14. When a fractured clavicle is fairly broken across it is more easily treated, but when broken obliquely it is more difficult to manage. Matters are different in these cases from what one would have supposed; for a bone fairly broken across can be more easily restored to its natural state, and with proper care the upper part may be brought down by means of suitable position and proper bandaging, and even if not properly set, the projecting part of the bone is not very sharp. But in oblique fractures the case is similar to that of bones which have been torn away, as formerly described; for they do not admit of being restored to their place, and the prominence of the bone is very sharp. For the most part, then, it should be known, no harm results to the shoulder or to the rest of the body from fracture of the clavicle, unless it sphacelate, and this rarely happens. A deformity, however, may arise from fracture of the clavicle, and in these cases it is very great at first, but by and by it becomes less. A fractured clavicle, like all other spongy bones, gets speedily united; for all such bones form callus in a short time. When, then, a fracture has recently taken place, the patients attach much importance to it, as supposing the mischief greater than it really is, and the physicians bestow great pains in order that it may be properly bandaged; but in a little time the patients, having no pain, nor finding any impediment to their walking or eating, become negligent; and the physicians finding they cannot make the parts look well, take themselves off, and are not sorry at the neglect of the patients, and in the meantime the callus is quickly formed. The method of dressing which is most appropriate, is similar to that used in ordinary cases, consisting of cerate, compresses, and bandages; and it should be most especially known in this operation, that most compresses should be placed on the projecting bone, and that the greatest pressure should be made there. There are certain physicians who make a show of superior skill by binding a heavy piece of lead on the part in order to depress the projecting bone; but this mode of treatment does not apply to the clavicle, for it is impossible to depress the projecting part to any extent worth mentioning. There are others who, knowing the fact that the bandages are apt to slip off, and that they do not keep the projecting parts in their place, apply compresses and bandages like the others, and then having girt the patient with a girdle, where it is usually applied with most effect, they make a heap of the compresses upon the projecting bone when they apply them, and having fastened the head of the bandage to the girdle in front, they apply it so as to bring the turns of it into the line of the clavicle, carrying them to the back, and then bringing them around the girdle they carry them to the fore part and again backward. There are others who do not apply the bandage round the girdle, but carry the rounds of it by the perineum and anus, and along the spine, so as to compress the fracture. To an inexperienced person these methods will appear not far from natural, but when tied, they will be found of no service; for they do not remain firm any length of time, even if the patient keep his bed, although in this position they answer best; and yet even when lying in bed, should he bend his leg, or should his trunk be bent, all the will be displaced; and, moreover, the bandaging is inconvenient, in as much as the anus is comprehended by it, and many turns of the bandage are crowded there in a narrow space. And in the method with the girdle, the girdle cannot be so firmly girt around, but that the turns of the bandage force the girdle to ascend, and hence of necessity all the other bandages must be slackened. He would seem to me to come nearest his purpose, although after all he effects but little, who would take a few turns round the girdle, but would use the bandage principally to secure the former bandaging; for in this manner the bandages would be most secure, and would mutually assist one another. Every thing now almost has been said which applies to fracture of the clavicle. But this also should be known, that in fractures of the clavicle, it is the part attached to the breast which is uppermost, and that the piece attached to the acromion is the lowermost. The cause of this is, that for the most part the breast can neither be depressed nor raised, there being but a slight movement of the joint at the breast, for the sternum is connected together on both sides with the spine. The clavicle admits of most motion at the joint of the shoulder, and this arises from its connection with the acromion. And, moreover, when broken, the part which is connected with the sternum flies upward, and is not easily forced downward; for it is naturally light, and there is more room for it above than below. But the shoulder, the arm, and the parts connected with them, are easily moved from the sides and breast, and, on that account, they admit of being considerably elevated and depressed. When, therefore, the clavicle is broken, the fragment attached to the shoulder inclines downward, for it inclines much more readily with the shoulder and arm downward than upward. Matters being as I have stated, they act imprudently who think to depress the projecting end of the bone. But it is clear that the under part ought to be brought to the upper, for the former is the movable part, and that which has been displaced from its natural position. It is obvious, therefore, that there is no other way of applying force to it (for the bandages no more force it to than they force it from); but if one will push the arm when at the sides as much as possible upward, so that the shoulder may appear as sharp as possible, it is clear that in this way it will be adjusted to the fragment of the bone connected with the breast from which it was torn. If one then will apply a bandage, secundum artem, for the purpose of promoting a speedy cure, and will reckon everything else of no value, except the position as described, he will form a correct opinion of the case, and will effect a cure in the speediest and most appropriate manner. It is of great importance, however, that the patient should lie in a recumbent posture. Fourteen days will be sufficient if he keep quiet, and twenty at most.
