---
title: "On the Articulations · Περὶ ἄρθρων"
author: "Hippocrates"
translator: "Francis Adams"
languages: [grc, en]
shelf: "Classical Greek"
section: 5 of 6
url: https://scriptura.si/works/hippocrates-on-the-articulations/5/
cite: "Hippocrates, tr. Francis Adams, On the Articulations · Περὶ ἄρθρων, section 5. Scriptura (scriptura.si), https://scriptura.si/works/hippocrates-on-the-articulations/5/"
---

# 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.

## 5. Sections 57–69

Source: https://scriptura.si/works/hippocrates-on-the-articulations/5/ · cite a paragraph as https://scriptura.si/works/hippocrates-on-the-articulations/5/#p-N

[¶0] 57. In dislocations of the head of the femur backward, which rarely occur, the patient cannot extend the leg, either at the dislocated joint, or at the ham, to any extent, and of all the dislocations, this is the variety in which the patients have the least power of making extension at the groin and the ham. But, moreover, this also should be known (for it is a valuable piece of knowledge, and of much importance, and yet most yet most people are ignorant of it), that persons in health cannot extend the joint at the ham, if they do not extend the joint at the groin at the same time, unless they raise the foot very high, for in this way they could do it; neither also could they bend the joint at the ham, but with much greater difficulty, if they do not bend the joint at the groin at the same time. There are many other things in the body which have similar connections, both with regard to the contractions of nerves (ligaments?), and the positions of muscles, and many of them more worthy of being known than is generally supposed, and with regard to the nature of the intestine and that of the whole internal cavity, and with regard to the displacements and contractions of the uterus; but all these things will be treated of elsewhere, in a work akin to the present one. But with regard to the matter on hand, they cannot make extension, as has been already stated; and the limb appears shortened, for two reasons-first, because it cannot be extended, and also because the bone has slipped into the flesh of the nates; for the head and neck of the femur, in this dislocation, are carried downward from their natural situation, to the outside of the nates. But yet they can bend the limb, unless prevented by pain, and the leg and foot appear pretty straight, and not much inclined toward either side, but at the groin the flesh, when felt, appears looser, from the bone of the joint having slipped to the other side, but at the nates the head of the femur may be felt to be more prominent than natural. Such are the symptoms accompanying dislocation of the thigh backward.

> Greek: 57. 57. Ὅσοισι δʼ ἂν ἐς τοὔπισθεν ἡ κεφαλὴ τοῦ μηροῦ ἐκπέσῃ, ὀλίγοισι δὲ ἐκπίπτει, οὗτοι ἐκτανύειν οὐ δύνανται τὸ σκέλος, οὔτε κατὰ τὸ ἄρθρον τὸ ἐκπεσὸν, οὔτε τι κάρτα κατὰ τὴν ἰγνύην· ἀλλʼ ἥκιστα τῶν ἐκπαλέων οὗτοι ἐκτανύουσι καὶ τὸ κατὰ τὸν βουβῶνα, καὶ τὸ κατὰ τὴν ἰγνύην ἄρθρον. Προσξυνιέναι μὲν οὖν καὶ τόδε χρὴ (εὔχρηστον γὰρ καὶ πολλοῦ ἄξιόν ἐστι, καὶ τοὺς πλείστους λήθει), ὅτι οὐδʼ ὑγιαίνοντες δύνανται κατὰ τὴν ἰγνύην ἐκτανύειν τὸ ἄρθρον, ἢν μὴ ξυνεκτανύωσι καὶ τὸ κατὰ τὸν βουβῶνα ἄρθρον, πλὴν ἢν μὴ πάνυ ἄνω ἀείρωσι τὸν πόδα, οὕτω δʼ ἂν δύναιντο· οὐ τοίνυν οὐδὲ ξυγκάμπτειν δύνανται τὸ κατὰ τὴν ἰγνύην ἄρθρον ὁμοίως, ἀλλὰ πολὺ χαλεπώτερον, ἢν μὴ ξυγκάμψωσι καὶ τὸ κατὰ τὸν βουβῶνα ἄρθρον. πολλὰ δὲ καὶ ἄλλα κατὰ τὸ σῶμα τοιαύτας ἀδελφίξιας ἔχει, καὶ κατὰ νεύρων ξυντάσιας, καὶ κατὰ μυῶν σχήματα, καὶ πλεῖστά τε καὶ πλείστου ἄξια γινώσκεσθαι, ἢ ὥς τις οἴεται, καὶ κατὰ τὴν τοῦ ἐντέρου φύσιν, καὶ τὴν τῆς ξυμπάσης κοιλίης, καὶ κατὰ τὰς τῶν ὑστερέων πλάνας καὶ ξυντάσιας· ἀλλὰ περὶ μὲν τούτων ἑτέρωθι λόγος ἔσται, ἠδελφισμένος τοῖσι νῦν λεγομένοισιν. περὶ οὗ δὲ ὁ λόγος ἐστὶν, οὔτε ἐκτανύειν δύνανται, ὥσπερ ἤδη εἴρηται· βραχύτερόν τε τὸ σκέλος φαίνεται διὰ δισσὰς προφάσιας, ὅτι τε οὐκ ἐκτανύεται, ὅτι τε πρὸς τὴν σάρκα ὠλίσθηκε τὴν τοῦ πυγαίου· ἡ γὰρ φύσις τοῦ ἰσχίου τοῦ ὀστέου ταύτῃ, ᾗ καὶ ἡ κεφαλὴ καὶ ὁ αὐχὴν τοῦ μηροῦ γίνεται, ὅταν δὲ ἐξαρθρήσῃ, καταφερὴς πέφυκεν ἐπὶ τοῦ πυγαίου τὸ ἔξω μέρος. ξυγκάμπτειν μέντοι δύνανται, ὅταν μὴ ἡ ὀδύνη κωλύῃ· καὶ ἡ κνήμη τε καὶ ὁ ποὺς ὀρθὰ ἐπιεικέως φαίνεται, καὶ οὔτε τῇ, οὔτε τῇ πολὺ ἐκκεκλιμένα· κατὰ δὲ τὸν βουβῶνα δοκέει τι ἡ σὰρξ λαπαρωτέρη εἶναι, ποτὶ καὶ ψαυομένη, ἅτε τοῦ ἄρθρου ἐς τὰ ἐπὶ θάτερα μέρη ὠλισθηκότος· κατὰ δὲ αὐτὸ τὸ πυγαῖον διαψαυομένη ἡ κεφαλὴ τοῦ μηροῦ δοκέει ἐξογκέειν μᾶλλον. τὰ μὲν οὖν σημήϊα ταῦτα, ᾧ ἂν ἐς τὸ ὄπισθεν ἐκπεπτώκῃ ὁ μηρός.

[¶1] 58. When this dislocation occurs in an adult, and is not reduced, he can walk, indeed, after a time, and when the pain has abated, and when he has been accustomed to rotate the articular bone in the flesh; he finds it necessary, however, to make strong flexion at the groin in walking, for two reasons, both because the limb, for the causes already stated, becomes much shorter, and he is far from touching the ground with his heel, and he can barely reach it with the ball of his foot, and not even thus, unless he bend himself at the groins, and also bend with the other leg at the ham. And in this case, he is under the necessity of supporting the upper part of the thigh with his hand at each step: this also contributes, in a certain degree, to make him bend the body at the groins; for, during the shifting of the feet in walking, the body cannot be supported on the unsound be supported on the unsound limb, unless it be pressed to the ground by the hand,-the end of the femur not being placed properly under the body, but having slipped backward to the nates; and if he should try to rest the weight of his body for a little, upon the foot, without any other support, he would fall backward, for there would be a great inclination in this direction, from the hips having protruded backward far beyond the line of the foot, and the spine inclining toward the hips. Such persons can walk, indeed, without a staff, if so accustomed, for because the sole of the foot is in its old line, and is not inclined outward, they do not require anything to balance them. Such, however, as, instead of grasping the thigh, prefer resting their weight upon a staff introduced into the armpit of the affected side, these, if they use a longer staff, will walk, indeed, more erect, but will not be able to reach the ground with the foot, or if they wish to rest upon the foot, they must take a shorter staff, and will require to bend the body at the groins. The wasting of the fleshy parts is analogous to what happens in the cases formerly described, for the wasting is greatest in those cases in which the patients keep the limb up, and do not exercise it, whilst those who practice walking, have the least atrophy. The sound leg, however, is not benefited, but is rather rendered more deformed, if the injured limb be applied to the ground, for it is forced to cooperate with the other, being protruded at the hip, and bent at the ham. But if the patient does not use the injured limb by applying it to the ground, but carries it up, and rests upon a staff, the sound leg thereby gains strength, for it is employed in its natural position, and further, the exercise gives it strength. But it may be said, these things are foreign to medicine; for what is the use of enlarging upon cases which are already past remedy? This is far from being the case, for it belongs to the knowledge of medicine to be acquainted also with these, and they cannot possibly be separated from one another; for to such as are curable, means are to be used to prevent them from becoming incurable, studying how they may best be prevented from getting into an incurable state. And incurable cases should be known, that they may not be aggravated by useless applications, and splendid and creditable prognostics are made by knowing where, how, and when every case will terminate, and whether it will be converted into a curable or an incurable disease. When then, from birth, or during one’s youth, this dislocation backward occurs, and is not reduced, whether it be connected with violence or disease (for many such dislocations occur in diseases, but the nature of the diseases in which dislocations take place, will be described afterward); if, then, the dislocated limb be not reduced, the bone of the thigh becomes shortened, the whole limb is impaired, is arrested in its growth, and loses its flesh from want of use; the articulation at the ham is also impaired, for the nerves (ligaments?) become stretched, from cases formerly stated, wherefore those who have this dislocation, cannot make extension at the knee-joint. In a word, all parts of the body which were made for active use, if moderately used and exercised at the labor to which they are habituated, become healthy, increase in bulk, and bear their age well, but when not used, and when left without exercise, they become diseased, their growth is arrested, and they soon become old. Among these parts the joints and nerves (ligaments?), if not used, are not the least liable to be so affected; they are impaired, then, for the reasons we have stated, more in this variety of dislocation than in the others, for the whole limb is wasted, both in its bones and in its fleshy parts. Such persons, then, when they attain their full growth, keep the limb raised and flexed, rest the weight of the body on the other leg, and support themselves with a staff, some with one, and others with two.

