---
title: "On the Articulations · Περὶ ἄρθρων"
author: "Hippocrates"
translator: "Francis Adams"
languages: [grc, en]
shelf: "Classical Greek"
section: 3 of 6
url: https://scriptura.si/works/hippocrates-on-the-articulations/3/
cite: "Hippocrates, tr. Francis Adams, On the Articulations · Περὶ ἄρθρων, section 3. Scriptura (scriptura.si), https://scriptura.si/works/hippocrates-on-the-articulations/3/"
---

# On the Articulations · Περὶ ἄρθρων

*Hippocrates, tr. Francis Adams*

Dislocated joints and how to reduce them.

> Greek: ed. Émile Littré, from the Perseus Digital Library (canonical-greekLit, tlg0627.tlg010, CC BY-SA 4.0).

> English: Francis Adams, from the Perseus Digital Library (tlg0627.tlg010.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 37–47

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

[¶0] 37. In those cases in which the fractured portions are depressed and flattened, if it is depressed in front at the cartilage, something may be introduced into the nostrils to rectify the parts. If not, all such deformities may be restored by introducing the fingers into the nostrils, if this can be managed, but if not, a thick spatula is to be introduced with the fingers, not to the fore part of the nose, but to the depressed portion, and the physician is to take hold of the nose externally on both sides, and at the same time raise it up. And if the fracture be much in the fore part one may introduce into the nostrils as already stated, either caddis scraped from a linen towel, or something such wrapped up in a piece of cloth, or rather stitched in Carthaginian leather, and moulded into a shape suitable to the place into which it is to be introduced. But if the fracture be at a greater distance, it is not possible to introduce anything within, for if it was irksome to bear anything of the kind in the fore part, how is it not to be so when introduced farther in? At first, then, by rectifying the parts from within, and sparing no pains upon them from without, they are to be brought to their natural position, and set. A fractured nose may be readily restored to shape, especially on the day of the accident, or even a little later, but the physicians act irresolutely, and touch it more delicately at first than they should; for the fingers should be applied on both sides along the natural line of the nose, and it is to be pushed downward, and thus, with pressure from within, the displacement is to be rectified. But for these purposes no physician is equal to the index-fingers of the patient himself, if he will pay attention and has resolution, for they are the most natural means. Either of the fingers is to be placed firmly along the whole nose, and thus it is to be gently held, and steadily, if possible until it become firm, but if not, he himself is to hold it for as long a time as possible, or if he cannot, a child or woman should do it, for the hands ought to be soft. Thus may a fracture of the nose, attended with depression, and not with displacement to the side, but in a straight line, be most properly treated. I have never seen a case of fractured nose which could not be rectified when attempted, before callus is formed, provided the treatment be properly applied. But although men would give a great price to escape being deformed, yet at the same time they do not know how to take care, nor have resolution, if they do not experience pain, nor fear death, although the formation of callus in the nose speedily place, for the most part is consolidated in ten days, provided sphacelus do not take place.

> Greek: 37. 37. Ὁκόσοισι μὲν οὖν ῤὶς ἐς τὸ κάτω καὶ ἐς τὸ σιμὸν ῤέπουσα κατεαγῇ, ἢν μὲν ἐκ τοῦ ἔμπροσθεν μέρεος κατὰ τὸν χόνδρον ἵζηται, οἷόν τέ ἐστι καὶ ἐντιθέναι τι διόρθωμα ἐς τοὺς μυκτῆρας· ἢν δὲ μὴ, ἀνορθοῦν μὲν χρὴ πάντα τὰ τοιαῦτα, τοὺς δακτύλους ἐς τοὺς μυκτῆρας ἐντιθέντα, ἢν ἐνδέχηται· ἢν δὲ μὴ, παχὺ ὑπάλειπτρον μὴ ἐς τὸ ἔμπροσθεν τῆς ῤινὸς ἀνάγοντα τοῖσι δακτύλοισιν, ἀλλʼ ᾗ ἵδρυται· ἔξωθεν δὲ τῆς ῤινὸς ἔνθεν καὶ ἔνθεν ἀμφιλαμβάνοντα τοῖσι δακτύλοισι, ξυναναγκάζειν τε ἅμα καὶ ἀναφέρειν ἐς τὸ ἄνω. καὶ ἢν μὲν πάνυ ἐν τῷ ἔμπροσθεν τὸ κάτηγμα ἔῃ, οἷόν τέ τι καὶ ἔσω τῶν μυκτήρων ἐντιθέναι, ὥσπερ ἤδη εἴρηται, ἢ ἄχνην τὴν ἀφʼ ἡμιτυβίου, ἢ ἄλλο τι τοιοῦτον ἐν ὀθονίῳ εἱλίσσοντα, μᾶλλον δὲ ἐν καρχηδονίῳ δέρματι ἐῤῥάψαντα, σχηματίσαντα τὸ ἁρμόσσον σχῆμα τῷ χωρίῳ, ἵνα ἐγκείσεται. ἢν μέντοι πρωσωτέρω ἔῃ τὸ κάτηγμα, οὐδὲν οἷόν τε ἔσω ἐντιθέναι· καὶ γὰρ εἰ ἐν τῷ ἔμπροσθεν ἀσηρὸν τὸ φόρημα, πῶς γε δὴ οὐκ ἐν τῷ ἐσωτέρω; τὸ μὲν οὖν πρῶτον, καὶ ἔσωθεν ἀναπλάσσεσθαι καὶ ἔξωθεν ἀφειδήσαντα, χρὴ ἀναγαγεῖν ἐς τὴν ἀρχαίην φύσιν, καὶ διορθώσασθαι. κάρτα γὰρ οἵη τε ῤὶς καταγεῖσα ἀναπλάσσεσθαι, μάλιστα μὲν αὐθήμερος, ἢν δὲ μὴ, ὀλίγῳ ὕστερον· ἀλλὰ καταβλακεύουσιν οἱ ἰητροὶ, καὶ ἁπαλωτέρως τὸ πρῶτον ἅπτονται, ἢ ὡς χρὴ· παραβάλλοντα γὰρ τοὺς δακτύλους χρὴ ἔνθεν καὶ ἔνθεν κατὰ τὴν φύσιν τῆς ῤινὸς ὡς κατωτάτω, κάτωθεν ξυναναγκάζειν, καὶ οὕτω μάλιστα ἀνορθοῦται σὺν τῇ ἔσωθεν διορθώσει. ἔπειτα δὲ ἐς ταῦτα ἰητρὸς οὐδεὶς ἄλλος ἐστὶ τοιοῦτος, εἰ ἐθέλοι καὶ μελετᾷν καὶ τολμᾷν, ὡς οἱ δάκτυλοι αὐτοῦ οἱ λιχανοί· οὗτοι γὰρ κατὰ φύσιν μάλιστά εἰσιν. παραβάλλοντα γὰρ χρὴ τῶν δακτύλων ἑκάτερον, παρὰ πᾶσαν τὴν ῤῖνα ἐρείδοντα, ἡσύχως οὗτως ἔχειν, μάλιστα μὲν, εἰοἷόν τε εἴη, αἰεὶ, ἐστʼ ἂν κρατυνθῇ, εἰ δὲ μὴ, ὡς πλεῖστον χρόνον, αὐτὸν, ὡς εἴρηται· εἰ δὲ μὴ, ἢ παῖδα ἢ γυναῖκά τινα· μαλθακὰς γὰρ τὰς χεῖρας δεῖ εἶναι. οὕτω γὰρ ἂν κάλλιστα ἰητρευθείη, ὁτέῳ ἡ ῤὶς μὴ ἐς τὸ σκολιὸν, ἀλλʼ ἐς τὸ κάτω ἱδρυμένη, ἰσόῤῥοπος εἴη. ἐγὼ μὲν οὖν οὐδεμίην που ῤῖνα εἶδον, ἥτις οὕτω κατεαγεῖσα οὐχ οἵη τε διορθωθῆναι, αὐτίκα πρὶν πωρωθῆναι ξυναναγκαζομένη, ἐγένετο, εἴ τις ὀρθῶς ἐθέλοι ἰητρέυειν. ἀλλὰ γὰρ οἱ ἄνθρωποι αἰσχροὶ μὲν εἶναι πολλοῦ ἀποτιμῶνται, μελετᾷν δὲ ἅμα μὲν οὐκ ἐπίστανται, ἅμα δὲ οὐ τολμέουσιν, ἢν μὴ ὀδυνέωνται, ἢ θάνατον δεδοίκωσιν· καίτοι ὀλιγοχρόνιος ἡ πώρωσις τῆς ῤινός· ἐν γὰρ δέκα ἡμέρῃσι κρατύνεται, ἢν μὴ ἐπισφακελίσῃ.

[¶1] 38. When the fractured bone is displaced laterally, the treatment is the same, but it is obvious that the reduction is to be made, not by applying equal force on both sides, but by pushing the displaced portion into its natural position, and pressing on it from without, and introducing something into the nostrils, and boldly rectifying the fragments which incline inward, until the whole be properly adjusted, well knowing that if you do not restore the parts at once, it is impossible but that the nose must be distorted. But when you restore the parts to their natural position, either the patient himself, or some other person, is to apply one finger or more to the part which protrudes, and keep it in position until the fracture be consolidated; but the little finger is, from time to time, to be pushed into the nostril, to rectify the parts which incline inward. When any inflammation supervenes, dough must be used, but attention must still be equally paid to the application of the fingers, although the dough be on the part. But if the fracture be in the cartilage, with lateral displacement, the end of the nose must necessarily be distorted. In such cases some of the aforementioned means of reduction, or whatever suits, is to be introduced into the nostril; but there are many convenient things to be found which have no smell, and are appropriate in other respects; thus, on one occasion, I introduced a slice of sheep’s lung, as it happened to be at hand; for sponges, if introduced, imbibe humidities. Then the outer skin of Carthaginian leather is to be taken, and a piece of the size of the thumb, or what will answer, is to be cut off and glued to the outside of the nostril which is turned aside, and then this piece of thong is to be stretched to the proper degree, or rather a little more than what will be sufficient to make the nose straight and regular. Then (for the thong must be long) it is to be brought below the ear and round the head, and the end of the thong may either be glued to the forehead, or a still longer one may be carried all round the head, and secured. This is a natural mode of setting the nose, is of easy application, and is calculated to enable the counter-extension on the nose to be made greater or less, as you may incline. In a case where the fractured nose is turned to the side, the treatment is to be conducted otherwise, as already described; and in most of them the thong ought to be glued to the end of the nose, in order to make extension in the opposite direction.

