---
title: "On the Articulations · Περὶ ἄρθρων"
author: "Hippocrates"
translator: "Francis Adams"
languages: [grc, en]
shelf: "Classical Greek"
section: 4 of 6
url: https://scriptura.si/works/hippocrates-on-the-articulations/4/
cite: "Hippocrates, tr. Francis Adams, On the Articulations · Περὶ ἄρθρων, section 4. Scriptura (scriptura.si), https://scriptura.si/works/hippocrates-on-the-articulations/4/"
---

# 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.

## 4. Sections 48–56

Source: https://scriptura.si/works/hippocrates-on-the-articulations/4/ · cite a paragraph as https://scriptura.si/works/hippocrates-on-the-articulations/4/#p-N

[¶0] 48. In curvatures forward of the vertebrae from a fall, or from some heavy body falling upon them, in general no one of them is displaced far beyond the others, but if one or more be so displaced, the case proves fatal; but, not withstanding, as formerly stated, the displacement is circular, and not angular. In such cases, then, the urine and faeces are more apt to be retained than in displacement outward, the feet and the whole inferior extremities are colder, and the symptoms are more fatal than in the former case; and if they do survive, they are more subject to retention of the urine, and to loss of strength, and to torpor in their legs. But if the displacement be in the upper part, they experience loss of strength and torpor of the whole body. I know no mechanical contrivance by which such a displacement could be reduced, unless that one might be benefited by succussion on a bladder, or any other similar plan of treatment, such as extension, as formerly described. I am not aware of any mode of pressure which might be applied along with the extension, like that of the board in displacement backward; for how could one apply pressure from before through the belly? (internal cavity?) The thing is impossible. But neither coughing nor sneezing has any power so as to cooperate with the extension, nor would the injection of air into the bowels have any effect. And to apply large cupping instruments with the view of drawing back the vertebrae which have protruded forward, shows a great error of judgment; for they rather propel than attract, and those who apply them are not aware even of this fact, for the greater will be the inclination forward the greater the instrument applied, the skin being forcibly drawn into the cupping-instrument. I could tell of other modes of succussion than those formerly described, which one might fancy would be more applicable in such an affection; but I have no great confidence in them, and therefore I do not describe them. On the main, it should be known, respecting the accidents which I have briefly described, that displacements forward are of a fatal and injurious nature; but that displacements backward, for the most part, do not prove fatal, nor occasion retention of urine nor torpor of the limbs, for they do not stretch the ducts leading toward the intestines, nor occasion obstruction of the same; but displacements forward produce both these bad effects, and many others in addition. And truly they are more apt to lose the power of their legs and arms, to have torpor of the body, and retention of urine, who experience no displacement either forward or backward, but merely a violent concussion along the spine, while those who have displacement backward are least subject to these symptoms.

> Greek: 48. 48. Ὅσοισι δὲ ἐς τὸ εἴσω σκολιαίνονται οἱ σπόνδυλοι ὑπὸ πτώματος, ἢ καὶ ἐμπεσόντος τινὸς βαρέος, εἷς μὲν οὐδεὶς τῶν σπονδύλων μέγα ἐξίσταται κάρτα ὡς ἐπὶ τὸ πολὺ ἐκ τῶν ἄλλων, ἢν δὲ ἐκστῇ μέγα ἢ εἷς, ἢ πλείονες, θάνατον φέρουσιν· ὥσπερ δὲ καὶ πρόσθεν εἴρηται, κυκλώδης καὶ αὕτη, καὶ οὐ γωνιώδης γίνεται ἡ παραλλαγή. οὖρα μὲν οὖν τούτοισι καὶ ἀπόπατος μᾶλλον ἴσχεται, ἢ τοῖσιν ἔξω κυφοῖσι, καὶ πόδες καὶ ὅλα τὰ σκέλεα ψύχεται μᾶλλον, καὶ θανατηφόρα ταῦτα μᾶλλον ἐκείνων· καὶ ἢν περιγένωνται δὲ, ῤυώδεες τὰ οὖρα μᾶλλον οὗτοι, καὶ τῶν σκελέων ἀκρατέστεροι καὶ ναρκωδέστεροι· ἢν δὲ καὶ ἐν τῷ ἄνω μέρεϊ μᾶλλον τὸ λόρδωμα γένηται, παντὸς τοῦ σώματος ἀκρατέες καὶ κατανεναρκωμένοι γίνονται. μηχανὴν δὲ οὐκ ἔχω οὐδεμίην ἔγωγε, ὅκως χρὴ τὸν τοιοῦτον ἐς τὸ αὐτὸ καταστῆσαι, εἰ μή τινα ἡ κατὰ τῆς κλίμακος κατάσεισις ὠφελέειν οἵη τε εἴη, ἢ καὶ ἄλλη τις τοιαύτη ἴησις, ἢ κατάτασις, οἵηπερ ὀλίγῳ πρόσθεν εἴρηται. Κατανάγκασιν δὲ σὺν τῇ κατατάσει οὐδεμίην ἔχω, ἥτις ἂν γίνοιτο, ὥσπερ τῷ κυφώματι τὴν κατανάγκασιν ἡ σανὶς ἐποιέετο. πῶς γὰρ ἄν τις ἐκ τοῦ ἔμπροσθεν διὰ τῆς κοιλίης ἀναγκάσαι δύναιτο; οὐ γὰρ οἷόν τε. ἀλλὰ μὴν οὔτε βῆχες, οὔτε πταρμοὶ οὐδεμίην δύναμιν ἔχουσιν, ὥστε τῇ κατατάσει ξυντιμωρέειν· οὐ μὴν οὐδʼ ἔνεσις φύσης ἐνιεμένη ἐς τὴν κοιλίην οὐδὲν ἂν δυνασθείη. καὶ μὴν αἱ μεγάλαι σικύαι προσβαλλόμεναι ἀνασπάσιος εἵνεκα δῆθεν τῶν ἔσω ῤεπόντων, σπονδύλων, μεγάλη ἁμαρτὰς γνώμης ἐστίν· ἀπωθέουσι γὰρ μᾶλλον, ἢ ἀνασπῶσιν· καὶ οὐδʼ αὐτὸ τοῦτο γινώσκουσιν οἱ προσβάλλοντες· ὅσῳ γὰρ ἄν τις μέζω προσβάλλῃ, τοσούτῳ μᾶλλον λορδοῦνται οἱ προσβληθέντες, ξυναναγκαζομένου ἄνω τοῦ δέρματος. τρόπους δὲ ἄλλους κατασεισίων, ἢ οἷοι πρόσθεν εἴρηνται, ἔχοιμι ἂν εἰπεῖν, ἁρμόσαι οὓς ἄν τις δοκέοι τῷ παθήματι μᾶλλον· ἀλλʼ οὐ κάρτα πιστεύω αὐτοῖσιν· διὰ τοῦτο οὐ γράφω. ἀθρόον δὲ ξυνιέναι χρὴ περὶ τούτων, ὧν ἐν κεφαλαίῳ εἴρηται, ὅτι τὰ μὲν ἐς τὸ λορδὸν ῤέψαντα ὀλέθριά ἐστι καὶ σινάμωρα, τὰ δὲ ἐς τὸ κυφὸν ἀσινέα θανάτου, καὶ οὔρων σχεσίων, καὶ ἀποναρκωσίων τὸ ἔπίπαν· οὐ γὰρ ἐντείνει τοὺς ὀχετοὺς τοὺς κατὰ τὴν κοιλίην, οὐδὲ κωλύει εὐρόους εἶναι ἡ ἐς τὸ ἔξω κύφωσις· ἡ δὲ λόρδωσις ταῦτά τε ἀμφότερα ποιέει, καὶ ἐς τὰ ἄλλα πολλὰ προσγίνεται. ἐπείτοι πολὺ πλείονες σκελέων τε καὶ χειρῶν ἀκρατέες γίνονται, καὶ καταναρκοῦνται τὸ σῶμα, καὶ οὖρα ἴσχεται αὐτέοισιν, οἷσιν ἂν μὴ ἐκστῇ μὲν τὸ ὕβωμα μήτε ἔξω, μήτε ἔσω, σεισθέωσι δὲ ἰσχυρῶς ἐς τὴν ἰθυωρίην τῆς ῤάχιος· οἷσι δὲ ἂν ἐκστῇ τὸ ὕβωμα, ἧσσον τοιαῦτα πάσχουσιν.

