(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Hippocrates"

[I 



\ 



THE LOEB CLASSICAL LIBRARY 

FOUNDED BY JAMES LOEB, LL.D. 

EDITED BY 
f T. E. PAGE, C.H., LITT.D. 

t E. CAPPS, ph.d., ll.d. t W. H. D. ROUSE, litt.d. 

L. A. POST, l.h.d. E. H. WARMINGTON, m.a.; f.r.hist.soc. 



HIPPOCRATES 

VOL. Ill 










*rotr.- 








REDUCTION OF THE SHOULDER JOINT. 
e/x/3oA;) (o/jou 6 6cct tov Karc^u^ovros 



HIPPOCRATES 

WITH AN ENGLISH TRANSLATION BY 
Da. E. T. WITHINGTON 



VOL III 




LONDON 

WILLIAM HEINEMANN LTD 

CAMUIUDGE, MASSACHUSETTS 

HARVARD UNIVERSITY PRESS 

MCMLIS 



First Printed . 1928 

Reprinted . 1944 

Reprinted 1948 

Reprinted . 1059 



Printed in Great Britain by The University Press, Aberdeen 



CONTENTS 



PACK 

translator's preface ....,.<.... v 

FREFACE Viii 

INTRODUCTION *i 

ON WOUNDS IN THE HEAD 1 

IN THE SURGERY 53 

FRACTURES, JOINTS, MOCHLICON ........ 83 

ON FRACTURES 95 

ON JOINTS 201 

INSTRUMENTS OF REDUCTION 399 

APPENDIX: SUPPLEMENTARY NOTES ....... 451 

ILLUSTRATIONS 

reduction of tue shoulder joint . . . Frontispiece 

the hippocratic BENCH or scamnum . Facing page 454 



TRANSLATORS PREFACE 



Anutius Foksius on coming (1594) to the surgical 
section of his Hippocrates says that some will find 
fault with him for editing treatises so fully discussed 
by many eminent writers : they will call his work 
futile and superfluous. Some will also cry out upon 
his notes as fragmentary, superficial and useless. 
Such fears are more natural in one who looks back 
not only on Foes himself and his contemporaries, but 
on the translation of Adams, the great edition of 
Petrequin, and the labours of Littre and Ermerins, 
nowhere more complete than when dealing with 
these treatises ; while behind them all loom the 
thousand pages of Galenic Commentaries and the 
dim light of the illustrations of Apollonius. He is 
overwhelmed by his material, and cannot hope to do 
more that attempt a fairly accurate translation with 
fragmentary notes condensing the more important 
discussions of preceding editors. 

The recent revolution in surgerv due to anaes- 
thetics, asepsis, radiography and other practical and 
scientific progress tends to put a modern surgeon 
rather out of touch with the great ancients. It 
makes him, perhaps, less able to appreciate their 
achievements, and more conscious of their un- 
avoidable errors. On the other side, recent criti- 

** vii 



TRANSLATOR'S PREFACE 

cism of the Corpus Hippocraticum relieves him 
from the necessity of assuming that Hippocrates 
wrote Mochlicon, and therefore of approaching it hat 
in hand. Its author assumes rather the appearance 
of a slave surgeon or student to whom his master 
gave a rather dilapidated copy of Fractures-Joints 
with instructions to summarise everything to do 
with dislocations, and be quick about it. That the 
result should have been held in honour for more 
than twenty centuries is high tribute to the 
excellence of the original. 

The translation was made independently of that 
by Adams, though some of his expressions were 
afterwards adopted. The notes and meanings of 
words are taken more frequently than usual from 
the Commentaries of Galen, who is surely our 
highest authority on the subject. The text is 
mainly that of Petrequin, a conservative scholar 
who often successfully defends the manuscript 
readings against rash alterations by Littre and Erme- 
rins. The recent edition by Kiihlewein (Teubner, 
1902) is doubtless an improvement even upon 
Petrequin, but was not directly available. Some of 
his emendations are adopted with due acknowledg- 
ment, and many of his variants are given in the 
notes, including all not otherwise attributed. The 
excessive " Ionicism " of all previous editions has 
been reduced in accordance with Kuhlewein's 
principles, as in the other volumes. 

In treatises so fully discussed by " so many most 
noble writers in that part of medicine," as Foes has 
observed, any novel suggestions are likely to be 
wrong, and the editor is duly conscious of presump- 
tion in submitting views of that character as to the 
viii 



TRANSLATOR'S PREFACE 

Hippocratic Bench, the astragalus and the origin of 
Chapters LXXIX-LXXXI on joints. 

The frontispiece is a reproduction of the Apol- 
lonius illustration for ip/SoXr) u/xov, 6 8ta tou kcito)- 
fiiloiTos [Tpo7ros], " the shouldering method of 
reducing the shoulder joint," taken from the 
thousand years old MS. ". B." It is doubtless a 
fairly accurate copy of the thousand years older 
original by Apollonius himself, or the artist he 
employed. I owe this and other assistance to the 
courtesy of Dr. Charles Singer, and am still more 
indebted to our chief authority on "Hippocrates," 
Dr. W. H. S. Jones. 



IX 



PREFACE 

The whole of this volume has been entrusted 
to Dr. E. T. Withington, of Balliol College. Only 
a trained surgeon can explain the surgical treatises 
of the Hippocratic Collection. 

The fourth (and last) volume will contain 
Aphorisms, Humours, Nature of Man, Regimen in 
Health I-IIi, and Dreams. The text of all these 
works has to be worked out from the manuscripts 
themselves, as Little's text is here very imperfect. 

W. H. S. J. 



GENERAL INTRODUCTION 

When Marcus Aurelius Severinus gave the title 
De efficaci Medic'ma to his work on surgery he 
probably 1 expected to annoy the professors of what 
was then considered a much higher branch of the 
healing art, but when he goes on to say that surgery 
is obviously a strenuous, potent and vital method of 
treatment, few who have been actively or passively 
concerned with broken bones, dislocated joints or 
bleeding wounds will venture to disagree with him. 
He was doubtless also thinking of Celsus, who had 
long before declared that the part of medicine which 
cures by hand has a more directly obvious effect 
than any other. 1 He adds that this is also the 
oldest part of medicine and, indeed, it must have 
been recognised from the dawn of reason that, in 
such common emergencies as those just mentioned, 
something has to be done, primarily with the hand, 
and that anyone who can do it quickly, effectively 
and without causing extreme pain is, for a time at 
least, " worth many other men." 

So says Homer 2 of the army surgeon, and both 
he and his hearers were well qualified to judge. As 
a great authority puts it, " Homer was not content 
to recite in general terms the wounds of the warriors 
as mere casual slashing ; he records each stab with 

1 VIL 1. « II. XI. 514. 

xi 



GENERAL INTRODUCTION 

anatomical precision, describing the path of the 
weapon and its effects." Condensing slightly Sir 
Clifford Allbutt's examples — " A spear driven through 
the buttock pierces the urinary bladder and comes 
out under the symphysis pubis (5. 65). The rock 
hurled by Ajax strikes Hector on the breast, he 
turns faint, pants for health and spits blood (14. 437). 
An epigastric wound exposes the pericardium 
(16. 481). Homer explains that, after the spear of 
Achilles had transfixed Hector's neck, he could still 
speak because the weapon had missed the trachea 
(22. 328). Yet more remarkable is the record (8. 83) 
of the rotatory movement of one of the horses of 
Nestor, which followed the stab of a spear at the 
base of the skull (Kaipiov, a deadly spot) — the weapon 
had pierced the cerebellum. We may wonder not 
only at the poet's surgery, but also that his hearers 
were prepared to comprehend such particulars." 1 

It will perhaps increase the wonder and interest 
if we contrast the Iliad with our mediaeval Romances 
of chivalry, where there is no end of wounds and 
violence but an almost complete absence of definite- 
ness or surgical interest. Take the famous fight 
between Balin and Balan in the Morte d Arthur : the 
champions first unhorse and stun one another, but 
spring up and fight desperately for a prolonged 
period, " wounding each other grievously " all the 
time. At length, when " all the place was red with 
their blood," when " they had smitten either other 
seven other great wounds so that the least of them 
might have been the death of the mightiest giant 
in the world," they have to take a good rest, but go 

1 Classical Review, 37- 130. 
xii 



GENERAL INTRODUCTION 

at it again with undiminished vigour for an indefinite 
time till at last Balin faints. To a Greek, the 
pathos of the incident would be obscured by its 
absurdity, while, of course, there is nothing surgical 
about it. Perhaps the only interesting wound from 
this point of view is that received by Sir Launcelot 
when shot by the lady huntress, " so that the broad 
arrow smote him in the thick of the buttock over 
the barbs," and even the ministrations of a hermit 
could not enable him to sit on his horse for weeks. 
So too in the Tale of Troy translated by Caxton, 
there is as much slaughter as in the Iliad. Did not 
the good knight Hector slay a thousand Greek 
knights in one day ? " He gave Patroclus a stroke 
upon his head and cleft it in two pieces, and Patroclus 
fell down dead." He cleft Archylogus in twain 
" notwithstanding his harness," and repeated this 
immediately on another Greek ; in fact he must 
evidently have kept it up for hours. But the only 
surgically interesting case is that where Ulysses 
" struck King Philumenus in his throat and cut 
asunder his original vein, and smote him as half 
dead," especially if "original" means "jugular," 
for Philumenus is as vigorous as ever soon after- 
wards. No one would dream of making a table of 
mortality from these romances, distinguishing the 
wounds by localities and weapons, as has been done 
for the 147 wounds described in the Iliad, with 
results fairly corresponding with surgical probability. 1 
The object of this comparison is to show that the 
Greeks, during what has been called their "middle 
ages," were a people who, in interest in their bodies, 

1 Frolich, Die M Hilar medizin Homer's, 1879. 

xiii 



GENERAL INTRODUCTION 

knowledge of the nature and results of injuries, and 
respect for those skilled in the methods of healing 
afterwards called Surgery, surpassed all those whom 
we know at a corresponding stage of civilisation. 

When we add to this the frequent sacrifices 
(which may help to explain their greater anatomical 
knowledge compared with that of our mediaeval 
ancestors), the vigorous funeral games, and the 
probably already widespread custom of gymnastic 
training, there seems no need to suppose borrowings 
from older civilisation to explain the rise of surgery 
in a few centuries to the height at which we find 
it in the Hippocratic writings. As regards the 
palaestra, if we may judge from the famous group 
of "the Wrestlers," and its great frequency, dis- 
location of the shoulder joint was often deliberately 
produced, and Hippocrates will tell us that it was 
part of a good education to know all the ways of 
putting it in again. 

The fact that medical schools first arose on the 
rim of the Greek world, especially in that part of 
the Asiatic coast where Ionian joined Dorian and 
both came in contact with remains of older cultures 
from Crete and Caria, as well as with strangers from 
Egypt and the East, may be partly accounted for 
by such contacts. Materials and methods of 
bandaging perhaps came from Egypt, and we may 
possibly find in a Cretan drain-pipe or Egyptian 
tomb a sample of that most interesting of Hippocratic 
instruments, the crown trephine; 1 but the special 

1 A large bronze crown trephine has been found at 
Nineveh, and was evidently worked with a cord like the 
Hippocratic instrument. Meyer Steineg Sudhoff, Geschichte 
d. Medizin, 1921, p. 25. 

xiv 



GENERAL INTRODUCTION 

treatment of Fractures and Dislocations which forms 
the main and most remarkable part of Hippocratic 
surgery was, we may be fairly sure, developed by 
the Greeks themselves. 

It is, however, only right to cast an admiring 
glance in passing on what little is visible of 
the Edwin Smith Papyrus. This dates from the 
seventeenth century b.c. at latest, and contained a 
" Book of Surgery and External Medicine," the 
remaining part of which comprises forty-eight 
typical cases extending from the top of the head 
to the thorax and breasts. The description of each 
case is divided into Examination, Diagnosis, Verdict, 
Treatment. No less than fourteen cases are declared 
incurable, and in nine of them no treatment is 
suggested. In only one case is the use of a charm 
mentioned. The following is Case 18, a wound of 
the temple, conden ed from Prof. Breasted's version. 1 
" You should probe, and if you find the bone whole 
without a psn, a thm or a fracture you should say, 
Treat it with fresh meat the first day and afterwards 
with ointment and honey." 

This remarkable Papyrus indicates that the 
Egyptians possessed a semi-scientific surgery not 
much inferior to that of Hippocrates more than a 
thousand years before his birth. Whether he was 
indebted to them is another question, but they 
evidently knew at least two forms of bone injury 
besides fracture, and it is not impossible that when 
we are told what " psn " and " thm " mean, we may 
get some light on the origin of the Hippocratic term 
hedra. 

1 In Recueil d'jZtudes tfgyptologiques, Paris, 1922. 

XV 



GENERAL INTRODUCTION 

The earliest historical Greek practitioner is 
represented as being most effective as a surgeon. 
Democedes, coming from Croton, a city famous for 
its gymnasts, though without instruments, so 
excelled his colleagues that he became medical 
officer with large and increasing salaries in Aegina, 
Athens and Samos successively. Brought as a slave 
to Susa, and probably again without instruments, he 
cured King Darius of an injury thus vividly described 
by a layman — " his foot was twisted, and twisted 
rather violently, for he got his astragalus dislocated 
from its joints." The Greek surgeon restored it 
effectively with little pain, saved the Egyptians, 
who had failed to do so, from impalement, fed at 
the king's table, and, if we may trust Herodotus, 
became a prominent figure in history. But he can 
hardly have lived to see the birth of Hippocrates, 
in whose time the most important of the treatises 
here translated were composed. According to all 
surviving evidence from antiquity, they were mostly 
written by him, and though there is now a tendency 
to believe that Hippocrates, like other great teachers, 
may have written nothing, we shall, while indicating 
the different amount of evidence for the genuineness 
of the various treatises, use " the writer '' and 
"Hippocrates" as synonymous terms. 

To show how these works were valued we may 
quote a paragraph from a high authority on Greek 
matters, which also introduces us to the remarkable 
MS. which contains most of them. "The MS. was 
written in Constantinople about the year a.d. 950, 
and it begins with a paean of joy over the discovery 
of the works of this ancient surgeon, Apollonius, 
with his accurate drawings to show how the various 

xvi 



GENERAL INTRODUCTION 

dislocations should be set. The text was written 
out. The illustrations were carefully copied. Where 
the old drawings were blurred and damaged, the 
copies were left incomplete lest some mistake should 
be made. Why ? Because this ancient surgeon, 
living about 150 b.c. [75 is more probable], knew how 
to set dislocated limbs a great deal better than 
people who lived a thousand years after him. It was 
a piece of good fortune to them to rediscover his 
work. And his writing again takes the form of a 
commentary on the fifth-century Hippocrates. 
Hippocrates' own writing does not look back. It is 
consciously progressive and original." x 

The writer, indeed, though he teaches with 
authority and confidence, confesses failures and 
welcomes improvements. His work, especially that 
on the surgery of the bones, formed the basis for 
future progress and did not prevent it. There was, 
in fact, steady progress for five centuries, and ancient 
surgery reached its culmination about a.d. 100. It 
began, says Celsus, to have its professors at 
Alexandria, but the first eminent practitioner whom 
we know as " the Surgeon " was Meges of Sidon, 
who practised at Rome shortly before Celsus, and is 
the source whence he drew much of his surgical 
knowledge. At the end of the century, Archigenes 
and Leonidas performed amputation almost in the 
modern style, while Heliodorus and his follower 
Antyllus showed themselves capable of doing all a 
surgeon could do, without the aid of modern dis- 
coveries. The former was especially famous for his 
work on the skull and lower part of the body 

1 Gilbert Murray, Rise of the Gitek Epic, 1911, p. 24. 

xvii 



GENERAL INTRODUCTION 

(hernia, fistula, stricture), the latter for the ligature 
of aneurisms and resection of bones, but he follows 
Heliodorus so closely that we do not know which 
was the greater or more original. The surgical 
writings of the earlier Celsus and the much later 
Paulus are interesting and very similar, but the first 
was a layman, the second may or may not have 
performed the operations he portrays ; for both are 
compilers. But when we pass to the Heliodorus- 
Antyllus fragments we feel a different atmosphere. 
There is a definiteness and determination in their 
language which leaves no doubt that they did what 
they describe. " The ancients refused to undertake 
a case of this kind, but we shall " etc., is a phrase 
which recurs. One is convinced that they did what 
they say and hopes the unfortunate patient had a 
large dose of mandragora. 1 This state of excellence, 
however, does not appear to have lasted. Galen 
tells us that when he came to Rome he found that 
serious operations were usually handed over to 
"those called surgeons." 2 Unless Antyllus was 
among them, none of their names have come down 
to us, and when, two centuries later, Oribasius made 
his great " Collections," he had to go back to him 
and Heliodorus for the best surgery ; while for 
ordinary fractures and dislocations he could find 
nothing better than Galen's commentaries on the 
treatises in this volume. 

Heliodorus, however, is introduced here not as 
part of an inadequate outline of Greek surgery, but 

1 They removed the whole arm-bone (humerus) and part of 
the shoulder-blade, and call resection of " the lower part of 
the jaw" an easy operation. Oribasius XLIV. 23. 

2 X. 455. 

xviii 



GENERAL INTRODUCTION 

because he will help us to explain some of the 
Hippocratic apparatus. The reader of this volume 
will hear a great deal about bandaging, but very 
little about definite forms of bandaging. In the 
surgery, says the writer, the kinds of bandages are 
the simple (circular) sceparnus, simus, the eye, the 
rhomb and the hemitome or hemirhomb. This 
contrasts vividly with the 50 bandages of Heliodorus, 
the 60 of Soranus, and the 90 odd given in the De 
Fasciis ascribed to Galen. 

We should gather from Galen's commentary 1 that 
three were simple and three complex, the first being 
a true circle (zvkvkXos) where each turn covers the 
former, so that there was no " distribution " up or 
down. The sceparnus, or "adze," was slightly 
oblique, and the simus, or " snub," very oblique, 
both being simple spirals. But Heliodorus, 2 an 
older and perhaps better authority on this point, 
says the simple bandage was a simple figure-of-eight 
used to fix a limb to some support, while the circular, 
which was called "the zvkvkXos of Hippocrates," was 
slightly spiral and could be distributed upwards or 
downwards, being used to close sinuses. 3 The 
sceparnus was a complex bandage, and commenced as 
an open figure-of-eight ; which agrees with a still 
older commentator, Asclepiades, 4 who says the 
Hippocratic sceparnus was a slightly oblique crossed 
bandage (\if£o/x€vos). The simus is more puzzling : 
De Fasciis says it is not a bandage at all, but refers 
to the shape of parts to which a sceparnus bandage 
should be applied. 6 Galen says Hippocrates trans* 

1 XVIII(2). 732. 2 Orib. XLVIII. 61. 

3 Ibid. (i4 * In Erotian, s.v. 6 XYIIIU). 772. 

xix 



GENERAL INTRODUCTION 

ferred the term from its use for a snub nose, or the 
sloping curve at the bottom of a hill, to denote a 
very sloping bandage, whence Petrequin concludes 
that it may be our favourite " spiral with reverses." 
But if this form had been known, it is hardly credible 
that we should not have had some clear account of 
it, and it seems more likely that it was sloping 
figure-of-eight. 

The complex bandages are described in detail by 
Heliodorus as "the Hippocratie eye" (dcf>6a\p6<;), 
very similar to the existing bandage for one eye, 
"the Hippocratie rhomb" which covered the top of 
the head, and the hemirhomb intended for the side 
of the face or unilateral dislocation of the jaw. 

Hippocrates was also fond of a bandage rolled up 
to the middle from either end and put on obliquely 
from two heads, and was evidently acquainted with 
many complex and ornamental forms though he does 
not approve of them. He had a peculiar method 1 
of bandaging fractures with an under and upper 
layer separated by splints and compresses, the under- 
bandaging being done according to a rule clearly 
laid down, but this, says Galen, went out of use, 
leaving only the technical terms t>7rdSeo-is and 
V7roSecr/xiSes. 

Ointments. — The under-bandages and the folded 
pieces of linen called o-7rAr/res (pads or compresses) 
were usually soaked in some application, the most 
important being two forms of " cerate," (1) white or 
liquid, which consisted of wax liquefied in olive oil or 
oil of roses, 2 supposed to prevent inflammation, 
while (2) (which was the same with the addition of 

" Surgery, XII. * XVIII(2). 3G5. 

xx 



GENERAL INTRODUCTION 

some pitch x ) was used for inflamed or open wounds, 
and was supposed to have anodyne properties and to 
favour the production of healthy pus ; wine and oil 
were also used. 2 

Splints. — Of the ordinary splints (vdpOrjKes) we know 
curiously little. The name (like the Latin ferulae) 
implies that they were stalks of an umbelliferous 
plant. 3 They were put on separately ; Celsus 4 tells us 
they were split ( ftssae) and Paulus 5 that they were 
wrapped in wool or flax. The nature of the large 
hollow splint (aukr/v), the canalis of Celsus, 6 is not 
altogether certain, in spite of much description. It 
is usually taken to be gutter-shaped, but Galen tells 
us 7 that it went right round the limb, more so than 
did the box splint (yXoxraoKo/jiov), from which it also 
differed in being circular outside ; it was therefore 
tubular and cylindrical. But the limb could be put 
upon it, so it must have been opened, and, indeed, 
we hear of an opened (dvoi/cTos) solen in the Galenic 
writings. 8 Perhaps this was a gutter splint, and the 
only form used in later times, for Paulus, who says 
the solen was made of earthenware as well as wood, 
uses crwA^i/oeior/? in a sense which must mean "like a. 
gutter." So also in Soranus (1. 85) a baby's pillow is 
to be hollowed, crwA^voeiSois, so as not to go right 
round its head : but Rufus uses the word of the 
spinal canal, and Dioscorides of a funnel pipe, so it 
will be prudent to keep to the ambiguous " hollow 

1 XVIII(2). 538. 

2 In the case of club foot the ointment was stiffened with 
resin. 

3 The giant fennel, light and strong, used by the Bacchants. 
* VIII. 10. 1. * VI. 99. 6 VIII. 10. 5. 

T XVIII(2). 504. * XIV. 795. 

xxi 



GENERAL INTRODUCTION 

splint." The writer's account of more complicated 
"machines" can only be made clearer by illus- 
trations. 1 

In conclusion we must mention a theory which 
brings together, and throws light upon, most of these 
treatises. Wounds in the Head has a place by itself, 
to be considered shortly, the other four have peculiar 
titles. In Fractures the Greek ay/Mos (for Karay/xa) is 
strange, as observed by Galen. Joints clearly means 
Reduction of dislocated joints, and is so given in 
our oldest MS., but the correction seems too obvious 
to be correct. 2 Both these treatises have abrupt 
beginnings, are probably mutilated and certainly in 
disorder, yet they rank in the first class of " genuine " 
works of Hippocrates. In (or About) a Surgerij, often 
ambiguously shortened to Surgery, but more instruc- 
tively expanded to Concerning things done i?i the 
Surgery, is a collection of notes, chiefly on bandaging, 
and is obviously derived in part from Fractures, yet 
it contains at least one passage requisite to explain 
a statement in Fractures. Lastly the Mochlicon 
(Leverage), usually rendered Instruments of Reduction, 
begins with a chapter on the Nature of Bones, while 
the rest is almost entirely an abridgment from Joints. 

The Hippoeratic Corpus contains a treatise on the 
Nature of Bones which, after a very few remarks on 
that subject, is occupied by a variety of confused 
accounts of blood vessels. It is a wreck which has 
gathered debris from various sources ; }^et it contains 
several peculiar words which are quoted in the 

1 See Appendix : Supplementary Note. 

2 Still, the irepl &p9pwu of Apollonius and Galen may be an 
abbreviation ; following which example we shall call it 
"Joints." 

xxii 



GENERAL INTRODUCTION 

Hippocratic Lexicons of Erotian and Galen as being 
closely connected with Mochlicon. The author of 
Joints says he intends to write a treatise on the 
veins and arteries and other anatomical matters. 

This condensed summary may suffice to lead up to 
the following inferences : — 

The Hippocratic part of the Nature of Bones 
originally came after the first chapter of Mochlicon, 
which is really its first chapter. This treatise, thus 
enlarged, had as Preface our Surgery, the whole 
being an abridgment from an earlier work by the 
great Hippocrates "for use in the Surgery," which 
was perhaps its original title (see p. 56). Such a 
work would be well adapted either for teaching or 
for refreshing a surgeon's memory. 

Of the larger and older work our Fractures and 
Joints are important fragments, but there was 
probably an Introduction (now lost) containing the 
passage now extant in Surgery necessary to explain 
the later statement in Fractures. This earlier work 
may also have comprised an original treatise by 
Hippocrates on bunes and blood vessels, of which 
part of our Nature of Bones is an abridgment. Both 
these surgical works got broken up, and assumed 
something like their present form before reaching 
the haven of the Alexandrian Library. 

Littre has hints of the above theory, but it is 
more fully worked out by O. Regenbogen, 1 who 
carries it a step further. The seven books of 
Epidemics were, even before Galen's time, divided 
into three sections: I and III were universally held 
to be the oldest and most genuine; II, IV, VI, 

1 Op. cit., infra. 

xxiii 



GENERAL INTRODUCTION 

which, as Galen says, 1 are not composed works 
(avyypdix/xaTa) but memoranda {virofxvrjjxaTa), were 
generally supposed to have been compiled by 
Thessalus, son of Hippocrates, from his father's 
note-books; V and VII, as Galen remarks, 2 are 
beyond the range of the Hippocratic spirit (yvw/xr]), 
and, we may add, within that of the Macedonian 
artillery, which indicates a date later than 340 B.C. 3 
Galen has his doubts about the single authorship of 
the middle section, and these are shared by modern 
critics; but there is no doubt that Epidemics II, IV 
and VI are closely connected with the three works, 
Surgery, Bones, Mochlicon, which we have ventured 
to call an abridgment, but which, if we had not got 
a good deal of the original, might aptly be termed 
memoranda. Not only do whole passages in either 
set correspond verbally, or almost verbally, but there 
are peculiar philological similarities ; in particular the 
verb Spav, which, before the rise of drama, was 
typically Doric, occurs in all six treatises, and a few 
others belonging to what may be called the middle 
Hippocratic period, but neither in the earlier nor 
the later ones. It is not found, for instance, in 
Fractures or Joints, nor in Epidemics V and VII. 
Perhaps it is not too fanciful to suggest that after 
the triumph of Sparta (404 b.c) these strangers 
from Cos, who had their surgeries along the northern 
edge of the Greek world from Perinthus to Crannon, 
may have remembered that they too might claim to 

1 VII. 890. Cf. also VII. 825, 854. 2 XVII. 579. 

8 Littre tries, not very successfully, to get them all into 
the fifth century. V. 16 ff. The date of Epidemics V, VII, 
is fixed by the siege of Daton where a patient (94) was 
wounded by "an arrow from a catapult." 

xxiv 



GENERAL INTRODUCTION 

be Dorians and might have expressed the claim by 
occasional use of a strong Doric word. 1 Anyhow, 
there seems all the evidence we can expect that 
Surgery and Mochlicon formed part of an " abridg- 
ment " used in tbe first half of the fourth century 
by the practitioners who compiled Ep demies II, IV, 
VI, while Fractures, Joints and Wounds in the Head 
belong to the previous generation. 2 

Some little evidence as to the order of these 
treatises is given by grammarians. They point out 
that the infinitive used as imperative, characteristic 
of older Greek, is especially prominent in the 
Hippocratic Corpus. During the fifth century it was 
being driven out by the imperative and became 
demoralised in the process. This "depraved" use 
was shown mainly by the substitution of the accusa- 
tive for the nominative of the participle to represent 
the second person imperative. 3 Now, as regards our 
treatises, " depraved infinitives'-' occur only in Surgery 
and Mochlicon, and are absent from Fractures and 
Joints, except those parts of the latter which are 
interpolated from Mochlicon. We thus have further 
evidence that these chapters are interpolated, and 
that Surgery and Mochlicon are not by the author of 
Fractures — Join Is. 

1 The popularity of the Athenian dramatists, who use the 
word frequently, is perhaps a simpler explanation. 

2 Cf. Schulte, op. cit., infra. 

3 "In cases of the second person the subject is in the 
nominative, but when the infinite is equivalent to the third 
person of the imperative, its subject is in the accusative." 
Goodwin, Greek Moods and Tenses, p. 784. 



XXV 



GENERAL INTRODUCTION 

Manuscripts, Editions and Commentaries 

The Hippocratic manuscripts and editions have 
already been discussed in these volumes by a more 
competent authority. The chief MSS. of the surgical 
works are: (1) B (Laurentianus 74. 7) ninth or 
tenth century, referred to above, and described in 
detail by Schone in the preface to his Apollonius, 
(Teubner, 1896); (2) M (Marcianus Venetus 269) 
eleventh century ; (3) V (Vaticanus Graecus 276), 
twelfth century. M and V, with their progeny, 
form the basis of all editions up to the last by Kiihle- 
wein (Teubner, 1902), in which B is for the first time 
fully utilised. Unfortunately the whole of Mochlicon 
and the last five chapters of Wounds in the Head 
have been cut out of this oldest MS. 

The chief editors have paid marked attention to 
these treatises, and Petrequin's Chirurgie d' Hippocrate 1 
— text and translation with very copious notes and 
appendices, the fruit of thirty years' labour by a 
practising surgeon — probably represents the most 
thorough treatment of any ancient medical docu- 
ments. It is to this work that the present edition 
is mainly indebted. 

Francis Adams translated the treatises in his 
Genuine Works of Hippocrates. 2 He could spare 
less time and had fewer advantages than Petrequin. 
The translation, based upon Littre's text, is straight- 
forward and readable, and the notes have special 
value owing to the author's practical experience in 
almost Hippocratic circumstances, though they are 



i Paris, 1877-1878. 

8 Sydenham Society, 1849. 



XXVI 



GENERAL INTRODUCTION 

sometimes flatly opposed to the views of the equally 
experienced Petrequin. 

Since the appearance of Scheme's beautiful edition 
of Apollonius of Kitiirm (Illustrated Commentary on 
the Hippocratic Treatise on Joints), German scholars 
have paid much attention to the subject. Schone 
himself attempted to show that Fractures— Joints at 
any rate was a genuine work of the great Hippocrates, 
but was opposed by the eminent scholar Hermann 
Diels. 1 More recently, three interesting Theses on 
the connections, 2 grammar 3 and style 4 respectively 
of the surgical treatises have appeared. Their con- 
tents are very briefly outlined in the introductions, 
and will repay study by those interested in the 
subject. 5 

1 Diels, Sitzungsberichte tier k.p. Akademie, 1910, p. 1140f. 

2 Regenbogen, 0., Symbola Hippocralea, 1914. 

3 Schulte, E , Observational Hippocrateac Grammatkae, 1914 

4 Kramer, .)., Questiovwm Hippocraticarum capita duo, 1914 
6 See also Kiihlewein, H., Die chirurgischen Schriften ales 

Hippocrates, Nordhausen, 1898. 



Abbreviations in Notes 

B. M. V. = the three chief MSS. noted above. 
Erm. Pq. Kw. = the three more recent editors : 

Ermerins 1S5G, Petrequin and Kiihlewein as 

above. 



XXV11 



HIPPOCRATES 

ON WOUNDS IN THE HEAD 



VOI . III. 



INTRODUCTION 

No Hippocratic work has attracted more attention 
than this short treatise. All the prominent Alex- 
andrian medical commentators discussed it, and it 
is in Erotian's list of genuine works. Galen, of 
course, wrote a commentary, though only a fragment 
survives. 1 All ancient writers on the subject from 
Celsus to Paul us had it before them. At the 
Renaissance it attracted the attention both of 
anatomists and surgeons, and continued to do so 
almost to our own times. Its genuineness has 
hardly been questioned except by those who doubt 
whether Hippocrates wrote anything. 

This celebrity is perhaps equally due to its 
excellence and its peculiarities. The former may 
be seen in its clear descriptions and magisterial 
language; the writer teaches with authority. The 
latter are two: its account of the sutures, and its 
doctrine as to trephining. With regard to the 
former, we may say that, as modified by Galen to 
the effect that the H form is the only normal one, 
it is fairly correct so far as it goes, and that it 
is much better than the later account of Aristotle 
— that men have three sutures radiating from a 
centre and women one, which goes in a circle. 2 
The ancients (and Vesalius) accepted this view of 

1 In Oribasius, XLVI. 21. 2 Hist. Anim. 1. 7. 



INTRODUCTION 

the sutures, but all surgeons, from the post-Hippo- 
cratic age onwards, have been troubled by his 
rule as to trephining, which may be condensed as 
follows : — 

If the skull is contused or fissured, you should 
trephine at once, but an open depressed fracture 
does not usually "come to trephining," and is less 
dangerous ; in short, an injured skull should have a 
hole made in it if there is not one already. 

The Alexandrians, as we gather from Celsus, 
rejected this: "the ancients," he says (piously 
leaving Hippocrates unnamed), advised immediate 
operation, but it is better to use ointments — and 
wait for symptoms. The vast majority of surgeons 
have done so, but many have regretfully wondered, 
after the patient's death, whether the Hippocratic 
trephining might not have saved a life. " Hippo- 
crates " (as the supposed author of Epidemics V. 27) 
is praised by Celsus, and many others, for confessing 
that he thought a fissure was a suture and so left a 
patient untrephined. Symptoms appeared later; 
he trephined on the fifteenth day, but the patient 
died on the sixteenth ; yet this is just what any 
later surgeon would have done, even had he 
recognised the fissure. The reader will find in Littre 
and Pelrequin extensive quotations from French 
surgeons, and from our own Percival Pott, on the 
probability of lives being saved by preventive 
trephining used as an operation of choice before it 
is obviously necessary, but the Hippocratic rule is 
no more likely to be reintroduced than is the use of 
vigorous venesection, which would also doubtless 
sometimes save life. 

The use of the common word tjju'wv as a semi- 

3 



INTRODUCTION 

technical term for a complicated surgical instrument 
brings us to another noticeable point in the treatise : 
there seems to be an attempt to establish a medical 
vocabulary. Eminent theologians have recently 
settled the controversy on St. Luke's alleged 
medical language by declaring that the Greeks had 
none, "the whole assumption of medical language 
in any ancient writer is a mare's nest," x but if the 
writer of Acts had told us that St. Paul at Lystra 
got a hedra in the region of the bregma which 
penetrated to the diploe, they would have been 
fairly confident that he was a physician who made a 
rather pedantic use of his medical vocabulary. 
Here are three simple Greek words which are given 
such peculiar meanings that they have to be defined 
and not translated. 

The last term had some difficulty in keeping, or 
recovering, the somewhat unnatural sense 2 here given 
to it, and probably did so only through the prestige 
of this little work. Hedra could not be saved even 
by the authority of Hippocrates and his care in 
defining it. It is that form of skull injury which is 
left as its mark (or seat) by the weapon, and varies 
in size and shape accordingly from a prick to a gash, 
but without depression, " for then it becomes a 
depressed fracture." It included mainly what are 
now called "scratch fractures" and, as Galen says, 
would also comprise an oblique slice — anoo-Keirap- 
vtcr/xos. It was too vague to last, and was partly 
replaced by lyKoirr) — incision. Its vagueness has 
made some confusion in the treatise, for though 

1 Jackson and Lake, Prolegomena to Ads, II. 355. 

2 i.e. the porous bone tissue between the two hard layers 
of the skull bones. 



INTRODUCTION 

there is little doubt that Hippocrates intended to 
describe five forms of skull injury — as is twice 
asserted by Galen 1 — later scribes by splitting up 
the hedra have tried to make seven, though, strange 
to say, no MS. mentions a sixth. 

Several cases in Epidemics V. seem intended as 
illustrations to this treatise. A patient with con- 
tusion of the skull is trephined largely down to the 
diploe, he gets inflammatory swelling of the face 
(erysipelas) and is purged : the Hippocratic rules 
being thus followed, he recovers (V. 16). The 
patient with fissure (V. 27) is left untrephined till it 
is too late A girl dies because the trephining was 
insufficient. She has spasm on the side opposite 
the injury (V. 28). 

These cases are more remarkable because skull 
injuries have nothing to do with epidemics, and 
there is no such notice of bodily fractures or dis- 
locations. Epidemics V., as we have seen, probably 
belongs to the third Hippocratic generation, when 
the rules of the Master, as to the treatment of 
wounds in the head, may have begun to be called in 
question. 

With regard to the style of the treatise, every 
reader will be struck by the frequent repetition of 
the same words and phrases, often unnecessarily. 
This occurs in another manner and to a less extent 
in Fractures and Joints, where we shall discuss it 
further in considering the probability of a common 
authorship. 

1 XVIII(2). 672. Orib. as above. 



nEPI TON EN KE^AAHI 
TPOMATON 

I. Twv avOpwirctiv ai /cecpaXal ovBev o/xottw? 
acpcaiv avrals, ov8e ai pacpal t?}? K€(f)aXf]<; iravrwv 
Kara ravra Trecpv/eacriv. dXX' oaris p.ev €%ei 
e/c tov efiirpoaOev t>/9 «e(£aA,r/9 TrpofioXrjv — r) Se 
7T/90/3oX?; ear iv avrou tov 1 oareou h^eyov arpoy- 
yvXov irapa to dXXo — tovtov eialv ai pacpal 
Tre(f)VKvlai ev Trj /cecfyaXj] 0)9 2 ypdpLpua to Tad, T, 
ypdcperai, ttjv fiev yap ftpa^VTeprji' ypafip,r)v ex ei 
irpb tj/9 TrpoftoXr)? eiriKapo-i\]v ire^vKvlav tijv 8e 

10 €Tepj)v ypajJLfiijv eyei 8id p,ear]<; rfjs /eecpaXijs /card 
pLrjtco? irecpv/cvlav e? tov Tpa%i]Xov alei. oo~ti<> 
8 OTTiaOev Trj<; KecfyaXrjs tt)v Trpo(3oXi~)v e%e£, ai 
pa<paL tovto) Trecpv/cacri Tavavrta i) tw nporepu)' 
7) p,ev yap ftpayvTepr) ypafip,r) irpb 7-7)9 TrpofioXr)<; 
7re<pVK€V eTTifcapair)" r) 8e pLa/cporepr) 81a /xecr?;<? 
7-779 tc€(j)aXri<; nrecpv/ce Kara pir/icos e'9 to p,eT(oirov 
aiei. 6'(TTt9 8e teal 3 dp^poTepcoOev 7-779 KecpaXfj? 
TrpojBoXrjv e%€i, etc re tov epurpoaOev teal e/c tov 
oiTLadev, tovtw ai pafjyai elcriv 6p,oL(o<; ire^vKvlai, 

20 C09 ypapupia to 7]Ta, H, ypdcperai' Trecpvtcaai 8e 
T(ov <ypapLpb€(ov ai puev pia/cpal irpb 7-779 7rpo/3oXfj<; 
ercaTeprj? eTri/cdpcriai irecpvicvlar 77 8e ^pa\eiri 8id 
/Aeo-779 7-779 fcetpaX-fjs Kara p,r]KOs 777509 exaTepyv 
reXevTCoaa ti)v p.aKprjv ypapLp.i)v* bo~Ti<; 8e ya>;Se 
6 



ON WOUNDS IN THE 
HEAD 

I. Men's heads are not alike nor are the sutures 
of the head disposed the same way in all. When a 
man has a prominence in the front of his head— the 
prominence is a rounded outstanding projection of the 
bone itself — his sutures are disposed in the head as the 
letter tau, T, is written ; for he has the shorter line 
disposed transversely at the base of the prominence ; 
while he has the other line longitudinally disposed 
through the middle of the head right to the neck. 
But when a man has the prominence at the back of 
his head, the sutures in his case have a disposition 
the reverse of the former, for while the short line is 
disposed transversely at the prominence, the longer is 
disposed through the middle of the head longitudinally 
right to the forehead. He who has a prominence at 
each end of his head, both front and back, has the 
sutures disposed in the way the letter eta, H, is 
written, for the long lines have a transverse 
disposition at either prominence and the short goes 
through the middle of the head longitudinally, 
ending each way at the long lines. He who has no 



• So B. Kw. for rb toC Pq. The older MSS. BV omit the 
letters T H X. 

2 &<rn*p- * Omit Kai. 

* tj7<tj naKpfiai ypa/ufj.y<rtv. 



IIEPI TON EN KEOAAHI TPftMATHN 

erepwdi p,rj8ep,Lr/v TrpofioXrjv e^ei, ovtos e-^ei ras 
pa(f)a<; rr)<; K€(pa\fj<; co? <ypd/Afia to %t, X, ypd- 
<f)€TctL' Tre<f>VKaai he at ypapupal rj pev eTepr/ 
eiriKapa'ir) 77-009 tov KpoTcufiov d<fii]Kovaa' r) he 
eTepr) Kara pr)KO<i hid p.earj<; trjs KecfraXr}?. 
30 AnrXoov 8' earl to oaTeov Kara pearjv rr/v 
fcecfraXtfv o-fcXrjporaTOV he Kal ttvkvotcitov civtov 
ire(f)VK€v to Te avtorarov y 1 r) opoxpoirj tov oaTeov 
r) vtto Trj crap/a, Kal to KaTWTaTOV to 7roo? tt) 
p.ijviy<yt 77 1 r) opboy^poir) tov oaTeov r) kutco' 
airoycapeov he diro tov clvcotcitov oaTeov Kal tov 

KCLTCOTaTOV, dlTO TOiV aK\rjp0TaT(OV KCU TTVKVO- 

tcltwv eirl to p,a\$aKOJTepov fcal rjaaov ttvkvov 
Kal eiriKoikoTepov e? Trjv hiirXorjv aiei. r) he 

SlTtXoT} KOlXoTaTOV KCU pa\dctK(X)TCLTOV KCU pdXiaTa 

40 ar)payywhe<i eaTiv eaTi Be kcu ttuv to oaTeov 
tt)<; $€(pa\rj<i, ttXtjv KapTa oXiyov tov Te dvatTaTov 
kciI tov KctTcoTaTOv airoyycp o/xoiov kcu e%et to 
oaTeov ev ea)VTa> opoia aapKia iroWa Kal vypd, 
Kal el Tf? aiiTa hiaTpiftoi Total haKTvXoiai atp,a 
av hiayivono ei; avTwv eveaTi 8" ev tw 6aTea> Kal 

46 <f>\e/3ia XeiTTOTepa Kal Koikorepa aiparos ifKea. 
II. ~%K\rqp6TriTO<? pev ovv Kal p,a\0aKOTr)TO<; 
Kal koi\6ttjto<; 2 &he e^ei. TrayyTr]Ti he Kal 
\eTTTOTrjTi, oi>t&)?* 3 avp,7rdar)s t?}? KecpaXrjs to 
oaTeov Xe7TTOTaTOV eaTi Kal daOeveaTaTov to 
KaTa ftpeypa, Kal adpKa o\iyiaTr\v Kal XeirTOTa- 
ttjv e%6i e<f> ea>vT(p TavTjj t?}? Ke<j)a\i]<; to oaTeov, 
Kal 6 eyKecpaXos KaTa tovto tt}<; /ee^aA.?}"? 7r\eiaT0<i 
vireaTiv. Kal hrj oti ovtco raura e%«, T ^ v Te 

1 Kw. omits. 8 So BV. Kw. Pq. has dative throughout. 
8 Kw. omfts. 
8 



ON WOUNDS IN THE HEAD, i.-n. 

prominence at either end has the sutures of his head 
as the letter chi, X, is written : the lines are disposed 
one transversely coming down to the temple, the 
other longitudinally through the middle of the 
head. 

The skull is double along the middle of the head, 
and the hardest and most dense part of it is disposed 
both uppermost where the smooth surface of the skull 
comes under the scalp, and lowest where the smooth 
surface below is towards the membrane. 1 Passing 
from the uppermost and lowest layers, the hardest 
and most dense parts, the bone is softer, less dense 
and more cavernous right into the diploe. The diploe 
is very cavernous and soft and particularly porous. 
In fact, the whole bone of the head except a very 
little of the uppermost and lowest is like sponge, and 
the bone contains numerous moist fleshy particles like 
one another and one can get blood out of them by 
rubbinjr them with the finders. There are also rather 
thin hollow vessels full of blood contained within the 
bone. 

II. Such then is the state of hardness, softness and 
porosity, but in thickness and thinness of the skull 
generally, the bone is thinnest and weakest at the 
bregma, 1 and has the least and thinnest covering of 
flesh in this part of the head, and there is most under- 
lying brain at this part of the head. It follows from 
such a state of things that when a man is wounded 

1 Dura mater. 

2 The bregma comprises the front part of the top of the 
head, where the skull remains longest open. 

9 



IIEPI TON EN KEOAAHI TPDMATON 

rpooaicov Kal rcov f3eXecov 'iaeov re eovrcov Kara 

10 peyeOo? teal eXaaaovcov, real 6/aoloo<; re rpcodels 
teai r)aaov, rb oareov ravrr) T/75 KecpaXrjs <pXarai 
re puaXXov teal pi')yvvrai zeal eaco eacpXarai, teal 
Oavaacpcorepd eari real ^aXerrcorepa lr)rpeveaOaire 
leal ifecpvyyciveiv rov ddvarov ravrr) r] ttov aXXodi 
rr)s K€(f>a\rj<;' e^iacov re eovrcov rcov rpcopdrcov 
real 0/AOU09 re rpcoOels zeal r)aaov, cnroOvijaKei 6 
avOpwiTOS, OTTorav real aXXws peXXr) diroBavelaOai 
etc rov rpwparo<;,ev eXdaaovc ^povoo 6 ravrrj ey^oov 
to rpcopa rr)q Ke<paXr}<; r] ttov ciXXoOi. 6 yap 

20 iyKecpaXos rd~%iard re teal pdXtara Kara ro 
fipeypa alaOdverai rcov KaKcov rcov yivopevcov ev 
re rfj trapxl koX t&> oarecp' vtto Xerrrordrco yap 
oarew earl ravrr] iyKe<paXos Kal oXiyiarr) aapKi, 
koX irXelaros eyK€(paXo<; vtto rS> ftpeypari 
Kelrai. rcov Se aXXcov to Kara toi)? Kpordcpovs 
dadtveararov eanv avpQoXr) re yap t>}<> Karoo 
yvdOov 777309 ro Kpavlov, Kal Kivrjai^ eveartv ev 
tw Kpord4>(p dvoo Kal Karoo coarrep dpBpov Kal r) 
a.K or) rrXrjaLOV yiverai avrov, Kal (f)Xe\p- Sid rov 

30 Kpordcfrov rerarai KoiXr) re Kal la^vpi). layv- 
porepov 6" eari rP)<; KecpaXrjs ro oareov drrav ro 
owtadev t>}? Kopvepfjs Kal rcov ovdreov rj dirav 
ro rrpoadev, Kal adpKa irXeova Kal j3adurepT)v 
ecp eoovroo e%ei rovro ro oareov. Kal Si) rovroov 
ovroo<; e\6vra>v, vrro re rcov rpcoaicov Kal rcov 
fieXeoov laoov eovroov,^ Kal opoioov Kal pe^ovcov Kal 
6poi(o<i rirpcoaKopei>o<; Kal paXXov, ravrr) t?}? 
K€<pa\r)<; to oareov r)aaov pqyvvrai Kal cf)Xdrai 
eaco, Ki]v p.eX\r) wvdpooiro<$ diroOi'rjaKeiv Kal aXXoos 

40 ex rov rpooparos, ev tw ornaOev t>/9 KecpaXi)*; 
10 



ON WOUNDS IN THE HEAD, 11. 

equally or less, the wounding and weapons being equal 
or smaller, the bone in this part of the head is more 
contused or fractured, and fractured and contused 
with depression, the lesions are more mortal, medical 
treatment and escape from death more difficult here 
than in any part of the head. When wounded 
equally or less, the wounds being alike, the patient, 
if he is going to die in any case from the wound, dies 
sooner when he has it in this part of the head than 
anywhere else ; for it is at the bregma that the brain 
is most quickly and especially sensitive to evils that 
arise in scalp or skull, since the brain is covered here 
by thinnest bone and least flesh, and the greatest 
part of the brain lies under the bregma. Of the 
other parts, that at the temples is weakest, for the 
junction of the lower jaw with the cranium is at 
the temple, and there is an up-and-down movement 
there as in a joint. Near it is the organ of hearing, 
and a large and thick blood vessel extends through 
the temporal region. The whole skull behind the 
vertev and the ears is stronger than any part in front, 
and this bone has a fuller and thicker covering of 
flesh. It follows from such a state of things that 
when a man is stricken equally or more severely by 
woundings or weapons which are equal and similar or 
larger in this part of the head, the bone is less 
fractured, or contused with depression ; and if the man 
is going to die in any case from the wound, he takes 

1 airdvTwv Pq. 

II 



IIEPI TDN EN KEOAAHI TPfiMATQN 

e%o>z/ to rpcofia ev rrXeiovi ^poi>&> dirodavelrar 
ev rrXelovi yap XP 0V( P T0 oareov epbrrvtaKerai re 
teal BiaTrvtaKerai Karco eirl tov eyKecpaXov Bid 
tt]v ira-^vrrjia tov oareov, teal eXdaacov ravrrj 
tt)<; KecpaXrjs 6 eyKecpaXov vireari, koI irXeove<i e'/c 
cpvyydvovai tov ddvarov rcov oiriadev rirpcoaKo- 
fievcov rrj<; Ke<paXr)s eo? cttI to rroXv r) tcov 
epuirpoaOev. Kai ev xeipioyvi rrXeiova %povov £77 
S)vO p(07ros tj ev Qepei, oanv /cat aXXcos pueXXei 1 

50 diroOavelaflat etc tov rpoop,aTO<; oirov dv rr)<i 

51 KecpaXr)<; e%G)v 2 to rpcbp,a. 

III. At Be eBpai rwv fieXecov tcov o^ecov tea* 
/coveporepcov, avral cttI acpwv avrecov yivop,evam 
iv tu> oaretp dvev pcoypbfp; re kou (pXacrios Kai 
eaco eacpXdatos — avrai Be yivovrai 6/zot'cw? ev re 
rut ep.irpoaOev t?}? KecpaXfjs /cal ev rm oiriadev — 
€K rovrcov 6 Odvaros ov yiverat Kara ye Blktjv, 
oi)o° rjv yivr/rai. pacprj Be ev eX/cet cpavelaa, 
oareov ■^nXwOevros, rravrayov tt\% KecpaXr}*; tov 
e'A/ceo? yevopuevov, dadeveararov ylverai rfj rpooaei 

10 /ecu to) /3eXec dvrexeiv,el tv-^oi to /3eXo>i e$ avri/v 
ttjv pacprjv arrjpixdev' — irdvrcov Be pudXiara, rjv 
to /9eAo? 3 ev ra> fipeypLari yevop,evov Kara to 
dadeveararov rrjs Ke(paXrjs — Kai at pacpai et 
rv^oiev eovaai Trepl to eX/cos Kai to /SeXos 

15 avrecov rv^oi tcov pnepcov. 

IV. TirpooaKerai Be oareov to ev rrf Ke<paX7) 
ToaovaBe rpoTrov*}' tcov Be rpoircov eKaarov 
TrXeLoves IBeat yivovrai rov Karrjy pharos ev rfj 
rpcoaei. oareov prjyvvrai TirpwaKo/xcvov Kai 
rfj pcoypif) 4 ev rep rrepieyovri oarecp rrjv pcoyp,r)v, 
dvdyKTj cpXdaiv rrpoayeveoOai, i]V7rep payfj' tcov 

12 



ON WOUNDS IN THE HEAD, n.-iv. 

longer time dying when he has it in the back of the 
head. For suppuration of the bone takes longer to 
come on and penetrate down to the brain because of 
the thickness of the skull; also there is less brain in 
this part of the head, and, as a rule, more of those 
wounded in the hinder part of the head escape death 
than of those wounded in front. In winter, too, a 
man lives longer than in summer, if he is going to 
die from the wound in any case, in whatever part of 
the head he may have the wound. 

III. Hedrae 1 of sharp and light weapons, occurring 
by themselves in the skull without fissure, contusion 
or contused depression (these happen alike in front 
and at the back of the head) do not, at any rate by 
rights, cause death even if it occurs. If a suture 
appears in the wound when the bone is denuded, 
wherever the wound may be, the bone makes very 
weak resistance to lesion or weapon [if the weapon 
happens to get stuck in the suture itself] 2 — most of 
all if the weapon gets in the bregma, the weakest 
part of the head — and if, when the sutures happen to 
be in the region of the wound, the weapon also 
happens to strike the sutures themselves. 

IV. The bone of the head is injured in the 
following number of modes, and for each mode 
several forms of fracture occur in the lesion. The 
bone is fractured when wounded, and the fracture 
is necessarily complicated by contusion of the bone 
about it, if it was really fractured. For the very 

1 See Introduction. * This seems a superfluous gloss. 

1 ocrris hv iw»! fitWr/. 

1 (XV Kw.'b conjecture. 

8 f\Kos Pq. Erm. &(\os Kw. codd. 

i rrjs t>wyiiTJs Pq. ; V omits. 

