arts one examines, it will be found that the natural position of the arms is not the same in each, but that in every case the arms are put into the attitude which suits best with the instrument that is used, and the work to be performed. In practicing archery, no doubt this is the best attitude of the left arm, for gingly-moid extremity of the humerus being fixed in the cavity of the ulna, in this position, throws the bones of the forearm and arm into a line, as if they constituted a single bone, and all flexion at the joint is prevented in this position. It is no doubt certain that the member is thus put into the most unbending and extended position possible, so as not to be overcome or yield when the string is drawn by the right arm, and thus will the archer be enabled to draw the string farthest, and discharge his arrow with the greatest force and rapidity, for arrows thus discharged have the greatest swiftness and force, and are carried to the greatest distances. But there is nothing in common between the binding up of an arm and archery. Moreover, if having thus bound up the arm, the physician direct the patient to keep it thus, he will occasion him greater pain than he had from the wound itself; and thus also, if the physician order him to bend the arm, neither the bones, the nerves, nor the flesh will any longer be in the same condition, but will be arranged differently, having overcome the bandaging. What use, then, is there of the archer’s attitude? And these mistakes, the physician, conceited in his knowledge, would probably not have committed if he had allowed the patient himself to present his arm.

> Greek: 2. 2. τὴν μὲν οὖν χεῖρα, περὶ οὗ ὁ λόγος, ἔδωκέ τις ἐπιδῆσαι, πρηνέα ποιήσας· ὁ δʼ ἠνάγκαζεν οὕτως ἔχειν, ὥς περ οἱ τοξεύοντες, ἐπὴν τὸν ὦμον ἐμβάλλωσι, καὶ οὕτως ἔχουσαν ἐπέδει, νομίζων ἑωυτῷ εἶναι τοῦτο αὐτέῃ τὸ κατὰ φύσιν· καὶ μαρτύριον ἐπήγετο τά τε ὀστέα ἅπαντα τὰ ἐν τῷ πήχει, ὅτι ἰθυωρίην κατάλληλα εἶχε, τήν τε ὁμοχροίην, ὅτι αὐτὴ καθʼ ἑωυτὴν τὴν ἰθυωρίην ἔχει οὕτω καὶ ἐκ τοῦ ἔξωθεν μέρεος καὶ ἐκ τοῦ ἔσωθεν· οὕτω δὲ ἔφη καὶ τὰς σάρκας καὶ τὰ νεῦρα πεφυκέναι, καὶ τὴν τοξικὴν ἐπήγετο μαρτύριον. ταῦτα λέγων καὶ ταῦτα ποιέων, σοφὸς ἐδόκεεν εἶναι· τῶν δὲ ἄλλων τεχνέων ἐπελελήθει, καὶ ὁκόσα ἰσχύϊ ἐργάζονται, καὶ ὁκόσα τεχνήμασιν, οὐκ εἰδὼς ὅτι ἄλλο ἐν ἄλλῳ τὸ κατὰ φύσιν σχῆμά ἐστιν, καὶ ἐν τῷ αὐτέῳ ἔργῳ ἕτερα τῆς δεξιῆς χειρὸς σχήματα κατὰ φύσιν ἐστὶ, καὶ ἕτερα τῆς ἀριστερῆς, ἢν οὕτω τύχῃ. ἄλλο μὲν γὰρ σχῆμα ἐν ἀκοντισμῷ κατὰ φύσιν, ἄλλο δὲ ἐν σφενδονήσει, ἄλλο δὲ ἐν λιθοβολίῃσιν, ἄλλο ἐν πυγμῇ, ἄλλο ἐν τῷ ἐλινύειν. ὁκόσας δʼ ἄν τις τέχνας εὕροι, ἐννοέοι οὐ τὸ αὐτὸ σχῆμα τῶν χειρέων κατὰ φύσιν εἶναι ἐν ἑκάστῃ τῶν τεχνέων· ἀλλὰ πρὸς τὸ ἄρμενον ὃ ἂν ἔχῃ ἕκαστος, καὶ πρὸς τὸ ἔργον ὃ ἂν ἐπιτελέσασθαι θέλῃ, σχηματίζονται αἱ χεῖρες. τοξικὴν δὲ ἀσκέοντι εἰκὸς τοῦτο τὸ σχῆμα κράτιστον εἶναι τῆς ἑτέρης χειρός· τοῦ γὰρ βραχίονος τὸ γιγγλυμοειδὲς, ἐν τῇ τοῦ πήχεος βαθμίδι ἐν τουτέῳ τῷ σχήματι ἐρεῖδον, ἰθυωρίην ποιέει τοῖσιν ὀστέοισι τοῦ πήχεος καὶ τοῦ βραχίονος, ὡς εἰ ἓν εἴη τὸ πᾶν· καὶ ἡ ἀνάκλασις τοῦ ἄρθρου κέκλασται ἐν τουτέῳ τῷ σχήματι. εἰκὸς μὲν οὖν οὕτως ἀκαμπτότατόν τε καὶ τετανώτατον εἶναι τὸ χωρίον, καὶ μὴ ἡσσᾶσθαι, μηδὲ ξυνδιδόναι, ἑλκομένης τῆς νευρῆς ὑπὸ τῆς δεξιῆς χειρός· καὶ οὕτως ἐπὶ πλεῖστον μὲν τὴν νευρὴν ἑλκύσει, ἀφήσει δὲ ἀπὸ στερεωτάτου καὶ ἀθροωτάτου· ἀπὸ τῶν τοιουτέων γὰρ ἀφεσίων τῶν τοξευμάτων, ταχεῖαι καὶ αἱ ἰσχύες καὶ τὰ μήκεα γίνονται. ἐπιδέσει δὲ καὶ τοξικῇ οὐδὲν κοινόν. τοῦτο μὲν γὰρ, εἰ ἐπιδήσας ἔχειν τὴν χεῖρα οὕτως ἐκέλευε, πόνους ἂν ἄλλους πολλοὺς προσετίθει μείζονας τοῦ τρώματος· τοῦτο δʼ, εἰ ξυγκάμψαι ἐκέλευεν, οὔτε τὰ ὀστέα, οὔτε τὰ νεῦρα, οὔτε αἱ σάρκες ἔτι ἐν τῷ αὐτέῳ ἐγίνοντο, ἀλλὰ ἄλλῃ μετεκοσμεῖτο, κρατέοντα τὴν ἐπίδεσιν· καὶ τί ὄφελός ἐστι τοξικοῦ σχήματος; καὶ ταῦτα ἴσως οὐκ ἂν ἐξημάρτανε σοφιζόμενος, εἰ εἴα τὸν τετρωμένον αὐτὸν τὴν χεῖρα παρασχέσθαι.

[¶2] 3. But another physician putting the arm into the state of supination, gives orders to extend the arm thus, and bandages it in this position, reckoning it the one according to nature, judging thus from the skin, and also fancying the bones to be thus in their natural position, because the bone which protrudes at the wrist, where the little finger is, appears to be in a line with the bone from which people measure the bone of the fore-arm. These things he brings forward as proofs that the parts are in their natural state, and he is supposed to speak correctly. But, indeed, if the arm be kept stretched in a supine position, it will become very painful, and this fact any one may ascertain by extending his own arm in this attitude. And also a weaker man grasping with his hands a stronger man whose arm is turned in a supine position, could lead him wherever he chose, and neither, if a man held a sword thus in his hand, could he make any proper use of it, so constrained is this position. And, moreover, if, when a physician has thus bound up the arm, he allow it to remain in the same position, the patient will endure greater pain if he walk about, but considerable, even if he remain at rest. And thus, too, if he shall bend the arm, the muscles and the bones must necessarily assume a different position. But, in addition to other mischief, he is ignorant of these facts regarding the position, that the bone which protrudes at the wrist, close to the little finger, belongs to the fore-arm, whereas the one at the joint, from which people measure the fore-arm, is the head of the humerus. He fancies that both these belong to the same bone, and many others are of this opinion. The latter, in fact, is the same part as that which is called the elbow, upon which we sometimes rest, and when he holds the arm thus in a supine position, in the first place the bone appears distorted, and in the next place the tendons which extend from the carpus along the inner side and from the fingers become distorted while the arm has a supine position; for these tendons proceed to the bone of the humerus, from which the fore-arm is measured. Such, and so many mistakes and marks of ignorance are committed, regarding the natural construction of the arm. But if one will extend a broken arm as I direct, he will turn the bone, situated at the extremity of the little finger, into the straight line, and also the one at the elbow, and the tendons which stretch from the carpus to the extremity of the humerus will be placed in the straight line; and when the arm is suspended in a sling, it will be in the same attitude as that in which it was bound up, and will give no pain to the patient when he walks about, nor when he lies reclined, and will not become fatigued. The man should be so seated that the prominent part of the bone may be turned to the brightest light which is at hand, so that the operator in making the extension, may be at no loss to discover if it be sufficiently straight. The prominence of a broken bone could not escape being detected by the hand of an experienced person, when applied for this purpose, and, moreover, the projecting part is particularly painful to the touch.