[¶1] 49. And one might observe many other instances in medicine, of considerable injuries not proving serious, but producing a crisis in some affection, while less considerable injuries prove more serious, give rise to chronic diseases, and extend their effects to the whole system. Now something similar may happen in fracture of the ribs; for in fracture of one or more ribs, in general, if the fractured bones are not driven inward, nor are laid bare, fever rarely supervenes, neither does it often happen that there is haemoptysis, empyema, and suppurating sores, which require treatment with pledgets, nor necrosis of the bones; and in these cases the ordinary regimen is sufficient. For, unless they be seized with continual fever, a strict diet does more harm than good, by inducing inanition, and increasing the pain, fever, and cough; for moderate fullness of the intestines has a tendency to replace the ribs, while evacuation leads to suspension of the ribs, and suspension induces pain. Ordinary bandaging, externally, is sufficient in such cases; the bandages should be applied moderately tight, along with cerate and compresses, or a pad of wool may be applied. The rib is consolidated in twenty days, for callus soon forms in such bones.

> Greek: 49. 49. πολλὰ δὲ καὶ ἄλλα ἐν ἰητρικῇ ἄν τις θεάσοιτο, ὧν τὰ μὲν ἰσχυρὰ ἀσινέα ἐστὶ, καὶ καθʼ ἑωυτὰ τὴν κρίσιν ὅλην λαμβάνοντα τοῦ νουσήματος, τὰ δὲ ἀσθενέστερα σινάμωρα, καὶ ἀποτόκους νοσημάτων χρονίους ποιέοντα, καὶ κοινωνέοντα τῷ ἄλλῳ σώματι ἐπὶ πλέον. ἐπεὶ καὶ πλευρέων κάτηξις τοιοῦτόν τι πέπονθεν· οἷσι μὲν γὰρ ἂν καταγῇ πλευρὴ, μία ἢ πλέονες, ὡς τοῖσι πλείστοισι κατάγνυται, μὴ διασχόντα τὰ ὀστέα ἐς τὸ ἔσω μέρος, μηδὲ ψιλωθέντα, ὀλίγοι μὲν ἤδη ἐπυρέτηναν· ἀτὰρ οὐδὲ αἷμα πολλοὶ ἤδη ἔπτυσαν, οὐδὲ ἔμπυοι πολλοὶ γίνονται, οὐδὲ ἔμμοτοι, οὐδὲ ἐπισφακελίσιες τῶν ὀστέων· δίαιτά τε φαύλη ἀρκέει· ἢν γὰρ μὴ πυρετὸς ξυνεχὴς ἐπιλαμβάνῃ αὐτοὺς, κενεαγγέειν κάκιον τοῖσι τοιούτοισιν, ἢ μὴ κενεαγγέειν, καὶ ἐπωδυνέστερον, καὶ πυρετωδέστερον, καὶ βηχωδέστερον· τὸ γὰρ πλήρωμα τὸ μέτριον τῆς κοιλίης, διόρθωμα τῶν πλευρέων γίνεται· ἡ δὲ κένωσις κρεμασμὸν τῇσι πλευρῇσι ποιέει· ὁ δὲ κρεμασμὸς, ὀδύνην. ἔξωθέν τε αὖ φαύλη ἐπίδεσις τοῖσι τοιούτοισιν ἀρκέει· κηρωτῇ καὶ σπλήνεσι καὶ ὀθονίοισιν ἡσύχως ἐρείδοντα, ὁμαλὴν τὴν ἐπίδεσιν ποιέεσθαι, ἢ καὶ ἐριῶδές τι προσεπιθέντα. κρατύνεται δὲ πλευρὴ ἐν εἴκοσιν ἡμέρῃσιν· ταχεῖαι γὰρ αἱ ἐπιπωρώσιες τῶν τοιουτέων ὀστέων.

[¶2] 50. But when there is contusion of the flesh about the ribs, either from a blow, or a fall, or a bruise, or any like cause, there is often copious vomiting of blood, for there are canals stretched along the vacuity of each rib (intercostal space?), and nerves proceeding from the most important parts of the body have their origin there. Many of these, therefore, are troubled with coughs, tubercles, empyema, external suppurations, and sphacelus of the ribs. And even when no such symptoms supervene from contusion of the skin about the ribs, still in such cases there is, generally, more combined pain than in fractures of the ribs, and relapses of pain in the seat of the injury are more apt to occur. Wherefore some physicians pay much less attention to such injuries, than where the rib is fractured, whereas, if they were wise, they would treat such cases with far greater care than the other; for it is proper that the diet should be restricted, that the patients should remain at rest as much as possible, and abstain from venery, from fat articles of food, from such as excite cough, and from everything strong; they should be bled in the arm, speak as little as possible, should have the contused part bound round with folded compresses, plenty of bandages, broader than the contusion, and which should be smeared with cerate; in applying the bandages, broad and soft shawls should be used, and they should be put on moderately firm, so that the patient will say that they are neither too tight nor loose, and the bandaging should commence at the seat of the injury, and be made more particularly tight there, and the bandaging should be conducted as is done with a double-headed roller, so that the skin about the ribs may not be ruffled, but may lie smooth, and the bandaging should be renewed every day, or every alternate day. It is better also to open the bowels with some gentle medicine, so as just to produce an evacuation of the food, and the diet is to be restricted for ten days, and then the body is to be recruited and filled up; while you are upon the reducing system, the bandaging should be tighter, but when you are making him up again, it must be looser; and, if he spit blood from the commencement, the treatment and bandaging should be continued for forty days; but if there be no haemoptysis, treatment for twenty days will generally be sufficient; but the length of time must be regulated by the magnitude of the injury. When such contusions are neglected, if no greater mischief result there from, at all events the bruised part has its flesh more pulpy than it had formerly. When, therefore, any such thing is left behind, and is not properly dissipated by the treatment, it will be worse if the mucosity be lodged near the bone, for the flesh no longer adheres to the bone as formerly, the bone becomes diseased, and chronic sloughings of the bone in many cases arise from such causes. But if the mischief be not upon the bone, but it is the flesh itself which is pulpy, relapses and pains will return from time to time, if there happen to be any disorder in the body; wherefore proper bandaging, and for a considerable time, must be had recourse to, until the extravasated blood forming in the bruise be dried up and absorbed, and the part be made up with sound flesh, and the flesh adhere to the bone. The best cure is the cautery in those cases which, from neglect, have become chronic, and the place turns painful, and the flesh is pulpy. And when the flesh itself is pulpy, the burning should be carried as far as the bone, but the bone itself should not be heated; but if it be in the intercostal space, you need not make the burning so superficial, only you must take care not to burn quite through. But if the contusion appear to be at the bone, if it be still recent, and the bone has not yet become necrosed, if it be very small, it is to be burned as has been described; but if the rising along the bone be oblong, several eschars are to be burned over it. Necrosis of the rib will be described along with the treatment of suppurating sores.