»3 



nEPI TQN EN KEOAAHI TPftMATHN 

yap fieXeoov 6 re irep prjyvvai rb oareov, rb avrb 
rovro Kal cpXa to oareov rj pdXXov ij rjaaov, 
avrb re ev ooirep Kal prjyvvai rrjv pooypyjv kcu rd 

10 rrepie~%ovra barea r>]V pcoyp-yv el? ovtos rpoiro^. 
iheai he pa>yp,ea)v rravrolai yivovrat' Kal yap 
Xerrrbrepai re /cal Xerrral rrdvv, ware ov Kara- 
cpavees yivovrai, eariv at rcov pcoypewv, 1 ovre 
avrl/ca puerd rrjv rpwaiv, ovr' iv rfjaiv 1'ipepijaiv 
iv fjaiv av /cal ttovcov ocpeXoi yevoiro rov Oavarov 
rw avOpooTTw. 2 al 5' av rrayyrepal re koX 
evpvrepai prjyvvvrai rebv pcoyp,ecov, eviai he tcaX 
rrdvv evpeai. eari he avrecov icai ai p,ev em 
piaKpbrepov prjyvvvrai, al he enrl fSpa^vrepov Kal 

20 al pev Wvrepai, al he Welai rrdvv, al he Kapnrv- 
Xoorepal re /cal KapirvXai 1 kcu ftaQvrepai re es 
to Karoo icai hid rravrbs rod oareov [/cal rjaaov 

23 ftadetai Kal ov hid iravros rov oareov]? 

V. QXaaPeir) S' av rb oareov pievov ev rfj ecov- 
rov <f)vaei, Kal pooypi) rfj cpXaaei ovk av rrpoa- 
yevoiro ev ra> 6ari(p ovhepia' hevrepos ovros 
T/307TO?. Iheai he t% cp\daio<; TrXelovs yivovrai' 
Kal yap pdXXov re Kal rjaaov cpXdrai Kai e? 
j3a9vrepbv re Kal hid 7ravrb<i toO oareov, Kal 
rjaaov e? /3adv Kal ov hid iravrbs rov oareov, 
Kal i'/rl TrXeov re Kal hXaaaov puJKeos re Kal 
rr\arvri]ro<i. dXXd ov 4 rovrcov rebv Iheotv 

10 ovheplav earlv Ihbvra roiaiv ocpOaXpols yvcovai 
ottou) Tt? iariv rijv Ihetjv Kal orroarj ri<i to 
p,eye6os' ovhe yap el rre^Xaorai eovra>v re 
irecpXaapevwv Kal rov KaKov yeyevrjpevov yiverai 
rolatv bcpOaXpolaiv Karatyavh ihelv avr'iKa piera. 

1 ea-rj 8' airtov yojy/j.t&v Pc^., V. 

14 



ON WOUNDS IN THE HEAD, iv.-v. 

same part of the weapon which breaks the bone 
also contuses it more or less ; and this happens just 
at the place where it makes the fracture, and in the 
bones containing the fracture. This is one mode. 1 
As to forms of fracture, all kinds occur, for some 
are rather small and very small, so as to be not 
noticeable either immediately after the lesion or in 
the days during which the patient might be helped 
in his sufferings and saved from death. Again, 
some of the fractures are larger and wider, and 
some very broad. Some are longer, some shorter, 
rather straight or quite straight, rather curved 
or bent, going rather deep and right through the 
bone [and not so deep and not through the bone]. 2 

V. The bone may be contused and keep in its 
place, and the contusion may not be complicated 
by any fracture of the bone. This is a second mode. 3 
There are many forms of contusion ; for the bone 
is more contused or less, to a greater depth, going 
right through, or less deeply, not going through the 
bone, and to a greater or smaller extent in length 
and breadth. Now none of these forms can be 
distinguished by the eye as to its precise shape and 
size, for it is not even clear to the eye immediately 
after the injury whether contusion has taken place, 
even if the parts are contused and the damage done ; 

1 " Fissure fracture." 2 I, ittre's insertion. 

* "Contusion." 



2 Obscure passage : "help for sufferings may be also help 
;ainst death." Littre suggests ko.1 tov Qavirou. 

3 Added by Littre\ 
Pq. omits. 

*5 



IIEPI TON EN KEOAAHI TPftMATftN 

rr)v rpSxriv, oocnrep oi/Se twv pooyp.ea>v eviai e/ca? 1 
16 iovaai re teal eppcoyoros tov oaTeov. 

VI. 'FicrcpXarai to oaTeov i/c t?}? <fii>ato<; rfj? 
ecovrov eaw aijv pcoy/u.rjaiv aXXa><; yap ov/c av 
ia&Xaadeirt- to yap iacbXooaevov, airopprjyvv- 
p,evov re icai rcarayvvp-evov, eacpxaTat, eaa> airo 
tov aXXov oariov p,evovTO<i iv (pvaei rfj ecovrov' 
Kal Br) ovrco pwypy av irpoaeirj ttj iacpXdaer 
TpiTOS ovtos T/307TO?. iacfiX&Tat Be to oareov 
TToXXas IBeas' koX yap iirl irXeov tov oaTeov icai 
eir eXaaaov, Kal p.aXXov re Kal e'v /3a9vTepov 

10 kcltu), Kal rjaaov /cal iimroXaioTepov. 

VII. Kal eBprjs yevo/xevrj'i iv tw oaTew fieXeos 
irpocryevoLTO av pwyp,r) rfj eBpr), rfj Be pcoypifj 
Kal <f)Xdaiv rrpoayeveadai dvayKalov eaTi r] 
puaXXov r) rjaaov, rjvirep Kal pwypbr) TrpoayevrjTai 
evdairep Kal eSprj eyeveTO Kal i) p(oyp.rj, iv ra> 
oo-T6ft) TrepiexovTL Tijv re eoprjv Kal rrjv pcoyp,r)V 
TeTapTO? ovtos t/)07to?. Kal eBprj p,ev av yevoiTo 
(f)Xdcrtv e^ovaa tov oaTeov irepl avTrjv, p(oyp.rj Be 
ovk av irpoayevoiTO ttj eBprj ko\ Tfj <f>Xdaet vtto 

10 tou /SeXeo?* [7re/x7TT09 ovros Tp6iros\ [Kal eBprj 
Be toO /3eXeo9 yiveTai iv tw 6aTea>' eBprj Be KaXel- 
Tai, OTav puevov to oaTeov iv tt) kwvToi) cpvaei to 
fteXos aTijpi^av e<? to oaTeov BrjXov iroLrjarj ottov 
iaTtjpi^ev 2 ] iv Be tw Tpoirw e/cacrTW TrXeioves IBeai 
yivovTai Kal irepl fxev tyXaaios tc Kal pwyp,?)?, 
rjv apL(f)Q) TavTa irpoayevrjTai rfj eBprj, Kal rjv 
<f)Xdai<i /Aovvrj yevrjTai, ■ijBi] ire^paaTai oti iroXXai 

1 eAdffffovs Kw.'s suggestion in Hermes XX., but he does 
not print it. 

2 Kw.puts this passage first, as is done in the translation. 

16 



ON WOUNDS IN THE HEAD, v.-vn. 

just as some fractures are not visible, being far from 
the wound, 1 though the bone be broken. 

VI. The bone is contused and depressed inwards 
from its natural position with fractures, for otherwise 
it would not be depressed. For the depressed bone, 
broken off and fractured, is crushed inwards away 
from the rest of the bone, which keeps its place ; 
and of course there will thus be a fracture as well 
as a contused depression. This is a third mode. 
Contused depressed fracture has many forms, for it 
extends over more or less of the skull, is more 
depressed and deeper, or less so and more 
superficial. 

VII. Again, a weapon hedra occurs in the skull. 
It is called "hedra" when, the bone keeping its 
natural position, the weapon sticks into it and makes 
a mark where it stuck. 2 When a weapon hedra 
occurs in the skull, there may be a fracture as well 
as the hedra ; and the fracture must necessarily be 
accompanied by more or less contusion (if a fracture 
also occurs) where the hedra and fracture happened, 
in the bone containing the hedra and fracture. This 
is a fourth mode. And a hedra may occur with 
contusion of the bone about it, without being 
accompanied by a fracture in addition to contu- 
sion by the weapon. [This is a fifth mode. 3 ] Of 
each mode there are many forms ; and as regards 
contusion and fracture (whether both of them 
accompany the hedra, or contusion only), it has 
already been declared that there are many forms, 

1 Or, "rather small," Kw. 

2 Vest i<j'u in teli, "scratch fracture." This passage is 
obviously out of place in the Greek text. 

8 Pq. omits. 

17 



IIEPI TON EN KEOAAHI TPQMATQN 

IBeat. ylvovrai real tt}? (pXdaios real t?}<? paiyLii)*;. 

7) Be eBprj avrrj e<f> ecovrrjs ylveTai pLareporepr/ real 

20 fipa^VTept] eovaa, real KafXTrvXcojeprj, «al lOvrkpt), 

real rcvreXoTepn'^- real 7roXXal aXXac cheat rov 

TOIOVTOV rpOTTOV, 01T0L0V CIV TO KCU TO (T^rjixa 1 TOV 

/3eXeo<; rj' at Be aural /cal /3a6vrepai to Kara) real 
fidXXov teal rjcraov, real arevorepal T€ real rjaaov 
(TTeval real evpvrepai, real irdvv evpeai, rj Bia- 
Kerc6(f)arar 8tarco7rr/ Be 6tto<tt)ti(tovv yivopLevr) 
/xrjrceos re real evpuTriros iv ra> oaiea), k'Bpr) iariv, 
r)v ra dXXa oarea rd nrepikyovTa tj)v Siareo7rr)v 
Lievfl iv rrj <j)vaei ttj ewvTwv, real fit) crvveo~(pXdTat, 

30 rfj hiareoTTi] eaco ere ry<i cpvaios tt}? icovTOJV ovtco 

31 Be ea(j)Xa(Ti<; av etr) real ovre eri eBpTj. 

VIII. ^Oareov TCTpcoaKerai aXXyj t?}? reetyaXrj? 
rj ij to eX/eos e^ei oivOpcoiros real to oareov 
eijfiXwOri t?)? crap/eos' Tre/xiTTos 2 oirro? Tpoiros. 
real ravrrjv rrjv aup,<f>opijv, oirorav yevrjrai, ovre 
av e^of? d)(peXtjaai ovBev ovBe yap, el ireirovQe 
to reareov tovto, ovre eaTiv oVoj? XPV avrbv 
e^eXey^avra elhevai, el TreirovOe to reareov tovto 

8 u>v dp (OTTOS, ovBe onrij 3 Tr}<; /ee4>aXrj<;. 

IX. Tovtqiv twv Tpoirwv t?)? reaT i^ios €9 irplaiv 
d(f)}]reei y Te (f)Xdai<i i) aef)avr)<i IBetv real ijv 7rco9 
TVXH <paveprj yevo/xevr] real ?) pcoy/xr) rjv atyavris 
IBelv real r\v (fravepr) f). real i'lv, eopr]<; yevo/xevrj<; 
rov /3e'A.eo<? iv tw bo-Tew, tt poo~yevi]Tai pcoy/xt) real 
(j)Xdai<] Trj eSpj], real i)v (f)Xdo~i<; fiovvii irpoayevr}- 
Tai dvev pcoyp,rj<; rf/ e'Bpi], real avT)] e? nrplaiv 
d(p)jreei. to Be ecrw ia(pXu>p.evov boTeov ere ti}<; 
(f)vcrio<i t>}? eeovTOv oXiya twv ttoXXmv irptaLos 

10 TTpoaSeiTat' real to, LidXiaTa ecr<j>Xao-OevTa real 
18 



ON WOUNDS IN THE HEAD, vn.-ix. 

both of the contusion and of the fracture. The 
hedra taken by itself is long or short, rather bent, 
or straighter, or rounded ; and there are many other 
forms of this mode, according to the shape of the 
weapon. These same hedrae vary in depth and 
narrowness, and may be rather broad or very broad 
where there is a cleft; for a cleft in the bone of 
any size whatsoever as to length and breadth is a 
hedra if the rest of the bone round the cleft keeps 
its natural place and is not crushed in by the cleft ; 
for this would be a contused depressed fracture, and 
no longer a hedra. 

VII I. The skull is wounded in a part of the head 
other than that in which the patient has the lesion 
and the bone is denuded of flesh. This is a fifth 
mode. 1 When this accident occurs, you can do 
nothing to help ; for if the man has suffered this 
injury, there is no possible way of examining him 
to make sure that he has suffered it, or where- 
abouts in the head it is. 

IX. Of these modes of "fracture," 2 contusion, 
whether invisible or somehow becoming manifest, is 
a case for trephining, also fissure-fracture, whether 
invisible or manifest; and if, when there is a weapon 
hedra in the bone, the hedra is accompanied by 
fracture and contusion, or if contusion alone accom- 
panies the hedra without fracture, this also is a case 
for trephining. But as for contused depressed 
fractures, only a small proportion of them require 
trephining ; and the more the bones are contused, 

1 Seventh Kw., our " controcoup." 

2 Evidently taken as = injury. 

1 <Tr6/jLa. * ?/35ojttos. * '6-nov Erin. 

19 



nEPI THN EN KEOAAHI TPOMATON 

fiaXiara Karappayevra, ravra rrpi,aio<; rjKiara 
K6XPV rai ' °v$£ ehp-q avTr] e^' eoovTr)<; yevop,evrj 
drep pa)yp,i)s Kal (pXdatos, ovBe avrrj irpicnos 
Belrar 1 ovo' r) BiaKOirrj rjv 2 p,eyd\r) kal evpeia rj, 

15 ouS' avrrj- BiaKOirr) jap Kal eBprj rcovrov iariv. 
X. Ylpwrov Be XPV T0V Tpavfiarlr/v aKorrelaQai, 
otttj e%€L to rpco/xa tt)? K€(f)a\.f}<i, elr iv rolaiv ta%v- 
porepoiaiv elr* iv rolaiv dadeiearepoiai, icai ra<i 
r/jt^a? Karap-ai ddveiv Ta? rrepl rb e\«:o<?, el Siatce- 
Kofyarai vrrb tov /3e'A.eo?, icai el eaco ijlaav 3 i$ to 
rpcop-a, Kal rjv tovto f/, <pdvai KivBvveveiv to 
oareov tyi\bv elvai rrjs aapKos /cal e%eiv ri alvos 
to oareov vrrb tov /3eAeo<?. 4 ravra p.ev ovv XRV 
drrbrrpoaOev aKetydpievov Xe^ai, p,r) dirrop-evov tov 

10 dvdpdnrov dirrbpLevov c7 rfir/ ireipdaOai elBevai 
adepa e'i iari -^nXbv to oareov rr)<; crap/ebs rj oir 
Kal rjv fiev Karafyaves rj rolai o<f>0aXp.olai to 
oareov, yjriXov el Be p-t], rfj p*r)\r) aKerrreadat. 
Kal rjv p,ev evpys tyiXbv ibv to oareov rrj<; aapKO<i 
Kal pur] vyies drrb tov Tpu)p,aro<;, xph T0V ev T $ 
6area> iovro^ ttjv Bidyvwaiv Trpcbra iroielauai, 
bpoivra orroaov re iari to KaKov Kal tlvos Belrai 
epyov. xpr] Be Kal ipcordv tov rerpcop^evov 07ra)? 
eiraOe Kal rlva rpbirov. rjv Be puij Karafyavh y 
to oareov, el e%et ti KaKov 5 rj p,rj ej(ei, iroXXw en 
-ypr) puaXXov rrjv ipcbrrjaiv iroielaQai, "tyCXov re 
iovros tov oareov, to TpSipua ottw? iyevero Kai 
ovriva rpbrrov rd<; yap (pXdaias Kal ras pa>yp,a<i 
Ta? oil (fraivop.evas iv rw oarew, iveovaas Be, e'/c 
Tr)<i vTTOKpiaio^ tov rerpo)p.evov rrpebrov Biaytvco- 

1 S€?toi— tvpe7a Kw. B. 2 old' %v liattoiri). 3 tXr\aav. 
20 



20 



ON WOUNDS IN THE HEAD, ix.-x. 

depressed and comminuted, the less they require 
trephining. Nor does a hedra, occurring by itself 
without fracture or contusion, require trephining, 
and even if the cleft is large and wide, not even 
then ; for cleft and hedra are the same. 

X. The first thing to look for in the wounded 
man is whereabouts in the head the wound is, 
whether in the stronger or weaker part, and to 
examine the hair about the lesion, whether it has 
been cut through by the weapon and gone into the 
wound. If this is so, declare that it is likely that 
the bone is denuded of Hesh and injured in some 
way by the weapon. One should say this at first 
inspection, without touching the patient. It is while 
handling the patient that you should try to make 
sure whether the bone is denuded of Hesh or not. 
If the bone is visible to the eye, it is bare ; if not, 
examine with the probe. Should you find the bone 
bare of Hesh and injured by the wound, you should 
first distinguish the nature of the osseous lesion, its 
extent, and the operation required. And you should 
also ask the wounded man how he suffered the 
injury, and of what kind it was. If the bone is not 
visible so as to show whether it is or is not affected, 1 
it is far more necessary than when the bone is bare 
to make the interrogation as to the origin and 
nature of the wound. For, in the case of contusions 
and fractures which do not appear in the bone, 
though they are there, you should first try to 

1 Reading v6<rrma.. 

4 I give Kw.'s order of these sentences. 
6 v6ai]^a B. Kw. * anoKplo tos. 

21 



IIEPI TON EN KEOAAHI TPQMATON 

aiceiv rreipdaOai, el n rrerrovOe rovrcov to oareov 
r) ov rrerrovOev. eireira he /cal Xoyw /cal epyw 
e^eXey^eiv, rrXr/v prfXu>aio<;. p,t']\o)ai<; yap ov/c 
e^eXey^ei, el irkirovBe ti rovrcov twv /ca/ccov to 

30 oareov, ical e'l ti e%ei ev ecovrw, r) ov nrkirovQev 
alOC ehpijv re rod fieXeos e^eXey^ei prjXcoats, /cal 
rjv ep,(pXaa0j} rb oareov e/c t?;? cpvaios tj}? ewvrov, 
/cal rjv iayyp&'i payf/ rb oareov, airep /cal rolai 

34 6(f)6a\pLolai KarcHpavea earlv opwvra yivoba/ceii'. 1 
XI. Yi'p/vvrai oe rb oareov ra<; re depaveas 
pojypa<i /cal rds (pavepdf, /cal (pXdrai rat depaveas 
cpXaaias, /cal eacpXdrai eaco e/c t?}? <f>vaio<; ri]<; 
ewvrov, pdXiara btrbrav erepos u$' erepov rtrpco- 
aKopevos eViT^Se? rpcoaai 2 /3ovXopevo<; rj brtbrav 
de/ccov — teal brrbrav i£ ii^r^Xorepov ylvrjrai r) 
/3oXr) rj r) irXrjyi], oirorepr) av fi, pudXXov t) orrorav 
e£ laorrehov rov yjMplov, koX rjv rrepi/cparfi rfj 
X €l P^ T0 /SeXo?, i]v re /3dXXr) rjv re rvirrrj, /cal 

10 la^vporepo^ io)V dadevearepov rirp water), orroaoi 
he nriirrovre^ rirpwa/covrai irpos re to oareov /cal 
avrb rb oareov, 6 dirb vtyifkordrov irnrrcov /cal 
enl a/cXi/porarov /cal dp,{3Xvrarov, rovrw /clvSwo? 
rb oareov payrjval re ical <pXaa0i}vai /cal eaoi 
eo<pXaa8r)vaL e/c tt}? (pvaios rrjs ecovrov' ru> Be e'£ 
laoiretov pdXXov %copiov nrtrrrojri /cal eiri paXOa- 
Kcorepov, rjaaov ravra Trda^eL rb oareov rj ov/c 
av rrdOoi. biroaa he earTinrovra e? rr-jv /cecpaXrjv 
/3eXea rirpwa/cei rrpbs rb oareov /cal avrb to 

20 oareov, rb dirb {jyJrrjXordrov epneadv /cal i)/ciara 
if; laorrehov, real a/cXrjporarov re dpa /cal dp/3\v- 
rarov ical /Sapvrarov, /cal rj/ciara Kovcpov /cal 

1 Lobeck considers the last two words superfluous, but 
they are in all MSS. 
22 



ON WOUNDS IN THE HEAD, x.-xi. 

distinguish by the patient's report whether the 
skull has or has not suffered in these ways. Then 
test the matter by reasoning and examination, avoid- 
ing the probe ; for probing does not prove whether 
the bone has or has not suffered one of these evils, 
and what is the result. What probing proves is 
the existence of a hedra or weapon mark, or whether 
the skull has a contused fracture with depression, 
or is badly broken, things which are also clearly 
obvious to ocular inspection. 

XL The skull suffers invisible and visible fractures, 
invisible and visible contusions, and contused fracture 
with depression from its natural place, especially when 
one person is deliberately and wilfully wounded by an- 
other, rather than when the wound is unintentional ; 
when the missile or the blow, whichever it be, 
comes from above rather than from level ground ; 
when the weapon, whether used to throw or 
strike, is in full control, 1 and when a stronger man 
wounds a weaker. As to those who are wounded 
about the skull or in the skull itself by falling, he 
who falls from a very great height upon something 
very hard and blunt is likely to get his skull broken 
or contused, or to have a contused fracture with 
depression ; while if a man falls from more level 
ground on to something rather soft, his skull suffers 
less in this way, or not at all. As to missile weapons 
which wound the parts about the skull or the skull 
itself, a thing will fracture or contuse the bone in 
proportion as it falls from a great height rather than 
the level, and is very hard as well as blunt, and 

1 Adams' "if the instrument be of a powerful nature" 
seems hardly correct. 

2 kTf.ujey; Pq. text obscure. 

23 



IIEPI TDN EN KEOAAHI TPflMATQN 

rjtcuna 6£v Kal fxaXOaKov, tovto av pij^eie to 
oaTeov nai (fiXdaetev. 

Kal pudXiard ye ravTa traayeiv to oaTeov 
klvovvos, oworav ravrd re ylvT]Tai Kal e? 16 v 
rpcoOfj Kal Kar dvriov yevijTai to octcov tov 
/3eX,eo9, i]v re TrXriyf] e* %eJoo? tfv Te /3\y]0r] r\v 
re ti i/uLirear] avTco Kal i]v avTOS KaTaweaobv 

30 TpcoOfj Kal oirwaovv TpwOels KaT dvTiov yevo- 
/nevov tov oaTeov Ttt> fieXei. Ta S' e? rrXdyiov 
tov oaieov Trapaavpavra fieXea r/aaov Kal 
pijyvvai to oaTeov Kal (f)Xa Kal eaa) eacfoXd, 
ktjv -tyiXcdOfi to oaTeov Tr)<> aapKo<?' evia yap 
twv TpcofiaTwv T(ov ovto) TpcodevTwv ovSe yjnXov- 
Tat to oaTeov -n}? aapKo<;. tmv Se fieXeaiv 
pyjyvvai fiaXtaTa to oareov Ta? Te (f>avepd<; 
pcoypLca Kal Ta? d<fiav£a<i Kal (f>Xa tc Kal 
iacpXa haw eK tt}? (f)vaio<; ti)? cwvtov to oaTeov 

40 tcl aTpoyyv^Ka Te Kal irepL^epea Kal dpTiaTopia, 
dfij3Xea Te eovTa Kal fiapia Kal aKXripd' Kal ttjv 
adpKa TavTa (fiXa tc Kal ireireipav iroiel Kal k6ttt€1' 
koI tcl eXKea yiveTai vtto tmv toiovtwv fieXecov, 
e'9 T€ irXdyiov Kal ev kvkXw vrroKoiXa, Kal hidirvd 
Te pidXXov ytvcTai Kal vypd Iotiv Kal eVl 
irXeova y^povov KaBaipeTav dvdyKr\ yap tcls 
adpKas Tas (pXaaBeiaas Kal Koireiaa^ irvov yevo- 
fxevas eKTaKrjvai. Ta he (BeXea tcl iTpop.?]Kea 
eVi 7roXv XeiTTa eovTa Kal o^ea Kal Kovcpa, ttjv tc 

50 adpKa otaTafivei fidXXov r) cpXa, Kal to oaTeov 
a>aavTco<i' Kal ehp:)v fiev epuTroiel avTO Kal Sia- 
Kotyav x — BiaKOTrrj yap Kal e&pi] twvtov eaTi — (f)Xa 
8e ov [xdXa to oaTeov tcl TOiavTa fieXea ovSe 
ptjyvvaiv ovo' eK ttj<; cpvaios eau eacpXa. 
24 



ON WOUNDS IN THE HEAD, xi. 

heavy — in other words, the least light, sharp, and 
soft. 

And the skull is especially likely to suffer this 
when the wound happens in those circumstances, 
and is perpendicular, the skull being directly op- 
posed to the weapon, whether the agent be a blow 
or missile or something falling on the patient, or 
the patient falling himself, or being wounded in any 
way whatsoever, so long as the bone is at right 
angles to the weapon. When weapons graze the 
skull obliquely, they are less apt to cause fracture, or 
contusion, or contused fracture with depression, even 
if the bone is denuded ; for in some wounds of this 
kind the bone is not even denuded of flesh. Those 
weapons which especially cause visible and invisible 
fractures, and contuse and crush in the bone out of 
its natural place, are rounded, smooth-surfaced, 
blunt, heavy and hard. These contuse the scalp, and 
pound it to a pulp. The wounds caused by such 
weapons become undermined both at the side and all 
round, and more likely to suppurate ; they are moist 
and take long to cleanse, for the crushed and pounded 
tissue must necessarily become pus and slough away. 
Elongated weapons being usually slender, sharp and 
light, cut through the flesh rather than bruise it, and 
likewise the skull ; they make a hedra in it and a 
cleaving 1 (for cleft is the same as hedra), but such 
weapons do not readily contuse the bone or break 
it, or crush it inwards out of its place. 

1 Or, " It leaves a hedra while cleaving." 



1 In these words avrb refers to otntov, 5iai<6\f/av to #«A«a 
(fc'Aos). Erm. 

25 



IIEPI TftN EN KEOAAHI TPflMATQN 

'AXXd ^prj 717)0? ttj o^rev rfj ecovTOV, 6 Tt 
dv aoi (palvrjTcii ev to> oareqs, teal epcoTrjatv 
•KOielaOai irdvTwv tovtwv. tov yap pudXXov Te 
Kat ijaaov rpcodevTOS ravrd eaTi arjp,ela, /cal i)v 
o rpcodels KapwOfj koX otcoto? irepiyydr) ical rjv 

60 Slvos e"^!i ical ireaj]. 

XII. 'Oirorav Se tv^J] tfriXcoffev to oaTeov rfj<i 
aap/cb<; virb tov /3t\\.eo?, ical tv)(t) /car avrds Ta? 
pa</xx? yevopuevov to eXicof, j^aXerrbv ylveTai ical 
ri)v eSprjv tov /3eXeo? cppdaaadai tt)v ev tw 
aXXu> 6o~Tea> (f>avepy)v yevopevrjv, clt evecrriv ev 
to) 6aTe<p eiVe pri eveaTiv, ical i)v tv%$ yevopevi] i) 
k'Spt) ev auTrjai Trjai pacpfjaiv. avy/cXeTTTei 1 yap 
auTt] r) patpi] Tprj^vTep)] eovaa tov dXXov oaTeov, 
ical ov Sid8>]Xov 6 Tt re avTov pacprj eaTi /cal o ti 

10 tov fieXeos ehpti, t)v prj /cdpTa p,eydXt] yevr/rai r) 
e&p7). Trpoayi'verai Be /cal p>]!;i<; tt) eSpy a>? eirl 
to ttoXv Trj ev Trjai pacf)fjcri yivopevy, 2 /cal yiveTai 
/cal ai>T7] 1) prj^i'i \aXe7rcoTep)) cppdaaaBai, eppco- 
70T09 tov oaTeov, Sid tovto otl /caT avTi)i> Trjv 
pa<pi]v 1) p^a yiveTai, i]v prjyvvTai, co? eirl to 
ttoXv' eTOupLOV yap TavTrj p/jywadai to oaTeov 
/cal Sia^aXav 81a Trjv daOeveirjv t/~/? (pvaios tov 
oaTeov TavTtj ical hid Trjv dpaioTrjTa, ical S?; aVe 
t/)? pacprjs eToipi]<i eovat]<; p/jyvvaOai ical 81a- 

20 ^aXdv. Ta 8e aXXa oaTea Ta irepiexpvTa Tr)v 
pa(f)ijv pcevei dppayea, oti loyypoTepd eaTi Trf$ 
pac^/)?. rj 8e prjl~i<; r) KaTa tt)i> pacprjv yivopevii 
ical Bia^dXaais eaTi T/79 pa</>?}?, ical (ppdaaadai 
ovk evp.apjj'i, ovt€ el 3 dirb e&prjs tov /3t'\eo? 
yevopiev^s ev tt} pa<f>f], eTreiBdv payfj ical Bia^a- 
Xdarj, ovt€ i)v <pXaa0evTo<; tov oaTeov icaTa ra? 
26 



ON WOUNDS IN THE HEAD, xi.-xii. 

Now, besides your own inspection of what you 
may see in the bone, inquiry should be made into 
all these things, for they are indications of the 
greater or less gravity of the wound, also as to 
whether the patient was stupefied and plunged in 
darkness, or had vertigo and fell down. 

XII. Whenever the skull happens to be laid bare 
of flesh by the weapon, and the wound happens to 
occur just at the sutures, it becomes difficult to make 
an assertion as to the presence or absence of a 
weapon hedra in the bone which would be obvious in 
another part, especially if the hedra happens to come 
in the sutures themselves. For the suture itself 
being more uneven than the rest of the skull is 
deceptive, and it is not very clear which part is 
suture and which hedra, unless the hedra is very 
large. As a rule, too, fracture accompanies the 
hedra when it occurs in the sutures, and the fracture 
itself is harder to make out — though the bone is 
broken — for this reason, viz. that when there is a 
break it comes, as a rule, just in the suture. For 
the skull here is readily fractured or comes apart 
owing: to the natural weakness of the bone in this 
place, and because of its porosity. Besides, the 
suture as such is ready to rupture and come apart, 
but the bones containing it remain unbroken because 
they are stronger than the suture. Fracture occur- 
ring in a suture includes a giving way of the suture, 
and it is not easy to make out whether the breaking 
and coming apart follows a weapon hedra occurring in 
the suture, or whether it is after contusion of the 

1 Scaliger's emendation for cufifiAtirei, confirmed by B. 

* al>Tr)rnv . . . ytyio/xeviicri l'q. 3 tfv. 

27 



IIEPI TON EN KEOAAHI TPftMATHN 

o~dptca<;, payfj teal Bta^dXacrt]' dXX* eo~Ti ^aXeird)- 
repov (ppdaaaOai, ttjv vltto tt)<; cfiXdcrio? pcoyp,rjv. 
<TV<ytc\eTTT0vcn yap ttjv yvcofitjv teal tijv o^jriv tov 

30 IrjTpov avral at pacpal pcoyp,oei8ee<> cf>aiv6pevai 
ical rprj^vrepai eovaat tov aXXov ocneov, on fir/ 
lo")(ypS><; hieKOTrri ical 8te^dXaaev 8iatco7rr) 8e teal 
ehprj tu>vtov icrriv. dXXa %/o»;, 6i ' Kara rd<; pacpas 
to Tpcoiia yevotro ical 7rpo? 76 to ocrreov teal e? to 
ocneov aTrjpi^eie to /3eA.o<?, irpoaeyovTa tov voov 
dvev pia tceiv ti dv Tre-novBr) to ocneov. diro yap 
icrcov Te ffeXeoov to p,eyeOo<; teal opcoicov teal 7roXXa> * 
T6 iXaaaovcov, icai 6/W&)? tc TpeoOels icai ttoXXo) 2 
y]cxaoVy ttoXXw p,e^ov e/CTtjcraTO t6 icaicbv ev tw 

40 oanew e? ras pacf>ds 8e^dp,evo<i to fteXos r) fir) 
e<? Ta? paepds 8ei;dfievo<;. icai tovtcov to. 7roXXd 
irpieadat 8et° dXX* ov xprj avTas Ta<? pacpas 
nrpieiv, aAA,' diroyviprfo-avTa ev tu> TrXrjcriov 6o~Tew 

44 ttjv irpiaiv iroielaBat, rjv irpir)^. 

XIII. Tie pi 8e ujo~ios TpwaiwvTwv ev ttj tcecpaXf) 
ical 6V&)9 xpr) e£eXey%eiv rd? ird6a<; Ta? ev to> 
6o~Te<o yevofievas Ta<; fir) cpavepds, (b8e fioi Botcel. 
eXreosev tjj icefyaXf) ov^prjTeyyeiv ovhevl, ov8e otvw, 
dXX«9 rjfcicTTa' 3 ov8e tcaTarrXdo-aeiv, ov8e fiOTfp 
ttjv tr/aiv Troieiadai, ov8 eirtSeiv )(pr) eX/cos ev tt} 
KecpaXfj, i)v firj ev tw fieTooirw 17 to eX/cos, rj ev tw 
■^nXa) tmv Tpiyjhv, i) irepl ttjv ocppvv ical tov 
6(f)0aXfjLov. evTavOa 8e yivofieva ra eXicea tcaTa- 

10 TrXdo-ios ical eTri8ecrio<; fidXXov Ke^piiTai, »; ttov 

1 TTOWSv. 

2 iro\i. 

3 o\a' is rjKHTTa P(j., but with less support from MSS. or the 

context. 

28 



ON WOUNDS IN THE HEAD, xii.-xm. 

skull and flesh that it breaks and comes apart. 
Still, the fracture that follows contusion is harder to 
make out. For the sutures themselves, having a 
fracture-like appearance, and being more uneven 
than the rest of the skull, deceive the mind and eye 
of the physician, when not violently cleft or gaping 
— cleft and hedra are the same. 1 Now, if the wound 
is at the sutures, and the weapon penetrated the 
parts about the bone, and to the bone, you should 
devote your attention to finding out what injury the 
bone has suffered. For a person wounded by weapons 
of equal, similar or much less size to a similar or 
much less extent suffers far greater mischief in his 
skull if he receives the weapon at the sutures than 
when it is not so received, and the majority of these 
cases require trephining. You should not, however, 
trephine the sutures themselves, but, leaving an 
interval, operate on the adjacent part of the bone, if 
you do trephine. 

XIII. The following is my view of the treatment 
of wounds in the head, and the way to discover 
affections of the skull which are not manifest. A 
lesion 2 in the head should not be moistened with 
anything, not even wine, much less anything else, 3 
nor should the treatment include plasters or plugging, 
nor ought one to bandage a lesion in the head, unless 
it is on the forehead or in the part devoid of hair, or 
about the eyebrow or eye. Wounds occurring here 
are more suited to plasters and bandaging than those 

1 Surely an insertion. 

* (Kkos is defined by Galen as " a lesion of continuity in the 
soft parts." The "wound," therefore, concerns the scalp 
only. 

3 Or, reading a\K' iis i'ikhttu "except the least possible," 
but the "correction" seems needless. 

29 



IIEPI TON EN KE$AAHI TPQMATQN 

dXXoui tt)<; K€<fia\f)<; rrj<i aXXt;?' Trepie^/ei yap 
rj K€(j)a\r] t) aXXrj to perwirov rrdv e/c 8e rcov 
Trepie^ovTOOv ra eXtcea, real iv 6'tw civ fj to- eXicea, 
(f)\eypaivei Kal eiravoi8ia Kerai oV a'tparos irrip- 
poijv. XPV 8e ov8e ra iv ra> perunTO) 8id rravrbs 
tov xpovov KararrXdaaeiv Kal iiriheiv, aU' 
iireiSav rravarjrai <$Xey paivovra, /ecu to ol'hrjpa 
Karaarfj rravaaadai KararfXaaaovra Kal irn- 
Seovra,' iv he rfj aX\y /cecpaXf) eXKOs ovre porovv 
20 xprj, ovre KaratrXdaaeiv ovt e-rrihelv, el prj Kal 
roprjs 8eoiro. 

Tdpveiv 8e XPV T ^ v eXicewv rcov iv fce(f>aXr) 
yevopevcov, Kal iv rw perdoirw, onov av to pev 
oareov tyiXov 77 rrjs crap/cos, Kal Bo/cr/ tl vivos 
eyew vrro tov /3eA.eo?, ra he eX/cea pt] i/cava to 
pieyedos tov pi]Keo<; Kal rrjs evpvrrjros e? TrjV 
crKeyjnv tov oareov, el tl ireiTovOev vrro tov /3eXeo? 

KaKOV Ka* 07TOLOV Tl 7T€7TOvde, Kal OTTOaOV pev f) 

aap£ irefyXaarai Kai to oareov e%ei tl alvos, Kal 
30 8 avre el derives re ecrTi to oareov virb tov /3eXeo<? 
Kal prjhev irerrovOe KaKov, Kal e? rrjv 'irjaiv, OTroirjs 
tivos helrai to re cXkos rj re adp% Kal rj ird0>] 
tov oareov ra 8e roiavra rcov k\Keu>v ropitjs 
8elrai. Kal orav 1 pev to oareov y^riXwOr/ rrjs 
aapKos, vwoKOiXa 8e f) e? rrXdyiov eVl iro\v 
irravarapveiv to koTXov, ottov pi] ev%epe<; rS> 
(frappaKW d(piKeaOai, orroiw av rivv XP'I' Kai T ^ 
KVKXorepea rcov eXKecov Kal viroKOiXa etrl rroiXi) 
Kat, ra roiavra iiravarapvcov rbv kvkXov 8ix") 
40 Kara pf]KO<i, &>? 7re<pvKev covOpwiros, paKpbv 
iroielv to eXKos. 

Tdp,voi'Ti 8e KecpaXy'jV, ra pev dXXa rrj<; 
3° 



ON WOUNDS IN THE HEAD, xm. 

elsewhere in the head, for the rest of the head 
surrounds the whole forehead, and it is from the 
surrounding parts that lesions, wherever they may 
be, get inflamed and swollen by afflux of blood. 
Not even on the forehead should you use plasters 
and bandaging all the time, but when inflammation 
ceases and the swelling subsides, stop plasters and 
bandaging. On the rest of the head you should not 
plug, plaster, or bandage a wound unless incision is 
also required. 

One should incise wounds occurring in the head 
and forehead where the bone is laid bare and seems 
to be in some way injured by the weapon, while the 
wounds are not long and broad enough for inspection 
of the bone, to see whether it has suffered any harm 
from the weapon, the nature of the injury and extent of 
the contusion of the flesh and any lesion of the bone, 
or, on the other hand, whether the bone is uninjured 
by the weapon, and has suffered no harm ; also, as 
regards treatment to see what the wound requires, 
both as regards the flesh and the bone lesion. These 
are the kinds of wounds that require incision. When 
the skull is laid bare and there is considerable 
undermining on one side, open out by incision the 
hollow part where it is not easy for the suitable 
remedy to penetrate. In the case of circular 
wounds which are undermined to a considerable 
extent, open these out also by a double incision 
up and down as regards the patient l so as to make 
the wound a long one. 

Incisions may be safely made by the surgeon in 

1 i.e. at opposite sides of the wound above and below. 

1 h.v ixtv P. 

3* 



IIEPI TON EN KEOAAHI TPOMATQN 

K€<f)a\rj<; da(pa\€irjv eyei Ta/xvofieva' 6 Be Kpora- 
(fyos, /eat dvcoOev en, rov Kpord<pov, Kara rrjv 
<})\e/3a rr/v Bid, rov xpordfpov <pepop,evyv, rovro 
Be rb j(wpiov p,rj rdfxveiv, airaapLOS yap eirikapi- 
ftdvei rbv TfMjdevra' ical rjv p,ev eV' dpiarepa 
rp,rj$f} Kpordcfrov, 1 ra errl Be^ia o arraapuo^ eVtXa/x- 
ftdvei, rjv Be eVi ra Be^ia r/j,r/6fj Kpordtpov, ra, 

50 eV 1 dpiarepa o arraapib^ €Tn\ap,/3dvei. 

XIV. "Orav ovv rdpLvrjs eAvco? iv KecpaXfj 
oareov eZveica rr)<i cra/j/co? eyjrtXuip.ei'OV, deXcov 
elBevai et ri ey^ei rb oareov icaicbv vtto rov /3eA,eo<? 
r) Kal ovk ex^i, rdpuvetv %pr) rb fiffyepo? rrjv 
wreiXyjv, 2 orroar] av Bokt) aTro^prjvai. rdpivovra 
Be %pr) dvaarelXai rrjv adptca drrb rov oareov 17 
7rpo? rfi pbrjviyyi Kal 77-/90? ra> oarew irecpvKev, 
eireira Biapiorwaai to eX/co? rrdv p,orw, bans av 
evpvrarov to e\«o? irape^ei e? ri]V varepairjv avv 

10 ekayiarw ttovw' fiorcoaavra Be KararrXdajxari 
yjprjaOai birbaov av irep %p6vov Kal rw p,orw, p-dfrs 
€K Xeirrwv dXcpirwv, ev 6'fet Be pudaaeiv, fhJreiV Be 
Kal yXiaxprjv rroielv 009 p,d\iara. rfj Be vare- 
pair) i)p,epr), erreiBdv e^eXr/s rbv puorov, KariBwv ro 
oareov b ri rreirovdev, edv p.r) aoi Kara<f>avrj<; 
y r) rpwais, brro'i^ Tt<? eariv ev rw oarew, p,i]Be 
BiaryivwaKrj'i et re ri €%ei to oareov KaKov ev 
ewvrw, r) Kal ovk e^ei, to Be /SeA.09 Bokj} d<f)iKe- 
adai €9 rb oareov Kal aivaadai, em^veiv ^pr] ru> 

20 ^varfjpi Kara ftdOos Kal Kara p.i)Kos rov dvdpw- 
7rov to? Tre'cpvKe, Kal av9i<i emKapaiov ro oareov 
rwv prjtjiwv elvexa rwv dcpavewv IBeiv Kal tt/9 

1 iv t$ . . . Kpordcpcv also below eV T<? eirl 8e£ia Tju^flf) 
Kpordipcp, Kw. 

32 



ON WOUNDS IN THE HEAD, xm.-xiv. 

any other part of the head, but lie should not incise 
the temple, or the part above it in the region 
traversed by the temporal blood-vessel, for spasm 
seizes the patient. And if incision of the temple is 
made on the left, spasm seizes the parts on the 
right, while if the incision is on the right, spasm 
seizes the parts on the left. 

XIV. When, therefore, you incise a head wound 
because the bone is denuded, and you want to know 
whether it has, or has not, suffered any injury from 
the weapon, the size of the open wound should be such 
as seems fully sufficient. When operating you should 
detach the scalp from the skull where it is adherent 
to the membrane * and to the bone. Then plug the 
whole wound with lint, so that next day it will 
present the widest possible lesion of continuity with 
least pain. When plugging use a plaster of dough 
from fine barley meal to be kept on as long as the 
lint. Knead it up with vinegar and boil, making it 
as glutinous as possible. Next day, when you take 
out the lint, if, on looking to see what the bone has 
suffered, the nature of the lesion is not clear, and 
you cannot even see whether the skull has anything 
wrong with it, yet the weapon seems to have 
reached and damaged the bone, you should scrape 
down into it with a raspatory, both up and down as 
regards the patient, and again transversely so as to 
get a view of latent fractures and contusion which 

1 Vidius suggests that this refers to the connections 
between pericranium and dura mater at the sutures Celsus 
seems to translate "membranula quae sub cute, calvariam 
cingit." VIII. 4. 



to^tju, Kw's conjecture. 

33 



vol. rn. 



IIEPI TON EN KEOAAHI TPOMATDN 

<f>Xdaio<> elve/ca t% d<f)aveo<; tt?9 ovk ia(pX(o/ J tevr)<i 
kaoo etc Trj<i (pvaios rrjs K€(f}aXi)<; rov aXXov oareov. 
ei;€XeyXei yap r) Averts fidXa to ica/cov, rjv /jur) Kal 
aWax; Karacpavees ewaiv avrai al irddai al eovaai 
iv rat oarew [rou /3e\eo9]- 1 /cal rjv eBprjv lBr)<; iv 
ra oarew rov /3eA,eo9 5 im^veiv XPV av TVV re rrjv 
eBprjv Kal rd ireptexovra avrr)v barea, /xr) rroX- 
30 \cLKLq rfi eBprj rrpoayeviirai pl)i;t<> Kal (pXdais, rj 
jAovr) (fyXaais, erretra XavOdvrj ov /earcKpavea 

&OV7CL. 

ErreiBdv Be %v<rr]<; rb oareov tm ^varijpi, rjv 
Liev BoKrj e? rrptacv dcpijKeiv r) rpebaa rov oareov, 
rrpieiv XPV> Ka{/ Ta<i T P € ^ ^p-epas fir) vrrepfidXXeiv 
dirptwrov, dXX iv ravryai rrpieLv, aXXcos re /cal 
T^9 Oep/iris copr/s, i)v e£ dpx")? Xap/3dvr)<; rb Irrpua. 
*Hy Be vrroTTTevrjs p.ev to oareov ippwyevai rj 
7re<pXda0ai, rj dp,(f>6repa ravra, reKfiaipofievo^ ore 

40 layvpw? rerpwrai etc ro)v Xoycov rov rpw^iarlov, 
Kal on virb laxvporepov rov rpd>aavro<;, rjv erepo'i 
v(f)' erepov rpcodfj, Kal to /5e\o9 orat erpcodrj, 
on rbbv fcatcovpyatv fieXecov r)v, erreira rov 
dvdpcoiTov on Blvos re eXafte Kal aKoros, Kal 
eKapooOrj Kal Kar'erreaev rovrwv Be ovrco yevofxe- 
vo)v, rjv fxr) BiayivdyaKrjs el eppwye ro oar ov rj 
7re<f)Xaarai, i) Kal d/xfyorepa ravra, p.yre dXXws 2 
opecov Bvvrj, Bel Br) errl ro oareov to tijktov to 
fieXdvrarov Bevaas, 3 rur p.eXavi (f)app.aK(p tw 
rr)Kop,ev(p arelXat* rb eXKo<;, viroreiva<; oQoviov 

50 eXa'iw rty^as' 5 elra KararrXdaas ry p-d^y *7riBfj- 
aai. rfi Be varepaiy diroXvaa^, eKKadifpas ro cXko? 
im^vaai. Kal i)v firj rj vyies, dXX ippojyy Kal 
1 Omit B. Kw. a '6\us Pq. * Sevaavra. 

34 



ON WOUNDS IN THE HEAD, xiv. 

is latent because the rest of the bone is not crushed 
in out of its natural position. For rasping shows up 
the mischief well, even if these lesions though existing 
in the bone are not otherwise manifest. And if you 
see a weapon hedra in the bone, you should scrape 
the hedra itself and the bone containing it, in case, 
as often happens, fissure with contusion or contusion 
alone accompanies the hedra, and not being well 
marked, is overlooked. 

When you scrape the bone with the raspatory, if 
the skull lesion seems to be a case for trephining, you 
should operate and not leave the patient untrephined 
till after the three days, but trephine in this period, 
especially in the hot season, if you take on the 
treatment from the first. 

Should you suspect the skull to be fractured or 
contused or both, judging from the patient's account 
that the blow was severe and inflicted by a stronger 
person — if he was struck by someone else— and that 
the instrument with which he was wounded was of a 
dangerous kind ; further, that the man suffered 
vertigo and loss of sight, was stunned and fell down : 
in such circumstances if you cannot otherwise dis- 
tinguish by inspection whether the skull is fractured 
or contused or even both, then you must drop on 
the bone the very black solution, anoint the wound 
with the dissolved black drug, putting linen on it 
and moisten with oil, and then apply the barley- 
meal plaster and bandage. Next day, having 
opened and cleansed the wound, scrape further, 
and, if it is not sound but fractured and contused, 



4 Difficult text. <TT«rAai = swperteycre, inungcre. 



35 



IIEPI TDN EN KEOAAHI TPDMATftN 

Tre(j)\acr/jLevov rj, to /xev aXXo earai Sareov \evtcbv 
eTTi^vofievov r) 8e pcoyp.rj ical r) (p\dcri<;, Karara- 
tcevTos tov <f)ap/j,dKov, Se^a/xevrj to <f)dpp,a/cov e? 
koavTrjV fie\av iov, kcTai fie\aiva ev \evtcw t&> benew 
t& dWw. aWa xpr) a-v9i<; Trjv pa>yfxr)v TavTrjv 
<pavelcrav fieXaivav em^veiv icaTa fiddos' teal rjv 
fiev €7ri^v(ov [ttjv po)yp,rjv TavTtjv (paveiaav p,e\ai- 

60 vav\ 1 i^i\r}<; /cal depavea Troirjcrr)?, <p\do-i<; p,ev 
yeyivrjTcu tov bo~Teov rj pbdWov r) fjararov, r)Ti<; 
7repieppr)^e /cat ttjv pcoyp,r)v ttjv dcpavicrOetcrav vtto 
tov %vo-Ti)po<i' r)o~o~ov Be <f>o/3epbv /cal r)acrov dv 
Trpryyp,a air avTrj? yevoiTO d(f>avio-0eio~r)<; tt/9 
pcoyfifjs- rjv Be /caTci fiddos rj ical p.r) edeXrj e^ievai 

66 iTrii;vop,€vr], d<f>rj/cei €<? nrplcnv r) TOiavTt) av/j,(f>oprj. 
XV. 'AXXa ^PV irpiaavTa to, \onrd IrjTpeveiv 
to e\.«o<?. (pv\do~o~ea6ai Be %pr) ott(o<; p.rj ti 
/ca/cbv arroXavcrr) to 6o~t£ov dirb t% aapicos, 
rjv Ka/cS)<; hiTpevrjTat,. oaTeco yap /cal Treirpio-- 
fxeva) real aWea aTTpio-Tw e-^nXcop-evq) Be, /cal 2 
vyiel Be iovri /cal eyovTi ti vivos vtto tov /3e\eo<;, 
Bo/ceovTi Be vyiel eivai, /civBvvbs ecrTt, p.aX\ov 
vttottvov yeveaOai, rjv ical aWeos fir) fieWrj, rjv 
real r) crdpi; r) irepieyovcra to bcTTeov /ca/c(b<; 

10 OepaTrewjTai, teal (pXeyfiaivrj tc koX TrepicrfyLy- 
yrjTar TrvpeTcbBe'i yap yiveTai /cal ttoWov 
cpXoyfiov nrXeov ical Br) to 6o~t€ov i/c tS)v 
irepieypvawv crapicwv e<> ewvTO Qepfi-qv T€ zeal 
epXoypibv /cal dpaBov ifnroiel /cal o~<f)vy/jLov, zeal 
birbcra irep r) odp% e^et /ca/cd ev ecovTy, /cal i/c 
tovtwv a)8e 3 vttottvov yiveTai. /ca/cbv Be /cal 
vyprjv tc elvac ttjv adp/ca ev tS> e\/cel ical 

1 Probably a gloss : many codd. and editt. omit. 
36 



ON WOUNDS IN THE HEAD, xiv.-xv. 

the rest of the bone will be white after scraping, 
but the fracture and contusion will have absorbed 
the dissolved drug and will be black in the white 
bone. You should again scrape down into this 
fracture which shows black, and if on further 
scraping [this fracture which shows black] you clear 
it away and make it invisible, there has been more 
or less contusion of the bone, which also produced 
the fracture now abolished by the raspatory, but it 
is less formidable and less danger will result from it 
now the fracture has disappeared. Should it go 
deep and refuse to disappear when scraped, such an 
accident is a case for trephining. 

XV. After the operation you should use the other 
treatment requisite for the wound. 1 You should guard 
against any mischief spreading from the tissues to 
the skull owing to improper treatment. For when 
the bone is trephined or otherwise denuded without 
trephining — whether really sound, or injured in 
some way by the weapon though apparently sound 
— there is greater risk of suppuration, even if it 
would not otherwise occur, if the flesh about the 
bone receives improper treatment and gets inflamed 
and strangulated. For a sort of fever occurs in it, 
and it becomes full of burning heat, and finally the 
bone draws into itself heat and inflammation from 
the tissues about it, also irritation and throbbing, 
and everything bad which the flesh already con- 
tains, and so it becomes purulent. It is also bad 
for the tissues in the wound to be moist and 

1 Vidius : "cetera t'acienda sunt quae ulceris curatio 
postulat." 

2 topiary St, Kal B. K\v. ; the rest omit. 3 ovrw j. 

37 



IIEPI TON EN KEOAAHI TPCJMATQN 

puvboiaav /cal cttI 7ro\\bv ypovov /caOaipeaOar 
aX\d xpr) bidirvov piev Troifjaat rb k'X/co<; &>9 

20 rd^iara' ovtco yap av r)Kiara cf)Xeyp.atvoi to, 
irepieyovTa to eX/cos /cal Ta^iar av KaOapbv 
elrj. dvdy/crj yap eyei ras adp/ca<; ra? /coirelaas 
real cfiXaadeiaas vtto tov /3e\eo9, vwoirvowi 
yevop,eva<i, e/cTaKrjvat. eireibav be /caOapdr}, 
^rjpoTepov xprj ylveadat to eX/co<>' ovra> yap 
av rd^iara vyies yevoiro, i;i]pf]S aapicb<; fiXaa- 
Tovarjs /cat fx-q vyprj?, real ovtco? ov/c av 
vTrepaap/ct)aete rb eA/eo9. o be avrb 1 ? \6yos 
koX virep 1 ttj<s pu'iviyyos T779 irepl tov iy/cecfraXov 

30 r)v yap ai/TL/ca e/cirpiaa<; to oaTeov ical dcfreXwv 
d-Tro t?}9 p,t]Viyyo<; -^TLXu/arjfi avTrjv, /cadaprjv XPh 
TTOirjcrat &>9 rdyjLQ-Ta /cal ^rjprjv, &)9 p-r) eVt 
ttoXvv y^povov vyprj eovaa /xvhf) T€ /cal e^aiprjrar 2 
tovtwv yap ovtco ytvopevcov aa-nrp/ai ai>Tr)v 

36 /civbwos. 

