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

# 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.

## 3. Sections 30–48

Source: https://scriptura.si/works/hippocrates-on-fractures/3/ · cite a paragraph as https://scriptura.si/works/hippocrates-on-fractures/3/#p-N

[¶0] 30. In such cases as do not admit of bandaging according to any of the methods which have been described, or which will be described, great pains should be taken that the fractured part of the body be laid in a right position, and attention should be paid that it may incline upward rather than downward. But if one would wish to do the thing well and dexterously, it is proper to have recourse to some mechanical contrivance, in order that the fractured part of the body may undergo proper and not violent extension; and this means is particularly applicable in fractures of the leg. There are certain physicians who, in all fractures of the leg, whether bandages be applied or not, fasten the sole of the foot to the couch, or to some other piece of wood which they have fixed in the ground near the couch. These persons thus do all sorts of mischief but no good; for it contributes nothing to the extension that the foot is thus bound, as the rest of the body will no less sink down to the foot, and thus the limb will no longer be stretched, neither will it do any good toward keeping the limb in a proper position, but will do harm, for when the rest of the body is turned to this side or that, the bandaging will not prevent the foot and the bones belonging to it from following the rest of the body. For if it had not been bound it would have been less distorted, as it would have been the less prevented from following the motion of the rest of the body. But one should sew two balls of Egyptian leather, such as are worn by persons confined for a length of time in large shackles, and the balls should have coats on each side, deeper toward the wound, but shorter toward the joints; and the balls should be well stuffed and soft, and fit well, the one above the ankles, and the other below the knee. Sideways it should have below two appendages, either of a single or double thong, and short, like loops, the one set being placed on either side of the ankle, and the other on the knee. And the other upper ball should have others of the same kind in the same line. Then taking four rods, made of the cornel tree, of equal length, and of the thickness of a finger, and of such length that when bent they will admit of being adjusted to the appendages, care should be taken that the extremities of the rods bear not upon the skin, but on the extremities of the balls. There should be three sets of rods, or more, one set a little longer than another, and another a little shorter and smaller, so that they may produce greater or less distention, if required. Either of these sets of rods should be placed on this side and that of the ankles. If these things be properly contrived, they should occasion a proper and equable extension in a straight line, without giving any pain to the wound; for the pressure, if there is any, should be thrown at the foot and the thigh. And the rods are commodiously arranged on either side of the ankles, so as not to interfere with the position of the limb; and the wound is easily examined and easily arranged. And, if thought proper, there is nothing to prevent the two upper rods from being fastened to one another; and if any light covering be thrown over the limb, it will thus be kept off from the wound. If, then, the balls be well made, handsome, soft, and newly stitched, and if the extension by the rods be properly managed, as has been already described, this is an excellent contrivance; but if any of them do not fit properly, it does more harm than good. And all other mechanical contrivances should either be properly done, or not be had recourse to at all, for it is a disgraceful and awkward thing to use mechanical means in an unmechanical way.

> Greek: 30. 30. ὅσους δὲ μὴ οἷόν τε ἐπιδέσει ἰήσασθαι διά τινα τούτων τῶν εἰρημένων τρόπων, ἢ τῶν εἰρησομένων, τούτους περὶ πλείονος χρὴ ποιέεσθαι, ὅκως εὐθέτως σχήσουσι τὸ κατεηγὸς τοῦ σώματος κατʼ ἰθυωρίην, προσέχοντα τὸν νόον, καὶ τῷ ἀνωτέρω δὲ μᾶλλον ἢ τῷ κατωτέρω. εἰ δέ τις μέλλοι καλῶς καὶ εὐχερῶς ἐργάζεσθαι, ἄξιον καὶ μηχανοποιήσασθαι, ὅκως κατάτασιν δικαίην καὶ μὴ βιαίην σχήσει τὸ κατεηγὸς τοῦ σώματος· μάλιστα δὲ ἐν κνήμῃ ἐνδέχεται μηχανοποιέειν Εἰσὶ μὲν οὖν τινες, οἳ ἐπὶ πᾶσι τοῖσι τῆς κνήμης κατήγμασι καὶ τοῖσιν ἐπιδεμένοισι, καὶ τοῖσι μὴ ἐπιδεομένοισι, ὸν πόδα ἄκρον προσδέουσι πρὸς τὴν κλίνην, ἢ πρὸς ἄλλο τι ξύλον παρὰ τὴν κλίνην κατορύξαντες. οὗτοι μὲν οὖν πάντα κακὰ ποιέουσιν, ἀγαθὸν δὲ οὐδέν· οὔτε γὰρ τοῦ κατατείνεσθαι ἄκος ἐστὶ τὸ προσδεδέσθαι τὸν πόδα, οὐδὲν γὰρ ἧσσον τὸ ἄλλο σῶμα προσχωρήσει πρὸς τὸν πόδα, καὶ οὕτως ν ἔτι τείνοιτο· οὔτʼ αὖ ἐς τὴν ἰθυωρίην οὐδὲν ὠφελέει, ἀλλὰ καὶ βλάπτει, στρεφομένου γὰρ τοῦ ἄλλου σώματος ἢ τῇ ἢ τῇ, οὐδὲ κωλύσει ὁ δεσμὸς τὸν πόδα καὶ τὰ ὀστέα τὰ τῷ ποδὶ προσηρτημένα ἐπακολουθέειν τῷ ἄλλῳ σώματι. εἰ δὲ μὴ προσεδέδετο, ἧσσον ἂν διεστρέφετο· ἧσσον γὰρ ἂν ἐγκατελείπετο ἐν τῇ κινήσει τοῦ ἄλλου σώματος. εἰ δέ τις σφαίρας δύο ῤάψαιτο ἐκ σκύτεος αἰγυπτίου τοιαύτας οἵας φοροῦσιν οἱ ἐν τῇσι μεγάλῃσι πέδῃσι πολλὸν χρόνον πεπεδημένοι, αἱ δὲ σφαῖραι ἔχοιεν ἔνθεν καὶ ἔνθεν χιτῶνας, τὰ μὲν πρὸς τοῦ τρώματος βαθυτέρους, τὰ δὲ πρὸς τῶν ἄρθρων βρ· χυτέρους, εἶεν δὲ ὀγκηραὶ μὲν καὶ μαλθακαὶ, ἁρμόζουσαι δὲ, ἡ μὲν ἄνωθεν τῶν σφυρῶν, ἡ δὲ κάτωθεν τοῦ γούνατος· ἐκ δὲ πλαγίης ἄκρης δισσὰ ἡ κάτωθεν ἔχοι προσηρτημένα, ἢ ἁπλόου ἱμάντος, ἢ διπλόου, βραχέα ὥσπερ ἀγκύλας, τὰ μέν τι τοῦ σφυροῦ ἑκατέρωθεν, τὰ δέ τι τοῦ γούνατος· καὶ ἡ ἄνωθεν σφαῖρα ἕτερα τοιαῦτα ἔχοι κατὰ τὴν ἰθυωρίην τὴν αὐτήν. κἄπειτα κραναΐνας ῤάβδους τέσσαρας λαβὼν ἴσον τὸ μέγεθος ἀλλήλῃσιν ἐχούσας, πάχος μὲν ὡς δακτυλιαίας, μῆκος δὲ ὡς κεκαμμέναι ἐναρμόσωσιν ἐς τὰ ἀπαιωρήματα, ἐπιμελόμενος ὅκως τὰ ἄκρα τῶν ῤάβδων μὴ ἐς τὸν χρῶτα, ἀλλʼ ἐς τὰ ἄκρα τῶν σφαιρέων ἐγκέλσει. εἶναι δὲ χρὴ ζεύγεα τρία τῶν ῤάβδων, καὶ πλέω, καί τινι μακροτέρας τὰς ἑτέρας τῶν ἑτέρων, καί τινι καὶ βραχυτέρας καὶ σμικροτέρας, ὡς καὶ μᾶλλον διατείνειν, ἢν βούληται, καὶ ἧσσον· ἔστωσαν δὲ αἱ ῤάβδοι ἑκάτεραι ἔνθεν καὶ ἔνθεν τῶν σφυρῶν. ταῦτα τοίνυν εἰ καλῶς μηχανοποιηθείη, τήν τε κατάτασιν καὶ δικαίην ἂν παρέχοι καὶ ὁμαλὴν κατὰ τὴν ἰθυωρίην, καὶ τῷ τρώματι πόνος οὐδεὶς ἂν εἴη· τὰ γὰρ ἀποπιέσματα, εἴ τι καὶ ἀποπιέζοιτο, τὰ μὲν ἂν ἐς τὸν πόδα ἀπάγοιτο, τὰ δὲ ἐς τὸν μηρόν· αἵ τε ῤάβδοι εὐθετώτεραι, αἱ μὲν ἔνθεν, αἱ δὲ ἔνθεν τῶν σφυρῶν, ὥστε μὴ κωλύεσθαι τὴν θέσιν τῆς κνήμης· τό τε τρῶμα εὐκατάσκεπτον καὶ εὐβάστακτον· οὐδὲν γὰρ ἐμποδὼν, εἴ τις ἐθέλοι τὰς δύο τῶν ῤάβδων τὰς ἀνωτέρω αὐτὰς πρὸς ἀλλήλας ζεῦξαι, καὶ ἤν τις κούφως βούληται ἐπιβάλλειν, ὥστε τὸ ἐπιβαλλόμενον μετέωρον ἀπὸ τοῦ τρώματος εἶναι. εἰ μὲν οὖν αἵ τε σφαῖραι προσηνέες καὶ καλαὶ καὶ μαλθακαὶ καὶ καιναὶ ῤαφεῖεν, καὶ ἡ ἔντασις τῶν ῤάβδων χρηστῶς ἐνταθείη, ὥσπερ ἤδη εἴρηται, εὔχρηστον τὸ μηχάνημα· εἰ δέ τι τουτέων μὴ καλῶς ἕξει, βλάπτοι ἂν μᾶλλον ἢ ὠφελέοι. χρὴ δὲ καὶ τὰς ἄλλας μηχανὰς ἢ καλῶς μηχανᾶσθαι, ἢ μὴ μηχανᾶσθαι· αἰσχρὸν γὰρ καὶ ἄτεχνον μηχανοποιέοντα ἀμηχανοποιέεσθαι.