> Greek: 3. 3. ἄλλος δʼ αὖ τις τῶν ἰητρῶν ὑπτίην τὴν χεῖρα δοὺς, οὕτω κατατείνειν ἐκέλευε, καὶ οὕτως ἔχουσαν ἐπέδει, τοῦτο νομίζων τὸ κατὰ φύσιν εἶναι, τῷ τε χροϊ σημαινόμενος, καὶ τὰ ὀστέα νομίζων κατὰ φύσιν εἶναι οὕτως, ὅτι φαίνεται τὸ ἐξέχον ὀστέον τὸ παρὰ τὸν καρπὸν, ἧ ὁ σμικρὸς δάκτυλος, κατʼ ἰθυωρίην εἶναι τοῦ ὀστέου ἀφʼ ὁτέου τὸν πῆχυν οἱ ἄνθρωποι μετρέουσιν. ταῦτα τὰ μαρτύρια ἐπήγετο, ὅτι κατὰ φύσιν οὕτως ἔχει, καὶ ἐδόκεεν εὖ λέγειν. ἀλλὰ τοῦτο μὲν, εἰ ὑπτίη ἡ χεὶρ κατατείνοιτο, ἰσχυρῶς πονοίη ἄν· γνοίη δʼ ἄν τις τὴν ἑωυτοῦ χεῖρα κατατείνας, ὡς ἐπώδυνον τὸ σχῆμα. ἐπεὶ καὶ ἀνὴρ ἥσσων κρέσσονα διαλαβὼν οὕτως εὖ τῇσιν ἑωυτοῦ χερσὶν, ὡς κλᾶται ὁ ἄγκων ὕπτιος, ἄγοι ἂν ὅπῃ ἐθέλοι· οὔτε γὰρ εἰ ξίφος ἐν ταύτῃ τῇ χειρὶ ἔχοι, ἔχοι ἂν ὅ τι χρήσαιτο τῷ ξίφει, οὕτω βίαιον τοῦτο τὸ σχῆμά ἐστιν. τοῦτο δὲ, εἰ ἐπιδήσας τις ἐν τουτέῳ τῷ σχήματι ἐῴη, μέζων μὲν πόνος, εἰ περιιοι, μέγας δὲ καὶ εἰ κατακέοιτο. τοῦτο δὲ, εἰ ξυγκάμψει τὴν χεῖρα, ἀνάγκη πᾶσα τούς τε μύας καὶ τὰ ὀστέα ἄλλο σχῆμα ἔχειν. ἠγνόει δὲ καὶ τάδε τὰ ἐν τῷ σχήματι χωρὶς τῆς ἄλλης λύμης· τὸ γὰρ ὀστέον τὸ παρὰ τὸν καρπὸν ἐξέχον, τὸ κατὰ τὸν σμικρὸν δάκτυλον, τοῦτο μὲν τοῦ πήχεός ἐστιν· τὸ δʼ ἐν τῆ ξυγκάμψει ἐὸν, ἀπʼ ὅτευ τὸν πῆχυν οἱ ἄνθρωποι μετρέουσι, τοῦτο δὴ τοῦ βραχίονος ἡ κεφαλή ἐστιν. ὁ δὲ ᾤετο τωὐτὸ ὀστέον εἶναι τοῦτό τε κακεῖνο, πολλοὶ δὲ καὶ ἄλλοι· ἔστι δʼ ἐκείνῳ τῷ ὀστέῳ τωὐτὸ ὁ ἄγκων καλεόμενος, ᾧ ποτὶ στηριζόμεθα. οὕτως οὖν ὑπτίην ἔχοντι τὴν χεῖρα, τοῦτο μὲν, τὸ ὀστέον διεστραμμένον φαίνεται· τοῦτο δὲ, τὰ νεῦρα τὰ ἀπὸ τοῦ καρποῦ τείνοντα ἐκ τοῦ εἴσω μέρεος καὶ ἀπὸ τῶν δακτύλων, ταῦτα ὑπτίην ἔχοντι τὴν χεῖρα διεστραμμένα γίνεται· τείνει τε γὰρ ταῦτα τὰ νεῦρα πρὸς τὸ τοῦ βραχίονος ὀστέον, ὅθεν ὁ πῆχυς μετρεῖται. αὗται τοσαῦται καὶ τοιαῦται αἱ ἁμαρτάδες καὶ ἄγνοιαι τῆς φύσιος τῆς χειρός. εἰ δʼ, ὡς ἐγὼ κελεύω, χεῖρα κατεαγυῖαν κατατείνοι τις, ἐπιστρέψει μὲν τὸ ὀστέον ἐς ἰθὺ, τὸ κατὰ τὸν σμικρὸν δάκτυλον, τὸ ἐς τὸν ἀγκῶνα τεῖνον, ἰθυωρίην δὲ ἕξει τὰ νεῦρα τὰ ἀπὸ τοῦ καρποῦ πρὸς τοῦ βραχίονος τὰ ἄκρα τείνοντα· ἀναλαμβανομένη δὲ ἡ χεὶρ ἐν παραπλησίῳ σχήματι ἔσται, ἐν ᾧ περ καὶ ἐπιδεομένη, ἄπονος μὲν ὁδοιπορέοντι, ἄπονος δὲ κατακειμένῳ καὶ ἀκάματος. Καθίννυσθαι δὲ χρὴ τὸν ἄνθρωπον οὕτως, ὅκως ᾖ τὸ ἐξέχον τοῦ ὀστέου πρὸς τὴν λαμπροτάτην τῶν παρεουσέων αὐγέων, ὡς μὴ λάθῃ τὸν χειρίζοντα ἐν τῇ κατατάσει, εἰ ἱκανῶς ἐξίθυνται. τοῦ γε μὴν ἐμπείρου οὐδʼ ἂν τὴν χεῖρα λάθοι ἐπαγομένην τὸ ἐξέχον· ἀτὰρ καὶ ἀλγέει μάλιστα κατὰ τὸ ἐξέχον ψαυόμενον.

[¶3] 4. In cases of fracture in either of the bones of the forearm, it is easier to effect a cure if the upper bone be broken, although it be the thicker one, both because the sound bone is situated below, and forms a support to it, and because the deformity is more easily concealed, there being a thick mass of flesh on the upper side, except near to the wrist. But the lower bone is without a covering of flesh, is not easily concealed, and requires stronger extension. If it is not this bone, but the other which is broken, a more feeble extension proves sufficient, but if both be broken, a more powerful extension is required. In the case of a young person I have known the extension made more strong than was necessary, but in general the extension made is less than what is required. And when they are extended, the physician should apply the palms of the hands, and adjust the fractured parts and then having rubbed the parts with cerate, but not in large quantity so that the bandages may not come off, it is to be bound up in this state, care being taken that the hand be not lower than the elbow, but a little higher, so that the blood do not flow toward the extremity, but may be determined to the upper part; and then it is to be secured with the bandage, the head of which is to be placed at the fracture, and the bandage should impart firmness to the parts without occasioning strong compression. When you have carried the bandage twice or thrice round at the seat of the fracture, it is to be carried upward, so that the afflux of blood into it may be stopped, and the bandage should terminate there, and the first bandages ought not to be long. The head of the second bandage is also to be placed upon the seat of the fracture, and a single round of it being made there, it is then to be carried downward, and is not to be applied so tight as the other, and there should be greater distances between the turns, so that the bandage may prove sufficient to revert to the spot where the other terminated. The bandages may be rolled to the left hand or to the right, or to whatever side suits best with the position of the fractured arm, or according to the inclination which it may have. Afterward we must place along the arm, compresses, smeared with a little cerate, for thus they occasion less uneasiness, and are more easily arranged. And then we must apply the bandages crossways, sometimes to the right hand, and sometimes to the left, for the most part beginning below and terminating above, but sometimes commencing above and ending below. The parts which are thinly covered with flesh should be wrapped round with compresses, and inequalities should be made up, not by a number of folds at once, but by degrees. Some slack turns are also to be made around the wrist, to this side and to that. These two bandages are sufficient at first.