> Greek: 58. 58. ὅτεῳ μὲν οὖν ἂν τετελειωμένῳ ἤδη ἐκπεσὼν μὴ ἐμπέσῃ, ὁδοιπορέειν μὲν δύναται, ὅταν ὁ χρόνος ἐγγένηται, καὶ ἡ ὀδύνη παύσηται, καὶ ἐθισθῇ τὸ ἄρθρον ἐν τῇ σαρκὶ ἐνστροφᾶσθαι· ἀναγκάζεται μέντοι ἰσχυρῶς ξυγκάμπτειν κατὰ τοὺς βουβῶνας ὁδοιπορέων, διὰ δισσὰς προφάσιας, ἅμα μὲν ὅτι πολλῷ βραχύτερον τὸ σκέλος γίνεται διὰ τὰ προειρημένα, καὶ τῇ μὲν πτέρνῃ καὶ πάνυ πολλοῦ δέεται ψαύειν τῆς γῆς· μόλις δὲ τῷ στήθεϊ τοῦ ποδὸς καθικνέεται, καὶ οὐδὲ οὕτως, ἢν μὴ κάμψῃ αὐτὸς ἑωυτὸν κατὰ τοὺς βουβῶνας, καὶ τῷ ἑτέρῳ σκέλεϊ κατὰ τὴν ἰγνύην ἐπιξυγκάμψῃ. ἐπὶ δὲ τούτοισιν ἀναγκάζεται, ὥστε τῇ χειρὶ τῇ κατὰ τὸ σιναρὸν σκέλος ἐρείδεσθαι ἐς τὸ ἄνω τοῦ μηροῦ ἐφʼ ἑκάστῃ ξυμβάσει· ἀναγκάζει οὖν τι καὶ τοῦτο αὐτὸ, ὥστε κάμπτεσθαι κατὰ τοὺς βουβῶνας· ἐν γὰρ τῇ μεταλλαγῇ τῶν σκελέων ἐν τῇ ὁδοιπορίῃ οὐ δύναται τὸ σῶμα ὀχέεσθαι ἐπὶ τοῦ σιναροῦ σκέλεος, εἰ μὴ προσκατερείδεται τὸ σιναρὸν πρὸς τὴν γῆν ὑπὸ τῆς χειρὸς, ἅτε οὐχ ὑφεστεῶτος τοῦ ἄρθρου ὑπὸ τῷ σῶματι, ἀλλʼ ἐς τὸ ὄπισθεν ἐξεστεῶτος κατὰ τὸ ἰσχίον· εἰ γὰρ πειρήσαιτο καὶ ἐπʼ ὀλίγον τοῦ ποδὸς ὀχηθῆναι μηδενὶ ἄλλῳ ἀντιστηριζόμενος, ἐς τὸ ὀπίσω ἂν πέσοι· ἡ γὰρ ῤοπὴ πολλὴ ἂν εἴη, τῶν ἰσχίων ἐπὶ πουλὺ ἐς τοὐπίσω ὑπερεχόντων ὑπὲρ τοῦ ποδὸς τῆς βάσιος, καὶ τῆς ῤάχιος ἐς τὰ ἰσχία ῤεπούσης. ἄνευ μὲν οὖν ξύλου δύνανται ὁδοιπορέειν οἱ τοιοῦτοι, ἢν ἄλλως ἐθισθέωσιν· διὰ τοῦτο, ὅτι ἡ βάσις τοῦ ποδὸς κατὰ τὴν ἀρχαίην ἰθυωρίην ἐστὶν, ἀλλʼ οὐκ ἐς τὸ ἔξω ἐκκεκλιμένη, διὰ τοῦτο οὐδὲ δέονται τῆς ἀντικοντώσιος. ὅσοι μέντοι βούλονται ἀντὶ τῆς τοῦ μηροῦ ἐπιλαβῆς ὑπὸ τὴν μασχάλην τὴν κατὰ τὸ σιναρὸν σκέλος ὑποτιθέμενοι σκίπωνα ἀντερείδειν, κεῖνοι, ἢν μὲν μακρότερον τὸν σκίπωνα ὑποτιθέοιντο, ὀρθότεροι μὲν ὁδοιπορήσουσι, τῷ δὲ ποδὶ πρὸς τὴν γῆν οὐκ ἐρείδονται· εἰ δʼ αὖ βούλονται ἐρείδεσθαι τῷ ποδὶ, βραχύτερον μὲν τὸ ξύλον φορητέον, κατὰ δὲ τοὺς βουβῶνας ἐπιξυγκάμπτεσθαι ἂν δέοι αὐτούς. τῶν δὲ σαρκῶν αἱ μινυθήσιες κατὰ λόγον. γίνονται καὶ τούτοισιν, ὥσπερ πρόσθεν εἴρηται· τοῖσι μὲν γὰρ μετέωρον ἔχουσι τὸ σκέλος καὶ μηδὲν ταλαιπωρέουσιν, τούτοισι καὶ μάλιστα μινύθουσιν· οἳ δʼ ἂν πλεῖστα χρέωνται τῇ ἐπιβάσει, τούτοισιν ἥκιστα μινύθουσιν. τὸ μέντοι ὑγιὲς σκέλος οὐκ ὠφελέεται, ἀλλὰ μᾶλλον αὶ ἀσχημονέστερον γίνεται, ἢν χρέωνται τῷ σιναρῷ σκέλεϊ ἐπὶ τὴν γῆν· ξυνυπουργέον γὰρ ἐκείνῳ ἐξίσχιόν τε ἀπαναγκάζεται εἶναι, καὶ κατὰ τὴν ἰγνύην ξυγκάμπτειν· ἢν δὲ μὴ προσχρέηται τῷ σιναρῷ ἐπὶ τὴν γῆν, ἀλλὰ, μετέωρον ἔχων, σκίπωνι ἀντερείδηται, οὕτω δὲ καρτερὸν γίνεται τὸ ὑγιὲς σκέλος· ἔν τε γὰρ τῇ φύσει διαιτᾶται, καὶ τὰ γυμνάσια προσκρατύνει αὐτό. φαίη μὲν οὖν ἄν τις, ἔξω ἰητρικῆς τὰ τοιαῦτα εἶναι· τί γὰρ δῆθεν δεῖ περὶ τῶν ἤδη ἀνηκέστων γεγονότων ἔτι προσξυνιέναι; πολλοῦ δὲ δεῖ οὕτως ἔχειν· τῆς γὰρ αὐτῆς γνώμης καὶ ταῦτα ξυνιέναι· οὐ γὰρ οἷόν τε ἀπαλλοτριωθῆναι ἀπʼ ἀλλήλων. δεῖ μὲν γὰρ ἐς τὰ ἀκεστὰ μηχανάασθαι, ὅκως μὴ ἀνήκεστα ἔσται, ξυνιέντα ὅκη ἂν μάλιστα κωλυτέα ἐς τὸ ἀνήκεστον ἐλθεῖν· δεῖ δὲ τὰ ἀνήκεστα ξυνιέναι, ὡς μὴ μάτην λυμαίνηται· τὰ δὲ προῤῥήματα λαμπρὰ καὶ ἀγωνιστικὰ, ἀπὸ τοῦ διαγινώσκειν, ὅπη ἕκαστον, καὶ οἵως, καὶ ὁκότε τελευτήσει, ἤν τε ἐς τὸ ἀκεστὸν τράπηται, ἤν τε ἐς τὸ ἀνήκεστον. Ὁκόσοισι δʼ ἂν ἐκ γενεῆς, ἢ καὶ ἄλλως πως ἐν αὐξήσει ἐοῦσιν, οὕτως ὀλίσθῃ τὸ ἄρθρον ὀπίσω, καὶ μὴ ἐμπέσῃ, ἤν τε βίῃ ὀλίσθῃ, ἤν τε καὶ ὑπὸ νούσου (πολλὰ γὰρ τοιαῦτα ἐξαρθρήματα γίνετα ἐν νούσοισιν· οἷαι δέ τινές εἰσιν αἱ νοῦσοι, ἐν ᾗσιν ἐξθρέεται τὰ τοιαῦτα, ὕστερον γεγράψεται), ἢν οὖν ἐκστὰν μὴ ἐμπέσῃ, τοῦ μὲν μηροῦ τὸ ὀστέον βραχὺ γίνεται, κακοῦται δὲ καὶ πᾶν τὸ σκέλος, καὶ ἀναυξέστερον γίνεται καὶ ἀσαρκότερον πολλῷ διὰ τὸ μηδὲν προσχρέεσθαι αὐτῷ· κακοῦται γὰρ τούτοισι καὶ τὸ κατὰ τὴν ἰγνύην ἄρθρον· τὰ γὰρ νεῦρα ἐντεταμένα γίνεται διὰ τὰ πρόσθεν εἰρημένα· διὸ οὐ δύνανται τὸ κατὰ τὴν ἰγνύην ἄρθρον ἐκτανύειν, οἷσιν ἂν οὕτως ἰσχίον ἐκπέσῃ. ὡς γὰρ ἐν κεφαλαίῳ εἰπεῖν, πάντα τὰ ἐν τῷ σώματι ὁκόσα ἐπὶ χρήσει γέγονε, χρεομένοισι μὲν μέτρια καὶ γυμναζομένοισιν ἐν τῇσι ταλαιπωρίῃσιν, ἐν ᾗσιν ἕκαστα εἴθισται, οὕτω μὲν ὑγιεινὰ καὶ αὔξιμα καὶ εὔγηρα γίνεται· μὴ χρεομένοισι δὲ, ἀλλʼ ἐλινύουσι νοσηρότερα γίνεται καὶ ἀναυξέα καὶ ταχύγηρα. ἐν δὲ τούτοισιν οὐχ ἥκιστα τὰ ἄρθρα τοῦτο πέπονθε καὶ τὰ νεῦρα, ἢν μή τις αὐτοῖσι χρέηται· κακοῦνται μὲν οὖν διὰ ταύτας τὰς προφάσιας μᾶλλόν τι ἐν τούτῳ τῷ τρόπῳ τοῦ ὀλισθήματος, ἢ ἐν τοῖσιν ἄλλοισιν· ὅλον γὰρ τὸ σκέλος ἀναυξὲς γίνεται, καὶ τῇ ἀπὸ τῶν ὀστέων φύσει, καὶ τῇ ἀπὸ τῶν σαρκῶν· οἱ οὖν τοιοῦτοι ὁκόταν ἀνδρωθῶσι, μετέωρον καὶ ξυγκεκαμμένον τὸ σκέλος ἴσχουσιν, ἐπὶ δὲ τοῦ ἑτέρου ὀχέονται, καὶ τῷ ξύλῳ ἀντιστηριζόμενοι, οἱ μὲν, ἑνὶ, οἱ δὲ, δυσίν.