> Greek: 38. 38. Ὁκόσοισι δὲ τὸ ὀστέον ἐς τὸ πλάγιον κατάγνυται, ἡ μὲν ἴησις ἡ αὐτή· τὴν δὲ διόρθωσιν δηλονότι χρὴ ποιέεσθαι, οὐκ ἰσόῤῥοπον ἀμφοτέρωθεν, ἀλλὰ τό τε ἐκκεκλιμένον ὠθέειν ἐς τὴν φύσιν, ἔκτοσθεν ἀναγκάζοντα, καὶ ἐσματτευόμενον ἐς τοὺς μυκτῆρας, καὶ τὰ εἴσω ῤέψαντα διορθοῦν ἀόκνως, ἔστʼ ἂν κατορθώσῃς, εὖ εἰδότα, ὅτι, ἢν μὴ αὐτίκα κατορθώσῃς, οὐχ οἷόν τε μὴ οὐχὶ διεστράφθαι τὴν ῤῖνα. ὅταν δὲ ἀγάγῃς ἐς τὴν φύσιν, προσβάλλοντα χρὴ ἐς τὸ χωρίον, ἢ τοὺς δακτύλους, ἢ τὸν ἕνα δάκτυλον, ᾗ ἐξέσχεν, ἀνακωχέειν, ἢ αὐτὸν, ἢ ἄλλον τινὰ, ἔστʼ ἂν κρατυνθῇ τὸ τρῶμα· ἀτὰρ καὶ ἐς τὸν μυκτῆρα τὸν σμικρὸν δάκτυλον ἀπωθέοντα, ἄλλοτε καὶ ἄλλοτε διορθοῦν χρὴ τὰ ἐγκλιθέντα. ὅ τι δʼ ἂν φλεγμονῆς ὑπογίνηται τουτέοισι, χρὴ τῷ σταιτὶ χρέεσθαι· τοῖσι μέντοι δακτύλοισι προσέχειν χρὴ ὁμοίως, καὶ τοῦ σταιτὸς ἐπικειμένου. ἢν δέ που κατὰ τὸν χόνδρον ἐς τὰ πλάγια καταγῇ, ἀνάγκη τὴν ῤῖνα ἄκρην παρεστράφθαι. χρὴ οὖν τοῖσι τοιούτοισιν ἐς τὸν μυκτῆρα ἄκρον διόρθωμά τι τῶν εἰρημένων, ἢ ὅ τι τούτοισιν ἔοικεν, ἐντιθέναι· πολλὰ δʼ ἄν τις εὕροι τὰ ἐπιτήδεια, ὅσα μήτε ὀδμὴν ἴσχει, ἄλλως τε καὶ προσηνέα ἐστίν· ἐγὼ δέ ποτε πλεύμονος προβάτου ἀπότμημα ἐνέθηκα, τοῦτο γάρ πως παρέτυχεν· οἱ γὰρ σπόγγοι ἐντιθεμένοι ὑγράσματα δέχονται. ἔπειτα χρὴ καρχηδονίου δέρματος λοπὸν, πλάτος ὡς τοῦ μεγάλου δακτύλου τετμημένον, ἢ ὅκως ἂν ξυμφέρῃ, προσκολλῆσαι ἐς τὸ ἔκτοσθεν πρὸς τὸν μυκτῆρα τὸν ἐκκεκλιμένον· κἄπειτα κατατεῖναι τὸν ἱμάντα, ὅκως ἂν ξυμφέρῃ· μᾶλλον δὲ ὀλίγῳ τείνειν χρὴ, [ἢ] ὥστε ὀρθὴν καὶ ἀπαρτῆ τὴν ῤῖνα εἶναι. ἔπειτα (μακρὸς γὰρ ἔστω ὁ ἱμὰς), κάτωθεν τοῦ ὠτὸς ἀγαγόντα αὐτὸν, ἀναγαγεῖν περὶ τὴν κεφαλήν· καὶ ἔξεστι μὲν κατὰ τὸ μέτωπον προσκολλῆσαι τὴν τελευτὴν τοῦ ἱμάντος, ἔξεστι δὲ καὶ μακρότερον ἐπιπεριελίσσοντα περὶ τὴν κεφαλὴν καταδέειν. τοῦτο ἅμα μὲν δικαίην τὴν διόρθωσιν ἔχει, ἅμα δὲ εὐταμίευτον, καὶ μᾶλλον, ἢν ἐθέλῃ, καὶ ἧσσον τὴν ἀντιῤῥοπίην ποιῆσαι τῆς ῤινός. ἀτὰρ καὶ ὁκόσοισιν ἐς τὸ πλάγιον ἡ ῤὶς κατάγνυται, τὰ μὲν ἄλλα ἰητρεύειν χρὴ, ὡς προείρηται· προσδέεται δὲ τοῖσι πλείστοισι καὶ τοῦ ἱμάντος πρὸς ἄκρην τὴν ῤῖνα προσκολληθῆναι τῆς ἀντιῤῥοπίης εἵνεκα.

[¶2] 39. When the fracture is complicated with a wound, one need not be troubled on that account, but pitch-cerate or any of the applications for fresh wounds is to be applied to the sores; for, in general, they admit of easy cure, even when there is reason to apprehend that pieces of bone will come out. The parts, at first, are to be adjusted fearlessly, taking care that nothing is omitted, and, subsequently, they are also to be adjusted with the fingers; more softly, indeed, but still it must be done; and of all parts of the body the nose is modeled with the greatest ease. And there is nothing to prevent us from having recourse to the practice of gluing on the thongs, and drawing the nose to the opposite side, even if there be a wound or the parts be inflamed, for these thongs give no pain.

> Greek: 39. 39. Ὅσοισι δὲ σὺν τῇ κτήξει καὶ ἕλκεα προσγίνεται, οὐδὲν δεῖ ταράσσεσθαι διὰ τοῦτο· ἀλλʼ ἐπὶ μὲν τὰ ἕλκεα ἐπιτιθέναι ἢ πισσηρὴν, ἢ τῶν ἐναίμων τι· εὐαλθέα γὰρ τῶν τοιούτων τὰ πλεῖστά ἐστιν ὁμοίως, κἢν ὀστέα μέλλῃ ἀπιέναι. τὴν δὲ διόρθωσιν τὴν πρώτην ἀόκνως χρὴ ποιέεσθαι, μηδὲν ἐπιλείποντα, καὶ τὰς διορθώσιας τοῖσι δακτύλοισιν ἐν τῷ ἔπειτα χρόνῳ, χαλαρωτέροισι μὲν χρεόμενον, χρεόμενον δέ· εὐπλαστότατον γάρ τι παντὸς τοῦ σώματος ἡ ῤίς ἐστιν. τῶν δὲ ἱμάντων τῇ κολλήσει καὶ τῇ ἀντιῤῥοπίῃ παντάπασιν οὐδὲν κωλύει χρέεσθαι, οὔτʼ ἢν ἕλκος ᾖ, οὔτʼ ἢν ἐπιφλεγμήνῃ ἀλυπόταται γάρ εἰσιν.

[¶3] 40. In fractures of the ear all sorts of bandages do harm. For one would not think of applying it quite loose, and if applied more tightly, it only does the more harm, for even the sound ear, when confined with a bandage, becomes painful, throbs, and gets into a febrile state. With regard to cataplasms, the heaviest, on the whole, are the worst; but almost all kinds are bad, form abscesses, occasion an increase of humors, and afterward troublesome suppurations; and a fractured ear stands in less need of such applications than any other part; the most ready, if required, is the paste of meal, but neither should it have weight. It should touch as little as possible; for it is a good sometimes to apply nothing at all, both to the ear and to many other cases. Attention must be paid to the patient’s position during sleep. And the body must be reduced, more especially if there be danger lest the ear suppurate; it will also be better to open the bowels, and if the patient can be readily made to vomit, this may be accomplished by means of the syrmaism. If the part come to suppuration, it should not be hastily opened; for often when matter appears to be formed it is absorbed again, even when no cataplasm is applied. But if forced to open it, the part will get soonest well if transfixed with a cautery, and yet it should be well understood that the ear gets maimed, and is less than the other if burned through. If not burned through, an incision, and not a very small one, should be made on the upper side; for the pus is found to be surrounded with a thicker covering than one would have supposed; and it may be said, in general, that all parts of a mucous nature and which form mucus, as being all viscid, when touched, slip from below the fingers to either side; and on that account the physician, in such cases, finds that he has to pass his instrument through a thicker substance than he supposed; and in certain ganglionic cases, when the skin is flabby and mucous, many physicians open them, expecting to find a collection in them; here the physician forms a wrong judgment, but by such a procedure no great harm results to the patient from having had the part opened. But with regard to watery parts, and such as are filled with mucus, and which are situated in regions where every one of the parts, if opened, will occasion death or some other injury, these will be treated of in another work. When, therefore, incision is made in the ear, all sorts of cataplasms and pledges should be avoided, and it is to be treated either with applications for recent wounds, or anything else which is neither heavy nor will occasion pain, for if the cartilage be laid bare and abscesses form, the case will be troublesome; this happens from such modes of treatment. In all aggravated cases, the most effectual remedy is the transfixing of the part with a hot iron.