[¶1] 31. Moreover, the greater part of physicians treat fractures, both with and without an external wound, during the first days, by means of unwashed wool, and there does not appear to be anything improper in this. It is very excusable for those who are called upon to treat newly-received accidents of this kind, and who have no cloth for bandages at hand, to do them up with wool; for, except cloth for bandages, one could not have anything better than wool in such cases; but a good deal should be used for this purpose, and it should be well carded and not rough, for in small quantity and of a bad quality it has little power. But those who approve of binding up the limb with wool for a day or two, and on the third and fourth apply bandages, and make the greatest compression and extension at that period, such persons show themselves to be ignorant of the most important principles of medicine; for, in a word, at no time is it so little proper to disturb all kinds of wounds as on the third and fourth day; and all sort of probing should be avoided on these days in whatever other injuries are attended with irritation. For, generally, the third and fourth day in most cases of wounds, are those which give rise to exacerbations, whether the tendency be to inflammation, to a foul condition of the sore, or to fevers. And if any piece of information be particularly valuable this is; to which of the most important cases in medicine does it not apply? and that not only in wounds but in many other diseases, unless one should call all other diseases wounds. And this doctrine is not devoid of a certain degree of plausibility, for they are allied to one another in many respects. But those who maintain that wool should be used until after the first seven days, and then that the parts should be extended and adjusted, and secured with bandages, would appear not to be equally devoid of proper judgment, for the proper judgment, for the most dangerous season for inflammation is then past, and the bones being loose can be easily set after the lapse of these days. But still this mode of treatment is far inferior to that with bandages from the commencement; for, the latter method exhibits the patient on the seventh day free from inflammation, and ready for complete bandaging with splints; while the former method is far behind in this respect, and is attended with many other bad effects which it would be tedious to describe. In those cases of fracture in which the bones protrude and cannot be restored to their place, the following mode of reduction may be practiced:— Some small pieces of iron are to be prepared like the levers which the cutters of stone make use of, one being rather broader and another narrower; and there should be three of them at least, and still more, so that you may use those that suit best; and then, along with extension, we must use these as levers, applying the under surface of the piece of iron to the under fragment of the bone, and the upper surface to the upper bone; and, in a word, we must operate powerfully with the lever as we would do upon a stone or a piece of wood. The pieces of iron should be as strong as possible, so that they may not bend. This is a powerful assistance, provided the pieces of iron be suitable, and one use them properly as levers. Of all the mechanical instruments used by men, the most powerful are these three, the axis in peritrochio, the lever, and the wedge. Without these, one or all, men could not perform any of their works which require great force. Wherefore, reduction with the lever is not to be despised, for the bones will be reduced in this way, or not at all. But if the upper fragment which rides over the other does not furnish a suitable point of support a suitable point of support for the lever, but the protruding part is sharp, you must scoop out of the bone what will furnish a proper place for the lever to rest on. The lever, along with extension, may be had recourse to on the day of the accident, or next day, but by no means on the third, the fourth, and the fifth. For if the limb is disturbed on these days, and yet the fractured bones not reduced, inflammation will be excited, and this no less if they are reduced; for convulsions are more apt to occur if reduction take place, than if the attempt should fail. These facts should be well known, for if convulsions should come on when reduction is effected, there is little hope of recovery; but it is of use to displace the bones again if this can be done with out trouble. For it is not at the time when the parts are in a particularly relaxed condition that convulsions and tetanus are apt to supervene, but when they are more than usually tense. In the case we are now treating of, we should not disturb the limb on the aforesaid days, but strive to keep the wound as free from inflammation as possible, and especially encourage suppuration in it. But when seven days have elapsed, or rather more, if there be no fever, and if the wound be not inflamed, then there will be less to prevent an attempt at reduction, if you hope to succeed; but otherwise you need not take and give trouble in vain.

> Greek: 31. 31. τοῦτο δὲ, οἱ πλεῖστοι τῶν ἰητρῶν τὰ κατήγματα, καὶ τὰ μεθʼ ἑλκέων, καὶ τὰ ἄνευ ἑλκέων, τὰς πρώτας τῶν ἡμερέων ἰητρεύουσιν εἰρίοισι ῤυπαροῖσιν· καὶ οὐδέν τι ἄτεχνον δοκέει τοῦτο εἶναι. ὅσοι μὲν ἀναγκάζονται ὑπὸ τῶν αὐτίκα νεοτρώτων ἐόντων, μὴ ἔχοντες ὀθόνια, εἰρίοισι παρασκευάσασθαι, τουτέοισι πλείστη συγγνώμη· οὐ γὰρ ἄν τις ἔχοι ἄνευ ὀθονίων ἄλλο τι πολλῷ βέλτιον εἰρίου ἐπιδῆσαι ἐπὶ τὰ τοιαῦτα· εἶναι δὲ χρὴ πάμπολλα, καὶ πάνυ καλῶς εἰργασμένα, καὶ μὴ τρηχέα· τῶν γὰρ ὀλίγων καὶ φλαύρων ὀλίγη καὶ ἡ δύναμις. ὅσοι δὲ ἐπὶ μίαν ἢ δύο ἡμέρας εἴρια ἐπιδέειν δικαιοῦσι, τρίτῃ δὲ καὶ τετάρτῃ ὀθονίοισιν ἐπιδέοντες πιέζουσι καὶ κατατείνουσι τότε μάλιστα, οὗτοι πουλύ τι τῆς ἰητρικῆς καὶ κάρτα ἐπίκαιρον ἀσυνετέουσιν· ἥκιστα γὰρ χρὴ τῇ τρίτῃ καὶ τετάρτῃ στυφελίζειν πάντα τὰ τρώματα, ὡς ἐν κεφαλαίῳ εἰρῆσθαι· καὶ μηλώσιας δὲ πάσας φυλάσσεσθαι χρὴ ἐν ταύτῃσι τῇσιν ἡμέρῃσι, καὶ ὁκόσοισιν ἄλλοισι τρώμασιν ἠρέθισται. τὸ ἐπίπαν γὰρ ἡ τρίτη καὶ τετότη ἡμέρη ἐπὶ τοῖσι πλείστοισι τῶν τρωμάτων τίκτει τὰς παλιγκοτήσιας, καὶ ὅσα ἐς φλεγμονὴν καὶ ἀκαθαρσίην ὁρμᾷ, καὶ ὅσα ἂν ἐς πυρετοὺς ἴῃ. καὶ μάλα πολλοῦ ἄξιον τοῦτο τὸ μάθημα, εἴ πέρ τι καὶ ἄλλο. τίνι γὰρ οὐκ ἐπικοινωνέει τῶν ἐπικαιροτάτων ἐν ἰητρικῇ, οὐ κατὰ τὰ ἕλκεα μοῦνον, ἀλλὰ καὶ κατὰ ἄλλα πουλλὰ νουσήματα; εἰ μή τις φήσειε καὶ τἄλλα νουσήματα ἕλκεα εἶναι. ἔχει γάρ τινα καὶ οὗτος ὁ λόγος ἐπιείκειαν· πολλαχῆ γὰρ ἠδέλφισται τὰ ἕτερα τοῖσιν ἑτέροισιν. ὁκόσοι μέντοι δικαιοῦσιν εἰρίοισι χρῆσθαι, ἔστʼ ἂν ἑπτὰ ἡμέραι παρέλθωσιν, ἔπειτα κατατείνειν τε καὶ κατορθοῦν, καὶ ὀθονίοισιν ἐπιδεῖν, οὗτοι οὐκ ἂν ἀσύνετοι ὁμοίως φανεῖεν· καὶ γὰρ τῆς φλεγμονῆς τὸ ἐπικαιρότατον παρελήλυθε, καὶ τὰ ὀστέα χαλαρὰ καὶ εὔθετα μετὰ ταύτας τὰς ἡμέρας ἂν εἴη. πολλῷ μέντοι ἡσσᾶται καὶ αὕτη ἡ μελέτη τῆς ἐξ ἀρχῆς τοῖσιν ὀθονίοισιν ἐπιδέσιος· κεῖνος μὲν γὰρ ὁ τρόπος ἑβδομαίους ἐόντας ἀφλεγμάντους ἀποδείκνυσι, καὶ παρασκευάζει νάρθηξι τελέως ἐπιδεῖν· οὗτος δὲ ὁ τρόπος πουλὺ ὑστερεῖ, βλάβας δέ τινας καὶ ἄλλας ἔχει, ἀλλὰ μακρὸν ἂν εἴη πάντα γράφειν.