> Greek: 50. 50. ἀμφιφλασθείσης μέντοι τῆς σαρκὸς ἀμφὶ τῇσι πλευρῇσιν, ἢ ὑπὸ πληγῆς, ἢ ὑπὸ πτώματος, ἢ ὑπὸ ἀντερείσιος, ἢ ἄλλου τινὸς τοιουτοτρόπου, πολλοὶ ἤδη πουλὺ αἷμα ἔπτυσαν· οἱ γὰρ ὀχετοὶ οἱ κατὰ τὸ λαπαρὸν τῆς πλευρῆς ἑκάστης παρατεταμένοι, καὶ οἱ τόνοι ἀπὸ τῶν ἐπικαιροτάτων τῶν ἐν τῷ σώματι τὰς ἀφορμὰς ἔχουσιν· πολλοὶ οὖν ἤδη βηχώδεες, καὶ φυματίαι, καὶ ἔμπυοι ἐγένοντο, καὶ ἔμμοτοι, καὶ ἡ πλευρὴ ἐπεσφακέλισεν αὐτοῖσιν. ἀτὰρ καὶ οἷσι μηδὲν τοιοῦτον προσεγένετο, ἀμφιφλασθείσης τῆς σαρκὸς ἀμφὶ τῇσι πλευρῇσιν, ὅμως δὲ βραδύτερον ὀδυνώμενοι παύονται οὗτοι, ἢ οἷσιν ἂν πλευρὴ καταγῇ, καὶ ὑποστροφὰς μᾶλλον ἴσχει ὀδυνημάτων τὸ χωρίον ἐν τοῖσι τοιούτοισι τρώμασιν, ἢ τοϊσιν ἑτέροισιν. μάλα μὲν οὖν μετεξέτεροι καταμελέουσι τῶν τοιούτων σινέων, μᾶλλον ἢ ἢν πλευρὴ κατεαγῇ αὐτέοισιν· ἀτὰρ καὶ ἰήσιος σκεθροτέρης οἱ τοιοῦτοι δέονται, εἰ σωφρονοῖεν· τῇ τε γὰρ διαίτῃ ξυμφέρει ξυνεστάλθαι, ἀτρεμέειν τε τῷ σώματι ὡς μάλιστα, ἀφροδισίων τε ἀπέχεσθαι, βρωμάτων τε λιπαρῶν, καὶ κερχνωδέων, καὶ ἰσχυρῶν πάντων, φλέβα τε κατʼ ἀγκῶνα τέμνεσθαι, σιγᾷν τε ὡς μάλιστα, ἐπιδέεσθαί τε τὸ χωρίον τὸ φλασθὲν σπλήνεσι μὴ πολυπτύχοισι, συχνοῖσι δὲ καὶ πολὺ πλατυτέροισι πάντη τοῦ φλάσματος, κηρωτῇ τε ὑποχρίειν, ὀθονίοισί τε πλατέσι σὺν ταινίῃσι πλατείῃσι καὶ μαλθακῇσιν ἐπιδέειν, ἐρείδειν τε μετρίως, ὥστε μὴ κάρτα πεπιέχθαι φάναι τὸν ἐπιδεδεμένον, μηδʼ αὖ χαλαρόν· ἄρχεσθαι δὲ τὸν ἐπιδέοντα κατὰ τὸ φλάσμα, καὶ ἐρηρεῖσθαι ταύτῃ μάλιστα, τὴν δὲ ἐπίδεσιν ποιέεσθαι, ὡς ἀπὸ δύο ἀρχέων ἐπιδέεται, ἵνα μὴ περιῤῥεπὲς τὸ δέρμα τὸ περὶ τὰς πλευρὰς ἔῃ, ἀλλʼ ἰσόῤῥοπον, ἐπιδέειν δὲ ἢ καθʼ ἑκάστην ἡμέρην, ἢ παρʼ ἑτέρην. ἄμεινον δὲ καὶ τὴν κοιλίην μαλθάξαι κούφῳ τινὶ, ὅσον κενώσιος εἵνεκεν τοῦ σίτου, καὶ ἐπὶ μὲν δέκα ἡμέρας ἰσχναίνειν, ἔπειτα ἀναθρέψαι τὸ σῶμα, καὶ ἁπαλῦναι· τῇ δὲ ἐπιδέσει, ἔστʼ ἂν μὲν ἰσχναίνῃς, ἐρηρεισμένῃ μᾶλλον χρέεσθαι, ὁκόταν δὲ ἐς τὸν ἁπαλυσμὸν ἄγῃς, ἐπιχαλαρωτέρῃ· καὶ ἢν μὲν αἷμα ἀποπτύσῃ καταρχὰς, τεσσαρακονθήμερον τὴν μελέτην καὶ τὴν ἐπίδεσιν ποιέεσθαι χρή· ἢν δὲ μὴ πτύσῃ τὸ αἷμα, ἀρκέει ἐν εἴκοσιν ἡμέρῃσιν ἡ μελέτη ὡς ἐπὶ τὸ πολύ· τῇ ἰσχύϊ δὲ τοῦ τρώματος τοὺς χρόνους προτεκμαίρεσθαι χρή. ὅσοι δʼ ἂν ἀμελήσωσι τῶν τοιουτέων ἀμφιφλασμάτων, ἢν καὶ ἄλλο μηδὲν αὐτοῖσι φλαῦρον μέζον γένηται, ὅμως τό γε χωρίον ἀμφιφλασθὲν μυξωδεστέρην τὴν σάρκα ἴσχει, ἢ πρόσθεν εἶχεν. ὅκου δέ τι τοιοῦτον ἐγκαταλείπεται, καὶ μὴ εὖ ἐξιποῦται τῇ γε ἀλθέξει, φαυλότερον μὲν, ἢν παρʼ αὐτὸ τὸ ὀστέον ἐγκαταλειφθῇ τὸ μυξῶδες· οὔτε γὰρ ἔτι ἡ σὰρξ ὁμοίως ἅπτεται τοῦ ὀστέου, τό τε ὀστέον νοσηρότερον γίνεται, σφακελισμοί τε χρόνιοι ὀστέου πολλοῖσιν ἤδη ἀπὸ τοιουτέων προφασίων ἐγένοντο. ἀτὰρ καὶ ἢν μὴ παρὰ τὸ ὀστέον, ἀλλʼ αὐτὴ ἡ σὰρξ μυξώδης ἔῃ, ὅμως· ὑποστροφαὶ γίνονται καὶ ὀδύναι ἄλλοτε καὶ ἄλλοτε, ἤν τι τῷ σώματι τύχῃ πονήσας· καὶ διὰ τοῦτο τῇ ἐπιδέσει χρέεσθαι χρὴ, ἅμα μὲν ἀγαθῇ, ἅμα δὲ ἐπὶ πουλὺ προηκούσῃ, ἕως ἂν ξηρανθῇ μὲν καὶ ἀναποθῇ τὸ ἐκχύμωμα τὸ ἐν τῇ φλάσει γενόμενον, αὐξηθῇ δὲ σαρκὶ ὑγιέϊ τὸ χωρίον, ἅψηται δὲ τοῦ ὀστέου ἡ σάρξ. οἷσι δʼ ἂ ἀμεληθεῖσι χρονιωθῇ, καὶ ὀδυνῶδες τὸ χωρίον γένηται, καὶ ἡ σὰρξ ὑπόμυξος ἔῃ, τούτοισι καῦσις ἴησις ἀρίστη. καὶ ἢν μὲν αὐτὴ ἡ σὰρξ μυξώδης ἔῃ, ἄχρι τοῦ ὀστέου καίειν χρὴ, μὴ μὴν διαθερμανθῆναι τὸ ὀστέον· ἢν δὲ μεσηγὺ τῶν πλευρέων ἔῃ, ἐπιπολῆς μὲν οὐδʼ οὕτω χρὴ καίειν, φυλάσσεσθαι μέντοι, μὴ διακαύσῃς πέρην. ἢν δὲ πρὸς τῷ ὀστέῳ δοκέῃ εἶναι τὸ φλάσμα, καὶ ἔτι νεαρὸν ἔῃ, καὶ μήπω σφακελίσῃ τὸ ὀστέον, ἢν μὲν κάρτα ὀλίγον ἔῃ, οὕτω καίειν χρὴ ὥσπερ εἴρηται· ἢν μέντοι παραμήκης ἔῃ ὁ μετεωρισμὸς ὁ κατὰ τὸ ὀστέον, πλείονας ἐσχάρας ἐμβάλλειν χρή· περὶ δὲ σφακελισμοῦ πλευρῆς ἅμα τῇ τῶν ἐμμότων ἰητρείῃ εἰρήσεται.

[¶3] 51. There are four modes of dislocation at the hip-joint: of which modes, dislocation inward takes place most frequently, outward, the most frequently of all the other modes; and it sometimes takes place backward and forward, but seldom. When, therefore, dislocation takes place inward, the leg appears longer than natural, when compared with the other leg, for two reasons truly; for the bone which articulates with the hip-joint is carried from above down to the ischium where it rises up to the pubes, upon it, then, the head of the femur rests, and the neck of the femur is lodged in the cotyloid foramen (foramen thyroideum?). The buttock appears hollow externally, from the head of the thighbone having shifted inward, and the extremity of the femur at the knee is turned outward, and the leg and foot in like manner. The foot then being turned outward, physicians, from ignorance, bring the sound leg to it and not it to the sound leg; on this account, the injured limb appears to be much longer than the sound one, and in many other cases similar circumstances lead to error in judgment. Neither does the limb at the groin admit of flexion as in the sound limb, and the head of the bone is felt at the perineum too prominent. These, then, are the symptoms attending dislocation of the thigh inward.