> Greek: 40. 40. ἢν δὲ οὖς κατεαγῇ, ἐπιδέσιες μὲν πᾶσαι πολέμιαι· οὐ γὰρ οὕτω τις καλαρὸν περιβάλλοι· ἢν δὲ μᾶλλον πιέζῃ, πλέον κακὸν ἐργάζεται· ἐπεὶ καὶ ὑγιὲς οὖς, ἐπιδέσει πιεχθὲν, ὀδυνηρὸν καὶ σφυγματῶδες καὶ πυρετῶδες γίνεται. ἀτὰρ καὶ τὰ ἐπιπλάσματα, κάκιστα μὲν τὰ βαρύτατα τὸ ἐπίπαν· ἀτὰρ καὶ τὰ πλεῖστα φλαῦρα καὶ ἀποστατικὰ, καὶ μύξαν τε ὑποποιέει πλείω, κἄπειτα ἐκπυήσιας ἀσηράς· τούτων δὲ ἥκιστα οὖς κατγὲν προσδέεται· ἄγχιστα μὴν, εἴπερ χρὴ, τὸ γλίσχρον ἄλητον· χρὴ δὲ μηδὲ τοῦτο βάρος ἔχειν. ψαύειν δὲ ὡς ἥκιστα ξυμφέρει· ἀγαθὸν γὰρ φάρμακόν ἐστιν ἐνίοτε καὶ τὸ μηδὲν προσφέρειν καὶ πρὸς οὖς καὶ πρὸς ἄλλα πολλά. χρὴ δὲ καὶ τὴν ἐπικοίμησιν φυλάσσεσθαι· τὸ δὲ σῶμα ἰσχναίνειν, καὶ μᾶλλον, ᾧ ἂν κίνδυνος ἔῃ ἔμπυον τὸ οὖς γενέσθαι· ἄμεινον δὲ καὶ μαλθάξαι τὴν κοιλίην· ἢν δὲ καὶ εὐήμετος ἔῃ, ἐμέειν ἀπὸ συρμαϊσμοῦ. ἢν δὲ ἐς ἐμπύησιν ἔλθῃ, ταχέως μὲν οὐ χρὴ στομοῦν· πολλὰ γὰρ καὶ τῶν δοκεόντων ἐκπυέεσθαι ἀναπίνεταί ποτε, κἢν μηδέν τις καταπλάσῃ. ἢν δὲ ἀναγκασθῇ στομῶσαι, τάχιστα μὲν ὑγιὲς γίνεται, ἤν τις πέρην διακαύσῃ· εἰδέναι μέντοι χρὴ σαφῶς, ὅτι κυλλὸν ἔσται τὸ οὖς καὶ μεῖον τοῦ ἑτέρου, ἢν πέρην διακαυθῇ. ἢν δὲ μὴ πέρην καίηται, τάμνειν χρὴ τὸ μετέωρον, μὴ πάνυ σμικρὴν τομήν· διὰ παχυτέρου μὴν καὶ τὸ πῦον εὑρίσκεται, ἢ ὡς ἄν τις δοκέοι· ὡς δʼ ἐν κεφαλαίῳ εἰπεῖν, καὶ πάντα τἄλλα τὰ μυξώδεα καὶ μυξοποιὰ, ἅτε γλίσχρα ἐόντα, ὑποθιγγανόμενα διολισθάνει ταχέως ὑπὸ τοὺς δακτύλους καὶ ἔνθα καὶ ἔνθα· διὰ τοῦτο διὰ παχυτέρου εὑρίσκουσι τὰ τοιαῦτα οἱ ἰητροὶ, ἢ ὡς οἴονται· ἐπεὶ καὶ τῶν γαγγλιωδέων ἔνια, ὅσα ἂν πλαδαρὰ ἔῃ, καὶ μυξώδεα σάρκα ἔχῃ, πολλοὶ στομοῦσιν, οἰόμενοι ῤεῦμα ἀνευρήσειν ἐς τὰ τοιαῦτα· ἡ μὲν οὖν γνώμη τοῦ ἰητροῦ ἐξαπατᾶται· τῷ δὲ πρήγματι τῷ τοιούτῳ οὐδεμία βλάβη στομωθέντι. ὅσα δὲ ὑδατώδεα χωρία ἐστὶν, ἢ μύξης πεπληρωμένα, καὶ ἐν οἵοισι χωρίοισιν ἕκαστα θάνατον φέρει στομούμενα, ἢ καὶ ἀλλοίας βλάβας, περὶ τούτων ἐν ἄλλῳ λόγῳ γεγράψεται. ὅταν οὖν τάμῃ τις τὸ οὖς, πάντων μὲν καταπλασμάτων, πάσης τε μοτώσιος ἀπέχεσθαι χρή· ἰητρεύειν δὲ ἢ ἐναίμῳ, ἢ ἄλλῳ τῳ, ὅ τι μήτε βάρος, μήτε πόνον παρασχήσει· ἢν γὰρ ὁ χόνδρος ἄρξηται ψιλοῦσθαι, καὶ ὑποστάσιας ἴσχῃ, ὀχλῶδες· γιγνεται δὲ τοῦτο διʼ ἐκείνας τὰς ἰήσιας. πάντων δὲ τῶν παλιγκοτησάντων ἡ πέρην διάκαυσις αὐταρκέστατον.

[¶4] 41. The vertebrae of the spine when contracted into a hump behind from disease, for the most part cannot be remedied, more especially when the gibbosity is above the attachment of the diaphragm to the spine. Certain of those below the diaphragm are carried off by varices in the legs, more especially by such as occur in the vein at the ham; and in those cases where the gibbosities are removed, the varices take place also in the groin; and some have been carried off by a dysentery when it becomes chronic. And when the gibbosity occurs in youth before the body has attained its full growth, in these cases the body does not usually grow along the spine, but the legs and the arms are fully developed, whilst the parts (about the back) are arrested in their development. And in those cases where the gibbosity is above the diaphragm, the ribs do not usually expand properly in width, but forward, and the chest becomes sharp-pointed and not broad, and they become affected with difficulty of breathing and hoarseness; for the cavities which inspire and expire the breath do not attain their proper capacity. And they are under the necessity of keeping the neck bent forward at the great vertebra, in order that their head may not hang downward; this, therefore, occasions great contraction of the pharynx by its inclination inward; for, even in those who are erect in stature, dyspnoea is induced by this bone inclining inward, until it be restored to its place. From this frame of body, such persons appear to have more prominent necks than persons in good health, and they generally have hard and unconcocted tubercles in the lungs, for the gibbosity and the distension are produced mostly by such tubercles, with which the neighboring nerves communicate. When the gibbosity is below the diaphragm, in some of these cases nephritic diseases and affections of the bladder supervene, but abscesses of a chronic nature, and difficult to cure, occur in the loins and groins, and neither of these carries off the gibbosity; and in these cases the hips are more emaciated than when the gibbosity is seated higher up; but the whole spine is more elongated in them than in those who have the gibbosity seated higher up, the hair of the pubes and chin is of slower growth and less developed, and they are less capable of generation than those who have the gibbosity higher up. When the gibbosity seizes persons who have already attained their full growth, it usually occasions a crisis of the then existing disease, but in the course of time some of them attack, as in the case of younger persons, to a greater or less degree; but, not withstanding, for the most part, all these diseases are less malignant. And yet many have borne the affection well, and have enjoyed good health until old age, more especially those persons whose body is inclined to be plump and fat; and a few of them have lived to beyond sixty years of age, but the most of them are more short-lived. In some cases the curvature of the spine is lateral, that is to say, either to the one side or the other; the most of such cases are connected with tubercles (abscesses?) within the spine; and in some, the positions in which they have been accustomed to lie cooperate with the disease. But these will be treated of among the chronic affections of the lungs; for these the most suitable prognostics of what will happen in these cases are given.