[¶2] 32. When you have reduced the bones to their place, the modes of treatment, whether you expect the bones to exfoliate or not, have been already described. All those cases in which an exfoliation of bone is expected, should be treated by the method of bandaging with cloths, beginning for the most part at the middle of the bandage, as is done with the double-headed bandage; but particular attention should be paid to the shape of the wound, so that its lips may gape or be distorted as little as possible under the bandage. Sometimes the turns of the bandage have to be made to the right, and sometimes to the left, and sometimes a double-headed bandage is to be used. It should be known that bones, which it has been found impossible to reduce, as well as those which are wholly denuded of flesh, will become detached. In some cases the upper part of the bone is laid bare, and in others the flesh dies all around; and, from a sore of long standing, certain of the bones become carious, and some not, some more, and some less; and in some the small, and in others the large bones. From what has been said it will be seen, that it is impossible to tell in one word when the bones will separate. Some come away more quickly, owing to their smallness, and some from being merely fixed at the point; and some, from pieces not separating, but merely exfoliating, become dried up and putrid; and besides, different modes of treatment have different effects. For the most part, the bones separate most quickly in those cases in which suppuration takes place most quickly, and when new flesh is most quickly formed, and is particularly sound, for the flesh which grows up below in the wound generally elevates the pieces of bone. It will be well if the whole circle of the bone separate in forty days; for in some cases it is protracted to sixty days, and in some to more; for the more porous pieces of bone separate more quickly, but the more solid come away more slowly; but the other smaller splinters in much less time, and others otherwise. A portion of bone which protrudes should be sawn off for the following reasons: if it cannot be reduced, and if it appears that only a small piece is required in order that it may get back into its place; and if it be such that it can be taken out, and if it occasions inconvenience and irritates any part of the flesh, and prevents the limb from being properly laid, and if, moreover, it be denuded of flesh, such a piece of bone should be taken off. With regard to the others, it is not of much consequence whether they be sawed off or not. For it should be known for certain, that such bones as are completely deprived of flesh, and have become dried, all separate completely. Those which are about to exfoliate should not be sawn off. Those that will separate completely must be judged of from the symptoms that have been laid down.

> Greek: 32. 32. Ὁκόσοισι δὲ τὰ ὀστέα κατεηγότα καὶ ἐξίσχοντα μὴ δύνηται ἐς τὴν ἑωυτῶν χώρην καθιδρύεσθαι, ἥδε ἡ κατάστασις· σιδήρια χρὴ ποιέεσθαι ἐς τοῦτον τὸν τρόπον ὕνπερ οἱ μοχλοὶ ἔχουσιν, οἷς οἱ λατύποι χρέονται, τὸ μέν τι πλατύτερον, τὸ δὲ τι στενότερον· εἶναι δὲ χρὴ καὶ τρία καὶ ἔτι πλείω, ὡς τοῖσι μάλιστα ἁρμόζουσί τις χρήσαιτο· ἔπειτα τουτέοισι χρὴ ἅμα τῇ κατατάσει μοχλεύειν ὑποβάλλοντα, πρὸς μὲν τὸ κατώτερον τοῦ ὀστέου τὸ κατώτερον ἐρείδοντα, πρὸς δὲ τὸ ἀνώτερον τὸ ἀνώτερον τοῦ σιδηρίου, ἁπλῷ δὲ λόγῳ ὥσπερ εἰ λίθον τις ἢ ξύλον μοχλεύοι ἰσχυρῶς· ἔστω δὲ σθεναρὰ τὰ σιδήρια ὡς οἷόν τε, ὡς μὴ κάμπτηται. αὕτη μεγάλη τιμωρίη, ἤν τε τὰ σιδήρια ἐπιτήδεια ᾖ, καὶ μοχλεύηταί τις ὡς χρή. ὁκόσα γὰρ ἀνθρώποις ἄρμενα μεμηχάνηται, πάντων, ἰσχυρότατά ἐστι τρία ταῦτα, ὄνου τε περιαγωγὴ, καὶ μόχλευσις, καὶ σφήνωσις. ἄνευ δὲ τούτων, ἢ ἑνὸς δή τινος, ἢ πάντων, οὐδὲν τῶν ἔργων τῶν ἰσχυροτάτων οἱ ἄνθρωποι ἐπιτελέουσιν. οὔκουν ἀτιμαστέη αὕτη ἡ μόχλευσις· ἢ γὰρ οὕτως ἐμπεσεῖται τὰ ὀστέα, ἢ οὐκ ἄλλως. ἢν δʼ ἄρα τοῦ ὀστέου τὸ ἄνω παρηλλαγμένον μὴ ἐπιτήδειον ἔχῃ ἐνέδρην τῷ μοχλῷ, ἀλλὰ πάροξυ ἐὸν παραφέρῃ, παραγλύψαντα χρὴ τοῦ ὀστέου ἐνέδρην τῷ μοχλῷ ἀσφαλέα ποιῆσαι. μοχλεύειν δὲ χρὴ καὶ τείνειν αὐθήμερα, ἢ δευτεραῖα, τριταῖα δὲ μὴ, τεταρταῖα δὲ, ὡς ἥκιστα, καὶ πεμπταῖα. καὶ γὰρ μὴ ἐμβάλλοντι, ὀχλήσαντι δὲ ἐν ταύτῃσι τῇσιν ἡμέρῃσιν, φλεγμονὴν ἂν ποιήσειε, καὶ ἐμβάλλοντι οὐδὲν ἧσσον· σπασμὸν μέντοι ἐμβάλλοντι πουλὺ ἂν μᾶλλον ποιήσειεν, ἢ ἀπορήσαντι ἐμβάλλειν. ταῦτα εὖ χρὴ εἰδέναι· καὶ γὰρ εἰ ἐπιγένοιτο σπασμὸς ἐμβάλλοντι, ἐλπίδες μὲν οὐ πολλαὶ σωτηρίης· λυσιτελέει δὲ ὀπίσω ἐκβάλλειν τὸ ὀστέον, εἰ οἷόν τε εἴη ἀόχλως. οὐ γὰρ ἐπὶ τοῖσι χαλαρωτέροισι τοῦ καιροῦ σπασμοὶ καὶ τέτανοι ἐπιγίνονται, ἀλλʼ ἐπὶ τοῖσιν ἐντεταμένοισι μᾶλλον. περὶ οὗ οὖν ὁ λόγος, οὐ χρὴ ἐνοχλέειν ἐν τῇσι προειρημένῃσιν ἡμέρῃσι ταύτῃσιν, ἀλλὰ μελετᾷν ὅκως ἥκιστα φλεγμανεῖ τὸ ἕλκος, καὶ μάλιστα ἐκπυήσει. ἐπὴν δὲ ἑπτὰ ἡμέραι παρέλθωσιν, ἢ ὀλίγῳ πλείους, ἢν ἀπύρετος ᾖ, καὶ μὴ φλεγμαίνῃ τὸ ἕλκος, τότε ἧσσον κωλύει πειρῆσθαι ἐμβάλλειν, ἢν ἐλπίζῃς κρατήσειν· ἢν δὲ μὴ, οὐδὲν δεῖ μάτην ὀχλέειν καὶ ὀχλέεσθαι. 33. ἢν μὲν οὖν ἐμβάλῃς τὰ ὀστέα ἐς τὴν ἑωυτῶν χώρην, γεγράφαται ἤδη οἱ τρόποι οἵως χρὴ ἰητρεύειν, ἤν τε ἐλπίζῃς ὀστέα ἀποστήσεσθαι, ἤν τε μή. χρὴ δὲ, καὶ ἢν μὲν ἐλπίζῃς ὀστέα ἀποστήσεσθαι, τῷ τρόπῳ τῶν ὀθονίων ἐπὶ πᾶσι τοῖσι τοιουτέοισι τὴν ἐπίδεσιν ποιέεσθαι, ἐκ μέσου τοῦ ὀθονίου ἀρχόμενον ὡς ἐπὶ τὸ πουλὺ, ὡς ἀπὸ δύο ἀρχέων ὑποδεσμὶς ἐπιδεῖται· τεκμαίρεσθαι δὲ χρὴ πρὸς τὴν μορφὴν τοῦ ἕλκεος, ὅκως ἥκιστα σεσηρὸς καὶ ἐκπεπλιγμένον ἔσται παρὰ τὴν ἐπίδεσιν· τοῖσι μὲν γὰρ ἐπὶ δεξιὰ ἐπιδεῖν ξυντρόφως ἔχει, τοῖσι δὲ ἐπʼ ἀριστερὰ, τοῖσι δὲ ἀπὸ δύο ἀρχέων.