> Greek: 51. 51. ἢν δὲ μηροῦ ἄρθρον ἐξ ἰσχίου ἐκπέσῃ, ἐκπίπτει δὲ κατὰ τέσσαρας τρόπους, ἐς μὲν τὸ ἔσω πλειστάκις, ἐς δὲ τὸ ἔξω τῶν ἄλλων πλειστάκις· ἐς δὲ τὸ ὄπισθεν καὶ τὸ ἔμπροσθεν ἐκπίπτει μὲν, ὀλιγάκις δέ· οἷσι μὲν οὖν ἂν ἐκβῇ ἐς τὸ ἔσω, μακρότερον τὸ σκέλος φαίνεται, παραβαλλόμενον πρὸς τὸ ἕτερον, διὰ δισσὰς προφάσιας εἰκότως· ἐπί τε γὰρ τὸ ἀπὸ τοῦ ἰσχίου πεφυκὸς ὀστέον, τὸ ἄνω φερόμενον πρὸς τὸν κτένα, ἐπὶ τοῦτο ἡ ἐπίβασις τῆς κεφαλῆς τοῦ μηροῦ γίνεται, καὶ ὁ αὐχὴν τοῦ ἄρθρου ἐπὶ τῆς κοτύλης ὀχέεται. ἔξωθέν τε αὖ ὁ γλουτὸς κοῖλος φαίνεται, ἅτε ἔσω ῤεψάσης τῆς κεφαλῆς τοῦ μηροῦ, τό τε αὖ κατὰ τὸ γόνυ τοῦ μηροῦ ἄκρον ἀναγκάζεται ἔξω ῤέπειν, καὶ ἡ κνήμη καὶ ὁ ποὺς ὡσαύτως. ἅτε οὖν ἔξω ῤέποντος τοῦ ποδὸς, οἱ ἰητροὶ διʼ ἀπειρίην τὸν ὑγιέα πόδα πρὸς τοῦτον προσίσχουσιν, ἀλλʼ οὐ τοῦτον πρὸς τὸν ὑγιέα· διὰ τοῦτο πουλὺ μακρότερον φαίνεται τὸ σιναρὸν τοῦ ὑγιέος· πολλαχῆ δὲ καὶ ἄλλῃ τὰ τοιαῦτα παραξύνεσιν ἔχει. οὐ μὴν οὐδὲ ξυγκάμπτειν δύνανται κατὰ τὸν βουβῶνα ὁμοίως τῷ ὑγιέϊ· ἀτὰρ καὶ ψαυομένη ἡ κεφαλὴ τοῦ μηροῦ κατὰ τὸν περίνεον ὑπερογκέουσα εὔδηλός ἐστιν. τὰ μὲν οὖν σημήϊα ταῦτά ἐστιν, οἷσιν ἂν ἔσω ἐκπεπτώκῃ ὁ μηρός.

[¶4] 52. When, then, a dislocation has not been reduced, but has been misunderstood or neglected, the leg, in walking, is rolled about as is the case with oxen, and the weight of the body is mostly supported on the sound leg, and the limb at the flank, and the joint where the dislocation has occurred is necessarily hollow and bent, while on the sound side the buttock is necessarily rounded. For if one should walk with the foot of the sound leg turned outward, the weight of the body would be thrown upon the injured limb, but the injured limb could not carry it, for how could it? One, then, is forced in walking to turn the leg inward, and not outward, for thus the sound leg best supports its own half of the body, and also that of the injured side. But being hollow at the flank and the hip-joint, they appear small in stature, and are forced to rest on a staff at the side of the sound leg. For they require the support of a staff there, since the nates inclines to this side, and the weight of the body is carried to it. They are forced also to stoop, for they are obliged to rest the hand on the side of the thigh against the affected limb; for the limb which is injured cannot support the body in changing the legs, unless it be held when it is applied to the ground. They who have got an unreduced dislocation inward are forced to put themselves into these attitudes, and this from no premeditation on their part how they should assume the easiest position, but the impediment itself teaches them to choose that which is most conformable to their present circumstances. For persons who have a sore on the foot, or leg, and cannot rest upon the limb, all, even children, walk in this way; for they turn the injured limb outward in walking, and they derive two advantages therefrom, to supply two wants; the weight of the body is not equally thrown upon the limb turned outward, as upon the one turned inward, for neither is the weight in a line with it, but is much more thrown upon the one under the body; for the weight is in a straight line with it, both in walking and in the shifting of the legs. In this position one can most quickly turn the sound limb under the body, by walking with the unsound limb outward, and the sound inward. In the case we are now treating of, it is well that the body finds out the attitudes which are the easiest for itself. Those persons, then, who have not attained their growth at the time when they met with a dislocation which is not reduced, become maimed in the thigh, the leg, and the foot, for neither do the bones grow properly, but become shortened, and especially the bone of the thigh; and the whole limb is emaciated, loses its muscularity, and becomes enervated and thinner, both from the impediment at the joint, and because the patient cannot use the limb, as it does not lie in its natural position, for a certain amount of exercise will relieve excessive enervation, and it will remedy in so far the deficiency of growth in length. Those persons, then, are most maimed who have experienced the dislocation in utero, next those who have met with it in infancy, and least of all, those who are full grown. The mode of walking adopted by adults has been already described; but those who are children when this accident befalls them, generally lose the erect position of the body, and crawl about miserably on the sound leg, supporting themselves with the hand of the sound side resting on the ground. Some, also, who had attained manhood before they met with this accident, have also lost the faculty of walking erect. Those who were children when they met with the accident, and have been properly instructed, stand erect upon the sound leg, but carry about a staff, which they apply under the armpit of the sound side, and some use a staff in both arms; the unsound limb they bear up, and the smaller the unsound limb, the greater facility have they in walking, and their sound leg is no less strong than when both are sound. The fleshy parts of the limb are enervated in all such cases, but those who have dislocation inward are more subject to this loss of strength than, for the most part, those who have it outward.