> Greek: 41. 41. σπόνδυλοι δὲ οἱ κατὰ ῤάχιν, ὅσοισι μὲν ὑπὸ νοσημάτων ἕλκονται ἐς τὸ κυφὸν, τὰ μὲν πλεῖστα ἀδύνατα λύεσθαι, ποτὶ καὶ ὅσα ἀνωτέρω τῶν φρενῶν τῆς προσφύσιος κυφοῦται. τῶν δὲ κατωτέρω μετεξέτερα λύουσι κιρσοὶ γενόμενοι ἐν τοῖσι σκέλεσι, μᾶλλον δέ τι ἐγγινόμενοι κιρσοὶ ἐν τῇ κατʼ ἰγνύην φλεβί· οἷσι δʼ ἂν τὰ κυφώματα λύηται, ἐγγίνονται δὲ καὶ ἐν τῇ κατὰ βουβῶνα· ἤδη δέ τισιν ἔλυσε καὶ δυσεντερίη πολυχρόνιος γενομένη. καὶ οἷσι μὲν κυφοῦται ῤάχις παισὶν ἐοῦσι, πρὶν ἢ τὸ σῶμα τελειωθῆναι ἐς αὔξησιν, τουτέοισι μὲν οὐδὲ ξυναύξεσθαι ἐθέλει κατὰ τὴν ῤάχιν τὸ σῶμα, ἀλλὰ σκέλεα μὲν καὶ χεῖρες τελειοῦνται· ταῦτα δὲ ἐνδεέστερα γίνεται. καὶ ὅσοισιν ἂν ᾖ ἀνωτέρω τῶν φρενῶν τὸ κῦφος, τούτοισι μὲν αἵ τε πλευραὶ οὐκ ἐθέλουσιν ἐς τὸ εὐρὺ αὔξεσθαι, ἀλλʼ ἐς τοὔμπροσθεν, τό τε στῆθος ὀξὺ γίνεται, ἀλλʼ οὐ πλατὺ, αὐτοί τε δύσπνοοι γίνονται, καὶ κερχώδεες· ἧσσον γὰρ εὐρυχωρίην ἔχουσιν αἱ κοιλίαι αἱ τὸ πνεῦμα δεχόμεναι καὶ προπέμπουσαι. καὶ μέντοι καὶ ἀναγκάζονται κατὰ τὸν μέγαν σπόνδυλον λορδὸν τὸν αὐχένα ἔχειν, ὡς μὴ προπετὴς ἔῃ αὐτέοισιν ἡ κεφαλή· στενοχωρίην μὲν οὖν πολλην τῇ φάρυγγι παρέχει καὶ τοῦτο, ἐς τὸ ἔσω ῤέπον· καὶ γὰρ τοῖσιν ὀρθοῖσι φύσει δύσπνοιαν παρέχει τοῦτο τὸ ὀστέον, ἢν ἔσω ῤέψῃ, ἔστʼ ἂν ἀναπιεχθῇ. διʼ οὖν τὸ τοιοῦτον σχῆμα ἐξεχέβρογχοι οἱ τοιοῦτοι τῶν ἀνθρώπων μᾶλλον φαίνονται, ἢ οἱ ὑγιέες· φυματίαι τε ὡς ἐπὶ τὸ πολὺ κατὰ τὸν πλεύμονά εἰσιν οἱ τοιοῦτοι σκληρῶν φυμάτων καὶ ἀπέπτων· καὶ γὰρ ἡ πρόφασις τοῦ κυφώματος καὶ ἡ ξύντασις τοῖσι πλείστοισι διὰ τοιαύτας ξυστροφὰς γίνεται, ᾗσιν ἂν κοινωνήσωσιν οἱ τόνοι οἱ ξύνεγγυς. Ὅσοισι δὲ κατωτέρω τῶν φρενῶν τὸ κύφωμά ἐστι, τούτοισι νοσήματα μὲν ἐνίοισι προσγίνεται νεφριτικὰ, καὶ κατὰ κύστιν· ἀτὰρ καὶ ἀποστάσιες ἐμπυήματι καὶ κατὰ κενεῶνας, καὶ κατὰ βουβῶνας, χρόνιαι καὶ δυσαλθέες, καὶ τουτέων οὐδετέρη λύει τὰ κυφώματα· ἰσχία δὲ τοῖσι τοιουτέοισιν ἔτι ἀσαρκότερα γίνεται, ἢ τοῖσιν ἄνωθεν κυφοῖσιν· ἡ μέντοι ξύμπασα ῤάχις μακροτέρη τουτέοισιν, ἢ τοῖσιν ἄνωθεν κυφοῖσιν· ἥβη δὲ καὶ γένειον βραδύτερα καὶ ἀτελέστερα, καὶ ἀγονώτεροι οὗτοι τῶν ἄνωθεν κυφῶν. οἷσι δʼ ἂν ηὐξημένοισιν ἤδη τὸ σῶμα ἡ κύφωσις γένηται, τούτοισιν ἀπαντικρὺ μὲν τῆς νούσου τῆς τότε παρεούσης κρίσιν ποιέει ἡ κύφωσις· ἀνὰ χρόνον μέντοι ἐπισημαίνει τι τῶν αὐτέων, ὥσπερ καὶ τοῖσι νεωτέροισιν, ἢ πλέον, ἢ ἔλασσον· ἧσσον δὲ κακοήθως ὡς τὸ ἐπίπαν μὴν τοιαῦτα πάντα ἐστίν. πολλοὶ μέντοι ἤδη καὶ εὐφόρως ἤνεγκαν καὶ ὑγιεινῶς τὴν κύφωσιν ἄχρι γήρως, μάλιστα δὲ οὗτοι, οἷσιν ἂν ἐς τὸ εὔσαρκον καὶ πιμελῶδες προτράπηται τὸ σῶμα· ὀλίγοι μὴν ἤδη καὶ τῶν τοιούτων ὑπὲρ ἑξήκοντα ἔτη ἐβίωσαν· οἱ δὲ πλεῖστοι βραχυβιώτεροί εἰσιν. ἔστι δʼ οἷσι καὶ ἐς τὸ πλάγιον σκολιοῦνται σπόνδυλοι ἢ τῇ, ἢ τῇ· πάντα μὴν ἢ τὰ πλεῖστα τὰ τοιαῦτα γίνεται διὰ ξυστροφὰς τὰς ἔσωθεν τῆς ῤάχιος· προσξυμβάλλεται δὲ ἐνίοισι ξὺν τῇ νούσῳ καὶ τὰ σχήματα, ἐφʼ ὁκοῖα ἂν. ἐθισθέωσι κεκλίσθαι. ἀλλὰ περὶ μὲν τούτων ἐν τοῖσι χρονίοισι κατὰ πλεύμονα νοσήμασιν εἰρήσεται· ἐκεῖ γάρ εἰσιν αὐτῶν χαριέσταται προγνώσιες περὶ τῶν μελλόντων ἔσεσθαι.

[¶5] 42. When the spine protrudes backward, in consequence of a fall, it seldom happens that one succeeds in straightening it. Wherefore succussion on a ladder has never straightened anybody, as far as I know, but it is principally practiced by those physicians who seek to astonish the mob-for to such persons these things appear wonderful, for example, if they see a man suspended or thrown down, or the like; and they always extol such practices, and never give themselves any concern whatever may result from the experiment, whether bad or good. But the physicians who follow such practices, as far as I have known them, are all stupid. The device, however, is an old one, and I give great praise to him who first invented this, and any other mechanical contrivance which is according to nature. For neither would I despair, but that if succussion were properly gone about, the spine, in certain cases, might be thereby rectified. But, indeed, for my own part, I have been ashamed to treat all such cases in this way, because such modes of procedure are generally practiced by charlatans.

> Greek: 42. 42. Ὅσοισι δὲ ἐκ καταπτώσιος ῤάχις κυφοῦται, ὀλίγα δὴ τούτων ἐκρατήθη, ὥστε ἐξιθυνθῆναι. τοῦτο μὲν γὰρ, αἱ ἐν τῇ κλίμακι κατασείσιες οὐδένα πω ἐξίθυναν, ὧν γε ἐγὼ οἶδα· χρέονται δὲ οἱ ἰητροὶ μάλιστα αὐτῇ οὗτοι οἱ ἐπιθυμέοντες ἐκχαυνοῦν τὸν πολὺν ὄχλον· τοῖσι γὰρ τοιούτοισι ταῦτα θαυμάσιά ἐστιν, ἢν ἢ κρεμάμενον ἴδωσιν, ἢ ῤιπτεόμενον, ἢ ὅσα τοῖσι τοιούτοισιν ἔοικε, καὶ ταῦτα κληΐζουσιν αἰεὶ, καὶ οὐκέτι αὐτοῖσι μέλει, ὁκοῖόν τι ἀπέβη ἀπὸ τοῦ χειρίσματος, εἴτε κακὸν, εἴτε ἀγαθόν. οἱ μέντοι ἰητροὶ οἱ τὰ τοιαῦτα ἐπιτηδεύοντες, σκαιοί εἰσιν, οὓς ἔγωγε ἔγνων· τὸ μὲν γὰρ ἐπινόημα ἀρχαῖον, καὶ ἐπαινέω ἔγωγε σφόδρα τὸν πρῶτον ἐπινοήσαντα καὶ τοῦτο καὶ ἄλλο πᾶν, ὅ τι μηχάνημα κατὰ φύσιν ἐπενοήθη· οὐδὲν γάρ μοι ἄελπτον, εἴ τις καλῶς σκευάσας καλῶς κατασείσειε, κἂν ἐξιθυνθῆναι ἔνια. αὐτὸς μέντοι κατῃσχύνθην πάντα τὰ τοιουτότροπα ἰητρεύειν οὕτω, διὰ τοῦτο ὅτι πρὸς ἀπατεώνων μᾶλλον οἱ τοιοῦτοι τρόποι.

[¶6] 43. Those cases in which the gibbosity is near the neck, are less likely to be benefited by these succussions with the head downward, for the weight of the head, and tops of the shoulders, when allowed to hang down, is but small; and such cases are more likely to be made straight by succussion applied with the feet hanging down, since the inclination downward is greater in this way. When the hump is lower down, it is more likely in this case that succussion with the head downward should do good. If one, then, should think of trying succussion, it may be applied in the following manner:—The ladder is to be padded with leather lined cushions, laid across, and well secured to one another, to a somewhat greater extent, both in length and breadth, than the space which the man’s body will occupy; he is then to be laid on the ladder upon his back, and the feet, at the ankles, are to be fastened, at no great distance from one another, to the ladder, with some firm but soft band; and he is further to be secured, in like manner, both above and below the knee, and also at the nates; and at the groins and chest loose shawls are to be put round in such a fashion as not to interfere with the effect of the succussion; and his arms are to be fastened along his sides to his own body, and not to the ladder. When you have arranged these matters thus, you must hoist up the ladder, either to a high tower or to the gable-end of a house; but the place where you make the succussion should be firm, and those who perform the extension should be well instructed, so that they may let go their hold equally to the same extent, and suddenly, and that the ladder may neither tumble to the ground on either side, nor they themselves fall forward. But, if the ladder be let go from a tower, or the mast of a ship, fastened into the ground with its cordage, it will be better, so that the ropes run upon a pulley or axle-tree. But it is disagreeable even to enlarge upon these matters; and yet, by the contrivances now described, the proper succussion may be made.