[¶2] 59. In dislocations of the head of the thigh-bone forward (they are of rare occurrence), the patients cannot extend the leg completely, but least of all can they bend it at the groin; they are pained, also, if forced to bend the limb at the ham. The length of the leg, if compared at the heel, is the same as that of the other; but the extremity of the foot inclines less to project forward. But the whole limb has its natural direction, and inclines neither to this side nor to that. These cases are particularly attended with severe pain, and they are more apt to be accompanied with retention of urine at first than any of the other dislocations; for the head of the thigh-bone is lodged very near to important nerves. And the region of the groin appears swelled out and stretched, while that of the nates is more wrinkled and flabby. The symptoms now stated are those which attend this dislocation of the thigh-bone.

> Greek: 59. 59. οἷσι δʼ ἂν ἐς τοὔμπροσθεν ἡ κεφαλὴ τοῦ μηροῦ ἐκπέσῃ, ὀλίγοισι δὲ τοῦτο γίνεται, οὗτοι ἐκτανύειν μὲν τὸ σκέλος δύνανται τελείως, ξυγκάμπτειν δὲ ἥκιστα οὗτοι δύνανται τὰ κατὰ τὸν βουβῶνα· πονέουσι δὲ, καὶ ἢν κατὰ τὴν ἰγνύην ἀναγκάζωνται ξυγκάμπτειν. μῆκος δὲ τοῦ σκέλεος παραπλήσιον φαίνεται, κατὰ μὲν τὴν πτέρνην καὶ πάνυ· ἄκρος δὲ ὁ ποὺς ἧσσόν τι προκύπτειν ἐθέλει ἐς τοὔμπροσθεν· ὅλον δὲ τὸ σκέλος ἔχει τὴν ἰθυωρίην τὴν κατὰ φύσιν, καὶ οὔτε τῇ, οὔτε τῇ ῤέπει. ὀδυνῶνται δὲ αὐτίκα οὗτοι μάλιστα, καὶ οὖρον ἴσχεται τὸ πρῶτον τούτοισι μᾶλλόν τι, ἢ τοῖσιν ἄλλοισιν ἐξαρθρήμασιν· ἐγκέεται γὰρ ἡ κεφαλὴ τοῦ μηροῦ ἐγγυτάτω τούτοισι τῶν τόνων τῶν ἐπικαίρων. καὶ κατὰ μὲν τὸν βουβῶνα ἐξογκέον τε καὶ κατατεταμένον τὸ χωρίον φαίνεται, κατὰ δὲ τὸ πυγαῖον, στολιδωδέστερον καὶ ἀσαρκότερον. ταῦτα μὲν οὖν σημήϊά ἐστι τὰ εἰρημένα, ὧν ἂν οὕτως ἐκπεπτώκῃ ὁ μηρός.

[¶3] 60. When persons have attained their full growth before meeting with this dislocation, and when it has not been reduced, upon the subsidence of the pain, and when the bone of the joint has been accustomed to be rotated in the place where it is lodged, these persons can walk almost erect without a staff, and with the injured leg almost quite straight, as it does not admit of easy flexion at the groin and the ham; owing, then, to this want of flexion at the groin, they keep the limb more straight in walking than they do the sound one. And sometimes they drag the foot along the ground, as not being able to bend the upper part of the limb, and they walk with the whole foot on the ground; for in walking they rest no less on the heel than on the fore part of the foot; and if they could take great steps, they would rest entirely on the heel in walking; for persons whose limbs are sound, the greater the steps they take in walking, rest so much the more on the heel, while they are putting down the one foot and raising the opposite. In this form of dislocation, persons rest their weight more on the heel than on the anterior part of the foot, for the fore part of the foot cannot be bent forward equally well when the rest of the limb is extended as when it is in a state of flexion; neither, again, can the foot be arched to the same degree the limb is bent as when it is extended. The natural state of matters is such as has been now described; and in an unreduced dislocation, persons walk in the manner described, for the reasons which have been stated. The limb, moreover, is less fleshy than the other, at the nates, the calf of the leg, and the whole of its posterior part. When this dislocation occurs in infancy, and is not reduced, or when it is congenital, in these cases the bone of the thigh is more atrophied than those of the leg and foot; but the atrophy of the thigh-bone is least of all in this form of dislocation. The fleshy parts, however, are everywhere attenuated, more especially behind, as has been stated above. If properly trained, such persons, when they grow up, can use the limb, which is only a little shorter than the other, and yet they support themselves on a staff at the affected side. For, not being able to use properly the ball of the foot without the heel, nor to put it down as some can in the other varieties of dislocation (the cause of which has been just now stated), on this account they require a staff. But those who are neglected, and are not in the practice of putting their foot to the ground, but keep the limb up, have the bones more atrophied than those who use the limb; and, at the articulations, the limb is more maimed in the direct line than in the other forms of dislocation.

> Greek: 60. 60. Ὁκόσοισι μὲν οὖν ἂν ἤδη ἠνδρωμένοισι τοῦτο τὸ ἄρθρον ἐκπεσὸν μὴ ἐμπέσῃ, οὗτοι, ὁκόταν αὐτοῖσιν ἡ ὀδύνη παύσηται καὶ τὸ ἄρθρον ἐθισθῇ ἐν τῷ χωρίῳ τούτῳ στροφᾶσθαι, ἵνα ἐξέπεσεν, οὗτοι δύνανται σχεδὸν εὐθὺς ὀρθοὶ ὁδοιπορέειν ἄνευ ξύλου, καὶ πάνυ μέντοι εὐθέες, ἐπὶ δὲ τὸ σιναρὸν, ἅτε οὔτε κατὰ τὸν βουβῶνα εὔκαμπτοι ἐόντες, οὔτε κατὰ τὴν ἰγνύην· διὰ οὖν τοῦ βουβῶνος τὴν ἀκαμπίην εὐθυτέρῳ ὅλῳ τῷ σκέλεϊ ἐν τῇ ὁδοιπορίῃ χρέονται, ᾒ ὅτε ὑγίαινον. καὶ σύρουσι δὲ ἐνίοτε πρὸς τὴν γῆν τὸν πόδα, ἅτε οὐ ῤηϊδίως ξυγκάμπτοντες τὰ ἄνω ἄρθρα, καὶ ἅτε παντὶ βαίνοντες τῷ ποδί οὐδὲν γὰρ ἧσσον τῇ πτέρνῃ οὗτοι βαίνουσιν, ἢ τῷ ἔμπροσθεν· εἰ δέ γε ἠδύναντο μέγα προβαίνειν, κἂν πάνυ πτερνοβάται ἦσαν· καὶ γὰρ οἱ ὑγιαίνοντες ὅσῳ ἂν μέζον προβαίνοντες ὁδοιπορέωσι, τοσούτῳ μᾶλλον πτερνοβάται εἰσὶ, τιθέντες τὸν πόδα, αἴροντες δὲ τὸν ἐναντίον. Ὁκόσοισι δὲ δὴ οὕτως ἐκπέπτωκε, καὶ ἔτι μᾶλλον τῇ πτέρνῃ προσεγχρίπτουσιν, ἢ τῷ ἔμπροσθεν· τὸ γὰρ ἔμπροσθεν τοῦ ποδὸς, ὅταν ἐκτεταμένον ἔῃ τὸ ἄλλο σκέλος, οὐχ ὁμοίως δύναται ἐς τὸ πρόσω καμπύλλεσθαι, ὥσπερ ὅταν ξυγκεκαμμένον ἔῃ τὸ σκέλος· οὔτʼ αὖ σιμοῦσθαι δύναται ὁ ποὺς, ξυγκεκαμμένου τοῦ σκέλεος, ὡς ὅταν ἐκτεταμένον ἔῃ τὸ σκέλος. ὑγιαίνουσά τε οὖν ἡ φύσις οὕτω πέφυκεν, ὥσπερ εἴρηται· ὅταν δὲ ἐκπεσὸν μὴ ἐμπέσῃ τὸ ἄρθρον, οὕτως ὁδοιπορέουσιν, ὡς εἴρηται, διὰ τὰς προφάσιας ταύτας τὰς εἰρημένας· ἀσαρκότερον μέντοι τὸ σκέλος τοῦ ἑτέρου γίνεται, κατά τε τὸ πυγαῖον, κατά τε τὴν γαστροκνημίην, καὶ κατὰ τὴν ὄπισθεν ἴξιν. οἷσι δʼ ἂν νηπίοισιν ἔτι ἐοῦσι τὸ ἄρθρον οὕτως ὀλισθάνον μὴ ἐμπέσῃ, ἢ καὶ ἐκ γενεῆς οὕτω γένηται, καὶ τούτοισι τὸ τοῦ μηροῦ ὀστέον μᾶλλόν τι μινύθει, ἢ τὰ τῆς κνήμης καὶ τὰ τοῦ ποδός· ἥκιστα μὴν ἐν τούτῳ τῷ τρόπῳ τοῦ ὀλισθήματος ὁ μηρὸς μειοῦται. μινύθουσι μέντοι αἱ σάρκες πάντη, μάλιστα δὲ κατὰ τὴν ὄπισθεν ἴξιν, ὥσπερ ἤδη καὶ πρόσθεν εἴρηται. ὅσοι μὲν οὖν ἂν τιθηνηθῶσιν ὀρθῶς, οὗτοι μὲν δύνανται προσχρέεσθαι τῷ σκέλεϊ αὐξανόμενοι, βραχυτέρῳ μέν τινι τοῦ ἑτέρου ἐόντι, ὅμως δὲ ἐρειδόμενοι ξύλῳ ἐπὶ ταῦτα, ᾗ τὸ σιναρὸν σκέλος· οὐ γὰρ κάρτα δύνανται ἄνευ τῆς πτέρνης τῷ στήθεϊ τοῦ ποδὸς χρέεσθαι, ἐπικαθιέντες ὥσπερ ἐν ἑτέροισι χωλεύμασιν ἔνιοι δύνανται· αἴτιον δὲ τοῦ μὴ δύνασθαι τὸ ὀλίγῳ πρόσθεν εἰρημένον· διὰ οὖν τοῦτο προσδέονται ξύλου. ὅσοι δʼ ἂν καταμεληθέωσι καὶ μηδὲν χρέωνται ἐπὶ τὴν γῆν τῷ σκέλεϊ, ἀλλὰ μετέωρον ἔχωσι, τούτοισι μινύθει μὲν τὰ ὀστέα ἐς αὔξησιν μᾶλλον, ἢ τοῖσι χρεομένοισιν· μινύθουσι δὲ καὶ αἱ σάρκες πολὺ μᾶλλον, ἢ τοῖσι χρεομένοισιν· κατὰ δὲ τὰ ἄρθρα ἐς τὸ εὐθὺ πηροῦται τούτοισι τὸ σκέλος μᾶλλόν τι, ἢ οἷσιν ἂν ἄλλως ἐκπεπτώκῃ.