> Greek: 52. 52. οἷσι μὲν ἂν οὖν ἐκπεσὼν μὴ ἐμπέσῃ, ἀλλὰ καταπορηθῇ καὶ ἀμεληθῇ, ἥ τε ὁδοιπορίη περιφοράδην τοῦ σκέλεος ὥσπερ τοῖσι βουσὶ γίνεται, καὶ ἡ ὄχησις πλείστη αὐτέοισιν ἐπὶ τοῦ ὑγιέος σκέλεός ἐστιν. καὶ ἀναγκάζονται κατὰ τὸν κενεῶνα καὶ κατὰ τὸ ἄρθρον τὸ ἐκπεπτωκὸς κοῖλοι καὶ σκολιοὶ εἶναι· κατὰ δὲ τὸ ὑγιὲς ἐς τὸ ἔξω ὁ γλουτὸς ἀναγκάζεται περιφερὴς εἶναι· εἰ γάρ τις ἔξω τῷ ποδὶ τοῦ ὑγιέος σκέλεος βαίνοι, ἀπωθοίη ἂν τὸ σῶμα τὸ ἄλλο ἐς τὸ σιναρὸν σκέλος τὴν ὄχησιν ποιέεσθαι· τὸ δὲ σιναρὸν· οὐκ ἂν δύναιτο ὀχέειν· πῶς γάρ; ἀναγκάζεται οὖν οὕτω κατὰ τοῦ ὑγιέος σκέλεος τῷ ποδὶ ἔσω βαίνειν, ἀλλὰ μὴ ἔξω· οὕτω γὰρ ὀχέει μάλιστα τὸ σκέλος τὸ ὑγιὲς, καὶ τὸ ἑωυτοῦ μέρος τοῦ σώματος, καὶ τὸ τοῦ σιναροῦ σκέλεος μέρος. Κοιλαινόμενοι δὲ κατὰ τὸν κενεῶνα καὶ κατὰ τὰ ἄρθρα, μικροὶ φαίνονται, καὶ τῷ ξύλῳ ἀναγκάζονται ἀντερείδεσθαι πλάγιοι κατὰ τὸ ὑγιὲς σκέλος· δέονται γὰρ ἀντικοντώσιος ταύτῃ· ἐπὶ τοῦτο γὰρ οἱ γλουτοὶ ῤέπουσι, καὶ τὸ ἄχθος τοῦ σώματος ὀχεεται ἐπὶ τοῦτο. ἀναγκάζονται δὲ καὶ ἐπικύπτειν· τὴν γὰρ χεῖρα τὴν κατὰ τὸ σκέλος τὸ σιναρὸν ἀναγκάζονται κατὰ πλάγιον τὸν μηρὸν ἐρείδειν· οὐ γὰρ δύναται τὸ σιναρὸν σκέλος ὀχέειν τὸ σῶμα ἐν τῇ μεταλλαγῇ τῶν σκελέων, ἢν μὴ κατέχηται πρὸς τὴν γῆν πιεζόμενον. ἐν τούτοισιν οὖν τοῖσι σχήμασιν ἀναγκάζονται ἐσχηματίσθαι, οἷσιν ἂν ἔσω ἐκβὰν τὸ ἄρθρον μὴ ἐμπέσῃ, οὐ προβουλεύσαντος τοῦ ἀνθρώπου, ὅκως ἂν ῤήϊστα ἐσχηματισμένον ἔῃ, ἀλλʼ αὐτὴ ἡ ξυμφορὴ διδάσκει ἐκ τῶν παρεόντων τὰ ῤήϊστα αἱρέεσθαι. ἐπεὶ καὶ ὁκόσοι ἕλκος ἔχοντες ἐν ποδὶ ἢ κνήμῃ οὐ κάρτα δύνανται ἐπιβαίνειν τῷ σκέλεϊ, πάντες, καὶ οἱ νήπιοι, οὕτως ὁδοιπορέουσιν· ἔξω γὰρ βαίνουσι τῷ σιναρῷ σκέλεϊ· καὶ δισσὰ κερδαίνουσι, δισσῶν γὰρ δέονται· τό τε γὰρ σῶμα οὐκ ὀχέεται ὁμοίως ἐπὶ τοῦ ἔξω ἀποβαινομένου, ὥσπερ ἐπὶ τοῦ εἴσω· οὐδὲ γὰρ κατʼ ἰθυωρίην αὐτῷ γίνεται τὸ ἄχθος, ἀλλὰ πολλῷ μᾶλλον ἐπὶ τοῦ ὑποβαινομένου· κατʼ ἰθυωρίην γὰρ αὐτῷ γίνεται τὸ ἄχθος ἔν τε αὐτῇ τῇ ὁδοιπορίῃ καὶ τῇ μεταλλαγῇ τῶν σκελέων. ἐν τούτῳ τῷ σχήματι τάχιστα ἂν δύναιτο ὑποτιθέναι τὸ ὑγιὲς σκέλος, εἰ τῷ μὲν σιναρῷ ἐξωτέρω βαίνοι, τῷ δὲ ὑγιέϊ ἐσωτέρω. περὶ οὗ οὖν ὁ λόγος, ἀγαθὸν εὑρίσκεσθαι αὐτὸ ἑωυτῷ τὸ σῶμα [ἐς] τὰ ῤήϊστα τῶν σχημάτων. Ὅσοισι μὲν οὖν μήπω τετελειωμένοισιν ἐς αὔξησιν ἐκπεσὼν μὴ ἐμπέσοι, γυιοῦται ὁ μηρὸς καὶ ἡ κνήμη καὶ ὁ πούς· οὔτε γὰρ τὰ ὀστέα ἐς τὸ μῆκος ὁμοίως αὔξεται, ἀλλὰ βραχύτερα γίνεται, μάλιστα δὲ τὸ τοῦ μηροῦ, ἄσαρκόν τε ἅπαν τὸ σκέλος καὶ ἄμυον καὶ ἐκτεθηλυσμένον καὶ λεπτότερον γίνεται, ἅμα μὲν, διὰ τὴν στέρησιν τῆς χώρης τοῦ ἄρθρου, ἅμα δὲ, ὅτι ἀδύνατον χρέεσθαί ἐστιν, ὅτι οὐ κατὰ φύσιν κέεται· χρῆσις γὰρ μετεξετέρη ῤύεται τῆς ἄγαν ἐκθηλύνσιος· ῥύεται δέ τι καὶ τῆς ἐπὶ μῆκος ἀναυξήσιος. κακοῦται μὲν οὖν μάλιστα, οἷσιν ἂν ἐν γαστρὶ ἐοῦσιν ἐξαρθρήσῃ τοῦτο τὸ ἄρθρον, δεύτερον δὲ, οἷσιν ἂν ὡς νηπιωτάτοισιν ἐοῦσιν, ἥκιστα δὲ τοῖσι τετελειωμένοισιν. τοῖσι μὲν οὖν τετελειωμένοισιν εἴρηται, οἵη τις ἡ ὁδοιπορίη γίνεται· οἷσι δʼ ἂν νηπίοισιν ἐοῦσιν ἡ ξυμφορὴ αὕτη γένηται, οἱ μὲν πλεῖστοι καταβλακεύουσι τὴν διόρθωσιν τοῦ σώματος, ἀλλὰ κακῶς εἰλέονται ἐπὶ τὸ ὑγιὲς σκέλος, τῇ χειρὶ πρὸς τὴν γῆν ἀπερειδόμενοι τῇ κατὰ τὸ ὑγιὲς σκέλος· καταβλακεύουσι δὲ ἔνιοι τὴν ἐς τὸ ὀρθὸν ὁδοιπορίην, καὶ οἷσιν ἂν τετελειωμένοισιν αὕτη ἡ ξυμφορὴ γένηται. ὁκόσοι δʼ ἂν νήπιοι ἐόντες, ταύτῃ τῇ ξυμφορῇ χρησάμενοι, ὀρθῶς παιδαγωγηθῶσι, τῷ μὲν ὑγιέϊ σκέλεϊ χρέονται ἐς ὀρθὸν, ὑπὸ δὲ τὴν μασχάλην τὴν κατὰ τὸ ὑγιὲς σκέλος σκίπωνα περιφέρουσι, μετεξέτεροι δὲ, καὶ ὑπʼ ἀμφοτέρας τὰς χεῖρας· τὸ δὲ σιναρὸν σκέλος μετέωρον ἔχουσι, καὶ τοσούτῳ ῤηΐους εἰσὶν, ὅσῳ ἂν αὐτοῖσιν ἔλασσον τὸ σκέλος τὸ σιναρὸν ἔῃ· τὸ δὲ ὑγιὲς ἰσχύει αὐτέοισιν οὐδὲν ἧσσον, ἢ εἰ καὶ ἀμφότερα ὑγιέα ἦν. Θηλύνονται δὲ πᾶσι τοῖσι τοιούτοισιν αἱ σάρκες τοῦ σκέλεος, μᾶλλον δέ τι θηλύνονται αἱ ἐκ τοῦ ἔξω μέρεος, ἢ αἱ ἐκ τοῦ ἔσω ὡς ἐπὶ πολύ.