> Greek: 43. 43. Ὅσοισι μὲν οὖν ἐγγὺς τοῦ αὐχένος ἡ κύφωσις γίνεται, ἧσσον εἰκὸς ὠφελέειν τὰς κατασείσιας ταύτας τὰς ἐπὶ κεφαλὴν· σμικρὸν γὰρ τὸ βάρος ἡ κεφαλὴ καὶ τὰ ἀκρώμια καταῤῥέποντα· ἀλλὰ τούς γε τοιούτους εἰκὸς ἐπὶ τοὺς πόδας κατασεισθέντας μᾶλλον ἐξιθυνθῆναι· μέζων γὰρ οὕτως ἡ καταῤῥοπίη ἡ ἐπὶ ταῦτα. Ὅσοισι δὲ κατωτέρω τὸ ὕβωμα, τουτέοισιν εἰκὸς μᾶλλον ἐπὶ κεφαλὴν κατασείεσθαι. εἰ οὖν τις ἐθέλοι κατασείειν, ὀρθῶς ἂν ὧδε σκευάζοι· τὴν μὲν κλίμακα χρὴ σκυτίνοισιν ὑποκεφαλαίοισι πλαγίοισιν, ἢ ἐρινέοισι, καταστρῶσαι εὖ προς δεδεμένοισιν, ὀλίγῳ πλέον καὶ ἐπὶ μῆκος καὶ ἔνθεν καὶ ἔνθεν, ἢ ὅσον ἂν τὸ σῶμα τοῦ ἀνθρώπου κατάσχοι· ἔπειτα τὸν ἄνθρωπον ὕπτιον κατακλῖναι ἐπὶ τὴν κλίμακα χρή· κἄπειτα προσδῆσαι μὲν τοὺς πόδας παρὰ τὰ σφυρὰ πρὸς τὴν κλίμακα μὴ διαβεβῶτας, δεσμῷ εὐόχῳ μὲν, μαλθακῷ δέ· προσδῆσαι δὲ κατωτέρω ἑκάτερον τῶν γουνάτων, καὶ ἀνωτέρω· προσδῆσαι δὲ καὶ κατὰ τὰ ἰσχία· κατὰ δὲ τοὺς κενεῶνας καὶ κατὰ τὸ στῆθος χαλαρῇσι ταινίῃσι περιβαλέειν οὕτως, ὅκως μὴ κωλύωσι τὴν κατάσεισιν· τὰς δὲ χεῖρας παρὰ τὰς πλευρὰς παρατείναντα προσκαταλαβεῖν πρὸς αὐτὸ τὸ σῶμα, καὶ μὴ πρὸς τὴν κλίμακα. ὅταν δὲ ταῦτα κατασκευάσῃς οὕτως, ἀνέλκειν τὴν κλίμακα ἢ πρὸς τύρσιν τινὰ ὓψηλὴν, ἢ πρὸς ἀέτωμα οἴκου· τὸ δὲ χωρίον, ἵνα κατασείεις, ἀντίτυπον ἔστω· τοὺς δὲ ἀνατείνοντας εὐπαιδεύτους χρὴ εἶναι, ὅκως ὁμαλῶς καὶ ἰσοῤῥόπως καὶ ἐξαπιναίως ἀφήσουσι, καὶ μήτε ἡ κλίμαξ ἑτερόῤῥοπος ἐπὶ τὴν γῆν ἀφίξεται, μήτε αὐτοὶ προπετέες ἔσονται. ἀπὸ μέντοι τύρσιος ἀφιεὶς ἢ ἀπὸ ἱστοῦ καταπεπηγότος καρχήσιον ἔχοντος, ἔτι κάλλιον ἄν τις σκευάσαιτο, ὥστε ἀπὸ τροχιλίης τὰ χαλώμενα εἶναι ὅπλα, ἢ ἀπὸ ὄνου. ἀηδὲς μὴν καὶ μακρολογέειν περὶ τούτων· ὅμως δὲ ἐκ τουτέων ἂν τῶν κατασκευῶν κάλλιστʼ ἄν τις κατασεισθείη.

[¶7] 44. But if the hump be situated very high up, and if succussion be by all means to be used, it will be better to do it with the feet downward, as has been said, for the force downward will be the greater in this case. The patient is to be well fastened to the ladder by cords at the breast, at the neck by means of a very loose shawl so as merely to keep the part properly on the ladder, and the head is to be fastened to the ladder at the forehead, the arms are to be stretched along and attached to the patient’s body, and not to the ladder, and the rest of the body is not to be bound, except so as to keep it in place by means of a loose shawl wrapped round it and the ladder; attention, moreover, should be paid that these ligatures do not interfere with the force of the succussion, and the legs are not to be fastened to the ladder, but should be placed near one another, so as to be in line with the spine. These matters should be thus arranged, if recourse is to be had at all to succussion on a ladder; for it is disgraceful in every art, and more especially in medicine, after much trouble, much display, and much talk, to do no good after all.

> Greek: 44. 44. εἰ μέντοι κάρτα ἄνω εἴη τὸ ὕβωμα, δέοι δὲ κατασείειν πάντως, ἐπὶ πόδας κατασείειν λυσιτελέει, ὥσπερ ἤδη εἴρηται· πλείων γὰρ οὕτω γίνεται ἡ καταῤῥοπίη ἐπὶ ταῦτα. Ἑρμάσαι δὲ χρὴ, κατὰ μὲν τὸ στῆθος πρὸς τὴν κλίμακα προσδήσαντα ἰσχυρῶς, κατὰ δὲ τὸν αὐχένα ὡς χαλαρωτάτῃ ταινίῃ, ὅσον τοῦ κατορθοῦσθαι εἵνεκα· καὶ αὐτὴν τὴν κεφαλὴν κατὰ τὸ μέτωπον προσδῆσαι πρὸς τὴν κλίμακα· τὰς δὲ χεῖρας παρατανύσαντα πρὸς τὸ σῶμα προσδῆσαι, καὶ μὴ πρὸς τὴν κλίμακα· τὸ μέντοι ἄλλο σῶμα ἄδετον εἶναι χρὴ, πλὴν, ὅσον τοῦ κατορθοῦσθαι εἵνεκα, ἄλλῃ καὶ ἄλλῃ ταινίῃ χαλαρῇ περιβεβλῆσθαι· ὅκως δὲ μὴ κωλύωσιν οὗτοι οἱ δεσμοὶ τὴν κατασεισιν, σκοπέειν· τὰ δὲ σκέλεα πρὸς μὲν τὴν κλίμακα μὴ προσδεδέσθω, πρὸς ἄλληλα δὲ, ὡς κατὰ τὴν ῤάχιν ἰθύῤῥοπα ἔῃ. ταῦτα μέντοι τοιουτοτρόπως ποιητέα, εἰ πάντως δέοι ἐν κλίμακι κατασεισθῆναι· αἰσχρὸν μέντοι καὶ ἐν πάσῃ τέχνῃ καὶ οὐχ ἥκιστα ἐν ἰητρικῇ πουλὺν ὄχλον, καὶ πολλὴν ὄψιν, καὶ πουλὺν λόγον παρασχόντα, ἔπειτα μηδὲν ὠφελῆσαι.

[¶8] 45. In the first place, the structure of the spine should be known, for this knowledge is requisite in many diseases. Wherefore, on the side turned to the belly (the anterior?) the vertebrae are in a regular line, and are united together by a pulpy and nervous band of connection, originating from the cartilages, and extending to the spinal marrow. There are certain other nervous cords which decussate, are attached (to the vertebrae?), and are extended from both sides of them. But we will describe in another work the connections of the veins and arteries, their numbers, their qualities, their origin, their functional offices in particular parts, in what sort of sheaths the spinal marrow is inclosed, where they arise, where they terminate, how they communicate, and what their uses. On the opposite side (behind?) the vertebrae are connected together by a ginglymoid articulation. Common cords (nerves?) are extended to all parts, both those within and without. There is an osseous process from the posterior part of all and each of the vertebra, whether greater or smaller; and upon these processes there are cartilaginous epiphyses, and from them arise nervous productions (ligaments?), akin to the external nerves (tonoi). The ribs are united to them, having their heads inclined rather to the inside than the out, and every one of them is articulated with the vertebrae; and the ribs in man are very curved, and, as it were, arched. The space between the ribs and the processes of the vertebrae is filled on both sides by muscles, which arise from the neck and extend to the loins (?). The spine, longitudinally, is a straight line slightly curved; from the os sacrum to the great vertebra which is connected with the articulation of the femur, the spine inclines backward, for the bladder, the organs of generation, and the loose portion of the rectum, are situated there. From this, to the attachment of the diaphragm, the spine inclines inward, and this portion alone, from the internal parts, gives origin to muscles, which are called psoae. From this to the great vertebra (seventh cervical?) which is above the tops of the shoulders, it is convex behind lengthways; but it is more in appearance than it really is, for the spinous processes are highest in the middle, and less so above and below. The region of the neck is convex before.

> Greek: 45. 45. χρὴ δὲ πρῶτον μὲν γινώσκειν τὴν φύσιν τῆς ῤάχιος, οἵη τίς ἐστιν· ἐς πολλὰ γὰρ νουσήματα προσδέοι ἂν αὐτῆς. τοῦτο μὲν γὰρ, τὸ πρὸς τὴν κοιλίην ῤέπον, οἱ σπόνδυλοι ἐντὸ ἄρτιοί εἰσιν ἀλλήλοισι, καὶ δέδενται πρὸς ἀλλήλους δεσμῷ μυξώδεϊ καὶ νευρώδεϊ, ἀπὸ χόνδρων ἀποπεφυκότι ἄχρι πρὸς τὸν νωτιαῖον. ἄλλοι δέ τινες τόνοι νευρώδεες διανταῖοι, πρόσφυτοι, παρατέτανται ἔνθεν καὶ ἔνθεν αὐτῶν. αἱ δὲ φλεβῶν καὶ ἀρτηριῶν κοινωνίαι ἐν ἐτέρῳ λόγῳ δεδηλώσονται, ὅσαι τε καὶ οἷαι, καὶ ὅθεν ὡρμημέναι, καὶ ἐν οἵοισιν οἷα δύνανται, αὐτὸς δὲ ὁ νωτιαῖος οἷσιν ἐλύτρωται ἐλύτροισι, καὶ ὅθεν ὡρμημένοισι, καὶ ὅπη κραίνουσιν, καὶ οἷσι κοινωνέουσι, καὶ οἷα δυναμένοισιν. ἐν δὲ τῷ ἐπέκεινα, ἐν ἄρθροισι γεγιγγλύμωνται πρὸς ἀλλήλους οἱ σπόνδυλοι. τόνοι δε κοινοὶ παρὰ πάντας, καὶ ἐν τοῖσιν ἔξω μέρεσι, καὶ ἐν τοῖσιν ἔσω παρατέτανται. ἀπόφυσις δέ ἐστιν ὀστέου ἐς τὸ ἔξω μέρος ἀπὸ πάντων τῶν σπονδύλων, μία ἀπὸ ἑνὸς ἑκάστου, ἀπό τε τῶν μειζόνων, ἀπό τε τῶν ἐλασσόνων· ἐπὶ δὲ τῇσιν ἀποφύσεσι ταύτῃσι χονδρίων ἐπιφύσιες, καὶ ἀπʼ ἐκείνων νεύρων ἀποβλάστησις ἠδελφισμένη τοῖσιν ἐξωτάτω τόνοισιν. πλευραὶ δὲ προσπεφύκασιν, ἐς τὸ εἴως μέρος τὰς κεφαλὰς ῤέπουσαι μᾶλλον, ἢ ἐς τὸ ἔξω· καθʼ ἕνα δὲ ἕκαστον τῶν σπονδύλων προσήρθρωνται· καμπυλώταται δὲ πλευραὶ ἀνθρώπου εἰσὶ ῤαιβοειδέα τρόπον. τὸ δὲ μεσηγὺ τῶν πλευρέων καὶ τῶν ὀστέων τῶν ἀποπεφυκότων ἀπὸ τῶν σπονδύλων, ἀποπληρέουσιν ἑκατέρωθεν οἱ μύες ἀπὸ τοῦ αὐχένος ἀρξάμενοι, ἄχρι τῆς προσφύσιος. αὐτὴ δὲ ἡ ῤάχις κατὰ μῆκος ἰθυσκόλιός ἐστιν· ἀπὸ μὲν τοῦ ἱεροῦ ὀστέου ἄχρι τοῦ μεγάλου σπονδύλου, παρʼ ὃν προσήρτηται τῶν σκελέων ἡ πρόσφυσις, ἄχρι μὲν τούτου κυφή· κύστις τε γὰρ, καὶ γοναὶ, καὶ ἀρχοῦ τὸ χαλαρὸν ἐν τουτέῳ ἔκτισται. ἀπὸ δὲ τούτου ἄχρι φρενῶν προσαρτήσιος, ἰθυλόρδη· καὶ παραφύσιας ἔχει μυῶν τοῦτο μοῦνον τὸ χωρίον ἐκ τῶν εἴσωθεν μερῶν, ἃς δὴ καλέουσι ψόας. ἀπὸ δὲ τούτου ἄχρι τοῦ μεγάλου σπονδύλου τοῦ ὑπὲρ τῶν ἐπωμίδων, ἰθυκύφη· ἔτι δὲ μᾶλλον δοκέει ἢ ἐστίν· ἡ γὰρ ἄκανθα κατὰ μέσον ὑψηλοτάτας τὰς ἐκφύσιας τῶν ὀστέων ἔχει, ἔνθεν δὲ καὶ ἔνθεν ἐλάσσους. αὐτὸ δὲ τὸ ἄρθρον τοῦ αὐχένος λορδόν ἐστιν.