AVI. Uo~t€ov be ti or) ajroaT^vat bet airo 
Tov aX\ov oaTeov, eX/ceos ev /cecpaXrj yevop,evov, 
ebprjs re eovarj<; tOv /3e\eo9 ev too oaTeco, r) 
aXXco? eirl ttoXv yfriXcoOevTos tov oaTeov, 
dcpLaTaTai eirl ttoXv h^aipuov yevop.evov. dva^rj- 
palveTai yap to alpa e/c tov oaTeov vtto tc tov 
%p6vov teal v7ro <$>app,dicwv twv irXeiaTOiv. Ta- 
^icna £>' av diroaTair), el Tt9 to eX«09 cl)9 TayiaTa 
Ka9i')pa<; frrjpalvot to Xoittov to re eX/cos /cal to 

10 oaTeov, /cal to pie^ov ical to r)aaov. to yap 
TayjLaTa d-rro^ripavOev /cal diroaTpaKcoOev tovtq) 
p^dXiaTCL difiiaTaTai diro tov dXXov oareov tov 



1 * 



38 



ON WOUNDS IN THE HEAD, xv.-xvi. 

macerated, and to take a long time to clean up. You 
should rather make the wound suppurate as quickly 
as possible ; for thus the parts about it will be least 
inflamed and it will be most rapidly cleansed ; 
for the tissues that are pounded and contused by 
the weapon must necessarily become purulent and 
slough away. When the wound is cleansed it 
should get rather dry, for so it will soonest become 
healthy, the growing tissue 1 being dry and not 
moist, and thus the wound will have no exuberance 
of flesh. The same principle applies to the mem- 
brane covering the brain. For if you trephine at once 
and by taking away the bone denude this mem- 
brane, you should make it clean and dry as soon as 
possible, lest by being moist a long time it should 
fungate and swell up, for in such circumstances 
there is risk of its becoming putrid. 

XVI. Any bone which is bound to separate from 
the rest, when a wound has occurred in the head 
and there is a weapon hedra in the skull, or when 
the bone is otherwise extensively denuded, usually 
separates after becoming bloodless, for the blood 
in the bone is dried up both by time and by most 
applications. The separation would occur most 
rapidly if, after cleansing the wound as soon as 
possible, one should next dry both the wound 
and the bone whether larger or smaller. For what 
is soonest dried up and made like a potsherd, 
thereby most readily separates from the rest of 
the bone which is lull of blood and life, having 

1 Our "granulation tissue." 
2 ^epjjrat, 

39 



IIEPI TON EN KEOAAHI TPflMATQN 

ivaifiov re /cat £coz>to?, avrb e^at/nov re <yev6p,evov 
14 /ecu %r)pbv [rq> evaiptw Kal ^wvrt fidXa d<^'tararai\?- 

XVII. "Oaa 8e rwv oarecov eacpXdrat eaoi i/c 
tt;? (pucrios ri}s ecovrcov, Karappayevra rj Kal 
SiaKonevra rrdvv evpea, uKivovvorepa rd rotavra 
ylverai, eirrp rj firjvty^ vyirjs $• Kal ra rrXeoat 
pcoyp^fjatv ea Karappayevra Kal eupvreprjatv en 
aKivhuvorepa Kal evptapiarepa e? rrjv dcpaipeaiv 
ylverai. Kal ov yprj irpieiv rwv roiovroiv ovSev, 
ovoe KivSvveveiv rd oarea 7reipct>p,evov d<paipetv 
irplv rj avru/xara eirav'ty el/cb<i irpwrov %aXd- 

10 aavros. 2 eiravepyerat 8e tt)<? aapKos viro<f>vo- 
/ie^'7;?• vrro^verai 8e etc t>}? cH7rXo?7? rod oareov 
Kal €K rov byieos, rjv 1) dvaiOev potpr) rov oareov 
fiovvT] a^aKeXiarj. ovrco 8' av rdyiara rj re 
adp£ v7to<J)volto Kal ftXaardvot Kal rd oarea 
iiravtoi, et ri<; to cXkos <w? rdyj,ara Sidirvov 
Trou)aa<; Kadapbv rroujarjrai.^ Kal rjv 81a 
iravrb'i rov oareov dfx(f>a) at ptolpat eacpXaaOwaiv 
eaco e? ttjv firjviyya, rj Te dvco fioiprj tov oariov 
Kal rj Kara), Irjrpevovri ooaavrco<; to e'A.«o? vytes 

20 rdytara earai, Kal rd oarea rdyiara errdveiai 

21 rd iafyXaaQevra eao). 

XVIII. T<yy 8e irai8lu>v rd oarea Kal Xcttto- 
repd eari kuI fiaXOaKcorepa Bid rovro, on evai- 
pLorepd iari, Kal KolXa Kal ar)payyd)8ea Kal 
ovre rrvKvd ovre areped. Kal vrro rwv fieXewv 



1 Following Kw.'s reading and punctuation of this much 
controverted passage. Scaliger and others omit the last 
words. 

2 ' ' This passage is corrupt and depraved in all the 
examples." Foes. 



40 



ON WOUNDS IN THE HEAD, xvi.-xvm. 

become itself bloodless and dry [it readily comes 
away from the vascular and living part]. 

XVII. Cases of contused fracture of the bones 
with depression when they are broken up and 
even comminuted very widely, are less dangerous 
(than other injuries) if the covering of the brain 
is unharmed, and where the bones are broken in 
with many and rather wide fractures they are still 
less dangerous, and are more readily removed. In 
such cases you should do no trephining, nor run 
risk in trying to remove bone fragments before they 
come up of their own accord : they naturally come 
up when there is a loosening. 1 Now the frag- 
ments come up when the Hesh grows from below, 
and it grows up from the diploe of the skull 
and its healthy part, if there is necrosis of the 
upper table of the skull only. Such upgrowth 
from below and burgeoning of the flesh will 
take place most rapidly if one brings the wound 
as soon as possible to suppuration and cleanses it. 
If the whole bone with both its "tables," 2 both 
upper and lower, is contused inwards and depressed 
into the cerebral membrane, it is by the same 
treatment that the wound will heal soonest and 
the bone fragments that are crushed inwards come 
up most quickly. 

XVIII. The (skull) bones of young children are 
thinner and softer because they contain more blood 
and are hollow and porous and neither dense nor 
hard. And when wounded by equal or weaker 

_ * " Subsidence of the swelling," Adams, reading otSeos for 
clubs as Littre. 

2 Literally " parts." 

8 iroirjaetfy. 

4* 



IIEPI TON EN KEd>AAHI TPOMATDN 

caoov re ibvToav Kal aa9evearepo)v, Kal rpcoOevrcov 
o/aolws re Kal rjacrov, to tov vewrepov nraiSiou 
kcli fia.KX.6v teal Odcraov viroTrvtaKerai rj to tou 
Trpecrfivripov, Kal iv iXdacrovc xpovo) - Kal ova 
av a\\(t)<; pteWrj airodavelaOai €K tov Tpcop.aTO 1 ?, 
10 o i'€(OTepo<i tov Trpeafivrepov daaaov aTToWvrai. 
AWa XP 1 !' V v ^L\co6y tyj<; (rap/ebs to ocrreov, 
TrpoakyovTa tov voov, Tretprjadai Siaya'coa/ceii* 
b ti pa] eo~Ti Tola iv 6cf)@a\p,olo~iv ISelv, Kal 
yvwvai el eppcoye to oareov /cal el 7re<fi\acrTai, 
r) pLovvov TrecfiXaaTat, teal el, eSprjs yevop,evi]<; 
rov /3e\eo<;, irpocrecrTL (j)\do~i<; i) pooypLi] f) dpufxv 
TavTa. Kal i]V ti tovtwv irerrovOe to 6o~Teov, 
a<j)eh'ai tov aip,aTO<; TpvircovTa to oareov a/xtfcpa) 
Tpvrrdvu), (pv\.aaa6pievov eV oXlyov \eirTOTepov 

20 yap to oariov Kal imiroXaLOTepov to>v vecov rj 

21 twv Trpeo-fBvTepcov. 

XIX. ' Oo"Tt? he pLeWei etc Tpa>p,ciT(i)v iv xecpaXfj 
aTTodin'jaiceiv, Kal pLrj 8vi>aTov avTov vyid yeve- 
adat p.i]$e awO^vai, eK Twv8e tcov o~r)p,el(ov \Ph 
ttjv hidyvwaiv iroieiodai tov /ze'AAoz'TO? aTroOvrj- 
aKeiv, Kal irpoXeyeiv to fieWov eaeaOai. Trdaye^ 
yap T(iSe' oiroTav Ti? oariov KaTerjyos rj ippcoyb? 
f) 7re<fi\ao p,evov, -t) 6tu> yovv Tpo-rrco KaTerjyb? 
evvoi']aa^ dfidprrj, Kal p,i]T€ ^vtrrj purjTe rrplarj 
/j.>'jTe Seop,evov, pajre * 8e a>? vyieos 6vto<; tov 
10 oo~Teov, Ttpb tojv TecraepaKaiheKa rjpLepeoov Trvperbs 
eTri\i']y\r€Tai, o>9 iirl ttoXv iv ^e/yucow, iv Be too depet 
p,eTa Ta<; e-rrTa r)p,epa<i 6 irvpeTOs iirt\apL{3dvei. Kal 
iiretSav tovto yevtjTai, to eX/co? d)(poov yiverai 

1 This fourtii ,u.7jTf puzzles nearly all the translators. 
They leave it out. I follow Petrequin. ju*0j) 8« Litt. Erra. 
42 ' 



ON WOUNDS IN THE HEAD, xvm.-xix. 

weapons to a similar or less extent the skull of 
the younger child suppurates more readily and 
rapidly than that of the elder and for a shorter 
period, 1 and when they are going to die in any case 
from the wound, the younger perishes sooner than 
the elder. 

But if the bone is denuded of flesh you should 
devote your intelligence to trying to distinguish a 
thing which cannot be known by inspection — 
whether there is fracture and contusion of the skull 
or only contusion, and whether, if there is a 
weapon kedra, it is accompanied by contusion or 
fracture, or both of these. If the bone is injured 
in any of these ways, let blood by perforating 
with a small trepan, keeping a look-out, at short 
intervals, 2 for in young subjects the skull is 
thinner and more on the surface 3 than in older 
persons. 

XIX. When anyone is going to die from wounds 
in the head, and it is impossible to make him 
well or even save his life, the following are the 
signs from which one should make the diagnosis 
of approaching death and foretell what is going 
to happen. He has the following symptoms— 
when, after recognising that the skull is injured, 
either broken or contused, or injured in some way, 
one makes a mistake and neither scrapes nor trephines 
as though it were not required, yet the bone is 
not sound, fever as a rule will seize the patient 
within fourteen days in winter, and in summer 
just after seven days. When this occurs, the lesion 

1 So Petrequin, avoiding a tautology. 
1 Cf. Oafxiua (TKmriw/j.fi'OS, XXI. 

8 i,e. has less depth. 

43 



IIEPI TON EN KEOAAHI TPDMATDN 

/ecu ££ avrov *%&>/) pel o-pi/cpo<>' ical to cpXeypal- 
vov i/CTe@v7)K€v €% avrov' ical /3A.f^<wSe<? x <y'iveTai 
/cat (frcuverai oiatrep Tapvypk, \poir]v irvppbv, 
vrroireXiov /cal to oareov cr^a/ceXl^eiv TrjvacavTa 
dpyerai, ical yiverai wepicvbv Xelov ov, 2 reXev- 
ralov he hirco^pov yevopevov rj e/cXet'/cov. orav 

20 o 77677 vttottvov 77, iirl rfj yXwo~o~r) (pXv/CTalvai 
juvovTai, /cal TrapcKppovewv TeXevrd. ical aTracrp6<{ 
iiriXapfidvei tou? irXeiarov<i tcl eVt ddrepa tov 
<T(i>paTO<;' rjv pev iv tc3 eV apio-repa tj}? icecpaXrjs 
^XV T0 eXKO^, ra eVl he£td tov acoparof 6 
<nrao~pb<i Xapfidvei' rjv 8' iv ra> iirl he£id T779 
K€<paXr}<; e'^77 to eX.«09, to, iir dpiaTepd tov 
ad>paTO<; o"7raoyio? €TriXap,/3dvei. elal 6° ot 
ical dTTOTrXrjKTOi ylvovTai, /cal ovtws d-rroXXvvTai 
irpo kiTTa r/pepcov iv depei rj Teaadpcov /cal heica 

30 iv yeip&vi' opolcos he tc\ crrjpeia ravra arjpaivei, 
/cal iv TrpecrfivTepcp iovTi to> TpcopaTi 77 ical iv 
veoiTepw. 

'AXXa XPV> el ivvoirj^ tov irvpeTov iiriXapfid- 
vovTa /cal twv aXXtov tl arjpelov tovtco 7rpoaye- 
vopevov, prj htaTplftetv, dXXa irplaavTa to ocneov 
7T/J09 T77i> prjviyya rj icara^vcravTa tu> ^vaTtjpi — 
€impio~TOv 3 he yiverai ical cv^vcttov — eireiTa tc\ 
Xonra ovtgos IrjTpeveiv oVta? dv hoicr) avp(pepeiv, 

39 7T/30? to yivopevov 6pa>v. 

XX. "Orav o" iirl TpcopaTC iv /ce(f>aXf} dvdpoo- 
7rov rj ireTT picopevov 77 dirpKorov, i-^nXa>pevov he 
tov oaTeov, othrjp,a iiriyevr]Tai ipvdpbv ical ipvai- 
ireXaTwhes iv tg> irpoardoirtp /cal iv iolaiv 
O(p0a\polo~iv dp,<f)OTepot,o~iv 77 tco eTepw, ical ei tis 
diTTono tov olhripaTos, 6hvv<oTo, ical 7rvpeTO<; 
44 



ON WOUNDS IN THE HEAD, xix.-xx. 

»ets a bad colour and a little ichor flows from it, 
the inflammation dies completely out of it, it gets 
macerated and looks like dried fish of a rather livid 
reddish colour. Necrosis of the bone then sets in, 
it gets dark coloured instead of white, 1 finally 
turning yellowish or dead white. When it has 
become purulent, blebs appear on the tongue and 
the patient dies delirious. Most cases have spasm 
of the parts on one side of the body ; if the patient 
has the lesion on the left side of the head, spasm 
seizes the right side of the body ; if he has the 
lesion on the right side of the head, spasm seizes 
the left side of the body. Some also become 
apoplectic and die in this state within seven days 
in summer and fourteen in winter. These symptoms 
have the same value both in an older and a younger 
patient. 

If, then, you recognise that fever is seizing upon 
a patient and that any of these symptoms accom- 
panies it, make no delay but, after trephining the 
bone down to the membrane, or scraping with 
the raspatory (for the bone becomes easy to saw 
or scrape), treat the case in future as may seem best 
in view of the circumstances. 

XX. When in case of a wound in the head, 
whether the patient has been trephined or not, 
the bone being denuded, there supervenes a red 
erysipelatous oedema of the face and one or both 
eyes and the oedema is painful when touched, 

1 Rending \*vi<6v. Xt'iov Pq. and codd. "without ceasing to 
be smooth" (?) 

1 So Kw. following Erotiao and Archigenes. y\i<rxp^fs 
Pq. codd. 

■ \tvKuv i6v Kw. etc * Kairup6v. 

45 



IIEPI TON EN KE&AAHI TPQMATQN 

i-7riXap,/3di>oi 1 /cal plyos, to 8e e'X/cos avro Te 2 
airo t?}? aap/co<; /caXa) 1 ; e%ot IheaOai teal tutto 
tov ocneov, ical ra Trzpiiyo VTa to eX/cos '^X 0L 

10 tfaA.to9, Tr\i]v tov oIS/j/acitos tov iv TrpoacoTrcp 
/cai aXXyv dpaprdha pbi)8epiiav e^ot to olhrjpua 
Trj<i dXXrjs BicuTrjs, tovtov %prj tijv /cdrco /coiXirjv 
VTTOtcaOrjpcLL (pap/xciKO) 6 ti xoXrjv ayei' ical ovtco 
KdTapdevTos, 6 re Trvperbs dcplyai ical to oiSr/fxa 
/cadlararai /cal vyir]<? ylveTat. to 8e (pdpfia/cov 
Xpi) 8i86vai 7T/9o<? tyjv 8vvafiiv tov dvOpcoirov opoiv, 

17 to? ay ey(7] io-%uo<?. 

XXI. Uepl 8e irpLcnos, orav /cara\d/3rj dvdy/cr] 
irpiaai dvOpcoirov, 0)8e yivd>o~tceiv. rjv e'£ apx?)? 
Xafitov to h]fia irpirj^, ov XPh iicirpUiv to oareov 
7T/90? rrjv ixrjviyya avTi/ca- ov yap o~upi(pepei tijv 
p,y']viyya yjriX?jv elvac tov oareov eVi ttoXvv 
Xpovov tea/coir aQ ova av , dXXa TeXevTwad Try /cal 
8i6p.v8t)aev. s ecrri Be ical erepos klvSvvos, rjv 
avTL/ca d(paipfj<i 7rpo? rrjv purjviyya e/cirptcra<; to 
ocrreov, TpoiaaL iv tu> epy<p tw ivpiovi rrjv 

10 fii'jviyya. dXXa xph Trpiovra, irreiBdv oXiyov 4 
irdvv her) SiaTreirpicrOai, /cal i')8t) /civr/rat to 
oaiiov, TTavaaaOai irpipvja, ical idv iirl to 
avropuaTOV diroar^vai to oareov' iv yap t&> 8ia- 
irpiooTU) oaretp ical iiriXeXeiptpbevM t>}? 7rptcrt09 
ovk iirtyevoiTO /ca/cov ov8ev, Xstttov yap to 
Xenropuevov fjSr) yiverai. ra 8e Xotird irjaOai XP'1> 
&)? dv 8o/cfj crvfxcpepetv t&j eX/cei. 

1 1-mXafx finny. 2 ti« re Reinhold. 

8 aaireTcra Sie/j.vdr]<Tev Scaliger ; but this is surgically the 
wrong order. Reinhold suggests Ste/j.vd7j<re nal TeKevrwaa 
iaairr). 

4 6 



ON WOUNDS IN THE HEAD, xx.-xxi. 

and fever also seizes him with a rigor, but the 
lesion itself has a healthy appearance in the part 
affecting the scalp and skull, and the parts about 
the wound look healthy except for the oedema 
of the face, and the oedema is not further com- 
plicated by an error in regimen, in this case you 
should cleanse the bowel with a cholagogue. After 
such purging the fever departs, the oedema sub- 
sides and the patient gets well. In giving the drug 
you should have an eye to the patient's vigour, 
what strength he has. 

XXI. As to trephining when it is necessary to 
trephine a patient, keep the following in mind. 
If you operate after taking on the treatment from 
the beginning, you should not, in trephining, 
remove the bone at once down to the membrane, 
for it is not good for the membrane to be denuded 
of bone and exposed to morbid influences for a long 
time, or it may end by becoming macerated. 1 
There is also another danger that, if you immediately 
remove the bone by trephining down to the mem- 
brane, you may, in operating, wound the membrane 
with the trephine. You should rather stop the 
operation when there is very little left to be sawn 
through, and the bone is movable; and allow it 
to separate of its own accord. For no harm will 
supervene in the trephined bone, or in the part left 
unsawn, since what remains is thin enough. For the 
rest the treatment should be such as may seem 
beneficial to the lesion. 

1 " Becomes macerated, and finally putrefies." R. 
4 6\iyov. 

47 



IIEPI THN EN KEOAAHI TPDMATON 

Upiovra Be %pr) Trv/civa e^aipelv rov irplova rr}<; 
6epp,aah]<; e'tveKa rov oareov, Kal vBart yjrvypw 

20 evairo^dnreiv. 6epp.aiv6p,evo<; yap virb rr)<; 
wepioBov 6 irpicov Kal rb oareov eKdeppalvwv 
Kal dva^T] paivwv /cara/caUi, zeal p.e'Qov rroiei 
acptaraadai to ocrreov to irepieyov ttjv rrplaiv 
r) oaov pueKkei dfylaraaOai. Kal rjv avr'iKa f3ov\rj 
eKirpiaai to 77/309 rr)v fiijviyya, eireira afyeXelv 
to oareov, ft)<xauTa)9 %pi] irvKivd re e^aipelv rov 
TTp'iova Kal evaTToftdirreiv ra> vBan ra> ^rvypG). 

*Hv Be p,i) e'£ dp^r}? \apbftdvr]<i to L7)pt,a, dWa, 
irap a\Xov TrapaBeyrj varepi^wv T3§s lr')aio<i, 

30 irpiovi xpr) yapaKT(t> x eKirpleiv p,ev avr'iKa to 
oareov 7r/?o? rr)v prjvtyya, Oapiiva Be e^aipevvra 
rov irpvova aKoirelaQai Kal aA.X&)? Kal rfj pn']\rj 
rrepi% Kara rt)v oBov rov irpiovos' Kal yap ttoXv 
vdaaov Biairpierai rb oareov, rjv vttottvov re ebv 
■i'jBr] Kal Bidrrvov irpirj<i, Kal ttoWukl^ rvyydvei 
eirnroXaiov ebv to oareov, aAA&>9 re Kal rjv 
ravrrj rr)^ Kecf)dXrj^ fj to rpcofia fj rvy^dvei 
\eTTroTepov eov to oareov rj rrayyrepov. dX\d 
<fyv\aaaea6ab xpr) &>9 p,rj \d6r)<i Trpoaj3a\u>v rov 

40 irpiova, d\\' OTrrj BokcI irdyiarov elvai rb oareov, 
69 tovto alel evanqpl^eiv rov irpiova, Oapuva 
aKOTTov/jLevos, Kai ireipaaOai, dvaKivetov to oareov 
avafidWeiv, dcfieXwv Be ra \oirra hirpeveiv &>9 dv 
Bokjj avpL<f>epeiv ra> e\Kei [777309 rb ytvopcevov 
opea>v\. 

Kal yv, e£ «/0%r)9 Xaficov rb hjfia, avriKa fiovky 
eKirpiaas rb oareov d(pe\elv d-rrb ttjs fiijviyyos, 



48 



1 " Serra acutiori" Vidius. Cf. Galen's Lexicon. 
* Pq. omits, but see Kw.'s note. 



ON WOUNDS IN THE HEAD, xxi. 

While trephining, you should frequently take out 
the saw and plunge it into cold water to avoid 
heating the bone, for the saw gets heated by 
rotation, and by heating and drying the bone 
cauterises it and makes more of the bone around 
the trephined part come away than was going to 
do. If you want to trephine down to the membrane 
at once, and then remove the bone, the trephine 
should in like manner be often taken out and 
plunged in cold water. 1 

If you do not take on the cure from the be- 
ginning, but receive it from another, coming late 
to the treatment, trephine the bone at once down 
to the membrane with a sharp-toothed trephine, 
taking it out frequently for inspection, and also 
examining with a probe around the track of the 
saw. For the bone is much more quickly sawn 
through if you operate when it is already suppurating 
and full of pus ; and the skull is often found to 
have no depth, especially if the wound happens 
to be in the part of the head where the bone 
inclines to be thin rather than thick. You must 
be careful not to be heedless in placing the 
trephine, but always to fix it where the bone seems 
thickest Examine often, and try by to-and-fro 
movements to lift up the bone ; and, after removing 
it, treat the rest as may seem beneficial to the 
lesion [having regard to what has happened]. 

If you take on the case from the beginning, and 
want to trephine the bone at once completely and 
remove it from the membrane, you should likewise 

1 As we learn from Celsus, VIII. 3, and Holiodorus in 
Oribasius XLVI. 11, the trephine was rotated by a bow and 
cord, not by a handle as in modern times. 

49 



IIEPI TQN EN KEOAAHI TPOMATHN 

dxravTcos -)/ph ttvkivo. tc cncoirelaOai Ty [xrjXr] rr/v 
TreptnBov tov Trpiovos, /cat e? to irayyTaTov alel 

50 TOV OCTT60V TOV TrpiOVO, il>0~T>]pL%€lV, KCll GLVClKlvkwV 

fiovXeadai dcpeXelv to ocneov. rjv Se Tpviravw 
XPV> 7i"po? fh v fi'jvi'y'ya fit] a(f)t reveler ft at, r\v e£ 
apXV^ Xap.{3dva)V to 'u]/u.a Tpviras, a\V ernXbTrelv 
tov ocrTeov Xstttov, wairep /cat, £v T?} rrpiaei, 
55 yeypaTTTai. 



5° 



ON WOUNDS IN THE HEAD, xxi. 

often examine the circular track of the saw with 
the probe, always fixing the trephine in the 
thickest part of the bone, and aim at getting it 
away by to-and-fro movements. If you use a 
perforating trepan, do not go down to the membrane, 
if you perforate on taking the case from the be- 
ginning ; but leave a thin layer of bone, as was 
directed in trephining. 



5* 



IN THE SURGERY 



INTRODUCTION 

Concerning Things in the Surgery — (irepl twv /car' 
IrjTpelor) is, according to Galen, the full title for 
works of this kind, which were written by Diodes, 
Philotimus and Mantias as well as by Hippocrates. 
Our surviving sample has not only a mutilated 
heading, but contents which, as Galen admits, might 
be more accurately called for the most part, Notes 
on Bandaging. He thinks this incompleteness is 
perhaps due to its being intended for beginners, but 
recognises its need of a commentary many times 
longer than itself. 1 

It is a note book in which many things, gram- 
matical and didactic, are left to be understood and 
have been understood diversely by various commen- 
tators, while some remain unintelligible, requiring, 
as Galen says, a diviner rather than a commentator. 
The note book style is combined with a tautology 
which converts the whole into a curious mixture 
of brevity and repetition, due perhaps to insertion 
of comments into the text, or to another cause 
mentioned below. 

On account, probably, of its obscurity the work 
attracted as much attention in antiquity as did 
Wounds in the Head. All the chief Hippocratic 
commentators from Bacchius (early in the third 
century b.c) to Galen have dealt with it. Besides 
a long and careful exposition by Galen, a good deal 

» XVII I (2). 629-632. 

54 



INTRODUCTION 

of the treatise is comprised in the preface to the 
Galenic work On Bandages, while the whole of the 
later treatise on that subject ascribed to him 
is taken from it and the commentary. Almost all 
ancient authorities considered it "genuine," though 
Galen suggests that it was not intended for publica- 
tion and may have first been given out by Thessalus, 
who, according to some, was its author. 

In modern times, Littre at first considered it 
spurious, an analysis or abridgment of some lost 
work, just as Mochlicon is certainly abridged from 
Fractures-Joints, but he afterwards changed his mind 
for the following reasons: — It has a peculiar con- 
nection with Fractures : Thus a statement in 
Fractures IV on the quantity of bandages is un- 
intelligible unless we know their length, and this 
is only given in Surgery XII ; on the other hand " ^ " 
used to denote "rather than," Surgery XIV, seems 
(as Galen had observed) addressed to persons who 
knew Fractures XXII, where the context shows that 
it must have this sense. In Surgery XX, 6Vt (and still 
more 8ioti read by some) strongly suggests a note 
which the writer intends to enlarge upon. Littre 
concludes that Surgery is probably a " canevas " or 
preliminary sketch for a larger work of the kind 
which has perished, though part of it survives in our 
Fractures, and since Surgery XIX almost repeats XV, 
there may have been two such preliminary outlines 
which have been imperfectly conflated. We shall 
notice a similar duplication in Mochlicon, 

Littre, however, does not entirely reject the view 
that Surgery is a later abstract or collection of 
memoranda from an earlier work ; and the philo- 
logical evidence is strongly on this side. 

55 



INTRODUCTION 

The verb Spav is common, in fact reaches its 
highest frequency, in this treatise. " Depraved " 
infinitives with accusative participles posing as second 
person imperatives also occur, e.g. IV (where the two 
are combined) XII, XXIV. We naturally look for 
some connection with the 8p5v (or middle) division of 
the books on Epidemics, and find that the beginning 
of Epid. IV. 45 corresponds verbally with part of 
Surge?!/ I and II. We conclude that the work 
probably belongs to the second Hippocratic genera- 
tion, may have been written by Thessalus son of 
Hippocrates, but can hardly have the same author 
as the great treatise Fractures- Joints. 

Galen * and Palladius 2 tell us that, according to 
some, " In the Surgery " was the original title of the 
combined treatises Fractures-Joints, and this tradition 
may represent a truth. There was, perhaps, a great 
work on the surgery of the bones (of which we have 
fragments), and one or more abridgments of it, 
or possibly both an abridgment and a collection 
of memoranda in note-book style. Our Surgery 
would represent the beginning of the latter, our 
Mochlicon the end of the former, while the dupli- 
cations may be due to an imperfect mixture of 
the two. 

There are other curious resemblances between 
Surgery and Fractures. Thus, Surgery XVI seems 
condensed from Fractures IV, but while the writer of 
the latter says he has only seen over-extension in the 
case of a child, the epitomist has " over-extension is 
harmful except in children." 

1 XVIII(2). 323. 

* In. Hp. Fract. Preface. 

56 



INTRODUCTION 

Surgery XVIII corresponds to Fractures VI, but it is 
only by reference to the latter that we can discover 
that splints are to be applied on the seventh day, 
and not at the seventh dressing, which is the more 
natural translation. The writer was, perhaps, relying 
upon memory, but this appears to be further evidence 
that Surgery is a later epitome, not a preliminary 
outline. 



57 



KAT' 'IHTPEION 

I. *H ofioia i) avofxoia, ei; apXV** " 77 "o T ^ )V 
fxeyicrrcov, airo tcov prjiaroiv, anu tcov TrdvTTj 
irdvTU)<i yivioo-Kopukvwv, a teal l&elv tcai Qiyelv real 
aKovaai eanv a kcu rfj o-yjrei Kal ttj d(f>f] /cai 
ttj aKofj Kal rfj pivl Kal -rfj yXcoaar) tcai rfj yvco/xi] 
eariv alcrOeadar a, ol? ytvcoaKOfiev, airacnv 

7 earl yvcovai. 

II. Fa 8e 69 yeipovpyly^v /car Irjrpetov 6 
atrOevetov, o Spcov, oi virTjperai, ra opyava, to 
<£&>?, 07rou, 07T&)?- baa, oloiv, oVa)?, 1 ottote' to 

4 acofxa, to, appieva' 6 %p6vo<;, 6 T/307ro<?, 6 tottos. 

III. O Bpcov, rj Ka6i]/x€V0<; r) eaTecos, avpu- 

fl€Tpa><; 7T/909 €COVTOV, 7T/0O? TO %€ipi%0/J.€VOV, 7T/30? 

ttjv avyi)v. 

Avyr/s p,ev ovv hvo elhea, to fiev koivov, to he 
Te^yi)TQV to fiev ovv koivov ovk icp ripuv, to he 
t€%vi]tov /<al i<fi i)fiiv. cov i/caTepov Siaaal 2 
Xpijaies, i] 7T/0O? avyr/v rj vir avyr)V. hir auyrjv 
fiev ovv 6\iyrj Te r) -%PW L S fcaTacfrav}}*; T€ ?) 
fjL€TpioTr)<;' to. he irpo<; ai/yrjv, €k tcov irapeovcrecov. 
10 e« tcov av/xepepovcricov avyecov 7T/0o<? ttjv XafMirpo- 
T&Trjv Tpeireiv to yeipi'^op.evov, ttXt]v o-rroaa 
Xadelv hel i) opav alcr^pov, ovtco he to p.ev 
yeipi^opuevov ivavTtov tt} avyjj, tov he yeipi^ovTa 
ivavTiov tw ")(€Lpi^op.ev(p, ir\rjv cooTe fxr/ £ttio~ko- 



58 



1 oh- i>s. But Galen read Uus twice (XVIII(2). 6G9). 

2 hvo 0.1. 



IN THE SURGERY 

I. [Examination : look for] what is like or unlike 
the normal, beginning with the most marked signs 
and those easiest to recognise, open to all kinds of 
investigation, which can be seen, touched and heard, 
which are open to all our senses, sight, touch, hear- 
ing, the nose, the tongue and the understanding, 
which can be known by all our sources of knowledge. 

II. Operative requisites in the surgery; the patient, 
the operator, assistants, instruments, the light, 
where and how placed; their number, which he uses 
how and when ; the (patient's ?) person and the 
apparatus ; time manner and place. 1 

III. The operator whether seated or standing 
should be placed conveniently to himself, to the 
part being operated upon and to the light. 

Now, there are two kinds of light, the ordinary and 
the artificial, and while the ordinary is not in our 
power the artificial is in our power. Each may be 
used in two ways, as direct light and as oblique 
light. Oblique light is rarely used, and the suitable 
amount 2 is obvious. With direct light, so far as 
available and beneficial, turn the part operated upon 
towards the brightest light — except such parts as 
should be unexposed and are indecent to look at — 
thus while the part operated upon faces the light, the 
surgeon faces the part, but not so as to overshadow 

1 "Part affected," according to Galen: XVIII(2). 674. 

2 This is the usual meaning of ^«Tp<(<T7}v. See Fractures V. 

59 



KAT' 'IHTPEION 
Ta^eiv ovtco yap av 6 p.ev Bpcov opiprj, to Be 

\€ipi^6p,eVOV OVX OpfpTO. 

Tlpos ecovTov Be, fcaOrjfievco p.ev iroSe^ e'9 rrjv 
dvco i£iv Kar I6v yovvaar BidoTaaiv Be oXiyov 
<7fyu,/3e/8wT69. yovvara Be avwrkpw fiovfioovoov 

20 ap.iK.pov, Staaraatv Be, dyKcovcov deaei, 1 icaX 
nrapaOeaer ip.aTiov evaraXecos, ev/cpivetos, tcrcos, 
o/xoLWi djKcocnv wjioiaiv. 

11/30? Be to yeLpi^opevov, tov p,ev -rpocrco /ecu 
€771/9 [opiov,] 2 /cal tov dvco itaX tov kutq), Kdl evQa 
7] evOa i) p,eaov. tov p.ev -rpocrco koX €771/9 opiov, 
dyfecovas e'9 fiev to irpoadev yovvara p,rj dp.eC/3eiv, 
e's Be to OTTiadev 7rXevpd<i' tov Be dvw fir/ dvcoTepco 
fid^cov d/cpas xeipas exeiv tov Be kutco, fir/ 
KdTWTepw rj C09 to aTr)0o<; eVt yovvacriv e^ovTa, 

30 ^etyoa9 a«pa9 ex €tv £yy<ovlov<- 717)09 /3paxiova<;. 
to, fiev Kcnd p.eo~ov ovtw to, Be evda r) evda, 
firj e^co T/79 eBprjf, KUTa Xoyov Be tt)<; etna t pocpr)^ 
7rpoo~f3a.Wop.evov to acop.a, koX tov crcop,aTo<; to 
epya£6p.evov. 

'EcrTecoTa Be, IBeiv /xev teal eV dp.<poTepcov 
/3e/3acoTa e'£ taov tcov ttoBcov dXi<;, Bpdv Be tco 
€Tepa> eirifSefScoTa, p,t) tco /caTa tt/v Bpcoaav 
Xetpa" vyfros yovvaTcov 3 737)09 /Sovftcovas &>9 ev 
eBpty koX to, aXXa opia to, ai/Ta. 

40 'O Be xeipi^opevo'i tw ye i P l K 0V ' Tl ' T V dXXco tov 
o~cop.aTO<; p.epet vTrr/peTeCTCo, rj ecrTeco-- rj Ka6i')p,evo<~ 
rj tceCp.evo<>, 07ra)9 4 av prjiaTa Bel o~xVf J - a ex wv 
BiaTeXfj, cbvXdacrcov viroppvciv, vTTooTaaiv, €«• 



1 ayKwcrtv, Oeaei, 

- Omit Pq. Litt. and codd. : except V. 

3 v\pos- yovvara Kw. vtyos yovvaros Littr6. 



60 



IN THE SURGERY, m. 

it. For the operator will in this way get a good 
view and the part treated not be exposed to view. 

As regards himself, when seated his feet should be 
in a vertical line straight up as regards the knees, 
and be brought together with a slight interval. 
Knees a little higher than the groins and the 
interval between them such as may support and 
leave room for the elbows. Dress well drawn 
together, without creases, even and corresponding on 
elbows and shoulders. 

As regards the part operated upon, there is limit 
for far and near, up and down, to either side and 
middle. The far and near limit is such that the 
elbows need not pass in front of the knees or behind 
the ribs, and for up and down, that the hands are 
not held above the breasts, or lower than that, when 
the chest is on the knees, the forearms are kept at 
right angles to the arms. Such is the rule as regards 
the median position but deviation to either side is 
made by throwing forward the body, or its active 
part, with a suitable twist, without moving the 
seat. 1 

If he stands, he should make the examination 
with both feet fairly level, but operate with the 
weight on one foot (not that on the side of the hand 
in use) ; height of knees 2 in the same relation to groins 
as when seated, and the other limits the same. 

Let the patient assist the surgeon with the other 
(free) part of his body standing, sitting or lying so 
as to maintain most easily the proper posture, on his 
guard against slipping, collapse, displacement, pen- 

1 According to Galen, the anatomical " seat " or pelvis. 

2 The other foot is on some elevated support : see Fractures 
VIII. Galen XVIII(2). 700. 

6l 



KAT' 1HTPEI0N 

rpeyjnv, KcnavTiav, &>? o Bel acotyrcu koX o~j(r)pLa 
teal etSo? tov yeipi^op.evov iv 7rape^ei, iv X €l P l ~ 
46 crfiS), ev rrj eireiTa e£ei. 

IV. "Oi'ir^a? iJ,r)T6 virepe^eiv fi)]T€ iXXetireiv 
BaKTvXcov icopvfyds' * e? ^pr\(Tiv aaicelv 8a/cTvXotat 
p,ev aicpouri, ra irXelaTa Xi^avq) 777)09 pueyav 
oXy Be Karairp^vel, dpb<$>oTepr)o~i Be ivavTcyatv. 
BciktvXoov eixpvii]- p,eya to iv pLeo~(p twv Ba/c- 
tvXcov, real direvavTiov tov pueyav t<£ \i%av(p. 
vov<ro<i Be, oY r)v /cal fiXdirTOVTai, Tolaiv i/c 
yever)*; rj iv rpocpfj eiOiarai 6 p.eya<; vtto twv 
aXXcov BclktvXwv Kare^eadai BrjXov. to, epya 

10 irdvra da/celv e/carepr) BpoiVTa, kol dp.(poTepr)criv 
dpia — op.oiat yap elcriv dp,§oTepcu—o-Toya- 
^op-evov dya6a)<;, /caXciyi, ra^ew?, dirovcof, evpv- 

13 6p,(0<S, eU7TO/3&)?. 

V. "Opyava pev kol ore, teal o«w?, apijaerai. 
07rov Set p,ij ipLiroBwv rep epy(p p,r}Be €kttoScov rfj 
dvaipeoei, nrapd to epya^6p.evov Be tov crco/^aro? 
eaTco' aXXos Be rjv BlBu), eVot/i.09 oXiyw irpoTepov 

5 eo-Tw, TTOieiTco Be, otclv /ceXevys. 

VI. Ot Be irepl tov dadeveovTa, to p,ev X €l P tr ~ 
£6p,evov irapeyovTo&v, a>? dv 8o0fj' 2 to Be dXXo 
atopa KaTeyovTwv, &>9 bXov aTpepifj, aiyoovTe^, 

4 dicovovTe<i tov ecfieaTewTos. 

VII. 'E7TiSecri09 Bvo e'tBea, elpyaap-evov kcu 
epya^opevov. ipya%6p.evov puev Ta^eco?, dirovw;, 
evnopca, evpvOp.co<i. TO^ew9 fiev dvvetv Ta epya' 

1 KOpVCpTJS. 2 SOKTJ. 

1 The meaning can only be fully understood after reading 
Fractures. 

62 



IN THE SURGERY, m.-vii. 

dency, so that the position and form of the part 
treated may be properly preserved during presenta- 
tion, operation, and the attitude afterwards. 1 

IV. The nails neither to exceed nor come short of 
the finger tips. Practise using the finger ends 
especially with the forefinger opposed to the thumb, 
with the whole hand held palm downwards, and 
with both hands opposed. Good formation of fingers : 
one with wide intervals and with the thumb opposed 
to the forefinger, but there is obviously a harmful 
disorder in those who, either congenitally or through 
nurture, habitually hold down the thumb under the 
fingers. Practise all the operations, performing them 
with each hand and with both together — for they are 
both alike — your object being to attain ability, grace, 
speed, painlessness, elegance and readiness. 

V. As to instruments, the time and manner of 
their use will be discussed. Their proper position is 
such as neither to be in the way of the operation nor 
to be out of the way when wanted ; their place is by 
the operator's hand, 2 but if an assistant gives them, 
let him be ready a little beforehand, and act when 
you bid him. 

VI. Let those who look after the patient present 
the part for operation as you want it, and hold fast 
the rest of the body so as to be all steady, keeping 
silence and obeying their superior. 

VII. Of bandaging there are two aspects, com- 
pleted and in process of application. As regards 
application, speedily, painlessly, with resource and 
neatness. Speedily to bring the operation to an end, 

2 This seems to refer to the surgeon, as above, not to the 
part operated on {rb x^'P'Co/xtyov). 

63 



KAT' 'IHTPEION 

a7rovco<i Be prflBlo)^; Bpdv eviropa)? 1 Be, e? trav 
eroipax;' evpvOp,co<; Be 6pr)a6ai r)Beo}<;' «$' wv 
Be ravTa daKr/pdrcov eipr/Tai. elpyacr pevov Be 
dyaOws, Ka\a)<;' kclXcos p,ev a7rA.o>9 ev/cpivea)*;' rj 
bp,ota kcli icra, iao)<; Ka\ 6pbOLW<;' rj dviaa koX 
avopioia aviacos /cal dvopoiws. ra pev e'iBea 

10 dirXovv [ev/cv/cXov] 2 cr/ceTrapvov, cnpbv, 6<j)0a\[i6<i, 
/cal pop,/3o<; /cal rjpLLTopov appbo^ov to elBo? ru> 

12 ecBei teal rw irdOet tov €TTiBeop,evov. 

VIII. 'Aya#&J9 Be Buo elBea rod eiriBeopievov' 
icryyos pev rj iriegei, rj Tr\r]det hOovlwv. to pev 
ovv avrr) i) eiriBecn^ Ifjrai, to Be rolcriv la)p,evoLai,v 
vinjpeTei. e? p,ev ovv ravra vopos' ev Be rovroiai 
pLeyiara eiriBeaw Trie^cs pev &are ra etriKeip^eva 
pr) dfyeo-rdvai, pcrjBe eprjpelaOai [/cdpra], 3 dX)C 
r)ppoo~9ai pbev, Trpoarjvay/cdaOai Be prj, rjacrov pev 
rd eayaja, rj/ciara Be ra p,eaa. dppa /cal pdp,p.a 
vepo pevov p,rj Kara), aAA' dvco, ev irapk^ei teal 

10 o-^ecrei, teal emBeaei ical irie^ei. dpvds /3d\\ea6at, 
pLT/ €tti to eA-zco?, aAA evaa to apipa. to be appa 
purjre ev TpL(3a> prjre ev epyw, p^jre e/cecae oirou 
eveov, <W9 p,r) €<? to eveov /celcreTai. 4 cip,p,a Be /cat 

14 pdpLpua p.a\6a/cov, purj peya. 

1 evnopir] . . . evpuOfilr]. 

2 ftlKvKAov or iyicvitXov was inserted as explanation of 
hirXovv by Artemidorus and Dioscorides. Cf. Galen, XVIII(2). 
729. 

3 Added by Littre from Galen de Fasc. 

4 Kw.'s reading of this obscure passage. 

1 So Galen. 

2 As Galen remarks, there is no "second" unless we take 
it to include all other good qualities ; some apply it to the 
two objects of bandaging. 

3 A puzzle to commentators as contrasted with later 
directions, cf. XII. 

64 



IN THE SURGERY, vn.-vm. 

painlessly to do it with ease, with resource ready for 
anything, with neatness that it may be pleasant to 
look at. Exercises for attaining these ends have been 
mentioned. Completed bandaging should be well 
and neatly done. Neatly means smoothly, well 
distributed, 1 evenly and alike where the parts are 
even and similar, unevenly and unlike where they 
are unlike and uneven. As to kinds, simple 
(circular), oblique (adze like), very oblique (reversed ?), 
the eye, the rhomb, the half rhomb, (use) the form 
suited to the shape and the affection of the part 
bandaged. 

VI 11. " Well " has two aspects when applied to 
the part bandaged : first 2 firmness got either by 
tension or by the number of bandages. Now, the 
bandaging may either cure by itself or assist the 
curative agents. There is a rule for this and it 
includes the most important elements of bandaging. 
Pressure so that the applications neither fall away 
nor are very tight, fitting to the part without forcible 
compression, less at the ends and least in the middle. 3 
Knot and thread suture carried upwards and not 
downwards in presentation, attitude, bandaging and 
compression. 4 The ends (for tying) to be put, not 
over the wound, but where the knot is to be. The 
knot where there is neither friction nor motion, and 
not where it will be useless, lest its purpose be not 
served. 5 Knot and suture soft and not large. 

4 «£ei " fixation" is what we should expect, but the whole 
is obscure. 

6 A much discussed passage. Perhaps means not close to 
tho edge of the dressing lest it slip off. Heliodorus (Orib. 
XLVIII. 70) and Galen seem to ignore the last six words, but 
both say that ivt6v = K ei>t6u u useless." Can it be a pun, "not 
where there is a void lest it be void of use"? As Galen says, 
we should expect " not over a hollow " such as the armpit. 

6 5 

VOL. III. D 



KAT' 'IHTPEION 

IX. Eu ye ixtjv ecrri yvcovai on e? ra Kardvrr] 
Kal arro^ii cpevyei Trd<; eiriBeafios, olov KecpaXfj? 
/lev to dvco, Ki>i'i[jbrj<i he to Karco. ernBelv Be£id 
67r' dpiarepd, dpiarepd Be eVt Be^id, ttXt)v rr/s 
Kecpatkffs , ravTrjv icar i'fjiv. ra Be vrrevavria^ 
airo ovo ap^eoov r)v be airo fin]?, ecp [eKarepa]" 
brrep bfioiov e? to p,ovip.ov, olov to pecrov t?}? 
Ke<fia\r)<i, 7) o n dXXo roiovrov. ra Be Kivev/neva, 
olov dpdpa, ottt] [iev avyKap^-nrerai, co<; rj/cicrTa 

10 Kal euaraXearara TrepifSdXXeiv, olov lyvvrjv birrj 
Be rrepirelverai, arrrXd re Kal rrXarea, olov fivXri' 
Trpocr TrepifSdXXeiv Be KaraXi'f^ios fiev rcov irepl 
ravra elvetca, dvaXi'i-ty-ios Be rod crvfnrdvros eiri- 
Becrfiov, ev roiaiv arpefieovai Kal Xan apcorepoiai 
tou acbfiaros, olov to dvco Kal to Karoo rov 
yovvaro<;' bfioXoyet Be, wfiov fiev 7) irepl rr)v 
ereptiv ybacrydXrfv irepifSoXSf, fSovfScovo? Be r\ irepl 
rbv erepov Kevecova, Kal Kvrjp,iis 7) virep yaarpo- 
Kvr]fiiv}<i. oirocroiai fiev dvco 7) cpvy7j, KarcoOev 7) 

20 dvriXrjyjrK;, olai Be Kara), rovvavr'tov oIctl Be fir) 
kariv, olov KecpoXfj, rovrcov ev rco ofiaXcordrco 
rd$ KaraXTj-ifnas iroielaOai, Kal i'iKio~ra Xo^co rat 
eiriBecrficp ^pfjadai, 00? to fiovificorarov vararov 
7repi/3X7]0ev ra irXavcoBearara Kareyrj. oirbaoicri 
Be. rolaiv oOovioiat firj evKaraXr']TTrco^, fir]Be ev- 
avaX7)irrco<; e%ei, pdfifiaai rds dvaX^y^na*; ttol- 

27 elaOai 6« KarafSoXr)^ rj crvppacf)r)<;. 



1 ra Ka0' cKarepov fxtpos 6/xolu>s SiaKeipepa. — Galen. 

2 Most MSS. omit. 



66 



IN THE SURGERY, ix. 

IX. It is well to bear in mind that every bandage 
slips towards the pendent and conical parts, such as 
the top of the head and the bottom of the leg. 
Bandage parts on the right side towards the left, 
and those on the left to the right, except the head ; 
do this vertically. 1 Parts with opposite sides alike 2 
require a two-headed bandage, but if you bandage 
from one end, extend it each way so that it may 
have a similar relation to the fixed part, such as the 
middle of the head or the like. As to mobile parts, 
such as joints, where there is flexion the turns 
should be as few and as contracted as possible, as 
with the back of the knee, but where the part is 
extended, like the knee cap, spread out and broad. 
Make additional turns both to hold fast applications 
in these parts, and to support the dressing in the 
fixed and flatter parts of the body, such as those 
above and below the knee. In case of the shoulder, 
a turn round the opposite armpit is suitable, for the 
groin, one round the opposite flank, and for the leg, 
the part above the calf. In cases where the tend- 
ency is to slip up, the support is from below, when 
clown the reverse. Where this is impossible, as on 
the head, make the hold-fasts on the smoothest part, 
and avoid obliquity as far as you can, so that 
the outermost and firmest turn may hold down the 
most mobile ones. Where it is not easy to get either 
good fixation or support with the bandages, make 
supports with threaded sutures in loops 3 or continuous 
suture. 

1 "From vertex to chin." Galen. 

2 Galen's paraphrase. 
s Apparently our interrupted sutures, with long ends to 

ie. " Stitching with ligatures." Adams. 



3 

ti 



6 7 



KAT' 'IHTPEION 

X. 'KiriheapciTa /caOapd, tcovcfia, p,aX0aKa, 
Xeirrd. eXiaaeiv dptyoreprjaiv cifia, kcu exarepr) 
%a>p\s da/ceiv. rf} Trpeirovar) he e? ra irXdrrj kcli 
to trd^rj roiv juoptcov 1 Tetcpaipbpevov ^prjaOai. 
eXt^io<; /cecfraXai, a/cX^paL, 2 opiaXai, eu/cpivees. rd 
he hr/ peXXovra aTTOTrnrreiv [/mXoi?] 3 ra)^ew<i 

dTr07T6(TUVT(OV A TO, he &>? pt,T}T€ TTl€^€lV pL7}T€ CITTO- 

8 TTLiTTeiv rd elpiipueva. 

XL 9 £lv he e^erai rj eirlheai^ r) virbheais rj 
dpKpoTepa' viroheais pev alrit] ware r; dcpearewTa 
irpoarelXai, rj eKireirjap-eva avarelXai, rj avve- 
araXpeva hiaarelXai, i) hiearpap,p.eva hiopOwacu, 
rj TavavTia. irapaaicevr) he' bObvia icoxx^a, Xe7rrd, 
p,aX0a/cd, icaOapd, irXarea, prj e^ovra avppa(pd<i, 
purjh' iguanas, kcli uyta ware rdvvaiv (pepetv koX 
oXljo) Kpeaaco, p,r) ^rjpd, dXX ey^ypa X V / X V *P 
e/cacrTa avvrpocpa. d(f>eaT€0)Ta pev 5 ware rd 

10 pberecopa t% eoprjs yjraveiv puev, TTie^ecv he pa'p 
dpyeaOai 6 he ex tov vyieos, reXevrdv he 777305 
to e\/eo<;, coare to pev virebv e^adeXyrjrai, erepov 
he p-rj eTTiavXXeyrjTaf eirthetv rd pev 6p6d e'5 
bpObv, rd he Xo£d Xb^co^, ev a^ijparc dirovw, 
ev (p prjre dTTOcKpiy^is pi'jre drrbaTaai^ karat 
[t£<?] 7 e£ ov brav pLeraXXdaarj, ?/ e'5 dvdXi]\friv 
r) e? Qeaiv, p,r) p,eraXXd^ovaiv, dXX' op,ota 
ravra 8 e^ovai /iue?, (pXeftes, vevpa, barea [y 

1 bOoviuiv. 

* aicAripal puzzled Galen. Ermerins inserts a negative, jidj. 
The edges of a bandage should not be hard. 

3 Kaidoi Kw. codd. kciXws Erm. Pq. 

4 A much discussed passage. G. says awontcr^vTwy is a 
Bolecism, either as imperative or participle. 

6 Add irpoffTfiKai. 

68 



IN THE SURGERY. 



x.— XI. 



X. Bandages, clean, light, soft, thin. Practise 
the rolling with both hands at once, and with each 
separately. Use one of suitable size, estimating by 
the thickness and breadth of the parts. Edges of 
the roll firm, not frayed, without creases. When 
things are really going to fall off, it is well that they 
do so quickly (?). Modes of bandaging such as 
neither compress nor fall off are those mentioned. 