[¶3] 34. Such cases are to be treated with compresses and vinous applications, as formerly laid down regarding bones which will separate. We must avoid wetting it at the beginning with anything cold; for there is danger of febrile rigors, and also of convulsions; for convulsions are induced by cold things, and also sometimes by wounds. It is proper to know that the members are necessarily shortened in those cases in which the bones have been broken, and have healed the one across the other, and in those cases in which the whole circle of the bone has become detached. Those cases in which the bone of the thigh, or of the arm, protrudes, do not easily recover. For the bones are large, and contain much marrow; and many important nerves, muscles, and veins are wounded at the same time. And if you reduce them, convulsions usually supervene; and, if not reduced, acute bilious fevers come on, with singultus and mortification. The chances of recovery are not fewer in those cases in which the parts have not been reduced, nor any attempts made at reduction. Still more recover in those cases in which the lower, than those in which the upper part of the bone protrudes; and some will recover when reduction has been made, but very rarely indeed. For modes of treatment and peculiarity of constitution make a great difference as to the capability of enduring such an injury. And it makes a great difference if the bones of the arm and of the thigh protrude to the inside; for there are many and important vessels situated there, some of which, if wounded, will prove fatal; there are such also on the outside, but of less importance. In wounds of this sort, then, one ought not to be ignorant of the dangers, and should prognosticate them in due time. But if you are compelled to have recourse to reduction, and hope to succeed, and if the bones do not cross one another much, and if the muscles are not contracted (for they usually are contracted), the lever in such cases may be advantageously employed.

> Greek: 34. 34. ὁκόσα δὲ κατηπορήθη ὀστέα ἐμπεσεῖν, ταῦτα αὐτὰ εἰδέναι χρὴ ὅτι ἀποστήσεται, καὶ ὅσα τελέως ἐψιλώθη τῶν σαρκῶν· ψιλοῦται δὲ ἐνίων μὲν τὸ ἄνω μέρος, μετεξετέρων δὲ κύκλωθεν ἀμφιθνήσκουσιν αἱ σάρκες· καὶ τῶν μὲν ἀπὸ τοῦ ἀρχαίου τρώματος σεσάπρισται ἔνια τῶν ὀστέων, τῶν δʼ οὔ· καὶ τῶν μὲν μᾶλλον, τῶν δʼ ἧσσον· καὶ τὰ μὲν σμικρὰ, τὰ δὲ μεγάλα. διὰ οὖν ταῦτα τὰ εἰρημένα οὐκ ἔστιν ἑνὶ ὀνόματι εἰπεῖν, ὁκότε τὰ ὀστέα ἀποστήσεται. τὰ μὲν γὰρ διὰ σμικρότητα, τὰ δὲ διὰ τὸ ἐπʼ ἄκρου ἔχεσθαι, θᾶσσον ἀφίσταται· τὰ δὲ, διὰ τὸ μὴ ἀφίστασθαι, ἀλλὰ λεπιδοῦσθαι, καταξηρανθέντα, καὶ σαπρὰ γενόμενα· πρὸς δὲ τούτοις, διαφέρει τι καὶ ἰητρείη ἰητρείης. ὡς μὲν οὖν τὸ ἐπίπαν τάχιστα τουτέων ὀστέα ἀφίσταται, ὧν τάχισται μὲν αἱ ἐκπυήσιες, τάχισται δὲ καὶ κάλλισται αἱ σαρκοφυΐαι· καὶ γὰρ αἱ ὑποφυόμεναι σάρκες κατὰ τὸ σιναρὸν αὗται μετεωρίζουσι τὰ ὀστέα ὡς ἐπὶ τὸ πουλύ. ὅλος μὴν ὁ κύκλος τοῦ ὀστέου, ἢν ἐν τεσσαράκοντα ἡμέρῃσιν ἀποστῇ, καλῶς ἀποστήσεται· ἔνια γὰρ ἐς ἑξήκοντα ἡμέρας ἀφικνεῖται, ἢ καὶ πλείους· τὰ μὲν γὰρ ἀραιότερα τῶν ὀστέων θᾶσσον ἀφίσταται· τὰ δὲ στερεώτερα, βραδύτερον· τὰ δὲ ἄλλα τὰ μείω, πολλὸν ἐνδοτέρω, ἄλλα δʼ ἄλλως. Ἀποπρίειν δʼ ὀστέον ἐξέχον ἐπὶ τῶνδε τῶν προφασίων χρὴ, ἢν μὴ δύνηται ἐμβάλλειν, μικροῦ δέ τινος αὐτῷ δοκέῃ δεῖν παρελθεῖν, καὶ οἷόν τε ᾖ παραιρεθῆναι· ἤν τε ἀσηρὸν ᾖ καὶ θραῦόν τι τῶν σαρκίων, καὶ δυσθεσίην παρέχῃ, ψιλὸν δὲ τυγχάνῃ ἐὸν, καὶ τὸ τοιοῦτον ἀφαιρέειν χρή. τὰ δʼ ἄλλα οὐδὲν μέγα διαφέρει, οὔτε ἀποπρῖσαι, οὔτε μὴ ἀποπρῖσαι. σαφέως γὰρ εἰδέναι χρὴ, ὅτι ὀστέα, ὅσα τελέως στέρεται τῶν σαρκῶν καὶ ἐπιξηραίνεται, πάντα τελέως ἀποστήσεται. ὅσα δὲ ἀπολεπιδοῦσθαι μέλλει, ταῦτα οὐ χρὴ ἀποπρίειν· τεκμαίρεσθαι δὲ χρὴ ἀπὸ τῶν τεταγμένων σημείων τὰ τελέως ἀποστησόμενα. 35. ἰητρεύειν δὲ τοὺς τοιούτους σπλήνεσι καὶ τῇ οἰνηρῇ ἰητρείῃ, ὥσπερ καὶ πρόσθεν γέγραπται ἐπὶ τῶν ἀποστησομένων ὀστέων. φυλάσσεσθαι δὲ χρὴ μὴ ψυχροῖσι τέγγειν τὸν πρῶτον χρόνον· ῤιγέων γὰρ πυρετωδέων κίνδυνος· κίνδυνος δὲ καὶ σπασμῶν· προκαλέεται γὰρ σπασμὸν τὰ ψυχρὰ, ποτὶ δὲ καὶ ἕλκη. εἰδέναι δὲ χρὴ, ὅτι ἀνάγκη βραχύτερα τὰ σώματα ταύτῃ γίνεσθαι, ὧν ἀμφότερα τὰ ὀστέα κατεηγότα καὶ παρηλλαγμένα ἰητρεύεται, καὶ οἷς ὅλος ὁ κύκλος τοῦ ὀστέου ἀπέστη.

[¶4] 36. Having effected the reduction, you must give an emollient draught of hellebore the same day, provided it has been reduced on the day of the accident, but otherwise it should not be attempted. The wound should be treated with the same things as are used in fractures of the bones of the head, and nothing cold should be applied; the patient should be restricted from food altogether, and if naturally of a bilious constitution, he should have for a diet a little fragrant oxyglyky sprinkled on water; but if he is not bilious, he should have water for drink; and if fever of the continual type come on, he is to be confined to this regimen for fourteen days at least, but if he be free of fever, for only seven days, and then you must bring him back by degrees to a common diet. To those cases in which the bones have not been reduced, a similar course of medicine should be administered, along with the same treatment of the sores and regimen; and in like manner the suspended part of the body should not be stretched, but should rather be contracted, so as to relax the parts about the wound. The separation of the bones is protracted, as also was formerly stated. But one should try to escape from such cases, provided one can do so honourably, for the hopes of recovery are small, and the dangers many; and if the physician do not reduce the fractured bones he will be looked upon as unskillful, while by reducing them he will bring the patient nearer to death than to recovery.

> Greek: 36. 36. Ὅσοισι δὲ μηροῦ ὀστέον ἢ βραχίονος ἐξέσχεν, οὗτοι οὐ μάλα περιγίνονται. τὰ γὰρ ὀστέα μεγάλα καὶ πολυμύελα, καὶ πολλὰ καὶ ἐπίκαιρα τὰ συντιτρωσκόμενα νεῦρα καὶ μύες καὶ φλέβες· καὶ ἢν μὲν ἐμβάλλῃς, σπασμοὶ φιλέουσιν ἐπιγίνεσθαι, μὴ ἐμβληθεῖσι δὲ, πυρετοὶ ὀξέες, καὶ ἐπίχολοι, καὶ λυγγώδεες, καὶ ἐπιμεαινονται. περιγίνονται δὲ οὐχ ἧσσον, οἷσι μὴ ἐμβληθῇ, μηδὲ ειρηθῇ ἐμβάλλεσθαι· ἔτι δὲ μᾶλλον περιγίνονται, οἷσι τὸ κάτω μέρος τοῦ ὀστέου ἐξέσχεν, ἢ οἷσι τὸ ἄνω· περιγένοιντο δʼ ἂν καὶ οἷσιν ἐμβληθείη, σπανίως γε μήν. μελέται γὰρ μελετέων μέγα διαφέρουσι, καὶ φύσιες φυσίων τῶν σωμάτων εἰς εὐφορίην. διαφέρει δὲ μέγα, καὶ ἢν ἔσω τοῦ βραχίονος καὶ τοῦ μηροῦ τὰ ὀστέα ἐξέχῃ· πολλαὶ γὰρ καὶ ἐπίκαιροι κατατάσιες φλεβῶν ἐν τῷ ἔσω μέρει, ὧν ἔνιαι τιτρωσκόμεναι σφάγιαί εἰσιν· εἰσὶ δὲ καὶ ἐν τῷ ἔξω μέρει, ἧσσον δέ. ἐν τοῖσιν οὖν τοιούτοισι τρώμασι τοὺς μὲν κινδύνους οὐ χρὴ λήθειν, ὁκοῖοί τινές εἰσι, καὶ προλέγειν χρὴ πρὸς τοὺς καιρούς. εἰ δὲ ἀναγκάζοιο μὲν ἐμβάλλειν, ἐλπίζοις δὲ ἐμβαλεῖν, καὶ μὴ πολλὴ ἡ παράλλαξις εἴη τοῦ ὀστέου, καὶ μὴ ξυνδεδραμήκοιεν οἱ μύες (φιλέουσι γὰρ ξυνθεῖν), ἡ μόχλευσις καὶ τούτοισι μετὰ τῆς κατατάσιος εὖ ἂν ξυλλαμβάνοιτο.