[¶5] 53. Some tell a story how the Amazonian women dislocate the joints of their male children while mere infants, some at the knee, and others at the hip-joint, that they may be maimed, and that the male sex may not conspire against the female, and that they use them as artisans to perform any sedentary work, such as that of a shoemaker or brazier. Whether these things be true or not I do not know, but this I know, that matters would be such as is represented, provided their children, while infants, were to have their joints dislocated. The consequences of dislocation inward at the hip-joint are much greater than of dislocation outward at the hip-joint, but at the knee, although there be some difference, it is less; but the mode of either impediment is peculiar, their legs are more bandied when the dislocation is outward, but those who have dislocation inward stand erect on their feet with less freedom. In like manner, when the dislocation is at the anklejoint, if outward they become vari (their toes are turned inward?), but they can stand; but if the dislocation be inward they become valgi (their toes are turned outward?), but they have less freedom of standing. The proportional growth of their bones is as follows: in those cases in which the bone of the leg is dislocated, the bones of the feet grow very little, as being very near the injury, but the bones of the leg increase in size, and with very little defect, but the fleshy parts (muscles?) are wasted. But when the ankle-joint is in its natural state, but the knee is dislocated, in these cases the bones of the leg do not grow in like manner, but become shortened, as being nearest the seat of the injury, and the bones of the feet also are atrophied, but not in the same proportion; because, as was said a little while ago, the ankle-joint is safe, and if they could use it, as in the case of club-foot, the bones of the foot would be still less atrophied. When the dislocation takes place at the hip-joint, the bone of the thigh, in this case, does not generally grow in like manner, as being the one nearest the seat of the injury, but becomes shorter than the sound one; but the growth of the bones of the leg is not arrested in like manner; nor of those of the feet, for this reason, that there is no displacement between the bones of the thigh and leg, nor between those of the leg and foot; in those cases, however, the fleshy parts of the whole limb are atrophied; but if they could make use of the limb, the growth of the bones would be still more developed, as formerly stated, only the thigh, although its flesh would be much less wasted, would still be by no means so fleshy as the sound limb. The following observations are a proof of this: those persons who are weasel-armed (galiancones) from birth, owing to dislocation of the humerus, or when the accident has happened to them before they have attained their full growth, such persons have the bone of the arm shortened, but those of the fore-arm and hand are little inferior in size to the sound, for the reasons which have been stated, because the humerus is the bone nearest to the joint affected, and, on that account, it is shorter than natural; but the fore-arm is not equally affected by the accident, because the joint at which the bones of the arm and forearm are articulated remains in its natural condition, and the hand is still further distant than the fore-arm from the seat of the injury. Such are the reasons why certain of the bones in this case increase in growth, and certain do not. The laborious office of the hand contributes much to the development of the flesh in the fore-arm and hand, for whatever work is done by the hand, these weasel-armed persons strive to do no less effectually with the other hand than with the sound; for the arms do not support the weight of the body like the legs, and the work performed by them is light. From exercise, then, the fleshy parts on the hand and fore-arm are not atrophied in weasel-armed persons, and by these means the arm, too, gains flesh. But in dislocation inward at the hip-joint, whether from birth or from childhood, the fleshy parts, on that account, are much more atrophied than those of the hand, because the patients cannot exercise the leg. Another proof will be given in the observations which will be presently stated, that these things are such as I things are such as I have represented.

> Greek: 53. 53. μυθολογοῦσι δέ τινες, ὅτι αἱ Ἀμαζονίδες τὸ ἄρσεν γένος τὸ ἑωυτῶν αὐτίκα νήπιον ἐὸν ἐξαρθρέουσιν, αἱ μὲν, κατὰ [τὰ] γούνατα, αἱ δὲ, κατὰ τὰ ἰσχία, ὡς δῆθεν χωλὰ γίνοιτο, καὶ μὴ ἐπιβουλεύοι τὸ ἄρσεν γένος τῷ θήλεϊ· χειρώναξιν ἄρα τουτέοισι χρέονται, ὁκόσα ἢ σκυτείης ἔργα, ἢ χαλκείης, ἢ ἄλλο ὅ τι ἑδραῖον ἔργον. εἰ μὲν οὖν ἀληθέα ταῦτά ἐστιν, ἐγὼ μὲν οὐκ οἶδα· ὅτι δὲ γίνοιτο ἂν τοιαῦτα, οἶδα, εἴ τις ἐξαρθρέοι αὐτίκα νήπια ἐόντα. κατὰ μὲν οὖν τὰ ἰσχία μέζον τὸ διάφορόν ἐστιν ἐς τὸ ἔσω, ἢ ἐς τὸ ἔξω ἐξαρθρῆσαι· κατὰ δὲ τὰ γούνατα διαφέρει μέν τι, ἔλασσον δέ τι διαφέρει· τρόπος δὲ ἑκατέρου τοῦ χωλώματος ἴδιός ἐστιν· κυλλοῦται γὰρ μᾶλλον, οἷσιν ἂν ἐς τὸ ἔξω ἐξαρθρήσῃ· ὀρθοὶ δὲ ἧσσον ἵστανται, οἷσιν ἂν ἐς τὸ ἔσω ἐξαρθρήσῃ. ὡσαύτως δὲ καὶ ἢν παρὰ τὸ σφυρὸν ἐξαρθρήσῃ, ἢν μὲν ἐς τὸ ἔξω μέρος, κυλλοὶ μὲν γίνονται, ἑστάναι δὲ δύνανται· ἢν δὲ ἐς τὸ ἔσω μέρος, βλαισοὶ μὲν γίνονται, ἧσσον δὲ ἑστάναι δύνανται. ἥ γε μὴν ξυναύξησις τῶν ὀστέων τοιήδε γίνεται· οἷσι μὲν ἂν τὸ κατὰ τὸ σφυρὸν ὀστέον τὸ τῆς κνήμης ἐκστῇ, τούτοισι μὲν τὰ τοῦ ποδὸς ὀστέα ἥκιστα ξυναύξεται, ταῦτα γὰρ ἐγγυτάτω τοῦ τρώματός ἐστι, τὰ δὲ τῆς κνήμης ὀστέα αὔξεται μὲν, οὐ πολὺ δὲ ἐνδεεστέρως, αἱ μέντοι σάρκες μινύθουσιν. οἷσι δʼ ἂν κατὰ μὲν τὸ σφυρὸν μένῃ τὸ ἄρθρον κατὰ φύσιν, κατὰ δὲ τὸ γόνυ ἐξεστήκῃ, τούτοισι τὸ τῆς κνήμης ὀστέον οὐκ ἐθέλει ξυναύξεσθαι ὁμοίως, ἀλλὰ βραχύτατον γίνεται, τοῦτο γὰρ ἐγγυτάτω τοῦ τρώματός ἐστιν· τοῦ μέντοι ποδὸς τὰ ὀστέα μινύθει μὲν, ἀτὰρ οὐχ ὁμοίως, ὥσπερ ὀλίγον τι πρόσθεν εἴρηται, ὅτι τὸ ἄρθρον τὸ παρὰ τὸν πόδα σῶόν ἐστιν· εἰ δέ οἱ χρέεσθαι ἠδύναντο, ὥσπερ καὶ τῷ κυλλῷ, ἔτι ἂν ἧσσον ἐμινύθει τὰ τοῦ ποδὸς ὀστέα τούτοισιν. οἷσι δʼ ἂν κατὰ τὸ ἰσχίον ἡ ἐξάρθρησις γένηται, τούτοισι τοῦ μηροῦ τὸ ὀστέον οὐκ ἐθέλει ξυναύξεσθαι ὁμοίως, τοῦτο γὰρ ἐγγυτάτω τοῦ τρώματός ἐστιν, ἀλλὰ βραχύτερον τοῦ ὑγιέος γίνεται· τὰ μέντοι τῆς κνήμης ὀστέα οὐχ ὁμοίως τούτοισιν ἀναυξέα γίνεται, οὐδὲ τὰ τοῦ ποδὸς, διὰ τοῦτο δὲ, ὅτι τὸ τοῦ μηροῦ ἄρθρον τὸ παρὰ τὴν κνήμην ἐν τῇ ἑωυτοῦ φύσει μένει, καὶ τὸ τῆς κνήμης τὸ παρὰ τὸν πόδα· σάρκες μέντοι μινύθουσι παντὸς τοῦ σκέλεος τούτοισιν· εἰ μέντοι χρέεσθαι τῷ σκέλεϊ ἠδύναντο, ἔτι ἂν μᾶλλον τὰ ὀστέα ξυνηυξάνετο, ὡς καὶ πρόσθεν εἴρηται, πλὴν τοῦ μηροῦ, κἂν ἧσσον ἄσαρκα εἴη, ἀσαρκότερα δὲ πολλῷ ἢ εἰ ὑγιέα ἦν. σημήϊον δὲ, ὅτι ταῦτα τοιαῦτά ἐστιν· ὁκόσοι γὰρ, τοῦ βραχίονος ἐκπεσόντος, γαλιάγκωνες ἐγένοντο ἐκ γενεῆς, ἢ καὶ ἐν αὐξήσει πρὶν τελειωθῆναι, οὗτοι τὸ μὲν ὀστέον τοῦ βραχίονος βραχὺ ἴσχουσι, τὸν δὲ πῆχυν καὶ ἄκρην τὴν χεῖρα ὀλίγῳ ἐνδεεστέρην τοῦ ὑγιέος, διὰ ταύτας τὰς προφάσιας τὰς εἰρημένας, ὅτι ὁ μὲν βραχίων ἐγγυτάτω τοῦ ἄρθρου τοῦ τρώματός ἐστιν, ὥστε διὰ τοῦτο βραχύτερος γέγονεν· ὁ δʼ αὖ πῆχυς διὰ τοῦτο οὐχ ὁμοίως ἐνακούει τῆς ξυμφορῆς, ὅτι τὸ τοῦ βραχίονος ἄρθρον τὸ πρὸς τοῦ πήχεος ἐν τῇ ἀρχαίῃ φύσει μένει, ἥ τε αὖ χεὶρ ἄκρη ἔτι τηλοτέρω ἄπεστιν, ἢ ὁ πῆχυς, ἀπὸ τῆς ξυμφορῆς. διὰ ταύτας οὖν τὰς εἰρημένας προφάσιας, τῶν ὀστέων τά τε μὴ ξυναυξανόμενα οὐ ξυναυξάνεται, τά τε ξυναυξανόμενα ξυναυξάνεται. ἐς δὲ τὸ εὔσαρκον τῇ χειρὶ καὶ τῷ βραχίονι ἡ ταλαιπωρίη τῆς χειρὸς μέγα προσωφελέει· ὅσα γὰρ χειρῶν ἔργα ἐστὶ, τὰ πλεῖστα προθυμέονται οἱ γαλιάγκωνες ἐργάζεσθαι τῇ χειρὶ ταύτῃ, ὅσα περ καὶ τῇ ἑτέρῃ δύνανται, οὐδὲν ἐνδεεστέρως τῆς ἀσινέος· οὐ γὰρ δεῖ ὀχέεσθαι τὸ σῶμα ἐπὶ τῶν χειρῶν, ὡς ἐπὶ τῶν σκελέων, ἀλλὰ κοῦφα αὐτέῃσι τὰ ἔργα ἐστίν. διὰ δὲ τὴν χρῆσιν οὐ μινύθουσιν αἱ σάρκες αἱ κατὰ τὴν χεῖρα καὶ τὸν πῆχυν τοῖσι γαλιάγκωσιν, ἀλλὰ καὶ ὁ βραχίων τι προσωφελέεται ἐς εὐσαρκίην διὰ ταῦτα· ὅταν δὲ ἰσχίον ἐκπαλὲς γένηται ἐς τὸ ἔσω μέρος ἐκ γενεῆς, ἢ καὶ ἔτι νηπίῳ ἐόντι, μινύθουσιν αἱ σάρκες διὰ τοῦτο μᾶλλον ἢ τῆς χειρὸς, ὅτι οὐ δύνανται χρέεσθαι τῷ σκέλεϊ. μαρτύριον δέ τι ἓν ἔσται καὶ ἐν τοῖσιν ὀλίγον ὕστερον εἰρησομένοισιν, ὅτι ταῦτα τοιαῦτά ἐστιν.