XI. What bandaging, whether upper or under 
or both, aims at. The function of an under bandage 
is to bring together what is separated, reduce 
everted wounds, separate what is adherent, adjust 
what is distorted, or the reverse. 1 Apparatus. Linen 
bandages light, thin, soft, clean, broad, without sutures 
or projections, sound so as to bear the tension 
required, and a little stronger ; not dry, but soaked 
in a liquid suited to each case. Close a sinus 2 so 
that the upper parts touch the base without pressing 
on it, begin bandaging from the sound part and end 
at the open wound, so that while the contents are 
pressed out no more is accumulated. Bandage 
vertical ones 3 in a vertical direction and the oblique 
obliquely, in a position causing no pain, without 
either compression or laxity, so that when the 
change is made to a sling or fixation the muscles, 
vessels, ligaments and bones will retain their normal 

1 G. refers this to bad bandaging. 

2 A sinus is a superficial abscess which has opened and 
continues to discharge. 

3 G. refers this to the sinus, not to affected parts 
generally. 

* i5f>x 0at Galen Kw. 7 Omit Galen Vulg. K\v. 

8 6ixoi6raTa Kw. 

6 9 



KAT' 'IHTPEION 

fia\i<na evdera /cat evcr^era]. 1 dvaXeXd(f>dai 2 

20 Be r} Keladai ev cr^parL air6v(p tw Kara <f)vcriv' 
oiv Be civ [/*?;] 3 airoarfi, ravavria' ow he eKire- 
irrapeva trv&tetXdi, rd pev aXXa to. avrd, e/c 
ttoXXov Be twos Bel rrjv avvaycoyiji/, /cal etc irpoa- 
ayayyf/s ttjv ttU^iv, to irpwrov ^Kiara, eireira 
eirl pdXXov, opiov rov pudXiara to avpyjravetv. 
ouv Be cuvearaXpeva BiaarelXai, ai/v pev <pXey- 
povfj, rdvavrla. dvev Be ravrrj^, irapao-Kevfj pev 
tt) avrfj, emBea-et Be evavrir]. Biearpappeva Be 
Biopdcocrat, rd pev dWa /card ravrd' Bel Be rd 

30 pev aTreXrjXvOora eirdyeiv [to Be eireXi]Xv86ra 
dirdyeti']^ iiriBeo'et, rrapaKoXXrjcrei, dvaXifaei, 

32 [Secret]' 4 rd Be evavria, evavriws. 

XII. [Kartfypacri Be] gttXi-jvwv pr\K.ea, irXdrea, 
Trdyea, irXijOea. prjicos oarj rj eiriBecri^' rrXdros, 
rpifav rj reo-adpoyv Ba/crvXwv 7m'^o?, rpiTrrv^ov; 
r} TerpaTrrv^ovf 5 ttXtjOos, /cv/cXevvras pr] virep- 
(BdXXeiv, pyBe eXXet7reiv olcri Be e? BiopQwaiv, 
p-rjicos tcv/cXevvra' irdy^os kcu irXdros rfj evBeirj 
revpaipeaOai, pr) dOpoa irXr/povvra. 

icov be ouoviwv vTrooea pioes eicri ovo' rj] 
irpdorrj iic rov alveos e\ to dvw reXevrcoarp 6 rfj 

10 Be Bevreprj e'/c rov alveos e? to Kara), ex rov /carco 

1 Read by Galen ; not in the codd. 2 ava\e\dn<pdai. 

8 ,utj Kw. ; suggested by Galen's predecessors. 
4 Omit BV. 6 rpimrvxtt TtTpdirTuxa. 

6 j] . . . reXevrwcra Erm. Reinhold. Pq. suggests re\ev- 
T&tri, as Aid. 

1 Restored from Galen's Commentary. 

2 G. gives three other interpretations, without the 
negative. 

70 



IN THE SURGERY, xi.-xii. 

positions [in which they are best put up and sup- 
ported]. 1 Let the part be slung or put up in a 
natural comfortable position. Where there is no 
open sinus the reverse. 2 Where there is a gaping 
wound bring the parts together just as in other 
cases, but start the joining up at a good distance; 
and graduate the pressure, first very little, then 
increasing, the extreme limit being contact of the 
parts. In separating what is adherent, if there is 
inflammation the reverse holds good, 3 if not use the 
same apparatus, but bandage in the opposite way. 
To adjust what is distorted act generally on the 
same principles ; what is turned out must be brought 
in [and what is turned in brought out] by bandag- 
ing, agglutination, 4 suspension, setting — the reverse 
reversely. 

XII. In fractures, the length, breadth, thickness 
and number of compresses. Length to correspond 
with the bandaging, breadth, three or four fingers, 
thickness, folded thrice or four times. Number, 
sufficient to go round without overlapping or vacancy: 
when required to adjust the shape, 5 long enough to 
go round, estimating breadth and thickness by the 
deficiency, but not filling it up with one compress. 

Of the linen bandages, the under ones 6 are two in 
number. Start with the first from the lesion and 
end upwards, but carry the second downwards from 

3 i.e. avoid bandaging as far as possible ; Galen. 

* Refers to turned in eyelashes. 

8 i.e. in conical or irregular parts: not "deformity" as 
Adams. 

8 This Hippocratic division of under and upper bandages 
did not survive. vnodfafiiSts remains a peculiar Hippocratic 
word for bandages below the pads or compresses. XV1II(2). 
785 Galen. 

7* 



KAT' "IHTPEION 

e? to avco reXevTcoaj} to, Kara to vivos irte^eiv 
fidXiara, i']Kiara ra aicpa, ra Be dXXa Kara. 
Xoyov. r) Be eVtSecrt? tto\v tov vyieos Trpocr- 
\ap,(3avera). 

'EiriBeo-pcov Be irXrjOos, fir)rco<;, 7rXaTO?* •n\r)6o<i 
pev fir) rjaaaaOai tov aLveos, p,i]8e vdpdii^iv 
ivepeicriv elvai, p,r]8e d^dos, purjBe ireplppe^nv, 
pi]Be eicdrfkvvo-iv p.r)KO<i Be /cat irXaTOs, Tptoov r) 
reaadpcov r) Trevre rj e£ ir^yewv p,ev fifj/cos, Baic- 
20 rvXwv Be 7rXaTO?. real 7rapaip)]p,aT0<; ireptfioXal 
Toaaurai ware p,r) nrie^eiv p,a\6a/cd Be, p,rj irayka' 
ravTa iravra a>? eir\ p,rjfcei /cal irXdret koX ird^ei 
tov iraOovTOS. 

Ndpdrjrces Be \eloi, opaXoi, aip,ol icar aicpa, 
crpiKpG) pLeiovs hvdev ical evBev Tr)s iircBeaiof, 
TrayvTaroi Be fj e%r)pnre to tcdTtjypa. oiroaa Be 
Kvprd /cal aaapica (fivcrei, (f>v\acro~6pevov twv 
VTrepe^ovrcov, olov ra Kara, Ba/CTv\ovi r) acfrvpd, 
r) tt} decree rj rfj /3pa%vTr)Ti. Trapaipijpaai Be 

30 dppo^eiv, prj Trie^etv to nrpwTov Kr/pcorfj p,a\0a/cf) 

31 real Xeirj /cal tcadapf) eXiaaerco. 

XIII. "TBaros 6eppbOT7)<i, ir\r)do<;' OeppbOTrjs pev 
Kara rfj<; ecovTOv %ety0O9 Kara^elv, irXijOos Be 
yakdaai pev teal la^vrjvai to TrXecarov apicrrov, 
aapicwaai Be koX aTraXvvai to perpiov perpov 
Be rfjs natayyaios, en p,€Teu>pi^6p,evov Bel, irplv 
avprniirretv, iraveaOai,' to pev jap mrpSirov 

7 delperai, enetra Be iayvaiverai. 

XIV. ©ecrt? Be pa\6aici), 6pa\rj, dvdppoiros 
rolai e^e^ovai tov aco/iaTO?, olov irrepvy /cal 

1 Or "where the fracture occurred." 

72 



IN THE SURGERY, xn.-xiv. 

the lesion, bringing it up again to end at the top. 
Make most pressure over the lesion and least at the 
ends, the rest in proportion. Let the bandaging 
include a good deal of the sound part. 

Amount, length and breadth of the bandages. 
Amount sufficient to deal with the lesion, without 
either pressing in the splints, or being burdensome, 
or slipping round, or causing weakness. As to 
length and breadth, three, four, five or six cubits for 
length, fingers for breadth. The supporting bands 
in such a number of coils as not to compress, soft 
and not thick. All these suited to the length, 
breadth and thickness of the part affected. 

Splints, smooth, even, tapering at the ends, a 
little shorter in each direction than the bandaging; 
thickest over the prominence at the fracture ; x avoid- 
ing cither by position or shortening the convexities 
naturally uncovered by flesh, such as on the fingers 
and ankles. Fit them on by supporting bands with- 
out pressure. Let the first dressing be made 
with bandages rolled in soft, smooth and clean 
cerate. 2 

XIII. Of water (one must consider) temperature, 
quantity. Temperature by pouring it over one's own 
hand. Quantity, for relaxation and attenuation the 
more the better, but for flesh forming and softening 
observe moderation, and for moderate douching one 
should stoj) while the part is still swollen up before 
it collapses, for first it swells and then becomes 
attenuated. 

XIV. Permanent position: soft, smooth, sloping 
uj) for projecting parts as with the heel or hip, so 

2 So Galea, for cerate see Introduction. Pq. "before 
bandaging anoint tho skin with." 

73 



KAT T 'IHTPEION 

tcr^tft), a)? fxrjre dvaKXdrai [/xrjre diroKXaTai] 1 
/xy'jre eKTpeTrrjTai, 2 awXr/va iravjl to> a/ceXei rj 
■fj/uiicref e\ to 7ra<9o? Be fiXerrreiv Kal ra aXXa 
(i 6/cocra ftXdirrei BfjXa? 

XV. Hdpe^c<i 7^/°> 4 Ka l BiaTaais, Kal dvd- 
7rX.a<jt9, teal rd dXXa Kara (pvaiv. <j>vcri<; Be ev 
fitv epyois, tov epyov rf) irp>]i;ei, b ftovXerai 
T€KpapT€ov e? Be ravra, e/c tov iXivvovTos, €K 
tov kolvov, i/c tov e9 eo$' €K p,ev TOV iklVVOVTOS 
teal dfyeipevov to.? Idvcopias OKeirTeadaL, olov to 
t^9 \eipo<;' iiC Be tov kolvov, eKTaaiv, avyKap^riv, 
olov to iyyvs tov iyycoviov 7r?^eo? irpos /3/oa- 
ylova' €K tov eOeos, otl ovk dXXa a^ijpara 

10 (pepeiv SvvaTWTcpa. olov o~KeXea eKTaaiv dirb 
TovTOiv yhp 'py)laTa ttXcIcttov ^povov eyoi av pri 
p.eTaXXdaaoi'Ta. ev Be tj) pueTaXXayfj eK Bia- 
TaaLos opoioTaTa ex oV(7lv 5 6< > %£ a> V Geo'tv pves, 
<pXe/3€<;, vevpa, barea, rj p.dXio~Ta evOera Kal 

15 evcr)(€Ta. 

XVI. AtaTacrt?, pdXiora tcl pueyioTa Kal ird- 
yiaTa, Kal oirov dpcftoTepa' Bevrepa, &v to vtto- 
TeTayp,evov, >]Kio~Ta wv to dvw pudXXov Be tov 
p,eTpiov fiXdftrj, ttXi]v TraiBitov e^eiv dvdvTt] 
o~p,LKpbv BiopOoocnos rrapaBeiypa, to 6p,(ovvpov, to 

6 bpb^vyov, to opoiov, to vyies. 

1 Galen omits. 

2 eKTpeireTcu vulg Galen ; inrplfiriTai Pq. The things to be 
feared are distortion or abrasion which would be iKTpi$r)Tai ; 
airoKKarai, which implies fracture, seems hardly possible. 

rifilafi — Gahm says r) is negative (avr' ano<pd<rews) as in 
Iliad 1. 117, but we discover this only by reference to 
Fracture* XXII. 

3 St/AciSt). * 8«. 

74 



IN THE SURGERY, xiv.-xvi. 

as neither to be bent back [bent aside? broken off?] 
or distorted. Apply a hollow splint to the whole 
leg rather than to half. Consider the affection and 
also the obvious disadvantages (of this splint). 

XV. Presentation, extension, setting, and the rest, 
according to nature. Now nature shows itself in 
actions, and one must judge what nature wants x by 
the performance of action : for the above matters 
(judge) from the state of rest, from what is normal, 
from the customary. From rest and relaxation esti- 
mate proper direction, for example as regards the 
arm : from what is normal judge extension and flexion, 
such as the nearly rectangular relation of the fore- 
arm to the arm ; from habit infer the posture more 
easy to maintain than any other, such as extension 
in the case of the legs ; for one would most easily 
keep such postures for the longest time without 
changing, and in the change after [surgical] extension 
the muscles, vessels, tendons and bones have the most 
similar relations as to habit and posture, and are 
thus most conveniently put up or slung. 

XVI. Extension, most when the largest and 
thickest and when both bones [of the arm] are 
broken. Next in cases where it is the underneath 
one [ulna], least where it is the upper. Excessive 
tension does damage except in children. 2 Keep the 
limb a little raised. As model for adjustment take 
the homonymous, 3 corresponding, similar, sound 
limb. 

1 LittnS- Adams " what we want." 

2 Because their tendons are more elastic, G. ; but it may 
be a confused reference to the case in Fract. IV. 

8 (J. says it should be "synonymous." 



6 6p.ot6raTa exou<ri»< Kw. ci/xoio Tavra 'i^ovai Pq., as in XI. 

75 



KAT 'IHTPEION 

XVII. Avdrpiyfris Bvvcltcli Xvcrai, Brjaai, o~ap- 
Koxrai, fjLivv9?)aai' r) a/cXr/pr) BPjaat' r) paXa/cr) 

3 Xvcrar r) TroWrj pLvv9y)aar r) fieTpirj irayvvai. 

XVIII. 'EiriBeiv Be to irpwrov 6 e7nBeBtp,epo<; 
fxaKiara (paTco TreTrieydai Kara to o~ii'o?' "jkhtto, 
ra aicpa- rjpp.oadai 1 Be, prj TreirieyOaf TrXr']6et, 
fxij layvr ti]V Be r)fxeprjv Tavrrjv ical vv/cra, oXljay 
p,dXXov, rrjv Be vaTeprjv, r)aaov Tp'nri, yaXapd. 
evpeOijTco Be rfj p,ev varepalr) ev cucpoicriv ocBrjpa 
puaXOaicov. tfi rplrij Be rb eiriBeOev XvOev, 
ccryvoTepov, irapa 7rdaa<; ras e7riBeaia<i tovto. 
rfj Be varepairj emBeaei, r)v 8iKaLa><; e7ri8eBep,evov 

10 (j)ai>f), paOelv Bel' ivrevOev Be p-aXXov teal eVl 
irXeoai TTieyBrjTW rfj Be rpirrj eVt p-dXXov ical 
eirl irXeoaiv. ttj Be ef3B6p,j] dirb r?}? TrpdoTr/s 
eiriBeartos' XvOevra evpedrjTw layvd, yaXapd to, 
ocnea. e\ Be vapOr/tcas BeOevra, r)i> Icryyd ical 
aKvrja/xa teal dveXicea fj, edv p,eypt<; elicoaiv r)pe- 
pecov dirb tov aiveos' rjv Be tl vTro7rT€vi]Tat, Xvaai 

17 ev tS> iie(T(p' vdpO>]Ka<; Bid rpirrj^ epeLBew. 

XIX. 'H dvd\rjy\ri<i, r) 6 eats, r) eTTlBe'&K', ew? ev 
tu> avra> ayt']fiaTi BiacfyvXdcrcreiv. K€(f)dXaLa o-yr/- 
pbdrcov, hdea, (fiveies eicdaTov rwv peXecov t« Be 
etBea, eic tov Tpeyeiv, oBonropeew, eardvat, /cara- 

5 K€io~0ai, e/e tov epyov, etc tov dtpelaOai. 

XX. "Otc 2 ypf/afi KpaTvvet, dpyirj Be Tijicei. 

XXI. 'H TTie%i<i 7rXi'j0ei, p,rj 3 ccryvi. 

1 iipfxaffOai. rb Se, '6ri ; Kw. 8 ij. 

1 Cf. F>act. VI. 2 i.e. on alternate days. 

3 G. considers XIX. a marginal note to XV. 
* Cf. Joints LVIII. 

76 



IN THE SURGERY, xvii.-xxi 



XVII. Friction can produce relaxation, constric- 
tion, increase of flesh, attenuation. Hard friction 
constricts, soft relaxes : if long continued it attenuates, 
when moderate it increases flesh. 

XVIII. As to the first bandaging: the patient 
should say there is pressure chiefly over the injury, 
least at the ends : that the dressing fits firmly but 
without compression : pressure should be got by 
amount of bandaging not by tension. During this 
day and night pressure should increase a little, but 
be less during the next day, and lax on the third. 
A soft swelling should be found on the second day 
at the extremities. On the third the part when 
unbandaged should be less swollen, and so with 
every dressing. At the second dressing one must 
find out whether it seems properly done, and then 
use more bandages and greater pressure ; at the 
third still more with more coils of bandage. On 
the seventh day 1 after the first dressing the parts 
when set free should be found without swelling and 
the bones mobile. When put up in splints, if the 
parts are not swollen and are free from itching or 
wound, leave alone till twenty days after the injury ; 
but if there is any suspicion remove in the interval. 
Make the splints firm every third day. 2 

XIX. In suspension, putting up, bandaging, take 
care that the part keeps the same attitude, the 
general principle being the habitual natural position 
of each limb. The kinds of attitude are derived from 
running, walking, standing, lying, work, relaxation. 3 

XX. (Remember) that use strengthens, disuse 
debilitates. 4 

XXI. The pressure by quantity (of bandages) not 
by force. 

77 



KAT 'IHTPEION 

XXII. Oiroaa he ete^vp,oop.aTa, i) (pXdap,ara, 
i] airdapaTa, ij olhtjpaTa dcpXeypavTa, e^apverai 
alfia ite tov Tpojp,aTo<i, e'9 p,ev to avco tov aoopa- 
ro<i to irXelo-Tov , ftpa^!) he ri teal e'<? to Karw 
prj Kcndvrr] rrjv %etpa eyovra rj to cr^eA-Of Tide- 
pevov ttjv dp%t]v teard to Tpwpa teal pdXicna 
epeihoi'Ta, i'jKUTTa rd atepa, peo~co<; rd Sid peaov. 
to eayaTOV irpos to dvco tov crcopaTos vep,6pevov 
eTTiSeo-ei, irie^ei- arap teal ravra irXtjOet, pudXXov 

10 rj layyi. pd\i<na he tovtoictiv bOovia, Xeirrd, 
tcovcfra, paXOatca, teaOapd, irXarea, vyid, <w? dv 
12 dvev vapd/j/ecov teal Katayyoei -^prjadai irXeovi. 

XX III. Ta he e/CTTToopaTa, rj o~Tpep,para, rj 
hiaaTijpara, i) dtr a tt da para, rj air oteXdcrpLaT a, i) 
oiaarpefipaTa, ola rd tcvXXd, rd erepoppoira, 
odev 1 p,ev itjeaTr), avvhihovTa, oirrj he, <tvvt€i- 
vovra, &)<? e? rdvavria peirp, eirihedevra r) irplv 
eiriheOijvai, apuiepcp pdXXov rj ware e£ io~ov elvar 
teal roiaiv eirihecrpLOLai, teal toIgi CTrXrjveai, teal 
rolatv dvaXrjppaai, teal Tolai a^paai, teara- 
jdaei, dva-rpl^rei, hiopdooaet, [ravja teaX\ 2 teara- 

10 •yyoei TvXeovi. 

XXIV. Ta he pnvvOi^para, ttoXv irpoaXapb- 
(Sdvovra tov vjLeos, ernhelv o>? dv e£ e7rihpopij<; 
Ta crvvTateevra TrXeov i) avrd 3 ipuvvOei, dXXoiy tjj 
eTTtheaei irapaXXd^avra, eteteXivei 4 e'<? tijv av^r/aiv 
teal ttjv dvdrrXaaiv twv o-apteu)i> iroii'jcrrjTai. 
fSeXriov he teal ra dvwOev, olov KVTffvqq teal tov 
p,t]p6>', teal to erepov crieeXo<i tw v<yiei 5 avveiriheiv, 

1 %;div. - O.nit Galen. Kw. 3 avriyara. 

4 eKchlvri. 6 rb vyies. 

1 Includes club foot, knock knee, bandy leg. 
78 



IN THE SURGERY, xxn.-xxiv. 

XXII. In case of bruisings, crushings, ruptures of 
muscles or swellings without inflammation, blood is 
expressed from the injured part [by bandaging] 
mostly upwards, but some little downwards. This 
is done (with neither arm nor leg in a pendent 
position) by beginning the bandage at the wound 
and making most pressure there, least at the ends 
and moderate in between ; the final turns being 
brought upwards. By bandaging, by compression — 
but here, too, pressure must be got by quantity of 
bandage rather than by force. In these cases 
especially, the linen bandages should be thin, light, 
soft, clean, broad and sound, as one would use 
without splints ; use also copious douching. 

XXIII. [ Bandaging as regards] dislocations,sprains, 
separations, avulsions, fractures near joints or dis- 
tortions, such as deformities to either side: 1 yield- 
ing on the side from which it deviates, bracing 
up on the side towards which it deviates, so that 
when it is put up, or before it is put up, it is not 
straight but has a slight inclination the opposite 
way. The treatment includes use of bandages, com- 
presses, suspension, postures, extension, friction, 
adjustment; and in addition copious douching. 

XXIV. [Bandaging as regards] atrophied parts: 
Apply the bandage, taking in a good deal of the 
sound parts in a way that the wasted tissues may 
gain more by afflux than they lose spontaneously ; 
by changing to a different mode of bandaging- it 
may divert (the tissues) towards growth and bring 
about flesh formation. It is a rather good plan to 
bandage the upper parts also, such as the top of the 
leg and the thigh, also the sound leg that it may be 

1 From that described iu XXII. A very obscure passage. 

79 



KAT' 'IHTPEION 

&>? o/xotorepov rj real o/jlolcos eXivvr/, koX ofioito? 
T/)<> TpO(f)f)$ a7rofc\eir]Tai Kal he^rjraL. odovLwv 

10 TrXrjdei, fjbr] TTie^ec dviivra irpoirov to fidXtara 
Seofievov, teal dvaTplyjret, ^poofievov aapKovarj zeal 

12 Kara^vaer ctvev vapdiJKwv. 

XXV. To. he. epfxdafiara /cal d-rroaT^piyfiaTa, 
olov ari'jOei, 7rXevpfjai, KecpaXP), teal rolaiv aXXot,- 
aiv, baa roiavra' ra fxev acpvyficov evetcev, &>? 
fir) ivaetr^rai' ra he teal rcov hiaaraaicov tcov 
Kara Ta? apjAovias ev roiai \roiv\ Kara ttiv 
K€<fiaXr]v oarecov * ipeia /jlutcov ydpiv eVt T€ 
fSrj-^oov r) Tnapfiwv, r) aUi)? Kivtjaios, olov 2 Kara 
OcoprjKa Kal Kecf)aXi]v aTroarrfpLyfiaTa yiyverai. 
tovtwv dirdvTcov ai avral av/x/xerpiat rr)<i eiifiBi- 

10 aw y p-ev yap ra aivrj fiaXicna iFtirikyftai' 
VTToriOevai ovv [etpiov] 3 fiaXOaKov dpfio^ov tu> 
irdOer eirihelv he p,rj fidXXov nrie^evira r) ware 
TOV<i acj)vyaou<i fir) evaeleiv, firjhe fidXXov i) ware 
T&v SieaTrjKorcov rd eayara rcov dpjiovicov av/i- 
ijraveiv dXXijXcov, firjoe rds /3f)%a<; Kal toi)? 
irrapfiovs ware KcoXveiv, dXX" ware aTtoaTr t piyfia 

17 elvai &)? fiiJTe hiavayKa^rjrai, firjre evaeli)Tai. 

1 omeois omit tu>v. 2 ola ra. 

8 Littre aud Pq. omit and add ti after p.a\Qaii6v. 



So 



IN THE SURGERY, xxiv.-xxv. 

in a like state, and share alike in rest and the de- 
privation or reception of nutriment. Use plenty of 
bandages, not compression ; relaxing first where it 
is most needed, using friction of the flesh-forming 
kind and douching— no splints. 

XXV. Supports attached or separate, 1 such as 
those for chest, ribs, head and other such parts; 
sometimes used because of pulsations 2 that the part 
may not be shaken ; at other times, in cases of 
separation of the commissures in the bones of the 
head, as supports : also in case of coughings, sneez- 
ings and other movements they serve as separate 
supports (cushions?) for the chest and head. The 
suitable modes of bandaging in all these cases are 
the same, for where the lesion is there should be 
the chief pressure. Put something 3 soft underneath 
suited to the affection. Do not make the bandaging 
tighter than suffices to prevent the pulsations from 
shaking the part, or than is necessary to bring the 
edges of the separated commissures into touch with 
one another; nor is it intended to prevent couffhingrs 
and sneezings, 4 but to act as a support for the 
avoidance both of forcible separation and shaking. 

1 So Galen, who says the words are usually synonymous. 

2 Includes everything from tvvitchings to respiratory move- 
ments. G. 

3 Reading ixa\f)jic6v n. 

4 The text seems corrupt, but it can hardly mean "so 
tight as to prevent sneezing"! 



8i 



FRACTURES, JOINTS, 
MOCHLICON 



INTRODUCTION 

There is no question as to the relationship of 
these three treatises. Fractures and Joints probably 
once formed a single work, and are certainly by the 
same author, 1 while Mochlicon is composed of an ab- 
breviation of those parts of them which treat of dis- 
locations. In antiquity no one doubted that Fractures 
and Joints were by the great Hippo rates, except a 
few who attributed them to another man of the 
same name, his grandfather, the son of Gnosidicus. 2 
Galen, in all his lists, classes them first, or nearly first, 
among the yvrjaiwraTa 3 or " most genuine " works. Of 
the two things we know for certain about the teach- 
ing of Hippocrates, Plato's statement that he held it 
impossible to understand the body without studying 
nature as a whole has proved too vague to be attached 
to any particular treatise, but the condemnation by 
his kinsman Ctesias of his reduction of the hip- 
joint (unless it refers to verbal teaching or to some 
work which has vanished) must apply, as Galen 
says, 4 to Joints, where the subject is treated in 
detail. 

1 This seems sufficiently proved by the fact that references 
are made from Joints to Fractures in exactly the same terms 
as to the earlier parts of Joints: e.g. J LXVTI, LXXII, is 
Kal irpdrdtv etprjTat. elprji on [ftjrjKa B. Apoll.] Kal irpindev, 
which refer to F XXXI and XIII respectively. Reference 
to another treatise is put differently : e. g. 4v ere'pai \6yqi 
JXLV. P ' * PV 1V 

2 Galen, XV. 456. 3 XVII(l). 577. * XVIII(l). 731. 

84 



INTRODUCTION 

The work was known to, and in part paraphrased 
by, Diodes, 1 who was probably adult before Hippo- 
crates died, and there is no record that he doubted 
its authorship. We may therefore, perhaps, con- 
clude that nothing in the Corpus has a better claim 
to be by Hippocrates himself than Fractures-Joints, 
and proceed to discuss them in some detail. 

The question asked in antiquity was: Why does 
Fractures contain a good deal about dislocations 
(joints) while Joints has some sections on fractures ? 
To which Galen replies that Hippocrates cared 
less for words than for things, and fractures and 
dislocations often come together. This answer is 
not quite satisfactory, for the weak point of the 
work is precisely the absence of any clear account 
of fracture dislocations : besides, it seems probable 
to most careful readers that the result is mainly 
due to a work on fractures and dislocations having 
been broken up and put together again in disorder. 

We may perhaps indicate this most clearly and 
briefly by taking Mochlicon, in which a natural 
order is preserved, as our guide, showing at the 
same time its relationship to the older treatise, or 
treatises. The order of Mochlicon is face, upper 
and lower limbs from above downwards, spine and 
ribs, though, like other Hippocratic works, it ends 
in a confused mass of rough notes. 

M 1 1— II I, nose and ear, are derived from J XXXV- 
XL. M IV, lower jaw, from J XXX-XXXI. M V 
epitomizes in one chapter the remarkable account 
of shoulder dislocations, J I— XII. M VI is from 
J XIII, on dislocation of the outer end of the collar- 
bone considered as avulsion of the acromion. 

1 Apollonius, 13; Galen, XVIIl(l). 519. Cf. Liltrel. 3.34. 



INTRODUCTION 

We are surprised to find that M VII-XIX are not 
an epitome but a verbal repetition of J XVII-XXIX. 
They are derived mainly ( VI 1-XV) from F XXXVIII- 
XLVII, on the elbow ; XVI-XVI II, on the wrist, have 
no extant original, and XIX, on the fingers, does 
not appear to be an abridgment of the long account 
in J LXXX. 

There seems no reasonable doubt, from the nature 
of the case, the style of the writing and peculiarities 
of language, that the epitome was made by the 
author of Mochlicon and afterwards transferred to 
Joi?its to fill up a vacancy. A reader of the latter 
observes a sudden change of style, the appearance 
of new words (i£ai<f>vr)<; for i£aTrcvr]<;) and a whole 
string of depraved infinitives ; 1 but the section is in 
perfect harmony with the rest of Mochlicon. 

M XX-XXIV abbreviate the very full account of 
thigh dislocations in J LI-LX, while the directions 
for reduction, given at length in J LXX-LXXVIII, 
are condensed into M XXV. 

M XXVI-XXXI on knee, ankle and foot repeat 
the phenomenon of VII-XIX. They correspond 
verbally with J LXXXII-LXXXVII and are epito- 
mized from Fractures X-XIV — except XXVI, on 
the knee, which is. in part, from F XXXVII. We 
shall find that J LXXXII-LXXXVII form part of 
an appendix to the original treatise. 

M XXXII condenses the account of club foot 
given in J LXII. 

M XXXII I-XXXV deal with compound disloca- 

1 We may note that, according to our text, M XII has the 
more normal nominatives which have become accusatives on 
transference to J XXII. 

86 



INTRODUCTION 

tions, loss or amputation of parts, gangrene and 
necrosis. They are derived from J LXIII-LXIX. 

M XXXVI feebly represents the long account of 
spinal curvature in J XLI-XLVI, also fracture and 
contusion of the ribs, J XLIX. 

In XXXVII M begins to go to pieces. It is based 
partly on J XLI, partly on J L, and the rest of the 
treatise is a mass of confused notes on dislocations 
and fractures, often hardly intelligible, but obviously 
all taken from Fractures- Joints. Imbedded in it is 
a paragraph (XXXIX) on disease of the palate corre- 
sponding almost verbally with passages in Epidemics 
II, IV, and VI ; and interesting as showing that 
Mochticon, like Surgery, has some connection with 
the middle division of this series. 

Fractures and Joints may now be summarized 
briefly. About one-fourth of Fractures deals with 
dislocations The first seven chapters treat fracture 
of the forearm in detail as a typical case. Chapter 

VIII fracture of the upper arm : IX-XXIII disloca- 
tions of the foot and ankle, and fractures of the 
lower limb. We are surprised to be told in chapter 

IX that dislocation of the wrist has already been 
mentioned. The remainder is devoted partly 
(XXI V-XXXVII) to compound fractures, and 
partly (XXXVIII-XLV11I) to dislocations of the 
elbow, with a few words on dislocation of the 
knee (XXXVIII) and fracture of the olecranon. 

Joints begins similarly with a sample case, dis- 
location of the shoulder-joint, described in great 
detail (I-XII). Then comes fracture of the collar- 
bone and its dislocation (XI1I-XVI). Next (XVII- 
XXIX) is the interpolation from Mochlicon, on elbow, 
wrist, and finger-joints. Injuries of the jaw, nose 

87 



INTRODUCTION 

and ear (XXX-XL) are given great attention, 
doubtless owing to the vigorous boxing methods 
then in use. XL-L treat of the spine and ribs in 
detail, and show much anatomical knowledge. 
LI-LXI include the celebrated account of disloca- 
tion of the hip and its results, and LXII has the 
excellent description of club foot. In LXIII-LXIX 
we are diverted to the consideration of compound 
dislocations, amputation, necrosis and gangrene, and 
finally return to the hip-joint and its reduction in 
LXXI-LXXVIII. 

According to Galen, chapter LXXVIII is the last, 
and his commentary ends here. So does that ot 
Apollonius, except for some rough notes, most of 
which occur at the end of our Mochlicon. 

This view is confirmed by the nature of chapter 
LXXIX, which is a brief introduction to the study of 
dislocations, and would come more appropriately at 
the beginning. 

Chapter LXXX looks like the original account 
of finger-joint dislocation ; but was unknown to 
Apollonius, who says (on chapter XXIX) that 
Hippocrates made only a few remarks on the 
subject owing to its simplicity, and proceeds to 
supplement them by an extract from Diodes, 
which seems almost certainly based upon LXXX, 
and to form part of the " paraphrase " mentioned 
by Galen. We may perhaps conjecture that 
chapter LXXX was lost and discovered again after 
its place had been occupied. The rest of the 
appendix is an epitome of knee, foot and ankle 
lesions supplied from Mochlicon, the originals having 
somehow got into Fractures. 

The answer to the question of antiquity is, then, 

88 



INTRODUCTION 

that the great work on Fractures and Dislocations 
got into disorder soon after it was written, and that 
parts were lost, either temporarily (as J LXXX) or 
permanently, as with the original account of the 
wrist. The excellences of. its disjecta membra speak 
for themselves, and have been recognized by all 
surgeons ancient and modern. An editor has the 
less agreeable task of dealing with defects and 
difficulties. 

Many questions which occur to a modern reader 
are unlikely to receive satisfactory answers. Why 
does Hippocrates say that the fibula is longer than 
the tibia and projects above it * (apparently because 
he saw and exaggerated its analogy with the ulna) 
and that twenty days are " very many " for consolida- 
tion of a broken collar-bone, whereas we allow three 
to six weeks ? 2 Why does he assert with emphasis 
that inward dislocation of the thigh-bone is much 
the most frequent, 3 and all antiquity (together with 
Ambrose Pare) 4 agree with him, whereas all modern 
evidence is to the contrary? Why does he ignore 
injuries of the knee-cap, and the use of that ancient 
instrument the safety-pin ? These problems and 
other statements which will surprise the surgeon, 
such as the cure of hump back by varicose veins 
and the frequency of dislocation of the knee, must 

1 Fractures, XII, XXXVII. 

* Joints. XlV. s Joints, LT. 

4 So Adams (558). In his chapter on hip dislocation 
(XVI. 38) Pare says " leplus souventen dehors et en dedans, 
en deviant et en derriere rarement." He may have held the 
modern view (dehors comes first) but have been unwilling to 
Contradict such authorities as Hippocrates, Celsus and Galen. 
Possibly some grip in ancient wrestling made the internal 
form then more frequent. 

8 9 



INTRODUCTION 

remain unsolved. Two subjects, however, require 
further consideration : the accounts of elbow and 
ankle dislocations. The former is treated by most 
editors at some length, and it is generally admitted 
that the latest and longest discussion (that of Petre- 
quin) throws light on the subject. He points out 
that some difficulties are removed by supposing the 
Hippocratic attitude of the arm to be that with the 
bend of the elbow turned inwards, not forwards, 
and since Hippocrates speaks of dislocation of the 
humerus or upper arm (the convex from the con- 
cave), whereas we speak of dislocation of the fore- 
arm, a double correction is necessary, his inwards 
and outwards becoming our backwards and forwards 
respectively. Similarly, with lateral dislocation, the 
Hippocratic forwards and backwards become our 
inwards and outwards. This seems the best that 
can be done, though it brings the two surgical 
editors, Petrequin and Adams, into violent contra- 
diction on some points. 

The second puzzle is why — though Herodotus 
knows exactly what happened to the astragalus ot 
Darius when he sprained his ankle — does Hippo- 
crates never mention the bone, and give us a very 
obscure account of ankle dislocation ? In part, 
doubtless, it is the layman rushing in where the 
specialist fears to tread ; but the existence of a 
duplicate epitome of each of these subjects will 
enable us to discuss them further in the text. 

Soranus tells us that the father of rhetoric, Gorgias, 
was one of the teachers of the father of medicine, 
and so long as such works as The Art and Breaths 
were considered genuine, they might have been 
adduced either as showing the result of this teach- 

90 



INTRODUCTION 

ing, or as possibly giving origin to such a legend. 
But the story may very well be correct, for Gorgias 
and Hippocrates were both in Thessaly about the 
same time, and the physician may have admired not 
only the fine constitution of the elder man, which 
was destined to prolong his life well beyond a 
century, but also his fine language, and have taken 
some lessons in composition. But if we look for 
traces of rhetoric in what are now considered pos- 
sibly genuine works, we are surprised to find them 
most prominent in the great surgical treatises. 
Fractures-Joints abound, if not in purple patches, at 
least in purple spots, as if the writer was trying to 
make use of recently acquired knowledge of rhe- 
torical forms. Attention was called to this by Diels, 
and it has been more fully worked out by Kromer. 
Some rhetorical forms show through even the worst 
translation, and the reader will easily discover at 
least twelve examples of the rhetorical query. Plays 
upon words are also frequent and obvious in the 
Greek, though difficult to repeat in English. Of 
special interest is the frequent occurrence of chi- 
asmus and other forms of the evenly balanced 
sentence. A short sample of either may be found 
respectively in Fractures, XLVII : ttoXXCw /xev yap av 
KwKvfjLa elr), (j)tji(Xlr] 8c oAiycov, and Joints, XLVI : dAAa 
Kut oirra>5 av airoddvni, irapaxprjfxa oe ovk airoOdvoi. 

The latter, with the allied form of anaphora, or 
needless but ornate repetition of the same word 
(e.g. of aAAo in Fractures, II ; rja-crov, Joints, XI) 
may remind readers of the less artistic repetitions 
common in IVounds in the Head, and suggest that in 
spite of diversity of style it may be by the same 
author. We notice also a similarity of doctrine, 

91 



INTRODUCTION 

especially the statement that contusions of bones 
are usually more serious than fractures, applied 
respectively to skull and ribs. 

Too much weight may, perhaps, be given to this. 
Thus Littre (IV. 566) notes a resemblance between 
Fractures, XXXI, and Diet in Acute Diseases, VII. In 
both there is a disapproval, expressed in very similar 
language, of any marked interference, operative or 
dietetic respectively, during the third, fourth, or 
fifth days. He considers that the identity in sense 
and form of criticism, together with " the identity 
of the epoch," is enough to prove identity of author- 
ship. He might have added that there is a number 
of curious terms common to Diet in Acute Diseases 
and Fractures- Joints : e.g. ayxurra, in the sense of 
/AaAurra, and rj8e\<fii(Tpivo'i, onrapri, to enLirav. 1 But 
there are differences which raise doubts. Thus the 
favourite drink of the author of Fiactures— Joints is 
oxyglvphy (hydromel, prepared by boiling squeezed- 
out honey-combs). 2 Diet in Acute Diseases never 
mentions this, though it has much to say about the 
closely allied oxymel and meliorate, which are ignored 
in Fractures — Joints. 

The most formidable opponent of the Hippocratic 
authorship was H. Diels, whose main contention is 
that ancient writers did not refute one another by 
name, nor mention those whom they copied. There- 
fore, probably, neither Ctesias nor Diodes named 
Hippocrates. That they refer to him is only Galen's 
assumption. Reasons to the contrary are adduced 
by Kromer, and seem equally potent. 3 The " para- 
phrase " of Diodes at least shows that the work was 



1 See Kiihlewein op. cit. p. 6. 2 Galen, XVIII(2). 466 
8 Op. cit. p. 7. 



92 



INTRODUCTION 

well known early in the fourth century, which is 
sufficient to refute the second argument usually 
Drought against its Hippocratic origin, that the 
writer knows too much anatomy, and in particular 
distinguishes clearly between arteries and veins. If 
we may trust Caelius Aurelianus, their distinction 
was known to Euryphon, 1 who was older than 
Hippocrates, while the writer's ability to give a 
good account of the shoulder-joint and spine, and 
promise of further details, is only what we should 
expect from what Galen says about the anatomical 
studies of the old Asclepiadae. 2 

Still, we must agree with Diels that this last 
attempt to demonstrate at least one genuine work 
of Hippocrates may be met by the ancient warning, 
Soko? 8' eVi 7ra<xi rervKrai, or rather that the whole 
sentence of Xenophanes may appropriately be applied 
to the Hippocratic problem, "Even if one hit upon 
the truth, he would not be sure he had done so, for 
guess-work is spread over all things." 

» T. P. 2. 10. 2 Anat. Adm. 2. 1 



93 



riEPI AFMON 

I. Kxprjv tov Irjrpov tmv ifCTTTayaicov re icai 
KaTayfxaTwv oo<; Wvrara t«? Karard<xia<i Trotet- 
a9ai' avrri yap r/ Si/caiOTcirr] (pvaif. rjv Be rt 
iyfcXtvr) r) rj) i) rrj, e7rl to Trprjves peireiv 
eXdaawv yap r) d/xapra<; rj eirl to vtttiov. o'i p,ev 
ovv p,r]Bev irpofiovXevovTat ovBev e^ajxaprdvovaiv 
&)<? e-n\ to troXv' avro? yap e7rtBi]o-6jievo<s x ttjv 
X € ^P a diropeyet ovtcos vtto tt)<; BiKatrjs <f>vato<} 
avay/ca^ofievov oi Be irjrpol o~o<f)i£6fi€vot Bijdev 

10 hariv dpa i(p ot? 2 dfiapTavovo-i. cnrovBr) fiev 
ovv ov iroXXr/ X e ^P a tmeriyvlav X €l P^ <Tal > KCLI > 
TravTo<; Be Ir/Tpov, &>9 eVo? elirelv dvay/cd^o/nai Be 
eyd> 7rXet&) ypucpeiv nepl avrov 3 on ocBa Irjrpov^ 
ero(/>oi><? Bof^avTas elvat diro cr^/iaTtwy x el P ^ *v 
eirtBeaet, d(p cov dptadea<; avTOvs exprjv Bo/cetv 
elvat. aXXa* yap iroXXa ovtw Tavrr]<; t% Texi'V? 
KpLveraf to yap £evorr perres outto) avvievre^, et 
Xpr)o~Tov, /xdXXov etratveovatv rj to avvriOes, o 
rjBrj oiBaatv OTt XP r )°" r0 ' v > Kai T0 dXXoKOTOV rj to 

20 evBrjXov. prjTeov ovv OTrocra<; dv eOeXw twv d/xap- 
rdBwv to)v Irjrpwv, to? pev aTToBtBd^at, Ta? Be 
8tBdgai[' dp^optat Be] 5 7repl tt)? (fivaios rf}? 

1 6 iTrtdt6nevos. 8 tony u'l. 

3 aurrjs. 

94 



ON FRACTURES 

I. In dislocations and fractures, the practitioner 
should make extensions in as straight a line as 
possible, for this is most conformable with nature ; l 
but if it inclines at all to either side, it should turn 
towards pronation (palm down) rather than supina- 
tion (palm up), for the error is less. Indeed, those 
who have no preconceived idea make no mistake as 
a rule, for the patient himself holds out the arm for 
bandaging in the position impressed on it by con- 
formity with nature. The theorizing practitioners are 
just the ones who go wrong. In fact the treatment 
of a fractured arm is not difficult, and is almost any 
practitioner's job, but I have to write a good deal 
about it because I know practitioners who have got 
credit for wisdom by putting up arms in positions 
which ought rather to have given them a name for 
ignorance. And many other parts of this art are 
judged thus: for they praise what seems outlandish 
before they know whether it is good, rather than 
the customary which they already know to be good ; 
the bizarre rather than the obvious. One must 
mention then those errors of practitioners as to the 
nature of the arm on which I want to give positive 

1 Galen makes this a general statement ; but the writer is 
apparently speaking of the forearm, which he had already 
mentioned in a lost introduction. 

« dA/a. « Omit Kw. BMV. 

95 



IIEPI ArMQN 

^et/309* /ecu yap dXXcov ocnecov tcov Kara, to 
24 a(H)fia hlhayp,a ohe 6 X.0709 eariv. 

II. Trjv /Lcev ovv \elpa, trepl ov 1 6 Xoyos, 
ehcoKe ri<i KaTahrjcraL Trpijvea 2 TTODJaav 6 he 
rjvdyKa^ev oi/tw? ^X €lv Mcnrep oi TO^evoi'res, eTrrjv 
tov copbov ep./3dXXcoo-i, kol ovtcik; eyovaav e-reheL, 
vopLi^wv ewvro) elvai tovto avir/ to tccna cpvcriv 
kcu pLapTvpiov eV ijyeTO to, tg oaTea airavTO. to. 
ev tu> nrrj^ei, otl Wvcopi>)v KaTaXX^Xa el^e, 3 Tqv 

T€ Op-OypOLIJV, OTL ClVTt) /Ca0 €fi)VTl)V TTjV L0VCOpLt]V 

eyeL ovtco kol i/c tov e^coOev pLepeos real etc tov 
10 etrcoOev ovtco he ecprj kol ra? crap/cas kcu tc\ 
vevpa TrecpvKevac, ical ttjv to^lktjv eirriyeTO puapTV- 
piov. tclvtcl Xeycov kol TavTa iroiecov crocpos 
ihoKei elvai' tcov he dXXcov Te^vecov eireXeXrjOeL 
kcu QTToaa lct^vl epyd^ovTcu kcu oirocra Teyvr)- 
pLaaiv, ovk eiheos otl aXXo ev aXXco to kcltcl 
cpvcrLv cr^rjfid ecrTiv, kcu ev tw avTco epyco erepa 
t^9 he^Lrjs xeipos a^pLUTa kcltcl cpvcnv eo~TL, kcll 
eTepa tj}9 dpiaTeprjs, rjv ovtco Tvyr). aXXo piev 
yap a-yr\pL,a ev aKOVTiapLco KaTa (fiver iv, aXXo he ev 
20 crcpevhov^aei, dWo he ev \i0o/3o\lt)o-l, aXXo ev 
Trvypbf], aXXo ev tco eXivveiv. 07r6cra<; S' dv tis 
Te^/^a? evpoi ev f/aiv ov to avTo o-yrjpLa tcov ^eipcov 

KaTCL (pVCTLV icTTLV KoX i iv eKaCTTT) TCOV TC^VCOV, 

czXXa 4 777)09 to dppbevov o e'^77 eyeao-7-09, Kal 7roo9 

1 ol because it is an idiom or phrase not referring specially 
to fi X f lp- a e^'5!j<rai KaraTr previa. 

3 %x* 1 KaraAATjAa. * aWa. (omitting Kal). 

1 Commentators, from Galen downwards, point out the 
absurdity of teaching "errors." Ermeiius got rid of it in 

96 



ON FRACTURES, i.-ii. 

and negative instruction, 1 for this discourse is an 
instruction on other bones of the body also. 

II. To come to our subject, a patient presented 
his arm to be dressed in the attitude of pronation, 
but the practitioner made him hold it as the archers 
do when they bring forward the shoulder, 2 and 
he put it up in this posture, persuading himself 
that this was its natural position. He adduced as 
evidence the parallelism of the forearm bones, and 
the surface also, how that it has its outer and inner 
parts in a direct line, declaring this to be the 
natural disposition of the flesh and tendons, and he 
brought in the art of the archer as evidence. This 
gave an appearance of wisdom to his diseoui - se and 
practice, but he had forgotten the other arts and 
all those things which are executed by strength 
or artifice, not knowing that the natural position 
varies in one and another, and that in doing the 
same work it may be that the right arm has one 
natural position and the left another. For there 
is one natural position in throwing the javelin, 
another in using the sling, another in casting a 
stone, another in boxing, another in repose. How 
many arts might one find in which the natural 
position of the arms is not the same, but they 
assume postures in accordance with the apparatus 

his usual bold manner by reading ri for rds. Diels considered 
it a glaring hy.steron proteron which can be simply remedied 
by reversal, and this is practically done in the translation. 
It seems a play upon words at which the writer is more 
successful elsewhere. See chap. XXX end. 

2 Galen says the archer held his left arm back downwards 
or nearly so ; but this is contrary to ancient representations. 
What the writer chiefly objects to is putting up a broken 
forearm with the elbow extended. 

E 97 

VOL. III. 



IIEPI ATMtm 

to epyov o av iiriTeXeaao-Oai deXrj, o~yr\paTL'CpvTai 
at yelpes' to^iktjv 8e aa/ceovTi eiVo? tovto to 
cfyr]jxa fcpuTiarov elvai T/79 eTepi]<; ;\;et/)6V T °v 1&P 
fipayjovos to ytyyXvpoei8e<s, iv tt) tov 7r?/^eo<? 
ffa6p,i8i iv tovtg) ra> <ryj)pbaTi ipelSov I6vu3plr\v 
30 iroiel rotaiv buTeoicnv tov iri'iyeos Kal tov /3payi- 
ovos, oj<> dv ev e'tr] to -ndv Kal r) avd/cXaais tov 
apdpov fce/cXaaTai 1 iv tovtw tu> ayi)p,aTi. et/co? 

p,€V OVV Ol/TO)? d/Cap,7TT0TaT0V TC KOI TCTaVOOTaTOV 

elvai to ycoplov, Kal pi] i)aadcrdai, pr]8e avvhihbvat,, 
e\Kop,ivrj<; t?}<? vevpfjs viro t?}? Se^i/}? ^etoo?* Kal 
ovtcos eVt rrXelaTOv piev Ti)v vevprjv eXKvaei, 
acf))']o~€i Se dirb aTepecoTUTov Kal aOpocoTUTOV 
dirb to>v toiovtwv yap dcpeaLcov t&v TO^evpaTcov, 
Tayeiai Kal a! lo~yve<; Kal to, p,i]Kea ylvovTat. 

40 irnheaei he Kal To^iKp ovSev koivov. tovto p,ev 
yap, el iirih^aa^ eyeiv ti]v yelpa o{/t&)<? ep,eXXe, 2 
irovovs av aXXovs ttoXXovs TrpoaeTiQei pei^ovas 
tov Tpcop,aTos' tovto 8\ el cvyKap-^ai iKeXevev, 
ovTe to, ocrTea ovtc to. vevpa ovtc al crdpKes eTt, 
iv tco aliTW iyivovTO, dXXa dXXrj peTeKoapelTO 
KpaTeovTa Tr/v iTTiZeaiv Kal t'l bcfieXos io~Ti 
to^ikov o"%/]p,aTos ; Kal Tai)Ta lo'cos ovk av 
i^7)pdpTave <ro(pi£6pevos, el eta tov tct pcopevov 

49 avTov Tt]V yelpa Trapaayeadai. 

III. "AA.A.O? 6" av TtS twv IrjTptbv vtttltjv Tr\v 
yelpa Sou?, ovtco KaTaTeiveiv eKe\eve, z Kal out&>9 
eypvaav iTrehei, tovto vopi^wv to KaTa (fivaiv 
elvai, t&) Te ypol a>ipaivop,evo<; Kal ra ooTea 
vopifav KaTa (pvaiv elvai ovtcos, oti (paiveTai to 
i^eyov bciTeov to irapd tov Kapirov y 6 apuKpos 

1 TfTarai K\V. (TiTaadai B'). 
98 



ON FRACTURES, ii.-im. 

each man uses and the work he wants to accom- 
plish ! As to the practiser of archery, he naturally 
finds the above posture strongest for one arm : for 
the hinge-like end of the humerus in this position 
being pressed into the cavity of the ulna makes 
a straight line of the bones of the upper arm and 
forearm, as if the whole were one, and the flexure 
of the joint is extended (abolished) in this attitude. 
Naturally then the part is thus most inflexible 
and tense, so as neither to be overcome or give 
way when the cord is drawn by the right hand. 
And thus he will make the longest pull, and shoot 
with the greatest force and frequency, for shafts 
launched in this way fly strongly, swiftly and 
far. But there is nothing in common between 
putting up fractures and archery. For, first, if the 
operator, after putting up an arm, kept it in this 
position, he would inflict much additional pain, 
greater than that of the injury, and again, if he bade 
him bend the elbow, neither bones, tendons, nor 
flesh would keep in the same position, but would 
rearrange themselves in spite of the dressings. 
Where, then, is the advantage of the archer 
position ? And perhaps our theorizer would not 
have committed this error had he let the patient 
himself present the arm. 

III. Again, another practitioner handing over the 
arm back downwards had it extended thus and then 
put it up in this position, supposing it to be the 
natural one from surface indications : presuming also 
that the bones are in their natural position because 
the prominent bone at the wrist on the little finger 

99 



IIEPI ArMftN 

hd/cTvXos, Kan? Wvaipirjv elvai tov oaTeov, acp* 
oreov 1 tov irrix vv oi avOptoirai fierpiovaiv ravra 
ra fxapTvpia eirr^yeTO on Kara fyvaiv outgo? e\ei, 
10 /cal eho/cei ev Xeyeiv. 