> Greek: 4. 4. τῶν δὲ ὀστέων τοῦ πήχεος, ὧν μὴ ἀμφότερα κατέηγε, ῤᾴων ἡ ἴησις, ἢν τὸ ἄνω ὀστέον τετρωμένον ἔῃ, καί περ παχύτερον ἐόν· ἅμα μὲν ὅτι τὸ ὑγιὲς ὑποτεταμένον γίνεται ἀντὶ θεμελίου, ἅμα δʼ ὅτι εὐκρυπτότερον γίνεται, πλὴν εἰ τὸ ἐγγὺς τοῦ καρποῦ· παχείη γὰρ ἡ τῆς σαρκὸς ἐπίφυσις ἡ ἐπὶ τὸ ἄνω. τὸ δὲ κάτω ὀστέον ἄσαρκον, καὶ οὐκ εὐξύγκρυπτον, καὶ κατατάσιος ἰσχυροτέρης δέεται. ἢν δὲ μὴ τοῦτο ξυντριβῇ, ἀλλὰ τὸ ἕτερον, φαυλοτέρη ἡ κατάτασις ἀρκέει· ἢν δὲ ἀμφότερα κατεηγῇ, ἰσχυροτάτης κατατάσιος δεῖται· παιδίου μὲν γὰρ ἤδη εἶδον καταταθέντα μᾶλλον ἢ ὡς ἔδει, οἱ δὲ πλεῖστοι ἧσσον τείνονται ἢ ὡς δεῖ. χρὴ δʼ, ἐπὴν τείνωσι, τὰ θέναρα προσβάλλοντα διορθοῦν· ἔπειτα χρίσαντα κηρωτῇ μὴ πάνυ πουλλῇ, ὡς μὴ περιπλέῃ τὰ ἐπιδέσματα, οὕτως ἐπιδεῖν, ὅκως μὴ κατωτέρω ἄκρην τὴν χεῖρα ἕξει τοῦ ἀγκῶνος, ἀλλὰ σμικρῷ τινι ἀνωτέρω, ὡς μὴ τὸ αἷμα ἐς ἄκρον ἐπιῤῥέῃ, ἀλλὰ ἀπολαμβάνηται· ἔπειτα ἐπιδεῖν τῷ ὀθονίῳ, τὴν ἀρχὴν βαλλόμενος κατὰ τὸ κάτηγμα· ἐρείδων μὲν οὖν, μὴ πιέζων δὲ κάρτα. ἐπὴν δὲ περιβάλλῃ κατὰ τωὐτὸ δὶς ἢ τρὶς, ἐπὶ τὸ ἄνω νεμέσθω ἐπιδέων, ἵνα αἱ ἐπιῤῥοαὶ τοῦ αἵματος ἀπολαμβάνωνται, καὶ τελευτησάτω κεῖθι· χρὴ δὲ μὴ μακρὰ εἶναι τὰ πρῶτα ὀθόνια. τῶν δὲ δευτέρων ὀθονίων, τὴν μὲν ἀρχὴν βάλλεσθαι ἐπὶ τὸ κάτηγμα· περιβαλὼν δὲ ἅπαξ ἐς τωὐτὸ, ἔπειτα νεμέσθω ἐς τὸ κάτω, καὶ ἐπὶ ἧσσον πιέζων, καὶ ἐπὶ μέζον διαβιβάσκων, ὡς ἂν αὐτὸ ἱκανὸν γένηται τὸ ὀθόνιον ἀναπαλινδρομῆσαι κεῖθι, ἵνα περ τὸ ἕτερον ἐτελεύτησεν. ἐνταῦθα μὲν οὖν τὰ ὀθόνια ἐπʼ ἀριστερὰ ἢ ἐπὶ δεξιὰ ἐπιδεδέσθω ἢ ἐπὶ ὁκότερα ἂν ξυμφέρῃ πρὸς τὸ σχῆμα τοῦ κατεηγότος, καὶ ἐφʼ ὁκότερα ἂν περιῤῥέπειν ξυμφέρῃ. μετὰ δὲ ταῦτα, σπλῆνας κατατείνειν χρὴ κεχρισμένους κηρωτῇ ὀλίγῃ· καὶ γὰρ προσηνέστερον καὶ εὐθετώτερον· ἔπειτα οὕτως ἐπιδεῖν τοῖσιν ὀθονίοισιν ὡς ἐναλλὰξ, ὁτὲ μὲν ἐπὶ δεξιὰ, ὁτὲ δὲ ἐπʼ ἀριστερά· καὶ τὰ μὲν πλείω κάτωθεν ἀρχόμενος, ἐς τὸ ἄνω ἄγειν, ἔστι δʼ ὅτε καὶ ἄνωθεν ἐς τὸ κάτω. τὰ δὲ ὑπόξηρα ἀκέεσθαι τοῖσι σπλήνεσι κυκλεῦντα· τῷ δὲ πλήθει τῶν. περιβολέων μὴ πᾶν ἀθρόον ξυνδιορθοῦντα, ἀλλὰ κατὰ μέρος· περιβάλλειν δὲ χρὴ χαλαρὰ καὶ περὶ τὸν καρπὸν τῆς χειρὸς, ἄλλοτε καὶ ἄλλοτε. πλῆθος δὲ τῶν ὀθονίων ἱκανὸν τὸ πρῶτον, αἱ δύο μοῖραι.

[¶4] 5. And these are the signs that the patient has been well treated and properly bandaged: if you ask him if the arm feels tight, and he says it does, but moderately so, and especially about the fracture; and this reply he should make all along, if the bandage be properly applied. And these are symptoms of the bandaging being moderately tight; if for the first day and night he fancies that the tightness does not diminish, but rather increases; and if on the next day there be a soft swelling in the hand, for this is a sign of moderate compression, but at the end of the second day the compression should feel less, and on the third day the bandaging should appear loose. And if any of these symptoms be wanting, you may conclude that the bandaging is slacker than it should be; or if any of these symptoms be in excess, you may infer that the compression is more than moderate; and judging from these, you will apply the next bandages either slacker or tighter. Having removed the bandages on the third day, you must make extension and adjust the fracture, and bind it up again; and if the first bandaging was moderately applied, the second bandaging should be made somewhat tighter. The heads the bandages should be placed on the fractures as in the former case; for, so doing, the humors will be driven to the extremities, whereas if you bandage any other part beforehand, the humors will he forced from it to the seat of the fracture: it is of much importance that this should be properly understood. Thus the bandaging and compression should always commence at the seat of the fracture, and everything else should be conducted on the same principle, so that the farther you proceed from the fracture, the compression should always be the less. The bandages should never be actually loose, but should be smoothly put on. At each dressing the number of bandages should be increased; and the patient, if asked, should answer, that he feels the bandages somewhat tighter than on the former occasion, especially about the fracture, and everything else in proportion; and with respect to the swelling, the pain, and recovery, everything should proceed as after the former dressing. But on the third day the outer bandaging should appear looser. Then having removed the bandages, you should bind it up again, somewhat tighter than before, and with all the bandages which will be required on the occasion, and afterwards one ought to experience the same train of symptoms as at the former periods of bandaging.

> Greek: 5. 5. σημεῖα δὲ τοῦ καλῶς ἰητρευμένου ταῦτα, καὶ ὀρθῶς ἐπιδεομένου, εἰ ἐρωτῴης αὐτὸν εἰ πεπίεκται, καὶ εἰ φαίη μὲν πεπιέχθαι, ἡσύχως δὲ, καὶ μάλιστα εἰ κατὰ τὸ κάτηγμα φαίη· τοιαῦτα τοίνυν φάναι χρὴ πεπρηγμένα διὰ τέλεος τὸν ὀρθῶς ἐπιδεόμενον. σημεῖα δὲ ταῦτα τῆς μετριότητος, τὴν μὲν ἡμέρην ἣν ἂν ἐπιδεθῇ, καὶ τὴν νύκτα δοκείτω αὐτὸς ἑωυτῷ μὴ ἐπὶ ἧσσον πεπιέχθαι, ἀλλʼ ἐπὶ μᾶλλον· τῇ δʼ ὑστεραίῃ οἰδημάτιον ἐλθεῖν ἐς χεῖρα ἄκρην μαλθακόν· μετριότητος γὰρ σημεῖον τῆς πιέξιός σου. τελευτώσης δὲ τῆς ἡμέρης, ἐπὶ ἧσσον δοκείτω πεπιέχθαι· τῇ δὲ τρίτῃ, χαλαρά σοι δοκείτω εἶναι τὰ ἐπιδέσματα. κἢν μέν τι τούτων τῶν εἰρημένων ἐλλείπῃ, γινώσκειν χρὴ ὅτι χαλαρωτέρη ἡ ἐπίδεσις τοῦ μετρίου· ἢν δέ τι τῶν εἰρημένων πλεονάζῃ, χρὴ γινώσκειν ὅτι μᾶλλον ἐπιέχθη τοῦ μετρίου· καὶ τουτέοισι σημαινόμενος, τὸ ὕστερον ἐπιδέων, ἢ χαλᾷν μᾶλλον, ἢ πιέζειν. ἀπολύσαντα δὲ χρὴ τριταῖον ἐόντα, κατατεινάμενον καὶ διορθωσάμενον, αὖθις ἐπιδῆσαι· κἢν μετρίως τὸ πρῶτον τετυχήκῃς ἐπιδήσας, ταύτην τὴν ἐπίδεσιν χρὴ ὀλίγῳ μᾶλλον ἢ ἐκείνην πιέσαι. βάλλεσθαι δὲ χρὴ τὰς ἀρχὰς κατὰ τὸ κάτηγμα, ὥσπερ καὶ τὸ πρότερον· ἢν μὲν γὰρ τοῦτο πρότερον ἐπιδέῃς, ἐξειρύαται ἐκ τούτου οἱ ἰχῶρες ἐς τὰς ἐσχατιὰς ἔνθα καὶ ἔνθα· ἢν δέ τι ἄλλο πρότερον πιέζῃς, ἐς τοῦτο ἐξειρύαται ἐκ τοῦ πιεχθέντος· ἐς πολλὰ δʼ εὔχρηστον τὸ ξυνιέναι. οὕτως οὖν ἄρχεσθαι μὲν αἰεὶ χρὴ τὴν ἐπίδεσιν καὶ τὴν πίεξιν ἐκ τουτέου τοῦ χωρίου, τὰ δʼ ἄλλὰ κατὰ λόγον, ὡς προσωτέρω ἀπὸ τοῦ κατήγματος ἀγάγῃς, ἐπὶ ἧσσον τὴν πίεξιν ποιέεσθαι. χαλαρὰ δὲ παντάπασι μηδέποτε περιβάλλειν, ἀλλὰ προσπεπτωκότα. ἔπειτα δὲ πλείοσιν ὀθονίοισι χρὴ ἐπιδεῖν ἑκάστην τῶν ἐπιδεσίων. ἐρωτώμενος δὲ φάτω ὀλίγῳ μᾶλλόν οἱ πεπιέχθαι, ἢ τὸ πρότερον, καὶ μάλιστα φάτω κατὰ τὸ κάτηγμα, καὶ τὰ ἄλλα δὲ κατὰ λόγον· καὶ ἀμφὶ τῷ οἰδήματι, καὶ ἀμφὶ τῷ πονέειν, καὶ ἀμφὶ τῷ ῤῃΐζειν, κατὰ λόγον τῆς προτέρης ἐπιδέσιος γινέσθω. ἐπὴν δὲ τριταῖος ᾖ, χαλαρώτερά οἱ δοκείτω εἶναι τὰ ἐπιδέσματα. ἔπειτα ἀπολύσαντα χρὴ αὖθις ἐπιδῆσαι, ὀλίγῳ μᾶλλον πιέζοντα, καὶ ἐν πᾶσι τοῖσιν ὀθονίοισιν οἷσί περ ἤμελλεν ἐπιδεῖσθαι· καὶ ἔπειτα αὐτὸν πάντα ταῦτα καταλαβέτω, ἅπερ καὶ ἐν τῇσι πρώτῃσι περιόδοισι τῶν ἐπιδεσίων.