[¶4] 61. In a word, luxations and subluxations take place in different degrees, being sometimes greater and sometimes less; and those cases in which the bone has slipped or been displaced to a much greater extent, are in general more difficult to rectify than otherwise; and if not reduced, such cases have greater and more striking impairment and lesion of the bones, fleshy parts, and attitudes; but when the bone has slipped, or been displaced to a less extent, it is easier to reduce such cases than the other; and if the attempts at reduction have failed, or have been neglected, the impairment in such cases is less, and proves less injurious than in the cases just mentioned. The other joints present great differences as to the extent of the displacements which they are subject to. But the heads of the femur and humerus are very similar to one another as to their dislocations. For the heads of the bones are rounded and smooth, and the sockets which receive the heads are also circular, and adapted to the heads; they do not admit then of being dislocated in any intermediate degree, but, not withstanding, from their rounded shape, the bones slip either outward or inward. In the case we are now treating of, then, there is either a complete dislocation or none at all, and yet these bones admit of being displaced to a greater or less extent; and the thigh is more subject to these differences than the arm.

> Greek: 61. 61. ὡς μὲν οὖν ἐν κεφαλαίῳ εἰρῆσθαι, τὰ ἄρθρα τὰ ἐκπίπτοντα καὶ τὰ ὀλισθάνοντα ἀνίσως αὐτὰ ἑωυτοῖσιν ἐκπίπτει καὶ ὀλισθάνει, ἄλλοτε μὲν πουλὺ πλεῖον, ἄλλοτε δὲ πολὺ ἔλασσον· καὶ οἷσι μὲν ἂν πολὺ πλεῖον ὀλίσθῃ ἢ ἐκπέσῃ, χαλεπώτερα ἐμβάλλειν τὸ ἐπίπαν ἐστὶ, καὶ ἢν μὴ ἐμβιβασθῇ, μέζους καὶ ἐπιδηλοτέρας τὰς πηρώσιας καὶ κακώσιας ἴσχει τὰ τοιαῦτα, καὶ ὀστέων, καὶ σαρκῶν, καὶ σχημάτων· ὅταν δὲ μεῖον ἐκπέσῃ καὶ ὀλίσθῃ, ῤηΐδιον μὲν ἐμβάλλειν τὰ τοιαῦτα τῶν ἑτέρων γίνεται, ἢν δὲ καταπορηθῇ ἢ ἀμεληθῇ ἐμπεσεῖν, μείους καὶ ἀσινέστεραι αἱ πηρώσιες γίνονται τούτοισιν, ἢ οἷσιν ὀλίγῳ πρόσθεν εἴρηται. τὰ μὲν οὖν ἄλλα ἄρθρα καὶ πάνυ πολὺ διαφέρει ἐς τὸ ὁτὲ μὲν μεῖον, ὁτὲ δὲ μεῖζον τὸ ὀλίσθημα ποιέεσθαι· μηροῦ δὲ καὶ βραχίονος κεφαλαὶ παραπλησιώτατα ὀλισθάνουσιν αὐτὴ ἑωυτῇ ἑκατέρη· ἅτε γὰρ στρογγύλαι μὲν αἱ κεφαλαὶ ἐοῦσαι, ἁπλῆν τῆν στρογγύλωσιν καὶ φαλακρὴν ἔχουσι, κυκλοτερέες δὲ αἱ κοιλίαι ἐοῦσαι, αἱ δεχόμεναι τὰς κεφαλὰς, ἁρμόζουσι δὲ τῇσι κεφαλῇσιν· διὰ τοῦτο οὐκ ἔστιν αὐτῇσι τὸ ἥμισυ ἐκστῆναι τοῦ ἄρθρου· ὀλισθάνοι γὰρ ἂν διὰ τὴν περιφερείην, ἢ ἐς τὸ ἔξω, ἢ ἐς τὸ ἔσω. περὶ οὗ οὖν ὁ λόγος, ἐκπίπτουσι τελέως ἤδη, ἐπεὶ ἄλλως γε οὐκ ἐκπίπτουσιν· ὅμως δὲ καὶ ταῦτα ὁτὲ μὲν πλεῖον ἀποπηδᾷ ἀπὸ τῆς φύσιος, ὁτὲ δὲ ἔλασσον· μᾶλλον δέ τι μηρὸς τοῦτο βραχίονος πέπονθεν.

[¶5] 62. Wherefore, then, some of these congenital displacements, if to a small extent, may be reduced to their natural condition, and especially those at the ankle-joint. Most cases of congenital club-foot are remediable, unless the declination be very great, or when the affection occurs at an advanced period of youth. The best plan, then, is to treat such cases at as early a period as possible, before the deficiency of the bones of the foot is very great, and before there is any great wasting of the flesh of the leg. There is more than one variety of club-foot, the most of them being not complete dislocations, but impairments connected with the habitual maintenance of the limb in a certain position. In conducting the treatment, attention must be paid to the following points: to push back and rectify the bone of the leg at the ankle from without inward, and to make counter-pressure on the bone of the heel in an outward direction, so as to bring it bring it into line, in order that the displaced bones may meet at the middle and side of the foot; and the mass of the toes, with the great toe, are to be inclined inward, and retained so; and the parts are to be secured, with cerate containing a full proportion of resin, with compresses, and soft bandages insufficient quantity, but not applied too tight; and the turns of the bandages should be in the same direction as the rectifying of the foot with the hand, so that the foot may appear to incline a little outward. And a sole made of leather not very hard, or of lead, is to be bound on, and it is not to be applied to the skin but when you are about to make the last turns of the bandages. And when it is all bandaged, you must attach the end of one of the bandages that are used to the bandages applied to the inferior part of the foot on the line of the little toe; and then this bandage is to be rolled upward in what is considered to be a sufficient degree, to above the calf of the leg, so that it may remain firm when thus arranged. In a word, as if moulding a wax model, you must bring to their natural position the parts which were abnormally displaced and contracted together, so rectifying them with your hands, and with the bandaging in like manner, as to bring them into their position, not by force, but gently; and the bandages are to be stitched so as to suit the position in which the limb is to be placed, for different modes of the deformity require different positions. And a small shoe made of lead is to be bound on externally to the bandaging, having the same shape as the Chian slippers had. But there is no necessity for it if the parts be properly adjusted with the hands, properly secured with the bandages, and properly disposed of afterward. This, then, is the mode of cure, and it neither requires cutting, burning, nor any other complex means, for such cases yield sooner to treatment than one would believe. However, they are to be fairly mastered only by time, and not until the body has grown up in the natural shape; when recourse is had to a shoe, the most suitable are the buskins, which derive their name from being used in traveling through mud; for this sort of shoe does not yield to the foot, but the foot yields to it. A shoe shaped like the Cretan is also suitable.