'AXXa tovto p,ev, el innlr) rj x e ^P KaraTeivono, 
l(T')(vpo)<; ttovolt} av yvoir) o" av n<; ttjv ecovTov 

X e ^P a KCLTCLTeLvaS CO? €7TCoBuVOV TO CT^?}/Za. 67Tel 

/cal dvrjp ijaaeov /cpiacrova hiaXaftwv outgo? ev 2 
Trjaiv eoovTov x e P°~ lv > °°? /cXarai 6 dy/cwv vittios, 
ayoi av oirrj eueXoi' ovre yap ei, £t<po? ev ravrr/ 
rfj %e//)l e%oi, e^oi av 6 tl XPVO~atTO tw %i(f)et' outgo 
f&iaiov tovto to ax^ip-d Iotiv. tovto he, el eiu- 
hrjaas Tt? ev tovtw tw axyp>ctTi €G>rj, fie^cov p,ev 

20 TTovo'i, el irepuoi, p,eya<; he ica\ el /caTa/ceotTO. tovto 
he, el avy/cdp,yjrei ttjv xeipa, avayicri irdaa 3 tou? tg 
p,va<i /cal tcl oaTea aXXo axVf ia ^X €IV ' 'hyvoei he 
teal Tahe Ta ev too axvp-ciTi %copt9 tt}? aXXijs 
\vp,rj<i' to yap oaTeov to irapa tov Kapirov 
e^exov, to Kara tov apiKpbv hdiCTvXov, tovto 
piev tov Tn'ixzos eaTiv to he ev t[) avy/cdp,ij/ei ebv 
airo Tev 4 toj' ttt}x vv 0l dvOpanroi p,eTpiovai, tovto 
he tov ftpaxlovos i) Ke<f>aXij eaTiv. 6 he uieTO tcovto 
oaTeov etvai tovto tc /cd/cecvo, iroXXol he /cal 

30 aXXoi' eo-Ti he e/ceivcp tw oaTew tgouto 6 ay/coov 
/caXovp,evo<i, eo 7toti 6 aTrjpi%op,e6a. outgo? ovv 
vtttItiv exovri t?]v x e ^P a > tovto fiev to oaTeov hc- 
eo~Tpap,pbevov ^aiverai, tovto he to, vevpa tcl enro 
tov KapTTov TeivovTa eic tov eaia /nepeos ical airo 
twv haKTvXcov, TavTa vTTTLrjv exovTi ttjv X € ^P a & l ~ 
eoTpap.p.eva ylveTai' TelveTai 6 yap Tama tcl vevpa 

1 &7r' Stsv. 2 iv. 3 Kw. omita. 

IOO 



ON FRACTURES, in. 

side appears to be in line with the bone from 
which men measure the foreai'm (cubit). He 
adduced this as evidence for the naturalness of the 
position, and seemed to speak well. 

But, to begin with, if the arm were kept extended 
in supination it would be very painful ; anyone who 
held his arm extended in this position would find 
how painful it is. In fact, a weaker person grasping 
a stronger one firmly so as to get his elbow extended 
in supination might lead him whither he chose, for 
if he had a sword in this hand he would be unable 
to use it, so constrained is this attitude. Further, if 
one put up a patient's arm in this position and left 
him so, the pain, though greater when he walked 
about, would also be great when he was recumbent. 
Again, if he shall bend the arm, it is absolutely 
necessary for botli the muscles and bones to have 
another position. Besides the harm done, the 
practitioner was ignorant of the following facts as 
to the position. The projecting bone at the wrist 
on tlie side of the little finger belongs indeed to 
the ulna, but that at the bend of the elbow from 
which men measure the cubit is the head of the 
humerus, whereas he thought the one and the 
other belonged to the same bone, and so do many 
besides. It is the so-called elbow on which we lean 
that belongs to this bone. 1 In a patient with the 
forearm thus supinated, first, the bone is obviously 
distorted, and secondly, the cords stretching from 
the wrist on its inner side and from the fingers also 
undergo distortion in this supine position, for 

1 i.e. the olecranon process is part of the ulna. 



in-' uTtv. 6 Hv itotI. • rtlvci. 



IOI 



IIEPI ArMQN 

7T/0O? to rov ppaxiovos oareov, oOev 6 rrtj^v; 
/xerpelrai. avrat roaavrai /cat, roiavrai ai 
dp,aprdhe<; /cat dyvoiai tt}? (pvaios T/79 yeipos. eo 
40 he, &>9 eyd> K€\eva>, %et/?a Karer/yvlav /carareivoi 
Tt9, emarpe-^rei piev ro oareov e'9 Wv, ro Kara rov 
apuKpov haKrvkov, to e<? rov dyfcwva reivov, 
IBvwpiriv he e%ei rd vevpa xa drrb rov Kapirov 
rrpos rov p3paylovo<; rd aicpa retvovra' avaXapu- 

ftavopukvr) he rj X eL P ^ v r n a P a 'n r X' r }< J ' l <p °~X , ']l xaTl 
earai, iv a> rrep /cat ernheopievr), arrovos p,ev 
ohoirropeovn, dirovos he KaraKeipieva icai aica- 
p,aro<>. KaOivvvaOai he XPV r ° v dvOpwirov ovroys, 
07r&)9 77 to e^eypv rov oareov rrpo^i rijv Xapurrpora- 

50 rr)v rwv rrapeovaewv avyewv, o>9 pit) XdOrj rov 
yeiplt,ovra ev rfj /carardaei, el l/cava)<; e^iOvvrai. 
rov ye p,r)v ipnreipov ovo' dv rr\v yelpa XdOoi eVa- 
yopievrjv to e^eyov drdp kcu dXyet pudXiara Kara 

64 to e^eyov -ty-avopbevov. 

I V. Twv he oarewv rov rrrj-yeo^, mv p-r) dp,(f)6repa 
Karetjye, 1 pda>v 17 Irjais, r\v ro dvco oareov rerpco- 
pievov rj /cat rrep rrayyrepov eov apia p.ev on ro 
vyiei vrrorerapLevov yiverai dvrl OepieXiov, dpua he 
on evKpvnrorepov yiverai, irXrjv el 2 to €77119 toi> 
Kapirov' naye'iT] yap 7) rr)<; aap/cos ernfyvais r) em 
to dvco. ro he Kara) oareov daapnov icai ovk 
evavyicpvirrov, icai Karardaio^ lo"xyporepv]<i helrai. 
fjv he pbr) rovro avvrpiplfj, dXXd ro erepov, 

10 <pav\oreprj 3 r) tcardraai*; dp/cel. rjv he dpL<f)orepa 
Karerjyr], layvpordrr}^ Karardaio<; helrai' iraihiov 
piev yap Tjhr/ elhov KararaOevra pidXXov r) 0J9 

1 Kaririyev, . . . (I . . . TfTpwrai. % $. 

8 iAcuppoTtpr), 

102 



ON FRACTURES, m.-iv. 

these cords extend to the bone of the upper arm 
from which the cubit is measured. Such and so 
great are these errors and ignorances concerning the 
nature of the arm. But if one does extension of a 
fractured arm as I direct, he will both turn the 
bone stretching from the region of the little finger 
to the elbow so as to be straight * and will have the 
cords stretching from the wrist to the (lower) end 
of the humerus in a direct line ; further, the arm 
when slung will keep about the same position as it 
was in when put up, and it will give the patient no 
pain when he walks, no pain when he lies down and 
no sense of weariness. The patient should be so 
seated that the projecting part of the bone is turned 
towards the brightest light available, that the 
operator may not overlook the proper degree of 
extension and straightening. Of course the hand 
of an experienced practitioner would not fail to 
recognise the prominence (at the fracture) by 
touch ; also there is a special tenderness at the 
prominence when palpated. 

IV. When the bones of the forearm are not both 
fractured the cure is easier if the upper bone 
(radius) is injured, though it is the thicker, both 
because the sound bone lying underneath acts as 
a support and because it is better covered, except 
at the part near the wrist, for the fleshy growth 
on the upper bone is thick j but the lower bone 
(ulna) is fleshless, not well covered, and requires 
stronger extension. If it is not this bone but the 
other that is broken, rather slight extension suffices : 
if both are broken very strong extension is requisite 
In the case of a child I have seen the bones ex- 
1 i.e. the styloid process in line with the olecranon, 

103 



IIEPI ATMQN 

eBet, ol Be TrXelcyroi rjaaov reivovrai r) &><? Set. 
%pr) 6° €ttt)v Tetvaxri, rd Oevapa irpoa ftdXXovra 
Biopdovv eireira %plcravTa Krjputrf) p,r) irdvv 
woWf), ®? f^h TTGpwXeij ra eiriBeapaTa, o£Jto>9 
eiriBelv oVo)? prj KaroyTepco a/cpijv ttjv %ei/>a e^ei 
tov dy/ccovos, dXXd apucpw rivl dvcorepco, a)<? pt] 
to alpa e? d/cpov eTripperj, dWd aTroXap^dvijTai' 

20 €7T€tra eiriBelv t<u odovtca, ttjv dp-^rjv ftaXXopevos 
/card to /caTTjypa' epelBcov p,ev ovv, 1 pi] irie^wv Be 
/cdpra. eirrjV Be irepifidXr) Kara twvto Bl$ rj rpis, 
€7rl to avco vepeaOco eiriBeoiv, Xva at eTrippoal tov 
aiparos diroXapL^dvcovrai, /cal reXevrrjo-dTG) 
Keldi. XPV ^ e H'V P'O-Kpa elvcu rd irptara odovia. 
tS)v Be Bevrepa/v odovlwv ttjv pev dp^rjv fidXXecrdai 
eirl to /cdrrjypa' 7repi,/3aX(ov re 2 carat; e? tcovto, 
evena vepueaOco e? to kutq) /cat eVi r)acrov Trie^cov, 
/cal eirl pe%ov Biafiifidcr/ccov, d>>i av avro 3 l/cavhv 

30 yevrjrai to bdoviov dva7raXivBpoprjcrat iceWi \va 
irep to erepov ereXevrrjaev. evravOa pev ovv ra 
odovia eir dpiarepd rj eirl Be^td eTri8eBeo-8a), rj 
eirl oTrorepa av avpcfrepij too? to o~yr\pa tov 
KareayoTos* teal ecf> oirorepa av irepippeireiv 
ervpepepj}. perd Be ravra, o~7r\rjva<; KaTarelveiv 
%pr) Ke^picr pevov<i /crjpooTrj oXiyrp fcal yap irpoar)- 
vecrrepov koX evderuirepov. eireira ovtco? e7riBeiv 
TOtaiv oOov'toiaiv o>? 5 evaXXd%, ore pev eirl Belaid, 
ore Be eV dpicrrepd' /cal rd pev irXeia) KarcoOev 

40 dpxopevos e? to ava> dyeiv, eari 8' ore /cal dva>6ev 
e? to /cdrco. ra Be vTro^rjpa d/cetadai toicti 
cnrXrjveai KV/cXevvxa' tw Be irXijdei tcov irepi- 

1 Omit oiv. Si. * airy. 

104 



ON FRACTURES, iv. 

tended more than was necessary, but most patients 
get less than the proper amount. During extension 
one should use the palms of the hands to press 
the parts into position, then after anointing with 
cerate (in no great quantity lest the dressings should 
slip), proceed to put it up in such a way that 
the patient shall have his hand not lower than 
the elbow but a little higher ; so that the blood 
may not flow to the extremity but be kept back. 
Then apply the linen bandage, putting the head 
of it at the fracture so as to give support, but 
without much pressure. After two or three turns 
are made at the same spot, let the bandage be 
carried upwards that afflux of blood may be kept 
back, and let it end off there. The first bandages 
should not be lengthy. Put the head of the second 
bandage on the fracture, making one turn there ; 
then let it be carried downwards, with decreasing 
pressure and at wider intervals, till enough of the 
bandage is left for it to run back again to the 
place where the other ended. Let the bandages 
in this part of the dressing be applied either to 
left or right, whichever suits the form of the fracture 
and the direction towards which the limb ought 
to turn. After this, compresses should be laid 
along after being anointed witli a little cerate ; for 
the application is more supple and more easily 
made. Then put on bandages crosswise to right 
and left alternately, beginning in most cases from 
below upwards but sometimes from above down- 
wards. Treat conical parts by surrounding them 
with compresses, bringing them to a level not all 

4 KarriynaTos. 6 Omit is. 

i°5 



IIEPI AITMON 

fioXecov /XT] irav ddpobv avvBiopdovvTa, dXXd 
Kara /iepo<$. TrepiffdXXeiv Be %pi] %a\a/5a Kal 
irepl tov Kapirov T/79 %6£/0O9 aXXore Kal aXXore. 
TrXrjdos Be twv hQov'iwv ikclvov to irpSirov ai Bvo 

47 pbolpai. 

V. S^?/A6ta Be tov fcaXcbs li]Tpevp.evov ravra, 
Kal 6p6(b<; €7riBeop,ei>ov, el epa>ra>rj<; avrbv el 
TTeirieK-rait /cat el (pair/ pev ireirie-^Oai, ^avyw^ 
Be, Kal fidXiara el Kara to KaT7]yp.a (frairj' 
roiavra tolvw (frdvai ^pi) Treirpriyfieva Bid reA.eo9 
tov 6p0(b<; eirtBeofievov. arjpela Be Tavra tt)? 
pbeTpioTrjTOS, tiiv p.ev y)p,eprjv, r)v av eiriBeQfj, Kal 
TTjV VVKTa BoKeiTQ) avTOS ewvTw pur) eTrl rjacrov 
TreTTie^Oai, dXX* enl piaXXov ttj Be vaTepaly 

10 olBrjpdrwv eXOelv e? X e ^P a & K PV V p-aXdaKOV 
pL€TptoTy]TO<i yap arjpelov tt}? irie£io<; aov TeXev- 
T(0cn]<; Be Trjs rjpbepii*;, 67rt r\aaov Bokcltco Tretrie- 
\0ai' tt) Be TpiTTj ^aXapd aoi BoKeirw eivai tcl 
e7riBeaf.iaTa. Krjv p,ev tl tovtohv twv elpr)p,evcov 
eXXeiTrr), ytvooo-Keiv ^pr) otl ^aXapfOTepii earlv t) 
err IBecr £9 tov pLerplov i}v Be tl tcov elprjpievwv 
irXeovd^r), ^pr) yivcocrKeiv oti pcdXXov eirie-xPv tov 
pueTpiov Kal tovtoio-i arjpaiv6fxevo<; to vaTepov 
eTTiBecov rj %aXciv pudXXov, ri irie^eiv. diroXvaavTa 

20 Be xph fpnalov eovra KaraTetvdp,evov Kal Biop0co- 
crdp,evov Kal tjv pieTpicoq to TrputTov TeTt/%/;«?79 
€TTiB>]oa<>, TavTtjv Tt)v iiriBeo~iv x,PV oXiyw p,dXXov 

1 Littre inserts aidis iTrtdqrrai — and renders (as followed 
by Adams), "Having removed the bandages on the third 
day, you must make extension and adjust the fracture and 
bind it up again." As Petrequin remarks, this seems con- 
trary to common sense, surgery and the express directions 

106 



ON FRACTURES, iv.-v. 

at once but gradually by the number of circum- 
volutions. You should put additional loose turns 
now and then at the wrist. The two sets of 
bandages are a sufficient number for the first 
dressing. 

V. These are the indications of good treatment 
and correct bandaging : — If you ask the patient 
whether the part is compressed and he says it is, 
but moderately and that chiefly at the fracture. 
A properly bandaged patient should give a similar 
report of the operation throughout. The following 
are the indications of a due moderation. During 
the day of the dressing and the following night 
the pressure should appear to the patient not to 
diminish but rather to increase, and on the following 
day a slight and soft swelling should appear in 
the hand ; you should take this as a sign of the 
due mean as to pressure. At the end of the day 
the pressure should seem less, and on the third 
day you should find the bandages loose. If, then, 
any of the said conditions are lacking you may 
conclude that the bandaging was slacker than the 
mean, but if any of them be excessive you may 
conclude that the pressure was greater than the 
mean, and taking this as a guide make the next 
dressing looser or tighter. You should remove the 
dressing on the third day after the extension and 
adjustment, 1 and if your first bandaging hit the 

of the author (XXXI). The limb is supposed to be set, any 
farther adjustment being made on the seventh day. Celsus 
(VIII. 10. 1), Galen (Meth. Med. VI. 5) and Paulus (VI. 99) 
all follow Hippocrates, but make no mention of a second 
setting on the third day. Still, in the case of the leg he 
seems to recommend interference at every dressing ; and 
grammar is on the side of Littre. 

I07 



iiepi ArMfjN 

rf eK€LVi]v TTieaat. fidWeadai 8e ^PV Ta< > «P% a< > 
Kara to Karrjypa, wcrirep icai to irporepov r/v 
fiev yap tovto irporepov ivrther]^, e^eipvarai x e« 
tovtov ol t'^wyoe? e\ Ta? io")£aTia<; evOa Kal evBa' 
rjv 8e ti aXXo irporepov 7rte?7??, e? tovto i^erpvarai 1 
etc tov Trie^OevTO^' e<? iroWd 8e ev)(p>]arov rb 2 
avvievai. ovto)<> ovv apyeoOai pkv alel )(PV T V V 
30 eiriheaiv Kal tt)v irie^iv Ik tovtov tov -^coplov, to, 
8e a\\a KaTa \oyov, &>9 rrpoacoTepco dirb tov 
KarijypaTOS dydyrjs, errl r)o~aov ttjv Ttte^iv troiel- 
crQai. yjxkapa 8e TravTairaai pr/herrore Trepi- 
fidXXeiv, dWd TrpocrireTTTcoKvia. eireira 8e 
irXeloaiv oOovioicu xph iiriheiv eKdarr/v twv 
eir i8ea lodv . epcoTdopevos 8e <f)dTa> oXiyrp p,aX\ov 
ol ireTrie^Oai,, r) to irpoTepov, Kat, pdXtaTa (f)aT(o 
KaTa, to KaTtjypa Kal to, a\\a 8e KaTa \oyov 
Kal dp<pl tw olSijpaTi, Kal dp,(pl tm Troveeiv, /cat 

40 apcpl t&) pf)t£eiv, KaTa Xoyov Trjs 7rpoTeprj<; eVt- 
Seaios yiveaOco. €7rr)v he Tpnalos rj, ^aXapojrepa 
ol 8ok€lt(0 elvai to. iiriheo-paTa' hrreiTa airoXv- 
aavTa \pr) avdi<i iirihrjo-ai, oXiyw pdXXov 
irie^ovTa, Kal ev Tract toZoiv oOovioicnv oloi irep 
tftieXXev iirihetaOar eireiTa 8e irdvTa avTov 
TavTa KaTaXafteTQ), airep Kal ev Tjjai rrpcoTrjat 

47 TrepioSoicri tcov eiriheo~Lwv. 

VI. 'ETrrjv 8e TptTaios yevrjTat, e/38op,aio<; 8e 
diro ttjs 7r/)ft)T?/9 eu i8ea ios , rjv opOws e7ri8ei)rat, to 
p,ev oi8rjp,a ev aKprj ttj %et/9t eo~Tai, oi)8e tovto 
Xlrpj p,eya' to 8 , e7rt8e6pevov yjuapiov ev TTaarjai 
tTjo-iv €7ri8eo~€o~iv eirl to XewTOTepov Kat, ia^yoTe- 
pov evpedt')o-€Tai, ev 8e ttj e(386p,r) Kal irdvv \etiTov-, 

1 i^eipyarai bis. See note, p. 158. 
ic8 



ON FRACTURES, v.-vi. 

proper mean this one should be a little tighter. 
The heads of the bandages should be applied over 
the fracture as before, for if you did this before, 
the serous effusions were driven thence into the 
outer parts on both sides, but if you formerly made 
the pressure anywhere else, they were driven into 
this place (the fracture) from the part compressed. 
It is useful for many things to understand this. It 
shows that one should always begin the bandaging 
and compression at this point, and, for the rest, 
in proportion as you get further from the point 
of fracture make the pressure less. Never mak^ 
the turns altogether slack, but closely adherent. 
Further, one should use more bandages at each 
dressing, and the patient when asked should say he 
felt a little more pressure than before, especially 
at the point of fracture, and the rest in proportion. 
And as regards the swelling, feeling of pain and 
relief, things should be in accord with the previous 
dressing. When the third day comes, he should 
find the dressings rather loose. Then after undoing 
them he should bandage again with a little more 
pressure and with all the bandages that he is going 
to use, and afterwards the patient should experience 
all those symptoms which he had in the first periods 
of bandaging. 

VI. When the third day is reached (the seventh 
from the first dressing), if he is being properly 
bandaged, there will be the swelling on the hand, 
but it will not be very marked. As to the part 
bandaged, it will be found to be thinner and more 
shrunken at each dressing, and on the seventh day 



* toCto. 



109 



IIEPI AriVfftN 

/ecu tci ocrre'a ra KaTeijyoTa €ttI p,aXXov Kivevp-eva 
tcai evirapdyooya e? Kciropdcocriv. /cal i)v r) Tavra 
Toiavra, KaropOcocrcLfievov %p)) enrihijcrai ci? '9 vdp- 

10 dtjKas, oXtyco p,dXXov irteaavTa i) to irpoTepov, rjv 
p,r) irovo<i it? irXeiwv r) utto tov olh>jp,aTO<; tov ev 
aicprj tt) X €l P i - ^h v ^' eTrih/jarjs toIctlv odovioicri, 
Toi><i vdpQijKas irepiOelvai xp>) Kal TrepiXaftelv ev 
tolctl heapioiai 009 y/aXapooTciTOicriv, oirocrov rjpe- 
p,elv, (bcTTe purjoev crvpb/3dXXea6ai e? tijv irlefjiv Trjs 
%etpo9 Tr)v TOiv vapOi'jKcov irpoaSeatv. pueTa he 
TavTa, 6 T6 ttovos, ai Te paaTcovai ai avTal 
yiveaOcocrav ai irep teal ev Tr/at TrpcoTycri 1 irepi- 
6801a 1 ram eTTthea'Kov. eirrjv he TptTalos eoov cpf) 

20 -%aXapov elvac, tot eirena j(p>j toi»9 vdpdrjKa<i 
epelcraadai, pbdXiaTa pev KaTa to KaTrjyp,a, ciTap 
/cal TaXXa KaTa Xoyov, yirep /cal r) iirlhecn,? 
e\aXa apa 2 pbdXXov 7) eirie^ev. irayyTaTOv he 
Xpt) elvac tov vdpOijKa fj e'^ecrrr; to KaTr/ypua, p,r) 
purjv iroXXcp. eTTiTijheveiv he ^pr; p,dXio~Ta p,ev /caT 
Wvcopuijv tov p,eydXov ha/CTvXou, a>9 p,r) KeicreTai 6 
vdpdi]^, dXXa tt) rj tt}, pcyhe KaTa Trjv tov apuKpov 
idvcopuyv, rj to ocrTeov virepe^ei ev too Kaprrw, 
dXXd ttj 1) ttj' rjv he apa 777909 to KaTijypca 

30 crvp,(p€pr/ KelaOai KaTa TavTaTivas tS>v vapOi'jKcov, 
^pa"xyTepov<i avTous ^pr) tcov ciXXcov iroielv, 019 
pur) i^tKi'icoiTat 7roo9 ra oaTea to, uTrepe^ovTa 
jrapa tov Kapirov Ktvhvvos yap eXKooaios real 
vevpcov \lriXd)aio<i. ^pq he htd TptTijs ipelheiv 
Tolcrt vdpOtj^i, irdvv r)av)^i}, ovtco tij yvd>p,)j 
eyovTa, ci>9 oi vapdtjKes (pvXaK?j<i e'iveKa x?}9 



1 •xporipyau 



IIC 



ON FRACTURES, vi. 

it will be quite thin, while the fractured bones will 
be more mobile and ready for adjustment. If this is 
so, after seeing to the adjustment you should bandage 
as for splints, making a little more pressure than 
before, unless there is any increase of pain from 
the swelling on the hand. When you dress with 
the bandages you should apply the splints round the 
limb and include them in ligatures as loose as 
possible consistently with firmness, so that the 
addition of the splints may contribute nothing to 
the compression of the arm. After this the pain 
and the relief following it should be the same as 
in the previous periods of bandaging. When, on 
the third day, he says it is loose, then indeed you 
should tighten up the splints, especially at the 
fracture, and the rest in proportion where the 
dressing also was loose rather than tight. The 
splint should be thicker where the fracture projects, 
but not much so, and you should take special care 
that it does not lie in the line of the thumb, but on 
one side or the other, nor in the line of the little 
finger where the bone projects at the wrist, but on 
one side or the other. If, indeed, it is for the bene- 
fit of the fracture that some of the splints should be 
placed thus, you should make them shorter than 
the rest, so that they do not reach as far as the 
bones which project at the wrist, for there is risk 
of ulceration and denuding of tendons. You should 
tighten the splints every third day 1 very slightly, 
bearing in mind that they are put there to maintain 

1 i.e. every other day 



2 P<1« <U"A.cya codd. ; but this is not Greek. Kw. omits 
Spa- 



Ill 



IIEPI ArMQN 

eTrioeaios irpOdKeovrai * dXX 1 ov t/}<? 7rte£to<? 

38 e'iveicev e7r thehevrai. 2 

Vll. rlf fnv ovv ev 610779 on i/cavax; ra oarea 
airiduvTai iv rfjai irpo-reprjcn iiriheaeai, kcli firjTe 
Kvrja/xoi Tives Xvireaioi, yx?/Te Tt? eXxcoaif fxrjhe/xia 
VTTOTTTevrjrai elvai, idv XPV iirtheheaOat, iv rolat 
vdpdrj^i, ear dv vjrep ecKoaiv fjpepas yevrjTCiL. 
iv Tpiij/covra he fidXicTa rfjai avpLirdayat tcpa- 
zvverai ocnea rd iv to> Trrj^ei to eiriirav drpeices 
he ovhev fxdXa yap /cat (pvcri<; (frvcreos teal rjXtKLt] 
rfXuclrjS hiacpepei. iirliv he Xvart^, vhiop 0epp,6v 

10 Karaj^eai XPV ical p.ere7rih7jcrai, rjacrov p.ev oXiytp 
TriecravTa 7) to irpoaOev, eXdaaoai he rotatv 
odovioiaiv 7) to irporepov /cat eirena hid rpLrrj^ 
r)fiep>i<; Xucravra iirtheiv, eVt fxev r\aaov TTie^ovra, 
67rt he iXdaaoat roloiv bdovioiaiv. iirriv he, orav 
Total vdp0T]£i heOfj, vTroTTTevrjs rd oarea fir) 
opOcof /celaOai, 7) aXXo ti o^Xer) tov Terpw/xevov, 
Xvcrai iv ru> rj/xiaei 3 tov \povov r) 6Xiya> irpoaOev, 
/cat avOis p^ereirihrjo-ai. hiaira he tovtoiglv olaiv 
dv pit] kXicea i£ dp%r)<; yevrjTat rj oarea e^co 

20 i%io~XO, dpKel v7rocpauX7]. \jypbiicpov tl /cat ydp\ 4 
ivheeojepov 5 XPh htandv a^pt? r)p,epe<ov he/ca, 
are hi] ical iXivvovras" /cat o-^roiaiv diraXolcri 
Xprjaflai orrocra rfj hie^ohw p,eTpioT7]Ta irapa- 
o-yjiGei, olvov he. zeal Kpe7/<paytrjq dire^eadat' 
eireira pukvroi e/c irpocrayoyyr)^ dvaicopbL^eaOai. 
ouTO? Xoyos coo-7rep i/opo? /celrai hi/cato$ irepl 
KaTTjy/ndToov h'laios, w? re yeip'iteiv XPV> w 5 re 
dirofSaiveiv diro t?}<? St/cat?/? x €l P^ l °S' 6 ri S' dv 
p.7] outw? dirofiaivr), elhevav XP 1 ! ° rL €V r V 

1 TrpocrKtooviai Vulg. : TrpoffKtaTai K\V. 
112 



ON FRACTURES, vi.-vn. 

the dressing, but not bound in for the sake of 
pressure. 

VII. If you are convinced that the bones are 
sufficiently adjusted in the former dressings, and 
there is no painful irritation nor any suspicion of a 
sore, you should leave the part put up in splints till 
over the twentieth day. It takes about thirty days 
altogether as a rule for the bone of the forearm to 
unite. But there is nothing exact about it, for both 
constitutions and ages differ greatly. When you 
remove the dressing, douche with warm water and 
replace it, using a little less pressure and fewer 
bandages than before ; and after this, remove and 
re-apply every other day with less pressure and fewer 
bandages. If, in any case where splints are used, 
you suspect that the bones are not properly adjusted, 
or that something else is troubling the patient, 
remove the dressing and replace it in the middle of 
the interval or a little sooner. Light diet suffices 
in those cases where there is no open wound at 
the first, or protrusion of the bone, for it should be 
slightly restricted for the first ten days, seeing that 
the patients are resting ; and soft foods should be 
taken such as favour a due amount of evacuation. 
Avoid wine and meat, but afterwards gradually feed 
him up. This discourse gives a sort of normal rule 
for the treatment of fractures, how one should handle 
them surgically, and the results of correct handling. 
If any of the results are not as described, you may 

a (iriSfcui'Td.i Vulg. : ^7ri8e5e'aToi Kw. 
8 fx(<rr\-yv. 



4 80 (ialen and some MSS. Omit Littre, Erra. Kw. 

5 ifQetffTfpof 5*. 



"3 



IIEPI ArMQN 

30 j^eipi^ei Tt evhees TreiroiriTab rj irevXeovaaTai. 
€TC he rdhe XPV irpcxravvievat ev touto) tw 
cnrXw TpoTTCp, a ou Kcipra eiripLeXeovTat ol Irjrpoi, 
KaiTOi Traaav jxeXerriv /cal rraaav eTTiheaiv old 
re hiafydeipeiv io~TL, p,7j 6pdw<; Troievfieva' r\v 
'yap ra /xev oared dfi^co Karrpyf], r) to koItco 
fxovvov, 6 he eirihehepievos ev rcuvir) nvl tt)v 
X e ^P a ^XV ^aXeXap./J.ivtjv, 1 rvyxdvp Be i) Taivir) 
Kara to KaT7]y/jba TrXeiaTr] eovaa, evOev he /cal 
evdev j; X ei P o\iraLooprjTai, tovtov dvdyKi) to 

40 oareov evpedrjvat hiearpapLpLevov exovra 777309 to 
avco fiepos' r)v he, /careTiyoTatv rcov oarewv ovtws, 
a/cprjv re ttjv X e ^P a ^ v T V Talv ^V *XV Ka1, 7ra / 3 ^ T0V 
dyicoiva, 6 he ciXXos tt?)X v ^ Lp-vI 2 p>€T6(opo<; rj, 
ovtws 3 evpeOijcreTai to ocrreov e? to kutco fxepo^ 
hieaTpap,p,evci)<i exov. XPV °^ v > ^ v Tcui'irj 7rXaT0? 
ixovo-r], [xaXOaicfi, to TrXelarov tov 7T^eo9 /cal 

47 tov Kaprrbv tt}? x el P 0< > O/uaXco? alwpelaOai. 

VIII. *Hi> he 6 /3paxi(ov Karayf), r)v [i,ev Tt$ 
diroTavvaas rrjv X € ^P a * v T °v T( p T< ?> a XVP- aTl 
hiareivr), 6 /u,u<i rov (Spaxiovo'i Kararerapievos 
€7nhe0ijcr€Tai' eirrjv 6° eiriheOels crvyfcdpf^rr) top 
dyKoJva, 6 fids tov ySpa^tofo? aXXo o-xfifia 
o~xyo~€L. hiKaiordrr) ovv /Spa^toyo? Kardraais 
ijhe' %u\ov nr^yyalov V o\uy<p ftpaxvTepov, biroloi 
oi areiXaiot elcri ru>v aicafy'uov, Kpe/xdaai xph evdev 
/cat, evOev, aetpfj hijaavra' Kadioavra he tov 

10 dvQ pcoir ov eVi v\jn)Xov nvos, ttjv %etpa tnrep- 
Keladai, &>? vtto rfj /xacr^aA,?; yevr/Tat 6 aTeiXaios 
e^cov av/ApieTpcos, (bare fioXis hvvaadai /caOiv- 

1 a.vu\e\a/j./j.4i'OS* 

114 



ON FRACTURES, vii.-vih. 

be sure there has been some defect or excess in the 
surgical treatment. You should acquaint yourself 
further with the following points in this simple 
method, points with which practitioners do not 
trouble themselves very much, though they are such 
as (if not properly seen to) can bring to naught all 
vour carefulness in bandaging. If both bones are 
broken, or the lower (ulna) only, and the patient, 
after bandaging, has his arm slung in a sort of scarf, 
this scarf being chiefly at the point of fracture, while 
the arm on either side is unsupported, he will 
necessarily be found to have the bone distorted 
towards the upper side ; while if, when the bones 
are thus broken, he has the hand and part near the 
elbow in the scarf, while the rest of the arm is 
unsupported, this patient will be found to have the 
bone distorted towards the lower side. It follows 
that as much as possible of the arm and wrist should 
be supported evenly in a soft broad scarf. 

VIII. When the humerus is fractured, if one 
extends the whole arm and keeps it in this posture, the 
muscle of the arm x will be bandaged in a state of 
extension, but when the bandaged patient bends his 
arm the muscle will assume another posture. It 
follows that the most correct mode of extension of the 
arm is this : — One should hang up a rod, in shape like 
a spade handle and of a cubit in length or rather 
shorter, by a cord at each end. Seat the patient on a 
high stool and pass his arm over the rod so that it comes 
evenly under the armpit in such a position that the 

1 Bicep8. 

2 Omit ; but Galen defends both readings (x\ iii(2). 415). 

3 OUTQS ■ . . bltJTfia./J./AtVQl' i^UlV. 

"5 



IIEPI ATMHN 

vvcrOai tov avdpwrrov, apuKpov Beoma fierecapov 
eivar eireira Oevra ti ciXXo e(j>eBpov, Kal vtro- 

OeVTCL GKVTIVOV V7T0K€(f)dXai0V, i) ev rj irXeia), 
07Tg>? av/j,p,6Tp(o$ a^aei v-^reos tov Trrfyeos 
ifXayiov Trpds opOrjv ycoviijv, cipiarrov p,ev o~kvto$ 
ttXcitv Kal fxaXOaKov r) Taivnjv irXaTerjv dpucfri- 
ftaWovra, twv p.eydX(ov rt crrad ixiwv e^apTrjaai, 

20 o Tt [xerpiu)^ e£ei Kararelvetv el Be /jlt], tcov 
dvBpcov ocrrt? eppcofievos, ev tovtw tw a^J][xaTi 
tov 7T^eo<? eovTos irapa tov ay/ccova Karavay- 
fca^era) e? to /carco. 6 Be IrjTpos 6p06s pAv ea>v 
%eipi%€T(0, tov erepov iroBa eVt vtyrfXoTepov tivos 
e'Xjcov, Karop6u>o-a<i Be tolcti Qevapcri to OGTeov 
prjiBicos Be KaT0p6d>aeTai' dyadrj yap r) KaTa- 
crTacrt?, 1 i]v Tf? KaXws irapaaKevdarjTat. eireiTa 
eTTtBeiTU), Ta? tc ap^as f3aXXop,evo<; eVt to 
KaT7]ypLa, Kal TaXXa irdvTa o)o-nep irpoTepov 

30 TrapijveOrj, %eipi^eTG>' Kal epwTr\p,aTa TavTa 
epcoTaTco' Kal crr]p,eioiai %o?;cr#&> Toiaiv avTotai, 
el yu,eTOi&)<? exei, rj oir Kal Bta Tp(,Tr]<; e7riBeiTco, 
Kal errl /xdXXov Trie^ero). Kal e/38o/na?ov rj ev- 
vaTalov ev vdp0i)£i Brjadrw Kal rjv vTroirTevcrj 
fxr) Ka\co<i Ketadat to ocneov /xearjyv tovtov 
tov xpovov, XvcraTQ), Kal evOeTiadfievos pueT- 
G7nBr]o-dTa>. 

KpaTvveTai Be fidXiaTa ^pa\iovo<i oo~Teov 
ev TeaaapaKovTa 7]p,epr/aiv. eTrtjv Be Tavras 

40 VTrepfidXr), Xveiv %P 7 h Kai ^ 7ri V (T(T0V irie^eiv 
Toiaiv oOovloiai Kal eirl iXdaaoaiv iiriBelv. BLai- 
Tav Be dKpij3eareprjv tivci rj to irpoTepov BiaiTav, 
Kal 7rXeca) xpovov T€Kp.alpeo~6ai Be Trpof tov 
olBi')p,aTO<; tov ev ctKprj ttj X eL P l > T V V pdifirjv 
n6 



ON FRACTURES, vm. 

man can hardly sit and is almost suspended. Then 
placing another stool, put one or more leather 
cushions under the forearm as may suit its elevation 
when flexed at a right angle. The best plan is to 
pass some broad soft leather or a broad scarf round 
the arm and suspend from it heavy weights sufficient 
for due extension ; failing this, let a strong man 
grasp the arm in this position at the elbow and force 
it downwards. As to the surgeon, he should operate 
standing with one foot on some elevated support, 
adjusting the bone with the palms of his hands. 
The adjustment will be easy, for there is good 
extension x if it is properly managed. Then let him 
do the bandaging, putting the heads of the bandages 
on the fracture and performing all the rest of the 
operation as previously directed. Let him ask the 
same questions, and use the same indications to 
judge whether things are right or not. He should 
bandage every third day and use greater pressure, 
and on the seventh or ninth day put it up in splints. 
If he suspects the bone is not in good position, let 
him loosen the dressings towards the middle of this 
period, 2 and after putting it right, re-apply them. 

The bone of the upper arm usually consolidates in 
forty days. When these are passed one should 
undo the dressings and diminish the pressure and 
the number of bandages. A somewhat stricter diet 
and more prolonged (is required here) than in the 
former case. Make your estimate from the swelling 
in the hand, having an eye to the patient's strength. 

1 Reading Kardracrts. 

2 i.e. the period in splints. 



* Ka.76.jo.a1s Galen Kw. 

117 



IIEPI ArMQN 

bpecov. irpoaawtevai Be xph /cal rdSe, on 6 
(3pa")(Lwv Kvpros 7ri<f>v/cev e? to e^co p,epo<;- e? 
tovto TOivvv to fiepos cpiXet 8iao~Tpi(j)6o~0ai, iiTrjv 
p,r/ /caXco<; ir)Tpevr)Tai' drap kcu T&XXa iravra 

50 barea e'<? orrep irecpv/ce Sieo-rpa/xfieva, e<? tovto /cal 
IrjTpevo/xeva cpiXel BiaaTpecpetrdat, eir^v /caTeayfj. 
XPV TOivvv, eirr/v tolovtov ti VTTOTTTevr\Tai, Taivir) 
irXaTer) 7rpoa€7TiXap,/3dveiv tov Qpayiova kvkXco 
irepl to cnrjOos irepi&eovTCC /cal eir^v dva- 
TraveaOai peXXrj, p^eariyv tov dy/ccovo<; /cal tcov 
irXevpecov airX^vd Tiva ttoXvtttv^ov TTTv^avTa 
vwoTtOevai, r) aXXo ti b tovtco eoi/cev ovtco yap 
civ lOv 1 to KvpTco/xa tov octt€OV yevoiTO' <puXda- 
areaOai Be puevTOi XP y 'l> 07ro} ^ , a h V dyav e<> to 

60 eaco p,epo<;. 

IX. [Iou9 Be dvOpioirov e/c ttoXXmv /cal a pn/cpcov 
ocrTecov crvy/cetTai, coairep real X ei P ^ K PV icaT- 
dyvvTai p,ev ov irdvv ti TavTa tcl 6o~Tea, r)v //,r) 

CTVV TCp XP WTi 2 TlTpCOLTKOpieVCp V7T0 6%eO$ Til'O? 

i) fiapeos' xa p.ev ovv TiTpcocricop,eva, ev eX/ccoaicov 
p.epei elprjcreTai &>? XPV irjTpeveiv. f)v Be ti 
KLVi]0fj e/c tt}? ^ro/5>79, rj tcov Ba/CTvXcov dpOpov 
r) aXXo ti tcov otrrecov tov Tapcrov /caXovp,evov, 
dvay/ca^eiv pcev XP 1 ) e? T V V ccovtov x°^PV v 
10 e/caaTOV, coa-nep /cal to, ev ty/ X €l P l el'prjTar 3 
IrjTpeveiv Be /cr/pcoTrj /cal cnrXi]veai /cal oOovloiai 
cotnrep /cal Ta /caTJ]yp,aTa, ttX^i' tcov vapdij/ccov, 
tov pev avTov Tpo-nov irie^evvTa , Bid TptTr)? Be 
eiriBeovTa 1 viroKptvecrOco Be 6 eTriBeop.evo<; irapa- 
TvXr]cna, old irep /cal ev tolcti /caTijypacri, /cal 
Trepl tov ireTTLex^ai' real irepl tov x a ^- a P ov (Ivai. 4 

1 a\opti6Ta.Tov B. Kw. 19b MY Pq. Littr6. 
118 



ON FRACTURES, vm.-ix. 

One must also bear in mind that the humerus is 
naturally convex outwards, and is therefore apt to 
get distorted in this direction when improperly 
treated. In fact, all bones when fractured tend to 
become distorted during the cure towards the side 
to which they are naturally bent. So, if you suspect 
anything of this kind, you should pass round it an 
additional broad band, binding it to the chest, and 
when the patient goes to bed, put a many-folded 
compress, or something of the kind, between the 
elbow and the ribs, thus the curvature of the bone 
will be rectified. You must take care, however, 
that it is not bent too much inwards. 

IX. The human foot, like the hand, is composed 
of many small bones. These bones are not often 
broken, unless the tissues are also wounded by some- 
thing sharp or heavy. The proper treatment of 
the wounded parts will be discussed in the section 
on lesions of soft parts. 1 But if any of the bones be 
displaced, whether a joint of the toes or some bone 
of what is called the tarsus, you should press each 
back into its proper place just in the way described 
as regards the bones of the hand. Treat as in cases 
of fracture with cerate, compresses and bandages, 
hut without splints, using pressure in the same way 
and changing the dressings every other day. The 
patient's answers both as to pressure and relaxation 
should be similar to those in cases of fracture. All 

1 Rather " com pound fractures," cf. XXIV, XXV. Galen 
defines « A/cos as a lesion of a soft part. 

2 xpvs = rb aap'do^f s (Galen). 

:i A lost chapter, condensed in Moch. XVI, Joints XXVI. 

119 



IIEPI ATMON 

vyiea Be yiverai iv et/coatv rjp,epr)ai Te\e<w<? 
airavra, ttXtjv oiroaa Koivwvel rotat Trjs kvi]ju,t]^ 
oaikoicn tcai avrfj rf) i^ei. 1 avpcfiepei Be Kara- 
20 Keiadai tovtov rbv %p6vov. dXXa yap ov 
ToXpeovaiv i/7T€pop(t)VT€<; to voai~ip,a, dXXd irept- 
kpyovTdi Trplv vyiees yeveaOai. Bid tovto teal 
01 ir\eio~TOt ov/c e^vyiaivovcri reXecos. dXXa 
TroWd/cis avrowi o ttovo<; vnopipvija/cei' e//coT&><?, 
oXov yap to or^#o? rod crooparos ol 7ro8e<i o^e- 
ovai. orrorav ovv piynu) vyiees iovres 6801- 
7ropea)0~i, <f)Xaupa)<i avvaXO daaerai 2 to. dpdpa ra 
KivrjOevra- Sid tovto aXXoTe /cal dXXore 6801- 

29 7T0pe0VT€<i oBvvOiVTat T« 7T/509 Ttj KVH)prj. 

X. Ta Be KOivoiveovTa Tolai tt}<; /cvtjpi]*; bcrTeoiai 
puei^oy t€ tcov erepcov iai'i, icai /civ>]@€vtcov tovtoov 
7ToXvxpovia)Tepr) 1) a\8t%i<;. 'Irjcns pev ovv rj 
avTr)' oOoviotai Be TTXeiocn ypr)a6ai /cal airXr]- 
vecri, /cal eirl irdv evdev icai evOev iwiBelv Tue^eiv 
8e oiaiTep /cal TciXXa rrdvTa, TavTrj pudXiara rj 
i/civi)6r), /cal to? Trp(i)Ta<; nreptj3oXd^ tcov oOoviwv 
Kara TavTa TroielaBai' iv Be h/cdenr) tcov d-noXv- 
aicov v8aTi rroXXfp 6epp.(p ^prjaOar iv Traai Be 

10 ttoXXov vBcop Karayelv Tolai /car dpdpa crlvecnv. 
at 8e TTie^ies icai at xaXdaie? iv Tolaiv avTolcri 
"£povoio~i Ta avTa or\p.eia Bei/cvvovTcov airep iirl 
Tolai irpocrOev icai Ta? p,eTe7riBeaia<i coaavTWi 
%prj iroielaOai. vyiees Be TeXea><; ovtol ytvovTai 
ev Tecraepd/covTa ypeprjcri paXiara, rjv roXpewai 
KaTaKelaOar rjv Be p,r], irdaypvav TavTa a Kal 

17 rrpoTepov, /cal eVt pbdXXov. 

XI. ' Oaoi Be •jr>]8>jaavT€<i d<£' i/ylryXoO rivo<i 

1 kot' ai/r^v rr)y t^iy. 
I20 



ON FRACTURES, ix-xi. 

these bones are completely healed in twenty days, 
except those which are connected with the leg-bones 
in a vertical line. It is good to lie up during this 
period, but patients, despising the injury, do not 
bring themselves to this, but go about before they 
are well. This is the reason why most of them do 
not make a complete recovery, and the pain often 
returns ; naturally so, for the feet carry the whole 
weight. It follows that when they walk about 
before they are well, the displaced joints heal up 
badly ; on which account they have occasional pains 
in the parts near the leg. 

X. 1 The bones which are in connection with those 
of the leg are larger than the others, 2 and when they 
are displaced healing takes much longer. Treatment, 
indeed, is the same, but more bandages and pads 
should be used, also extend the dressings completely 
in both directions. Use pressure, as in all cases so 
here especially, at the point of displacement, and 
make the first turns of the bandage there. At each 
change of dressing use plenty of warm water ; 
indeed, douche copiously with warm water in all 
injuries of joints. There should be the same signs 
as to pressure and slackness in the same periods as 
in the former cases, and the change of dressings 
should be made in the same way. These patients 
recover completely in about forty days, if they bring 
themselves to lie up ; failing this, they suffer the 
same as the former cases, and to a greater degree. 

XI. Those who, in leaping from a height, come 

1 Displacement of the astragalus ? 
* " Those of the wrist." Adams. 

' cwaKBeiTcu. 

121 



IIEPI ATMQN 

ea-njpi^avTO rfj Trrepvp la^vpws, tovtoi<; Bua- 
ravrai fiev ra oarea, <pXe/3ia Be eK^vfiovvrai 
apbcpicpXaaOeicrrjs rfj<; crap/cos apicpi to ocrreov, 
oiBrj/ia Be eiriyiveTai zeal ttovos 7toXv<>. to yap 
oaTeov tovto ov o~fitrcp6v eo~Ti, zeal virepe-^ei fiev 
vtto ttjv Wvwpiiiv t% KV7]pLT]<i, zeoivwvet Be cpXe^l 
real vevpoieri eirizeaipoicri' o Tevcov Be OTriaOio? 
TOVTCO 7rpoo-/]pTi]Tat T&> ocrTeo). tovtovs %pr) 

10 IrjTpeveiv pbev zcrjpeoTr} zeat, airX-i'p'eai zeal bdovi- 
olctlv vBaTi Be Oeppiut TrXeicrTw e7rl tovtoicti 
^prjaOat zeal o6ovlu>v irXeiovcov eirl tovtoictl Bel 
zeal aW(o<i a><i /3e\rio~TG)v zeal irpoarjvecrTdT(ov. 
zeal rjv pbev Tvyj) diraXov to Bepp,a cpvaec e%ov 
to ap.(pl tji TTTepvr), 1 edv ovtco<; w i)v Be iray^v zeal 
azeXtipov, ola p,eTe%eTepoi layovcnv, teaTaTapLveiv 
j^pi-j o/xaXd»? real BiaXeTTTVveiv, pirj BiaTiTpcocrzeovTa. 
e7rt,8elv Be tiyaOws ov nravTOs dvBpos eo~Ti to, 
ToiavTa' rjv ytip tis eiriBerj, wairep teal to, ciXXa 

20 to, ieaTc\ to crcpupa eiriBelTai, otc fiev irepl tov 
iroBa irepiftaXXopievos, oTe Be irepl tov TevovTa, 
at aTTorr<f)Ly!~ies avTai r ywpi'C,ov<Ti Ti)v TTTepvrjv 
fi to epXaapua iyeveTO' zeal ovto) zclvBvvos acpa- 
KeXiaai to ocrreov to t% irTepv)]^' Kalroi rjv 
acpaKeXiat], tov aloova ircivTa itcavbv avTicr^eiv 
to voo-rfpua. zeal yap TaXXa baa purj ere toiovtov 
Tpoirov acpaKeXt^ei, dXX* ev tcaTazeXio-ei fieXav- 
0€Lar)<; tT;? mepvi^ vtto dpt,eXeu]<; tov cr)^ij/j.aTO<i 
rj ev /cvijp,r] Tpiop,aTo<$ yevopuevov eirizeaipov icai 

30 xpnviov zeal kolvov Trj TTTepvrj, rj ev ptr/pa) rj eir* 
dXXrp voarjpLaTi vwTiacrpiov %poviov yevoptevov, 
o/aw? zeal Total tolovtoicti ^povia, zeal 6)(X(oBea 
zeal TroXXd/CLS dvappr)yvv/j,eva, rjv fir) XPV aT V f J, ^ v 

122 



ON FRACTURES, xi. 

down violently on the heel, get the bones separated, 
while there is extravasation from the blood-vessels 
since the flesh is contused about the bone. Swell- 
ing supervenes and severe pain, for this bone is not 
small, it extends beyond the line of the leg, and is 
connected with important vessels and cords. The 
back tendon x is inserted into this bone. You should 
treat these patients with cerate, pads and bandages, 
using an abundance of hot water, and they require 
plenty of bandages, the best and softest you can get. 
If the skin about the heel is naturally smooth, leave 
it alone, but if thick and hard as it is in some 
persons, you should pare it evenly and thin it down 
without going through to the flesh. It is not every 
man's job to bandage such cases properly, for if one 
applies the bandage, as is done in other lesions at the 
ankle, taking one turn round the foot and the next 
round the back tendon, the bandage compresses the 
part and excludes the heel where the contusion is, so 
that there is risk of necrosis of the heel-bone ; and 
if there is necrosis the malady may last the patient's 
whole life. In fact, necrosis from other causes, as 
when the heel blackens while the patient is in bed 
owing to carelessness as to its position, or when 
there is a serious and chronic wound in the leg con- 
nected with the heel, or in the thigh, or another 
malady involving prolonged rest on his back — all 
these necroses are equally 2 chronic and troublesome, 
and often break out afresh if not treated with most 

1 Tendo Achillis. 

2 d^d's, Littre's emendation for o/iws, "nevertheless" (Kw. 
and codd). 

I23 



iiepi ArivmN 

pueXerr) OepairevOfj, rroXXfj Be i)(jvyir), eo? ra ye 
(j^aKeki^ovra' etc rov roiovrov Be rpoirov o$aKe- 
Xi^ovra Kai kwBvvov<; p:eydXov<; ra> aco/mart 
Trapeyei irpbs rfj aWy Xv/jltj. Kai yap rrvperoi 
virepol-ees, avvexees, rpopuoSees, Xvyyd>Bee<;, 
yvcop,r]<i avropievoi, /ecu oXiy/ip,epoi Kre'ivovre<i re' 

40 yevotVTO S" av Kai (pXefiwv aip-oppowv ireXiwaie<i 
vapKooaies x Kai yayypaiva)aie<; vrrb t/}<? rne^ioq' 
yevoiro 8' av ravra e£co rov aXXov a(f)aKeXio~p.ov. 
ravra p,ev ovv e'tpyjrai, ola ra la^yporara 
(pXdapiara yiverar ra pievroi rrXelcrra r)av)/aL(i)<i 
dp,(pt(f)Xdrai /cal ovBepiirj iroXXi] arrovBr) rr)<i 
p,e\errj<;, aX\' 6'yu.w? opdo)? ye Bel yeipi^eiv . errr)v 
pievroi icryvphv Bo^y elvai to epeiapia, rd re 
eipt]p.eva rroielv XP } 1> Kai T V V ^rriBeaiv ri]v 
rrXelarriv iroieiodai dp-(pl rr)v Trrepvyv irepi- 

50 j3dXXovra, aXXore Trpos rd dicpa rov 7roSo? 
dvrnrepiftdXXovra, aXXore rrpos ra p,eaa, 
aXXore 7rpo? rd rrepl rr)v Kprypuriv' irpoaerriBelv 
he Kai rd rrXrjaiov rrdvra evOev Kai evOev, coenrep 
Kai rrpoaOev elpr^rai' Kai la^vprjv piev pir) 
rroieladai rr)v rrie^iv, ev iroXXolai he rolaiv 
69ovioiaiv. dp-eivov Be Kai eXXefiopov mmaKeiv 2 
av0)]p,epbv tj rfj vo repair]' dnoXvaai Be rpiraiov 
Kai avOis pererriBrjo-ai. arjpieia Be rdBe, el 
iraXiyKoraivei i) ov' errrjv /J-ev rd eK^vp-oo/uara 

60 roiv (pXeficov Kai rd pieXaapLara Kai rd eyyv<i 
CKeivcov virepvOpa yivijrai Kai viroaKXripa, KivBvvo? 
•naXiyKorriaar a\V r)v p.ev d-nvpero^ r), (pappia- 
Keveiv dv<o XP r 'h wenrep etprjrai, Kai oaa av pirj 
crvvexv 3 ttvperaivvftaf* r)v Be crvvexfj rrvperai- 
vrjrai, p,r) <papp.aKeveiv, direx^v Be airnov Kai 

124 



ON FRACTURES, xi. 

skilful attention and long rest. Necroses of this 
sort, indeed, besides other harm, bring great dangers 
to the body, for there may be very acute fevers, 
continuous and attended by tremblings, hiccoughs 
and affections of the mind, fatal in a few days. 
There may also be lividity and congestion of the 
large blood-vessels, loss of sensation and gangrene 
due to compression, and these may occur without 
necrosis of the bone. The above remarks apply to 
very severe contusions, but the parts are often 
moderately contused and require no very great care, 
though, all the same, they must be treated properly. 
When, however, the crushing seems violent the above 
directions should be observed, the greater part of the 
bandaging being about the heel, taking turns some- 
times round the end of the foot, sometimes about the 
middle part, and sometimes carrying it up the leg. 
All the neighbouring parts in both directions should 
be included in the bandage, as explained above ; and 
do not make strong pressure, but use many bandages. 
It is also good to give a dose of hellebore on the 
first and second days. Remove the bandage and 
re-apply it on the third day. The following are signs 
of the presence and absence of aggravations. When 
there are extravasations from the blood-vessels, and 
blackenings, and the neighbouring parts become 
reddish and rather hard, there is danger of aggrava- 
tion. Still, if there is no fever you should give an 
emetic as was directed ; also in cases where the 
fever is not continuous; but if there is continued 
fever, do not give an evacuant, but avoid food, solid 

1 vavcriwaies (regurgitations), Galen and most MSS., but 
hard to accept. 

a ir?<rai. 8 0w«x««- * •KvptTalvri bis. 