14. 14. κληϊς δὲ κατεαγεῖσα, ἢν μὲν ἀτρεκέως ἀποκαυλισθῇ, εὐιητοτέρη ἐστίν· ἢν δὲ παραμηκέως, δυσιητοτέρη. τἀναντία δὲ τούτοισίν ἐστιν, ἢ ὡς ἄν τις οἴοιτο· τὴν μὲν γὰρ ἀτρεκέως ἀποκαυλισθεῖσαν προσαναγκάσειεν ἄν τις μᾶλλον ἐς τὴν φύσιν ἐλθεῖν· καὶ γὰρ εἰ πάνυ προμηθηθείη, τὸ ἀνωτέρω κατωτέρω ἂν ποιήσειε, σχήμασί τε ἐπιτηδείοισι καὶ ἐπιδέσει ἁρμοζούσῃ· εἰ δὲ μὴ τελέως ἱδρυνθείη, ἀλλʼ οὖν τὸ ὑπερέχον γε τοῦ ὀστέου οὐ κάρτα ὀξὺ γίνεται. ὧν δὲ ἂν παράμηκες τὸ ὀστέον κατεαγῇ, ἰκέλη ἡ ξυμφορὴ γίνεται τοῖσιν ὀστέοισι τοῖσιν ἀπεσπασμένοισι, περὶ ὧν πρόσθεν γέγραπται· οὔτε γὰρ ἱδρυνθῆναι αὐτὸ πρὸς ἑωυτὸ κάρτα ἐθέλει, ἥ τε ὑπερέχουσα ὄκρις τοῦ ὀστέου ὀξείη γίνεται κάρτα. τὸ μὲν οὖν ξύμπαν, εἰδέναι χρὴ, ὅτι βλάβη οὐδεμίη τῷ ὤμῳ, οὐδὲ τῷ ἄλλῳ σώματι γίνεται διὰ τὴν κάτηξιν τῆς κληῗδος, ἢν μὴ ἐπισφακελίσῃ· ὀλιγάκις δὲ τοῦτο γίνεται. αἶσχός γε μὴν προσγίνεται περὶ τὴν κάτηξιν τῆς κληῗδος, καὶ τούτοισι τὸ πρῶτον αἴσχιστον, ἔπειτα μὴν ἐπὶ ἧσσον γίνεται. ξυμφύεται δὲ ταχέως κληϊς, καὶ τἄλλα πάντα ὅσα χαῦνα ὀστέα· ταχείην γὰρ τὴν ἐπιπώρωσιν ποιέεται τὰ τοιαῦτα. ὅταν μὲν οὖν νεωστὶ κατεαγῇ, οἱ τετρωμένοι σπουδάζουσιν, οἰόμενοι μέζον τὸ κακὸν εἶναι, ἢ ὅσον ἐστίν· οἵ τε ἰητροὶ προθυμέονται δῆθεν ὀρθῶς ἰῆσθαι· προϊόντος δὲ τοῦ χρόνου, οἱ τετρωμένοι, ἅτε οὐκ ὀδυνώμενοι, οὐδὲ κωλυόμενοι οὔτε ὁδοιπορίης, οὔτε ἐδωδῆς, καταμελέουσιν· οἵ τε αὖ ἰητροὶ, ἅτε οὐ δυνάμενοι καλὰ τὰ χωρία ἀποδεικνύναι, ἀποδιδράσκουσι, καὶ οὐκ ἄχθονται τῇ ἀμελείῃ τῶν τετρωμένων· ἐν τούτῳ δὲ ἡ ἐπιπώρωσις ξυνταχύνεται. ἐπιδέσιος μὲν οὖν τρόπος καθέστηκε παραπλήσιος τοῖσι πλείστοισι, κηρωτῇ καὶ σπλήνεσι καὶ ὀθονίοισι μαλθακοῖσιν ἰητρεύειν· καὶ τάδε δεῖ προσξυνιέναι καὶ μάλιστα ἐν τούτῳ τῷ χειρίσματι, ὅτι τούς τε σπλῆνας πλείστους κατὰ τὸ ἐξέχον χρὴ τιθέναι, καὶ τοῖσιν ἐπιδέσμοισι πλείστοισι καὶ μάλιστα κατὰ τοῦτο πιέζειν. Ἐἰσὶ δὲ δή τινες, οἳ ἐπεσοφίσαντο ἤδη μολύβδιον βαρὺ προσεπικαταδεῖν, ὡς καταναγκάζειν τὸ ὑπερέχον· ξυνιᾶσι μὲν οὖν ἴσως οὐδὲ οἱ ἁπλῶς ἐπιδέοντες· ἀτὰρ δὴ οὐδʼ οὗτος ὁ τρόπος κληῗδος κατήξιός ἐστιν· οὐ γὰρ δυνατὸν τὸ ὑπερέχον καταναγκάζεσθαι οὐδὲν, ὅ τι καὶ ἄξιον λόγου. ἄλλοι δʼ αὖ τινές εἰσιν, οἵτινες, καταμαθόντες τοῦτο, ὅτι αὗται αἱ ἐπιδέσιες παράφοροί εἰσι καὶ οὐ κατὰ φύσιν καταναγκάζουσι τὰ ὑπερέχοντα, ἐπιδέουσι μὲν αὐτοὺς, σπλήνεσι καὶ ὀθονίοισι χρώμενοι, ὥσπερ καὶ οἱ ἄλλοι· ζώσαντες δὲ τὸν ἄνθρωπον ταινίῃ τινὶ, ᾗ εὐζωστότατος αὐτὸς ἑωυτοῦ ἐστιν, ὅταν ἐπιθῶσι τοὺς σπλῆνας ἐπὶ τὰ ὑπερέχοντα τοῦ κατήγματος, ἐξογκώσαντες ἐπὶ τὰ ἐξέχοντα, τὴν ἀρχὴν τοῦ ὀθονίου προσέδησαν πρὸς τὸ ζῶσμα ἐκ τοῦ ἔμπροσθεν, καὶ οὕτως ἐπιδέουσιν, ἐπὶ τὴν ἴξιν τῆς κληῗδος ἐπιτανύοντες, ἐς τοὔπισθεν ἄγοντες· κἄπειτα περιβάλλοντες περὶ τὸ ζῶσμα, ἐς τοὔμπροσθεν ἄγουσι, καὶ αὖθις ἐς τοὔπισθεν. οἱ δέ τινες οὐχὶ περὶ τὸ ζῶσμα περιβάλλουσι τὸ ὀθόνιον, ἀλλὰ περὶ τὸ περίνεόν τε καὶ παρʼ αὐτὴν τὴν ἕδρην, καὶ παρὰ τὴν ἄκανθαν κυκλεύοντες τὸ ὀθόνιον, οὕτω πιέζουσι τὸ κάτηγμα. ταῦτα γοῦν ἀπείρῳ μὲν ἀκοῦσαι φαίνεται ἐγγὺς τοῦ κατὰ φύσιν εἶναι, χρεομένῳ δὲ ἄχρηστα· οὔτε γὰρ μόνιμα οὐδένα χρόνον, οὐδʼ εἰ κατακέοιτό τις, καίτοι ἐγγυτάτω ἂν οὕτως· ἀλλʼ ὅμως εἰ καὶ κατακείμενος ἢ τὸ σκέλος συγκάμψειεν, ἢ αὐτὸς καμφθείη, πάντα ἂν τὰ ἐπιδέσματα κινέοιτο· ἄλλως τε ἀσηρὴ ἡ ἐπίδεσις· ἥ τε γὰρ ἕδρη ἀπολαμβάνεται, ἀθρόα τε τὰ ὀθόνια ἐν ταύτῃ τῇ στενοχωρίῃ γίνεται· τά τε αὖ περὶ τὴν ζώνην περιβαλλόμενα, οὐχ οὕτως ἰσχυρῶς ἔζωσται, ὡς οὐκ ἀναγκάσαι ἐς τὸ ἄνω τὴν ζώνην ἐπανιέναι, καὶ οὕτως ἀνάγκη ἂν εἴη πάντα χαλᾷν τὰ ἐπιδέσματα. ἄγχιστα δʼἄν τις δοκέοι ποιέειν, καίπερ οὐ μεγάλα ποιέων, εἰ τοῖσι μέν τισι τῶν ὀθονίων περὶ τὴν ζώνην περιβάλλοι, τοῖσι δὲ πλείστοισι τῶν ὀθονιων τὴν ἀρχαίην ἐπίδεσιν ἐπιδέοι· οὕτω γὰρ ἂν μάλιστο τὰ· ἐπιδέσματα μόνιμά τε εἴη, καὶ ἀλλήλοισι τιμωρέοι. τὰ μὲν οὖν πλεῖσταεἴρηται, ἅσσα καταλαμβάνει τοὺς τὴν κληῗδα καταγνυμένους. Προσξυνιέναι δὲ καὶ τόδε χρὴ, ὅτι κληϊς ὡς ἐπὶ τὸ πολὺ κατάγνυται, ὥστε τὸ μὲν ἀπὸ τοῦ στήθεος πεφυκὸς ὀστέον ἐς τὸ ἄνω μέρος ὑπερέχειν, τὸ δὲ ἀπὸ τῆς ἀκρωμίης πεφυκὸς ὀστέον ἐν τῷ κάτω μέρει εἶναι. αἴτια δὲ τούτων τάδε, ὅτι τὸ μὲν στῆθος οὔτε κατωτέρω ἂν πολὺ, οὔτε ἀνωτέρω χωρήσειεν· σμικρὸς γὰρ ὁ κιγκλισμὸς τοῦ ἄρθρου τοῦ ἐν τῷ στήθεϊ· αὐτό τε γὰρ ἑωυτῷ ξυνεχές ἐστι τὸ στήθος, καὶ τῇ ῤάχει· ἄγχιστα μὴν ἡ κληϊς πρὸς τὸ τοῦ ὤμου ἄρθρον πλοώδης ἐστίν· ἠνάγκασται γὰρ πυκινοκίνητος εἶναι διὰ τὴν τῆς ἀκρωμίης σύζευξιν. ἄλλως τε, ὅταν τρωθῇ, φεύγει ἐς τὸ ἄνω μέρος τὸ πρὸς τῷ στήθει προσεχόμενον, καὶ οὐ μάλα ἐς τὸ κάτω μέρος ἀναγκάζεσθαι ἐθέλει· καὶ γὰρ πέφυκε κοῦφον, καὶ ἡ εὐρυχωρίη αὐτῷ ἄνω πλείων ἢ κάτω. ὁ δὲ ὦμος, καὶ ὁ βραχίων, καὶ τὰ προσηρτημένα τούτοισιν εὐαπόλυτά ἐστιν ἀπὸ τῶν πλευρέων καὶ τοῦ στήθεος, καὶ διὰ τοῦτο δύναται καὶ ἀνωτέρω πολὺ ἀνάγεσθαι καὶ κατωτέρω ὅταν οὖν καταγῇ ἡ κληϊς, τὸ πρὸς τῷ ὤμῳ ὀστέον ἐς τὸ κατωτέρω ἐπιῤῥέπει· ἐς τοῦτο γὰρ ἐπιφορώτερον αὐτὸ ἅμα τῷ ὤμῳ καὶ τῷ βραχίονι κάτω ῤέψαι μᾶλλον, ἢ ἐς τὸ ἄνω. ὁπότε οὖν ταῦτα τοιαῦτά ἐστιν, ἀξυνετέουσιν ὅσοι τὸ ὑπερέχον τοῦ ὀστέου ἐς τὸ κάτω καταναγκάσαι οἴονται. ἀλλὰ δῆλον, ὅτι τὸ κάτω πρὸς τὸ ἄνω προσακτέον ἐστίν· τοῦτο γὰρ ἔχει κίνησιν, τοῦτο γάρ ἐστι καὶ τὸ ἀποστὰν ἀπὸ τῆς φύσιος. δῆλον οὖν, ὅτι ἄλλως μὲν οὐδαμῶς ἐστιν ἀναγκάσαι τοῦτο (αἱ γὰρ ἐπιδέσιες οὐδέν τι μᾶλλον προσαναγκάζουσιν ἢ ἀπαναγκάζουσιν)· εἰ δέ τις τὸν βραχίονα πρὸς τῇσι πλευρῇσιν ἐόντα ἀναγκάζοι ὡς μάλιστα ἄνω, ὡς ὅτι ὀξύτατος ὁ ὦμος φαίνηται εἶναι, δῆλον ὅτι οὕτως ἂν ἁρμοσθείη πρὸς τὸ ὀστέον τὸ ἀπὸ τοῦ στήθεος πεφυκὸς, ὅθεν ἀπεσπάσθη. εἰ οὖν τις τῇ μὲν ἐπιδέσει χρῷτο τῇ νομίμῃ τοῦ ταχέως ξυναλθεσθῆναι εἵνεκα, ἡγήσαιτο δὲ τἄλλα πάντα μάτην εἶναι παρὰ τὸ σχῆμα τὸ εἰρημένον, ὀρθῶς τε ἂν ξυνίοι, ἰητρεύοι τε ἂν τάχιστα καὶ κάλλιστα. κατακέεσθαι μέντοι τὸν ἄνθρωπον μέγα τὸ διάφορόν ἐστιν· καὶ ἡμέραι ἱκαναὶ τεσσαρεσκαίδεκα, εἰ ἀτρεμέοι, εἴκοσι δὲ πάμπολλαι.