[¶5] 6. When the third day arrives, that is to say, the seventh from the first dressing, if properly done, the swelling in the hand should be not very great; and the part which has been bandaged should be found more slender and less swelled at each time, and on the seventh day the swelling should be quite gone, and the broken bones should be more readily moved, and admit of being easily adjusted. And if these things be so, you should, after setting the fracture, apply the bandages so as to suit the splints, and a little more tight than formerly, unless there be more pain from the swelling in the hand. When you have applied the bandages, you must adjust the splints all around the limb, and secure them with strings so loose as just to keep them in their place, without the application of the splints contributing at all to the compression of the arm. After this the pain and recovery should proceed as in the preceding periods of the bandaging. But if, on the third day, the patient say that the bandaging is loose, you must then fasten the splints, especially at the fracture, but also elsewhere, wherever the bandaging is rather loose than tight. The splint should be thickest where the fracture protrudes, but it should not be much more so than elsewhere. Particular attention should be paid to the line of the arm corresponding to the thumb, so that no splint be laid on it, but upon each side of it, nor in the line of the little finger where the bone is prominent at the wrist, but on each side of it. And if it be found necessary that splints should be applied in these directions at the seat of the fracture, they should be made shorter than the others, so as that they may not reach the bones which are prominent at the wrist, for otherwise there is danger of ulceration, and of the tendons being laid bare. The splints should be adjusted anew every third day, in a very gentle manner, always keeping in mind that the object of the splints is to maintain the lower bandages in their place, and that they are not needed in order to contribute to the compression.

> Greek: 6. 6. ἐπὴν δὲ τριταῖος γένηται, ἑβδομαῖος δὲ ἀπὸ τῆς πρώτης ἐπιδέσιος, ἢν ὀρθῶς ἐπιδέηται, τὸ μὲν οἴδημα ἐν ἄκρῃ τῇ χειρὶ ἔσται, οὐδὲ τοῦτο λίην μέγα· τὸ δʼ ἐπιδεόμενον χωρίον ἐν πάσῃσι τῇσιν ἐπιδέσεσιν ἐπὶ τὸ λεπτότερον καὶ ἰσχνότερον εὑρεθήσεται, ἐν δὲ τῇ ἑβδόμῃ καὶ πάνυ λεπτὸν, καὶ τὰ ὀστέα τὰ κατεηγότα ἐπὶ μᾶλλον κινεύμενα καὶ εὐπαράγωγα ἐς κατόρθωσιν. καὶ ἢν ᾖ ταῦτα τοιαῦτα, κατορθωσάμενον χρὴ ἐπιδῆσαι ὡς ἐς νάρθηκας, ὀλίγῳ μᾶλλον πιέσαντα, ἢ τὸ πρότερον, ἢν μὴ πόνος τις πλείων ᾖ ἀπὸ τοῦ οἰδήματος τοῦ ἐν ἄκρῃ τῇ χειρί. ἐπὴν δὲ ἐπιδήσῃς τοῖσιν ὀθονίοισι, τοὺς νάρθηκας περιθεῖναι χρὴ καὶ περιλαβεῖν ἐν τοῖσι δεσμοῖσιν ὡς χαλαρωτάτοισιν, ὁκόσον ἠρεμέειν, ὥστε μηδὲν ξυμβάλλεσθαι ἐς τὴν πίεξιν τῆς χειρὸς τὴν τῶν ναρθήκων πρόσθεσιν. μετὰ δὲ ταῦτα, ὅ τε πόνος, αἵ τε ῤᾳστῶναι αἱ αὐταὶ γινέσθωσαν, αἵ περ καὶ ἐν τῇσι πρώτῃσι περιόδοισι τῶν ἐπιδεσίων. ἐπὴν δὲ τριταῖος ἐὼν φῇ χαλαρὸν εἶναι, τότʼ ἔπειτα χρὴ τοὺς νάρθηκας ἐρείσασθαι, μάλιστα μὲν κατὰ τὸ κάτηγμα, ἀτὰρ καὶ τἄλλα, κατὰ λόγον, ᾗπερ καὶ ἡ ἐπίδεσις ἐχάλα μᾶλλον ἢ ἐπίεζεν. παχύτατον δὲ χρὴ εἶναι τὸν νάρθηκα, ᾗ ἐξέστη τὸ κάτηγμα, μὴ μὴν πολλῷ. ἐπιτηδεύειν δὲ χρὴ μάλιστα μὲν κατʼ ἰθυωρίην τοῦ μεγάλου δακτύλου, ὡς μὴ κείσηται ὁ νάρθηξ, ἀλλὰ τῇ ἢ τῇ, μηδὲ κατὰ τὴν τοῦ σμικροῦ ἰθυωρίην ᾗ τὸ ὀστέον ὑπερέχει ἐν τῷ καρπῷ, ἀλλὰ τῇ ἢ τῇ. ἢν δὲ ἄρα πρὸς τὸ κάτηγμα ξυμφέρῃ κεῖσθαι κατὰ ταῦτά τινας τῶν ναρθήκων, βραχυτέρους αὐτοὺς χρὴ τῶν ἄλλων ποιέειν, ὡς μὴ ἐξικνέωνται πρὸς τὰ ὀστέα τὰ ὑπερέχοντα παρὰ τὸν καρπόν· κίνδυνος γὰρ ἑλκώσιος, καὶ νεύρων ψιλώσιος. χρὴ δὲ διὰ τρίτης ἐρείδειν τοῖσι νάρθηξι πάνυ ἡσυχῇ, οὕτω τῇ γνώμῃ ἔχοντα, ὡς οἱ νάρθηκες φυλακῆς εἵνεκα τῆς ἐπιδέσιος προσκέωνται, ἀλλʼ οὐ τῆς πιέξιος εἵνεκεν ἐπιδέωνται.

[¶6] 7. If, then, you see that the bones are properly adjusted by the first dressings, and that there is no troublesome pruritus in the part, nor any reason to suspect ulceration, you may allow the arm to remain bandaged in the splints until after the lapse of more than twenty days. The bones of the fore-arm generally get consolidated in thirty days altogether; but there is nothing precise in this matter, for one constitution differs from another, and one period of life from another. When you remove the bandages, you must pour hot water on the arm and bind it up again, but somewhat slacker, and with fewer bandages than formerly: and again on the third day you undo the bandages, and bind it still more loosely, and with still fewer bandages. And if, while the arm is bound up in the splints, you should at any time suspect that the bones do not lie properly, or if anything about the bandages annoys the patient, you should loose them at the middle of the time, or a little earlier, and apply them again. A diet slightly restricted will be sufficient in those cases in which there was no external wound at first, or when the bone does not protrude; but one should live rather sparingly until the tenth day, as being now deprived of exercise; and tender articles of food should be used, such as moderately loosen the bowels; but one should abstain altogether from flesh and wine, and then by degrees resume a more nourishing diet. This diet. may be laid down as a just rule in the treatment of fractures, both as to how they should be treated, and what will be the results of a proper plan of treatment; so that one may know, that if things do not turn out thus, there has been some defect or excess in the treatment. And in this simple plan of treatment it is necessary to attend also to the following directions, which some physicians pay little attention to, although, when improperly executed, they are capable of marring the whole process of bandaging: for if both the bones be broken, or the lower one only, and the patient who has got his arm bandaged keep it slung in a shawl, and that the shawl is particularly loose at the fracture, so that the arm is not properly suspended at this end or that, in this case the bone must necessarily be found distorted upwards; whereas, when both bones are thus broken, if the arm recline in the shawl at the wrist and elbow, but the rest of it be not kept up, the bone in this case will be distorted to the lower side. The greater part of the arm and the wrist of the hand should therefore be equally suspended in a broad soft shawl.