125 



iiepi ArMfiN 

pocf)i]/ndTcov, 7T0T&) Be xpr/crOai vBarc Kal pr/ otva>, 
aKXa tS> o^vyXvKel. r/v Be fxr/ LieXXrj 7TaXiyK0- 
Taiveiv tcl iK-^v/xdi/xaTa /ecu ra fieXda/xara Kal 
rd TrepieyovTa, viro^Xuipa ylveTai Kal ov aKXr/pd' 

70 dyadov tovto to pLaprvpiov iv Trdai toIcflv e/c- 
jCVfjL(bfia<ri, rolcri lit/ LxeXXovat iraXiyKOTaivecv 
oaa Be avv a KXrjpva /xaa l ireXiovTai, kcvBvvos 
/xev LieXavdfjvai. tov Be iroBa iTTiTijBeveiv %pr) 
okcos dvcorepo) tov aXXov o~oo/xaTO<; eoTai rd 
irXelara oXiyov. vyir/s 6" dv yevoiTO iv e^iJKovTa 

76 i/Liepr/aiv, el aTpeLiel. 1 

XII. '11 Be Kvrjp.7} Bvo oarea e%et, 2 tt/ /xev 
<rv)(y& Xeirrorepov to erepov tov erepov, tt/ Be 
ov iroXXa) XeiTTOTepov avveyerai Be dXXr/Xoiai 
rd 7rpo? toO ttoBos, Kal iiri^vaiv Koivr\v eyei, 
iv Idvcopir/ Be t?}? Kinj/xr/s ov avve^erar to Be 
7T/0O9 toO p,r]pov avveyeTai, Kal etrupvaiv e%«, Kai 
y) eTTL(f)vo~i<; Sicufjv&iv fiaKporepov Be to [erepov] 
oo-reov aLiiKpcv rw 3 Kara tov a/xiKpov BaKTvXov 
Kal r) /xev <pvo-is TOiavTr/ twv oaTewv tcov iv tt/ 

10 KVlj/AT). 

XIII. 'OXitrOdvei Be eaTiv 6Ve Ta /xev 7roo9 
tov ttoBos, ot€ /xev o~vv TYj imcpvaei a/xcpoTepa 
Ta oaTea, OTe be ?; e7n<puo"t9 eKivijvt], otc oe to 
eTepov ocFTeov. TavTa Be 6)(XcoBea /xev yjaaov r/ Ta 
iv tu> KapirS) tcov yeipcov, el ToX/xcoev drpeiielv ol 
dvOpwnoi. ir/ffis Be TTapaTrXr/air/, o\r\ irep iKeivwv 
T7]v T€ ydp i/i/3oXt)v XPV Troieiadai eV KaTa- 
Taaco<i, toenrep iKeivcov, la)(^vpoTepr]<; Be BebTai 
Trjs KaTaTdaios, oaw Kal layyporepov to acoLia 

10 TavTy. e? Be Ta irXelaTa /xev dpKeovaiv dvBpe<; 



126 



1 aTpejueo*. 



ON FRACTURES, xi.-xni. 

or fluid, and for drink use water and not wine, but 
hydromel may be taken. 1 If there is not going to 
be aggravation, the effusions and blaekenings and 
the parts around become yellowish and not hard. 
This is good evidence in all extravasations that they 
are not going to get worse, but in those which turn 
livid and hard there is danger of gangrene. One 
must see that the foot is, as a rule, a little higher 
than the rest of the body. The patient will recover 
in sixty days if he keeps at rest. 

XII. The leg has two bones, one much more 
slender than the other at one end, but not so much 
at the other end. The parts near the foot are 
joined together and have a common epiphysis. In 
the length of the leg they are not united, but the 
parts near the thigh-bone are united and have an 
epiphysis, and the epiphysis has a diaphysis. 2 The 
bone on the side of the little toe is slightly the 
longer. This is the disposition of the leg-bones. 

XIII. The bones are occasionally dislocated at the 
foot end, sometimes both bones with the epiphysis, 
sometimes the epiphysis is displaced, sometimes one 
of the bones. These dislocations give less trouble 
than those of the wrist, if the patients can bring 
themselves to lie up. The treatment is similar to 
that of the latter, for reduction is to be made by 
extension as in those cases, but stronger extension is 
requisite since the body is stronger in this part. As 
a rule two men suffice, one pulling one way and one 

1 A decoction of honeycomb in water, cf. Galen xviii(2). 4G6. 

2 Spinous process or medial projection. 

3 Pq. t<£ for to codd. : omitting trepoy cf. XVIII, 
XXXVIL 

127 



IIEPI ATMDN 

hvo, 6 pev evOev, 6 he evdev relvovre^. r)v he 
fi7) layywxTLv, la^vporeptjv prjihiov eari iroieiv 
rrjv Kararaatv rj yap irXtj pvrjv Karopv^avra 
XP 7 h V a.X\o ri o ri tovtu) eoiKev, p,aX0aKov ri 
irepl rov rroha rrepifSdXXeiv eireira rrXareai 
Boeiotaiv Ipdcnv Trepih/jcravra rbv rrbha ras 
ap^as reap ipdvrcov r] irpbs virepov rj 7rpb<; erepov 
£vXov TrpoahrjaavTa, to iijvXov rrpbs rr)v TrXrjpvrjv 
dxpov evridevra eiravaKXav, 1 robs he. dvriretvecv 

20 dv(o6ev, ro)v re copwv exopevow; Kal rr)$ lyvvr)*;. 
eari he Kal to dvu> rov acbparo<i dvdyKj) rrpoaXa- 
/3elv rovro pev rjv /3ovXj], £vXov crrpoyyvXov, 
Xeiov, Karopv^a<; /3a0ea)<;, pepos ri avrov 
VTrepe^ov rov %vXov pearjyv rcbv cr/ce\ecov 
TroDjcraaOai rrapd rbv rrepivaiov, ax? kwXvt) 
aicoXovOelv to aoypa rolai ttoo? irohodv re'ivov- 
o~iv eirena rrpo^ rb retvopevov o~k£Xo$ pi] peireiv, 
rbv be rtva irXdyiov irapaKadrjpevov drrcoOelv 
rbv yXovrov, &)? pr) 7repieXK7jrai rb awpa. 

30 rovro he real rjv /3ovXr), rrepl rd<; pao-%dXa<; 
evdev teal evdev ra %vXa Trapaireir^yev , 2 at he 
^e?/565 rraparerapkvai <pvXdo~aovrai, 3 TrpoaeirL- 
XapjSaverw* he ri<; Kara ro yovv, kcu outco? 
dvrtreivoi.ro. rovro h' i)v it a pa to yovv /3ovXrj- 
rai, 5 aXXovs tpdvras rrepih^aa^ Kal rrepl rov 
prjpov, TrXrjpvrjv aXXr/v vrrep Ke<paXr)<; Karopv^as, 
e£apri]cra<; tou? ipdvras €K tivos £vXov, rb tjvXov 
arrjpi^cov e? rrjv trXr] p.vr)v rdvavria r&v irpbs 
rrohcbv eXKeiv. rovro 8! i)v fiovXtj, dvrl ra>v 

40 TrXrjpvewv hoKiha VTrorelvas vrrb ri]V kXlvtjv 
perpirjv, erretra irpbs rrjs hoKtho<; evOev Kal evOev 
rr/v K€(f)aXr)v a-rrjpl^cov Kal dvaKXwv ra, £vXa, 
128 



ON FRACTURES, xin. 

the other, but if they cannot do it, it is easy to 
make the extension more powerful. Thus, one 
should fix a wheel-nave or something similar in the 
ground, put a soft wrapping round the foot, and then 
binding broad straps of ox-hide about it attach the 
ends of the straps to a pestle or some other rod. 
Put the end of the rod into the wheel-nave and pull 
back, while assistants hold the patient on the upper 
side grasping both at the shoulders and hollow of the 
knee. The upper part of the body can also be fixed 
by an apparatus. First, then you may fix a smooth, 
round rod deeply in the ground with its upper part 
projecting between the legs at the fork, so as to 
prevent the body from giving way when they make 
extension at the foot. Also it should not incline 
towards the leg which is being extended, but an 
assistant seated at the side should press back the hip 
so that the body is not drawn sideways. Again, if you 
like, the pegs may be fixed at either armpit, and the 
arms kept extended along the sides. Let someone 
also take hold at the knee, and so counter-extension 
may be made. Again, if one thinks fit, one may like- 
wise fasten straps about the knee and thigh, and 
fixing another wheel-nave in the ground above the 
head, attach the straps to a rod ; use the nave as a 
fulcrum for the rod and make extension counter to 
that at the feet. Further, if you like, instead of the 
wheel-naves, stretch a plank of suitable length under 
the bed, then, using the head of the plank at each 
end as fulcrum, draw back the rods and make exten- 



1 ivBtvTa avaxKav. ' irapawenriyji. 8 (pvXaaawvrai. 

* wafjeiriAa/xjSai'jjTai. 6 /SouAp. 

129 
VOL. III. F 



IIEPI ArMftN 

Karareiveiv rovs ipdvras' rjv he OeXrjq, ovigkovs 
KaTa<TTrjaa<; evQev zeal evOev, eV eiceLvwv rr\v 
Kardraaiv TTOielcrOai. rroXXoi he /cal aXXoi 
rporrot, /cararacrifov' dptarov he, oari? ev iroXet 
peydXr/ tyrpevei, Ketcrfjatfat iafcevaapevov ^vXov, 
ev ft) rrdaai at dvay/cai eaovrai ttuvtwv pev 
/caTrjyp,drQ)v, irdvrcov he dpOpwv epfioXrjs i/e 

50 KaTardaios real p,o^\euo-io<; w dpKel he to ^vXov, 
rjv y toiovtov olov oi rerpdycovoi arvXot oloi 
hpvivoi ylvovrai, p,i]KO<; /cal 7rA.aTO? /cal ird^of. 

Ej7rr]V he l/cavws /cararavvays, piphiov ijhrj rb 
dpOpov ep,{3aXelv vvepaicopeirai yap e'9 IQvwpiyv 
vrrep rr/s dp^aLT/s ehpi]<;. /caropOovaOai ovv 
%py] rolcri Oevapai r&>v ^eipwv, rolai pep e<? to 
e^earrj/cb^ epe'thovra, toIctl he eirl ddrepa /carcore- 

58 pov rod aepvpov dvrepeihovra. 

XIV. 'Ejirrjv 8" epfidXys, rjv pev olov re y, 
/cararerapevov eirihelv XPV' V v °^ /ccoXvrjrai 
vrrrb tS)v [pdvTwv, e/celvovs Xvaavra dvri/cara- 
reiveiv, ecrr^ dv e7rihjjar/'i. eTrtheh' he rbv avrbv 
TpoTrov /cal rds dp^d? waavrwi ftaXXopevov /card 
to e^earr/Ko<i, kcu Ta<? TrepiploXas Ta? irpcoras 
irXeiaras Kara rovro 7roieicr0ai, /cal iov<i cnrXfj- 
va<; irXeiarovi Kara rovro, /cal rr/v rrle^iv 
p,d\.LO-ra Kara rcovro' tt poaeiriheiv he Kal evOev 

10 Kal evBev eirl av^yov pdXXov he rt rovro to 
dpdpov TteTTieyOai j^prj ev rfj irpd>rr) ernhkaei i) 
to ev rfj X eL P L ' GTTrjv he eTrthtjarjs, dvtoripco pev 
rov aXXov acoparos e\erco to eir ihe6 ei> , rrjv he 
Oeaiv hel TroietoOai ovrios, ottcos jJkio-tcl diratcd- 



130 



ON FRACTURES, xm.-xiv. 

sion on the straps. And if you choose, set up wind- 
lasses at either end and make the extension by them. 
There are also many other methods for extensions. 
The best thing for anyone who practises in a large 
city is to get a wooden apparatus comprising all the 
mechanical methods for all fractures and for reduction 
of all joints by extension and leverage. This wooden 
apparatus will suffice if it be like the quadrangular 
supports such as are made of oak * in length, breadth 
and thickness. 

When you make sufficient extension it is then easy 
to reduce the joint for it is elevated in a direct line 
above its old position. It should therefore be 
adjusted with the palms of the hands, pressing upon 
the projecting part with one palm and with the 
other making counter pressure below the ankle on 
the opposite side. 2 

XI V, After reduction, you should, if possible, 
apply a bandage, while the limb is kept extended. If 
the straps get in the way, remove them and keep up 
counter extension while bandaging. Bandage in the 
same way (as for fractures) putting the heads of 
the bandages on the projecting part and making 
the first and most turns there, also most of the 
compresses should be there and the pressure should 
come especially on this part. Also extend the dressing 
considerably to either side. This joint requires some- 
what greater pressure at the first bandaging than 
does the wrist. After dressing let the bandaged 
part be higher than the rest of the body, and put it 
up in a position in which the foot is as little as 

1 Adams' "threshing boards" — Littre's TpifioXoi, a ra9h 
suggestion which he afterwards withdrew. 

* The nature of these dislocations is discussed on pp. 425 ff. 

>3* 



IIEPI ATMQN 

prjOrjaerai o ttov^. rbv he ia^vaapbv rov 
crwfiaTOS ovt(o<; rroielaQai, oiro'ir)v riva hvvapiv 
e^et Kai to oXlaOypa' ra pev yap apiKpov, ra 
he peya oXiaddvei. to eir'nrav he layya'weiv 
pdXXov Kai eVt rrXeioy \povov XPV ev T0 '°"'' Kara 

20 ra a/ceXea rpoopaai i) ev rotai Kara rd? %elpas' 1 
Kai yap /xe^co Kai rrayyrepa ravra e\eivwv Kai 
hr) Kai dvayKalov eXivveiv to aoypa Kai Kara- 
Keiadat. per err th?] a at he to dpOpov ovre ri 
KwXvei rpiralov ovre KareireLyet,' Kai ra dXXa 
rrdvra 7rapa7r\t]aio)<i ^PV wjTpevBiv, wtnrep Kai 
rk rrapoiyopeva. Kai rjv pev roXpcl drpepa 
KaraKeladai, l/eavcu reacrapaKovra rjpepai, rjv 
p.ovvov e? rrjv eoivrcov ^ojpr/v ra 6<rrea avdi<i 
KaQl"Cpr\rai' rjv he p,rj deXrj drpepelv, xpwro pev 

30 av ov paoY&>9 2 tw CTKeXei, eirihelaOai he dvay- 
Ka^oir av ttoXvv %povov. orroaa pevroi rcov 
barewv prj reXeco^ 'it^ei e<? rt]v ecovrcov yd>pi]v, 
dXXd ri emXei'nei, roj xpovqi Xertrvverai la^lov 
Kai pijpbs Kai Kvr)p,r)' Kai rjv pev eaw okiadij, ro 
e£&> pepos XeTrrvver ai, rjv he et;a>, ro eaoi' ra 

36 irXelara he 69 to eaco oXiaOdvei. 

XV. 'EiTrrjv he Kv?jpr/^ barea dpcfiorepa Karayfj 
avev eX^coato<;, Karardcria lo")^vporepr}S heirat,. 
reiveiv 3 rovroav rwv rporvoav evioicri rwv npoeipi]- 
pevoav rial, rjv peydXai ai rrapaXXa^ies ecoaiv. 
iKaval he Kai at airb row dvhptov Karardate<i' 
ra irXelara yap dpKeoiev av huo arhpes eppoype- 
voi, 6 pev evOev, 6 he ev&ev avrtrewovre^. reneiv 
he e<> to Wv )(pt] Kara cpvatv Kai Kara rrjv 

1 kotci X € 'P°« Z PpaSiws, Oiuit ou. s Kara-rtivuv. 

132 



ON FRACTURES, xiv.-xv. 

possible unsupported. 1 The patient should undergo 
a reducing process corresponding to his strength and 
to the displacement, for the displacement may be 
small or great. As a rule the reducing treatment 
should be stricter and more prolonged in injuries 
about the leg region than in those about the arm 
region, for the former parts are larger and stouter 
than the latter. And it is especially needful for the 
body to be at rest and lie up. As to rebandaging 
the joint on the third day, there is neither hind- 
rance nor urgency, and one should conduct all the 
other treatment as in the previous cases. If the 
patient brings himself to keep at rest and lie up, 
forty days are sufficient, provided only that the 
bones are back again in their places. If he will not 
keep at rest, he will not easily recover the use 
of the leg and will have to use bandages for a long 
time. Whenever the bones are not completely 
replaced but there is something wanting, the hip, 
thigh and leg gradually become atrophied. If the 
dislocation is inwards the outer part is atrophied, if 
outwards, the inner : now most dislocations are 
inwards. 2 

XV. When both leg-bones are broken without an 
external wound, stronger extension is required. If 
there is much overlapping make extension by some 
of those methods which have been described. But 
extensions made by manpower are also sufficient, 
for in most cases two strong men are enough, one 
pulling at each end. The traction should be in a 
straight line in accordance with the natural direction 



'n 



1 Not merely prevented from hanging down, but kept at 
right angles to the log (cf. Galen,). 

2 i.e. of the foot outwards and the leg inwards. 

«33 



IIEPI ATMQN 

I0vwpir\v t?)? Kvr\pr]^ Kai rov prjpov, Kai rjv KVrjfir)? 

10 barea Kareriyvlrj<; Karareivr]<; t ical rjv prjpov. 
Kai eiriSeiv Be ovroos eKrerapevcov dp(porepo)v, 
birbrepov av rovrwv eTriBer)*;' ov <ydp ravrd 
avp,<fiepei aKeket re Kai %etpt- Trrfyeos p,ev yap 
Kai fipaxi.ovos eTrrjv eirtBeOcbaiv oared Karerjybra, 
dva\ap,/3dverai ?; X e ^P' Ka1, V v eKrerapeva 
e7riBer)<;, rd ayr)para roiv aapKwv erepoiovrai 
ev rfj avyKapyjrei rov dyKwvos' dBvvaros yap 
6 dyKoov eKrerdadai 7ro\vv xpovov ov yap 
Tro\\d/ci<; Iv roiovrw eWiarai ea^ripariaOai, 

20 dW ev TO) o-vy/ce/cdpfpOai' Kai Brj Kai are 
Bvvdpevoi ol dvdpwiroi Trepuevai avyK€Kap(p@ai 
Kara rov dyxwia Beovrai. cr/ceXo? Be ev re rfjaiv 
oBonropiyaiv Kai ev r& eardvai eWiarai ore p,ev 
eKrerdadai, ore Be apiKpov Belv eicreraaOar Kai 
eWiarai Ka6elo~6ai e? to Karen Kara rrjv (pvaiv, 
koI Br) Kai 7T/30? to oyeeiv to ciWo awpa- Bid rovro 
evepopov aiirw earl rb eKrerdaOai, orav dvdyKriv l 
^XV Kai &V Kal 6V T V at Koirfjai TToWaKis ev ra> 
o~%7]pLari rovrcp earlv [ev rS eKrerdaOai]' 2 eirrjv 

30 Be Br) rpwOrj, dvdyKrj 3 KaraBovXovrai rr)v 
yvcoprjv, on dBvvaroi p,erecopi%eaOai yivovrai, 
ware ovBe pepviivrai rrepl rov avyKapcfrdfjvai 
Kai dvaarijvai, dW drpepeovai* ev rovrtp rq> 
axijpari Keipevoi. Bia ovv ravra^ ra<; irpocpd- 
aias %eipb<; Kai aKe\eo<; o'vre r) Kardraais ovre 
r) eVtoWt? toO ax>]paro<; avpfyepei r) avri]. rjv 
puev ovv iKavr) r) Kardraai<i r) drrb rcov dvBpoiv ri, 
ov Bel fidrriv rroveladai — Kai yap aoXoiKorepov 
p,r)^avo7roi€tv pi]Bev Beov — >)v Be pr) iKavi] i) Kard- 

40 raais dwb rwv dvBpcov, Kai rcov aXXcov rivd ro>v 
J 34 



ON FRACTURES, xv. 

of the leg and thigh, both when it is being made for 
fractures of the leg bones and of the thigh. Apply 
the bandage while both l are extended, whichever 
of the two you are dressing, for the same treatment 
does not suit both leg and arm. For when fractures 
of the forearm and upper arm are bandaged, the 
arm is slung, and if you bandage it when extended 
the positions of the fleshy parts are altered by 
bending the elbow. Further, the elbow cannot be 
kept extended a long time, since it is not used to 
that posture, but to that of flexion. And besides, 
since patients are able to go about after injuries 
of the arm, they want it flexed at the elbow. But 
the leg both in walking and standing is accustomed 
to be sometimes extended and sometimes nearly so, 
and it is naturally directed downwards and, what is 
more, its function is to support the body. Extension 
therefore is easily borne when necessary and indeed 
it frequently has this position in bed. If then it is 
injured, necessity brings the mind into subjection, 
because patients are unable to rise, so that they do 
not even think of bending their legs and getting up, 
but keep lying at rest in this posture. For these 
reasons, then, the same position either in making 
extension or bandaging is unsuitable for both arm 
and leg. If, then, extension by man-power is enough, 
one should not take useless trouble, for to have 
recourse to machines when not required is rather 
absurd. But if extension by man-power is not enough, 

1 i.e. thigh and leg. 

1 avdyKT]. 

8 Seems an obvious gloss. Most editors omit. 

3 Kal t) avdyxri. * toKhohtiv. 

135 



IIEPI ArMHN 

dvay/cecov 7rpocr(pepeiv, r\vriva ye Trpocr^coperj. 1 
orav 8e Sr) i/cavws Kararadfj, prjtStov r]8rj /carop- 
6(naaa6aL ra oared ical e? rr/v tyvaiv dyayetv, 
Tolai devapari tcov yeiposv direvOvvovra ical 

45 e<~ewcpiveovra. 

XVI. , E t 7rrjV Be KaropOaxTrjs, iircSeiv toictiv 
oQovioicn Kararer apevov , i]v t' eVi 8e£ia rjv r eV 
aptarepa irepicpepeiv (rvp,<peprj avTolai ra it para 
odovia' fBdXXeaOai he tijv dp-^r/v rov 69ovlov 
Kara to /cdrijyfia, /cal 7repi/3dXXea0ai Kara, 
tovto rds 7rp(i)Tas Kepi/SoXd^ KciireiTa vefieadai 
eirl rrjv ctvco /cvi}fi>]v e7ri8ecov, oya-nep eirl rolaiv 
dXXoian KaTijy/xaai e'iprjTai. ra he 696via 
TrXarvrepa 'ypi] elvai /cal fia/cporepa /cal 7r\ea> 

10 iroXv av ra 2 /card to cr/ceXo? tcov iv rf} %et/ot. 
eTTijv 5' eTTiStjo-r]*;, /caraOelvai e<f> ofiaXov rivb<i 
ical paXda/cov, (bare /£»/ hieo~Tpd<p@at, rj rrj rj rfj, 
firjre Xophbv fiijre KV(j)bv eJvat,' fLaXicna he 
crvficpepet irpocT/cecpdXaiov, r) \iveov r) epiveov, 
firj a/cXr/pov, Xairapbv fietrov Kara firj/co<i ttoi?)- 
aavra, r) dXXo ri b tovtco eoi/cev. 

Tiepl yap tcov crcoXr]vu>v tcov v7roTi0epLevcov biro id 
aiceXea ra /carerjyoTa, diropeb) a tl crvfij3ovXevaco' 
7} uTToriOevai XPV V °v I clicpeXeovcri p.ev ydp, 

20 ovx oaov he oi viroriOevTes olovrar ov yap 
dvay/cd^ovcri oi o~coXr)ve<; drpep^eiv, a>? ol'ovrar 
oine yap rco aXXco crcofiari arpecpofievcp rj evOa 
r) evOa eiravayKa^ei 6 acoXrjv fir) eiraKoXovOeiv 
ro o~/ceXo^, rjv fir) eTrifieXrJTai avrbs covO pcoTros' 
ovre av ro 3 er/ceXo? dvev rov crcofiaTO? KcoXvet 6 
acoXrjv Kivt]6?]vai rj rrj rj rfj' dXXd fir)v dcrTep- 

136 



ON FRACTURES, xv.-xvi. 

bring in some of the mechanical aids, whichever may 
be useful. 1 When once sufficient extension is made, 
it becomes fairly easy to adjust the bones to their 
natural position by straightening them and making 
coaptation with the palms of the hands. 

XVI. After adjustment, apply the bandages while 
the limb is extended, making the turns with the 
first bandage, either to right or left as may be 
suitable. Put the head of the bandage at the frac- 
ture and make the first turns there, and then carry 
the bandaging to the upper part of the leg as was 
directed for the other fractures. The bandages 
should be broader and longer and much more 
numerous for the leg parts than those of the arm. 
On completing the dressing, put up the limb on 
something smooth and soft so that it does not get 
distorted to either side or become concave or convex. 
The most suitable thing to put under is a pillow of 
linen or wool, not hard, making a median longitudinal 
depression in it, or something that resembles this. 

As for the hollow splints which are put under 
fractured legs I am at a loss what to advise as 
regards their use. For the good they do is not so 
great as those who use them suppose. The hollow 
splints do not compel immobility as they think, for 
neither does the hollow splint forcibly prevent the 
limb from following the body when turned to either 
side, unless the patient himself sees to it, nor does it 
hinder the leg itself apart from the body from 
moving this way or that. Besides, it is, of course, 

1 tyi'Tiva Littre ; fjv vulg. : "if any is of use." 

2 For aura, (codd. ) ; cf. below, liue 25. rd Kw. 

3 aur6. 

137 



IIEPJ ATMQN 

yecrrepov %vkov vTrorerdaOai, rjv p.r) o/xw? av 1 Ti<i 
fia\6aKov Tt e? avro evredfj' ev^prjarorarov Be 
ecrriv ev Trial /xeduTroarpwaeai /cal ev rfjcriv e? 

30 d<poBov irpo^op/jaeaiv. eartv ovv avv crw\r)vi 
/cal dvev (7(o\y)vo<i, /cal «a\w? /cal ata-^pco? 
KaTaa-KevdaraaBai. iriOavdoTepov Be toIci Brjpo- 
ttj(tlv earl /cal tov IrjT pov dvapapTrjTOTepov 
elvai, rjv o~u>\r)v v-rroKerjrar kclitol iiT6)(ve(TTep6v 
ye ecrriv. Bel p,ev yap iff)' opuaXov real pa\da/cov 
/celaQai irdvrr\ iravTcof e? Wv' eirei roi ye 
dvdyKt] KpcLTrjOrjvab tijv emBeaiv vtto Tr/? Bia- 
<tt potyrjs rr)<; ev tti BiaOecrei, oitoi av peirrt /cal 
oirocra av perry. viro/cpivecrOct) Be o eTri,8e8ep,evo<; 

40 ravra, airep ical irporepov ecprjrai' real yap ttjv 
eirlhecnv ^prj TOiavrrjv elvai teal ro olBr/pa oi5ra>? 
igcteipecrOai e? to. d/cpea /cal rd<; ^aXdaia^ ourai, 
/cal Ta9 p.eT€TTi8ecrias Sid Tplrrj<i m /cal evpiaKecrdoi 
layjL'drepov to einBeopevov, ical Ta? eiriBecnas eirl 
fidWov itotetaOat /cal TrXeoai rolcriv odovtoiaiv' 
ireptXapfidveiv re tov iroBa ^a\apo)<i, rjv prj dyav 
iyyvs r} rod yovvaTo? to Tpwpa. tcaTaTeiveiv Be 
p,eTpi(o<i /cal i-rri/caTopOovv e<p e/cdo-Trj eiriBeaei %pr) 
Ta ocTTea- rjv yap 6p6o)<i pev IrjTpeutjTai, /card 
\6yov Be to oiB>)pa ^wpfj, ert 2 p,ev XeiTTOTepov /cal 

50 la^voTepov to emBeopevov yutp'iov ecrrai, eVt Be av 
irapaywyoTepa Ta oaTea, dva/covovra ttjs /caTa- 
Tao~io<i pbdWov. eirrjv Be efiBopalo? rj ivvaTalos 
7) ev8e/caTaio<; yevr)Tai, tov<; vdp0)j/ca<; irpoaTi- 
devai, 3 oiairep /cal e-irl Tolatv aWoicri KaTrjypaai 
etprjTai. tcov Be vapOritcwv Ta? ere'Spa? %pr) 
<pu\dcro~€o~dai /card T€ tcov cr<f)vpd)v t>)v I'^iv koX 
/caTa tov TevovTa tov ev ttj /cvrfprj tov 7roS6?. 
'38 



ON FRACTURES, xvi. 

rather unpleasant to have wood under the limh unless 
at the same time one inserts something soft. But 
it is very useful in changing the bed clothes, and 
in getting up to go to stool. It is thus possible either 
with or without the hollow splint to arrange the 
matter well or clumsily. Still the vulgar have 
greater faith in it, and the practitioner will be more 
free from blame if a hollow splint is applied, though 
it is rather bad practice. Anyhow, the limb should 
be on something smooth and soft and be absolutely 
straight, since it necessarily follows that the bandaging 
is overcome by any deviation in posture, whatever the 
direction or extent of it may be. The patient should 
give the same answers as those above mentioned, for 
the bandaging should be similar, and there should 
be the like swelling on the extremities, and so with 
the looseness and the changes of dressing every third 
day. So, too, the bandaged part should be found 
more slender and greater pressure be used in the 
dressings and more bandages. You should also make 
some slack turns round the foot if the injury is not 
very near the knee. One should make moderate 
extension and adjustment of the bones at each 
dressing ; for if the treatment be correct and the 
oedema subsides regularly, the bandaged part will be 
more slender and attenuated while the bones on 
their side will be more mobile and lend themselves 
more readily to extension. On the seventh, ninth, 
or eleventh day splints should be applied as was 
directed in the case of other fractures, and one must 
be careful as to the position of the splints, both in 
the line of the ankles, and about the back tendon 

1 ofxaAov Kw. in Hermes XXV II. o5tu in text. 
2 ht\ bis. 3 XPV irpoffTiOivui. 

139 



IIEPI ArMON 

oarea Be Kvfojujs icparvverai ev reaaapaKovra 
i)pepr)criv, rjv opOcos Irjrpeurjrai. rjv Be v-rroirrevrj^ 

60 tcov barewv ri Beladau rivos Biop0coaio<i 77 riva 
e\,K(ocnv oppfoSfjs, ev ra> p,eo-i]yv ^povco %ph 

62 Xvaavra teal eudericrdpbevov p,ereTriBrjo-ai. 

XVII. 'Hi/ Be to erepov oareov Karer/yf) ev 
Kvqprj, icar ai do to<? p,"ev doOevearepij^ Belrai. ov 
p,rjv eirCKelTreiv XPV> ovBe /3Xa/cevetv ev rfj Kara- 
rdoei, pdXiara pev rfj irpcorr) eViSecre*. icara- 
relveoQai oaov ecpiKvelrai alei irore itavra rd 
tear >)y para, el Be pit], o>9 rd^iara' 6 rt <ydp 
av pi] Kara rpoirov ^vOeriopevayv 1 rosv oorecov 
eTTiSefiov Ti? TTie'Qr), oBvvairepov ro ywpiov ylverai. 

9 f) Be aXXr) Ir/rpeir} r) avrrj. 

XV III. Twv Be barewv, to pev eaco rod dvrt- 
Kvr/plov tcaXeopuevov 6)(XoiBearepov ev rfj Irjrpeirj 
earl, koI /carardoios pudXXov Beop,evov, /cal rjv 
pLT) 6p6ai<i rd oarea redrj, dBvvarov Kpv^rai' 
(pavepov yap /cal daapKov irdv eariv icai eiri- 
ftalveiv eirl to aKeXos ttoXXo) fipaBvrepov Bvvaivr 
av, rovrov tcarerjyoros. rjv Be to e^co bareov 
/carerjyf], 2 iroXv p,ev eve}) poor epov (pepovai, ttoXv 
Be evKpvnrorepov, koX rjv p,i) KaXw^ avvreOf} 

10 (eirlaapKov yap earcv), eirl iroBa-i re Ta^e'to? 
laravrai, to irXelarov yap rov d%0eos oyel ro 
eacoOev rov dvrifcvrjplov oareov. dpa pev yap 
avTQ) rw a/ceXei >cai rfj Wvioply rov a^Oeo? rov 
Kara to a/ceXos, to trXelov e%et tou ttovov to eaco 
oareov rov yap p,r/pov r) Kecpa.Xr/ v-jrepo^el ro 
VTrepOev rov odiparos, avrr/ Be eowdev 7re<pvK€ 
rov aiceXeos koX ovk e^coOev, dXXa Kara rrjv rov 

1 evQtTiffixivuv. * Karayjj. 

140 



ON FRACTURES, xvi.-xviii. 

from leg to foot. The bones of the leg solidify 
in forty days if properly treated. If you suspect 
that one of the bones requires some adjustment, or 
are afraid of ulceration, you should unbandage the 
part in the interval and reapply after putting it right. 

XVII. If one 1 of the leg-bones be broken, the 
extension required is weaker : there should, however, 
be no shortcoming or feebleness about it. Especially 
at the first dressing sufficient extension should be 
made in all fractures so as to bring the bones 
together, or, failing this, as soon as possible, for 
when one in bandaging uses pressure, if the bones 
have not been properly set, the part becomes more 
painful. The rest of the treatment is the same. 

XVIII. Of the bones, the inner of the so-called shin 
is the more troublesome to treat, requiring greater 
extension, and if the fragments are not properly set, 
it cannot be hid, for it is visible and entirely without 
flesh. When this bone is broken, patients take 
longer before they can use the leg, while if the 
outer bone be fractured they have much less incon- 
venience to bear, and, even if not well set, it is much 
more readily concealed ; for it is well covered : and 
they can soon stand. For the inner shin bone 
carries the greatest part of the weight, since 
both by the disposition of the leg itself and by the 
direct line of the weight upon the leg the inner 
bone has most of the work. Further, the head of 
the thigh-bone sustains the body from below and has 
its natural direction towards the inner side of the 
leg and not the outer, but is in the line of the shin 

1 Littre and others apply tliia to the fibula, bub the 
limitation seems uncalled lor. 

141 



IIEPI ATMflN 

dvTi/cvrjpiov ifjiv cifia Be to aWo r/piiav tov 
<7(Ofiaro<i yeiToveverai paWov ravTrj rf] tljei, 

20 dW ov\l rf) e^o)0ei>' dpua Be, ore irayyTepov 
to eaco tov e^wOev, too-rrep /cal ev tw Tn]ye i to 
KOTO T7]V TOV pil/CpOV Ba/CTvXov t'^iv XeirTOTepov 
kcu pa/cpoTepov. ev pevTOi tw apOpw tu> kutco 1 
ov^opolij r\ v7TOTaai<; tov ooTeov tov p,a/cpoTepov 
dvopotoos yap o dy/cojv ical tj lyvvt] Kap-TneTdi. 
Bid ovv tclvtcis Tas Trpocpdaias tov p,ev e£a>6ev 
ocrTeov KaTerjyoTO?, 2 Ta^tlac at eiriftdaies, tov Be 

28 eaayflev /caTerjyoTos, ftpaBelai at eiriftdaies. 

XIX. ' Wv Be to tov pLrjpov baTeov KaTayfj, ttjv 
/caTaTaatv ftpr) iroieladai Trepl travTO^, birois 
p,rj evBeeoTepws a^ijaer irXeovaaOelaa ptev yap 
ovBev dv o'ivolto- ovBe yap el BieaTeooTa Ta 
ooTea V7rb t?}? la^vo? ttj<; /caTaTaaios eirtBeoi 
tis, ov/c av BvvaiTO KpaTeZv f) eirLBeais waTe 
BieaTavai, dXXa avveXdot dv Trpos dXXrjXa Ta 
ooTea oti Tuy}OTa [a^] 3 d§eir\aav oi TetvovTes' 
ira^elaL yap /cal la%vpal ai adp/ce<; eovaai, 

10 KpaTijaovai tt)? e7uBeaio<;, dXX ov /cpaTiy 
drjaovTat. irepl ov ovv 6 Xoyos, BiaTeiveiv ev 
ptdXa /cal dBiaaTpe7rT(0<i XP r 'h h br l^ v €7riXet7TovTa' 
peydXr/ yap r\ ala^vvij teal (SXdfirj /3pa~)(yTepov 
tov pripov diroBel^at. X ei P H-^ v Y"/°> Ppa^vTepr) 
yevopevy, /cal avy/cpv(p0ei,i) dv /cal ov pteya to 
a<pdXpa % a/ceXo<; Be {3pa%VT€pov yevoptevov ^coA.ot' 
diroBel^eie 4 tov dvOpwirov to yap vyies e\ey)(ei 
irapaTtBepevov pa/cpoTepov eov, waTe XvaiTeXel 
tov peXXovTa /ca/c(i)<; IrjTpeveaBai, dpcftoTepa 

20 /caTay?)vai ra a/ce\ea paXXov rj to eTepov 
laoppoiro<;yovv dv e'irj auTo? €(ovto). eirrjv pivtoi 
142 



ON FRACTURES, xvm.-xix. 

bone. So, too, the corresponding half of the body is 
nearer the line of this bone than that of the outer 
one, and besides, the inner is thicker than the outer, 
just as in the forearm the bone on the side of 
the little finger is longer and more slender; but in 
this lower articulation the longer bone does not lie 
underneath in the same way, for flexion at the elbow 
and knee are dissimilar. For these reasons, when the 
outer bone is fractured patients soon get about ; but 
when the inner one is broken they do so slowly. 

XIX. If the thigh-bone is fractured, it is most 
important that there should be no deficiency in the 
extension that is made, while any excess will do no 
harm. In fact, even if one should bandage while 
the bones were separated by the force of the ex- 
tension, the dressing would have no power to keep 
them apart, but they would come together immedi- 
ately when the assistants relaxed their tension. For 
the fleshy part being thick and powerful will prevail 
over the bandaging, and not be overcome by it. To 
come to our subject, one should extend very strongly 
and without deviation leaving no deficiency, for the 
disgrace and harm are great if the result is a shortened 
thigh. The arm, indeed, when shortened may be 
concealed and the fault is not great, but the leg 
when shortened will leave the patient lame, and the 
sound leg being longer (by comparison) exposes the 
defect ; so that if a patient is going to have unskilful 
treatment, it is better that both his legs should be 
broken than one of them, for then at least he will be 
in equilibrium. When, therefore, you have made suffi- 



1 T<£ k&tui &p8cp rovTCf). 2 KararytvTos bis. 

* OimL B M V K.W. * drro5«i{ej. 



143 



IIEPI ATMQN 

l/cavco? Kararavvcrrj^, Karop6o)crdp,evov %pr) roiai 
Oevapai roiv yetpoiv eiriSelv rov avrov rpoirov, 
ooarrep /cal rrpoaOev yeyparrrai, /cal ra$ apyas 
f3aW6p.evov, wairep el'pijrai, /cal vejxbpievov e? to 
dvco tj7 eniSeaei. /cal viro/cpiviaOa) ravrd wairep 
/cal rrpoaOev, ical rroveirco Kara ravra /cal 
prjl^ero)' koI fiererriSeiaOco u>aavTW<;, /cal vap- 
0>]tca)v irpoaOeais i) avrrj. Kparvverai Be 6 fir/pbs 

30 ev nrevr^/covra fj/ieprjcriv. 

AA. LLpoaavvievai, oe ^pr) /cat, rode, on o 
/xr]pb<i yavaos ianv e? to e%w puepos fi&Wov rj 
e$ to eaco, /cal e<? to e^irpocrOev fidXXov r) e<? 
roviriaOev e's ravra ro'tvvv rd fiepea ical Bca- 
<rrp€(p€Tai, eirrjv pit) /caAco<> Ir/rpevr/rai' /cal orj ical 
Kara ravra do~apKorepo<i avros ewvrov ecrnv, ware 
ovBe avy/cpvrrreiv Bvvavrai, ev rfj Biaarpocprj. 
r)v ovv ri rotovrov v7T07rrevr)<i, pLriyavoiroielcrOai 
%pr) old irep ev tw fipayiovi ru> Biearpap.p,evu> 

10 iraprfv^rai?- tt poo-TTepiffciWeiv Be XPV oXiya 
roi)i' oQovicov kvkXw d/x(f>l to layiov /cal ra<; L%va<$, 
ottcos dv ol f3ov/3wve<; re ical to apdpov rb Kara, 
rrjv rrXi^dBa /caXov/jL&vrjv rrpoaeTriSerjrai' /cal 
yap aWoos crvp,cf)epei, /cal ottco<; per) tc\ a/cpea rwv 
vapO)/K(ov crivrjrai irpb<i ra, dverriBera 7rpoo~/3a\- 
\6fxeva. arroXe'nreiv he ^PV arrb iov yvpbvov alel 
TOU9 vdp9i]/ca<i ical evOev /cal evOev i/cavco?' 2 ical 
rr]V Oka iv alel rcbv vapO/j/ccnv tt po/j,rj6ela0ai XP 7 h 
okcos pujre Kara, rb bareov rwv e^e^vvrwv rrapa 

20 rd dpOpa (pvaei rrecpvKorcov p-'jre Kara to 

21 [apdpov] 3 vevpov ecrrai. 

XXI. To. Be olB/jfiara rd Kar lyvvrjv, rj /card 
rroha, rj Kara n dWo e%aeipevp,eva 4 vtto tj}? 
144 



ON FRACTURES, xix.-xxi. 

cient extension, you should ad just the parts with the 
palms of the hands and bandage in the same way as 
was described before, placing the head of the bandage 
as directed and carrying it upwards. And he should 
give the same answers as before, and experience the 
same trouble and relief. Let the change of dressing 
be made in the same way, and the same application 
of splints. The thigh-bone gets firm in forty days. 

XX. One should also bear the following in mind, 
that the thigh-bone is curved outwards rather than 
inwards, and to the front rather than to the back, so 
it gets distorted in these directions if not skilfully 
treated. Futhermore it is less covered with flesh on 
these parts so that distortions cannot be hidden. 
If, then, you suspect anything of this kind, you 
should have recourse to the mechanical methods 
recommended for distortion of the upper arm. 
Some additional turns of bandage should be made 
round the hip and loins so that the groins and the 
joint at the so-called fork may be included, for 
besides other benefits, it prevents the ends of the 
splints from doing damage by contact with the un- 
covered parts. The splints should always come 
considerably short of the bare part at either end, 
and care should always be taken as to their position 
so that it is neither on the bone where there are 
natural projections about the joint, nor on the 
tendon. 

XXI. As to the swellings which arise owing to 
pressure behind the knee or at the foot or elsewhere, 

1 Cf. VIII. 2 l, ( ar6u. 

s &pdooi' codd., except B, which omits. Kw, omits. 

145 



IIEPI ATMQN 

TTie^ios, elpioiai ttoWolcti pvnapolcnv, ev /car- 
eipyaa/nevoicnv, olv<p /cal e\alco p?jva<;, /crjpcorfj 
viTO^pUov, /carabeiv, /cal r)v me^waiv 01 vdpO)]/ce<;, 
^a\dv Odaaov layvaivois S' dv, el errdvoj e? 1 tovs 
vdpOrjKas bfovloiai layi'olcnv emhkois rd 0181']- 
fiara, dp£d/jevo<; diro rov Karcordroi eVt to dvw 
veixop.evo'i' ovrco yap av rd^iara lo-^ybv rb olhr]p,a 

10 yevoiro, /cal vrrepOonj 2 av vrrep rd dpyala e7Ti8ecr- 
p.ara~ dW ov %pr] rovrw tg> rpoira) y^pr)o-Bai 
rrj<; eTrihecrios, rjv pt,r) klvSvvos y ev rS> ol8>jp,ari 
<p\vKTaivd>o-io<; r) fxeXaapbov' yiverat 8e ovSev 
roiovrov, rjv /XT) d<yav ri<i Tne^r/ rb /cdrr]yp:a, rj 
/cara/c pep dp,evov e^rj, rj /cvrjrai rfj %etpi, rj aXXo 

16 ri TvpoairlTTTrj epeOicrriKov e? 3 rbv xpcora. 

aaII. 2<(tiXr]va be rjv piev Tt? vrr avrov rov 
p^rjpbv vrroOeir] pur) vrrepftdWovra r?]v lyvvrjv, 
ftXairroi av p,dXXov rj cocpeXenf ovre yap av rb 
awp-a /ceoXvoi ovre rrjv /cvrjpijjv, avev rov per/pod 
KiveiaOai' darjpbv yap dv elrj 7rpo<? rrjv lyvvr/v 
irpocr fiaXXopievov /cal o rj/cicrra 8el, tout' dv 
eVoT pvvoi jroieiv, [ij/ctara yap Set] 4 Kara to yovv 
/cdparreiv irdaav yap dv rvpftrjv rrapeyoi rpaiv 
erri8eaeatv, /cal pir/pov iiriSeSepievov ical /cvt']p,i]<;, 

10 oaris Kara rb yovv /cdparroi. dvdytcrj yap dv 
elt) rovrw rov<; p,va<; aXXore /cal aXXore aXXo 
cj-yj)p,a lo-yeiv dvdy/crj S' av eh] ical rd ocrrea 
rd /carer/yora /civrjatv e%eiv. rrepl iravrbs ovv 
Troit]reov rrjv lyvvr/v evrerdaOai. So/ceot dv 
[6/Aoteo?] 5 6 acoXiiv 6 7repiexu>v 6 rrpos rbv iroSa drrb 

1 iiravtls Kw. suggested by Krm., confirmed by B. 

* vTrfp6ei7j codd. virepdoly Littr6. uneAOoi . . . vnb B Kw. 

3 irpbs Kw. 

146 



ON FRACTURES, xxi.-xxii. 

dress them with plenty of crude wool, well pulled out, 
sprinkling it with oil and wine, after anointing with 
cerate, and if the splints cause pressure relax them 
at once. You will reduce the swellings hy applying 
slender bandages after removing 1 the splints, begin- 
ning from the lowest part and passing upwards, for 
so the swelling would be most rapidly reduced and 
flow back above the original dressing. But you 
should not use this method of bandaging unless there 
is danger of blisters forming or mortification at the 
swelling. Now, nothing of this kind happens unless 
one puts great pressure on the fracture, or the part 
is kept hanging down or is scratched with the hand, 
or some other irritant affects the skin. 

XXII. As to a hollow splint, if one should pass it 
under the thigh itself and it does not go below the 
bend of the knee it would do more harm than good ; 
for it would prevent neither the body nor the leg 
from moving apart from the thigh, would cause 
discomfort by pressing against the flexure of the 
knee, and incite the patient to bend the knee, 
which is the last thing he should do. For when 
the thigh and leg are bandaged, he who bends the 
knee causes all sorts of disturbance to the dressings, 
since the muscles will necessarily change their relative 
positions and there will also necessarily be movement 
of the fractured bones. Special care, then, should 
be taken to keep the knee extended. I should think 
that a hollow splint reaching [evenly ?] from hip to 

1 Reading iiravfts. 



* Kvv. omits. 

6 6/uoiois seems out of place. /xot B Kw. 



147 



IIEPI ATMQN 

rov Lcr^tou, axpeXetv V7rori0ep,evo<;' real aWa><; 
/car lyvvrjv raivlrjv ^aXapco^ TrepifidWeiv ovv 
ra> acoXrjvi, coaTrep ret TraiBCa ev Trjai Kocrr/ai 
arrapyavovrai' elra errijv 6 p.r/pb<; e? to civco 

20 Biacrrpecpotro 1 rj e? to irXdyiov, evKaracrye- 
rcarepov e'trj av crvv rw acoXrjvi ovrcos. r)i> ovv 

12 BiapLirepes ?y, z Trotr/reo? 6 acoXrjv, i) ov 7roir)reo<;. 

XXIII. Hrepvrjs Be aKpr/s Kcipra j^pi] em- 
pieXeiaOai &>? evOerw<i e'^77, Kal ev rolcn Kara 
KvijpLTjv Kal ev rolcn kclto. pirjpbv Karr)yp,acnv. rjv 
p,ev yap dirauopr/rai rrovs rr)<; aWrjs Kvrjp,ri<; 
?]ppLaTicrpLev>]<;, avdytcr] Kara, to dvriKV7]puov ra 
ocrrea Kvpra. cpcuveaOar r)v Be r) p,ev irrepvr] 
v^rrfkoreprj \rf\ rov puerpiov rjpriapevr), 3 tj Be aWrj 
KvrjpLT] inro p,erea) po<; fj, avdytcr] rb ocrreov rovro 
Kara to dvTiKvrjpaov rovro KOiXorepov cpavijvai 

10 rov (xerpiov, irpoaen Kal r)v rj irrepvrj rvy^dvrj 
eovcra rov dvOpdiirov (fivcrei p,eydXr/. drdp Kal 
Kparvverai rrdvra ra ocrrea ftpaBvrepov, i)v p,r) 
Kara cpvcriv Kel/xeva [77, Kal ra p,rj\ 4 drpe- 
p.eovra iv r&> avru> o~)(fip,aTi Kal al rru>pu>cne^ 

15 daOevearepai. 

XXIV. Tavra p.ev Bij, ocroicri ra p.ev ocrrea 
Kareriyev, t'^e^et Be /la?;, /j,7]Be aXXa><; eXKoq eyevero. 
ottri Be Kal ra ocrrea Karerjyev d-nXS) rS> rporrcp 
Kal p,rj iroXva^iBet, ai>6^p,epa e/u,/3Xrjdevra rj rfj 
varepair), Kal Kara ^copr/v l^opueva, Kal p,rj 
eTTiBo^of r) drroaraai^ irapaa^iBwv ocrrewv dir- 
tevai, ?) Kal olaiv eX/co? p,ev eyevero, ra, Be oarea 
ra Karerjyora oi/k e^ia^ei, ovo' rporros rrj<i 
Karrjgwi tolovtos 0Z09 napaa^BcKi ocrrecov eovcras 

SiucTpecpriTai. 2 dia/j.irepr]s not. 

148 



ON FRACTURES, xxn.-xxiv. 

foot would be useful, especially with a band passed 
loosely round at the knee to include the splint, as 
babies are swaddled in their cots. Then if the 
thigh-bone is distorted upwards (i.e. forwards) or 
sideways it will thus be more easily controlled by 
the hollow splint. You should, then, use the hollow 
splint for the whole limb or not at all. 

XXI II. In fractures both of the leg and of tht 
thigh great care should be taken that the point of 
the heel is in good position. For if the foot is in 
the air while the leg is supported, the bones at the 
shin necessarily present a convexity, while if the 
foot is propped up higher than it should be, and the 
leg imperfectly supported, 1 this bone in the shin 
part has a more hollow appearance than the normal, 
especially if the heel happens to be large compared 
with the average in man. So, too, all bones solidify 
more slowly if not placed in their natural position 
and kept at rest in the same posture, and the callus 
is weaker. 

XXIV. The above remarks apply to those whose 
bones arc- fractured without protrusion or wound of 
other kind. In fractures with protrusion, where they 
are single and not splintered, if reduced on the 
same or following day, the bones keeping in place, 
and if there is no reason to expect elimination of 
splinters, or even cases in which, though there is an 
external wound, the broken bones do not stick out, 
nor is the nature of the fracture such that any 

1 vnoueTewpos, " rather low." Adams. 

4 xaranivri Kw.'s conjecture. BMV omit jj. B has ko.\ 

149 



nEPi ArMftN 

10 irnho^ovs etvai dvarfXwaai' rovs toiovtovs ol 
piev /x/]Te peya dyadov p/]re t aeya kcikov Troiovvres, 
irjrpevovai ra pev eX/cea Ka6a ; >riK(p rivt, r) 
Triaarjprjv erri6evre<i, r) evaipiov rj aXXo ri S)v 
eioouaai rroielv errdvco he tovs oivt/povs anXfjva^ 
7] elpia pvirapa emheovaiv rj aXXo ri roiovrov. 
irri-jv he rd eX/cea icaOapa yevrjrai tcai i'lhr) 
avpcpvtjrai, rore Tola iv odovloiai ovyvoiai irei- 
pwvrai einhelv /cat vdpdtj^i Karopdovv. aurrj 
p.ev r) ii]ai<; dyadbv ri iroiel, kclkov he ov peya. 