[¶6] 54. When the head of the femur is dislocated outward, the limb in these cases, when compared with the other, appears shortened, and this is natural, for the head of the femur no longer rests on a bone as in dislocation inward, but along the side of a bone which naturally inclines to the side, and it is lodged in flesh of a pulpy and yielding nature, and on that account it appears more shortened. Inwardly, the thigh about the perineum appears more hollow and flabby, but externally the buttock is more rounded, from the head of the thigh having slipped outward, but the nates appear to be raised up, owing to the flesh there having yielded to the head of the thigh-bone; but the extremity of the thigh-bone, at the knee, appears to be turned inward, and the leg and foot in like manner, neither does it admit of flexion like the sound limb. These, then, are the symptoms of dislocation outward.

> Greek: 54. 54. Ὁκόσοισι δʼἂν ἐς τὸ ἔξω ἡ τοῦ μηροῦ κεφαλὴ ἐκβῇ, τούτοισι βραχύτερον μὲν τὸ σκέλος φαίνεται παρατεινόμενον παρὰ τὸ ἕτερον· εἰκότως· οὐ γὰρ ἐπʼ ὀστέον ἡ ἐπίβασις τῆς κεφαλῆς τοῦ μηροῦ ἐστιν, ὡς ὅτε ἔσω ἐκπέπτωκεν, ἀλλὰ παρʼ ὀστέον παρεγκεκλιμένην τὴν φύσιν ἔχον, ἐν σαρκὶ δὲ στηρίζεται ὑγρῇ καὶ ὑπεικούσῃ· διὰ τοῦτο μὲν βραχύτερον φαίνεται. ἔσωθεν δὲ ὁ μηρὸς παρὰ τὴν πλιχάδα καλεομένην κοιλότερος καὶ ἀσαρκότερος φαίνεται· ἔξωθεν δὲ ὁ γλουτὸς ὑποκυρτότερος, ἅτε ἐς τὸ ἔξω τῆς κεφαλῆς τοῦ μηροῦ ὠλισθηκυίης· ἀτὰρ καὶ ἀνωτέρω φαίνεται ὁ γλουτὸς, ἅτε ὑπειξάσης τῆς σαρκὸς τῆς ἐνταῦθα τῇ τοῦ μηροῦ κεφαλῇ· τὸ δὲ παρὰ τὸ γόνυ τοῦ μηροῦ ἄκρον ἔσω ῤέπον φαίνεται, καὶ ἡ κνήμη, καὶ ὁ πούς· ἀτὰρ οὐδὲ ξυγκάμπτειν ὥσπερ τὸ ὑγιὲς σκέλος δύνανται. τὰ μὲν οὖν σημήϊα ταῦτα τοῦ ἔξω ἐκπεπτωκότος μηροῦ εἰσιν.

[¶7] 55. When such a dislocation is not reduced in adults, the whole limb appears to be shortened, and in walking they cannot reach the ground with the heel, but they walk with the ball of the foot on the ground, and the points of their toes incline a little inward. But the injured limb, in this case, can support the body much better than in dislocation inward, both because the head of the femur and the neck of its articular extremity, being naturally oblique, have formed a bed under a considerable portion of the hip, and because the extremity of the foot is not forcibly turned outward, but is nearly in a line with the body, and is even inclined more inwardly. When, then, the articular extremity of the femur has worn out a socket for itself in the flesh where it was lodged, and the flesh is lubricated, it ceases to be painful in the course of time, and when it becomes free from pain, they can walk without a staff, if so inclined, and they can support the body on the injured limb. From usage then, in such cases, the fleshy parts are less enervated than in those which have been mentioned a little before, still, however, they lose their strength more or less; but in general there is more enervation when the dislocation is inward than when it is outward. Some of them, then, cannot wear their shoes, owing to the unbending state of their leg, and some of them can. But when this dislocation takes place in utero, and when the dislocation having occurred at any time before manhood, from violence, has not been replaced, or when from disease the articular extremity has started from its socket, and is displaced (for many such cases occur, and from some of them, if the femur become necrosed, obstinate suppurations requiring the use of tents are formed, and in certain of them the bone is laid bare), whether the bone become necrosed or not, the bone of the thigh is much shortened, and does not usually grow like the sound one, the bones, too, of the leg, become shorter than those of the other, but in a small degree, for the same reasons that were formerly stated; such persons can walk, some of them in the same fashion as adults having an unreduced dislocation, and some of them walk with the whole foot on the ground, but limp in walking, being obliged to do so by the shortness of the limb. Such is the result, even though they be carefully and properly trained in the attitudes before they have strength for walking, and in like manner also, after they have acquired the necessary strength; but those persons require the most care who were very young when they met with the accident, for, if neglected while children, the limb becomes entirely useless and atrophied. The fleshy parts of the entire limb are more wasted than those of the sound limb, but this is much less apt to happen in their case than in dislocation inward, owing to usage and exercise, as they are speedily able to make use of the limb, as was stated a little before with regard to the weasel-armed (galiancones).