[¶5] 37. Luxations and subluxations at the knee are much milder accidents than subluxations and luxations at the elbow. For the knee-joint, in proportion to its size, is more compact than that of the arm, and has a more even conformation, and is rounded, while the joint of the arm is large, and has many cavities. And in addition, the bones of the leg are nearly of the same length, for the external one overtops the other to so small an extent as hardly to deserve being mentioned, and therefore affords no great resistance, although the external nerve (ligament?) at the ham arises from it; but the bones of the fore-arm are unequal, and the shorter is considerably thicker than the other, and the more slender (ulna?) protrudes, and passes up above the joint, and to it (the olecranon?) are attached the nerves (ligaments?) which go downward to the junction of the bones; and the slender bone (ulna?) has more to do with the insertion of the ligaments in the arm than the thick bone (radius?). The configuration then of the articulations, and of the bones of the elbow, is such as I have described. Owing to their configuration, the bones at the knee are indeed frequently dislocated, but they are easily reduced, for no great inflammation follows, nor any constriction of the joint. They are displaced for the most part to the inside, sometimes to the outside, and occasionally into the ham. The reduction in all these cases is not difficult, but in the dislocations inward and outward, the patient should be placed on a low seat, and the thigh should be elevated, but not much. Moderate extension for the most part sufficeth, extension being made at the leg, and counter-extension at the thigh.

> Greek: 37. 37. ἐμβάλλοντα δὲ, ἐλλέβορον μαλθακὸν πιπίσαι χρὴ αὐθημερὸν, ἢν αὐθημερὸν ἐμβληθῇ· εἰ δὲ μὴ, οὐδʼ ἐγχειρέειν χρή. τὸ δὲ ἕλκος ἰητρεύειν χρὴ, οἷσί περ κεφαλῆς ὀστέα κατεηγυίης, καὶ ψυχρὸν μηδὲν προσφέρειν· σιτίου δέ στερῆσαι τελέως· καὶ ἢν μὲν πικρόχολος φύσει ᾖ, ὀξύγλυκυ εὐῶδες ὀλίγον ἐπὶ ὕδωρ ἐπιστάζοντα, τουτέῳ διαιτᾷν· ἢν δὲ μὴ πικρόχολος ᾖ, ὕδατι πόματι χρῆσθαι· καὶ ἢν μὲν πυρεταίνῃ ξυνεχῶς, τεσσαρεσκαίδεκα ἡμέρῃσι τὸ ἐλάχιστον οὕτω διαιτᾷν, ἢν δὲ ἀπύρετος ᾖ, ἑπτὰ ἡμέρῃσιν· ἔπειτα ἐκ προσαγωγῆς κατὰ λόγον ἐς φαύλην δίαιταν ἄγειν. καὶ οἷσιν ἂν μὴ ἐμβληθῇ τὰ ὀστέα, καὶ τὴν φαρμακείην χρὴ τοιαύτην ποιέεσθαι, καὶ τῶν ἑλκέων τὴν μελέτην καὶ τὴν δίαιταν· ὡσαύτως καὶ τὸ ἀπαιωρεύμενον τοῦ σώματος μὴ κατατείνειν, ἀλλὰ καὶ προσάγειν μᾶλλον, ὥστε χαλαρώτερον εἶναι τὸ κατὰ τὸ ἕλκος. τῶν δὲ ὀστέων ἀπόστασις χρονίη, ὥσπερ καὶ πρόσθεν εἴρηται. μάλιστα δὲ χρὴ τὰ τοιαῦτα διαφυγεῖν, ἅμα ἤν τις καλὴν ἔχῃ τὴν ἀποφυγήν· αἵ τε γὰρ ἐλπίδες ὀλίγαι, καὶ οἱ κίνδυνοι πολλοί· καὶ μὴ ἐμβάλλων ἄτεχνος ἂν δοκέοι εἶναι, καὶ ἐμβάλλων ἐγγυτέρω ἂν τοῦ θανάτου ἀγάγοι, ἢ τῆς σωτηρίης.

[¶6] 38. Dislocations at the elbow are more troublesome than those at the knee, and, owing to the inflammation which comes on, and the configuration of the joint, are more difficult to reduce if the bones are not immediately replaced. For the bones at the elbow are less subject to dislocation than those of the knee, but are more difficult to reduce and keep in their position, and are more apt to become inflamed and ankylosed. For the most part the displacements of these bones are small, sometimes toward the ribs, and sometimes to the outside; and the whole articulation is not displaced, but that part of the humerus remains in place which is articulated with the cavity of the bone of the forearm that has a protuberance (ulna?). Such dislocations, to whatever side, are easily reduced, and the extension is to be made in the line of the arm, one person making extension at the wrist, and another grasping the armpit, while a third, applying the palm of his hand to the part of the joint which is displaced, pushes it inward, and at the same time makes counterpressure on the opposite side near the joint with the other hand.

> Greek: 38. 38. τὰ δὲ ὀλισθήματα τὰ κατὰ τὰ γούνατα, καὶ τὰ διακινήματα τῶν ὀστέων εὐηθέστερα πουλὺ τῶν κατʼ ἀγκῶνα κινημάτων καὶ ὀλισθημάτων. τό τε γὰρ ἄρθρον τοῦ μηροῦ εὐσταλέστερον ὡς ἐπὶ μεγέθει, ἢ τὸ τοῦ βραχίονος, καὶ δικαίην φύσιν μοῦνον ἔχον, καὶ ταύτην περιφερέα· τὸ δὲ τοῦ βραχίονος ἄρθρον μέγα τε καὶ βαθμίδας πλείονας ἔχον. πρὸς δὲ τούτοις, τὰ μὲν τῆς κνήμης ὀστέα παραπλήσια μῆκός ἐστι, καὶ σμικρόν τι οὐκ ἄξιον λόγου τὸ ἔξω ὀστέον ὑπερέχει, οὐδενὸς μεγάλου κώλυμα ἐὸν, ἀφʼ οὗ περ πέφυκεν ὁ ἔξω τένων ὁ παρὰ τὴν ἰγνύην· τὰ δὲ τοῦ πήχεος ὀστέα ἄνισά ἐστιν, καὶ τὸ βραχύτερον παχύτερον συχνῷ, τὸ δὲ λεπτότερον πολλῷ ὑπερβάλλει καὶ ὑπερέχει τὸ ἄρθρον· ἑξήρτηται μέντοι καὶ τοῦτο τῶν νεύρων κατὰ τὴν κοινὴν ξύμφυσιν τῶν ὀστέων· πλεῖον δὲ μέρος ἔχει τῆς ἐξαρτήσιος των νεύρων ἐν τῷ βραχίονι τὸ λεπτὸν ὀστέον, ἤπερ τὸ παχύ. ἡ μὲν οὖν φύσις τοιουτότροπος τῶν ἄρθρων τούτων καὶ τῶν ὀστέων τοῦ ἀγκῶνος. καὶ διὰ τὸν τρόπον τῆς φύσιος τὰ κατὰ τὸ γόνυ ὀστέα πολλάκις μὲν ὀλισθάνει, ῤηϊδίως δὲ ἐμπίπτει· φλεγμονὴ δὲ οὐ μεγαλη προσγίνεται, οὐδὲ δεσμὸς τοῦ ἄρθρου. ὀλισθάνει δὲ τὰ πλεῖστα ἐς τὸ ἔσω μέρος, ἔστι δʼ ὅτε καὶ ἐς τὸ ἔξω, ποτὲ δὲ καὶ ἐς τὴ ἰγνύην. τούτων ἁπάντων αἱ ἐμβολαὶ οὐ χαλεπαὶ, ἀλλὰ τὰ μὲν ἔξω καὶ ἔσω ὀλισθάνοντα, καθῆσθαι μὲν χρὴ τὸν ἄνθρωπον ἐπὶ χαμαιζήλου τινὸς, τὸ δὲ σκέλος ἀνωτέρω ἔχειν, μὴ μὴν πολλῷ. κατάτασις δὲ ὡς ἐπὶ τὸ πουλὺ μετρίη ἀρκέει, τῇ μὲν κατατείνειν τὴν κνήμην, τῇ δὲ ἀντιτείνειν τὸν μηρόν. 39. τὰ δὲ κατὰ τὸν ἀγκῶνα ὀχλωδέστερά ἐστι τῶν κατὰ τὸ γόνυ, καὶ δυσεμβολώτερα καὶ διὰ τὴν φλεγμονὴν καὶ διὰ τὴν φύσιν, ἢν μή τις αὐτίκα ἐμβάλῃ. ὀλισθάνει μὲν γὰρ ἧσσον, ἢ ἐκεῖνα, δυσεμβολώτερα δὲ καὶ δυσθετώτερα, καὶ ἐπιφλεγμαίνει μᾶλλον καὶ ἐπιπωροῦται.