15. But if the clavicle be fractured in the opposite manner (which does not readily happen), so that the fragment of bone connected with the breast is depressed, while the piece connected with the acromion is raised up and rides over other, this case does not require much management, for if the shoulder and arm be let go, the fragments of the bone will be adjusted to one another, and an ordinary bandage will suffice, and the callus will be formed in the course of a few days.
15. 15. εἰ μέντοι τινὶ ἐπὶ τἀναντία ἡ κληϊς κατεαγείη, ὃ οὐ μάλα γίνεται, ὥστε τὸ μὲν ἀπὸ τοῦ στήθεος ὀστέον ὑποδεδυκέναι, τὸ δὲ ἀπὸ τῆς ἀκρωμίης ὀστέον ὑπερέχειν καὶ ἐποχέεσθαι ἐπὶ τοῦ ἑτέρου, οὐδεμιῆς μεγάλης ἰητρείης ταῦτά γʼ ἂν δέοιτο· αὐτὸς γὰρ ὁ ὦμος ἀφιέμενος καὶ ὁ βραχίων ἱδρύοι ἂν τὰ ὀστέα πρὸς ἄλληλα, καὶ φαύλη ἄν τις ἐπίδεσις ἀρκέοι, καὶ ὀλίγαι ἡμέραι τῆς πωρώσιος γένοιντʼ ἄν.
16. If the fracture be not thus, but if it incline either forward or backward, it may be restored to its natural position, by raising the shoulder with the arm as formerly described, and brought back to its natural place, when the cure will be speedily accomplished. Most of the varieties of displacement may be rectified by raising the arm upward. When the upper bone is displaced laterally or downward, it would favor the adaptation of the parts if the patient would lie on his back, and if some elevated substance were placed between the shoulder-blades, so that the breast may be depressed as much as possible upon the two sides; and if, while another person raised the arm extended along the sides, the physician, applying the palm of the one hand to the head of the bone, would push it away, and with the other would adjust the broken bones, he would thus reduce the parts most readily to their natural position. But, as formerly stated, the upper bone (sternal fragment?) is rarely depressed downward. In most cases, after the bandages have been applied, that position is beneficial in which the elbow is fixed to the same side, and the shoulder is kept elevated; but in certain cases, the shoulder is to be raised, as has been directed, and the elbow is to be brought forward to the breast, and the hand laid on the acromion of the sound side. If the patient has the resolution to lie in bed, something should be placed so as to support the shoulder, and keep it as much elevated as possible. But if he walk about, the arm should be slung in a shawl, which embraces the point of the elbow, and is passed round the neck.
16. 16. εἰ δὲ μὴ κατεαγείη μὲν οὕτως, παρολισθάνοι δὲ ἐς τὸ πλάγιον ἢ τῇ ἢ τῇ, ἐς τὴν φύσιν μὲν ἀπαγαγεῖν ἂν δέοι, ἀναγαγόντα τὸν ὦμον σὺν τῷ βραχίονι, ὥσπερ καὶ πρόσθεν εἴρηται· ὅταν δὲ ἵζηται ἐς τὴν ἀρχαίην φύσιν, ταχείη ἂν ἡ ἄλλη ἰητρείη εἴη. τὰ μὲν οὖν πλεῖστα τῶν παραλλαγμάτων κατορθοῖ αὐτὸς ὁ βραχίων ἀναγκαζόμενος πρὸς τὰ ἄνω. ὅσα δὲ τῶν ἄνωθεν παρολισθάνοντα ἐς τὸ πλάγιον ἦλθεν, ἢ ἐς τὸ κατωτέρω, συμπορσύνοι ἂν τὴν κατόρθωσιν, εἰ ὁ μὲν ἄνθρωπος ὕπτιος κέοιτο, κατὰ δὲ τὸ μεσηγὺ τῶν ὠμοπλατέων ὑψηλότερόν τι ὀλίγῳ ὑποκέοιτο, ὡς περιῤῥηδὲς ἔῃ τὸ στῆθος ὡς μάλιστα· καὶ τὸν βραχίονα εἰ ἀνάγοι τις παρὰ τὰς πλευρὰς παρατεταμένον, ὁ δὲ ἰητρὸς τῇ μὲν ἑτέρῃ χειρὶ ἐς τὴν κεφαλὴν τοῦ βραχίονος ἐμβαλὼν τὸ θέναρ τῆς χειρὸς ἀπωθέοι, τῇ δὲ ἑτέρῃ τὰ ὀστέα τὰ κατεηγότα εὐτεθίζοι, οὕτως ἂν μάλιστα ἐς τὴν φύσιν ἄγοι· ἀτὰρ, ὥσπερ ἤδη εἴρηται, οὐ μάλα τὸ ἄνωθεν ὀστέον ἐς τὸ κάτω φιλέει ὑποδύνειν. τοῖσι μὲν οὖν πλείστοισιν, ὅταν ἐπιδεθῶσι, τὸ σχῆμα ἀρήγει, παρʼ αὐτὰς τὰς πλευρὰς τὸν ἀγκῶνα ἔχοντα, οὕτως ἐς τὸ ἄνω τὸν ὦμον ἀναγκάζεσθαι· ἔστι δʼ οἷσι μὲν τὸν ὦμον ἀναγκάζειν δεῖ ἐς τὸ ἄνω, ὡς εἴρηται, τὸν δὲ ἀγκῶνα πρὸς τὸ στῆθος παράγειν, ἄκρην δὲ τὴν χεῖρα παρὰ τὸ ἀκρώμιον τοῦ ὑγιέος ὤμου ἴσχειν. ἢν μὲν οὖν κατακέεσθαι τολμᾷ, ἀντιστήριγμά τι προστιθέναι χρὴ, ὡς ἂν ὁ ὦμος ἀνωτάτω ἔῃ· ἢν δὲ περιίῃ, σφενδόνην χρὴ, ἐκ ταινίης περὶ τὸ ὀξὺ τοῦ ἀγκῶνος ποιήσαντα, ἀναλαμβάνειν περὶ τὸν αὐχένα.
17. When the elbow-joint is displaced or dislocated to the side or outward, while its sharp point (olecranon?) remains in the cavity of the humerus, extension is to be made in a straight line, and the projecting part is to be pushed backward and to the side.
17. 17. ἀγκῶνος δὲ ἄρθρον παραλλάξαν μὲν ἢ παραρθρῆσαν πρὸς πλευρὴν ἢ ἔξω, μένοντος τοῦ ὀξέος τοῦ ἐν τῷ κοίλῳ τοῦ βραχίονος, ἐς εὐθὺ κατατείναντα, τὸ ἐξέχον ἀπωθεῖν ὀπίσω καὶ ἐς τὸ πλάγιον.
18. In complete dislocations toward either side, extension is to be made as in bandaging fracture of the arm; for thus the rounded part of the elbow will not form an obstacle to it. Dislocation, for the most part, takes place toward the sides (inwardly?). Reduction is to be effected by separating (the bones) as much as possible, so that the end (of the humerus) may not come in contact with the olecranon, and it is to be carried up, and turned round, and not forced in a straight line, and, at the same time, the opposite sides are to be pushed together, and propelled into their proper place. It will further assist if rotation of the fore-arm be made at the elbow, sometimes turning it into a supine position, and sometimes into a prone. The position for the treatment consists in keeping the hand a little higher than the elbow, and the arm at the sides; then it may either be suspended or laid at rest, for either position will answer; and nature and the usage of common means will accomplish the cure, if the callus does not form improperly: it is formed quickly. The treatment is to be conducted with bandages according to the rule for bandaging articulations, and the point of the elbow is to be included in the bandage.
18. 18. τὰ δὲ τελείως ἐκβάντα ἢ ἔνθα, ἢ ἔνθα, κατάτασις μὲν, ἐν ᾗ ὁ βραχίων κατεαγεὶς ἐπιδέεται· οὕτω γὰρ ἂν τὸ καμπύλον τοῦ ἀγκῶνος οὐ κωλύσει. ἐκπίπτει δὲ μάλιστα ἐς τὸ πρὸς πλευρὰς μέρος. τὰς δὲ κατορθώσιας, ἀπάγοντα ὅτι πλεῖστον, ὡς μὴ ψαύῃ τῆς κορώνης ἡ κεφαλὴ, μετέωρον περιάγειν, καὶ περικάμπτειν, καὶ μὴ ἐς εὐθὺ βιάζεσθαι, ἅμα δὲ ὠθέειν τἀναντία ἐφʼ ἑκάτερα, καὶ παρωθέειν ἐς χώρην· ξυνωφελοίη δʼ ἂν καὶ ἐπίστρεψις ἀγκῶνος ἐν τουτέοισιν, ἐν τῷ μὲν ἐς τὸ ὕπτιον, ἐν τῷ δὲ ἐς τὸ πρηνές. ἴησις δὲ, σχήματος μὲν, ὀλίγῳ ἀνωτέρω ἄκρην τὴν χεῖρα τοῦ ἀγκῶνος ἔχειν, βραχίονα δὲ κατὰ πλευράς· οὕτω δὲ καὶ ἀνάληψις, καὶ θέσις, καὶ εὔφορον· καὶ φύσις, καὶ χρῆσις ἐν κοινῷ, ἢν ἄρα μὴ κακῶς πωρωθῇ· πωροῦται δὲ ταχέως. ἴησις δὲ, ὀθονίοισι κατὰ τὸν νόμον τὸν ἀρθριτικὸν, καὶ τὸ ὀξὺ προσεπιδέειν.