> Greek: 7. 7. ἢν μὲν οὖν εὖ εἰδῇς ὅτι ἱκανῶς τὰ ὀστέα ἀπίθυνται ἐν τῇσι προτέρῃσιν ἐπιδέσεσι, καὶ μήτε κνησμοί τινες λυπέωσι, μήτε τις ἕλκωσις μηδεμία ὑποπτεύηται εἶναι, ἐᾷν χρὴ ἐπιδεδέσθαι ἐν τοῖσι νάρθηξιν, ἔστʼ ἂν ὑπὲρ εἴκοσιν ἡμέρας γίνηται. ἐν τριήκοντα δὲ μάλιστα τῇσι ξυμπάσῃσι κρατύνεται ὀστέα τὰ ἐν τῷ πήχει τὸ ἐπίπαν· ἀτρεκὲς δὲ οὐδέν· μάλα γὰρ καὶ φύσις φύσιος, καὶ ἡλικίη ἡλικίης διαφέρει. ἐπὴν δὲ λύσῃς, ὕδωρ θερμὸν καταχέαι χρὴ, καὶ μετεπιδῆσαι, ἧσσον μὲν ὀλίγῳ πιέσαντα, ἢ τὸ πρόσθεν, ἐλάσσοσι δὲ τοῖσιν ὀθονίοισιν, ἢ τὸ πρότερον· καὶ ἔπειτα διὰ τρίτης ἡμέρης λύσαντα ἐπιδεῖν, ἐπὶ μὲν ἧσσον πιέζοντα, ἐπὶ δὲ ἐλάσσοσι τοῖσιν ὀθονίοισιν. ἐπὴν δὲ, ὅταν τοῖσι νάρθηξι δεθῇ, ὑποπτεύῃς τὰ ὀστέα μὴ ὀρθῶς κεῖσθαι, ἢ ἄλλο τι ὀχλέῃ τὸν τετρωμένον, λῦσαι ἐν τῷ ἡμίσει τοῦ χρόνου, ἢ ὀλίγῳ πρόσθεν, καὶ αὖθις μετεπιδῆσαι. δίαιτα δὲ τουτέοισιν, οἷσιν ἂν μὴ ἕλκεα ἐξ ἀρχῆς γένηται, ἢ ὀστέα ἔξω ἐξίσχῃ, ἀρκέει ὑποφαύλη· ἐνδεέστερον δὲ χρὴ διαιτᾷν ἄχρις ἡμερέων δέκα, ἅτε ἤδη καὶ ἐλινύοντας· καὶ ὄψοισιν ἁπαλοῖσι χρῆσθαι, ὁκόσα τῇ διεξόδῳ μετριότητα παρασχήσει· οἴνου δὲ καὶ κρεηφαγίης ἀπέχεσθαι· ἔπειτα μέντοι ἐκ προσαγωγῆς ἀνακομίζεσθαι. οὗτος ὁ λόγος ὥσπερ νόμος κεῖται δίκαιος περὶ κατηγμάτων ἰήσιος, ὥστε χειρίζειν χρὴ, καὶ ὥστε ἀποβαίνει ἀπὸ τῆς δικαίης χειρίξιος· ὅ τι δʼ ἂν μὴ οὕτως ἀποβαίνῃ, εἰδέναι χρὴ ὅτι ἐν τῇ χειρίξει τι ἐνδεὲς πεποίηται, ἢ πεπλεόνασται. ἔτι δὲ τάδε χρὴ προσξυνιέναι ἐν τούτῳ τῷ ἁπλῷ τρόπῳ, ἃ οὐ κάρτα ἐπιμελέονται οἱ ἰητροὶ, καίτοι πᾶσαν μελέτην καὶ πᾶσαν ἐπίδεσιν οἷά τε διαφθείρειν ἐστὶ, μὴ ὀρθῶς ποιεύμενα· ἢν γὰρ τὰ μὲν ὀστέα ἄμφω κατηγῇ, ἢ τὸ κάτω μοῦνον, ὁ δὲ ἐπιδεδεμένος ἐν ταινίῃ τινὶ τὴν χεῖρα ἔχῃ ἀναλελαμμένην, τυγχάνῃ δὲ ἡ ταινίη κατὰ τὸ κάτηγμα πλείστη ἐοῦσα, ἔνθεν δὲ καὶ ἔνθεν ἡ χεὶρ ἀπαιωρέηται, τοῦτον ἀνάγκη τὸ ὀστέον εὑρεθῆναι διεστραμμένον ἔχοντα πρὸς τὸ ἄνω μέρος· ἢν δὲ, κατεηγότων τῶν ὀστέων οὕτως, ἄκρην τε τὴν χεῖρα ἐν τῇ ταινίῃ ἔχῃ καὶ παρὰ τὸν ἀγκῶνα, ὁ δὲ ἄλλος πῆχυς μὴ μετέωρος ἔῃ, οὗτος εὑρεθήσεται τὸ ὀστέον ἐς τὸ κάτω μέρος διεστραμμένον ἔχων. χρὴ οὖν ἐν ταινίῃ πλάτος ἐχούσῃ, μαλθακῇ, τὸ πλεῖστον τοῦ πήχεος καὶ τὸν καρπὸν τῆς χειρὸς ὁμαλῶς αἰωρέεσθαι.

[¶7] 8. When the arm is broken, if one stretch the fore-arm and adjust it while in this position, the muscle of the arm will be bound while extended; but when the dressing is over, and the patient bends his arm at the elbow, the muscle of the arm will assume a different shape. The following, then, is the most natural plan of setting the arm: having got a piece of wood a cubit or somewhat less in length, like the handles of spades, suspend it by means of a chain fastened to its extremities at both ends; and having seated the man on some high object, the arm is to be brought over, so that the armpit may rest on the piece of wood, and the man can scarcely touch the seat, being almost suspended; then having brought another seat, and placed one or more leather pillows under the arm, so as to keep it a moderate height while it is bent at a right angle, the best plan is to put round the arm a broad and soft skin, or broad shawl, and to hang some great weight to it, so as to produce moderate extension; or otherwise, while the arm is in the position I have described, a strong man is to take hold of it at the elbow and pull it downward. But the physician standing erect, must perform the proper manipulation, having the one foot on some pretty high object, and adjusting the bone with the palms of his hands; and it will readily be adjusted, for the extension is good if properly applied. Then let him bind the arm, commencing at the fracture, and do otherwise as directed above; let him put the same questions and avail himself of the same signs to ascertain whether the arm be moderately tight or not; and every third day let him bind it anew and make it tighter; and on the seventh or ninth day let him bind it up with splints, and leave it so until after the lapse of more than thirty days. And if he suspect that the bone is not lying properly, let him remove the bandages in the interval, and having adjusted the arm, let him bind it up again. The bone of the arm is generally consolidated in forty days. When these are past, the dressing is to be removed, and fewer and slacker bandages applied instead of it. The patient is to be kept on a stricter diet, and for a longer space of time than in the former case; and we must form our judgment of it from the swelling in the hand, looking also to the strength of the patient. This also should be known, that the arm is naturally inclined outward; to this side, therefore, the distortion usually takes place, if not properly treated; but indeed, all the other bones are usually distorted during treatment for fracture to that side to which they naturally incline. When, therefore, anything of this kind is suspected, the arm is to be encircled in a broad shawl, which is to be carried round the breast, and when the patient goes to rest, a compress of many folds, or some such thing, is to be folded and placed between the elbow and the side, for thus the bending of the bone will be rectified, but care must be taken lest it be inclined too much inwards.

> Greek: 8. 8. ἢν δὲ ὁ βραχίων καταγῇ, ἢν μέν τις ἀποτανύσας τὴν χεῖρα ἐν τουτέῳ τῷ σχήματι διατείνῃ, ὁ μῦς τοῦ βραχίονος κατατεταμένος ἐπιδεθήσεται· ἐπὴν δʼ ἐπιδεθεὶς ξυγκάμψῃ τὸν ἀγκῶνα, ὁ μῦς τοῦ βραχίονος ἄλλο σχῆμα σχήσει. δικαιοτάτη οὖν βραχίονος κατάτασις ἥδε· ξύλον πηχυαῖον ἢ ὀλίγῳ βραχύτερον, ὁκοῖοι οἱ στειλαιοί εἰσι τῶν σκαφίων, κρεμάσαι χρὴ, ἔνθεν καὶ ἔνθεν σειρῇ δήσαντα· καθίσαντα δὲ τὸν ἄνθρωπον ἐπὶ ὑψηλοῦ τινος, τὴν χεῖρα ὑπερκεῖσθαι, ὡς ὑπὸ τῇ μασχάλῃ γένηται ὁ στειλαιὸς ἔχων ξυμμέτρως, ὥστε μόλις δύνασθαι καθίννυσθαι τὸν ἄνθρωπον, σμικροῦ δέοντα μετέωρον εἶναι· ἔπειτα θέντα τι ἄλλο ἔφεδρον, καὶ ὑποθέντα σκύτινον ὑποκεφάλαιον, ἢ ἓν ἢ πλείω ὅκως ξυμμέτρως σχοίη ὕψεος τοῦ πήχεος πλαγίου πρὸς ὀρθὴν γωνίην. ἄριστον μὲν σκύτος πλατὺ καὶ μαλθακὸν, ἢ ταινίην πλατέην ἀμφιβάλλοντα, τῶν μεγάλων τι σταθμίων ἐξαρτῆσαι, ὅ τι μετρίως ἕξει κατατείνειν· εἰ δὲ μὴ, τῶν ἀνδρῶν ὅστις ἐῤῥωμένος, ἐν τούτῳ τῷ σχήματι τοῦ πήχεος ἐόντος, παρὰ τὸν ἀγκῶνα καταναγκαζέτω ἐς τὸ κάτω. ὁ δὲ ἰητρὸς ὀρθὸς μὲν ἐὼν χειριζέτω, τὸν ἕτερον πόδα ἐπὶ ὑψηλοτέρου τινὸς ἔχων, κατορθώσας δὲ τοῖσι θέναρσι τὸ ὀστέον· ῤηϊδίως δὲ κατορθώσεται· ἀγαθὴ γὰρ ἡ κατάστασις, ἤν τις καλῶς παρασκευάσηται. ἔπειτα ἐπιδείτω, τάς τε ἀρχὰς βαλλόμενος ἐπὶ τὸ κάτηγμα, καὶ τἄλλα πάντα ὥσπερ πρότερον παρῃνέθη, χειριζέτω· καὶ ἐρωτήματα ταὐτὰ ἐρωτάτω· καὶ σημείοισι χρήσθω τοῖσιν αὐτέοισιν, εἰ μετρίως ἔχει, ἢ οὔ· καὶ διὰ τρίτης ἐπιδείτω, καὶ ἐπὶ μᾶλλον πιεζέτω· καὶ ἑβδομαῖον ἢ ἐναταῖον ἐν νάρθηξι δησάτω [, ἔστʼ ἂν ὑπὲρ τριήκοντα ἡμέρας γίνηται]. καὶ ἢν ὑποπτεύσῃ μὴ καλῶς κεῖσθαι τὸ ὀστέον, μεσηγὺ τουτέου τοῦ χρόνου λυσάτω, καὶ εὐτεθισάμενος μετεπιδησάτω. κρατύνεται δὲ μάλιστα βραχίονος ὀστέον ἐν τεσσαράκοντα ἡμέρῃσιν. ἐπὴν δὲ ταύτας ὑπερβάλῃ, λύειν χρὴ, καὶ ἐπὶ ἧσσον πιέζειν τοῖσιν ὀθονίοισι, καὶ ἐπὶ ἐλάσσοσιν ἐπιδεῖν. δίαιταν δὲ ἀκριβεστέρην τινὰ ἢ τὸ πρότερον διαιτᾷν, καὶ πλείω χρόνον· τεκμαίρεσθαι δὲ πρὸς τοῦ οἰδήματος τοῦ ἐν ἄκρῃ τῇ χειρὶ, τὴν ῤώμην ὁρέων. Προσξυνιέναι δὲ χρὴ καὶ τάδε, ὅτι ὁ βραχίων κυρτὸς πέφυκεν ἐς τὸ ἔξω μέρος· ἐς τοῦτο τοίνυν τὸ μέρος διαστρέφεσθαι φιλέει, ἐπὴν μὴ καλῶς ἰητρεύηται· ἀτὰρ καὶ τἄλλα πάντα ὀστέα, ἐς ὅπερ πέφυκε διεστραμμένα, ἐς τοῦτο καὶ ἰητρευόμενα φιλέει διαστρέφεσθαι, ἐπὴν κατεαγῇ. χρὴ τοίνυν, ἐπὴν τοιοῦτό τι ὑποπτεύηται, ταινίῃ πλατείῃ προσεπιλαμβάνειν τὸν βραχίονα κύκλῳ περὶ τὸ στῆθος περιδέοντα· καὶ ἐπὴν ἀναπαύεσθαι μέλλῃ, μεσηγὺ τοῦ ἀγκῶνος καὶ τῶν πλευρέων σπλῆνά τινα πουλύπτυχον πτύξαντα ὑποτιθέναι, ἢ ἄλλο τι ὃ τουτέῳ ἔοικεν· οὕτω γὰρ ἂν ἰθὺ τὸ κύρτωμα τοῦ ὀστέου γένοιτο· φυλάσσεσθαι μέντοι χρὴ, ὅπως μὴ ᾖ ἄγαν ἐς τὸ ἔσω μέρος.