[¶7] 40. The end of the humerus at the elbow gets displaced (subluxated?) by leaving the cavity of the ulna. Such luxations readily yield to reduction, if applied before the parts get inflamed. The displacement for the most part is to the inside, but sometimes to the outside, and they are readily recognized by the shape of the limb. And often such luxations are reduced without any powerful extension. In dislocations inward, the joint is to be pushed into its place, while the fore-arm is brought round to a state of pronation. Such are most of the dislocations at the elbow.

> Greek: 40. 40. ἔστι δὲ καὶ τούτων τὰ μὲν πλεῖστα σμικραὶ ἐγκλίσιες, ἄλλοτε ἐς τὸ πρὸς τῶν πλευρέων μέρος, ἄλλοτε ἐς τὸ ἔξω· οὐ πᾶν δὲ τὸ ἄρθρον μεταβεβηκὸς, ἀλλὰ, μένον κατὰ τὸ κοῖλον τοῦ ὀστέου τοῦ βραχίονος, ᾗ τὸ τοὕ πήχεος ὀστέον τὸ ὑπερέχον, ἐξέσχεν. τὰ μὲν οὖν τοιαῦτα, κἂν τῇ ἢ τῇ ὀλίσθῃ, ῤηΐδιον ἐμβάλλειν, καὶ ἀπόχρη ἡ κατάτασις ἡ ἐς τὸ ἰθὺ γινομένη κατʼ ἰθυωρίην τοῦ βραχίονος, τὸν μὲν κατὰ τὸν καρπὸν τῆς χειρὸς τείνειν, τὸν δὲ κατὰ τὴν μασχάλην περιβάλλοντα, τὸν δὲ τῇ ἑτέρῃ πρὸς τὸ ἐξεστεὸς ἄρθρον τὸ θέναρ προσβάλλοντα ὠθέειν, τῇ δʼ ἑτέρῃ ἀντωθέειν προσβάλλοντα ἐγγὺς τῷ ἄρθρῳ. ἐνακούει δὲ οὐ βραδέως ἐμβαλλόμενα τὰ τοιαῦτα ὀλισθήματα, ἢν, πρὶν φλεγμήνῃ, ἐμβάλλῃ τις. ὀλισθάνει δὲ ὡς ἐπὶ τὸ πουλὺ μᾶλλον ἐς τὸ ἔσω μέρος, ὀλισθάνει δὲ καὶ ἐς τὸ ἔξω, εὔδηλα δὲ τῷ σχήματι. καὶ πολλάκις ἐμπίπτει τὰ τοιαῦτα, καὶ ἄνευ ἰσχυρῆς κατατάσιος· χρὴ δὲ τῶν ἔσω ὀλισθανόντων, τὸ μὲν ἄρθρον ἀπωθέειν ἐς τὴν φύσιν, τὸν δὲ πῆχυν ἐς τὸ καταπρηνὲς μᾶλλον ῤέποντα περιάγειν Τὰ μὲν πλεῖστα ἀγκῶνος τοιαῦτα ὀλισθήματα.

[¶8] 41. But if the articular extremity of the humerus be carried to either side above the bone of the fore-arm, which is prominent, into the hollow of the arm (?), this rarely happens; but if it does happen, extension in the straight line is not so proper under such circumstances; for in such a mode of extension, the process of the ulna (olecranon?) prevents the bone of the arm (humerus?) from passing over it. In dislocations of this kind, extension should be made in the manner described when treating of the bandaging of fractured bones of the arm, extension being made upward at the armpit, while the parts at the elbow are pushed downward, for in this manner can the humerus be most readily raised above its cavity; and when so raised, the reduction is easy with the palms of the hand, the one being applied so as to make pressure on the protuberant part of the arm, and the other making counter-pressure, so as to push the bone of the fore-arm into the joint. This method answers with both cases. And perhaps this is the most suitable mode of reduction in such a case of dislocation. The parts may be reduced by extension in a straight line, but less readily than thus.

> Greek: 41. 41. ἢν δὲ ὑπερβῇ τὸ ἄρθρον ἢ ἔνθα ἢ ἔνθα ὑπὲρ τὸ ὀστέον τοῦ πήχεος τὸ ἐξέχον ἐς τὸ κοῖλον τοῦ βραχίονος, γίνεται μὲν οὖν ὀλιγάκις τοῦτο, ἢν δὲ γένηται, οὐκ ἔτι ὁμοίως ἡ κατάτασις ἡ ἐς τὴν ἰθυωρίην γινομένη ἐπιτηδείη τῶν τοιουτέων ὀλισθημάτων κωλύει γὰρ ἐν τῇ τοιαύτῃ κατατάσει τὸ ἀπὸ τοῦ πήχεος ὑπσρέχον ὀστέον τὴν ὁπέρβασιν τοῦ βραχίονος. χρὴ τοίνυν τοῖσιν οὕτως ἐκβεβληκόσι τὴν κατάτασιν ποιέεσθαι τοιαύτην, οἵηπερ πρόσθεν γέγραπται, ἐπήν τις ὀστέα βραχίονος κατεηγότα ἐπιδέῃ, ἀπὸ μὲν τῆς μασχάλης ἐς τὸ ἄνω τείνεσθαι, ἀπὸ δὲ τοῦ ἀγκῶνος αὐτοῦ ἐς τὸ κάτω ἀναγκάζειν, οὕτω γὰρ ἂν μάλιστα ὁ βραχίων ὑπεραιωρηθείη ὑπὲρ τῆς ἑωυτοῦ βαθμίδος· ἢν δὲ ὑπεραιωρηθῇ, ῤηϊδίη ἡ κατάστασις, τοῖσι θέναρσι τῶν χειρῶν τὸ μὲν ἐξεστεὸς τοῦ βραχίονος ἐμβάλλοντα ὠθέειν, τὸ δὲ ἐς τὸ τοῦ πήχεος ὀστέον τὸ παρὰ τὸ ἄρθρον ἐμβάλλοντα ἀντωθέειν, τὸν αὐτὸν τρόπον ἄμφω. ἴσως μέντοι ἡ τοιαύτη κατάτασις τοῦ τοιούτου ὀλισθήματος δικαιοτάτη· ἐμβληθείη δʼ ἂν καὶ ἀπὸ τῆς ἐς ἰθὺ κατατάσιος, ἧσσον δὲ ἢ οὕτω.

[¶9] 42. If the arm be dislocated forward—this rarely happens, indeed, but what would a sudden shock not displace? for many other things are removed from their proper place, notwithstanding a great obstacle,—in such a violent displacement the part (olecranon?) which passes above the prominent part of the bones is large, and the stretching of the nerves (ligaments?) is intense; and yet the parts have been so dislocated in certain cases. The following is the symptom of such a displacement: the arm cannot be bent in the least degree at the elbow, and upon feeling the joint the nature of the accident becomes obvious. If, then, it is not speedily reduced, strong and violent inflammation, attended with fever, will come on, but if one happen to be on the spot at the time it is easily reduced. A piece of hard linen cloth (or a piece of hard linen, not very large, rolled up in a ball, will be sufficient) is to be placed across the bend of the elbow, and the arm is then to be suddenly bent at the elbow, and the hand brought up to the shoulder. This mode of reduction is sufficient in such displacements; and extension in the straight line can rectify this manner of dislocation, but we must use at the same time the palms of the hands, applying the one to the projecting part of the humerus at the bend of the arm for the purpose of pushing it back, and applying the other below to the sharp extremity of the elbow, to make counter-pressure, and incline the parts into the straight line. And one may use with advantage in this form of dislocation the method of extension formerly described, for the application of the bandages in the case of fracture of the arm; but when extension is made, the parts are to be adjusted, as has been also described above.