19. Dislocations at the elbow give rise to the most serious consequences, such as fevers, pain, nausea, vomitings of pure bile, and more especially when the humerus is displaced backward from pressure on the nerve, which occasions numbness; next to it is the dislocation forward; the treatment is the same; reduction in dislocation backward is by extension and adaptation; the symptom of this variety-loss of the power of extension; of dislocation forward-loss of the power of flexion, and in this case reduction is to be accomplished by placing a hard ball (in the bend of the elbow), and bending the fore-arm about it, along with sudden extension.
19. 19. Παλιγκοτώτατον δὲ ὁ ἀγκὼν πυρετοῖσιν, ὀδύνῃ ἀσώδεϊ, ἀκρητοχόλῳ, ἀγκῶνος δὲ μάλιστα τοὐπίσω διὰ τὸ ναρκῶδες, δεύτερον δὲ τοὔμπροσθεν· ἴησις δὲ ἡ αὐτή· ἐμβολαὶ δὲ, τοῦ μὲν ὀπίσω, ἐκτείναντα κατατεῖναι· σημεῖον δέ· οὐ γὰρ δύνανται ἐκτείνειν· τοῦ δὲ ἔμπροσθεν, οὐ δύνανται ξυγκάμπτειν· τουτέῳ δὲ ἐνθέντα τι ξυνειλιγμένον σκληρὸν, περὶ τοῦτο ξυγκάμψαι ἐξ ἐκτάσιος ἐξαίφνης.
20. Diastasis of the bones may be recognized by examining the part where the vein that runs along the arm divides.
20. 20. διαστάσιος δὲ ὀστέων σημήϊον, κατὰ τὴν φλέβα τὴν κατὰ τὸν βραχίονα σχιζομένην διαψαύοντι.
21. In those cases callus is quickly formed. In congenital dislocations the bones below the seat of the injury are shorter than natural, and, mostly, those nearest to the place; namely, the bones of the fore-arm, next those of the hand; and, third, those of the fingers. The arm and shoulder are stronger, owing to the nourishment which they receive, and the other arm, from the additional work which it has to perform, is still more strong. Wasting of the flesh takes place on the inside if the dislocation be on the outside; or otherwise, on the side opposite the dislocation.
21. 21. ταῦτα δὲ ταχέως διαπωροῦται· ἐκ γενεῆς δὲ, βραχύτερα τὰ κάτω τοῦ σίνεος ὀστέα, πλεῖστον τὰ ἐγγύτατα τοῦ πήχεος, δεύτερον, χειρὸς, τρίτον, δακτύλων· βραχίων δὲ καὶ ὦμος, ἐγκρατέστερα διὰ τὴν τροφήν· ἡ δὲ ἑτέρη χεὶρ διὰ τὰ ἔργα ἔτι πλείω ἐγκρατεστέρη. Μινύθησις δὲ σαρκῶν, εἰ μὲν ἔξω ἐξέπεσεν, ἔσωθεν· εἰ δὲ μὴ, ἐς τοὐναντίον, ᾗ ἐξέπεσεν.
22. When the elbow is dislocated either inward or outward, extension is to be made with the fore-arm at a right angle to the arm; the arm, suspended by means of a shawl passed through the armpit, and a weight attached to the extremity of the elbow; or force may be applied with the hands; when the articular extremity has been cleared, the displaced parts are to be rectified with the palms of the hand, as in dislocations of the hands. It is to be bandaged, suspended in a sling, and placed while in this attitude.
22. 22. ἀγκὼν δὲ ἢν ἔσω ἢ ἔξω ἐκβῇ, κατάτασις μὲν ἐν σχήματι ἐγγωνίῳ τῷ πήχεϊ πρὸς βραχίονα· τὴν μὲν μασχάλην ἀναλαμβάνοντα ταινίῃ ἀνακρεμάσαι, ἀγκῶνι δὲ ἄκρῳ ὑποτιθέντα τι παρὰ τὸ ἄρθρον βάρος, ἐκκρεμάσαι, ἢ χερσὶ καταναγκάζειν· ὑπεραιωρηθέντος δὲ τοῦ ἄρθρου, αἱ παραγωγαὶ τοῖσι θέναρσιν, ὡς τὰ ἐν χερσίν· ἐπίδεσις ἐν τουτέῳ τῷ σχήματι, καὶ ἀνάληψις, καὶ θέσις.
23. Dislocations backward are to be rectified by the palms of the hands, along with sudden extension; the two acts are to be performed together, as in other cases of the kind. But in dislocation forward the arm is to be bent around a ball of cloth of proper size, and at the same time replaced.
23. 23. τὰ δὲ ὄπισθεν, ἐξαίφνης ἐκτείνοντα, διορθοῦν τοῖσι θέναρσιν· ἅμα δὲ δεῖ ἐν τῇ διορθώσει καὶ ἐν τοῖσιν ἑτέροισιν. ἢν δὲ ἔμπροσθεν, ἀμφὶ ὀθόνιον ξυνειλιγμένον, εὔογκον, ξυγκάμπτοντα ἅμα διορθοῦν.
24. But if the displacement be on the other side, both these operations are to be performed in effecting the adjustment. For conducting the treatment, the position and bandaging are the same as in the other cases. But all these cases may be reduced by ordinary distention.
24. 24. ἢν δὲ ἑτεροκλινὲς ἔῃ, ἐν τῇ διορθώσει ἀμφότερα ἅμα χρὴ ποιέειν. τῆς δὲ μελέτης τῆς θεραπείης, κοινὸν τὸ σχῆμα καὶ ἡ ἐπίδεσις. δύναται δὲ καὶ ἐκ τῆς διατάσιος κοινῇ ξυμπίπτειν ἅπαντα.
25. Of the methods of reduction, some operate by raising up the part, some by extension, and some by rotation: the last consists in rapidly turning the fore-arm to this side and that.
25. 25. τῶν δὲ ἐμβολέων, αἱ μὲν ἐξ ὑπεραιωρήσιος ἐμβάλλονται, αἱ δὲ ἐκ κατατάσιος, αἱ δὲ ἐκ περισφάλσιος· αὗται δὲ ἐκ τῶν ὑπερβολέων τῶν σχημάτων, ἢ τῇ, ἢ τῇ, ξὺν τῷ τάχει.
26. The joint of the hand is dislocated either inward or outward, most frequently inward. The symptoms are easily recognized: if inward, the patient cannot at all bend his fingers; and if outward, he cannot extend them. With regard to the reduction,-by placing the fingers above a table, extension and counter-extension are to be made by other persons, while with the palm or heel of the hand on the projecting bone one pushes forward, and another from behind on the other bone; some soft substance is to be applied to it, and the arm is to be turned to the prone position if the dislocation was forward, but to the supine, if backward. The treatment is to be conducted with bandages.
26. 26. χειρὸς δὲ ἄρθρον ὀλισθάνει ἢ ἔσω, ἢ ἔξω, ἔσω δὲ τὰ πλεῖστα. σημήϊα δὲ εὔσημα· ἢν μὲν εἴσω, ξυγκάμπτειν τοὺς δακτύλους οὐ δύνανται· ἢν δὲ ἔξω, ἐκτείνειν. ἐμβολὴ δὲ, ὑπὲρ τραπέζης τοὺς δακτύλους ἔχων, τοὺς μὲν τείνειν, τοὺς δὲ ἀντιτείνειν, τὸ δὲ ἐξέχον ἢ θέναρι, ἢ πτέρνῃ ἅμα ἀπωθέειν, πρόσω καὶ κάτωθεν κατὰ τὸ ἕτερον ὀστέον, ὄγκον μαλθακὸν ὑποθεὶς, ἢν μὲν ἄνω, καταστρέψας τὴν χεῖρα, ἢν δὲ κάτω, ὑπτίην. ἴησις δὲ, ὀθονίοισιν.
27. The whole hand is dislocated either inward or outward, or to this side or that, but more especially inward; and sometimes the epiphysis is displaced, and sometimes the other of these bones is separated. In these cases strong extension is to be applied, and pressure is to be made on the projecting bone, and counter-pressure on the opposite side, both at the same time, behind and at the side, with the hands upon a table, or with the heel. These accidents give rise to serious consequences and deformities; but in the course of time the part gets strong, and admits of being used. The cure is with bandages, which ought to embrace both the hand and fore-arm; and splints are to be applied as far as the fingers; and when they are used they should be more frequently unloosed than infractures, and more copious affusions of water should be used.