[¶8] 9. The human foot is composed of several small bones like the hand. These bones therefore are scarcely ever broken, unless the skin at the same time be wounded by some sharp and heavy body. The treatment of such injuries, therefore, will be delivered under the head of wounds. But if any bone be moved from its place, or a joint of the toes be luxated, or any of the bones of the part called the tarsus be displaced, it must be forced back again to its place as described with regard to the hand; and is to be treated with cerate, compresses, and bandages, like the fractures, with the exception of the splints; and is to be secured tightly in the same way, and the bandages renewed on the third day; and the patient thus bandaged should return the same answers as in fractures, as to the bandages feeling tight or slack. All these bones recover perfectly in twenty days, except those that are connected with the bones of the leg, and are in a line with them. It is advantageous to lie in bed during the whole of this time; but the patients, thinking light of the complaint, have not perseverance to do this, and they walk about before they get well; wherefore many of these do not make a perfect recovery. And often the pain puts them in mind of the injury; and deservedly, for the feet sustain the weight of the whole body. When, therefore, they walk about before they are whole, the joints which have been luxated are cured incompletely; and, on that account, while walking about, they have pains in the leg from time to time.

> Greek: 9. 9. ποὺς δὲ ἀνθρώπου ἐκ πολλῶν καὶ μικρῶν ὀστέων ξύγκειται, ὥσπερ χεὶρ ἄκρη. κατάγνυται μὲν οὐ πάνυ τι ταῦτα τὰ ὀστέα, ἢν μὴ ξὺν τῷ χρωτὶ τιτρωσκομένῳ ὑπὸ ὀξέος τινὸς ἢ βαρέος· τὰ μὲν οὖν τιτρωσκόμενα, ἐν ἑλκωσίων μέρει εἰρήσεται, ὡς χρὴ ἰητρεύειν. ἢν δέ τι κινηθῇ ἐκ τῆς χώρης, ἢ τῶν δακτύλων ἄρθρον, ἢ ἄλλο τι τῶν ὀστέων τοῦ ταρσοῦ καλεομένου, ἀναγκάζειν μὲν χρὴ ἐς τὴν ἑωυτοῦ χώρην ἕκαστον, ὥσπερ καὶ τὰ ἐν τῇ χειρὶ εἴρηται· ἰητρεύειν δὲ κηρωτῇ καὶ σπλήνεσι καὶ ὀθονίοισιν, ὥσπερ καὶ τὰ κατήγματα, πλὴν τῶν ναρθήκων, τὸν μὲν ατὸν τρόπον πιεζεῦντα, διὰ τρίτης δὲ ἐπιδέοντα· ὑποκρινέσθω δὲ ὁ ἐπιδεόμενος παραπλήσια, οἷά περ καὶ ἐν τοῖσι κατήγμασι, καὶ περὶ τοῦ πεπιέχθαι, καὶ περὶ τοῦ χαλᾷν. ὑγιέα δὲ γίνεται ἐν εἴκοσιν ἡμέρῃσι τελέως ἅπαντα, πλὴν ὁκόσα κοινωνέει τοῖσι τῆς κνήμης ὀστέοισι· καὶ αὐτέῃ τῇ ἴξει. ξυμφέρει δὲ κατακεῖσθαι τοῦτον τὸν χρόνον· ἀλλὰ γὰρ οὐ τολμέουσιν ὑπερορῶντες τὸ νόσημα, ἀλλὰ περιέρχονται, πρὶν ὑγιέες γενέσθαι. διὰ τοῦτο καὶ οἱ πλεῖστοι οὐκ ἐξυγιαίνουσι τελέως. ἀλλὰ πολλάκις αὐτοὺς ὁ πόνος ὑπομιμνήσκει· εἰκότως· ὅλον γὰρ τὸ ἄχθος τοῦ σώματος οἱ πόδες ὀχέουσιν. ὁκόταν οὖν μήπω ὑγιέες ἐόντες ὁδοιπορέωσι, φλαύρως ξυναλθάσσεται τὰ ἄρθρα τὰ κινηθέντα· διὰ τοῦτο ἄλλοτε καὶ ἄλλοτε ὁδοιπορέοντες ὀδυνῶνται τὰ πρὸς τῇ κνήμῃ.

[¶9] 10. But those bones which are connected with the bones of the leg are larger than the others, and the cure of them when luxuated is more protracted. The mode of treatment then is the same; but we must use more bandages and more splints, and the bandage is to be carried round to this side and to that, and pressure is to be made as in the other cases, particularly at the seat of the luxation, and the first circles of the bandages are to be made there. And at each time the bandages are taken off, much hot water is to be used, for in all injuries at joints the affusion of hot water in large quantity is to be had recourse to. And the same symptoms of compression and relaxation should manifest themselves in the same times, as in the cases formerly treated of, and the subsequent bandagings should be conducted in like manner. These cases get completely well for the most part in forty days, if the patients have resolution to keep their bed; but if not, they are subjected to the complaints formerly described, or still worse.

> Greek: 10. 10. τὰ δὲ κοινωνέοντα τοῖσι τῆς κνήμης ὀστέοισι μείζω τε τῶν ἑτέρων ἐστὶ, καὶ κινηθέντων τούτων πουλυχρονιωτέρη ἡ ἄλθεξις. ἴησις μὲν οὖν ἡ αὐτή· ὀθονίοισι δὲ πλείοσι χρέεσθαι, καὶ σπλήνεσιν· καὶ ἐπὶ πᾶν ἔνθεν καὶ ἔνθεν ἐπιδέειν· πιέζειν δὲ, ὥσπερ καὶ τἄλλα πάντα, ταύτῃ μάλιστα ᾗ ἐκινήθη, καὶ τὰς πρώτας περιβολὰς τῶν ὀθονίων κατὰ ταῦτα ποιέεσθαι. ἐν δὲ ἑκάστῃ τῶν ἀπολυσίων ὕδατι πολλῷ θερμῷ χρέεσθαι· ἐν πᾶσι δὲ πολλὸν ὕδωρ θερμὸν καταχέειν τοῖσι κατʼ ἄρθρα σίνεσιν. αἱ δὲ πιέξιες καὶ αἱ χαλάσιες ἐν τοῖσιν αὐτέοισι χρόνοισι τὰ αὐτὰ σημεῖα δεικνυόντων, ἅπερ ἐπὶ τοῖσι πρόσθεν· καὶ τὰς μετεπιδέσιας ὡσαύτως χρὴ ποιέεσθαι. ὑγιέες δὲ τελέως οὗτοι γίνονται ἐν τεσσαράκοντα ἡμέρῃσι μάλιστα, ἢν τολμέωσι κατακεῖσθαι· ἢν δὲ μὴ, πάσχουσι ταῦτα ἃ καὶ πρότερον, καὶ ἐπὶ μᾶλλον.