> Greek: 42. 42. ἢν δὲ ἐς τοὔμπροσθεν ὀλίσθῃ ὁ βραχίων, ἐλαχιστάκις μὲν τοῦτο γίνεται, ἀλλὰ τί ἂν ἐξαπιναίη ἐκπάλησις οὐκ ἐκβάλλοι; πολλὰ γὰρ καὶ παρὰ τὴν οἰκείην φύσιν ἐκπίπτει, κἢν μέγα τι ᾖ τὸ κωλῦον· ταύτῃ δὲ τῇ ἐκπαλήσει μέγα τι τὸ ὑπερβαινόμενον τὸ ὑπὲρ τὸ παχύτερον τῶν ὀστέων, καὶ τῶν νεύρων συχνὴ κατάτασις· ὅμως δὲ δή τισιν ἐξεπάλησεν. σημεῖον δὲ τοῖσιν οὕτως ἐκπαλήσασιν· οὐδὲν γὰρ χρῆμα τοῦ ἀγκῶνος κάμψαι δύνανται, εὔδηλον δὲ καὶ τὸ ἄρθρον ψαυόμενον. ἢν μὲν οὖν μὴ αὐτίκα ἐμβληθῇ; ἰσχυραὶ καὶ βίαιοι φλεγμοναὶ καὶ πυρετώδεες γίνονται ἢν δὲ δὴ αὐίκα τις παρατύχῃ, εὐέμβολον. χρὴ δὲ ὀθόνιον σκληρὸν (ὀθόνιον γὰρ σκληρὸν εἱλιγμένον ἀρκέει μη μέγα) ἐνθέντα πλάγιον ἐς τὴν καμπὴν τοῦ ἀγκῶνος, ἐξαπίνης ξυγκάμψαι τὸν ἀγκῶνα, καὶ προσαγαγεῖν ὡς μάλιστα τὴν χεῖρα πρὸς τὸν ὦμον. ἱκανὴ μὲν οὖν αὕτη ἡ ἐμβολὴ τοῖσιν οὕτως ἐκπαλήσασιν· ἀτὰρ καὶ ἡ ἐς τὸ ἰθὺ κατάτασις δύναται εὐθετίζειν τοῦτον τὸν τρόπον τῆς ἐκβολῆς· τοῖσι μέντοι θέναρσι τῆς χειρὸς χρὴ, τὸν μὲν ἐμβάλλοντα ἐς τὸ τοῦ βραχίονος ἐξέχον τὸ παρὰ τὴν καμπὴν ὀπίσω ἀπωθέειν, τὸν δέ τινα κάτωθεν ἐς τὸ τοῦ ἀγκῶνος ὀξὺ ἐμβάλλοντα ἀντωθέειν ἐς τὴν ἰθυωρίην τοῦ πήχεος ῤέποντα. δύναται δὲ ἐν τουτέῳ τῷ τρόπῳ τῆς ὀλισθήσιος κἀκείνη ἡ κατάτασις ἡ πρόσθεν γεγραμμένη, ὡς χρὴ κατατείνειν τὰ ὀστέα τοῦ βραχίονος κατεηγότα, ἐπὴν μέλλωσιν ἐπιδεῖσθαι· ἐπὴν δὲ καταταθῇ, οὕτω χρὴ τοῖσι θέναρσι τὰς προσβολὰς ποιέεσθαι, ὥσπερ καὶ πρόσθεν γέγραπται.

[¶10] 43. But if the arm be dislocated backward (but this very rarely happens, and it is the most painful of all, and the most subject to bilious fevers of the continual type, which prove fatal in the course of a few days), in such a case the patient cannot extend the arm. If you are quickly present, by forcible extension the parts may return to their place of their own accord; but if fever have previously come on, you must no longer attempt reduction, for the pain will be rendered more intense by any such violent attempt. In a word, no joint whatever should be reduced during the prevalence of fever, and least of all the elbow-joint.

> Greek: 43. 43. ἢν δὲ ἐς τοὐπίσω βραχίων ἐκπέσῃ (ὀλιγάκις δὲ τοῦτο γίνεται, ἐπωδυνώτατόν τε τοῦτο πάντων καὶ πυρετωδέστατον ξυνεχέων πυρετῶν καὶ ἀκρητοχόλων, θανατωδέων καὶ ὀλιγημέρων), οἱ τοιοῦτοι ἐκτανύειν οὐ δύνανται. ἢν μὲν οὖν αὐτίκα παρατύχης, βιάσασθαι χρὴ ἐκτανύσαντα τὸν ἀγκῶνα, καὶ αὐτομάτως ἐμπίπτει. ἢν δέ σε φθάσῃ πυρετήνας, οὐκ ἔτι χρὴ ἔμβάλλειν· κατατείνειε γὰρ ἂν ἡ ὀδύνη ἀναγκαζομένου. ὡς δʼ ἐν κεφαλαίῳ εἰρῆσθαι, οὐδʼ ἄλλο χρὴ ἄρθρον πυρεταίνοντι ἐμβάλλειν, ἥκιστα δὲ ἀγκῶνα.

[¶11] 44. There are also other troublesome injuries connected with the elbow-joint; for example, the thicker bone (radius?) is sometime partially displaced from the other, and the patient can neither perform extension nor flexion properly. This accident becomes obvious upon examination with the hand at the bend of the arm near the division of the vein that runs up the muscle. In such a case it is not easy to reduce the parts to their natural state, nor is it easy, in the separation of any two bones united by symphysis, to restore them to their natural state, for there will necessarily be a swelling at the seat of the diastasis. The method of bandaging a joint has been already described in treating of the application of bandages to the ankle.

> Greek: 44. 44. ἔστι δὲ καὶ ἄλλα σίνεα κατʼ ἀγκῶνα ὀχλώδεα· τοῦτο μὲν γὰρ, τὸ παχύτερον ὀστέον ἔστιν ὅτε ἐκινήθη ἀπὸ τοῦ ἑτέρου, καὶ οὔτε ξυγκάμπτειν, οὔτε κατατανύειν ὁμοίως δύνανται. δῆλον δὲ γίνεται, ψαυόμενον κατὰ τὴν ξύγκαμψιν τοῦ ἀγκῶνος παρὰ τὴν διασχίδα τῆς φλεβὸς τὴν ἄνωθεν τοῦ μυὸς τείνουσαν. οἷσι δὲ τὸ τοιοῦτον, οὐκ ἔτι ῤηΐδιον ἐς τὴν ἑωυτοῦ φύσιν ἀγαγεῖν· οὐδὲ γὰρ ἄλλην οὐδεμίην ῤηΐδιον ξυμφυάδα κοινὴν δύο ὀστέων κινηθεῖσαν ἐς τὴν ἀρχαίην φύσιν ἱδρυνθῆναι, ἀλλʼ ἀνάγκη ὄγκον ἴσχειν τὴν διάστασιν. ὡς δʼ ἐπιδέειν χρὴ ἐν ἄρθρῳ, ἐν τῇ κατὰ σφυρὸν ἐπιδέσει εἴρηται.

[¶12] 45. In certain cases the process of the ulna (olecranon?) behind the humerus is broken; sometimes its cartilaginous part, which gives origin to the posterior tendon of the arm, and sometimes its fore part, at the base of the anterior coronoid process; and when this displacement takes place, it is apt to be attended with malignant fever. The joint, however, remains in place, for its whole base protrudes at that point. But when the displacement takes place where its head overtops the arm, the joint becomes looser if the bone be fairly broken across. To speak in general terms, all cases of fractured bones are less dangerous than those in which the bones are not broken, but the veins and important nerves (tendons?) situated in these places are contused; for the risk of death is more immediate in the latter class of cases than in the former, if continual fever come on. But fractures of this nature seldom occur.

> Greek: 45. 45. ἔστι δʼ οἷσι κατήγνυται τοῦ πήχεος τὸ ὀστέον τὸ ὁποτεταγμένον τῷ βραχίονι, ὁτὲ μὲν τὸ χονδρῶδες αὐτοῦ ἀφʼ οὗ πέφυκεν ὁ τένων ὁ ὄπισθεν τοῦ βραχίονος· [ὁτὲ δὲ τὰ πρόσω κατὰ τὴν ἀρχὴν τῆς ἐκφύσεως τοῦ προσθίου κορωνοῦ·] καὶ ἐπὴν τοῦτο κινηθῇ, πυρετῶδες καὶ κακόηθες γίνεται· τὸ μέντοι ἄρθρον μένει ἐν τῇ ἑωυτοῦ χώρῃ· πᾶσα γὰρ ἡ βάσις αὐτέου ταύτῃ ὑπερέχει. ὅταν δὲ ἀπαγῇ ταύτῃ ᾗ ὑπερέχει ἡ κεφαλὴ τοῦ βραχίονος, πλανωδέστερον τὸ ἄρθρον γίνεται, ἢν παντάπασιν ἀποκαυλισθῇ. ἀσινέστερα δὲ, ὡς ἐν κεφαλαίῳ εἰρῆσθαι, πάντα τὰ κατηγνύμενα τῶν ὀστέων ἐστὶν, ἢ οἷσι τὰ μὲν ὀστέα οὐ κατάγνυται, φλέβες δὲ καὶ νεῦρα ἐπίκαιρα ἀμφιφλᾶται ἐν τούτοισι τοῖσι χωρίοισιν· ἐγγυτέρω γὰρ θανάτου πελάζει ταῦτα ἢ ἐκεῖνα, ἢν ἐκπυρωθῇ ξυνεχεῖ πυρετῷ· ὀλίγα γε μὴν τὰ τοιαῦτα κατήγματα γίνεται.

[¶13] 46. It sometimes happens that the head of the humerus is fractured at its epiphysis; and this, although it may appear to be a much more troublesome accident, is in fact a much milder one than the other injuries at the joint.

> Greek: 46. 46. ἒστι δʼ ὅτε αὐτὴ ἡ κεφαλὴ τοῦ βραχίονος κατὰ τὴν ἐπίφυσιν κατάγνυται· τοῦτο δὲ δοκέον κακοσινώτερον εἶναι πολλῷ, πολλῷ τινι εὐηθέστερον τῶν κατʼ ἀγκῶνα σινέων ἐστίν.