> Greek: 62. 62. ἐπεὶ ἔνια καὶ τῶν ἐκ γενεῆς γενομένων ὀλισθημάτων, ἢν μικρὸν ὀλίσθῃ, οἷά τε ἐς τὴν φύσιν ἄγεσθαι, καὶ μάλιστα τὰ παρὰ τοῦ ποδὸς ἄρθρα. ὁκόσοι ἐκ γενεῆς κυλλοὶ γίνονται, τὰ πλεῖστα τούτων ἰήσιμά ἐστιν, ἢν μὴ πάνυ μεγάλη ἡ ἔκκλισις ἔῃ, ἢ καὶ προαυξέων γεγονότων ἤδη τῶν παιδίων ξυμβῇ. ἄριστον μὲν οὖν ὡς τάχιστα ἰητρεύειν τὰ τοιαῦτα, πρὶν πάνυ μεγάλην τὴν ἔνδειαν τῶν ὀστέων τῶν ἐν τῷ ποδὶ γενέσθαι, πρίν τε πάνυ μεγάλην τὴν ἔνδειαν τῶν σαρκῶν τῶν κατὰ τὴν κνήμην εἶναι. τρόπος μὲν οὖν κυλλώσιος οὐχ εἷς, ἀλλὰ πλείονες, τὰ πλεῖστα μὴν οὐκ ἐξηρθρηκότα παντάπασιν, ἀλλὰ διʼ ἔθος σχήματος ἔν τινι ἀπολήψει τοῦ ποδὸς κεκυλλωμένα. προσέχειν δὲ καὶ ἐν τῇ ἰητρείῃ τοισίδε χρή· ἀπωθέειν μὲν καὶ κατορθοῦν τῆς κνήμης τὸ κατὰ τὸ σφυρὸν ὀστέον, τὸ ἔξωθεν, ἐς τὸ ἔσω μέρος, ἀντωθέειν δὲ ἐς τὸ ἔξω μέρος τὸ τῆς πτέρνης τὸ κατὰ τὴν ἴξιν, ὅκως ἀλλήλοις ἀπαντήσῃ τὰ ὀστέα τὰ ἐξίσχοντα κατὰ μέσον τε καὶ πλάγιον τὸν πόδα· τοὺς δʼ αὖ δακτύλους ἀθρόους ξὺν τῷ μεγάλῳ δακτύλῳ ἐς τὸ εἴσω μέρος ἐγκλίνειν καὶ περιαναγκάζειν οὕτως· ἐπιδεῖν δὲ κηρωτῇ ἐῤῥητινωμένῃ εὖ, καὶ σπλήνεσι, καὶ ὀθονίοισι μαλθακοῖσι, μὴ ὀλίγοισι, μηδὲ ἄγαν πιέζοντα· οὕτω δὲ τὰς περιαγωγὰς ποιέεσθαι τῆς ἐπιδέσιος, ὥσπερ καὶ τῇσι χερσὶν ἡ κατόρθωσις ἦν τοῦ ποδὸς, ὅκως ὁ ποὺς ὀλίγῳ μᾶλλον ἐς τὸ βλαισὸν ῤέπων φαίνηται. ἴχνος δέ τι χρὴ ποιέεσθαι, ἢ δέρματος μὴ ἄγαν σκληροῦ, ἢ μολύβδινον, προσεπιδεῖν δὲ, μὴ πρὸς τὸν χρῶτα τιθέντα, ἀλλʼ ὅταν ἤδη τοῖσιν ὑστάτοισιν ὀθονίοισι μέλλῃς ἐπιδέειν· ὅταν δὲ ἤδη ἐπιδεδεμένος ἔῃ, ἑνός τινος τῶν ὀθονίων χρὴ, οἷσιν ἐπιδέεται, τὴν ἀρχὴν προσράψαι πρὸς τὰ κάτω τοῦ ποδὸς ἐπιδέσματα κατὰ τὴν ἴξιν τοῦ μικροῦ δακτύλου· ἔπειτα ἐς τὸ ἄνω τείνοντα, ὅκως ἂν δοκέῃ μετρίως ἔχειν, περιβάλλειν ἄνωθεν τῆς γαστροκνημίης, ὡς μόνιμον ἔῃ, κατατεταγμένον οὕτως. ἁπλῷ δὲ λόγῳ, ὥσπερ κηροπλαστέοντα, χρὴ ἐς τὴν φύσιν τὴν δικαίην ἄγειν καὶ τὰ ἐκκεκλιμένα καὶ τὰ συντεταμένα παρὰ τὴν φύσιν, καὶ τῇσι χερσὶν οὕτω διορθοῦντα, καὶ τῇ ἐπιδέσει ὡσαύτως, προσάγειν δὲ οὐ βιαίως, ἀλλὰ παρηγορικῶς· προσράπτειν δὲ τὰ ὀθόνια, ὅκως ἂν ξυμφέρῃ τὰς ἀναλήψιας ποιέεσθαι, ἄλλα γὰρ ἄλλης τῶν χωλωμάτων δέεται ἀναλήψιος. Ὑποδημάτιον δὲ ποιέεσθαι μολύβδινον, ἔξωθεν τῆς ἐπιδέσιος ἐπιδεδεμένον, οἷον αἱ χῖαι κρηπῖδες ῤυθμὸν εἶχον· ἀλλʼ οὐδὲν αὐτοῦ δεῖ, ἤν τις ὀρθῶς μὲν τῇσι χερσὶ διορθώσῃ, ὀρθῶς δὲ τοῖσιν ὀθονίοισιν ἐπιδέῃ, ὀρθῶς δὲ καὶ τὰς ἀναλήψιας ποιοῖτο. ἡ μὲν οὖν ἴησις αὕτη, καὶ οὔτε τομῆς, οὔτε καύσιος οὐδὲν δεῖ, οὔτʼ ἄλλης ποικιλίης· θᾶσσον γὰρ ἐνακούει τὰ τοιαῦτα τῆς ἰητρείης, ἢ ὡς ἄν τις οἴοιτο. Προσνικᾷν μέντοι χρὴ τῷ χρόνῳ, ἕως ἂν αὐξηθῇ τὸ σῶμα ἐν τοῖσι δικαίοισι σχήμασιν. ὅταν δὲ ἐς ὑποδήματος λόγον ἴῃ, ἀρβύλαι ἐπιτηδειόταται αἱ πηλοπάτιδες καλεόμεναι· τοῦτο γὰρ ὑποδημάτων ἥκιστα κρατέεται ὑπὸ τοῦ ποδὸς, ἀλλὰ κρατέει μᾶλλον· ἐπιτήδειος δὲ καὶ ὁ κρητικὸς τρόπος τῶν ὑποδημάτων.

[¶6] 63. In cases of complete dislocation at the ankle-joint, complicated with an external wound, whether the displacement be inward or outward, you are not to reduce the parts, but let any other physician reduce them if he choose. For this you should know for certain, that the patient will die if the parts are allowed to remain reduced, and that he will not survive more than a few days, for few of them pass the seventh day, being cut off by convulsions, and sometimes the leg and foot are seized with gangrene. It should be well known that such will be the results; and it does not appear to me that hellebore will do any good, though administered the same day, and the draught repeated, and yet it is the most likely means, if any such there be; but I am of opinion that not even it will be of service. But if not reduced, nor any attempts at first made to reduce them, most of such cases recover. The leg and foot are to be arranged as the patient wishes, only they must not be put in a dependent position, nor moved about; and they are to be treated with pitched cerate, a few compresses dipped in wine, and not very cold, for cold in such cases induces convulsions; the leaves also of beet, or of colt’s foot, of any such, when boiled in dark-colored austere wine, form a suitable application to the wound and the surrounding parts; and the wound may further be anointed with cerate in a tepid state. But if it be the winter season, the part is to be covered with unscoured wool, which is to be sprinkled from above with tepid wine and oil, but on no account is either bandage or compress to be applied; for this should be known most especially, that whatever compresses, or is heavy, does mischief in such cases. And certain of the dressings used to recent wounds are suitable in such cases; and wool may be laid upon the sore, and sprinkled with wine, and allowed to remain for a considerable time; but those dressings for recent wounds which only last for a few days, and into which resin enters as an ingredient, do not agree with them; for the cleansing of the sores is a slow process, and the sore has a copious discharge for a long time. Certain of these cases it may be advantageous to bandage. It ought also to be well understood, that the patient must necessarily be much maimed and deformed, for the foot is retracted outward, and the bones which have been displaced outward protrude: these bones, in fact, not being generally laid bare, unless to a small extent; neither do they exfoliate, but they heal by thin and feeble cicatrices, provided the patient keeps quiet for a length of time; but otherwise there is danger that a small ulcer may remain incurable. And yet in the case we are treating of, those who are thus treated are saved; whereas, when the parts are reduced and allowed to remain in place, the patients die.