20 ra pevroi oared oi>x 6p,ola)$ hvvarai Ihpueadai e\ 
rrjv ewvrtov -%copr)v, dXXd rivi 1 oyKi-jporepa 
aojpiara tov Kaipov ravrrj ylverai' yevoiro 8* dp 
p3pa^vrepa, tov dp,(p6repa ra barea Karer/yev i) 

24 7T?/Y eo ^ V KV))p,r]<i. 

XXV. "AXXot h' av rives elai ol odovloiai ra 
roiavra irjrpevovai evdecos zeal evdev p,ev teal evdev 
eiriheovai rolaiv odovloiai, Kara he rb eX/cos 
avro oiaXeiirouai, Kai ewaiv dve^vyOai' erreira 
emrideaai eirl to eA/co? rwv KadapriKUiv ri, 
Kai airXijveaiv oivrjpolai r) elpioiai purrapolai 
depairevovaiv. avrr/ r) ir)ai<; tcafct], Kai clkos 
rov<i ovrws ir)rpevovra<i rd pieyiara davverelv, 
Kai ev rolaiv aXXoiai Kartjypaai teal iv rolai 
10 roiovroiaiv. pieyiarov ydp iari ro yivcoa/eeiv 
tcaO oiTolov rporrov XPV r V v ^PX^ V l JL ^ v ftd\- 
Xeadai rod odovlov, Kai Kad' oirolov pdXiara 
rrerrie-yPai, Kai old re oxpeXeovrai r)v opdw? ri<i 
/3dXXr/rai rrjv dpyj)V Kai me^r) fj pdXiara XPV' 
Kai 61 a fiXdirrovrai r)v pir) 6p6oi<i tis /3dXXi)rai 
pnjhe TTie^r) fj p,dXiara XP } h dXXd evdev Kai etOev. 
€ip7]rac p.ev ovv Kai iv tois rrpuadev yeypap- 

150 



ON FRACTURES, xxiv.-xxv. 

splinters are likely to come to the surface : — in such 
cases they do neither much good nor much harm 
who treat the wound with a cleansing plaster, either 
pitch cerate, or an application for fresh wounds, or 
whatever else they commonly use, and bind over it 
compresses soaked in wine, or uncleansed wool or 
something of the kind. And after the wounds are 
cleansed and already united, they attempt to make 
adjustment with splints and use a number of band- 
ages. This treatment does some good and no great 
harm. The bones, however, cannot be so well 
settled in their proper place, but become somewhat 
unduly swollen at the point of fracture. 1 If both 
bones are broken, either of forearm or leg, there will 
also be shortening. 

XXV. Then there are others who treat such cases 
at once with bandages, applying them on either 
side, while they leave a vacancy at the wound itself 
and let it be exposed. Afterwards, they put one 
of the cleansing applications on the wound, and 
treat it with pads steeped in wine, or with crude 
wool. This treatment is bad, and those who use 
it probably show the greatest folly in their treatment 
of other fractures as well as these. For the most 
important thing is to know the proper way of apply- 
ing the head of the bandage, and how the chief 
pressure should be made, also what are the benefits 
of proper application and of getting the chief pressure 
in the proper place, and what is the harm of not 
placing the bandage rightly, and of not making 
pressure where it should chiefly be, but at one side 
or the other. Now, the results of each were ex- 

1 bcnia for awfxara ; callus develops. 



r 5i 



IIEPI ArMQN 

pevoioiv, oTrola aft eKarepcov l aTTofiaiver p-ap- 
rvpel Be teal avrrj i) lijrpeity avdy/cr] <yap rw oi!tw? 

20 iTriBeop,eva> to otSo? i^aeipeaOat, e? avrb ro eX/co?. 
Kal yap el vyiijs %/)&)? evdev Kal evdev eTTiBeOeirj, 
iv /ieo-ft) Be BtaXettpBeir}, p^dXiara Kara rrjv 
BidXeiylriv olBtjaetev av zeal d^/ponjcreiev 7rco5 
ovv ovyl eX/cos ye ravra av rrddoi ; dvayKaloos 
ovv e^et d^poov p,ev Kal i/cTreTrXiyp^vov to eX/co? 
elvai, BatcpvoiBes re /cal dve/cTTurjrov, oarea Be, 
/cal p,r) p,eXXovra diroa-rrjvai, drroarariKa yeve- 
adar cr(pvypoL)6e<; re Kal rrvpwBes ro eX/cos av 
eirj. dvay/cd^ovrat Be Bid to otSo? erriKara- 

30 7rXdaaeiv' davpxfiopov Be Kal rovro rolaiv evdev 
Kal evdev erriBeop.kvoiaiv' dydos yap dvaxfieXes 
7T/909 rw aXXo) a<pvyp.u) emylverai. reXevrcovres 
Be airoXvovai rd emBearp.ara, oirorav acpiv 
iraXiyKorfi, Kal lijrpeuovai ro Xolttov ctvev ern- 
Becrios' ovBev Be rjacrov, Kal ■tjv ri aXXo rpwp.a 
roiovrov \df3wai, ra> avra> rpoircp Irjrpevovaiv 
ov yap ol'ovrai rrjv e-TriBeaiv rr/v evdev Kai evdev, 
Kal rrjv dvd^rv^iv rov eX/ceo? alrir\v eivai, dXXa 
dXXrjv rivd drv^ii-jv ov p,evroi ye av eypacpov 

40 rrepl rovrou roaavra, el prj ev p,ev rjBetv davp-- 
j)opov eovcrav rr/v errlBeatv, o-w%vov<; Be ovro)<; 
Irjrpevovras, err'iKaipov Be to diropbddr)p,a, p,ap- 
rvpiov Be rov 6p6ws yey pd^Oau ra rrpoadev 
yeypd/jtp.eva ecre p^dXiara mearea ra Kari)yp.ara 

45 eire i]Kiara. 

1 eKarepov. 

1 That is, an unhealthy discharge without "purification." 

2 Exposure here cannot mean exposure to cold or even 
bareness — the foolish surgeons cover the wound with wool or 

'52 



ON FRACTURES, xxv. 

plained in what has been wi-itten above. The treat- 
ment, too, is itself evidence ; for in a patient so 
bandaged the swelling necessarily arises in the wound 
itself, since if even healthy tissue were bandaged 
on this side and that, and a vacancy left in the 
middle, it would be especially at the vacant part that 
swelling and decoloration would occur. How then 
could a wound fail to be affected in this way? 
For it necessarily follows that the wound is dis- 
coloured with everted edges, and has a watery 
discharge devoid of pus, 1 and as to the bones, 
even those which were not going to come away do 
come away. The wound will become heated and 
throbbing, and they are obliged to put on an ad- 
ditional plaster because of the swelling ; and this 
too will be harmful to patients bandaged at either 
side of the wound, for an unprofitable burden is 
added to the throbbing. They finally take off" the 
dressings, when they find there is aggravation, and 
treat it for the future without bandaging. Yet none 
the less, if they get another wound of the same sort, 
they use the same treatment, for they do not suppose 
that the outside bandaging and exposure 2 of the 
wound is to blame, but some mishap. However, I 
should not have written so much about this had I 
not known well the harmfulness of this dressing and 
that many use it ; and that it is of vital importance 
to unlearn the habit. Besides, it is an evidence of 
the truth of what was written before on the question 
whether the greatest or least pressure should come 
at the fracture. 3 

pads— it means absence of clue pressure, the proper graduation 
of which is the main point in ITippocratic bandaging. 

3 According to Adams this warning was still necessary in 
his time. 

153 



IIEPI ATMQN 

XXVI. Xpr) he, 009 ev K€(f)aAaia> elprjaOai, olaiv 
av fir) iTTiho^os rj r) twv oareoov airoaracn^ 
eaeadai, Tr)v avTr)v IrjTpelrjv IrjTpeveiv, coarrep av 
olcriv oared fiev Karerjyora elrj, eA,«o? he fir) 
eyovTCf t«9 Te yap KaTardcria*; /cat /caropdcaaia^ 
twv oaTicov tov avrov rpotrov Troieladai, tijv re 
eiriheaiv irapairXijaiov rpoirov. e-nl fiev aurb 
to eX/cos 7riaar]p7]v K>]pcoTr)v ^plaavra, airXrjva 
\eirrov htirXoov eiriheO^vai, 1 ra he irept^ Kr/pooTr) 

10 X.67TT?} y^pieiv. ra he odovia zeal ra aXXa TrXa- 
rvTepd nvi ea-^iapbiva ecrTco, r) el fir) eXtco<; el^ev 
/cat to av irpoorw €7riherjTai, o-vyjvCp ho-reo rov 
eX/ceos TrXaTurepov. ra yap crrevcnepa rov 
eXfceos ^doaavra e%ei to eA,/eo9- to he ov XP J h 
aXX i) Trpoiri) TrepiftoXr) oXov KaTe^eTO) to e\«:o9, 
/cal vTrepexera) to oOoviov evOev re real evdev. 
/3dXXea0ai fiev ovv XPV to oOoviov tear avrijv rrjv 
tf-iv rov e\/ceo<i, irie^eiv he oXlyo) rjaraov r) el 
fir) eX«o9 elx ev > €Trivefieadai he tj) eiriheaei, 

20 too-rrep icai irpoaOev eiptjrai. ra he oOovia alel 
fiev tov TpoTrov tov fiaXOatcov eaTcoaav, fifiXXov 
he Te 2 hel iv Total toiovtoio-iv, r/ el fir) eX/co<; el^ev. 
TrXrjOos he TOiv bOovlwv fir) eXdaaco earco twv 
irpoTepov elprjfievtjov, aXXd tivl koX TrXeico. i)v 
he eiriheOf), hofcetTco tco e7riheh€fievo) rjpfioaOai 3 
fiev, ireiriexPcLi he fi>y cf)aTO) he tcard to eX/cos 
fidXicTTa r)pfioo~0ai. tovs he xpovovs tov<; avToi)<i 
fiev XP 7 ) sivai eVt to fidXXov hoiceiv i)pfi6a0ai, 
TOU9 avrov 1 ; he eiri to fidXXov ho/celv x a ^-dv, 

30 coairep teal ev Total irpoaOev etprjrai. fieTeirihelv 
he hid TpiTrjs, rrdvTa fieTairoieovTa e\ tow 
T/3o7rou9 tou9 TrapaTrXrjoiovi, wanep Kal irpocrOev 
154 



ON FRACTURES, xxvi. 

XXVI. 1 To speak summarily, when there is no 
likelihood of elimination of bone, one should use 
the same treatment as in cases of fracture without 
extei-nal wound. The extensions and adjustments 
of the bones should be made in the same way, 
and so too with the bandaging. After anointing 
the wound itself with pitch cerate, bind a thin 
doubled compress over it, and anoint the sur- 
rounding parts with a thin layer of cerate. The 
bandages and other dressings should be torn in 
rather broader strips than if there was no wound, 
and the one first used should be a good deal wider 
than the wound ; for bandages narrower than the 
wound bind it like a girdle, which should be 
avoided ; rather let the first turn take in the whole 
wound, and let the bandage extend beyond it on 
both sides. One should, then, put the bandage 
just in the line of the wound, make rather less 
pressure than in cases without a wound, and 
distribute the dressing as directed above. The 
bandages should always be of the pliant kind, 
and more so in these cases than if there was no 
wound. As to number, let it not be less than those 
mentioned, before but even a little greater. When 
the bandying is finished it should appear to the 
patient to be firm without pressure, and he should 
say that the greatest firmness is over the wound. 
There should be the same periods of a sensation of 
greater firmness, and greater relaxation as were 
described in the former cases. Change the dressings 
every other day, making the changes in similar 

1 Proper treatment of compound fractures. 
1 iTTidtlvai. ! a 8 TjpfxaaBai bis. 

'55 



IIEPI ATMQN 

etprjTai, ttXtjv e? to avpnrav r)aaov rivi irie^etv 
ravra r) iicelva. koX rjv Kara Xoyov ra el/cora 
yevr/rai, la^yorepov pev alel evpe9>jaerai ro Kara 
to e\.«o9, lay^vov Be teal to aXXo rrdv to biro 
rr)q iiriBeaio<; Kare)(6pevov kclI at re e/c7TV7](Ties 
kaovrai ddaaovs r) rcav aXXcos irjrpevpevtov 
eXtciwv, oaa re aapxi'a iv tw rpcopari ipieXdvdr) 

10 /cal iSavarcodrj, ddaaov Trepipptjyvvrai teal eKiriiT- 
rei irrl ravr-p rfj Irjrpeir/ r) iv rfjai dXXr/aiv, e? 
wreiXds re ddaaov oppdrai to eX/co? ot/T&>? rj 
aWcos Iprpevpevov. rrdvrwv Be rovrcov alriov 
on layybv pev to Kara to eXKOs ywpiov yiverai, 
iayyd Be ra irepieyovra. ra pev ovv dXXa 
rrdvra 7rapa7rXyaia><i y^prj Ir/rpevetv, a>? ra dvev 
eXKOCHJios oarea Karr\yvvpeva' rovs Be vapOi/Kas 
ov Ypr) rrpoariBevai. Sid rovro /cal ra ouovia 
"fcpi) rovroiai TrXelco elvai rj rolaiv krepoiaiv, on 

50 re rjaaov irie^erai, on re ol vdpOrjKe^ (BpaBvrepoi l 
rrpoaridevrai' r)v pievroi rovs vdpOi)/ca<i rrpoa- 
riOfjs, pvr] Kara rrjv igiv rod e\./ceo? TrpocrriOevai, 
aXX(o<; re koX -y^aXapois rrpoaridevai, rrpopi]6ev- 
pevos 2 07TO)9 pirjSepiri acpiytys peydXr) karat 
drrb rwv vapOrjKcov e'{pi]rai Be rovro /cal iv rolai 
irpbrepov yeypappievoiaiv. rrjv pevroi Biairav 
d/cpi{3earepi]v /cal rrXeio) ^povov %pr) TroieiaOai 
olatv 0; dpXVS €\/cea yiverai /cai oiaiv oarea 
UgLcryet,' /cal ro avpirav he elprjadai, iirl rolaiv 

60 iayypordroiai rpcopaaiv d/cpi(3earepr]v icai 

61 TroXv^povKoreprjv elvai XPV T h v Biairav. 

XXV II. c II avrrj ii]rpeitj rebv eXtceoov ical olaiv 
oarea pev /carer]yev, cXko? Be e'£ dp^r}? pr/Bev 
fi, r)v Be iv ry ItjTpeirj eX/cos yevtjrai, r) rolaiv 
i<;6 



ON FRACTURES, xxvi.-xxvii. 

fashion except that, on the whole, the pressure should 
be less in these cases. If the case takes a natural 
course according to rule, the part about the wound 
will be found progressively diminished and all the 
rest of the limb included in the bandage will be 
slender. Purification 1 will take place more rapidly 
than in wounds treated otherwise, and all fragments 
of blackened or dead tissue are more rapidly 
separated and fall off under this treatment than with 
other methods. The wound, too, advances more 
quickly to cicatrisation thus than when treated 
otherwise. The cause of all this is that the wound 
and the surrounding parts become free from swelling. 
In all other respects, then, one should treat these 
cases like fractures without a wound, but splints 
should not be used. 2 This is why the bandages 
should be more numerous than in the other cases 
both because there is less pressure and because 
the splints are applied later. But if you do apply 
splints, do not put them in the line of the wound ; 
especially apply them loosely, taking care that there 
is no great compression from the splints. This direc- 
tion was also given above. Diet, however, should be 
more strict and kept up longer in cases where there 
is a wound from the first and where the bones 
protrude, and on the whole, the greater the injury 
the more strict and prolonged should be the dieting. 
XXVII. The same treatment of the wounds 
applies also to cases of fracture which are at first 
without wound, but where one occurs during treat- 

1 i.e. discharge of laudaMe pus. 

a We must evidently understand " so soon." 



1 PtiahvTtpov. 2 irpufxrjOtuixevois codd. Pq. 



157 



IIEPI AFMON 

odoviouTi ptaXXov TTi€)(devTo<i, r) vtto vdp6r)KO<$ 
ooive8pi]<i, i) v-rrb aXXr)<; tivos irpofydcnos. yivoi- 
a/cerai p.ev ovv to roiavra, rjv eA./co? vttt), ttj 
T€ ohvvrj /cai toIcti cr(j)vy/.ioi(Tiv kcu to ol8))p,a 
to iv toicti aKpoiai afcXrjporepov ylyveTai tcov 
toiovtcov, Kal el tov 8uktvXov &TTCL<yd<yOL<; i TO 

10 hpevOos e^aeipeTai, 1 aTap Kal avOis diroTpe^ei 
Ta^e&x?. rjv ovv ti toiovtov viroTTTevys, XvcravTa 
XPV> V v P^v V Kvrjo-pbo'i fcaTa Ta9 v7ro8eap.l8a<i 
7) eVt 2 to dXXo to i7ri8e8ep.evov Triacrijpfj Kt]p(OTjj 
(IvtI t^9 eT€prj<i ^prjaOai- rjv 8e tovtcov /xev p,t)8ev 
fj, avTO 8e to eA,/eos" r)pe0iap,evov ebplaiceTai 
p,eXav iirl iroXv r) 3 dfcdOapTov, /cal tcov p,ev 
crap/ccov eKTrvrjaop^evcov, tcov 8e vevpcov irpoaeK- 
TretrovpLevcov, tovtovs ov&ev 8el dvayfrv^eiv iravTa- 
iracnv, ovoe ti <po{3eicrdai Ta<; eKTrvijcrtas TavTas, 

20 dX.V IrjTpeveiv t& puev dXXa irapairXijaiov Tpoirov, 
wcnrep /cat olcriv e£ dp^rj^ eX/cos iyevero. Totai 
8e 6dovloi(Tiv apyeadai %prj e-niheovTa dirb tov 
ol8i']pLaTO<; tov iv toIctlv d/cpeoiai irdvv ^aXapcof, 
/cal eireiTa eirivepieo-Oai tt/ eiriSeaei alel e? to 
oivto, Kal Treirie^dai p,ev ov8ap.fi, ))pp,6o-0ai 4 8e 
pLaXtcTTa icaTa to gXkos, tcl he aXXa eirl rjcrcrov. 
tcl he oOovia Ta irpoiTa, TavTa p.ev KaOapa eo~Ta) 
Kal p.i] oTevd- to he TrXrjOos tcov oOovlwv eo-Tco 
ocrov rrep Kal iv Tolai vdp$i]£iv, el iirtheoLVTO, 5 rj 

30 bXiyco eXaaaov. eirl he ai>TO to e'A.«o<? iKavbv 
o-ttXtji'Iov ttj XevKrj KrjpwTfi Ke^pia pbkvov ijv tg 
yap adpi; r]v Te vevpov p,eXav8fj, irpoaeKireaelTai' 
tcl yap TOiavTa ov ^prj hpip.eatv IrjTpeveiv, dXXd 

1 i^ipytTai Kw.'s conjecture. Kw.'s note t^ipyerai scripsi, 
O-apelarat B 1 , i^ailf>trat B 2 Pq., i^afiparai M V, e'£aip«'eTai 

158 



ON FRACTURES, xxvu. 

ment either through too great compression by 
bandages or the pressure of a splint or some other 
cause. In such cases the occurrence of ulceration 
is recognised by pain and throbbing : also the 
swelling on the extremities gets harder, and if you 
apply the finger the redness is removed but 
quickly returns. So, if you suspect anything of 
this kind you should undo the dressings, if there 
is irritation below the under bandages, or in the 
rest of the bandaged part, and use pitch cerate 
instead of the other plaster. Should there be none 
of this, but the sore itself is found to be irritated, 
extensively blackened or foul with tissues about 
to suppurate and tendons on the way to be thrown 
off, it is by no means necessary to leave them 
exposed, or to be in any way alarmed at these 
suppurations, but treat them for the future in the 
same manner as cases in which there is a wound 
from the first. The bandaging should begin from 
the swelling at the extremities and be quite slack ; 
then it should be carried right on upwards, avoiding 
pressure in any place, but giving special support at 
the wound and decreasing it elsewhere. The first 
bandages must be clean and not narrow, their 
number as many as when splints are applied or 
a little fewer. On the wound itself a compress 
anointed with white cerate is sufficient ; for if Hesh 
or tendon be blackened it will also come away. 
One should treat such cases not with irritant, but 

Litt., ^aviaraTai Wb, rb iptvQus t^aelpaTai (Jalen in cit., 
l£apv*Tai : l<KevovTai wdM/Strat (Jalen in excgexi. Such is the 
discord about this word whenever it occurs ; but the meaning 
seems obvious. 

* Ka\ omitting ^. » f) M iroKv a.Ka.9aproy omitting p.4\av. 

4 T)pfid<r6at. l imStoiro. 

159 



nEPi ArMON 

fuiK6aKolcriv, cbcnrep ra irepiKavara. p,ererrihelv 
8e Sid rpirrjs, vdp0i]Ka<i Be pr) txpoaridevai' 
drpepelv he eirl pdXXov r) rb rrpbaQev, Kal 
bXiyoairelv elhevat oe xpr) el re aap%, el re 
vevpov to eKireaovpevov iari, on ovroy 7roXXm p,ev 
rjaaov vep,erai errl rrXelov, ttoXXG> 8e ddaaov 

40 eKireaelrai, ttoXXu) 8e la^vbrepa ra rrepiexovra 
earai, r) ei Tt? diroXvaas ra oOovia emBeir) ri 
rwv KaOapriKwv (pappaKcov errl to eA,/eo?. icairoi 
real rjv eKirear) rb eKtrvr)abpevov, Bdaaov re aap- 
Kovrai eKeLvcos rj erepcos Irirpevopevov, Kal Bdaaov 
ODrecXovrai. rrdvra p,r)V iari ravra bpBax; irriBelv 
teal p,erpiw<i enrlaraaBai. irpoaavp,/3dXXerai 8e 
teal ra ax>]para tcai ola \pr) elvai, zeal r) dXXrj 

48 Slaira, teal rwv bBov'twv r) eTn,rrj8eibrri<i. 

XXVIII. *Rv Be apa itjaTrajri0V<i «V roiai 
veorpooroiai, p,r) olbpevos oaremv airoaraatv 
eaeaBai, rd S' eiriho^a rj dva-rrXcoaai, ov -ypr) 
bppcohelv rovrov rbv rpbirov rrj<; Irjrpeir)?, ovoev 
yap dv pueya (pXavpov yevoir dv, 1 rjv povvov 
0I0? re r)<i rrj X^P 1 T ^ 9 eni8eaia<; dyaOas icai 
daiveas iroietaOai. aiipelov he rb8e, rjv peXXr] 
oarecov dirbaraai<i eaeaBai ev rat rpbirat rovrco 
rrj<; lr)rpeiri<i' irvov yap avyybv peet eic rod e\«eo? 

10 Kal bpydv (faaivercu. irvKvbrepov ovv pereTTi- 
BelaBai 2 Sid to ttXciBov eirel aXXox; re Kal 
dirvperoi ylvovrai, rjv pr) tedpra irie^wvrai v-rro 
rrjs eiriheaios, Kal rb eXKOt Kal ra irepMX ovra 
layvd' baai p.ev ovv XeirrSiv iravu oareoiv 

1 •ytvoi-ro. 
8 n*Tfit fifiv, 

160 



ON FRACTURES, xxvn.-xxvni. 

with mild applications, just like burns. Change the 
dressing every other day but do not apply splints. 
Keep the patient at rest and on low diet even more 
than in the former case. One should know if 
either flesh and tendon is going to come away that 
the loss will be much less extensive and will be 
brought about much quicker, and the surrounding 
parts will be much less swollen (by this treatment), 
than if on removing the bandage one applied some 
detersive plaster to the wound. Besides, when the 
part that is going to suppurate off does come away, 
flesh formation and cicatrisation will be more rapid 
with the former treatment than with any other. 
The whole point is to know the correct method and 
due measure in dressing these cases. Correctness of 
position also contributes to the result, as well as 
diet and the suitability of the bandages. 

XXVIII. If, perchance, you are deceived in fresh 
cases, and think there will be no elimination of 
bones, yet they show signs of coming to the sur- 
face, the use of the above mode of treatment need 
not cause alarm, for no great damage will be done 
if only you have sufficient manual skill to apply 
the dressings well and in a way that will do no 
harm. The following is a sign of approaching 
elimination of bone in a case thus treated. A large 
amount of pus flows from the wound, which appears 
turgid. So the dressing should be changed more 
often because of the soaking, 1 for thus especially 
they get free from fever, if there is no great 
compression by the bandages, and the wound and 
surrounding parts are not engorged. But separa- 
tions of very small fragments require no great 

1 " Maceration," "abundance of humours." 

161 
vol. in. a 



IIEPI ArMQN 

air o a t denes, ovBepir/s p,eydXr)<; p.eTa/3oXrj<; Beovrai, 
dXX' rj %akap(0T€pa einBelv, &>? p.rj diToXap.^dvrj- 
rai to ttvov, dXX' evcnroppvTov, rj icah ttvkvo- 
repov p,eTeiriBelv ear av airoaTy to oareov, teal 

19 vdpdrjKas pr/ irpoariOevai. 

XXIX. 'Ottoo-omti Be p,ei£ovo<; oareov dtro- 
o~raai<; etriBo^ 09 yevrjTai, rjv re e£ dp^r}? irpoyvax;, 
r\v re /ecu eiretra peTayvcps, ov/c en tt}? avTrjs 
IrjTpeir)? Beirut, 1 dXXd t<z? pev Karardo-ias real 
Ta? Biopdaocnas ovtoj TroteiaOai warrep etprjrar 
o~TrXr)vas Be xpr/ BlttXovs, rrXdros pev r)p,io~Tnda- 
pualovs, pur) eXdaaovs (ottoIov Be dv ti zeal to 
Tpoop,a 77, 717309 tovto Te/cp,aipeaOai), pfj/cos Be 
fipaxvTepov 1 ; pev 6Xlya> rj ware BU irepuKvelaOai 
10 irepl to awpa to Terpcopevov, pa/cpoTepov? Be 
av)£v<p rj ware aira^ Trepu/cveiaOai, 7rXr)@os Be 
owoaov; dv o~vp,(pepr}, iroirjadpevov, toi/tou? ev 
6tva> peXavi aucrTijpa) jSpeyovTa, \pr) etc p,ecrov 
dp^opevov, a>? a7ro Svo dpyosv vTroBeo-pls eiri- 
BeiTcu, TrepieXicrcretv, Kaireira aKeirapv^Bov irap- 
aXXdaaovra rd<; ap^ds dfpievcu. ravra /card re 
avTo to eX/co<; iroteli' real Kara to evOev koX evOev 
toO eX/ceo?- icai TTeirLe^Oa) p.ev p,rj, dXX* oaov 
epp-aapov eve/cev tov k'Xiceos TrpoaKeiadoy. ejrl 

20 Be avTo to eX/cos eirnidevcu xprj iria o~r)pr)v, rj ti 
twv evaipiwv r] ti t6)v d\Xcov tyapfAaiccov, 6 ti 
o~vvTpocj)6v 2 eaTiv [0] eniTey^ei? /ecu rjv pev r) 
copy] OepwT] r), errtTeyyeiv tw oXvw T01/9 airXijvas 
iTVKvd' rjv Be %eif-iepivri r) oipr] r), eipta iroXXa 
162 



ON FRACTURES, xxvin.-xxix. 

alteration of treatment beyond either loose bandaging 
so as not to intercept the pus but allow it to flow away 
freely; or even more frequent change of dressing till 
the bone separates, and no application of splints. 

XXIX. But in cases where separation of a rather 
large bone is probable, whether you prognosticate 
it from the first, or recognise it later, the treatment 
should not be the same, but, while the extensions 
and adjustments should be done as was directed, 
the compresses should be double, half a span 1 in 
breadth at least — take the nature of the wound as 
standard for this — and in length a little less than 
will go twice round the wounded part, but a good 
deal more than will go once round. Provide as many 
of these as may suffice, and after soaking them in 
dark astringent wine, apply them beginning from 
their middle as is done with a two headed under band- 
age ; enveloping the part and then leaving the ends 
crossed obliquely, as with the adze-shaped bandage. 
Put them both over the wound itself and on either 
side of it, and though there should be no com- 
pression, they should be applied firmly so as to 
support the wound. On the wound itself one should 
put pitch cerate or one of the applications for fresh 
injuries or any other appropriate remedy which will 
serve as an embrocation. If it is summer time 
soak the compresses frequently with wine, but if 

1 Adams strangely calls a span a fathom here and else- 
where. 

1 8«r. 

* ffvvrpocf>6y, as Galen says, means 'appropriate," as in 
Surgery, XI. 

* iirtTty^t P(|. takes as a verb. Kw. apparently takes it 
as subst., omitting 2. 

163 



IIEP1 ArMQN 

pvrrapa vevoTicr/xiva olva> Kal eXaim 1 eirLKeicrdco. 
l^aXrjv Be yph vTroTeTdadat, Kal evairoppvTa 
TToielv, (f>v\d<Tcrovra tou? inroppoovs, /xe/xvi]/xevov 

OTl 01 TOTTOl OVTOl, €V TOiCTl dVToicTl a^T]/xaai 

iroXXbv xpovov fceifievoiai, eKTpi/xfxara BuaaKeara 
30 iroieovaiv. 

XXX. 'Oo"ou<? Be fxrj olbv re eircBeaei l/jcraadai 
Bid Tiva Tovroiv rcov elprj/xivcov Tpoircov V} riov 
prjOrjcro/xevcov, tovtovs irepl irXeovos xprj ttoi- 
elcrdai 07r&>9 evderco^ cryJ)o~ovcn, to KaTer]yb<; tov 

(T(i)fMlTO<; KdT WvCOpilJV, 7T pOO kyOVl (X TOV VOOV Kal 

tu) dvwrkpw Be LidXXov rj tw Karoyrepo). el Be 
T45 fxeXXoi ica\6i<i Kal ev-^epios epyd^eadai, d^iov 
teal Li^yjuvoTroi^aacrdai, okios Kardraaiv SiKairjv 
teal fxi] /SiaiTjv o'X 1 ') <J V 2 T0 Rare^yo? T °v crw/xaTO?' 
10 /xdXXov 3 Be ev Kv>jp,r) eVSe^eTat /xi]%avo7roieiv. 
eicri /xev ovv rives o'l eirl irdcn toio~i tt}? Kvij/xrj? 
KaT>']y/xao~i, Kal rolai eiriBeop-evoiai Kal rolcn /x?] 
eTTiBeo/xevoiai, tov -rroBa dxpov Trpoo-Beovai Trpos 

TT)V K.Xlvr]V ?') 7T/30? dXXo Tl %1>X0V TTapd TTjV 

Kkivqv /caTopv^avres. ovtoi /xev ovv ttuvtu /catca 
TTOiovaiv, dyaObv Be ovhev ovre yap tov Kara- 
reivecrOai a«09 earl to TTpoaBeBeaOai tov iroBa, 
ovBev yap r/ao-ov to dXXo aw/xa Trpoa^wpt/aei 

7Tp09 TOV TToBa Kal OVTCOS OVK aV 6TL TeivOLTO' 

20 ovt av 4 e? ttjv Wvayplijv ovBev dxfreXei, dXXa 
ical /3XaTTT€i' aTp€(popLei'ov yap tov aXXov crco/xa- 
to9 7} tt) rj Trj, ovBev KcoXvaei 6 Bea/xb 1 ? tov iroBa 
Kal ra oaTea rd to> 7roBl irpoaijprijjxeva eiraKO- 
Xovdelv tw dXXo) aco/xaTi- el Be /xrj TrpoaeBeBeTO, 
rjaaov av BieaTpe(peTO' rjaaov yap dv ey/caTeXec- 
TT6TO ev Trj Kiv/jaei tov aXXov croo/xaTOs, el Be 
164 



ON FRACTURES, xxix.-xxx. 

winter apply plenty of crude wool moistened with 
wine and oil. A goat's skin should be spread 
underneath to make free course for discharges, 
giving heed to drainage and bearing in mind that 
these regions (when patients lie a long time in the 
same posture) develop sores difficult to heal. 

XXX. As to cases which cannot be treated by 
bandaging in one of the ways which have been or 
will be described, all the more care should be taken 
that they shall have the fractured limb in good 
position in accord with its normal lines, seeing to it 
that the slope is upwards rather than downwards. 
If one intends to do the work well and skilfully, it 
is worth while to have recourse to mechanism, that 
the fractured part may have proper but not violent 
extension. It is especially convenient to use 
mechanical treatment for the leg. Now, there are 
some who in all cases of leg fractures, whether they 
are bandaged or not, fasten the foot to the bed, or to 
some post which they fix in the ground by the bed. 
They do all sorts of harm and no good • for extension 
is not ensured by fastening the foot, since the rest 
of the body will none the less move towards the 
foot, and thus extension will not be kept up. Nor 
is it of any use for preserving the normal line, but 
even harmful. For when the rest of the body is 
turned this way or that, the ligature in no way pre- 
vents the foot and the bones connected with it from 
following the movement: If it were not tied up, 
there would be less distortion, for it would not be 
left behind so much in the movement of the rest of 
the body. Instead of this, one should get two 



1 Cf. the good Samaritan. 2 ax 7 ' " 6 '- 

8 fidAto-Ta. * avr-fiv. 



l°5 



IIEPI ArMQN 

Tf? fftf>alpa<i Bvo pdyjratTO e/c o~kvt€o<; Alywrniov 
Toiavras otas cpopeovatv ol iv ttjcti pLeydXrjai 
TTeSrjcri 7roXXbv j(p6vov ireTreBripLevoi, at Be 

30 crcpaipai e%oiev evOev real evOev ^tT&»'a<? ra p,ev 
irpbs tov Tpa)p,aro<; jSadvTepovs, ra Be 77770? twv 
apdpcov ftpa^VTepovs, elev Be oyKrjpal p,ev Kal 
pLaXdetfcal, dpp,bt,ovcrai Be, 77 p,ev dvwQev x t&v 
afyvpwv, r) Be KarwOev 2 tov yovaTOS' eK Be 
irXayirjq e/caTeprjs 3 Btacra e/caTepcotfev e%oi irpoa- 
7}pTrj/j.eva r) dirXoov IpudvTOs rj BnrXoov, ftpayy- 
repa 4 wo-irep dyKvXas, rd p,ev ti tov o~<pvpov 
eKCLTepaiOev, Ta Be ti tov yovaTOS' [/ecu r) ava>0ev 
arcpaipa eTepa toiclvtcl e%ot] 5 KaTa ttjv WvwpirjV 

40 Trjv avTtjv. Kairena Kpavatvas pd/38ov<; Teaaapa? 
Xaficov, lo~a<; to p,eye0o<; dXXrjXrjaiv e^oucra?, 
irdyo'i piev a>9 BaKTvXiala*;, p:r)Ko<; Be, &>? KeKapu- 
p,evai ivapp:6aovaiv e<? ia dTraicoprjpiaTa, eiripie- 
Xopt,evo<i 07ra)9 Ta ct/cpa tCov pd/38a)V pur) e? tov 
XpwTa, dXX' e'5 ta a/cpa twv acpaipecov eyKeXarj. 
elvai Be %pr) fevyea Tpia t5>v pdfSBcov, Kal TrXew, 
Kai tivi p,aKpoTepa<; ra? eTepas twv eTepwv Kal 
Tivt, Kal p3pa^vTepa<; Kal ap.iKpoTepa^, a>? Kal 
p,dXXov BiaTciveiv, 6 rjv /SovXrjTai, Kal rjaaov 

50 Kal eaTwcrav Be al pd/38oi eKarepai evdev Kal 
evdev TOiv crcpvpwv. TavTa tolvvv el KaX&s 
p,y)yavoTTOir\8eiri, Trjv re KaTaTaaiv Kal BiKalrjv 
dv irape^oi Kal opLaXrjv KaTa ttjv Wvcoplrfv, Kal 
T&) Tpcop-aTi 7rovo<i ovBel<i dv €lt)' Ta yap diroTTi- 
eo~p.aTa, el ti Kal diroTTie^oiTo, Ta ptev dv e'<? tov 
irdBa dirdyoiTO, Ta Be e<? tov p.rjpov at re pdftBoi 
evOeTcoTepai, a! p,ev evdev, at Be evdev tosv 
acpvpStv, wore fir) KQiXveadai ttjv Oscriv ti)<? 
166 



ON FRACTURES, xxx. 

rounded circlets sewn in Egyptian leather such as 
are worn by those who are kept a long time shackled 
in the large fetters. The circlets should have cover- 
ings on both sides deeper on the side facing the 
injury and shallower on that facing the joints. They 
should be large and soft, fitting the one above the 
ankle, the other below the knee. They should 
have on each side two attachments of leather thongs, 
single or double, short like loops, one set at the 
ankle on either side, the other on either side of the 
knee (and the upper circlet should have others like 
them in the same straight line, i.e. just opposite 
those below). Then take four rods of cornel wood 
of equal size, the thickness of a finger ; and of such 
length as when bent they fit into the appendices, 
taking care that the ends of the rods do not press 
upon the skin but on the projecting edges of the 
circlet. There should be three or more pairs of rods, 
some longer than the others and some shorter and 
more slender, so as to exert greater or less tension 
at pleasure. Let the rods be placed separately on 
either side of the ankles. This mechanism if well 
arranged will make the extension both correct and 
even in accordance with the normal lines, and cause 
no pain in the wound, for the outward pressure, if 
there is any, will be diverted partly to the foot and 
partly to the thigh. The rods are better placed, 
some on one side and some on the other side of the 
ankles, so as not to interfere with the position of the 



1 t<£ &va>6ev. * rw K<ira>9(v. 

6 Kw. omits ; Erin, omits the rest of the sentence also. 

167 



IIEPI ATMON 

KV)lfJLri<S' TO T€ rpSifia eVKara(TK6TTTOV xai ev- 

60 j3dcrTaKTov' ovSev yap epuroScav, el ri<; eOeXoi ra<? 
Svo rcov pdftScov Ta<? dvcorepto avrd<; rrpos dX- 
\tf\as fevijat, zeal ijv ti<? zcov(f)a><; ftovXoiro iiri- 
fidWeiv, ware to eirifiaXXopLevov p,erewpov diro 
rov rpwp,aTos eivai. ei p,ev ovv at, re ocfraipat 
Trpoarjvees zeal zcaXal zeal paXOa/eai zeai zcaivat 
pcupelev, zeal 1) evraai<; rwv pdftSwv ^prjarw^ 
evraOeir), wairep rjSrj elpr/rai, eu^prjarov ro 
p^rj-^avrj/na' el Se rt rovrwv p,r\ /caXaW e%ei, 
fiXdrrroL dv paXXov r) axfreXeoi. XPh ^ Kai T ^'> 

70 dXXas p,r/^avd<; r) zcaXws fxrj^avdadai, rj /jltj 
p,r)yjxvdod at, alo^pov yap zeal dreyyov p,r)yavo- 

72 iroieovra dp,r)yavoiroiela9 at. 

XXXI. Tovro Se, oi rrXelarot rwv Irjrpwv rd 
zearrjyfiara zeal ra ovv eX/eeai zeai ra avev eXzeewv, 
rd<; 7Ty0coTa? rwv r)p.epewv tr/rpevovoiv eipioioi 
pvrrapoioiv zeal ovSev rt areyyov Sozeeei rovro 
elvai. qttoctoi p,ev ovv dvayzed^ovrai viro rwv 
avrlzea veorpwrwv eovrwv, ovie 1 e\ovre<; oOovia, 
eipioioi rrapaozeevdoaodai, rovroioi irXecorri 
o~vyyvwp,rj' ov yap av Tt9 e%ot avev oOoviwv dXXo 
rt ttoWw fieXriov eipiov emSyjaai 2 rocavrw eivai 

10 Se XPV trdfnroWa zeal rrdvv /ea\<w<? elpyaapeva zeal 
p,r) rpr^-yea' rwv yap oXiywv /cat (p\avpa)v oXtyr) 
zeal r) Svvap:i<;. 0001 Se eVi fiirjv rj Svo r)p,epa<; 
eipia eirtSeiv Sizeaiovoi, rptrr) Se zeal rerdprrj 
odovloioiv emSeovres rnetpvo/,, zeal Karareivovat 

1 yA\. * iiriSrjffai M. 

I 68 



ON FRACTURES, xxx.-xxxi. 

leg ; and the wound is both easy to examine and 
easy to handle. 1 For, if one pleases, there is nothing 
to prevent the two upper rods from being tied 
together, so that, if one wants to put something 
lightly over it, the covering is kept up away from 
the wound. If then the circlets are supple, of good 
quality, soft and newly sewn, and the extension 2 by 
the bent rods suitably regulated as just described, 
the mechanism is of good use, but if any of these 
things are not well arranged it will harm rather than 
help. Other mechanisms also should either be well 
arranged or not used, for it is shameful and contrary 
to the art to make a machine and get no mechanical 
effect. 

XXXI. Again, most practitioners treat fractures, 
whether with or without wounds, by applying un- 
cleansed wool during the first days, and this appears 
in no way contrary to the art. Those who because 
they have no bandages are obliged to get wool for 
first aid treatment 3 are altogether excusable, for in 
the absence of bandages one would have nothing 
much better than wool with which to dress such 
cases ; but it should be plentiful, well pulled out 
and not lump}' ; if small in amount and of poor 
quality its value is also small. Now, those who 
think it correct to dress with wool for one or two 
days, and on the third or fourth day use bandages 
with compression and extension just at this period 

1 "Arrange" (Adams), better than "maintain" (Littre^ 
Petrequin) ; "sustinere aliquid " (Erm.) suits the context — 
" easily bears a covering," but see Herod. II. L25. 

2 ivmats perhaps connected with use of word in architecture, 
"slight outward curvature." 

* Gf Aristoph. Acharn. 12, Vesp. 275, Lysist. 987 on this 
use of wool. 

169 



IIEPI ArMON 

rore fioiXicrra, ovroi ttoXv ti tt}? Irjrpi/erjs /cal 
tcdpra iir'i/caipov davvereovar fjfciirra yap %pr) 
rfj rpirrj rjpieprj rj rfj rerdprr] arvcpeXi^eiv irdvtct 
rd rpcbpara, o>? iv /cecfraXaUo elpfjaOar /cal 
prjXoicrias he 1 Travel's (pvXdo-aeadai %prj iv 

20 ravrrjat, rfjeriv rjpeprjai, /cal ottoctoitiv dXXoiai 
rpcopacri 2 r)pk&iGTai. ro iirnrav yap rj rpirrj ical 
rerdpri] r)pieprj iirl roiai TrXeicrrotai rwv rpcopd- 
rcov rt/crei t<x9 iTaXiyicorr]aia<;, teal oera if 
(pXeypiovrjv /cal d/caOapairjv 6pp,a, ical oera dv if 
trvperovf Irj" /cal paXa ttoXXov a^iov rovro to 
p,ddr/p,a, el nrep ti, /cal dXXo' rlvi yap ov/c 
iiriKoivoiveZ rwv iiriicaipordreov ev irjrpi/cf}, ov 
Kara to e\/cea povov, dWa /cat /ear aXXa iroXXa 
voai^para ; el p,r\ Tt? (prjcreie ical rdXXa voarjpiara 

30 eX/cea elvar exei ydp riva /cal ovrof 6 Xoyos 
i7neiieeiav rroXXay^f] yap r}8eX(f}iarai ra erepa 
roicri erepoiai. birbcroi pevroi hi/caiovcriv elpioiai 
'XprjaOai, ear av kirra r}p,epai ixapeXBwcriv, hireira 
Karareiveiv re /cal /earopdovv /cal odovloiaiv 
iiriheiv, ovroi ov/c av davveroi o/zw'&>? (pavelev 
/cal yap rf/f ef>Xeypovr}f to irriKaiporarov irap- 
eXrjXvde, /cal rd oarea x a ^ a P a [fcal evdera] 3 perd 
ravraf xa? r}p,epa$ dv etrj. iroXXa) pevroi rja- 
o-rjrai kcu avrrj r) p,eXerr} rfjf ig dp%f)f rolacv 

40 ddovioiaiv imSec-tof /ceivos p,ev yap 6 rpoirof 
e(3hop,aiovf iovraf depXeyp,dvrouf dtrohei/cvvo-i, 
/cal irapaaKevd^et vdp0r]^i reXeax; iiriheiv ovrof 
Be 6 rpbrrof ttoXv varepei, {3Xd/3a<; he rivas /cal 
dXXaf e-^ei. dXXa paicpbv dv elrj ndvra ypd(peiv. 
'Oiroaoicri he rd ocrrea /carerjyora /cal ef*~ 

1 xp'h' * rpd/mrn. * Pq. omits, 

170 



ON FRACTURES, xxxi. 

are very ignorant of the healing art, and that on a 
most vital point. For, to speak summarily, the third 
or fourth day is the very last on which any lesion 
should be actively interfered with ; and all probings 
as well as everything else by which wounds are 
irritated 1 should be avoided on these days. For, 
as a rule, the third or fourth day sees the birth of 
exacerbations in the majority of lesions, both where 
the tendency is to inflammation and foulness, and in 
those which turn to fever. And if any instruction is 
of value this is very much so. For what is there of 
most vital importance in the healing art to which it 
does not apply, not only as regards wounds but 
many other maladies ? Unless one calls all maladies 
wounds, for this doctrine also has reasonableness, 
since they have affinity one to another in many 
ways. But those who think it correct to use wool 
till seven days are completed and then proceed to 
extension, coaptation and bandaging would appear 
not so unintelligent, for the most dangerous time 
for inflammation is past, and the bones after this 
period will be found loose and easy to put in place. 
Still, even this treatment is much inferior to the 
use of bandages from the beginning, for that method 
results in the patients being without inflammation 
on the seventh day and ready for complete dressing 
with splints, while the former one is much slower, 
and has some other disadvantages ; but it would 
take long to describe everything. 

In cases where the fractured and projecting bones 

1 Littre' — Adams, "in wounds attended by irritation," 
seems pleonastic (he has said that no wound is to be 
interfered with). I)ic6aa &\\a oI<ne ripfdiarat rpui/jiafftv (Petre- 
quin), This view is confirmed by Kw.'a reading, 

171 



IIEPI ATMQN 

layovra firj BvvrjTai e? rr/v ecovrwv ydyprjv KaOi- 
BpveaOai, ijBe r) KaTaaraai^' 1 o~i8i')pia XPV 
TroielcrOai e'9 tovtov tov Tpbirov ovirep 2 ol fio^Xol 
e%ovcriv, 049 ol Xarviroi ^peovrai, to p,ev n 
50 7r\aTvr€pov, to 84 tv arevoTepov elvai Be Xph 
kcli rpia teal en ir\eloi, &>9 rolcrt fidXiara 
dppio^ovcn Tt? xpijaairo' 3 eireiTa rovroiai XPV 
apLa rfi KdTCiTao-ei p,0)(\eveiv virepfiaWovTa, irpb^ 

fi€V TO KdTOiTepOV 4 TOV OCTTeOV TO KCLTCOTepOl' 

ipelBovra, 7T/90? Be to dvcorepov 5 to dvcorepov tov 
aiBrjptov, cnr\S> Be Xoyco, coanep el \idov ti<; r) 
£v\ov p,o)(\evoi lo")(yp5y<i' karay Be arOevapd rd 
aiBr]pia o>? olov re, o>9 p,rj /cdp,7rT7]rai. avrrj 
p,eyd\rj rip-topir), tfv re rd o-iBijpia e7riTr}8eia r) 

60 /cal pLO^X-evriTaL Ti<t 009 XPV' oiroaa yap dvOpco- 
•jroicnv dpfieva p.epr)X"' vr l Tal > Trdvroiv layvpoTard 
earl rpia ravra, ovov re irepiaywyr] kclL /tio^Xeu- 
OV9 kcu o~($>r}vwo~i<;' dvev Be tovtcov, r) ev 09 Be 6 
tivo<; r) irdvTtov, ovBev tcov epycov tcov Icryvpo- 
rdrcov ol dvOpcoiToi e*n ireXeov o~ iv . ovkovv dri- 
fiaaTerj avrr/ r) p:oy\evo~i<>' rj yap ovtco<; eyurre- 
aelrai rd oarea, rj ovk dWcos. rjv 8' dpa tov 
oareov to dvco iraprjWaypLevov p,rj eiriTr]Beiov 
^XV £veBpr/v tco pioyXco, dWa irdpo^v co 

70 Trapafyepr), 1 irapayXv-yp-aaa XPV tov oareov 
eveBpr/v tco p,oy\<p dacpaXea Troi^aaaOar pbO^Xev- 
eiv Be %prj real relveiv avdrjp,epa rj Bevrepaia, 
rpnala Be p.rj, reraprala Be &>9 rjKiara real 
TrepLiTTala. /cal p,rj ep,f3dWovra, 6')(Xi']o'avri Be 
iv ravrr/at rfjcriv rjp,epr]ai, (p\ey p,ovr)i> dv 

1 /caToo-Trjirai used by Asiatic Greeks for "put in its place." 
Galen, XVIII(2). 590.' 
172 



ON FRACTURES, xxxi. 

cannot be settled into their proper place, the follow- 
ing is the method of reduction. One must have 
iron rods made in fashion like the levers used by 
stone masons, broader at one end and narrower at 
the other. 1 There should be three and even more 
that one may use those most suitable. Then one 
should use these, while extension is going on, to 
make leverage, pressing the under side of the iron 
on the lower bone, and the upper side against the 
upper bone, in a word just as if one would lever 
up violently a stone or log. The irons should be 
as strong as possible so as not to bend. This is 
a great help, if the irons are suitable and the lever- 
age used properly; for of all the apparatus contrived 
by men these three are the most powerful in action 
— the wheel and axle, the lever and the wedge. 
Without some one, indeed, or all of these, men 
accomplish no work requiring great force. This 
lever method, then, is not to be despised, for the 
bones will be reduced thus or not at all. If, per- 
chance, the upper bone over-riding the other affords 
no suitable hold for the lever, but being pointed, 
slips past, 2 one should cut a notch in the bone to 
form a secure lodgment for the lever. The lever- 
age and extension should be done on the first or 
second day, but not on the third, and least of all on 
the fourth and fifth. For to cause disturbance 
without reduction on these days would set up inflam- 

1 "One rather broader— another narrower," Adams. 
* "Presents a point, which makes the lever slip," Pq.; 
" the protruding part is sharp," Adams. 



2 OUTTtp. * apftSlTOVCt . . . XP^CfTOf. 

* KaTonipca. 6 aviurtpw. 

8 ri. 7 7r<{/)o£uv irapaipipy. wdpo^v ibv Littre. 



l 7i 



IIEPI AmflN 

Troit'jcreie, real ep,/3dXXovri ov8ev r/crcrov a-rraapbov 
fiivTOL ifi/SciWoPTi, 7ro\v dv p,dXXov TTOirjcreiev r) 
drroprjcravTi epiftdXXeiv. ravra ev xph el8evar 
Kal yap el emyevotro G7raap,6<; ififitSfolkwri, 

80 e'X.7rtSe9 p>ev ov TroXXal awrr)pir)<^' XvatreXel 8e 
ottlctco £ic(3dWeiv to ocrreov, el olov re eh] 
ao^Xo)?. ov yap eirl rolcri ^aXapwrepoio'i tov 
Kaipov aird&fiol Kal reravoi eiriyLvovrai, dXXa 
eirl Toiaiv tt'Terapuivoiai p,ciXXov. irepl ov ovv 
6 X0709, ov XPV £vo)(\elv ev rfjai irpoetprjpievrjaiv 
r)p,epr)cn Tavrrjai, dXXa pbeXerdv ottco^ r\Kicna 
<pXeyp,avel to eA,«o? Kal p,dXiara eKirvijcrei. 
enrjv 8e eirra r'jpLepat rrapeXOcoaLv r) oXiyw 
irXelov;, r)v dirvperos rj, Kal fir) <pXeyp.atvr} rb 

90 eX,«o<?, tot6 r)<jaov KcoXvet, Treip^aOai ip,fidXXeiv, 
r)v eXirl^r/'i Kparijcreiv, r)v 8e pur), ouSev 8ec pudrrjv 

92 o^Xelv Kal 6y\eZcr6ai. 

XXXII. *Hv p.ev ovv epb^dXXr}<; rd bcrrea e? tyjv 
ecovrcov yotpr]v, yeypdcperai ySrj oi rpbiroi ouw? i 
%pr) Irjrpeveiv, rjv re eXTTifygs oarea aitotrTTi&'Gfr&di 
r\v re p.)'). xprj 8e, Kal rjv p,ev eX-Tri^r}? oarea 
dirocmjaeaOai, [a><> e(prjv,"\ 2 tw rpo-nw twv oOovuov 
€7tI Trdcn rolai Tovroicri rr)v eirihecriv rroielcrOai 
eK p,eaov tov oOov'iov dpyop^evov, &>? eirl to 
ttoXv, 005 dirb 8vo ap^cov v7ro8ecrpA<z eTri8elrai' 
TeKpuaipeaOai he XPh "npos tt\v p,op(fii)v tov eXKeo<i, 

10 07ra)9 r)KiGTa aecrrjpbs Kal eKTreirXiypbivov earai 
irapa tt)V eiriheaiv rolcn piev yap Irrl 8e£id 
eTuSelv crvvTp6(f)0)<i 3 e%et, rolat 8e eV dpiorepd, 

13 Tolcri 8e dtrb 8vo up^eav. 



174 



ON FRACTURES, xxxi.-xxxii. 

mation, and no less so if there was reduction ; spasm, 
indeed, would much more likely be caused if 
reduction succeeded than if it failed. It is well to 
know this, for if spasm supervenes after reduction 
there is not much hope of recovery. It is advan- 
tageous to reproduce the displacement, if it can be 
done without disturbance, for it is not when parts 
are more relaxed than usual that spasms and tetanus 
supervene, but when they are more on the stretch. 
As regards our subject, then, one should not disturb 
the parts on the days above mentioned, but study how 
best to oppose inflammation in the wound and favour 
suppuration. At the end of seven days, or rather 
more, if the patient is free from fever and the wound 
not inflamed, there is less objection to an attempt at 
reduction, if you expect to succeed ; otherwise you 
should not give the patient and yourself useless 
trouble. 