[¶14] 47. The treatment especially befitting each particular dislocation has been described; and it has been laid down as a rule, that immediate reduction is of the utmost advantage, owing to the rapid manner in which inflammation of the tendons supervenes. For even when the luxated parts are immediately reduced, the tendons usually become stiffened, and for a considerable time prevent extension and flexion from being performed to the ordinary extent. All these cases are to be treated in a similar way, whether the extremity of the articulating bone be snapped off, whether the bones be separated, or whether they be dislocated; for they are all to be treated with plenty of bandages, compresses, and cerate, like other fractures. The position of the joint in all these cases should be the same, as when a fractured arm or fore-arm has been bound up. For this is the most common position in all dislocations, displacements, and fractures; and it is the most convenient for the subsequent movements, whether of extension or flexion, as being the intermediate stage between both. And this is the position in which the patient can most conveniently carry or suspend his arm in a sling. And besides, if the joint is to be stiffened by callus, it were better that this should not take place when the arm is extended, for this position will be a great impediment and little advantage; if the arm be wholly bent, it will be more useful; but it will be much more convenient to have the joint in the intermediate position when it becomes ankylosed. So much with regard to position.

> Greek: 47. 47. ὡς μὲν οὖν ἕκαστα τῶν ὀλισθημάτων ἁρμόσσει μάλιστα ἰητρεύειν, γέγραπται, καὶ ὅτι παραχρῆμα ἐμβάλλειν μάλιστα ἄρθρον ξυμφέρει διὰ τὸ τάχος τῆς φλεγμονῆς τῶν νεύρων. καὶ γὰρ ἢν ἐκπεσόντα αὐτίκα ἐμπέσῃ, ὅμως φιλέει τὰ νεῦρα ξύντασιν ποιέεσθαι, καὶ κωλύειν ἐπὶ ποσὸν χρόνον τήν τε ἔκτασιν ὅσην περ φιλέει ποιέεσθαι, τήν τε ξύγκαμψιν. ἰητρεύειν δὲ πάντα παραπλησίως ταῦτα ξυμφέρει, καὶ ὁκόσα ἀπάγνυται, καὶ ὁκόσα διίσταται, καὶ ὁκόσα ὀλισθάνει· πάντα γὰρ χρὴ ὀθονίοισι πολλοῖσι καὶ σπλήνεσι καὶ κηρωτῇ ἰητρεύειν, ὥσπερ καὶ τἄλλα κατήγματα. τὸ δὲ σχῆμα τοῦ ἀγκῶνος ἐν τούτοισι παντάπασι δεῖ τοιοῦτον ποιέεσθαι, οἷόν περ οἷσι βραχίων ἐπεδεῖτο καταγεὶς, καὶ πῆχυς. κοινότατον μὲν γὰρ πᾶσι τοῖσιν ὀλισθήμασι καὶ τοῖσι κινήμασι καὶ τοῖσι κατήγμασι τοῦτο τὸ σχῆμά ἐστιν· κοινότατον δὲ πρὸς τὴν ἔπειτα διάτασιν, καὶ τὸ ἐκτανύειν ἕκαστα, καὶ ξυγκάμπτειν· ἐντεῦθεν γὰρ ὁδοὶ ἐς ἀμφότερα παραπλήσιοι. Εὐοχώτατον δὲ καὶ εὐανάληπτον αὐτῷ τῷ κάμνοντι τοῦτο τὸ σχῆμα. ἔτι δὲ πρὸς τούτοισιν, εἴ ἄρα κρατηθείη ὑπὸ τοῦ πωρώματος, εἰ μὲν ἐκτεταμένη ἡ χεὶρ κρατηθείη, κρέσσων ἂν εἴη μὴ προσεοῦσα, πολλῷ μὲν γὰρ κώλυμα εἴη, ὠφελοίη δὲ ὀλίγῳ· εἰ δʼ αὖ ξυγκεκαμμένη, μᾶλλον εὔχρηστος ἂν εἴη· πολλῷ δὲ εὐχρηστοτέρη, εἰ τὸ διὰ μέσου σχῆμα ἔχουσα πωρωθείη. τὰ μὲν περὶ τοῦ σχήματος τοιαῦτα.

[¶15] 48. In bandaging, the head of the first bandage should be placed at the seat of the injury, whether it be a case of fracture, of dislocation, or of diastasis (separation?), and the first turns should be made there, and the bandages should be applied most firmly at that place, and less so on either side. The bandaging should comprehend both the arm and the fore-arm, and on both should be to a much greater extent than most physicians apply it, so that the swelling may be expelled from the seat of the injury to either side. And point of the fore-arm should be comprehended in the bandaging, whether the injury be in that place or not, in order that the swelling may not collect there. In applying bandages, we must avoid as much as possible accumulating many turns of the bandage at the bend of the arm. For the principal compression should be at the seat of the injury, and the same rules are to be observed, and at the same periods, with regard to compression and relaxation, as formerly described respecting the treatment of broken bones; and the bandages should be renewed every third day; and they should appear loose on the third day, as in the other case. And splints should be applied at the proper time (for there is nothing unsuitable in them, whether the bones be fractured or not, provided there is no fever); they should be particularly loose, whether applied to the arm or the forearm, but they must not be thick. It is necessary that they should be of unequal size, and that the one should ride over the other, whenever from the flexion it is judged proper. And the application of the compresses should be regulated in the same manner as has been stated with regard to the splints; and they should be put on in a somewhat more bulky form at the seat of the injury. The periods are to be estimated from the inflammation, and from what has been written on them above.

> Greek: 48. 48. ἐπιδεῖν δὲ χρὴ, τήν τε ἀρχὴν τοῦ πρώτου ὀθονίου βαλλόμενον κατὰ τὸ βλαφθὲν, ἤν τε καταγῇ, ἤν τε ἐκστῇ, ἤν τε διαστῇ, καὶ τὰς περιβολὰς τὰς πρώτας κατὰ τοῦτο ποιέεσθαι· καὶ ἐρηρείσθω μάλιστα ταύτῃ, ἔνθεν δὲ καὶ ἔνθεν ἐπὶ ἧσσον. τὴν δὲ ἐπίδεσιν κοινὴν ποιέεσθαι χρὴ τοῦ τε πήχεος καὶ τοῦ βραχίονος, καὶ ἐπὶ πουλὺ πλέον ἑκάτερον ἢ ὡς οἱ πλεῖστοι ποιέουσιν, ὅκως ἐξαρύηται ὡς μάλιστα ἀπὸ τοῦ σίνεος τὸ οἴδημα ἔνθεν καὶ ἔνθεν. Προσπεριβαλλέσθω δὲ καὶ τὸ ὀξὺ τοῦ πήχεος, ἢν τὸ σίνος κατὰ τοῦτο ᾖ, ἤν τε μὴ, ἵνα μὴ τὸ οἴδημα ἐνταῦθα περὶ αὐτὸ ξυλλέγηται. Περιφεύγειν δὲ χρὴ ἐν τῇ ἐπιδέσει, ὅκως μὴ κατὰ τὴν καμπὴν πολλὸν τοῦ ὀθονίου ἠθροισμένον ἔσται ἐκ τῶν δυνατῶν· πεπιέχθαι δὲ κατὰ τὸ σίνος ὡς μάλιστα. καὶ τὰ ἄλλα καταλαβέτω αὐτὸν περὶ τῆς πιέξιος καὶ τῆς χαλάσιος ταὐτὰ, καὶ κατὰ τοὺς αὐτοὺς χρόνους ἕκαστα, ὥσπερ τῶν ὀστέων τῶν κατεηγότων ἐν τῇ ἰητρείῃ πρόσθεν γέγραπται· καὶ αἱ μετεπιδέσιες διὰ τρίτης ἔστωσαν· χαλᾷν δὲ δοκεέτω τῇ τρίτῃ, ὥσπερ καὶ τότε. καὶ νάρθηκας προσπεριβάλλειν ἐν τῷ ἱκνεομένῳ χρόνῳ (οὐδὲν γὰρ ἀπὸ τρόπου, καὶ τοῖσι τα ὀστέα κατεηγόσι, καὶ τοῖσι μὴ, ἢν μὴ πυρεταίνῃ), ὡς χαλαρωτάτους δὲ, τοὺς μὲν ἀπὸ τοῦ βραχίονος κατατεταγμένους, τοὺς δὲ ἀπὸ τοῦ πήχεος ἀνειμένους· ἔστωσαν δὲ μὴ παχέες οἱ νάρθηκες· ἀναγκαῖον δὲ καὶ ἀνίσους αὐτοὺς εἶναι ἀλλήλοισιν, παραλλάσσειν δὲ παρʼ ἀλλήλους, ᾗ ἂν ξυμφέρῃ, τεκμαιρόμενον πρὸς τὴν ξύγκαμψιν. ἀτὰρ καὶ τῶν σπληνῶν τὴν πρόσθεσιν τοιαύτην χρὴ ποιέεσθαι, ὥσπερ καὶ τῶν ναρθήκων εἴρηται, ὀγκηροτέρους δὲ ὀλίγῳ κατὰ τὸ σίνος προστιθέναι. τοὺς δὲ χρόνους τοὺς ἀπὸ τῆς φλεγμονῆς τεκμαίρεσθαι καὶ ἀπὸ τῶν πρόσθεν γεγραμμένων.