> Greek: 63. 63. Ὅσοισι δʼ ἂν κνήμης ὀστέα ἐξαρθρήσαντα καὶ ἕλκος ποιήσαντα τελείως ἐξίσχῃ κατὰ τὰ παρὰ τὸν πόδα ἄρθρα, εἴτε ἔσω ῤέψαντα, εἴτε μέντοι καὶ ἔξω, τὰ τοιαῦτα μὴ ἐμβάλλειν, ἀλλʼ ἐᾷν τὸν βουλόμενον τῶν ἰητρῶν ἐμβάλλειν. σαφέως γὰρ εἰδέναι χρὴ, ὅτι ἀποθανεῖται, ᾧ ἂν ἐμβληθέντα ἐμμείνῃ, καὶ ἡ ζωὴ δὲ ὀλιγήμερος τουτέοισι γενήσεται· ὀλίγοι γὰρ ἂν αὐτέων τὰς ἑπτὰ ἡμέρας ὑπερβάλλοιεν· σπασμὸς γὰρ ὁ κτείνων ἐστίν· ἀτὰρ καὶ γαγγραινοῦσθαι ἱκνέεται τὴν κνήμην καὶ τὸν πόδα. ταῦτα βεβαίως εἰδέναι χρὴ οὕτως ἐσόμενα· καὶ οὐκ ἄν μοι δοκέει οὐδὲ ἐλλέβορος ὠφελήσειν, αὐθημερόν τε δοθεὶς, καὶ αὖθις πινόμενος, ἄγχιστα δὲ, εἴπερ τι τοιοῦτον· οὐ μέντοι γε οὐδὲ τοῦτο δοκέω. ἢν δὲ μὴ ἐμβληθῇ, μηδʼ ἀπʼ ἀρχῆς μηδεὶς πειρηθῇ ἐμβάλλειν, περιγίνονται οἱ πλεῖστοι αὐτέων. χρὴ δὲ ἡρμόσθαι μὲν τὴν κνήμην καὶ τὸν πόδα οὕτως, ὡς αὐτὸς ἐθέλει, μοῦνον δὲ, μὴ ἀπῃωρημένα, μηδὲ κινεύμενα ἔστω· ἰητρεύειν δὲ πισσηρῇ καὶ σπλήνεσιν οἰνηροῖσιν, ὀλίγοισι, μὴ ἄγαν ψυχροῖσι, ψῦχος γὰρ ἐν τοῖσι τοιούτοισι σπασμὸν ἐπικαλέεται· ἐπιτήδεια δὲ καὶ φύλλα σεύτλων, ἢ βηχίου, ἢ ἄλλου τινὸς τῶν τοιουτέων, ἐν οἴνῳ μέλανι αὐστηρῷ ἡμίεφθα ἐπιτιθέντα ἰητρεύειν ἐπί τε τὸ ἕλκος, ἐπί τε τὰ περιέχοντα, κηρωτῇ δὲ χλιερῇ ἐπιχρίειν αὐτὸ τὸ ἕλκος· ἢν δὲ ἡ ὥρη χειμερινὴ ἔῃ, καὶ ἔρια ῤυπαρὰ οἴνῳ καὶ ἐλαίῳ καταῤῥαίνοντα χλιεροῖσιν ἄνωθεν ἐπιτέγγειν· καταδεῖν δὲ μηδὲν μηδενὶ, μηδε περιπλάσσειν· εὖ γὰρ εἰδέναι χρὴ, ὅτι πίεξις καὶ ἀχθοφορίη πᾶν κακὸν τοῖσι τοιούτοισίν ἐστιν. ἐπιτήδεια δὲ πρὸς τὰ τοιαῦτα καὶ τῶν ἐναίμων μετεξέτερα, ὅσοισιν αὐτῶν ξυμφέρει· ἔρια δὲ ἐπιτιθέντα, οἴνῳ ἐπιτέγγοντα, πουλὺν χρόνον ἐᾷν· τὰ δὲ ὀλιγημερώτατα τῶν ἐναίμων, καὶ ὅσα ῤητίνῃ προσκαταλαμβάνεται, οὐχ ὁμοίως ἐπιτήδεια ἐκείνοισίν ἐστιν· χρονίη γὰρ ἡ κάθαρσις τῶν ἑλκέων γίνεται τούτων· πουλὺν γὰρ χρόνον πλαδαρὴ γίνεται· τινὰς δὲ τούτων ἀγαθὸν ἐπιδέειν. εἰδέναι μὲν δή που σάφα χρὴ, ὅτι ἀνάγκη τὸν ἄνθρωπον χωλὸν αἰσχρῶς γενέσθαι· καὶ γὰρ ὁ ποὺς ἐς τὸ ἄνω ἀνέσπασται τῶν τοιούτων, καὶ τὰ ὀστέα τὰ διολισθήσαντα ἔξω ἐξέχοντα φαίνεται· οὔτε γὰρ ψιλοῦται τῶν τοιούτων ὀστέων οὐδὲν ὡς ἐπὶ τὸ πουλὺ, εἰ μὴ κατὰ βραχύ τι, οὔτε ἀφίσταται, ἀλλὰ περιωτειλοῦται λεπτῇσιν ὠτειλῇσι καὶ ἀσθενέσι, καὶ ταῦτα, ἢν ἀτρεμίζωσι πουλὺν χρόνον· ἢν δὲ μὴ, ἑλκύδριον ἐγκαταλειφθῆναι κίνδυνος ἀναλθές. ὅμως δὲ, περὶ οὗ ὁ λόγος, οὕτω μὲν ἰητρευόμενοι σώζονται, ἐμβληθέντος δὲ τοῦ ἄρθρου καὶ ἐμμείναντος, ἀποθνήσκουσιν.

[¶7] 64. The same rule applies to dislocations at the wrist, attended with a wound and projection of the bone, whether the bones of the arm be displaced inward or outward. For this should be well understood, that the patient will die in the course of a few days, by the same mode of death as formerly described, if the bone be reduced, and allowed to remain so. But in those cases in which they are not reduced, nor any attempt made to reduce them, the patients, for the most part, recover; and the same mode of treatment as has been described will be applicable; but the deformity and impediment of the limb must necessarily be great, and the fingers of the hand will be weak and useless; for if the bones have slipped inward, they cannot bend the fingers, or if outward, they cannot extend them.

> Greek: 64. 64. ωὑτὸς δὲ λόγος οὗτος, ἢν καὶ τὰ τοῦ πήχεος ὀστέα τὰ παρὰ τὸν καρπὸν τῆς χειρὸς ἕλκος ποιήσαντα ἐξίσχῃ, ἤν τε ἐς τὸ ἔσω μέρος τῆς χειρὸς, ἤν τε ἐς τὸ ἔξω. σάφα γὰρ ἐπίστασθαι χρὴ, ὅτι ἀποθανεῖται ἐν ὀλίγῃσιν ἡμέρῃσι τοιούτῳ θανάτῳ, οἵῳπερ καὶ πρόσθεν εἴρηται, ὅτῳ ἂν ἐμβληθέντα τὰ ὀστέα ἐμμείνῃ. οἷσι δʼ ἂν μὴ ἐμβληθῇ, μηδὲ πειρηθῇ ἐμβάλλεσθαι, οὗτοι πολὺ πλείονες περιγίνονται· ἰητρείη δὲ τοιαύτη τοῖσι τοιουτέοισιν ἐπιτηδείη, οἵηπερ εἴρηται· τὸ δὲ σχῆμα αἰσχρὸν τοῦ χωλώματος ἀνάγκη εἶναι, καὶ τοὺς δακτύλους τῆς χειρὸς ἀσθενέας καὶ ἀχρηΐους· ἢν μὲν γὰρ ἐς τὸ ἔσω μέρος ὀλίσθῃ τὰ ὀστέα, ξυγκάμπτειν οὐ δύνανται τοὺς δακτύλους· ἢν δὲ ἐς τὸ ἔξω μέρος, ἐκτανύειν οὐ δύνανται.

[¶8] 65. When the os tibiae, having made a wound at the knee, has protruded through the skin, whether the dislocation be outward or inward, in such a case, if the bone be reduced, death will be even more speedy than in the other cases, although speedy also in them. But the only hope of recovery is if you treat them without reduction. These cases are more dangerous than the others, as being so much higher up, as being so much stronger joints, and displaced from bones which are so much stronger. But if the os femoris form a wound at the knee, and slip through it, provided it be reduced and left so, it will occasion a still more violent and speedy death than in the cases formerly described; but if not reduced, it will be much more dangerous than those cases mentioned before, and yet this is the only hope of recovery.

> Greek: 65. 65. Ὅσοισι δʼ ἂν κνήμης ὀστέον, ἕλκος ποιησάμενον παρὰ τὸ γόνυ, ἔξω ἐξίσχῃ, ἤν τε ἐς τὸ ἔξω μέρος, ἤν τε ἐς τὸ ἔσω, τούτοισιν ἢν μέν τις ἐμβάλῃ, ἔτι ἑτοιμότερος ὁ θάνατός ἐστιν, ἤπερ τοῖσιν ἑτέροισι, καίπερ κἀκείνοισιν ἕτοιμος ἐών. ἢν δὲ μὴ ἐμβαλὼν ἰητρεύῃς, ἐλπίδες μὲν σωτηρίης οὕτω μόνως εἰσίν. κινδυνωδέστερα δὲ ταῦτα τῶν ἑτέρων γίνεται, ὅσῳ ἂν ἀνωτέρω, καὶ ὅσῳ ἂν ἰσχυρότερα ἔῃ, καὶ ἀπὸ ἰσχυροτέρων ὠλισθήκῃ. ἢν δὲ τὸ ὀστέον τὸ τοῦ μηροῦ τὸ πρὸς τοῦ γόνατος ἕλκος ποιησάμενον ἐξολίσθῃ, ἐμβληθὲν μὲν καὶ ἐμμεῖναν, ἔτι βιαιότερον καὶ θᾶσσον τὸν θάνατον ποιήσει τῶν πρόσθεν εἰρημένων· μὴ ἐμβληθὲν δὲ, πουλὺ κινδυνωδέστερον, ἢ τὰ πρόσθεν· ὅμως δὲ μούνη ἐλπὶς αὕτη σωτηρίης.

[¶9] 66. The same rule applies to the elbow-joint, and with regard to the bones of the fore-arm and arm. For when these bones protrude through a wound which they have made in the skin, all cases in which they are reduced prove fatal; but if not reduced, there is a chance of recovery; but to those that survive there is certain impediment. And if in any instance the bones of the upper articulations (shoulder-joint?), should be dislocated, and project through a wound which they have made in the skin, these, if reduced, are followed by more speedy death; and if not reduced, they are more dangerous than the others. But the mode of treatment which appears to me most suitable has been already described.