27. 27. ὅλη δὲ ἡ χεὶρ ὀλισθάνει, ἢ ἔσω, ἢ ἔξω, ἢ ἔνθα, ἢ ἔνθα, μάλιστα δὲ εἴσω· ἔστι δʼ ὅτε καὶ ἡ ἐπίφυσις ἐκινήθη· ἔστι δʼ ὅτε τὸ ἕτερον τῶν ὀστέων διέστη. τουτέοισι κατάτασις ἰσχυρὴ ποιητέη· καὶ τὸ μὲν ἐξέχον ἀπωθέειν, τὸ δὲ ἕτερον ἀντωθέειν, δύο εἴδεα ἅμα, ἐς τοὐπίσω καὶ ἐς τὸ πλάγιον, ἢ χερσὶν ἐπὶ τραπέζης, ἢ πτέρνῃ. Παλίγκοτα δὲ καὶ ἀσχήμονα· τῷ δὲ χρόνῳ κρατύνεται ἐς χρῆσιν. ἴησις, ὀθονίοισι ξὺν τῇ χειρὶ καὶ τῷ πήχεϊ· καὶ νάρθηκας μέχρι δακτύλων τιθέναι· ἐν νάρθηξι δὲ τεθέντα ταῦτα πυκνότερον λύειν, ἢ τὰ κατήγματα, καὶ καταχύσει πλείονι χρέεσθαι.
28. In congenital dislocations (at the wrist) the hand becomes shortened, and the atrophy of the flesh occurs, for the most part, on the side opposite to the dislocation. In an adult the bones remain of their natural size.
28. 28. ἐκ γενεῆς δὲ, βραχυτέρη ἡ χεὶρ γίνεται, καὶ μινύθησις σαρκῶν μάλιστα τἀναντία, ἢ ᾗ τὸ ἔκπτωμα· ηὐξημένῳ δὲ τὰ ὀστέα μένει.
29. Dislocation at the joint of a finger is easily recognized. Reduction is to be effected by making extension in a straight line, and applying pressure on the projecting bone, and counter-pressure on the opposite side of the other. The treatment is with bandages. When not reduced, callus is formed outside of the joint. When the dislocation takes place at birth, during adolescence the bones below the dislocation are shortened, and the flesh is wasted rather on the opposite than on the same side with the dislocation. When it occurs in an adult the bones remain of their proper size.
29. 29. δακτύλου δὲ ἄρθρον, ὀλισθὸν μὲν, εὔσημον. ἐμβολὴ δὲ, κατατείναντα ἐς ἰθὺ, τὸ μὲν ἐξέχον ἀπωθέειν, τὸ δὲ ἐναντίον ἀντωθέειν· ἴησις δὲ, ὀθονίοισιν. μὴ ἐμπεσὸν δὲ, ἐπιπωροῦται ἔξωθεν Ἐκ γενεῆς δὲ ἢ ἐν αὐξήσει ἐξαρθρήσαντα, τὰ ὀστέα βραχύνεται τὰ κάτω τοῦ ὀλισθήματος, καὶ σάρκες μινύθουσι τἀναντία μάλιστα, ἢ ὡς τὸ ἔκπτωμα· ηὐξημένῳ δὲ τὰ ὀστέα μένει.
30. The jaw-bone, in few cases, is completely dislocated, for the zygomatic process formed from the upper jaw-bone (malar?) and the bone behind the ear (temporal?) shuts up the heads of the under jaw, being above the one (condyloid process?), and below the other (coronoid process?). Of these extremities of the lower jaw, the one, from its length, is not much exposed to accidents, while the other, the coronoid, is more prominent than the zygoma, and from both these heads nervous tendons arise, with which the muscles called temporal and masseter are connected; they have got these names from their actions and connections; for in eating, speaking, and the other functional uses of the mouth, the upper jaw is at rest, as being connected with the head by synarthrosis, and not by diarthrosis (enarthrosis?): but the lower jaw has motion, for it is connected with the upper jaw and the head by enarthrosis. Wherefore, in convulsions and tetanus, the first symptom manifested is rigidity of the lower jaw; and the reason why wounds in the temporal region are fatal and induce coma, will be stated in another place. These are the reasons why complete dislocation does not readily take place, and this is another reason, because there is seldom a necessity for swallowing so large pieces of food as would make a man gape more than he easily can, and dislocation could not take place in any other position than in great gaping, by which the jaw is displaced to either side. This circumstance, however, contributes to dislocation there; of nerves (ligaments?) and muscles around joints, or connected with joints, such as are frequently moved in using the member are the most yielding to extension, in the same manner as well-dressed hides yield the most. With regard, then, to the matter on hand, the jaw-bone is rarely dislocated, but is frequently slackened (partially displaced?) in gaping, in the same manner as many other derangements of muscles and tendons arise. Dislocation is particularly recognized by these symptoms: the lower jaw protrudes forward, there is displacement to the opposite side, the coronoid process appears more prominent than natural on the upper jaw, and the patient cannot shut his lower jaw but with difficulty. The mode of reduction which will apply in such cases is obvious: one person must secure the patient’s head, and another, taking hold of the lower jaw with his fingers within and without at the chin, while the patient gapes as much as he can, first moves the lower jaw about for a time, pushing it to this side and that with the hand, and directing the patient himself to relax the jaw, to move it about, and yield as much as possible; then all of a sudden the operator must open the mouth, while he attends at the same time to three positions: for the lower jaw is to be moved from the place to which it is dislocated to its natural position; it is to be pushed backward, and along with these the jaws are to be brought together and kept shut. This is the method of reduction, and it cannot be performed in any other way. A short treatment suffices, a waxed compress is to be laid on, and bound with a loose bandage. It is safer to operate with the patient laid on his back, and his head supported on a leather cushion well filled, so that it may yield as little as possible, but some person must hold the patient’s head.