[¶9] 46. In cases of displacement backward along the vertebrae, it does not often happen, in fact, it is very rare, that one or more vertebrae are torn from one another and displaced. For such injuries do not readily occur, as the spine could not easily be displaced backward but by a severe injury on the fore part through the belly (which would prove fatal), or if a person falling from a height should pitch on the nates, or shoulders (and even in this case he would die, but not immediately); and it also would not readily happen that such a displacement could take place forward, unless some very heavy weight should fall upon it behind; for each of the posterior spinal processes is so constructed, that it would sooner be broken than undergo any great inclination forward from a force which would have to overcome the ligaments and the articulations mutually connecting them. And the spinal marrow would suffer, if from the displacement of a vertebra it were to be bent even to a small extent; for the displaced vertebra would compress the spinal marrow, if it did not break it; and if compressed and strangled, it would induce insensibility of many great and important parts, so that the physician need not give himself any concern about rectifying the displacement of the vertebra, accompanied, as it is, by many other ill consequences of a serious nature. It is evident, then, that such a case could not be reduced either by succussion or by any other method, unless one were to cut open the patient, and then, having introduced the hand into one of the great cavities, were to push outward from within, which one might do on the dead body, but not at all on the living. Wherefore, then, do I write all this? Because certain persons fancy that they have cured patients in whom the vertebra had undergone complete dislocation forward. Some, indeed, suppose that this is the easiest of all these dislocations to be recovered from, and that such cases do not stand in need of reduction, but get well spontaneously. Many are ignorant, and profit by their ignorance, for they obtain credit from those about them. These are deceived in this way, for they suppose the spinous processes to be the vertebrae themselves, because every one of them appears round to the touch, not knowing that these bones are processes from the vertebrae, as formerly stated; but the vertebrae are at a considerable distance before them; for of all animals, man, in proportion to his bulk, has the belly (internal cavity?) the narrowest from behind to before, especially at the breast. When, therefore, any of these processes are severely fractured, whether one or more, the part there appears lower than on either side, and for that reason they are deceived, supposing that the vertebrae are displaced inward. And the attitudes of the patient contribute also to deceive them; for if they attempt to put themselves into a bent position, they are pained, from the skin being stretched at the seat of the injury, and at the same time the fragments of the bones wound the skin still more; but if they bend forward, they feel easier, for the skin at the wound is thus relaxed, and the bones are less disposed to hurt them; and if touched, they shrink and bend forward, and the part which is touched appears empty and soft. All the circumstances now mentioned contribute to deceive the physician. Such patients speedily get well without any bad effects, for callus readily forms in all such bones as are porous.

> Greek: 46. 46. Ὁκόσοισι μὲν οὖν κυφώματα γίνεται κατὰ τοὺς σπονδύλους, ἔξωσις μὲν μεγάλη ἀποῤῥαγεῖσα ἀπὸ τῆς ξυμφύσιος ἢ ἑνὸς σπονδύλου, ἢ καὶ πλειόνων, οὐ μάλα πολλοῖσι γίνεται, ἀλλʼ ὀλίγοισιν. οὐδὲ γὰρ τὰ τρώματα τὰ τοιαῦτα ῤηΐδιον γίνεσθαι· οὔτε γὰρ ἐς τὸ ἔξω ἐξωσθῆναι ῤηΐδίον ἐστιν, εἰ μὴ ἐκ τοῦ ἔμπροσθεν ἰσχυρῷ τινι τρωθείη διὰ τῆς κοιλίης (οὕτω δʼ ἂν ἀπόλοιτο), ἢ εἴ τις ἀφʼ ὑψηλοῦ τοῦ χωρίου πεσὼν ἐρείσειε τοῖσιν ἰσχίοισιν ἢ τοῖσιν ὤμοισιν (ἀλλὰ καὶ οὕτως ἂν ἀποθάνοι, παραχρῆμα δὲ οὐκ ἂν ἀποθάνοι)· ἐκ δὲ τοῦ ὄπισθεν οὐ ῤηΐδιον τοιαύτην ἔξαλσιν γενέσθαι ἐς τὸ ἔσω, εἰ μὴ ὑπέρβαρύ τι ἄχθος ἐμπέσοι· τῶν τε γὰρ ὀστέων τῶν ἐκπεφυκότων ἔξω ἓν ἕκαστον τοιοῦτόν ἐστιν, ὥστε πρόσθεν ἂν αὐτὸ καταγῆναι, πρὶν ἢ μεγάλην ῤοπὴν εἴσω ποιῆσαι, τούς τε ξυνδέσμους βιησάμενον, καὶ τὰ ἄρθρα τὰ ἐνηλλαγμένα. ὅ τε αὖ νωτιαῖος πονοίη ἂν, εἰ ἐξ ὀλίγου χωρίου τὴν περικαμπὴν ἔχοι, τοιαύτην ἔξαλσιν ἐξαλλομένου σπονδύλου· ὅ τʼ ἐκπηδήσας σπόνδυλος πιέζοι ἂν τὸν νωτιαῖον, εἰ μὴ καὶ ἀποῤῥήξειεν· πιεχθεὶς δʼ ἂν καὶ ἀπολελαμμένος, πολλῶν ἂν καὶ μεγάλων καὶ ἐπικαίρων ἀπονάρκωσιν ποιήσειεν· ὥστε οὐκ ἂν μέλοι τῷ ἰητρῷ, ὅκως χρὴ τὸν σπόνδυλον κατορθῶσαι, πολλῶν καὶ βιαίων ἄλλων κακῶν παρεόντων. ὥστε δὴ οὐδʼ ἐμβαλεῖν οἷόν τε πρόδηλον τὸν τοιοῦτον οὔτε κατασείσει, οὔτε ἄλλῳ τρόπῳ οὐδενὶ, εἰ μή τις διαταμὼν τὸν ἄνθρωπον, ἔπειτα ἐσμασάμενος ἐς τὴν κοιλίην, ἐκ τοῦ εἴσωθεν τῇ χειρὶ ἐς τὸ ἔξω ἀντωθέοι· καὶ ταῦτα νεκρῷ μὲν οἷόν τε ποιέειν, ζῶντι δὲ οὐ πάνυ. διὰ τί οὖν ταῦτα γράφω; ὅτι οἴονταί τινες ἰητρευκέναι ἀνθρώπους, οἷσιν ἔσωθεν ἔπεσον σπόνδυλοι, τελέως ὑπερβάντες τὰ ἄρθρα· καίτοι γε ῤηΐστην ἐς τὸ περιγενέσθαι τῶν διαστροφέων ταύτην ἔνιοι νομίζουσι, καὶ οὐδὲν δέεσθαι ἐμβολῆς, ἀλλʼ αὐτόματα ὑγιέα γίνεσθαι τὰ τοιαῦτα. Ἀγνοέουσι δὲ πολλοὶ, καὶ κερδαίνουσιν, ὅτι ἀγνοέουσιν· πείθουσι γὰρ τοὺς πέλας. ἐξαπατῶνται δὲ διὰ τόδε· οἴονται γὰρ τὴν ἄκανθαν τὴν ἐξέχουσαν κατὰ τὴν ῤάχιν ταύτην τοὺς σπονδύλους αὐτοὺς εἶναι, ὅτι στρογγύλον αὐτῶν ἕκαστον φαίνεται ψαυόμενον, ἀγνοεῦντες ὅτι τὰ ὀστέα ταῦτά ἐστι τὰ ἀπὸ τῶν σπονδύλων πεφυκότα, περὶ ὧν ὁ λόγος ὀλίγῳ πρόσθεν εἴρηται· οἱ δὲ σπόνδυλοι πολὺ προσωτέρω ἄπεισιν· στενοτάτην γὰρ πάντων τῶν ζώων ὥνθρωπος κοιλίην ἔχει, ὡς ἐπὶ τῷ μεγέθει, ἀπὸ τοῦ ὄπισθεν ἐς τὸ ἔμπροσθεν, ποτὶ καὶ κατὰ τὸ στῆθος. ὅταν οὖν τι τούτων τῶν ὀστέων τῶν ὑπερεχόντων ἰσχυρῶς καταγῇ, ἤν τε ἓν, ἤν τε πλείω, ταύτῃ ταπεινότερον τὸ χωρίον γίνεται, ἢ τὸ ἔνθεν καὶ ἔνθεν, καὶ διὰ τοῦτο ἐξαπατῶνται, οἰόμενοι τοὺς σπονδύλους ἔσω οἴχεσθαι. Προσεξαπατᾷ δὲ ἔτι αὐτοὺς καὶ τὰ σχήματα τῶν τετρωμένων· ἢν μὲν γὰρ πειρῶνται καμπύλλεσθαι, ὀδυνῶνται, περιτενέος γινομένου ταύτῃ τοῦ δέρματος, ᾗ τέτρωνται· καὶ ἅμα τὰ ὀστέα τὰ κατεηγότα ἐνθράσσει οὕτω μᾶλλον τὸν χρῶτα· ἢν δὲ λορδαίνωσι, ῤᾴους εἰσίν· χαλαρώτερον γὰρ τὸ δέρμα κατὰ τὸ τρῶμα ταύτῃ γίνεται, καὶ τὰ ὀστέα ἧσσον ἐνθράσσει· ἀτὰρ καὶ ἤν τις ψαύῃ αὐτῶν, κατὰ τοῦτο ὑπείκουσι λορδοῦντες, καὶ τὸ χωρίον κενεὸν καὶ μαλθακὸν ψαυόμενον ταύτῃ φαίνεται. ταῦτα πάντα τὰ εἰρημένα προσεξαπατᾷ τοὺς ἰητρούς· ὑγιέες δὲ ταχέως καὶ ἀσινέες αὐτόματοι οἱ τοιοῦτοι γίνονται· ταχέως γὰρ πάντα τὰ τοιαῦτα ὀστέα ἐπιπωροῦται, ὅσα χαῦνά ἐστιν.