[¶10] 11. In persons who jumping from any high object pitch upon their heel with great force, the bones are separated, and the veins pour forth their contents, owing to the contusion of the flesh surrounding the bone, and hence a swelling and much pain supervene. For this bone (os calcis) is not a small one, protrudes beyond the line of the leg, and is connected with important veins and tendons; for the back tendon of the leg is inserted into this bone. Such cases are to be treated with cerate, and with compresses and bandages; and hot water is to be used in large quantity; and they require many bandages, which ought to be particularly good and appropriate. And if the patient happen to have a tender skin about the heel, nothing is to be done to it; but if, as some have it, the skin be thick and hardened, it is to be pared down smoothly and thinned, but without wounding it. It is not everybody who can apply the bandage properly in such cases; for if one shall bind the parts, as in other accidents about the ankle, sometimes bringing a fold round the foot and sometimes round the tendon, these turns leave out the heel, which is the seat of the contusion, and thus there is danger that the os calcis may sphacelate; and if this should take place, the impediment may endure for life and also in all the other cases of sphacelus, not proceeding from such a cause as this; as when, from being carelessly allowed to lie in a certain position during confinement to bed, the heel becomes black, or when a serious wound has occurred in the leg and it is long of healing, and is connected with the heel, or when the same thing happens in the thigh, or when in any disease a protracted decubitus takes place on the back, in all such cases the sores are inveterate, troublesome, and frequently break out again, unless particular attention be paid to the cure, along with much rest, as in all the cases attended with sphacelus. And cases of sphacelus connected with this cause, in addition to other inconveniences, are attended with great danger to the whole body. For they are apt to be attended with very acute fevers, of the continual type, accompanied with tremblings, hiccup, aberration of intellect, and which prove fatal within a few days: and there may be lividities of bloody veins, with nausea, and gangrene from pressure; these diseases may occur, besides the sphacelus. Those which have been described are the most violent contusion; but in general the contusions are mild, and no great care is required with regard to the treatment, and yet it must be conducted properly. But when the contusion appears to be severe, we must do as described above, making many turns of the bandage around the heel, sometimes carrying it to the extremity of the foot, sometimes to the middle, and sometimes around the leg; and, in addition, all the surrounding parts are to be bandaged in this direction and that, as formerly described; and the compression should not be made strong, but we should make use of many bandages, and it is better also to administer hellebore the same day or on the morrow; and the bandages should be removed on the third day and reapplied. And these are the symptoms by which we discover whether the case will get worse or not: when the extravasated blood, the lividities, and the surrounding parts become red and hard, there is danger of an exacerbation. But if there be no fever, we must give emetics, as has been said, and administer the other remedies which are applicable when the fever is not of a continual type; but if continual fever be present, we must not give strong medicines, but enjoin abstinence from solid food and soups, and give water for drink, and not allow wine but oxyglyky (a composition from vinegar and honey?). But if the case be not going to get worse, the ecchymosed and livid parts, and those surrounding them become greenish and not hard; for this is a satisfactory proof in all cases of ecchymosis, that they are not to get worse; but when lividity is complicated with hardness, there is danger that the part may become blackened. And we must so manage the foot as that it may be generally raised a little higher than the rest of the body. Such a patient will get well in sixty days if he keep quiet.

> Greek: 11. 11. ὅσοι δὲ πηδήσαντες ἀφʼ ὑψηλοῦ τινος ἐστηρίξαντο τῇ πτέρνῃ ἰσχυρῶς, τουτέοισι διισταται μὲν τὰ ὀστέα, φλέβια δʼ ἐκχυμοῦνται ἀμφιφλασθείσης τῆς σαρκὸς ἀμφὶ τὸ ὀστέον, οἴδημα δὲ ἐπιγίνεται καὶ πόνος πουλύς. τὸ γὰρ ὀστέον τοῦτο οὐ σμικρόν ἐστι, καὶ ὑπερέχει μὲν ὑπὸ τὴν ἰθυωρίην τῆς κνήμης, κοινωνέει δὲ φλεψὶ καὶ νεύροισιν ἐπικαίροισιν· ὁ τένων δὲ ὁ ὀπίσθιος τούτῳ προσήρτηται τῷ ὀστέῳ. τούτους χρὴ ἰητρεύειν μὲν κηρωτῇ καὶ σπλήνεσι καὶ ὀθονίοισιν· ὕδατι δὲ θερμῷ πλείστῳ ἐπὶ τουτέοισι χρῆσθαι· καὶ ὀθονίων πλειόνων ἐπὶ τουτέοισι δεῖ, καὶ ἄλλως ὡς βελτίστων καὶ προσηνεστάτων. καὶ ἢν μὲν τύχῃ ἁπαλὸν τὸ δέρμα φύσει ἔχων τὸ ἀμφὶ τῇ πτέρνῃ, ἐᾷν οὕτως· ἢν δὲ παχὺ καὶ σκληρὸν, οἷα μετεξέτεροι ἴσχουσιν, κατᾶτάμνειν χρὴ ὁμαλῶς, καὶ διαλεπτύνειν μὴ διατιτρώσκντ. ἐπιδεῖν δὲ ἀγαθῶς οὐ παντὸς ἀνδρός ἐστι τὰ τοιαῦτα· ἢν γάρ τις ἐπιδέῃ, ὥσπερ καὶ τὰ ἄλλα τὰ κατὰ τὰ σφυρὰ ἐπιδεῖται, ὁτὲ μὲν περὶ τὸν πόδα περιβαλλόμενος, ὁτὲ δὲ περὶ τὸν τένοντα, αἱ ἀποσφίγξιες αὗται χωρίζουσι τὴν πτέρνην, ᾗ τὸ φλάσμα ἐγένετο· καὶ οὕτω κίνδυνος σφακελίσαι τὸ ὀστέον τὸ τῆς πτέρνης· καίτοι ἢν σφακελίσῃ, τὸν αἰῶνα πάντα ἱκανὸν ἀντίσχειν τὸ νόσημα. καὶ γὰρ τἄλλα ὅσα μὴ ἐκ τοιούτου τρόπου σφακελίζει, ἀλλʼ ἐν κατακλίσει μελανθείσης τῆς πτέρνης ὑπὸ ἀμελείης τοῦ σχήματος, ἢ ἐν κνήμῃ τρώματος γενομένου ἐπικαίρου καὶ χρονίου καὶ κοινοῦ τῇ πτέρνῃ, ἢ ἐν μηρῷ, ἢ ἐπὶ ἄλλῳ νουσήματι ὑπτιασμοῦ χρονίου γενομένου, ὁμῶς καὶ τοῖσι τοιούτοισι χρόνια, καὶ ὀχλώδεα, καὶ πολλάκις ἀναῤῥηγνύμενα, ἢν μὴ χρηστῇ μὲν μελέτῃ θεραπευθῇ, πολλῇ δʼ ἡσυχίῃ, ὡς τά γε σφακελίζοντα· ἐκ τοῦ τοιούτου δὲ τρόπου σφακελίζοντα καὶ κινδύνους μεγάλους τῷ σώματι παρέχει πρὸς τῇ ἄλλῃ λύμῃ Καὶ γὰρ πυρετοὶ ὑπεροξέες, ξυνεχέες, τρομώδεες, λυγγώδεες, γνώμης ἁπτόμενοι, καὶ ὀλιγήμεροι, κτείνοντές τε· γένοιντο δʼ ἂν καὶ φλεβῶν αἱμοῤῥόων πελιώσιες, ναυσιώσιες, καὶ γαγγραινώσιες ὑπὸ τῆς πιέξιος· γένοιτο δʼ ἂν ταῦτα ἔξω τοῦ ἄλλου σφακελισμοῦ. ταῦτα μὲν οὖν εἴρηται, οἷα τὰ ἰσχυρότατα φλάσματα ίνεται· τὰ μέντοι πλεῖστα ἡσυχαίως ἀμφιφλᾶται, καὶ οὐδεμίη πολλὴ σπουδὴ τῆς μελέτης, ἀλλʼ ὅμως ὀρθῶς γε χρὴ χειρίζειν. ἐπὴν μέντοι ἰσχυρὸν δόξῃ εἶναι τὸ ἔρεισμα, τά τε εἰρημένα ποιέειν χρὴ, καὶ τὴν ἐπίδεσιν τὴν πλείστην ποιέεσθαι ἀμφὶ τὴν πτέρνην περιβάλλοντα, ἄλλοτε πρὸς τὰ ἄκρα τοῦ ποδὸς ἀντιπεριβάλλοντα, ἄλλοτε πρὸς τὰ μέσα, ἄλλοτε πρὸς τὰ περὶ τὴν κνήμην· προσεπιδεῖν δὲ καὶ τὰ πλησίον πάντα ἔνθεν καὶ ἔνθεν, ὥσπερ καὶ πρόσθεν εἴρηται· καὶ ἰσχυρὴν μὲν μὴ ποιέεσθαι τὴν πίεξιν, ἐν πολλοῖσι δὲ τοῖσιν ὀθονίοισιν· ἄμεινον δὲ καὶ ἐλλέβορον πιπίσκειν αὐθημερὸν, ἢ τῇ ὑστεραίῃ· ἀπολῦσαι δὲ τριταῖον, καὶ αὖθις μετεπιδῆσαι. σημεῖα δὲ τάδε, ἢν παλιγκοταίνῃ, ἢ οὔ· ἐπὴν μὲν τὰ ἐκχυμώματα τῶν φλεβῶν, καὶ τὰ μελάσματα, καὶ τὰ ἐγγὺς ἐκείνων ὑπέρυθρα γινηται καὶ ὑπόσκληρα, κίνδυνος παλιγκοτῆσαι. ἀλλʼ ἢν μὲν ἀπύρετος ᾖ, φαρμακεύειν ἄνω χρὴ, ὥσπερ εἴρηται, καὶ ὅσα ἂν μὴ ξυνεχῆ πυρεταίνηται· ἢν δὲ ξυνεχῆ πυρεταίνηται, μὴ φάρμακεύειν, ἀπέχειν δὲ σιτίων καὶ ῤοφημάτων, ποτῷ δὲ χρῆσθαι ὕδατι, καὶ μὴ οἴνῳ, ἀλλὰ τῷ ὀξυγλυκεῖ. ἢν δὲ μὴ μέλλῃ παλιγκοταίνειν, τὰ ἐκχυμώματα καὶ τὰ μελάσματα καὶ τὰ περιέχοντα ὑπόχλωρα γίνεται καὶ οὐ σκληρά· ἀγαθὸν τοῦτο τὸ μαρτύριον ἐν πᾶσι τοῖσιν ἐκχυμώμασιν, τοῖσι μὴ μέλλουσι παλιγκοταίνειν· ὅσα δὲ σὺν σκληρύσμασι πελιοῦται, κίνδυνος μὲν μελανθῆναι. τὸν δὲ πόδα ἐπιτηδεύειν χρὴ, ὅκως ἀνωτέρω τοῦ ἄλλου σώματος ἔσται τὰ πλεῖστα ὀλίγον. ὑγιὴς δʼ ἂν γένοιτο ἐν ἑξήκοντα ἡμέρῃσιν, εἰ ἀτρεμέοι.