30. 30. γνάθος δὲ ὀλίγοισι τελέως ἐξήρθρησεν· ὀστέον τε γὰρ τὸ ἀπὸ τῆς ἄνω γνάθου πεφυκὸς ὑπεζύγωται πρὸς τῷ ὑπὸ τὸ οὖς ὀστέῳ προσπεφυκότι, ὅπερ ἀποκλείει τὰς κεφαλὰς τῆς κάτω γνάθου, τῆς μὲν ἀνωτέρω ἐὸν, τῆς δὲ κατωτέρω τῶν κεφαλέων. τὰ δὲ ἄκρεα τῆς κάτω γνάθου, τὸ μὲν διὰ τὸ μῆκος οὐκ εὐπαρείσδυτον, τὸ δʼ αὖ κορωνόν τε καὶ ὑπερέχον ὑπὲρ τοῦ ζυγώματος· ἅμα τε ἀπʼ ἀμφοτέρων τῶν ἀκρέων τούτων νευρώδεες τένοντες πεφύκασιν, ἐξ ὧν ἐξήρτηνται οἱ μύες οἱ κροταφῖται καὶ μασσητῆρες καλεόμενοι· διὰ τοῦτο δὲ καλέονται, καὶ διὰ τοῦτο κινέονται, ὅτι ἐντεῦθεν ἐξήρτηνται· ἐν γὰρ τῇ ἐδωδ, καὶ ἐν τῇ διαλέκτῳ, καὶ ἐν τῇ ἄλλῃ χρήσει τοῦ στόματος, ἡ μὲν ἄνω γνάθος ἀτρεμέει· ξυνήρτηται γὰρ τῇ κεφαλῇ. καὶ οὐ διήρθρωται· ἡ δὲ κάω γνάθος κινέεται· ἀπήρθρωται γὰρ ἀπὸ τῆς ἄνω γνάθου, καὶ ἀπὸ τῆς κεφαλῆς. διότι μὲν οὖν ἐν σπασμοῖσι καὶ τετάνοισι πρῶτον τοῦτο τὸ ἄρθρον ἐπισημαίνει συντεταμένον, καὶ διότι πληγαὶ καίριοι καὶ καροῦσαι αἱ κροταφίτιδες γίνονται, ἐν ἄλλῳ λόγῳ εἰρήσεται. περὶ δὲ τοῦ μὴ κάρτα ἐξαρθρέειν τάδε τὰ αἴτια· αἴτιον δὲ καὶ τόδε, ὅτι οὐ μάλα καταλαμβάνουσι τοιαῦται ἀνάγκαι βρωμάτων, ὥστε τὸν ἄνθρωπον χανέειν μέζον ἢ ὅσον δύναται· ἐκπέσοι δʼ ἂν ἀπʼ οὐδενὸς ἄλλου σχήματος, ἢ ἀπὸ τοῦ μέγα χανόντα παραγαγεῖν τὴν γένυν ἐπὶ θάτερα. Προσξυμβάλλεται μέντοι καὶ τόδε πρὸς τὸ ἐκπίπτειν· ὁκόσα γὰρ νεῦρα καὶ ὁκόσοι μύες παρὰ τὰ ἄρθρα εἰσὶν, ἢ ἀπὸ ἄρθρων ἀφʼ ὧν ξυνδέδενται, τούτων ὅσα ἐν τῇ χρήσει πλειστάκις διακινέεται, ταῦτα καὶ ἐς τὰς κατατάσιας δυνατώτατα ἐπιδιδόναι, ὥσπερ καὶ τὰ δέρματα τὰ εὐδεψητότατα πλείστην ἐπίδοσιν ἔχει. περὶ οὗ οὖν ὁ λόγος, ἐκπίπτει μὲν γνάθος ὀλιγάκις· σχᾶται μέντοι πολλάκις ἐν χάσμῃσιν, ὥσπερ καὶ ἄλλαι πολλαὶ μυῶν παραλλαγαὶ και νεύρων τούτο ποιέουσιν. δῆλον μὲν οὖν ἐκ τῶνδε μάλιστά ἐστιν, ὅταν ἐκπεπτώκῃ· προΐσχει γὰρ ἡ κάτω γνάθος ἐς τοὔμπροσθεν, καὶ παρῆκται τἀναντία τοῦ ὀλισθήματος, καὶ τοῦ ὀστέου τὸ κορωνὸν ὀγκηρότερον φαίνεται παρὰ τὴν ἄνω γνάθον, καὶ χαλεπῶς ξυμβάλλουσι τὰς κάτω γνάθους. τούτοισι δὲ ἐμβολὴ πρόδηλος, ἥτις γίνοιτʼ ἂν ἁρμόζουσα· χρὴ γὰρ τὸν μέν τινα κατέχειν τὴν κεφαλὴν τοῦ τετρωμένου, τὸν δὲ περιλαβόντα τὴν κάτω γνάθον καὶ ἔσωθεν καὶ ἔξωθεν τοῖσι δακτύλοισι κατὰ τὸ γένειον, χάσκοντος τοῦ ἀνθρώπου ὅσον μετρίως δύναται, πρῶτον μὲν διακινέειν τὴν κάτω γνάθον χρόνον τινὰ, τῇ καὶ τῇ παράγοντα τῇ χειρὶ, καὶ αὐτὸν τὸν ἄνθρωπον κελεύειν χαλαρὴν τὴν γνάθον ἔχειν, καὶ ξυμπαράγειν, καὶ ξυνδιδόναι ὡς μάλιστα· ἔπειτα ἐξαπίνης σχάσαι, τρισὶ σχήμασιν ὁμοῦ προσέχοντα τὸν νόον· δεῖ μὲν γὰρ παράγεσθαι ἐκ τῆς διαστροφῆς ἐς τὴν φύσιν, δεῖ δὲ ἐς τοὐπίσω ἀπωσθῆναι τὴν γνάθον τὴν κάτω, δεῖ δὲ ἑπόμενον τούτοισι ξυμβάλλειν τὰς γνάθους, καὶ μὴ χάσκειν. ἐμβολὴ μὲν οὖν αὕτη, καὶ οὐκ ἂν γένοιτο ἀπʼ ἄλλων σχημάτων. ἰητρείη δὲ βραχείη ἀρκέει· σπλῆνα προστιθέντα κεκηρωμένον χαλαρῷ ἐπιδέσμῳ ἐπιδεῖν. ἀσφαλέστερον δὲ χειρίζειν ἐστὶν ὕπτιον κατακλίναντα τὸν ἄνθρωπον, ἐρείσαντα τὴν κεφαλὴν αὐτοῦ ἐπὶ σκυτίνου ὑποκεφαλαίου ὡς πληρεστάτου, ἵνα ὡς ἥκιστα ὑπείκῃ· προσκατέχειν δέ τινα χρὴ τὴν κεφαλὴν τοῦ τετρωμένου.
31. When the jaw is dislocated on both sides, the treatment is the same. The patients are less able to shut the mouth than in the former variety; and the jaw protrudes farther in this case, but is not distorted; the absence of distortion may be recognized by comparing the corresponding rows of the teeth in the upper and lower jaws. In such cases reduction should be performed as quickly as possible; the method of reduction has been described above. If not reduced, the patient’s life will be in danger from continual fevers, coma attended with stupor (for these muscles, when disordered and stretched preternaturally, induce coma); and there is usually diarrhea attended with billous, unmixed, and scanty dejections; and the vomitings, if any, consist of pure bile, and the patients commonly die on the tenth day.
31. 31. ἢν δʼ ἀμφότεραι αἱ γνάθοι ἐξαρθρήσωσιν, ἡ μὲν ἴησις ἡ αὐτή. ξυμβάλλειν δέ τι ἧσσον οὗτοι τὸ στόμα δύνανται· καὶ γὰρ προπετέστεραι αἱ γένυες τούτοισιν, ἀστραβέες δέ· τὸ δὲ ἀστραβὲς μάλιστʼ ἂν γνοίης τοῖσιν ὁρίοισι τῶν ὀδόντων, τῶν τε ἄνω καὶ τῶν κάτω κατʼ ἴξιν. τούτοισι ξυμφέρει ἐμβάλλειν ὡς τάχιστα· ἐμβολῆς δὲ τρόπος πρόσθεν εἴρηται. ἢν δὲ μὴ ἐμπέσῃ, κίνδυνος περὶ τῆς ψυχῆς ὑπὸ πυρετῶν ξυνεχέων καὶ νωθρῆς καρώσιος (καρώδεες γὰρ οἱ μύες οὗτοι, καὶ ἀλλοιούμενοι, καὶ ἐντεινόμενοι παρὰ φύσιν· φιλέει δὲ καὶ ἡ γαστὴρ ὑποχωρέειν τούτοισι χολώδεα, ἄκρητα, ὀλίγα· καὶ ἢν ἐμέωσιν, ἄκρητα ἐμέουσιν· οὗτοι οὖν καὶ θνήσκουσι δεκαταῖοι μάλιστα.
32. In fracture of the lower jaw, when the bone is not fairly broken across, and is still partially retained, but displaced, it should be adjusted by introducing the fingers at the side of the tongue, and making suitable counter-pressure on the outside; and if the teeth at the wound be distorted and loosened, when the bone is adjusted, they should be connected together, not only two, but more of them, with a gold thread, if possible, but otherwise, with a linen thread, until the bone be consolidated, and then the part is to be dressed with cerate, a few compresses, and a few bandages, which should not be very tight, but rather loose. For it should be well known that in fracture of the jaw, dressing with bandages, if properly performed, is of little advantage, but occasions great mischief if improperly done. Frequent examinations should be made about the tongue, and prolonged pressure should be applied with the fingers, in order to rectify the displaced bone. It would be best if one could do so constantly, but that is impossible.
32. 32. ἢν δὲ κατεαγῇ ἡ κάτω γνάθος, ἢν μὲν μὴ ἀποκαυλισθῇ παντάπασιν, ἀλλὰ ξυνέχηται τὸ ὀστέον, ἐκκεκλιμένον δὲ ἔῃ, κατορθῶσαι μὲν χρὴ τὸ ὀστέον, παρά γε τὴν γλῶσσαν πλαγίην ὑπείραντα τοὺς δακτύλους, τὸ δὲ ἔξωθεν ἀντερείδοντα, ὡς ἂν ξυμφέρῃ· καὶ ἢν διεστραμμένοι ἔωσιν οἱ ὀδόντες οἱ κατὰ τὸ τρῶμα καὶ κεκινημένοι, ὁκόταν τὸ ὀστέον κατορθωθῇ, ζεῦξαι τοὺς ὀδόντας χρὴ πρὸς ἀλλήλους, μὴ μόνον τοὺς δύο, ἀλλὰ καὶ πλέονας, μάλιστα μὲν χρυσίῳ, ἔστʼ ἂν κρατυνθῇ τὸ ὀστέον, εἰ δὲ μὴ, λίνῳ· ἔπειτα ἐπιδεῖν κηρωτῇ καὶ σπλήνεσιν ὀλίγοισι καὶ ὀθονίοισιν ὀλίγοισι, μὴ ἄγαν ἐρείδοντα, ἀλλὰ χαλαροῖσιν. εὖ γὰρ εἰδέναι χρὴ, ὅτι ἐπίδεσις ὀθονίων, γνάθου καταγείσης, μικρὰ μὲν ἂν ὠφελέοι, εἰ χρηστῶς ἐπιδέοιτο, μεγάλα δʼ ἂν βλάπτοι, εἰ κακῶς ἐπιδέοιτο. πυκνὰ δὲ παρὰ τὴν γλῶσσαν ἐσματέεσθαι χρὴ, καὶ πουλὺν χρόνον ἀντέχειν τοῖσι δακτύλοισι κατορθοῦντα τοῦ ὀστέου τὸ ἐκκλιθέν· ἄριστον δὲ, εἰ αἰεὶ δύναιτο, ἀλλʼ οὐχ οἶόν τε.