> Greek: 66. 66. ωὑτὸς δὲ λόγος καὶ περὶ τῶν κατὰ τὸν ἀγκῶνα ἄρθρων, καὶ περὶ τῶν τοῦ πήχεος καὶ βραχίονος· ἃ γὰρ ἂν τούτων ἐξαρθρήσαντα ἐξίσχῃ ἕλκος ποιησάμενα, πάντα, ἢν ἐμβληθῇ, θάνατον φέρει, μὴ ἐμβληθέντα δὲ, ἐλπίδα σωτηρίης· χώλωσις δὲ ἑτοίμη· τοῖσι περιγενομένοισιν. Θανατωδέστερα δὲ τοῖσιν ἐμβαλλομένοισίν. ἐστι τὰ ἀνωτέρω τῶν ἄρθρων, ἀτὰρ καὶ τοῖσι μὴ ἐμβαλλομένοισι κινδυνωδέστερα αὐτὰ ταῦτα. εἰ δέ τινι τὰ ἀνώτατα ἄρθρα ἐξαρθρήσαντα, ἕλκος ποιήσαντα, ἐξίσχοι, ταῦτα ἂν ἔτι καὶ ἐμβαλλόμενα ταχυθανατώτατα εἴη, καὶ μὴ ἐμβαλλόμενα κινδυνωδέστατα· ἰητρείη δὲ ἤδη εἴρηται, οἵη τις ἐμοὶ δοκέει ἐπιτηδειοτάτη εἶναι τῶν τοιουτέων.

[¶10] 67. When the joints of the toes or hands are dislocated, and the bones protrude through a wound which they have made, and when there is no fracture of the bone, but merely displacement of the joint, in these cases, if the reduction be made and allowed to remain, there is some danger of spasms (tetanus?) if not properly treated, and yet it may be worth while to reduce them, having warned the patient beforehand that much caution and care will be required. The easiest, the most efficient method, and the one most conformable to art, is that by the lever, as formerly described when treating of bones which have been fractured and protruded; then the patient must be as quiet as possible, lie in a recumbent position, and observe a restricted regimen. And it will be better also that he should get some gentle emetics. The sore is to be treated with dressings for fresh wounds, which permit of allusions, or with the leaves of camomile, or with the applications for fractured bones of the head, but nothing very cold must be applied. The first (most distant?) joints are least dangerous, but those still higher, are more so. Reduction should be made the same day, or the next, but by no means on the third or fourth, for it is on the fourth day that exacerbations especially attack. In those cases, then, where immediate reduction cannot be accomplished, we must wait until after the aforesaid days; for whatever you reduce within ten days, may be expected to induce spasm. But if the spasm supervene on its being reduced, the joint should be quickly displaced, and bathed frequently with warm water, and the whole body should be kept in a warm, soft, and easy condition, and more especially about the joints, for the whole body should rather be in a bent than in an extended state. Moreover, it is to be expected, that the articular extremities of the bones of the fingers will for this generally happens, if even the least degree of inflammation take place, so that if it were not that the physician would be exposed to censure, owing to the ignorance of the common people, no reduction should be made at all. The reduction of the bones of joints which have protruded through the skin, is attended with the dangers which have been described.

> Greek: 67. 67. Ὅσοισι δὲ ἄρθρα δακτύλων, ἢ ποδὸς ἢ χειρὸς, ἐξαρθρήσαντα, ἕλκος ποιήσαντα, ἐξέσχε, μὴ κατεηγότος τοῦ ὀστέου, ἀλλὰ κατʼ αὐτὴν τὴν ξύμφυσιν ἀποσπασθέντος, τούτοισιν ἢν ἐμβληθέντα ἐμμείνῃ, ἔνι μέν τις κίνδυνος σπασμοῦ, ἢν μὴ χρηστῶς ἰητρεύωνται· ὅμως δέ τι ἄξιον ἐμβάλλειν, προειπόντα ὅτι φυλακῆς πολλῆς καὶ μελέτης δέεται. ἐμβάλλειν μέντοι ῤήιστον καὶ δυνατώτατον καὶ τεχνικώτατόν ἐστι τῷ μοχλίσκῳ, ὥσπερ καὶ πρόσθεν εἴρηται ἐν τοῖσι καταγνυμένοισι καὶ ἐξίσχουσιν ὀστέοισιν· ἔπειτα ἀτρεμέειν ὡς μάλιστα χρὴ, καὶ κατακεῖσθαι, καὶ ὀλιγοσιτέειν· ἄμεινον δὲ καὶ φαρμακεῦσαι ἄνω κούφῳ τινὶ φαρμάκῳ· τὸ δὲ ἕλκος, ἰητρεύειν μὲν ἢ ἐναίμοισι τοῖσιν ἐπιτέγκτοισιν, ἢ πολυοφθάλμοισιν, ἢ οἷσι κεφαλῆς ὀστέα κατεηγότα ἰητρεύεται, κατάψυχρον δὲ κάρτα μηδὲν προσφέρειν. ἥκιστα μὲν οὖν τὰ πρῶτα ἄρθρα κινδυνώδεά ἐστι, τὰ δὲ ἔτι ἀνωτέρω κινδυνωδέστερα. ἐμβάλλειν δὲ χρὴ αὐθημερὸν, ἢ τῇ ὑστεραίῃ, τριταίῳ δὲ ἢ τεταρταίῳ ἥκιστα· τεταρταῖα γὰρ ἐόντα, ἐπισημαίνει τῇσι παλιγκοτίῃσι μάλιστα. οἷσιν ἂν οὖν μὴ αὐτίκα ἐγγένηται ἐμβάλλειν, ὑπερβαίνειν χρὴ ταύτας τὰς εἰρημένας ἡμέρας· ὅ τι γὰρ ἂν ἔσω δέκα ἡμερέων ἐμβάλλῃς, σπᾷν καταληπτέον. ἢν δὲ ἄρα ἐμβεβλημένῳ σπασμὸς ἐπιγένηται, ἐκβάλλειν τὸ ἄρθρον δεῖ ταχὺ, καὶ θερμῷ τέγγειν ὡς πλειστάκις, καὶ τὸ ὅλον σῶμα θερμῶς καὶ λιπαρῶς καὶ μαλθακῶς ἔχειν, καὶ μάλιστα κατὰ τὰ ἄρθρα· κεκάμφθαι δὲ μᾶλλον ἢ ἐκτετάσθαι πᾶν τὸ σῶμα χρή. προσδέχεσθαι μέντοι χρὴ κατὰ τοὺς δακτύλους τὰ ἄρθρα τὰ ἐμβαλλόμενα ἀποστατικὰ ἔσεσθαι· τὰ γὰρ πλεῖστα οὕτω γίνεται, ἢν καὶ ὁτιοῦν φλεγμονῆς ὑπογένηται, ὡς, εἰ μὴ διʼ ἀμαθίην τῶν δημοτέων ἐν αἰτίῃ ἔμελλεν ὁ ἰητρὸς ἔσεσθαι, οὐδὲν ἂν πάντως οὐδʼ ἐμβάλλειν ἔδει. τὰ μὲν οὖν κατὰ τὰ ἄρθρα ὀστέα ἐξίσχοντα ἐμβαλλόμενα οὕτω κινδυνώδεά ἐστιν, ὡς εἴρηται.

[¶11] 68. When the articular bones of the fingers are fairly chopped off, these cases are mostly unattended with danger, unless deliquium come on in consequence of the injury, and ordinary treatment will be sufficient to such sores. But when resection is made, not at the articulations, but at some other point in the bones, these cases also are free from danger, and are still more easily cured than the others; and the fractured bones of the fingers which protrude otherwise than at the joint admit of reduction without danger. Complete resections of bones at the joints, whether the foot, the hand, the leg, the ankle, the forearm, the wrist, for the most part, are not unattended with danger, unless one be cut off at once by deliquium animi, or if continual fever supervene on the fourth day.

> Greek: 68. 68. ὅσα δὲ κατὰ τὰ ἄρθρα τὰ κατὰ τοὺς δακτύλους ἀποκόπτεται τελείως, ταῦτα ἀσινέα τὰ πλεῖστά ἐστιν, εἰ μή τις ἐν αὐτῇ τῇ τρώσει λειποθυμήσας βλαβείη· καὶ ἰητρείη φαύλη ἀρκέσει τῶν τοιούτων ἑλκέων. ἀτὰρ καὶ ὅσα μὴ κατὰ τὰ ἄρθρα, ἀλλὰ κατʼ ἄλλην τινὰ ἴξιν τῶν ὀστέων ἀποκόπτεται, καὶ ταῦτα ἀσινέα ἐστὶ, καὶ ἔτι εὐαλθέστερα τῶν ἑτέρων· καὶ ὅσα κατὰ τοὺς δακτύλους ὀστέα κατεηγότα ἐξίσχει μὴ κατὰ τὸ ἄρθρον, καὶ ταῦτα ἀσινέα ἐστὶν ἐμβαλλόμενα. Ἀποκόψιες δὲ τέλειαι ὀστέων καὶ κατὰ τὰ ἄρθρα καὶ ἐν ποδὶ, καὶ ἐν χειρὶ, καὶ ἐν κνήμῃ, τοῖσι παρὰ τὰ σφυρὰ, καὶ ἐν πήχεϊ, τοῖσι παρὰ τοὺς καρποὺς, τοῖσι πλείστοισιν ἀποκοπτομένοισιν ἀσινέα γίνεται, ὅσα ἂν μὴ αὐτίκα λειποθυμίη ἀνατρέψῃ, ἢ τεταρταίοισιν ἐοῦσι πυρετὸς ξυνεχὴς ἐπιγένηται.