[¶10] 47. There are many varieties of curvature of the spine even in persons who are in good health; for it takes place from natural conformation and from habit, and the spine is liable to be bent from old age, and from pains. Gibbosities (or projections backward) from falls generally take place when one pitches on the nates, or falls on the shoulders. In this case some one of the vertebrae must necessarily appear higher than natural, and those on either side to a less degree; but yet no one generally has started out of the line of the others, but every one has yielded a little, so that a considerable extent of them is curved. On this account the spinal marrow easily bears such distortions, because they are of a circular shape, and not angular. The apparatus for the reduction in this case must be managed in the following manner: a strong and broad board, having an oblong furrow in it, is to be fastened in the ground, or, in place of the board, we may scoop out an oblong furrow in the wall, about a cubit above the floor, or at any suitable height, and then something like an oaken bench, of a quadrangular shape, is to be laid along (the wall?) at a distance from the wall, which will admit of persons to pass round if necessary, and the bench is to be covered with robes, or anything else which is soft, but does not yield much; and the patient is to be stoved with vapor, if necessary, or bathed with much hot water, and then he is to be stretched along the board on his face, with his arms laid along and bound to his body; the middle, then, of a thong which is soft, sufficiently broad and long, and composed of two cross straps of leather, is to be twice carried along the middle of the patient’s breast, as near the armpits as possible, then what is over of the thongs at the armpits is to be carried round the shoulders, and afterward the ends of the thong are to be fastened to a piece of wood resembling a pestle; they are to be adapted to the length of the bench laid below the patient, and so that the pestle-like piece of wood resting against this bench may make extension. Another such band is to be applied above the knees and the ankles, and the ends of the thongs fastened to a similar piece of wood; and another thong, broad, soft, and strong, in the form of a swathe, having breadth and length sufficient, is to be bound tightly round the loins, as near the hips as possible; and then what remains of this swathelike thong, with the ends of the thongs, must be fastened to the piece of wood placed at the patient’s feet, and extension in this fashion is to be made upward and downward, equally and at the same time, in a straight line. For extension thus made could do no harm, if properly performed, unless one sought to do mischief purposely. But the physicians, or some person who is strong, and not uninstructed, should apply the palm of one hand to the hump, and then, having laid the other hand upon the former, he should make pressure, attending whether this force should be applied directly downward, or toward the head, or toward the hips. This method of applying force is particularly safe; and it is also safe for a person to sit upon the hump while extension is made, and raising himself up, to let himself fall again upon the patient. And there is nothing to prevent a person from placing a foot on the hump, and supporting his weight on it, and making gentle pressure; one of the men who is practiced in the palestra would be a proper person for doing this in a suitable manner. But the most powerful of the mechanical means is this: if the hole in the wall, or in the piece of wood fastened into the ground, be made as much below the man’s back as may be judged proper, and if a board, made of limetree, or any other wood, and not too narrow, be put into the hole, then a rag, folded several times or a small leather cushion, should be laid on the hump; nothing large, however, should be laid on the back, but just as much as may prevent the board from giving unnecessary pain by its hardness; but the hump should be as much as possible on a line with the hole made in the wall, so that the board introduced into it may make pressure more especially at that spot. When matters are thus adjusted, one person, or two if necessary, must press down the end of the board, whilst others at the same time make extension and counter-extension as along the body, as formerly described. Extension may also be made with axles, which may either be fastened in the ground beside the bench, or the post of the axles may be attached to the bench itself, if you will make them perpendicular and overtopping (the bench?) a little at both ends, or at either end of the bench. These powers are easily regulated, so as to be made stronger or weaker, and they are of such force, that if one were to have recourse to them for a mischievous purpose, and not as a remedy, they would operate strongly in this way also; for by making merely extension and counter-extension longitudinally, without any additional force, one might make sufficient extension; and if, without making extension at all, one were only to press down properly with the board, sufficient force might be applied in this way. Such powers, then, are excellent which admit of being so regulated, that they can be made weaker and stronger as required. And the forces are applied in the natural way; for the pressure above forces the displaced parts into their place. Natural extension restores parts which have come too near one another to their natural position. I, then, am acquainted with no powers which are better or more appropriate than these; for extension along the spine downward has no proper hold at the bone called the os sacrum; and extension upward, along the neck and head, has indeed a hold; but extension thus made is unseemly to behold, and, besides, if increased, may occasion much mischief otherwise. I once made trial of the following plan. Having placed the patient on his back, I put below the hump a bladder, not inflated, and afterward introduced air into the bladder by means of a brass pipe connected with it. But the experiment did not succeed; for, when the man was fairly extended, the bladder yielded, and the air could not be forced into it; and, besides, the hump of the patient was apt to slip off the distended bladder when they were pressed together. But when I did not extend the man strongly, the bladder was swelled up by the air, and the man became more bent forward than proper. I have written this expressly; for it is a valuable piece of knowledge to learn what things have been tried and have proved ineffectual, and wherefore they did not succeed.