33. But if the bone be fairly broken across (this, however, rarely happens), it is to be set in the manner now described. When adjusted, the teeth are to be fastened together as formerly described, for this will contribute much toward keeping the parts at rest, especially if properly fastened, and the ends of the thread secured with knots. But it is not easy to describe exactly in writing the whole manipulation of the case; but the reader must figure the thing to himself from the description given. Then one must take a piece of Carthaginian leather; if the patient be a younger person, it will be sufficient to use the outer skin, but if an adult the whole thickness of the hide will be required; it is to be cut to the breadth of about three inches, or as much as will be required, and having smeared the jaw with a little gum (for thus it sticks more pleasantly), the end of the skin is to be fastened with the glue near the fractured part of the jaw, at the distance of an inch or a little more, from the wound. This piece is to be applied below the jaw; but the thong should have a cut in it, in the direction of the chin, so that it may go over the sharp point of the chin. Another piece of thong like this, or somewhat broader, is to be glued to the upper part of the jaw, at about the same distance from the wound as the other thong; this thong should be so cut as to encircle the ear. The thongs should be sharp-pointed at the part where they unite, and in gluing them, the flesh of the thong should be turned to the patient’s skin, for in this way it will be more tenacious; then we must stretch this thong, but still more so the one at the chin, in order to prevent the fragments of the jaw from riding over each other, and the thongs are to be fastened at the vertex, and then a bandage is to be bound round the forehead, and a proper apparatus is to be put over all, to prevent the bandages from being displaced. The patient should lie upon the sound side of the jaw, not resting upon the jaw, but upon the head. He is to be kept on a spare diet for ten days, and then nourished without delay. If there be no inflammation during the first days, the jaw is consolidated in twenty days; for callus quickly forms in this, as in all the other porous bones, provided there be no sphacelus (exfoliation?). But much remains to be said on the sphacelus of bones in another place. This method of distention with glued substances is mild, of easy application, and is useful for many dislocations in many parts of the body. Those physicians who have not judgment combined with their dexterity, expose themselves in fractures of the jaws, as in other cases, for they apply a variety of bandages to a fractured jaw-bone, sometimes properly, and sometimes improperly. For all such bandaging of a fractured jawbone has a tendency rather to derange the bones connected with the fracture, than to bring them into their natural position.
33. 33. ἢν δὲ ἀποκαυλισθῇ παντάπασι τὸ ὀστέον (ὀλιγάκις δὲ τοῦτο γίνεται), κατορθοῦν μὲν χρὴ τὸ ὀστέον οὕτω, καθάπερ εἴρηται. ὅταν δὲ κατορθώσῃς, τοὺς ὀδόντας χρὴ ζευγνῦναι, ὡς πρόσθεν εἴρηται· μέγα γὰρ ἂν ξυλλαμβάνοι ἐς τὴν ἀτρεμίην, προσέτι καὶ ἤν τις ὀρθῶς ζεύξῃ, ὥσπερ χρὴ, τὰς ἀρχὰς ῤάψας. ἀλλὰ γὰρ οὐ ῤηΐδιον ἐν γραφῇ χειρουργίην πᾶσαν ἀτρεκέως διηγέεσθαι, ἀλλὰ καὶ αὐτὸν ὑποτοπέεσθαι χρὴ ἐκ τῶν γεγραμμένων. ἔπειτα χρὴ δέρματος καρχηδονίου, ἢν μὲν νηπιώτερος ἔῃ ὁ τρωθεὶς, ἀρκέει τῷ λοπῷ χρέεσθαι, ἢν δὲ τελειότερος ἔῃ, αὐτῷ τῷ δέρματι· ταμόντα δὲ χρὴ εὖρος ὡς τριδάκτυλον, ἢ ὅκως ἂν ἁρμόζῃ, ὑπαλείψαντα κόμμι τὴν γνάθον (εὐμενέστερον γὰρ), κόλλῃ προσκολλῆσαι τὸ δέρμα ἄκρον πρὸς τὸ ἀποκεκαυλισμένον τῆς γνάθου, ἀπολείποντα ὡς δάκτυλον ἀπὸ τοῦ τρώματος ἢ ὀλίγῳ πλέον· τοῦτο μὲν ἐς τὸ κάτω μέρος· ἐχέτω δὲ ἐντομὴν κατὰ τὴν ἴξιν τοῦ γενείου ὁ ἱμὰς, ὡς ἀμφιβεβήκῃ ἀμφὶ τὸ ὀξὺ τοῦ γενείου. ἕτερον δὲ ἱμάντα τοιοῦτον, ἢ ὀλίγῳ πλατύτερον προσκολλῆσαι χρὴ πρὸς τὸ ἄνω μέρος τῆς γνάθου, ἀπολείποντα καὶ τοῦτον ἀπὸ τοῦ τρώματος, ὅσονπερ ὁ ἕτερος ἀπέλιπεν· ἐσχίσθω δὲ καὶ οὗτος ὁ ἱμὰς τὴν ἀμφὶ τὸ οὖς περίβασιν. Ἀποξέες δὲ ἔστωσαν οἱ ἱμάντες ἀμφὶ τὴν ξυναφήν· ἐν δὲ τῇ κολλήσει ἡ σὰρξ τοῦ σκύτεος πρὸς τοῦ χρωτὸς ἔστω, ἐχεκολλότερον γὰρ οὕτως. ἔπειτα κακατείναντα χρὴ καὶ τοῦτον τὸν ἱμάντα μᾶλλον δέ τι τὸν περὶ τὸ γένειον, ὡς ὅτι μάλιστα μὴ ἀπομυλλήνῃ ἡ γνάθος, ξυνάψαι τοὺς ἱμάντας κατὰ τὴν κορυφὴν, κἄπειτα περὶ τὸ μέτωπον ὀθονίῳ καταδῆσαι, καὶ κατάβλημα χρὴ εἶναι, ὥσπερ νομίζεται, ὡς ἀτρεμέῃ τὰ δεσμά. τὴν δὲ κατάκλισιν ποιεέσθω ἐπὶ τὴν ὑγιέα γνάθον, μὴ τῇ γνάθῳ ἐρηρεισμένος, ἀλλὰ τῇ κεφαλῇ. ἰσχναίνειν δὲ χρὴ τὸ σῶμα ἄχρι ἡμερέων δέκα, ἔπειτα ἀνατρέφειν μὴ βραδέως· ἢν γὰρ ἐν τῇσι πρώτῃσιν ἡμέρῃσι μὴ φλεγμήνῃ, ἐν εἴκοσιν ἡμέρῃσιν ἡ γνάθος κρατύνεται· ταχέως γὰρ ἐπιπωροῦται, ὥσπερ καὶ τὰ ἄλλα τὰ ἀραιὰ ὀστέα, ἢν μὴ ἐπισφακελίσῃ. ἀλλὰ γὰρ περὶ σφακελισμῶν τῶν ξυμπάντων ὀστέων ἄλλος μακρὸς λόγος λείπεται. αὕτη ἡ διάτασις ἡ ἀπὸ τῶν κολλημάτων εὐμενὴς, καὶ εὐταμίευτος, καὶ ἐς πολλὰ καὶ πολλαχοῦ διορθώματα εὔχρηστος. τῶν δὲ ἰητρῶν οἱ μὴ ξὺν νόῳ εὔχειρες, καὶ ἐν ἄλλοισι τρώμασι τοιοῦτοί εἰσι καὶ ἐν γνάθων κατήξεσιν· ἐπιδέουσι γὰρ γνάθον κατεαγεῖσαν ποικίλως καὶ καλῶς καὶ κακῶς. πᾶσα γὰρ ἐπίδεσις γνάθου οὕτω καταγείσης ἐκκλίνει τὰ ὀστέα τὰ ἐς τὸ κάτηγμα ῤέποντα μᾶλλον, ἢ ἐς τὴν φύσιν ἄγει.
34. But if the lower jaw be disjointed at its symphysis in the chin (there is but one symphysis in the lower jaw, but there are several in the upper; but I am unwilling to digress from the subject, as these matters will have to be touched upon in other kinds of disease)-if, then, the symphysis be separated at the chin, it is the work which anybody can perform, to rectify it; for the part which protrudes is to be pushed inward by pressure with the fingers, and the part that inclines inward is to forced outward by pushing with the fingers from within. It is after having applied extension to separate the fragments that this is to be done, for they will thus be more easily restored to their natural position, than if one should bring them together by using force. This is proper to be known as applying to all such cases. When you have set the parts, you must fasten the teeth on both sides to one another, as formerly directed. The treatment is to be accomplished with cerate, a few compresses, and bandages. This part, in particular, requires a short but complex (?) bandaging, for it is nearly cylindrical, though not exactly so; but the turn of the bandage is to be made, if the right jaw was dislocated, to the right hand (that is said to be to the right hand when the right hand conducts the bandaging); but if the other jaw be the seat of the dislocation, the bandaging is to be made in the other direction. And if matters be properly adjusted, and the patient keep quiet, there will be a speedy recovery, and the teeth will be uninjured; but if not, the recovery will be more protracted, the teeth will be distorted, will give trouble, and become useless.