[¶12] 69. With regard to the sphacelus of fleshy parts, it takes place in wounds where there are large blood-vessels, which have been strongly compressed, and in fractures of bones which have been bound too tight, and in other cases of immoderate constriction, when the parts which have been strangulated generally drop off; and the most of such patients recover, even when a portion of the thigh comes away, or of the arm, both bones and flesh, but less so in this case; and when the fore-arm and leg drop off, the patients readily recover. In cases then, of fracture of the bones, when strangulation and blackening of the parts take place at first, the separation of the dead and living parts quickly occurs, and the parts speedily drop off, as the bones have already given way; but when the blackening (mortification) takes place while the bones are entire, the fleshy parts, in this case, also quickly die, but the bones are slow in separating at the boundary of the blackening, and where the bones are laid bare. Those parts of the body which are below the boundaries of the blackening are to be removed at the joint, as soon as they are fairly dead and have lost their sensibility; care being taken not to wound any living part; for if the part which is cut off give pain, and if it prove not to be quite dead, there is great danger lest the patient may swoon away from the pain, and such swoonings often are immediately fatal. I have known the thigh-bones, when denuded in this manner, drop off on the eightieth day; but in the case of this patient, the parts below were separated at the knee on the twentieth day, and, as I thought, too early, for it appeared to me that this should be done more guardedly. In a case which I had of such blackening in the leg, the bones of the leg, as far as they were denuded, separated at its middle on the sixtieth day. But the separation of denuded bones is quicker or slower, according to the mode of treatment; something, too, depends upon whether the compression be stronger or weaker, and whether the nerves, flesh, arteries, and veins are quicker or slower in becoming blackened and in dying; since, when the parts are not strongly compressed, the separation is more superficial, and does not go the length of laying the bones bare, and in some cases it is still more superficial, so as not even to expose the nerves. For the reasons now stated, it is impossible to define accurately the time at which each of these cases will terminate. The treatment of such cases, however, is to be readily undertaken, for they are more formidable to look at than to treat; and a mild treatment is sufficient in all such cases, for they come to a crisis of themselves; only the diet must be attended to, so that it may be as little calculated to create fever as possible, and the body is to be placed in the proper positions: these are, neither raised very high up, nor inclined much downward, but rather upward, until the separation be completed; for at that time there is most danger of hemorrhage; on this account, wounds should not be laid in a declining position, but the contrary. But after a while, and when the sores have become clean, the same positions will no longer be appropriate; but a straight position, and one inclining downward, may be proper; and in the course of time, in some of these cases, abscesses form, and require bandages. One may also expect that such patients will be attacked with dysentery; for dysentery usually supervenes in cases of mortification and of hemorrhage from wounds; it comes on generally when the blackening and hemorrhage have arrived at a crisis, and is profuse and intense, but does not last many days; neither is it of a fatal nature, for such patients do not usually lose their appetite, nor is it proper to put them on a restricted diet.

> Greek: 69. 69. Ἀποσφακελίσιες μέντοι σαρκῶν, καὶ ἐν τρώμασιν αἱμοῤῥόοισι γενομένοισιν ἀποσφιγχθεῖσιν ἰσχυρῶς, καὶ ἐν ὀστέων κατήγμασι πιεχθεῖσι μᾶλλον τοῦ καιροῦ, καὶ ἐν ἄλλοισι δεσμοῖσι βιαίοισιν ἀποληφθέντα ἀποπίπτει πολλοῖσι, καὶ οἱ πολλοὶ περιγίνονται τῶν τοιούτων, καὶ οἷσι μηροῦ μέρος τι ἀποπίπτει, καὶ τῶν σαρκῶν καὶ τοῦ ὀστέου, καὶ οἷσι βραχίονος, ἧσσον δέ· πήχεός τε καὶ κνήμης ἀποπεσούσης, καὶ ἔτι εὐφόρως περιγίνονται. οἷσι μὲν οὖν, κατεαγέντων τῶν ὀστέων, ἀποσφίγξιες αὐτίκα ἐγένοντο καὶ μελασμοὶ, τούτοισι μὲν ταχεῖαι αἱ περιῤῥήξιες γίνονται τοῦ σώματος, καὶ τὰ ἀποπίπτοντα ταχέως ἀποπίπτει, ἥδη τῶν ὀστέων προενδεδωκότων· οἷσι δὲ, ὑγιέων ἐόντων τῶν ὀστέων, οἱ μελασμοὶ γίνονται, αἱ μὲν σάρκες ταχέως θνήσκουσι καὶ τούτοισι, τὰ δὲ ὀστέα βραδέως ἀφίσταται, ᾗ ἂν τὰ ὅρια τοῦ μελασμοῦ γένηται καὶ ἡ ψίλωσις τοῦ ὀστέου. χρὴ δὲ, ὅσα ἂν κατωτέρω τοῦ σώματος τῶν ὁρίων τοῦ μελασμοῦ ἔῃ, ταῦτα, ὅταν ἤδη πάμπαν τεθνήκῃ καὶ ἀναλγέα ἔῃ, ἀφαιρέειν κατὰ τὸ ἄρθρον, προμηθεόμενον ὅκως μὴ τιτρώσκῃ· ἢν γὰρ ὀδυνηθῇ ἀποταμνόμενος, καὶ μήπω κυρήσῃ τὸ σῶμα τεθνεὸς ταύτῃ, ἧ ἀποτέμνεται, κάρτα κίνδυνος ὑπὸ τῆς ὀδύνης λειποθυμῆσαι· αἱ δὲ τοιαῦται λειποθυμίαι πολλοὺς παραχρῆμα ἤδη ἀπώλεσαν. μηροῦ μὲν οὖν ὀστέον, ψιλωθὲν ἐκ τοιούτου τρόπου, ὀγδοηκοσταῖον εἶδον ἐγὼ ἀποστάν· ἡ μέντοι κνήμη τούτῳ τῷ ἀνθρώπῳ κατὰ τὸ γόνυ ἀφῃρέθη εἰκοσταίη, ἐδόκεε δέ μοι καὶ ἐγγυτέρω· οὐ γὰρ ἅμα, ἀλλʼ ἐπὶ τὸ προμηθέστερον ἔδοξέ μοί τι ποιέειν. κνήμης δὲ ὀστέα ἐκ τοιούτου μελασμοῦ, μάλα κατὰ μέσην τὴν κνήμην ἐόντα, ἑξηκοσταῖά μοι ἀπέπεσεν, ὅσα ἐψιλώθη αὐτέων. διενέγκοι μὲν γὰρ ἄν τι καὶ ἰητρείη ἰητρείης ἐς τὸ θᾶσσόν τε καὶ βραδύτερον τὰ ὀστέα ψιλούμενα ἀποπίπτειν· διενέγκοι δʼ ἄν τι καὶ πίεξις πιέξιος, καὶ ἐπὶ τὸ ἰσχυρότερόν τε καὶ ἀσθενέστερον, καὶ ἐς τὸ θᾶσσόν τε καὶ βραδύτερον ἀπομελανθέντα ἀποθανεῖν τὰ νεῦρα καὶ τὰς σάρκας καὶ τὰς ἀρτηρίας καὶ τὰς φλέβας· ἐπεὶ ὅσα μὴ ἰσχυρῶς ἀποληφθέντων θνήσκει, ἔνια τῶν τοιουτέων οὐκ ἀφικνέεται ἐς ὀστέων ψιλώματα, ἀλλʼ ἐπιπολαιότερα ἐκπίπτει· ἔνια δὲ οὐδὲ ἐς νεύρων ψιλώματα ἀφικνεῖται, ἀλλὰ ἐπιπολαιότερα ἐκπίπτει. διὰ οὖν ταύτας τὰς εἰρημένας προφάσιας οὐκ ἐστὶν ἓν οὔνομα ἀριθμοῦ τῷ χρόνῳ θέσθαι, ἐν ὁκόσῳ ἕκαστα τούτων κρίνεται. προσδέχεσθαι δὲ μάλα χρὴ τὰ τοιαῦτα ἰήματα· ἐσιδέειν γὰρ φοβερώτερά ἐστιν, ἢ ἰητρεύειν· καὶ ἰητρείη πραείη ἀρκέει πᾶσι τοιούτοισιν· αὐτὰ γὰρ ἑωυτὰ κρίνει μοῦνον· τῆς δὲ διαίτης ἐπιμελέεσθαι χρὴ, ὡς κατὰ δύναμιν ἀπύρετος ἔῃ, καὶ ἐν σχήμασι δικαίοισιν εὐθετίζειν τὸ σῶμα· δίκαια δὲ ταῦτα, μηδὲ μετέωρον ποιέειν, μηδὲ ἐς τὸ κάτω ῤέπον, ἀλλὰ μᾶλλον ἐς τὸ ἄνω, ποτὶ καὶ ἔστʼ ἂν τελείως περιῤῥαγῇ· αἱμοῤῥαγιέων γὰρ ἐν τούτῳ τῷ χρόνῳ κίνδυνος· διὰ τοῦτο οὖν οὐ χρὴ κατάῤῥοπα τὰ τρώματα ποιέειν, ἀλλὰ τἀναντία. ἐπεὶ ὅταν γε χρόνος ἐγγένηται πλείων, καὶ καθαρὰ τὰ ἕλκεα γένηται, οὐκ ἔτι τὰ αὐτὰ σχήματα ἐπιτήδειά ἐστιν, ἀλλʼ ἡ εὐθεῖα θέσις, καὶ ἐνίοτε ἐπὶ τὸ κατάῤῥοπον ῤέποντα· ἀνὰ χρόνον γὰρ ἐνίοισι τουτέων ἀποστάσιες πύου γίνονται, καὶ ὑποδεσμίδων δέονται. προσδέχεσθαι δὲ χρὴ τοὺς τοιούτους ἀνὰ χρόνον ὑπὸ δυσεντερίης πιέζεσθαι· καὶ γὰρ ἐπὶ τοῖσι μελαινομένοισι τοῖσι πλείστοισιν ἐπιγίνεται δυσεντερίη, καὶ ἐπὶ τῇσιν αἱμοῤῥαγίῃσιν ἐξ ἑλκέων· ἐπιγίνεται δὲ ὡς ἐπὶ τὸ πολὺ, κεκριμένων ἤδη τῶν μελασμῶν καὶ τῆς αἱμοῤῥαγίης, καὶ ὁρμᾶται μὲν λαύρως καὶ ἰσχυρῶς· ἀτὰρ οὔτε πολυήμερος γίνεται, οὔτε θανατώδης· οὔτε γὰρ μάλα ἀπόσιτοι γίνονται οἱ τοιοῦτοι, οὔτε ἄλλως ξυμφέρει κενεαγγέειν.