> Greek: 47. 47. Σκολιαίνεται μὲν οὖν ῤάχις, καὶ ὑγιαίνουσι, κατὰ πολλοὺς τρόπους· καὶ γὰρ ἐν τῇ φύσει καὶ ἐν τῇ χρήσει οὕτως ἔχει· ἀτὰρ καὶ ὑπὸ γήραος καὶ ὑπὸ ὀδυνημάτων ξυνδοτική ἐστιν. αἱ δὲ δὴ κυφώσιες, αἱ ἐν τοῖσι πτώμασιν, ὡς ἐπὶ τὸ πολὺ γίνονται, ἢν ἢ τοῖσιν ἰσχίοισιν ἐρείσῃ, ἢ ἐπὶ τοὺς ὤμους πέσῃ. ἀνάγκη γὰρ ἔξω φαίνεσθαι ἐν τῷ κυφώματι ἕνα μέν τινα ὑψηλότερον τῶν σπονδύλων, τοὺς δὲ ἔνθεν καὶ ἔνθεν, ἐπὶ ἧσσον· οὔκουν εἷς ἐπὶ πουλὺ ἀποπεπηδηκὼς ἀπὸ τῶν ἄλλων ἐστὶν, ἀλλὰ μικρὸν ἕκαστος ξυνδιδοῖ, ἀθρόον δὲ πολὺ γίνεται. διὰ οὖν τοῦτο καὶ ὁ νωτιαῖος μυελὸς εὐφόρως φέρει τὰς τοιαύτας διαστροφὰς, ὅτι κυκλώδης αὐτῷ ἡ διαστροφὴ γίνεται, ἀλλʼ οὐ γωνιώδης. χρὴ δὲ τὴν κατασκευὴν τοῦ διαναγκασμοῦ τοιήνδε κατασκευάσαι· ἔξεστι μὲν ξύλον ἰσχυρὸν καὶ πλατὺ, ἐντομὴν παραμήκεα ἔχον, κατορύξαι· ἔξεστι δὲ καὶ ἀντὶ τοῦ ξύλου ἐν τοίχῳ ἐντομὴν παραμήκεα ἐνταμεῖν, ἢ πήχεϊ ἀνωτέρω τοῦ ἐδάφεος, ἢ ὅκως ἂν μετρίως ἔχῃ· ἔπειτα οἷον στύλον δρύϊνον, τετράγωνον, πλάγιον παραβάλλειν, ἀπολείποντα ἀπὸ τοῦ τοίχου, ὅσον παρελθεῖν τινα, ἢν δέῃ· καὶ ἐπὶ μὲν τὸν στύλον ἐπιστορέσαι ἢ χλαίνας, ἢ ἄλλο τι, ὃ μαλθακὸν μὲν ἔσται, ὑπείξει δὲ μὴ μέγα· τὸν δὲ ἄνθρωπον πυριῆσαι, ἢν ἐνδέχηται, ἢ πολλῷ θερμῷ λοῦσαι· κἄπειτα πρηνέα κατακλῖναι κατατεταμένον, καὶ τὰς μὲν χεῖρας αὐτοῦ παρατείναντα κατὰ φύσιν προσδῆσαι πρὸς τὸ σῶμα· ἱμάντι δὲ μαλθακῷ, ἱκανῶς πλατέϊ τε καὶ μακρῷ, ἐκ δύο διανταίων ξυμβεβλημένῳ, μέσῳ, κατὰ μέσον τὸ στῆθος δὶς περιβεβλῆσθαι χρὴ ὡς ἐγγυτάτω τῶν μασχαλέων· ἔπειτα τὸ περισσεῦον τῶν ἱμάντων κατὰ τὴν μασχάλην, ἑκάτερον περὶ τοὺς ὤμους περιβεβλήσθω· ἔπειτα αἱ ἀρχαὶ πρὸς ξύλον ὑπεροειδές τι προσδεδέσθωσαν, ἁρμόζουσαι τὸ μῆκος τῷ ξύλῳ τῷ ὑποτεταμένῳ, πρὸς ὅ τι προσβάλλον τὸ ὑπεροειδὲς ἀντιστηρίζοντα κατατείνειν. τοιούτῳ δέ τινι ἑτέρῳ δεσμῷ χρὴ ἄνωθεν τῶν γουνάτων δήσαντα καὶ ἄνωθεν τῶν πτερνέων, τὰς ἀρχὰς τῶν ἱμάντων πρὸς τοιοῦτό τι ξύλον προσδῆσαι· ἄλλῳ δὲ ἱμάντι πλατέϊ, καὶ μαλθακῷ, καὶ δυνατῷ, ταινιοειδέϊ, πλάτος ἔχοντι καὶ μῆκος ἱκανὸν, ἰσχυρῶς περὶ τὰς ἰξύας κύκλῳ περιδεδέσθαι ὡς ἐγγύτατα τῶν ἰσχίων· ἔπειτα τὸ περισσεῦον τοῦ ταινιοειδέος, ἅμα ἀμφοτέρας τὰς ἀρχὰς τῶν ἱμάντων, πρὸς τὸ ξύλον προσδῆσαι τὸ πρὸς τῶν ποδῶν· κἄπειτα κατατείνειν ἐν τούτῳ τῷ σχήματι ἔνθα καὶ ἔνθα, ἅμα μὲν ἰσοῤῥόπως, ἅμα δὲ ἐς ἰθύ. οὐδὲν γὰρ ἂν μέγα κακὸν ἡ τοιαύτη κατάτασις ποιήσειεν, εἰ χρηστῶς σκευασθείη, εἰ μὴ ἄρα ἐξεπίτηδές τις βούλοιτο σίνεσθαι. τὸν δὲ ἰητρὸν χρὴ ἢ ἄλλον, ὅστις ἰσχυρὸς καὶ μὴ ἀμαθὴς, ἐπιθέντα τὸ θέναρ τῆς χειρὸς ἐπὶ τὸ ὕβωμα, καὶ τὴν ἑτέρην χεῖρα προσεπιθέντα ἐπὶ τὴν ἑτέρην, καταναγκάζειν, προσξυνιέντα, ἤν τε ἐς ἰθὺ ἐς τὸ κάτω πεφύκῃ καταναγκάζεσθαι, ἤν τε πρὸς τῆς κεφαλῆς, ἤν τε πρὸς τῶν ἰσχίων. καὶ ἀσινεστάτη μὲν αὕτη ἡ ἀνάγκη· ἀσινὲς δὲ καὶ ἐπικαθίζεσθαί τινα ἐπὶ τὸ κύφωμα, αὐτοῦ ἅμα κατατεινομένου, καὶ ἐνσεῖσαι μετεωρισθέντα. ἀτὰρ καὶ ἐπιβῆναι τῷ ποδὶ, καὶ ὀχηθῆναι ἐπὶ τὸ κύφωμα, ἡσύχως τε ἐπενσεῖσαι οὐδὲν κωλύει· τὸ τοιοῦτο δὲ ποιῆσαι μετρίως ἐπιτήδειος ἄν τις εἴη τῶν ἀμφὶ παλαίστρῃ εἰθισμένων. δυνατωτάτη μέντοι τῶν ἀναγκέων ἐστὶν, εἰ ὁ μὲν τοῖχος, ᾗ ἐντέτμηται, ἢ τὸ ξύλον τὸ κα. τορωρυγμένον, ᾗ ἐντέτμηται, κατωτέρω εἴη τῆς ῤάχιος τοῦ ἀνθρώπου, ὁκόσῳ ἂν δοκέῃ μετρίως ἔχειν, σανὶς δὲ φιλυρίνη, μὴ λεπτὴ, ἐνείη, ἢ καὶ ἄλλου τινὸς ξύλου· ἔπειτα ἐπὶ τὸ ὕβωμα ἐπιτεθείη ἢ τρύχιόν τι πολύπτυχον, ἢ σμικρόν τι σκύτινον ὑποκεφάλαιον· ὡς ἐλάχιστα μὴν ἐπικεῖσθαι ξυμφέρει, μόνον προμηθεόμενον, ὡς μὴ ἡ σανὶς ὑπὸ σκληρότητος ὀδύνην παρὰ καιρὸν προσπαρέχῃ· κατʼ ἴξιν δὲ ἔστω ὡς μάλιστα τῇ ἐντομῇ τῇ ἐς τὸν τοῖχον, τὸ ὕβωμα, ὡς ἂν ἡ σανὶς, ᾗ μάλιστα ἐξέστηκε, ταύτῃ μάλιστα πιέζῃ ἐπιτεθεῖσα. ὅταν δὲ ἐπιτεθῇ, τὸν μέν τινα καταναγκάζειν χρὴ τὸ ἄκρον τῆς σανίδος, ἤν τε ἕνα δέῃ, ἤν τε δύο, τοὺς δὲ κατατείνειν τὸ σῶμα κατὰ μῆκος, ὡς πρόσθεν εἴρηται, τοὺς μὲν τῇ, τοὺς δὴ τῇ. ἔξεστι δὲ καὶ ὀνίσκοισι τὴν κατάτασιν ποιέεσθαι, ἢ παρακατορύξαντα παρὰ τὸ ξύλον, ἢ ἐν αὐτῷ τῷ ξύλῳ τὰς φλιὰς τῶν ὀνίσκων ἐντεκτηνάμενον, ἤν τε ὀρθὰς ἐθέλῃς ἑκατέρωθεν σμικρὸν ὑπερεχούσας, ἤν τε κατὰ κορυφὴν τοῦ ξύλου ἔνθεν καὶ ἔνθεν. αὗται αἱ ἀνάγκαι εὐταμίευτοί εἰσι καὶ ἐς τὸ ἰσχυρότερον καὶ ἐς τὸ ἧσσον, καὶ ἰσχὺν ἔχουσι τοιαύτην, ὥστε, καὶ εἴ τις ἐπὶ λύμῃ βούλοιτο, ἀλλὰ μὴ ἐπὶ ἰητρείῃ, ἐς τοιαύτας ἀνάγκας ἀγαγεῖν, κἂν τούτῳ ἰσχυρῶς δύνασθαι· καὶ γὰρ ἂν κατατείνων κατὰ μῆκος μοῦνον ἔνθεν καὶ ἔνθεν οὕτω, καὶ ἄλλην ἀνάγκην οὐδεμίην προστιθεὶς, ὅμως κατατείνειεν ἄν τις ἱκανῶς· καὶ εἰ μὴ κατατείνων, αὐτῇ δὲ μοῦνον τῇ σανίδι οὕτως ἰποίη τις, καὶ οὕτως ἂν ἱκανῶς καταναγκάσειεν. καλαὶ οὖν αἱ τοιαῦται ἰσχύες εἰσὶν, ᾗσιν ἔξεστι καὶ ἀσθενεστέρῃσι καὶ ἰσχυροτέρῃσι χρέεσθαι αὐτὸν ταμιεύοντα. καὶ μὲν δὴ καὶ κατὰ φύσιν γε ἀναγκάζουσιν· τὰ μὲν γὰρ ἐξεστεῶτα ἐς τὴν χώρην ἀναγκάζει ἡ ἴπωσις ἰέναι, τὰ δὲ ξυνεληλυθότα· κατὰ φύσιν κατατείνουσιν αἱ κατὰ φύσιν κατατάσιες. οὔκουν ἐγὼ ἔχω τουτέων ἀνάγκας καλλίους, οὐδὲ δικαιοτέρας· ἡ γὰρ κατʼ αὐτὴν τὴν ἄκανθαν ἰθυωρίη τῆς κατατάσιος κάτωθέν τε καὶ κατὰ τὸ ἱερὸν ὀστέον καλεόμενον οὐκ ἔχει ἐπιλαβὴν οὐδεμίην· ἄνωθεν δὲ κατὰ τὸν αὐχένα καὶ κατὰ τὴν κεφαλὴν, ἐπιλαβὴν μὲν ἔχει, ἀλλʼ ἐσιδέειν γε ἀπρεπὴς ταύτῃ τοι γινομένη ἡ κατάτασις, καὶ ἄλλας βλάβας ἂν προσπαρέχοι πλεονασθεῖσα. Ἐπειρήθην δὲ δή ποτε, ὕπτιον τὸν ἄνθρωπον κατατείνας, ἀσκὸν ἀφύσητον ὑποθεῖναι ὑπὸ τὸ ὕβωμα, κἄπειτα αὐλῷ ἐκ χαλκείου ἐς τὸν ἀσκὸν τὸν ὑποκείμενον ἐνιέναι φῦσαν. ἀλλά μοι οὐκ. εὐπορεῖτο· ὅτε μὲν γὰρ εὖ κατατείνοιμι τὸν ἄνθρωπον, ἡσσᾶτο ὁ ἀσκὸς, καὶ οὐκ ἠδύνατο ἡ φῦσα ἐσαναγκάζεσθαι· καὶ ἄλλως ἕτοιμον περιολισθάνειν ἦν, ἅτε ἐς τὸ αὐτὸ ἀναγκαζόμενον, τό τε τοῦ ἀνθρώπου ὕβωμα, καὶ τὸ τοῦ ἀσκοῦ πληρουμένου κύρτωμα. ὅτε δʼ αὖ μὴ κάρτα κατατείνοιμι τὸν ἄνθρωπον, ὁ μὲν ἀσκὸς ὑπὸ τῆς φύσης ἐκυρτοῦτο, ὁ δὲ ἄνθρωπος πάντη μᾶλλον ἐλορδαίνετο ἢ ᾗ ξυνέφερεν. ἔγραψα δὲ ἐπίτηδες τοῦτο· καλὰ γὰρ καὶ ταῦτα τὰ μαθήματά ἐστιν, ἃ, πειρηθέντα, ἀπορηθέντα ἐφάνη, καὶ διʼ ἅσσα ἠπορήθη.