> Greek: 55. 55. οἷσι μὲν οὖν ἂν τετελειωμένοισιν ἤδη ἐκπεσὸν τὸ ἄρθρον μὴ ἐμπέσῃ, τούτοισι βραχύτερον μὲν φαίνεται τὸ ξύμπαν σκέλος, ἐν δὲ τῇ ὁδοιπορίῃ τῇ μὲν πτέρνῃ οὐ δύνανται καθικνέεσθαι ἐπὶ τῆς γῆς, τῷ δὲ στήθεϊ τοῦ ποδὸς βαίνουσιν ἐπὶ τὴν γῆν· ὀλίγον δὲ ἐς τὸ ἔσω μέρος ῤέπουσι τοῖσι δακτύλοισιν ἄκροισιν. ὀχέειν δὲ δύναται τὸ σῶμα τὸ σιναρὸν σκέλος τούτοισι πολλῷ μᾶλλον, ἢ οἷσιν ἂν ἐς τὸ ἔσω μέρος ἐκπεπτώκῃ, ἅμα μὲν, ὅτι ἡ κεφαλὴ τοῦ μηροῦ, καὶ ὁ αὐχὴν τοῦ ἄρθρου πλάγιος φύσει πεφυκὼς, ὑπὸ συχνῷ μέρεϊ τοῦ ἰσχίου τὴν ὑπόστασιν πεποίηται, ἅμα δὲ, ὅτι ἄκρος ὁ ποὺς οὐκ ἐς τὸ ἔξω μέρος ἀναγκάζεται ἐκκεκλίσθαι, ἀλλʼ ἐγγύς ἐστι τῆς ἰθυωρίης τῆς κατὰ τὸ σῶμα, καὶ τείνει καὶ ἐσωτέρω. ὅταν οὖν τρίβον μὲν λάβῃ τὸ ἄρθρον ἐν τῇ σαρκὶ, εἰς ἣν ἐξεκλίθη, ἡ δὲ σὰρξ γλισχρανθῇ, ἀνώδυνον τῷ χρόνῳ γίνεται· ὅταν δὲ ἀνώδυνον γένηται, δύνανται μὲν ὁδοιπορέειν ἄνευ ξύλου, ἢν ἄλλως βούλωνται· δύνανται δὲ ὀχέειν τὸ σῶμα ἐπὶ τὸ σιναρὸν σκέλος. διʼ οὖν τὴν χρῆσιν ἧσσον τοῖσι τοιούτοισιν ἐκθηλύνονται αἱ σάρκες, ἢ οἷσιν ὀλίγον πρόσθεν εἴρηται· ἐκθηλύνονται δὲ ἢ πλεῖον, ἢ ἔλασσον· μᾶλλον δέ τι ἐκθηλύνονται κατὰ τὸ ἔσω μέρος, ἢ κατὰ τὸ ἔξω, ὡς ἐπὶ τὸ πολύ. τὸ μέντοι ὑπόδημα μετεξέτεροι τούτων ὑποδέεσθαι οὐ δύνανται διὰ τὴν ἀκαμπίην τοῦ σκέλεος, οἱ δέ τινες καὶ δύνανται. οἷσι δὲ ἂν ἐν γαστρὶ ἐοῦσιν ἐξαρθρήσῃ τοῦτο τὸ ἄρθρον, ἢ ἔτι ἐν αὐξήσει ἐοῦσι βίῃ ἐκπεσὸν ἤδη μὴ ἐμπέσῃ, ἢ καὶ ὑπὸ νούσου ἐξαρθρήσῃ τοῦτο τὸ ἄρθρον καὶ ἐκπαλήσῃ (πολλὰ γὰρ τοιαῦτα γίνεται, καὶ ἐνίων μὲν τῶν τοιούτων ἢν ἐπισφακελίσῃ ὁ μηρὸς, ἐμπυήματα χρόνια καὶ ἔμμοτα γίνεται, καὶ ὀστέων ψιλώσιες ἐνίοισιν), ὁμοίως δὲ καὶ οἷσιν ἐπισφακελίζει, καὶ οἷσι μὴ ἐπισφακελίζει, τοῦ μηροῦ τὸ ὀστέον πολλῷ βραχύτερον γίνεται, καὶ οὐκ ἐθέλει ξυναύξεσθαι, ὥσπερ τοῦ ὑγιέος· τὰ μέντοι τῆς κνήμης βραχύτερα μὲν γίνεται, ἢ τὰ τῆς ἑτέρης, ὀλίγῳ δὲ, διὰ τὰς αὐτὰς προφάσιας, αἳ καὶ πρόσθεν εἴρηνται· ὁδοιπορέειν τε δύνανται οἱ τοιοῦτοι, οἱ μέν τινες αὐτῶν τοῦτον τὸν τρόπον, ὥσπερ οἷσι τετελειωμένοισιν ἐξέπεσε καὶ μὴ ἐνέπεσεν, οἱ δὲ καὶ βαίνουσι μὲν παντὶ τῷ ποδὶ, διαῤῥέπουσι δὲ ἐν τῇσιν ὁδοιπορίῃσιν, ἀναγκαζόμενοι διὰ τὴν βραχύτητα τοῦ σκέλεος. ταῦτα δὲ τοιαῦτα γίνεται, ἢν ἐπιμελέως μὲν παιδαγωγηθῶσιν ἐν τοῖσι σχήμασι καὶ ὀρθῶς, ἐν οἷσι δεῖ, πρὶν κρατυνθῆναι ἐς τὴν ὁδοιπορίην, ἐπιμελέως δὲ καὶ ὀρθῶς, ἐπὴν κρατυνθῶσιν· πλείστης δὲ ἐπιμελείης δέονται, οἷσιν ἂν νηπιωτάτοισιν ἐοῦσιν αὕτη ἡ ξυμφορὴ γένηται· ἢν γὰρ ἀμεληθῶσι νήπιοι ἐόντες, ἀχρήϊον παντάπασι καὶ ἀναυξὲς ὅλον τὸ σκέλος γίνεται. αἱ δὲ σάρκες τοῦ ξύμπαντος σκέλεος μινύθουσι μᾶλλον, ἢ τοῦ ὑγιέος· πάνυ μὴν πολλῷ ἧσσον τούτοισι μινύθουσιν, ἢ οἷσιν ἂν ἔσω ἐκπεπτώκῃ, διὰ τὴν χρῆσιν καὶ τὴν ταλαιπωρίην, οἷον εὐθέως δύνασθαι χρέεσθαι τῷ σκέλεϊ, ὡς καὶ πρόσθεν ὀλίγῳ περὶ τῶν γαλιαγκώνων εἴρηται.

[¶8] 56. There are persons who, from birth or from disease, have dislocations outward of both the thighs; in them, then, the bones are affected in like manner, but the fleshy parts in their case lose their strength less; the legs, too, are plump and fleshy, except that there is some little deficiency at the inside, and they are plump because they have the equal use of both their legs, for in walking they totter equally to this side that. Their nates appear very prominent, from the displacement of the bones of the joint. But if in their case the bones do not sphacelate (become carious?) and if they do not become bent above the hip-joint, if nothing of this kind happen to them, they become otherwise sufficiently healthy, but the growth of all the rest of the body, with the exception of the head, is arrested.

> Greek: 56. 56. εἰσὶ δέ τινες, ὧν τοῖσι μὲν ἐκ γενεῆς αὐτίκα, τοῖσι δὲ καὶ ὑπὸ νούσου ἀμφοτέρων τῶν σκελέων ἐξέστη τὰ ἄρθρα ἐς τὸ ἔξω μέρος· τούτοισιν οὖν τὰ μὲν ὀστέα ταὐτὰ παθήματα πάσχει· αἱ μέντοι σάρκες ἥκιστα ἐκθηλύνονται τοῖσι τοιούτοισιν· εὔσαρκα δὲ καὶ τὰ σκέλεα γίνεται, πλὴν εἴ τι ἄρα κατὰ τὸ εἴσω μέρος ἐλλείποι ὀλίγον· διὰ τοῦτο δὲ εὔσαρκά ἐστιν, ὅτι ἀμφοτέροισι τοῖσι σκέλεσιν ὁμοίως ἡ χρῆσις γίνεται· ὁμοίως γὰρ σαλεύουσιν ἐν τῇ ὁδοιπορίῃ ἔνθα καὶ ἔνθα· ἐξεχέγλουτοι δὲ οὗτοι ἰσχυρῶς φαίνονται διὰ τὴν ἔκστασιν τῶν ἄρθρων. ἢν δὲ μὴ ἐπισφακελίσῃ αὐτοῖσι τὰ ὀστέα, μηδὲ κυφοὶ ἀνωτέρω τῶν ἰσχίων γένωνται (ἐνίους γὰρ καὶ τὰ τοιαῦτα καταλαμβάνει), ἢν οὖν μὴ τοιοῦτόν τι γένηται, ἱκανῶς ὑγιηροὶ τἄλλα διαφέρονται· ἀναυξέστεροι μέντοι τὸ πᾶν σῶμα οὗτοι γίνονται, πλὴν τῆς κεφαλῆς.