34. 34. ἢν δὲ ἡ κάτω γνάθος κατὰ τὴν ξύμφυσιν τὴν κατὰ τὸ γένειον διασπασθῇ (μούνη δὲ αὕτη ξύμφυσις ἐν τῇ κάτω γνάθῳ ἐστὶν, ἐν δὲ τῇ ἄνω πολλαί· ἀλλʼ οὐ βούλομαι ἀποπλανᾷν τὸν λόγον, ἐν ἄλλοισι γὰρ εἴδεσι νουσημάτων περὶ τούτων λεκτέον), ἢν οὖν διαστῇ ἡ κατὰ τὸ γένειον ξύμφυσις, κατορθῶσαι μὲν παντὸς ἀνδρός ἐστιν· τὸ μὲν γὰρ ἐξεστεὸς ἐσωθέειν χρὴ ἐς τὸ ἔσω μέρος, προσβάλλοντα τοὺς δακτύλους· τὸ δὲ εἴσω ῤέπον ἀνάγειν ἐς τὸ ἔξω μέρος, ἐνερείσαντα τοὺς δακτύλους. ἐς διάστασιν μέντοι διατεινάμενον, ταῦτα χρὴ ποιέειν· ῥᾷον γὰρ οὕτως ἐς τὴν φύσιν ἥξει, ἢ εἰ ἐγχρίπτων τις ἐς ἄλληλα τὰ ὀστέα, καταναγκάζειν πειρᾶται· τοῦτο παρὰ πάντα τὰ τοιαῦτα ὑπομνήματα χάριεν εἰδέναι. ὁκόταν δὲ κατορθώσῃς, ζεῦξαι μὲν χρὴ τοὺς ὀδόντας τοὺς ἔνθεν καὶ ἔνθεν πρὸς ἀλλήλους, ὥσπερ καὶ πρόσθεν εἴρηται. ἰῆσθαι δὲ χρὴ κηρωτῇ καὶ σπλήνεσιν ὀλίγοισι καὶ ὀθονίοισιν. ἐπίδεσιν δὲ βραχείην ποικίλην μάλιστα τοῦτο τὸ χωρίον ἐπιδέχεται, ἐγγὺς γάρ τι τοῦ ἰσοῤῥόπου ἐστὶν, ὡς δὴ μὴ ἰσόῤῥοπον ἐόν· τοῦ δὲ ὀθονίου τὴν περιβολὴν ποιέεσθαι χρὴ, ἢν μὲν ἡ δεξιὴ γνάθος ἐξεστήκῃ, ἐπὶ δεξιὰ (ἐπὶ δεξιὰ γὰρ νομίζεται εἶναι, ἢν ἡ δεξιὴ χεὶρ προηγῆται τῆς ἐπιδέσιος)· ἢν δὲ ἡ ἑτέρη γνάθος ἐξεστήκῃ, ὡς ἑτέρως χρὴ τὴν ἐπίδεσιν ἄγειν. κἢν μὲν ὀρθῶς τις κατορθώσηται καὶ ἐπατρεμήσῃ ὡς χρὴ, ταχείη μὲν ἡ ἄλθεξις, οἱ δὲ ὀδόντες ἀσινέες γίνονται· ἢν δὲ μὴ, χρονιωτέρη μὲν ἡ ἄλθεξις, διαστροφὴν δὲ ἴσχουσιν οἱ ὀδόντες, καὶ σιναροὶ καὶ ἀχρήϊοι γίνονται.
35. Of fractures of the nose there are more than one variety, but those who, without judgment, delight in fine bandagings, do much mischief, most especially in injuries about the nose. For this is the most complex of all the forms of bandaging, having most of the turns of the bandage called “ascia,” and rhomboidal intervals and uncovered spaces of the skin. As has been said, those who practice manipulation without judgment are fond of meeting with a case of fractured nose, that they may apply the bandage. For a day or two, then, the physician glories in his performance, and the patient who has been bandaged is well pleased, but speedily the patient complains of the incumbrance of the bandage, and the physician is satisfied, because he has had an opportunity of showing his skill in applying a complex bandage to the nose. Such a bandaging does everything the very reverse of what is proper; for, in the first place, those who have their nose flattened by the fracture, will clearly have the part rendered still more flat, if pressure above be applied to it; and further, those cases in which the nose is distorted to either side, whether at the cartilage or higher up, will evidently derive no benefit from bandaging above it, but will rather be injured; for it will not admit of having compresses properly arranged on either side of the nose, and indeed, persons applying this bandage do not seek to do this.
35. 35. ἢν δὲ ἡ ῤὶς καταγῇ, τρόπος μὲν οὐχ εἷς ἐστι κατήξιος ἀτὰρ πολλὰ μὲν δὴ καὶ ἄλλα λωβέονται οἱ χαίροντες τῇσι καλῇσιν ἐπιδέσεσιν ἄνευ νόου, ἐν δὲ τοῖσι περὶ τὴν ῤῖνα μάλιστα· ἐπιδεσίων γάρ ἐστιν αὕτη ποικιλωτάτη, καὶ πλείστους μὲν σκεπάρνους ἔχουσα, διαῤῥωγὰς δὲ καὶ διαλείψιας ποικιλωτάτας τοῦ χρωτὸς ῤομβοειδέας. ὡς οὖν εἴρηται, οἱ τὴν ἀνόητον εὐχειρίην ἐπιτηδεύοντες ἄσμενοι ῤινὸς κατεαγυίης ἐπιτυγχάνουσιν, ὡς ἐπιδήσωσιν. μίαν μὲν οὖν ἡμέρην, ἢ δύο, ἀγάλλεται μὲν ὁ ἰητρὸς, χαίρει δὲ ὁ ἐπιδεδεμένος· ἔπειτα ταχέως μὲν ὁ ἐπιδεδεμένος κορίσκεται, ἀσηρὸν γὰρ τὸ φόρημα· ἀρκέει δὲ τῷ ἰητρῷ, ἐπειδὴ ἐπέδειξεν, ὅτι ἐπίσταται ποικίλως ῤῖνα ἐπιδέειν. ποιέει δὲ ἡ ἐπίδεσις ἡ τοιαύτη πάντα τἀναντία τοῦ δέοντος· τοῦτο μὲν γὰρ, ὁκόσοι σιμοῦνται διὰ τὴν κάτηξιν, δηλονότι, εἰ ἄνωθέν τις μᾶλλον πιέζοι, σιμώτεροι ἂν ἔτι εἶεν· τοῦτο δὲ, ὅσοισι παραστρέφεται ἢ ἔνθα ἢ ἔνθα ἡ ῤὶς, ἢ κατὰ τὸν χόνδρον, ἢ ἀνωτέρω, δηλονότι οὐδὲν αὐτοὺς ἡ ἄνωθεν ἐπίδεσις ὠφελήσει, ἀλλὰ καὶ βλάψει μᾶλλον· οὐχ οὕτω γὰρ εὖ ξυναρμόσει σπλήνεσι τὸ ἐπὶ θάτερον τῆς ῤινὸς, καίτοι οὐδὲ τοῦτο ποιέουσιν οἱ ἐπιδέοντες.
36. This bandaging would appear to me to answer best when the skin surrounding the bone is contused on its ridge near the middle, or if the bone itself have sustained some injury, but not a great one, in such cases, redundant callus forms in the nose, and the part becomes a little too prominent; and yet, even in these cases, the bandaging need not require much trouble, if, indeed, any bandage be applied at all; for it is enough if one lay a waxed compress on the contusion, and then apply the double-headed bandage, thus taking one turn with it. The best application to such accidents is a small cataplasm of wheaten flour, washed, and mixed up into a viscid mass. If the flour be made from good wheat, and if it be glutinous, it should be used alone for all such cases, but if it be not very glutinous, a little of the manna of frankincense, well pulverized, is to be moistened with water, and the flour is to be mixed up with it, or a very little gum may be mixed in like manner.
36. 36. ἄγχιστα δὲ ἡ ἐπίδεσίς μοι δοκέῃ ἄν τι ποιέειν, εἰ κατὰ μέσην τὴν ῤῖνα, κατὰ τὸ ὀξὺ, ἀμφιφλασθείη ἡ σὰρξ κατὰ τὸ ὀστέον, ἢ εἰ κατὰ τὸ ὀστέον μικρόν τι σίνος εἴη, καὶ μὴ μέγα· τοῖσι γὰρ τοιούτοισιν ἐπιπώρωμα ἴσχει ἡ ῤὶς, καὶ ὀκριοειδεστέρη τινὶ γίνεται· ἀλλʼ ὅμως οὐδὲ τούτοισι δή που πολλοῦ ὄχλου δέεται ἡ ἐπίδεσις, εἰ δή τι καὶ δεῖ ἐπιδέειν· ἀρκέει δὲ ἐπὶ μὲν τὸ φλάσμα σπληνίον ἐπιτείναντα κεκηρωμένον, ἔπειτα ὡς ἀπὸ δύο ἀρχέων ἐπιδέεται, οὕτως ὀθονίῳ ἐς ἅπαξ περιβάλλειν. ἀρίστη μέντοι ἰητρείη, τῷ ἀλήτῳ, τῷ σιτανίῳ, τῷ πλυτῷ, γλίσχρῳ, πεφυρημένῳ, ὀλίγῳ, καταπλάσσειν τὰ τοιαῦτα· χρὴ δὲ, ἢν μὲν ἐξ ἀγαθῶν ἔῃ τῶν πυρῶν τὸ ἄλητον καὶ εὐόλκιμον, τούτῳ χρέεσθαι ἐς πάντα τὰ τοιαῦτα· ἢν δὲ μὴ πάνυ ὅλκιμον ἔῃ, ὀλίγην μάννην ὕδατι ὡς λειοτάτην διέντα, τούτῳ φυρᾷν τὸ ἄλητον, ἢ κόμμι πάνυ ὀλίγον ὡσαύτως μίσγειν.