[¶11] 12. The leg consists of two bones, of which the one is much more slender than the other at one part, but not much more slender at another. These are connected together at the foot, and form a common epiphysis, but they are not united together along the line of the leg; and at the thigh they are united together and form an epiphysis, and this epiphysis has a diaphysis; but the other bone in a line with the little toe is a little longer. Such is the nature of the bones of the leg.

> Greek: 12. 12. ἡ δὲ κνήμη δύο ὀστέα ἐστὶ, τῇ μὲν συχνῷ λεπτότερον τὸ ἕτερον τοῦ ἑτέρου, τῇ δὲ οὐ πολλῷ λεπτότερον· ξυνέχεται δὲ ἀλλήλοισι τὰ πρὸς τοῦ ποδὸς, καὶ ἐπίφυσιν κοινὴν ἔχει, ἐν ἰθυωρίῃ δὲ τῆς κνήμης οὐ ξυνέχεται· τὰ δὲ πρὸς τοῦ μηροῦ ξυνέχεται, και ἐπίφυσιν ἔχει, καὶ ἡ ἐπίφυσις διάφυσιν· μακρότερον δὲ τὸ ἕτερον ὀστέον σμικρῷ τὸ κατὰ τὸν σμικρὸν δάκτυλον· ἡ μὲν φύσις τοιαύτη τῶν ὀστέων τῶν ἐν τῇ κνήμῃ.

[¶12] 13. Sometimes the bones connected with the foot are displaced, sometimes both bones with their epiphysis; sometimes the whole epiphysis is slightly moved, and sometimes the other bone. These cases are less troublesome than the same accidents at the wrist, if the patients will have resolution to give them rest. The mode of treatment is the same as that of the other, for the reduction is to be made, as of the other, by means of extension, but greater force is required, as the parts of the body concerned are stronger in this case. But, for the most part, two men will be sufficient, by making extension in opposite directions, but, not withstanding, if they are not sufficiently strong, it is easy to make more powerful extension in the following way: having fixed in the ground either the nave of a wheel, or any such object, something soft is to be bound round the foot, and then some broad thongs of ox-skin being brought round it, the heads of the thongs are to be fastened to a pestle or any other piece of wood, the end of which is to be inserted into the nave, and it, the pestle, is to be pulled away, while other persons make counter-extension by grasping the shoulders and the ham. It is also sometimes necessary to secure the upper extremity otherwise; this if you desire to effect, fasten deeply in the ground a round, smooth piece of wood, and place the upper extremity of the piece of wood at the perineum, so that it may prevent the body from yielding to the pulling at the foot, and, moreover, to prevent the leg while stretched, from inclining downward; some person seated at his side should push back the hip, so that the body may not turn round with the pulling, and for this purpose, if you think fit, pieces of wood may be fastened about the armpits on each side, and they are to be stretched by the hands, and thus secured, while another person takes hold of the limb at the knee, and aids in thus making counter-extension. Or thus, if you prefer it: having bound other thongs of leather about the limb, either at the knee, or around the thigh, and having fastened another nave of a wheel in the ground above the head, and adjusted the thongs piece of wood adapted to the nave, extension may thus be made in the opposite direction to the feet. Or if you choose, it may be done thus: instead of the naves, lay a moderate-sized beam under the couch, and then having fastened pieces of wood in this beam, both before and behind the head, make counter-extension by means of thongs, or place windlasses at this extremity and that, and make extension by means of them. There are many other methods of making extension. But the best thing is, for any physician who practices in a large city, to have prepared a proper wooden machine, with all the mechanical powers applicable in cases of fractures and dislocation, either for making extension, or acting as a lever. For this purpose it will be sufficient to possess a board in length, breadth, and thickness, resembling the quadrangular threshing-boards made of oak.

> Greek: 13. 13. ὀλισθάνει δὲ ἔστιν ὅτε τὰ πρὸς τοῦ ποδὸς, ὁτὲ μὲν ξὺν τῇ ἐπιφύσει ἀμφότερα τὰ ὀστέα, ὁτὲ δὲ ἡ ἐπίφυσις ἐκινήθη, ὁτὲ δὲ τὸ ἕτερον ὀστέον. ταῦτα δὲ ὀχλώδεα μὲν ἧσσον, ἢ τὰ ἐν τῷ καρπῷ τῶν χειρέων, εἰ τολμῷεν ἀτρεμέειν οἱ ἄνθρωποι. ἴησις δὲ παραπλησίη, οἵη περ ἐκείνων· τήν τε γὰρ ἐμβολὴν χρὴ ποιέεσθαι ἐκ κατατάσιος ὥσπερ ἐκείνων, ἰσχυροτέρης δὲ δεῖται τῆς κακατάσιος, ὅσῳ καὶ ἰσχυρότερον τὸ σῶμα ταύτῃ. ἐς τὰ πλεῖστα μὲν γὰρ ἀρκέουσιν ἄνδρες δύο, ὁ μὲν ἔνθεν, ὁ δὲ ἔνθεν τείνοντες. ἢν δὲ μὴ ἰσχύωσιν, ἰσχυροτέρην ῤηΐδιόν ἐστι ποιέειν τὴν κατάτασιν· ἢ γὰρ πλήμνην κατορύξαντα χρὴ, ἢ ἄλλο τι ὅ τι τούτῳ ἔοικεν, μαλθακόν τι περὶ τὸν πόδα περιβάλλειν· ἔπειτα πλατέσι βοείοισιν ἱμᾶσι περιδήσαντα τὸν πόδα, τὰς ἀρχὰς τῶν ἱμάντων, ἢ πρὸς ὕπερον, ἢ πρὸς ἕτερον ξύλον προσδήσαντα, τὸ ξύλον πρὸς τὴν πλήμνην ἄκρον ἐνθέντα ἐπανακλᾷν· τοὺς δὲ ἀντιτείνειν, ἄνωθεν τῶν τε ὤμων ἐχομένους καὶ τῆς ἰγνύης. ἔστι δὲ καὶ τὸ ἄνω τοῦ σώματος ἀνάγκῃ προσλαβεῖν· τοῦτο μὲν ἢν βούλῃ, ξύλον στρογγύλον, λεῖον, κατορύξας βαθέως, μέρος τι αὐτοῦ ὑπερέχον τοῦ ξύλου μεσηγὺ τῶν σκελέων ποιήσασθαι παρὰ τὸν περίνεον, ὡς κωλύῃ ἀκολουθέειν τὸ σῶμα τοῖσι πρὸς ποδῶν τείνουσιν· ἔπειτα πρὸς τὸ τεινόμενον σκέλος μὴ ῤέπειν, τὸν δέ τινα πλάγιον παρακαθήμενον ἀπωθέειν τὸν γλουτὸν, ὡς μὴ περιέλκηται τὸ σῶμα. τοῦτο δὲ καὶ ἢν βούλῃ, περὶ τὰς μασχάλας ἔνθεν καὶ ἔνθεν τὰ ξύλα παραπέπηγεν, αἱ δὲ χεῖρες παρατεταμέναι φυλάσσονται, προσεπιλαμβανέτω δέ τις κατὰ τὸ γόνυ, καὶ οὕτως ἀντιτείνοιτο. τοῦτο δʼ ἢν παρὰ τὸ γόνυ βούληται, ἄλλους ἱμάντας περιδήσας, ἢ περὶ τὸν μηρὸν, πλήμνην ἄλλην ὑπὲρ κεφαλῆς κατορύξας, ἐξαρτήσας τοὺς ἱμάντας ἔκ τινος ξύλου, τὸ ξύλον στηρίζων ἐς τὴν πλήμνην, τἀναντία τῶν πρὸς ποδῶν ἕλκειν. τοῦτο δʼ ἢν βούλῃ, ἀντὶ τῶν πλημνέων δοκίδα ὑποτείνας ὑπὸ τὴν κλίνην μετρίην, ἔπειτα πρὸς τῆς δοκίδος ἔνθεν καὶ ἔνθεν τὴν κεφαλὴν στηρίζων καὶ ἀνακλῶν τὰ ξύλα, κατατείνειν τοὺς ἱμάντας· ἢν δὲ θέλῃς, ὀνίσκους καταστήσας ἔνθεν καὶ ἔνθεν, ἐπʼ ἐκείνων τὴν κατάτασιν ποιέεσθαι. πολλοὶ δὲ καὶ ἄλλοι τρόποι κατατασίων. ἄριστον δὲ, ὅστις ἐν πόλει μεγάλῃ ἰητρεύει, κεκτῆσθαι ἐσκευασμένον ξύλον, ἐν ᾧ πᾶσαι αἱ ἀνάγκαι ἔσονται πάντων μὲν κατηγμάτων, πάντων δὲ ἄρθρων ἐμβολῆς ἐκ κατατάσιος καὶ μοχλεύσιος· ἀρκέει δὲ τὸ ξύλον, ἢν ᾖ τοιοῦτον οἷον οἱ τετράγωνοι τρίβολοι δρύϊνοι γίνονται, μῆκος καὶ πλάτος καὶ πάχος.