XXX T I. The proper modes of treatment after you 
reduce the bones to their place have already been 
described, both when you expect bones to come away 
and when you do not. Even when you expect bones 
to come away you should use in all such cases the 
method of separate bandages, as I said, beginning 
generally with the middle of the bandage as when 
an under-bandage is applied from two heads. Regu- 
late the process with a view to the shape of the wound 
that it may be as little as possible drawn aside or 
everted by the bandaging : for in some cases it is 
appropriate to bandage to the right, in others to 
the left, in others from two heads. 



2 Omit Littr<5, Erm. 

8 <TvvTp6<pa>s = auctions (Galen). Cf. XXIX. 



175 



IIEPI ArM^N 

XXXIII. 'Orroaa he KarrjiroprjOri oarea epnre- 
aeiv, ravra [aura] l elhevai XPV 0Tl diroarr)aerai, 
/cat 6a a reXecos e\JnX(oOr] rwv aapicwv. ypiXovrai 
he eviwv fiev ro avo) p,epo<i, pere^erepwv he 
KVfcXcoOei' dpcpiOvija/covaiv 2 ai adp/ces' icai rcov 
pev Li-no tou apya'hov rpoop,aro<; aeadirpiarai 
evict twi' oarewv, rcov he ov' teal ro>v p,ev pdXXov, 
rwv he ijaaov icai rd p,ev apuvpd, rd he pieydXa. 
Sid ovv ravra rd elprjpeva ov/c eariv evi ovopari 

10 elirelv, orrore rd oarea diroarr]aerai' ra pev 
yap hid apiKporyra, rd he. hid rb eir dtcpov 
e^eadai, ddaaov d<j)iararai' rd he, hid ro prj 
d(piaraa0ai, aXXa XerrthovaOai, iearafy]pav6evra 
teal aairpd yevdpeva' 7rpo? he rovrois, hiacpepei 
ri real ir/rpeii] irjrpeir}^. &>9 pev ovv to ermrav 
rd^tara rovrcov oarea dcpiararai wv rdyiara 
p,ev al eKTTvr'iaies, rdyjLarai he icai KaXXiarai ai 
aapKO(pvtai, teal yap al virocfrvopevai adp/ces 
Kara ro aivapbv avrai perecopi^ovai ra oarea 

20 ft>? errl to ttoXv. 6'X.o? pr)v 6 kvkXos rod oareov, 
rjv iv reaaapdieovra fjpepyaiv diroarfj, KaXws 
diroart]aerai' evia yap e<? e^rjKOvra rjpepas 
d(piKi'€irai [rj teal TrXetov?]* 3 rd p.ev yap dpaibrepa 
rS)V oarecov ddaaov dcpiararac, rd he arepeoo- 
repa, fipahvrepov rd he aXXa ra p,eiu>, ttoXXov 
evhorep(i), aXXa h* aXXo)<i. aTroirpieiv 6° oareov 
e%ex ov ^ 7rt Twvhe ra)V rrpo(paaiu>v XPV' V v M 
hvvi/rai epSdXXeiv, piiepov he rii'os aiirw hofefj 
helv irapeXOelv, koX oiov re rj irapatped^var i]v 

30 Te darjpbv f) /cat dpavov ri ro>v aap/etcov, icai 
hvadeairjv 7rapexy, tyiXov re rvyxdvrj eov, koX 

1 Omit B, Pq. 
I 7 6 



ON FRACTURES, xxxm. 

XXXIII. As to bones which cannot be reduced, 
it should be known that just these will come away, 
as also will those which are completely denuded. In 
some cases the upper part of the bones are denuded, 
in others the soft parts surrounding them perish, and 
the starting point of the necrosis is, in some of the 
bones, the old wound, in others not. It is more 
extensive in some and less so in others, and some 
bones are small, others large. It follows from the 
above that one cannot make a single statement as to 
when the bones will come away, for some separate 
sooner owing to their small size, others because they 
come at the end (of the fracture) while others do not 
come away (as wholes) but are exfoliated after 
desiccation and corruption. Besides this, the treat- 
ment makes a difference. As a general rule, bones 
are most quickly eliminated in cases where suppura- 
tion is quickest, and the growth of new flesh most 
rapid and good ; for it is the growth of new flesh 
in the lesion that as a rule lifts up the fragments. 
As to a whole circle of bone, if it comes away in 
forty days it will be a good separation, for some 
cases go on to sixty days or even more. The more 
porous bones come away more quickly, the more solid 
more slowly ; for the rest, the smaller ones take 
much less time, and so variously. The following 
are the indications for resection of a protruding 
bone : if it cannot be reduced, but only some 
small portion seems to come in the way, and it is 
possible to remove it ; if it is harmful, crushing 
some of the tissues, and causing wrong position 
of the part, and if it is denuded, this also should 

8 TTtpidvTJiTKouai. 8 Rw. Omits. 

177 



IIEPI ATMflN 

to toiovtov 1 d<paipeiv XPV' Ta &£ aXka ovBh> 
/xeya Btacfrepei, ovre ai: ott pia at ovTe fir) airo- 
irplaai. aa<$)e(o<s yap elBevai ypij on oaTea, oaa 
Te\eo)9 (XTepeerai twv aapicwv /cal eiri^qpaiveTat, 
on irdvra TeXew? dtroaTrjaeTai. oaa Be airo- 
\e"KiBovadai /xeXkei, raina ov ^PV diroTrpLeiv 
t e/c p,ai pea Bai Be XPV " 7r0 ' T ^ )V TeTayp,evcov 
39 ai]/xel(ov ra Te\e<w9 diroaTrjaopieva. 

XXXIV. 'Ir?T peveiv Be tol»<? toiovtov; airXT]- 
veai teal ttj olvripfj i)]Tpetrj, wairep /cal irpoaOev 
yeypa-nTai eVi tcov a.7roaTrjaop,evcov oaTewv. 
<pv\daaea6ai Be yprj ph "frvxpoiai 2 Teyyeiv top 
irputTov ypovov piyewv yap irvpeTcoBcov /clvBvvos' 
/civBvvos Be /cal airaap-cov irpo/caXetTat yap 
airaap-ov to, tyvypd, ttotI Be /cal eX/cr], elBevai 
Be XPV OTt dvdy/cr) fipayvTepa Ta au>/u.aTa TavTrj 
ylveaOai, wv dp,^>oTepa to, baTea /caTer\yoTa /cal 

10 77 aprjWay fieva lr]Tpew]Tai, ical olf oXos 6 /cv/cXos 

11 tov oaTeov direaTT). 

XXXV. "Oaoiai 3 Be fir/pov oaTeov rj ftpayjio- 
vo<; e^eayev, ovtoi ov p.d\a irepiyivovTai. to, 
yap oaTea p.eyd\a icai iro\vfive\a, /cat iroWa 
/cal eiriKaipa to, avvTiTpcoaKo^eva vevpa 4 /cal 
/Aves /cal $\e/3e?* /cal r)v /xev epuftdWr)?, avaa/xol 
(f)i\eovai eiriy'iveadai, pJr) ifi^Xrjdetai Be ttvpctoI 
o£ee<> /cal eTriyoXot /cal XvyycoBees, /cal eTTtp,e\aivov- 
Tar irepiylvovTai Be ovy rjaaov, olai pLrj ep,/3\T}0y, 
p,rj TreiprfOfi 5 ep,/3d\\ea0ar cti Be p,d\\ov irepi- 

10 yivovTai, olai to «<xto> /ie/?o? tov oaTeov e^eayev, 

1 roiovro. 

2 Ka.Tcupvxpo'icn (B M V). Kw. adopts Ermerins's sugges- 
tion icdpra. 

178 



ON FRACTURES, xxxm.-xxxv. 

be removed. In other cases it makes no great 
difference whether there is resection or not. For 
one should bear clearly in mind that when bones 
are entirely deprived of soft parts and dried up they 
will all come away completely : and one should not 
resect those bones which are going to be exfoliated. 
Draw your conclusion as to bones which will come 
away completely from the symptoms set forth. 

XXXTV. Treat such cases with compresses and 
vinous applications as described above in the case of 
bones about to be eliminated. Take care not to 
moisten with cold fluids at first, for there is risk of 
feverish rigors and further risk of spasms, for cold 
substances provoke spasms and sometimes 1 ulcera- 
tions. Bear in mind that there must be shortening of 
the parts in cases where, when both bones are 
broken, they are treated while over-lapping, also in 
cases where the circle of bone is eliminated entire. 

XXXV. Cases where the bone of the thigh or 
upper arm protrudes rarely recover ; for the bones 
are large and contain much marrow, while the cords, 
muscles and blood vessels which share in the injury 
are numerous and important. Besides, if you reduce 
the fracture, convulsions are liable to supervene, 
while in cases not reduced there are acute bilious 
fevers with hiccough and mortification. Cases 
where reduction has not been made or even attempted 
are no less likely to recover, and recovery is more 
frequent when the lower than when the upper part 

1 This seems the place where ttot! means irore as Galen 
says in his Lexicon, hut ttotI ko.1 is an expression peculiar to 
these treatises and means " especially." See Diels, op. cit. 

3 "Oouiv. * Ka\ veiipa. 

179 



IIEPI ATMQN 

rj olcri to ava>' TrepiytvoiVTO B av /cal olaiv 
ififiXrjQetT), enravico*; ye p,ijv. /xeXerai yap pLeXe- 
Tecov fiiya Bia&epovai, /cal <pvaie<; cpvaLcov tcov 
aco/xdrcov e? eu(popLTjv. 8ia(pepei Be p-eya, /cal 
rjv eao) rod /Spa^tovo? ical tov pLrjpov ra oarea 
£i;eXV' ^oXXal yap /cal eiriicaipoL /carardaie^ 
cpXefiwv ev ra> kaco fxepei, o>v eviai TirpcoarcopLevai 
acpdyiaL elaiv elo~i Be fcal ev ru> e£oo p,epei, 
r)aaov Be. ev rolcriv ovv roiovroiai rpco/uaat 

20 row? /xev kivBvvovs ov XPV ^V^ eiv ottolol rives 
elai, teal TrpoXeyeiv XPV ^pos toi)<? Kaipovs. el 
Be dvay/cd^oio pev eixfidXXeiv, eXiri^oi^ Be 
epbjSdXXeiv, /cal per) iroWij r) rrapaXXa^is eh] rod 
oareov, /cal pur) avvBeBpapLr^tcoiev oi pities — 
cptXeovai yap avvOelv — r) /io^Xeucn? /cal rovroiai 

26 p,erd rr}<; /carardaios ev av avXXapbffdvoiro. 

XXXVI. 'EpL/3dXXovra Be, iXXefiopov p,a\6a- 
/cov TrnrLaai XPV avdi)pLepov, rjv avP-rjpLepov 
epL/3\7]0fj, el Be p,7], ovB eyxeipeiv XPV' to Be 
eA.«09 Irjrpeveiv XPV' °* <Tt 7re P fcecpaXr)^ oarea 
Karer/yvl^s /cal ip-vxpbv p,rjBev rrpoacpepeiv, 
aiTLcov Be arepfjaai reXeu><i' /cal rjv puev TriKpox°- 
Xo? cpvaei rj, o^vyXv/cv evcoBes oXiyov i<p' vBcop 
ernard^ovra rovrw Biairdv rjv 67 p-r) 7ritcp6xoXos 
rj, vBart iropari XPV a @ ar lcai ' V v P ev TTvperaLvrj 

10 avvex&s, reaaapa/caiBe/ca r)p.eprjai x to eXax^rov 
ovto) Btairov, rjv Be drrvpero^ rj, errra rjpLeprjaiv 
etreira ere Trpoaaycoyr/s Kara Xoyov e<? (pavXr/v 
Biairav dyecv. /cal olaiv p,t] 2 ep.j3Xr/dfj ra oarea, 
/cal rrjv (pap/xa/ceLr/v XPV Toiavrrjv iroieiadai, /cai 

1 i)jxtpas bis. 2 hv fxi). 

180 



ON FRACTURES, xxxv.-xxxvi. 

of the bone projects. There may be survival even in 
cases where reduction is made, but it is rare indeed. 
There are great differences between one way of 
dealing with the case and another, and between one 
bodily constitution and another as to power of 
endurance. It also makes a great difference whether 
the bone protrudes on the inner or outer side of the 
arm or thigh, for many important blood vessels stretch 
along the inner side, and lesions of some of them are 
fatal ; there are also some on the outside, but fewer. 
In such injuries, then, one must not overlook the 
dangers or the nature of some of them, but foretell 
them as suits the occasion. If you have to attempt 
reduction and expect to succeed and there is no 
great overriding of the bone, and the muscles are not 
retracted (for they are wont to retract) leverage com- 
bined with extension would be well employed even 
in these cases. 

XXXVI. After reduction one should give a mild 
dose of hellebore on the first day, if it is reduced on 
the first day, otherwise one should not even attempt 
it. The wound should be treated with the remedies 
used for the bones of a broken head. Apply nothing 
cold and prescribe entire abstinence from solid food. 
If he is of a bilious nature give him a little aromatic 
hydromel 1 sprinkled in water, but if not, use water as 
beverage. And if he is continuously febrile keep him 
on this regimen for fourteen days at least, but if 
there is no fever, for seven days, then return by a 
regular gradation to ordinary diet. In cases where 
the bones are not reduced, a similar purgation should 
be made and so with the management of the wounds 

1 Decoction of honeycomb in water — air6fif\i in X I ; cf. 
Galen on its preparation. 

181 



IIEPI ATMQN 

tcov eXKecov ttjv /xeXeTrjv /ecu ttjv BLaiTav ooaavToo^ 
Kal to diraicopevfievov x rod crdofxaro^; firj Kara- 
Teiveiv, dXXa Kal irpoadyeiv fiaWov, oocrTe 
^aXapcorepov eivat to Kara to eX./co?. tcov Be 
oarecov aTroo-Taais 2 ^povtr], wcrirep /cal irpocrdev 

20 eiprjrai. fidXio-ra Be ^prj ra roiavra Btacpvyetv, 
cifia r]V rt? KaXr/v e'^77 ttjv diro^>vyi]v. at tc 
yap e\7TL$€<; oXiyai, real 01 klvBvvoi 7roXXoi' Kal 
fjbrj i/jL/3dXXcov arexyos civ Bok4oi elvat,, teal 
ejxfBdWajv eyyvTepoo av tov davdrov dydyoi rj 

25 o~u>Tr)plrj<i. 

XXXVII. To. Be 6\iadi')p.aTa ra Kara, to 
yovvara /cal ra BiaKivrj^ara twv oarewv evrj- 
decrTepa iroXv tcov /car dy/ewva Kivrj/maTcov /cal 
oXiadrj/jLaroyv to tc yap dpOpov tov firjpov 
evaTaXecrrepov &>? eirl /xeyeOet rj rb tov fipa- 
Xiovos, Kal Bt/cairjv (pvcriv fiovvov eyov, /cal Tavrrjv 
irepicpepea' to Be tov fipa~)(iiovo<; dpOpov p,eya re 
Kal /3adfiiBa<i TrXelovas hx ov - 77700? Be tovtois, 
to, puev tt}? Kvr)p,y) , $ oarea 7rapa7rXr)o-ia fj,rJKo<; 

10 ecrTL Kal afiiKpov re ovk a^iov \6yov to ejjco 
oareov virepe^i, ovBevbs pieydXov KOiXv/xa eov, 
d(£' ov TrefyvKev e^co Tevcov irapa tijv lyvvt]v 
ra Be tov Tr^eo? ocrTea dviad eaTiv, Kal to 
^pa\vrepov irayyTepov av^va), to Be XeiTTOTe- 
pov ttoXXov virepfidXXet Kal hirepe^ 1 to dpOpov 
e£i]pTr)Tai fievToi Kal tovtcov 3 tcov vevpcov Kara 
Ti}v Kotvrjv avfM(f>vaiv tcov oaTe'cov irXelov Be 
fiepo<; e^et Tr}? e^apTrjcnos tcov vevpcov ev tw 
{SpayLovi to Xctttov oareov rjirep to Trayy. r) 

20 p.ev ovv <j)vcri<; TOiovTOTpoiros tcov dpOpcov tovtcov 



T82 



8 TQV70. 



ON FRACTURES, xxxvi.-xxxvii. 

and the regimen. Likewise do not stretch the 
unreduced part, 1 but even bring it more together 
so that the seat of the wound may be more relaxed. 
Elimination of the bones takes time, as was said 
before. One should especially avoid such cases if 
one has a respectable excuse, for the favourable 
chances are few, and the risks many. Besides, if a 
man does not reduce the fracture, he will be thought 
unskilful, while if he does reduce it he will bring the 
patient nearer to death than to recovery. 

XXXVII. Dislocations at the knee and distur- 
bances of the bones are much milder than displace- 
ments and dislocations at the elbow ; for the 
articular end of the thigh-bone is more compact in 
relation to its size than is that of the arm-bone, 
and it alone has a regular conformation, a rounded 
one, whereas the articular end of the humerus is 
extensive, having several cavities. Besides this the 
leg-bones are about the same size, the outer one 
overtops the other to some little extent not worth 
mention, 2 and opposes no hindrance to any large 
movement though the external tendon of the ham 
arises from it. But the bones of the forearm are 
unequal, and the shorter (radius) much the thicker, 
while the more slender one (ulna) goes far beyond and 
overtops the joint. This, however, is attached to the 
ligaments at the common junction of the hones. 3 The 
slender bone has a larger share than the thicker one 
of the attachments of ligaments in the arm. Such 
then is the disposition of these articulations and of 

1 Kw.'s reading is the most suitable. 

■ A curious error, perliups due to an effort to make the 
fibula resemble the ulna as far as possible. (The fibula does 
not reach the top of the tibia ) 

s The ulna is attached to the ligaments of the elbow joint, 
at the point where it joins the radius. Galen. 

I8 3 



IIEPI ATMQN 

Kai Twv oarrecov tov ay/ccovos. Kai 8id tov 
rpoirov tj}? tfcuaios ra Kara to yovu oared 
iroXXa/cts fxtv oXiaOdvei, prjiBico? 8e ifnriTnei' 
(pXeyfjiovt) 8e ou p,eydXrj irpoaylveTai, ou8e 8eapb<; 
rov dpOpov. oXiaOdvei- 8e ra irXelara e? to earn 
p,epo<;, ecrri o ore e? to e^co, irore be kcu e? rrjv 
lyvvrjv. tovtcov diravToav al ep,8oXal ou 'xaXeirai' 
dXXa to, p,ev e^co teal haw oXiaddvovra, /caOr/aOai 

fiev *%ph T0V dvOpwTrov X a / Lia1 ' V e7r * X a l JLa, '& ( l^' 0V 

30 twos, to 8e aiceXos dvcorepco e-^eiv, pr] p.ev ttoXXw. 

KCLTaTaais 8e co? e7rl to 7roXu perpur] dp/cei, rf) 

pev Kararelveiv tyjv Kvi']p,yjv, rfj 8e dvTirelveiv tov 

33 p.rjpov. 1 

XXXVIII. Td 8e Kara top dyKwva 6)(Xw8e- 
o~Tepa iaTi twv Kara to yovv, Kai 8uaepf3oXw- 
Tepa /cat 8id ttjv <$>Xey pov-t-jv Kai 8id ttjv (puaiv, 
rjv p.7) Ti? avTi/ca ip,(3dXri' oXiaOdvei p,hv rjaaov 2 
i] eicelva, 8vaep/3oXcoTepa 8e teal 8ua0eTwrepa, 

6 Kai ernfyXey puaivei pdXXov /cal eTrnrwpovTai. 3 

XXXIX. ' EoTt 8e /cal tovtwv wXeiaTa* 
apii/cpai iy/c\iai€<>, aXXore e? to 7rpo? tojv ttXcv- 
pecov p.epo$, aXXore e? to h£w, ou irdv 8e to dpOpovp 
pLeTa/3e/37]rc6<;, aXXa pievov 5 to /card to koIXov 

1 End of Galen's Commentary as extant ; but later frag- 
ments are preserved in Orib. XLVI.6, XLVII.5, etc. 

2 ria-ffov opposed to iroWdxts above: but not true. Some 
therefore take it to mean " to a less extent." 

(TWTOpOVTCU. 4 TO fX€f 1T\il<TTa. 

6 /x6vov B, ixivovri rb M, fievov ti V, ijlovvov Kw. The 
reading is important for the writer's account of elbow 
dislocations. If ixevov, the chapter must refer to dislocation 
of the radius only and "inwards" would imply that the 
writer looked at the arm and hand as hanging back to front 
with the bend of the elbow turned inwards, the reverse of 
our position. Petrequfn first noticed this, and showed that 
184 



ON FRACTURES, xxxvn.-xxxix. 

the bones of the elbow. Owing to the way they 
are disposed the bones at the knee are often 
dislocated * but easily put in, and no great inflamma- 
tion or fixation of the joint supervenes. Most 
dislocations are inwards, 2 but some outwards and 
some into the knee flexure. Reduction is not 
difficult in any of these cases : as to external and 
internal dislocations, the patient should be seated on 
the ground or something low, and have the leg 
raised, though not greatly. Moderate extension as a 
rule suffices ; make extension on the leg and counter- 
extension on the thigh. 

XXXVIII. Dislocations at the elbow are more 
troublesome than those at the knee, and harder to 
put in, both because of the inflammation and because 
of the conformation of the bones, unless one puts 
them in at once. It is true that they are more 
rarely 3 dislocated than the above, but they are 
harder to put up, and inflammation and excessive 
formation of callus 4 is more apt to supervene. 

XXXIX. (Dislocation of radius.) The majority of 
these are small displacements sometimes inwards, 
towards the side and ribs, sometimes outwards (our 
''forwards" and "backwards"). The joint is not 
dislocated as a whole, but maintaining the con- 

1 A strange remark, perhaps includes displacement of the 
kneecap. Displacements of cartilages are not noticed. 
1 Of the thigh bone. 

3 Pq. says he treated ten times more elbow than knee 
dislocations. 

4 Cf. Celsus VIII. 16, "callus circumdatur." 

it explains much, /x&vov or fio^vov would impl}' a dislocation 
of the ulna only, and add another difficulty. It seems clear 
that the epitomist (M VII, J XVII) read fihov ; but these 
chapters have puzzled the scribes as well as the surgeons. 

I8 5 



IIEPI ArMON 

rov ocrreov tov j3pcf)(Lovo<i, rj to tov ^^eo? 
oariov to vnep£')(ov e^et. 1 tcl p.ev ovv roiavra, 
kclv tt) r) Trj 6Xto~9rj, prjiBiov efifidXXetv, nai 
aTro^prj r) KaTaracns r) e? to Wv ytvofxevrj kclt 
Wucopiijv tov /3pa)(iovo<~, tov p.ev kcltcx tov Kaptrbv 

10 Trjs yetpos Teivetv, rov Be kclto. ttjv p,ao-%d\r)v 
-repiftdXXovTa, tov Be ttj eTeprj 7roo<? to e^ecrTCo? 
apOpov to Oevap -rpoo~/3dX\ovTa co9eiv, tj/ Be 

13 eTeprj dvTcoOelv -rpoa/3d\'\ovTa 2 i<yyv~j tco apdpco. 
XL. 'SLvcucovei Be ov fipaBecos epb^aXXo/xeva 
tcl ToiavTa oXiaO li/AdTa, r)v mplv (pXeyp.rjvr) 
efifidXXrj Ti?. oXitrO civet Be co? eVi to ttoXv 
fiaXXov e'<? to eaco /xeoo?, oXicrOdvet Be icai e? 
to e£&>, evBrfka Be tco a^rj/xaTt. tcai iroXXaKt^ 

ep,-TL7TTet TCI TOlCtVTCZ, KCtl aV€V lo")(ypr)<i KOLTOL- 

rdato^' xpr/ Be tcov ecrco oXiaOavovToyv, to pev 
apOpov d-rwdelv e? Ttjv cpvcriv, tov Be -rfj-^vv e? to 
KaTa-rprjve<i pcaXXov peirovTa 3 -reptdyetv. tcl fiev 
10 irXelcna dy/cwvos ToiavTa 6Xia9i]p,aTa. 

XLI. *Hi/ Be v-repfifi to apOpov r) ev9a r) ev9a 
virep to ocrTeov tov 7t?/^609 to it^eyov e<? T0 
koIXov tov (3pa\lovo<i — ytveTdt fiev ovv oXtyditi*; 
tovto, i)v Be yii'r/Tai — ov/c cti o/aoku? r) kclto.- 
racri<; r) e'9 ttjv Wvcopirjv yivofievrj e-TtTr/Betrj tcov 
toiovtcov 6\ta9rjp,dTO)V' KcoXvet yap iv tt) ToiavTy 
KaraTaaet to citto tov -rrj-^eo^ v-repeyov otneov 
ttjv virepftacTiv tov jBpa-)(iovo<i. XPV tolvvv toictiv 

1 ttfo-xev B, Kw. f etc. * -rphs tov vtix-q- B, Kw. insert. 

8 Pq. omita. 
186 



ON FRACTURES, xxxix.-xli. 

nexion with the cavity of the humerus, where the 
projecting part of the ulna sticks out. Such cases, 
then, whether dislocation is to one side or the other, 
are easv to reduce, and direct extension in the line 
of the upper arm is quite enough, one person mav 
make traction on the wrist, another does so by 
clasping the arm at the axilla, while a third presses 
with the palm of one hand on the projecting part 
and with the other makes counter-pressure near the 
joint. 

XL. Such dislocations yield readily to reduction 
if one reduces them before they are inflamed ; the 
dislocation is usually rather inwards (forwards), but 
mav also be outwards, and is easily recognised bv 
the shape. And they are often reduced even with- 
out vigorous extension. In the case of internal 
dislocations one should push the joint back into its 
natural place, and turn the forearm rather towards 
the prone position. Most dislocations of the elbow 
are of this kind. 1 

XLI. (Complete dislocation of the elbow back- 
wards and forwards). If the articular end of the 
humerus passes either this way or that 2 over the 
part of the ulna which projects into its cavity (the 
latter 3 indeed occurs rarely, if it does occur), ex- 
tension in the line of the limb is no longer equally 
suitable, for the projecting part of the ulna prevents 
the passage of the humerus. In patients with these 

1 Adams agrees that XXXIX is " dislocation of the radius," 
but has to call XL " incomplete lateral dislocation of the fore- 
arm " since the radius alone cannot be dislocated '" inwards." 
The nature of these lesions is discussed on p. 411 ff. 

1 "to either side/' Adams. 

3 Refers to "backwards," which can hardly occur without 
fracture. 

13? 



IIEPI ArMQN 

ovrtos €K/36{3\r)fc6<rt rrjv Kardraaiv rroielaOai 

10 roiavrrjv, oh] irep Trpoadev yeyparrrai, irrr]v tj<? 
oared f3pa%Lovo<; Karerjyora eTrtSerj, airb pev rfjs 
paa^dXr]<; e? to ava> relveaOai, drrb he rod 
djK(bi'0<i avrov if to Kara) dvay/cd^etv ovrio yap 
av pdXiara o ^pa\taiv VTrepaicoptjdeir} vrrep rrjs 
ecovrov ftadpiho<;, fjv he virepaiwpi)Or], pyfihir] f] 
Kardaraaif, roiai Bevapai roiv \etpcov rb pev 
i^earebf 1 rov ^pa^iovof ip/3dXXovra a>9elv, rb 
he if rb rov rnfyeo? oareov rb rrapa rb dpQpov 
ep/3aXXovra avru>0elv, rbv avrbv rpbrrov dpcpco' 

20 f\oo~ov pevroi 2 fj roiavrij Kardracrif rov roiovrov 
oXicrdijparos hi/caiordrr)' ip/3Xr)0eir) h' av ical 

22 arro rr/f e<? Wv Karardaiof, rjaaov he fj ovrco. 

XLII. 'Hi; he is rovpirpoaOev bXiaOr) 6 fipa- 
%ia>v, i\a/)£io-rdtci<} pev rovro yiverai, dXXa rl av 
i^arrivri<i 3 i/aTaXr/ais ov/c i/.i/3dXXoi ; rroXXd 
yap /cal rrapa rrjv ol/ceLrjv* (jbvcriv ifCTriTrrei, koX 
v)v peya ri rj ro kcoXvov ravrrj he rfj ifCTraXijcrei 
peya ri rb vrrepfiaivopevov rb virep rb rra^yrepov 
rwv harrewv, koX r&v vevpwv avyyr) Kardraaif 
opcos he hi] ricriv i^eirdX^aev. aripeiov he rolaiv 
ovrwf itCTraXr]<jao~iv ovhev yap ^prjpa rov 

10 dynaivos Kap-yjrai hvvavrai, evhiiXov 5 he /cal 
rb dpOpov yjravopei'ov. fjv pev ovv pi) avrl/ca 
ipf3Xr)0f), to-^vpal koX (Blaiai (bXeypoval koX 
rrvperdyhees yivovrar fjv he hi) ahr'uca ris 
rraparvyr] evepftoXov, [XPV &* bQbviov o-/cXi)p6v] 6 

1 es rh il(<TT(6s. 

2 K\v, a/j.<pco, i\aaov fxhroi . . . He supposes a hiatus. 

3 i^t'Trivair]. 4 eoiKvlav. 

6 IvS-qhov. 6 Kw. omits. 

r88 



ON FRACTURES, xli.-xlii. 

dislocations, extension should be made after the 
manner which has been described above for putting 
up a fractured humerus. Make traction upwards 
from the armpit, and apply pressure downwards at 
the elbow itself, for this is the most likely way to 
get the humerus lifted above its own socket, and 
if it is so raised, replacement by the palms of hands 
is easy, using pressure with one hand to put in the 
projecting part of the humerus, and making counter- 
pressure on the ulna at the joint to put it back. 
The same method suits both cases. This has, in- 
deed, less claim to be called the most regular method 
of extension in such a dislocation and reduction 
would also be made by direct extension, but less 
easily. 1 

XLII. (Internal lateral distortion of the forearm, 
Petrequiris View). Suppose the humerus to be dis- 
located forwards. This happens very rarely ; but 
what might not be dislocated by a sudden violent 
jerk ? For many other bones are displaced from 
their natural position, 2 though the opposing obstacle 
may be great. Now, there is a great obstacle to 
this jerking out, namely the passage over the 
thicker bone (radius) and the extensive stretching 
of the ligaments, but nevertheless it is jerked out 
in some cases. Symptoms in cases of such jerk- 
ings out. They cannot bend the elbow at all, and 
palpation of the joint makes it clear. If, then, it 
is not reduced at once, violent and grave inflam- 
mation occurs with fever, but if one happens to be 
on the spot it is easily put in. One should take 

1 "Evidently meant as a description of complete lateral 
dislocation," Adams. 

2 Kw. " beyond what seems natural." 

189 



IIEPI ATMQN 

— oObviov yap aKkrjpbv el\iyp,evov dpicel, pur) peya 
— evdevTa TrXdyiov e'9 ttjv Kapbirr/v tov dy/ccovos, 
£%aTTLvri<; (TvyKa/xyjrai tov dyicosva Kal irpoa- 
ayayelv &>9 p.dXioTa rrjv X €L *P a 77/709 tov wpov. 
iKavr) pev aur>] rj ipfioXr] toIgiv ovtcos eKiraXrj- 
20 (facriv tnap Kal r) e'9 to 16 v /caTaracTis Svvarai 
evOeri^eiv tovtov tov Tpoirov Tr)<; ep/3oXi}<;' Total 
pievTot devapai tcov yeipwv XP } 1> T0V f 1 ^ €p,0d\- 

\0VTCL 69 TO TOV /3/)a^tOI>09 i^e^OV TO TTCLpa TT)V 

KapiTTrjv OTnaco aTTcoOelv, tov he Tiva KciTcodev e'9 
to tov dyic5)vo<i otjv ep,/3dXXovTa dvTwdelv e'9 Ti]V 
tdvcopi^v tov 7r?;^eo9 perrovTa. hvvaTai he ev 

TOVTCt) T(p TpOTTW Tt)s 6XlCrd )]& LO<i Ka/CelvT) 7] 

KaTaTao-i<i rj wpoadev iyyeypa.pL/j.evr}, 2 &>9 XPV 
KaTaTelveiv to, oaTea tov f3paxiovo<; KaTerjyoTa, 

30 iirrjv peXXcoaiv e7nheto~6ar eiryjv he KaTaTaOfj, 
ovTOi XPV Tolai devapat ra9 7rpoap3oXa<; ttoi- 

32 elcrdai, woirep koX irpoadev yeypairTai. 

XLIIL *Hv he e'9 to 07rto-ft) fipaXLCov eKirear) — 
dXiydfcis he tovto yiveTai, eircohwayTaTov Te tovto 
iravToav koX irvpeTwheaTaTOV, crwexewv irvpeTcov 
Kal d/cpr]TOx6\(i)v, Oavarcohecov /cal oXiyr/piepwv — 
oi ToiovTot eKTavveiv ov hvvavTUi. i)v he puev ovv 
avTL/ca 7rapaTi>xr]<;, /3ido~ao~0ai 3 XPV ifCTavv&avra 
tov dyKwva, Kal avTopaToxt epbirLTTTei. i)v he o~e 
<f)@dar) 7rvpeTaiv}'jo~a<i, ovk €ti XPV i/u./3dXXeiv' 
KaTatCTeiveie yap dv r) ohvvr) dvayKa^opevov. &>9 

10 8' ev Ke(pa\aia> elpr)o~6ai t ov$ dXXo XPV dpdpov 

11 TrvpeTaivovTi epfidXXeiv, rjKio~Ta he dy/ctova. 



1 t$ Toiovrcp. 2 Trp6cr6e ytypa/j.fi'vt). 

3 &td£eo-ecu. 



I90 



ON FRACTURES, xui.-xliii. 

a hard bandage (a hard rolled bandage of no great 
size is sufficient) and put it crosswise in the bend of 
the elbow, suddenly Hex the elbow, and bring the 
hand as close as possible to the shoulder. This 
mode of reduction is sufficient for such jerkings out. 
Direct extension, too, can accomplish this reduction. 
One must, however, use the palms, putting one on 
the projecting part of the humerus at the elbow 
and pushing backwards (our inwards), and with the 
other making counter-pressure below the point of 
the elbow, inclining the parts into the line of the 
ulna. 1 In this form of dislocation, the mode of 
extension described above as proper to be used in 
stretching the fractured humerus when it is going 
to be bandaged is also effective. And when exten- 
sion is made, application of the palms should be 
made as described above. 

XLIII. (External lateral dislocation of forearm). 2 
If the humerus is dislocated backwards (our "in- 
wards") — this occurs rarely, and is the most painful 
of all, most frequently causing continuous fever with 
vomiting of pure bile, and fatal in a few days — the 
patients cannot extend the arm. If you happen to 
be quickly on the spot, you ought to extend the 
elbow forcibly, and it goes in of its own accord. 
Hut if he is feverish when you arrive, do not reduce, 
for the pain of a violent operation would kill him. 
It is a general rule not to reduce any joint when 
the patient has fever, least of all the elbow. 

1 Adams. "Dislocation of ulna and radius backwards," 
II. 500, but II. 549, "It would seem to be dislocation of the 
forearm forwards." 

2 So Petrequin. It seems impossible that this should be 
dislocation of the forearm backwards, the commonest form, 
as Adams suggests. 

191 



IIEPI ATMQN 

XLIV. 'EcrTt Be real aXXa aivea kclt dy/co)va 
o^XcaBea- tovto pev ydp, to rva^vrepov bvreov 
ecTTiv ore ifcivr]@i] drrb rov erepov, /cal ovre 
avyKapwreiv ovre Kararavvetv 6poia)<; Bvvavrai. 
BtjXov Be yiverat \jravopevov Kara rrjv avy/capyfriv 
rov ay/c(bvo<; rrapd rr/v Biaa^lBa tP/? (£A.e/3o? rrjv 
ctvwSev rov pvb<} reivovaav olcri Be rb roiovrov, 
ovk en prjtBiov e? ri]V ecovrov <pvaiv dyayecv 
ovBe yap aXXrjv ovBepiijv prjtBiov avpfyvdBa 

10 KOivrjv Bvo oarecov Kivrjdeiaav e<? rrjv apyairp> 
(frvaiv IBpvvOrjvai, dXX* avayici) oynov lo"yeiv rijv 
Bidaraaiv. oj<? Be erriBelv %pr) ev dpQpw, ev rfj 

13 Kara acpvpov eiriBeaet etprjrai. 

XLV. "EerTi 6" olat Kardyvvrai 1 rov rrrj^eo<i 
to oareov ro viroreraypevov t&> fipayiovi, ore 
pev ro )(ovSp(bBe<; avrov acf> ov irecpvKev 6 revcov 
o oiriaOev rov ^pa^iovo<i <ore Be ra rrpoaco Kara 
rrjv dp-^rjv rrjs eKcpvatos rov rrpoaOiov icopwvov> z 
Kai, irrrjv tovto KivijOfj, 7rvp€rcoBe<; /cat «ra/eor/#e<? 
yiverar rb pevroi apOpov pevei ev rfj ewvrov 
■y^wpy iraaa yap 17 ftdo-is avrov ravrrj vireptyei. 3 
orav 4 Be airayf) ravrrj y vTrepe^et f) K6(paXrj rov 

10 fipa^iovos, TrXavcoBearepov rb apOpov yiverai, rjv 
rravrdrraaiv drroKavXtadfj. daivearepa Be, &)? ev 
KecpaXatco elpijaOai, irdvra ra /carayvvpeva rwv 
oarewv iarlv rj olcriv ra pev barea ov Kardyvvrai, 
(f)Xe/3e<; Be /cal vevpa eirLicaipa dpcfrtfiXarai ev 
rovroiai rolcri ywpioiaiv' eyyvrepco yap davdrw 

* aTra^i'UTat. 

2 Oiuit codd., vulg. ; restored by Littre from Galen in 
Orib. XLVI. 6. 

3 r f A * 

192 



ON FRACTURES, xliv.-xlv. 

XLIV. (Separation of radius). There are also other 
troublesome lesions of the elbow. Thus the thicker 
bone is sometimes separated from the other, and 
they can neither flex nor extend the joint as 
before. The lesion is made clear by palpation at 
the bend of the elbow about the bifurcation of 
the blood vessel 1 which passes upwards along the 
muscle. 2 In such cases it is not easy to bring the 
bone into its natural place, for no symphysis of two 
bones when displaced is permanently settled in its 
old position, but the diastasis (separation) necessarily 
remains as a swelling. How a joint ought to be 
bandaged was described in the case of the ankle. 

XLV. (Fractures of olecranon). There are cases 
in which the bone of the forearm (ulna) is fractured 
where it is subjacent to the humerus, sometimes the 
cartilaginous part from which the tendon at the 
back of the arm arises, sometimes the part in front 
at the origin of the anterior coronoid process, and 
when this occurs it is complicated with fever and 
dangerous, though the joint (articular end of hu- 
merus) remains in its place, for its entire base comes 
above this bone. 3 But when the fracture is in the 
place on which the articular head of the humerus 
rests, the joint becomes more mobile if it is a 
complete cabbage-stalk fracture (i.e. right across). 
Speaking generally, fractures are always less trouble- 
some than cases where no bones are broken, but 
there is extensive contusion of blood vessels and 
important cords in these parts. For the latter 

1 Cephalic vein. 2 Biceps. 

3 bir*pix«i, supersedet, "is above," the articular end of the 
humerus rests entirely on the olecranon, the arm being 
bent. "Protrudes at this point," Littre-Adaius. 

VOL. III. 



IIEPI ArMON 

TreXd^ei raura rj eKelva, r)v eicnvpuiOfi avve^el 
Trvpirq)' 6\iya ye firjv rd Toiavra KaTrjypara 
18 yiveTai. 

XLVI. "EcrTt Be 6Ve avrrj ff KecfaaXi) tov 

ftpaXLOVOS Kara ttjv eiricpvaiv KaTayvvTar 

tovto Be 86/ceov Ka/cocrivcoTarov elvai iroXXu) 

4 tivX x evr)Q ectTepov twv kcit ay/cwva aivecov earlv. 

XLVII. 'O? p.ev ovv k'/caara tmv oXiaOrjpdrcov 
dpp,ocrcrei 2 [ep/3dXXeiv /cat] 3 paXiara irjrpeveiv, 
yeypaiTTai, Kal oti 7rapa)(p>)pa ip/3dXXeiv pudX- 
icrTa dpdpov ovpKpepei Bid to tct^o? t% (fiXey- 
pLOV7]<i tcov vevpwv. real yap rjv eKirecrovTa dvriKa 
epLTriarj, 6p,co<; ^>iXel rd vevpa avmaaiv iroielaOat, 

Kal KQ)Xv€lV €7rl TTOCTOV ^poVOV T)')V T€ eKTaCTlV, 

oarjv irep (piXel* 7roi7]aaadai, 5 rrjv re crvyKap-^riv. 
IrjTpeveiv Be irdvra irapairXriaico^ rd TOiavTa 

10 o~vp(f>epei /cal oiroaa dirdyvvTai, teal oiroaa 
BuaTarai, teal oiroaa oXiaddvei- Trdvra yap XPV 
bdovloiai iroXXolai teal airX^veai ical terjpwrfj 
irjrpeveiv, coairep teal rdXXa /carrjypaTa. to Se 
o-yjnpa tov dyKtovos ev Tovroiai Brj teal -rravrd- 
iraai Xph toiovtov iroieladai, olov irep olai 
{Spayitov eireBeiTO /cctTayefe, teal Trr)X v ^' koivo- 
raTov piev yap irdai TOiaiv 6Xiadt]paai teal roiai 
Kivijpaai Kal TOiai KaTi')yp,aai tovto to a^r/pd 
eaTiv tcoivoraTOV Be 7T/90? ttjv eireiTa Bidaraaiv, 6 

20 Kal to etcTavveiv e/cao-Ta Kal avyKapnrTeiv 
evTevdev yap 6Bol e? apupoTepa irapairXijaioi' 
eboydiTaTov Kal evai'dXijirrov avTW tu> KapivovTi 
tovto to ayripO" %ti Be 7TyOO<? tovtoicti, el dpa 
KpaTrjdeh] vtto tov TrwpdopaTOs, el piev eKreTa- 

1 T<f. ? apfi6aei. 

194 



ON FRACTURES, xlv.-xlvii. 

lesions involve greater risk of death than do the 
former, if one is seized with continued fever. Still, 
fractures of this kind rarely occur. 

XLVI. Sometimes the actual head of the humerus 
is fractured at the epiphysis, but this, though ap- 
parently a very grave lesion, is much milder than 
injuries of the elbow joint. 

XLVII. How, then, each dislocation is most appro- 
priately [reduced and] treated has been described ; 
especially the value of immediate reduction owing to 
the rapid inflammation of the ligaments. For, even 
when parts that are put out are put in at once, the 
tendons are apt to become contracted and to hinder 
for a considerable time the natural amount of flexion 
and extension. All such lesions, whether avulsions, 
separations or dislocations, require similar treatment, 
for they should all be treated with a quantity of 
bandages, compresses and cerate, as with fractures. 
The position of the elbow should in these cases, too, 
be the same in all respects as in the bandaging of 
patients with fractured arm or forearm ; for this 
position is most generally used 1 for all the disloca- 
tions, displacements and fractures, and is also most 
useful as regards the future condition, in respect both 
of extension and flexion in the several cases, since 
from it the way is equally open in both directions. 
This attitude is also most easily kept up or returned 
to by the patient himself. And besides this, if 
ankylosis should prevail, an arm ankylosed in the 

1 koivotcltov almost = " most useful." 



3 Omit B, Kw. * TTt<pvK(. 

6 wottiodai. 6 SiaTacii' K. 



»95 



IIEP1 ArMftN 

jxevrj t) %et/> Kparrfdeirj, Kpeaawv av etrj fir) 
irpoaeovaa, 7roXX(p fiev yap KwXvfia ecrj, 6<peXeiq 
Be oXlyro, el S' av avyKeKa,a/u,evrj, fidXXov eu^pr/- 
<7T0? av eir), ttoXXS) Be ev^p^cTTorepr), el to Bid 
fieaov a^rffia eyovaa ircopcoQelr] [/cpeacTov]. 1 ra, 

30 fiev irepl tov cr^'/xaTO? roiciSe. 

XLVIII. KiriBelv Be -^prj ti]v re dpyr)V tov 
TrpdoTov odoviov /3aXXo/.ievov Kara, to /3Xa<f}6ev, 
r]v Te Karayfj, r]v T€ i/co-Tr), r]v re BiaaTrf, 
kcl\ ra? Trepif3o\d<i to<; 7rp;oTa<; kclto, tovto 
iroielcrOai, koi eprfpeiadro fidXiaTa TavTrj, evdev 
Be real evdev eirl r)o~crov. ttjv Be eTriBecriv Koivrjv 
iroieladai %pr) T0V Te ttvX €0 *> Kai T °v ftpa-%i>oyosi 
real eirl 7roXv irXeov exaTepov r) a>? ol nrXelcrTOi 
iroieovcriv, oVft)? e%apvr\Tai 2 &J9 fidXiaTa airo tov 

10 aiveo<; to oiBrf/ia evdev koX evdev. Trpocnrept- 
fSaXXecrdco Be ical to o%v tov 7rr;^eo?, r)v to 
vivos kclto, tovto tj, r)v Be fir], iva fiij to otSrifia 
evTavOa Trepl avTa 3 avXXey^Tai. 7repicf>evyeiv 
Be xph £ p T V iiriBeaei, oVw? firj kclto, Trjv Ka/nrr/v 
iroXXbv tov odoviov r)0poio-fievov eo~Tai ix tcov 
Bvvotwv TreiTie)(daL Be Kara to glvos a>? fidXiaTa. 
kcCi to, dXXa KaiaXafSeTw clvtov irepl t/)? TTie^io<; 
koX ttjs ■)£aXdo-io'$ toi/to, koX koto tovv avTov<; 
Xpovovs eKaaTa, (ocnrep tcov ocnecov tcov KaTerjyo- 

20 tcov ev Trj lr]Tpeirj irpoudev yey paiTTai' koX at (ist- 
eiuBecries Bid TpiTrjs earcoaav xaXdv Be BoKeiTco 
Trj Tp'iTr), cocrixep koX totc' kcu vdpdtfKas irpocr- 
TrepifidXXeiv ev Tip iKveofievcp xP^vco — ovBev yap 
airo Tpoirov, kcl\ tolctl to ocnea KaTer/yocri, kol 
tolctl fir], i)v fir) irvpeTalvrf — &>? ^aAapryTuTOi^ Be, 
1 itpiocrov or Kpiaawv codd. omnes ; but many editors omit. 
196 



ON FRACTURES, xlvii xlviii. 

extended position would be better away, for it would 
be a great hindrance and little use. If flexed, on 
the other hand, it would be more useful, and still 
more useful if the ankylosis occurred in an attitude of 
semiflexion. 1 So much concerning the attitude. 

XLVIII. One should bandage by applying the 
head of the first roll to the place injured whether it 
be fractured, dislocated, or separated. The first 
turns should be made there and the firmest pressure, 
slackening off towards each side. The bandaging 
should include both fore and upper arm, and be 
carried much further each way than most practi- 
tioners do, that the oedema may be repelled as far 
as possible from the lesion to either side. Let the 
point of the elbow be also included in the bandage, 
whether the lesion be there or not, that the oedema 
may not be collected about this part. One should 
take special care in the dressing that, so far as 
possible, there shall be no great accumulation of 
bandage in the bend of the elbow, and that the 
firmest pressure be made at the lesion. For the 
rest, let him deal with the case as regards pressure 
and relaxation, in the same way, and according to 
the same respective periods, as was previously 
described in the treatment of fractured bones. Let 
the change of dressings take place every third day, 
and he should feel them relaxed on the third day, 
as in the former case. Apply the splints at the 
proper time— for their use is not unsuitable whether 
there is fracture or not, if there is no fever— but 
they should be applied as loosely as possible, those of 



Omit 



apeffoov. 



i^tipyriTat Kw. 3 avrb. 

197 



IIEPI ArMQN 

tov<; fxev dirb l3pa-%i>ovo$ KaraTeTay/mevovj, tou<? Be 
a7ro tov irrj^eo^ dvei /xevovi' earwaav Be fir) 7ra/^ee? 
oi vdpdrjKe<;' avay/calov Be /cal dvtcrovs avTovs 
eivai aWijXoicri, irapaWdaaeiv Be irap aWrj\ov$ 

30 fi av crvpKpeprj, T€Kfxaipop.evov 7rpb$ ttjv avy- 
tcap.\friv. arap /cal roov airXyvwv tyjv irpoadecriv 
roiavrrjv XPV Troietadai, wcnrep /cal rwv vapO/j/ccov 
eiprjTai, oy/CT)poTepov<; Be oXtytp /cara rb <rlvo<; 
irpoanOevai. rom Be ^pbvov<; tol>? atrb tt}<? 
<p\eyp,ovr)<; re/cpLaipecrOai ^PV k °a ano rcbv nrpbaOev 

36 yeypap./u.evcov. 

1 Reinhold's emendation, robs fiiv kAtoo reray/j-fvous, robs 
8e &vw «ei/t«Vous, seems to give the sense most clearly. 



198 



ON FRACTURES, xlviii. 

the arm being under and those of the forearm on the 
top. 1 The splints should not be thick, and must be 
unequal in length in order to overlap one another 
where it is convenient, judging by the degree of 
flexion. So, too, as regards the application of com- 
presses, one should follow the directions for the 
splints. They should be rather thicker at the point 
of lesion. The periods are to be estimated by the 
inflammation and the directions already given. 

Hippocrates had no angular splints, and straight ones 
applied to the bent arm above and below the elbow had to 
be so arranged that one set overlapped the other at the 
sides. 



199 



IIEPI AP0PON 1 

I. "flfiov Be dpBpov eva rporrov olBa b\lo~6avov t 
rov €? rrjv p,ao-%dXr]v avo) he ovSeirore elhov, 
ovhe e? to e£a)' ov [xevrot, Sua^vpielco eycoye 2 
ei oXiaOdvoi av rj ov, Kalirep e^wv irepl avrov 6 
rt Xeyco. drdp oi/Be e<? rb ep.irpoaOev ov8e7ro) 
oirunra 6 ri eSo^e p,oi a>Xia0r)Kevar roicn /nevroc 
trjrpoiac hoicei /cdpra e'9 rovp,Trpoo~0ev oXiaddveiv, 
kcu p.dXiara i^ajrarcovrai iv rovroiacv, wv av 
<f>dlcri<i KaraXd/3r] ra<; crap/cas Ta<? irepl to apOpov 

10 t€ koX rov Qpa^iova' (f)alverai yap iv rolai 
roiovroiai rravrdiraai 1) Ke^aXrj rov /3pa%lovo<; 
i^e^ovaa if rovpurpoadev. /cal eycoye trore to 
roiovrov ov <pd<i i/C7r€7rT0)Kevai r)K.ovo~a cpXavpcof 
dirb 3 rcov Irjrp&v, vrro re ru>v hrjpborecov Sid rovro 
to Trprjypia' ehoKeov yap avrolaiv 'qyvo'qKevat 
pLovvos, 01 Se aXXot iyvwKevai, iea\ ovk rjSvvd/nrjv 
avrovq dvayvcoaai, el //.?; /ioXf?, 4 on roS icrrl 
roiovhe- et Tt? toO ^pa^lovo? yfn\too-ei€ p,ev r&v 
crapKtov rrjv eVty/itSa, yfrtXcoaeie Be rj 6 /aO? 

20 dvarelvei, yfnXcoaeie Se rov revovra rov /card 
rrjv pLaa%dXr)v T€ koi rr\v /cXrjlSa vpof to arrjOof 
eyovra, (palvoiro av t) KefyaXrj rov ^pa^lovof e? 
rovpLirpoadev i^e^ovaa Icr^ypcofy Kalirep ovk iKire- 
irrwKvla' wefivKe yap e? rovpuirpoaQev TrpoTrerrjf 
■f) KetyaXrj rov fipa'ylovo'i' to 6° aXXo bareov rov 

1 So Apollonius, Galen and most MSS. B M and Kw. add 
EMBOAH2. 

200 



ON JOINTS 

I. As to the shoulder-joint, I know only one 
dislocation, that into the armpit. I have never 
ohserved either the upward or outward form, but do 
not wish for my part to be positive as to whether 
such dislocations occur or not, though I can 
say something on the subject. Nor have I ever 
seen anything that seemed to me a dislocation 
forwards. Practitioners, indeed, think forward dis- 
location often happens, and they are especially 
deceived in cases where there is wasting of the 
flesh about the joint and arm, for in all such the head 
of the humerus has an obvious projection forwards. 
In such a case I myself once got into disrepute 
both with practitioners and the public by denying 
that this appearance was a dislocation. I seemed 
to them the only person ignorant of what the others 
recognised, and found it hardly possible to make 
them understand that the case was as follows : — 
Suppose one laid bare the point of the shoulder of 
the fleshy parts from the arm, and also denuded 
it at the part where the muscle x is attached, and 
laid bare the tendon stretching along the armpit 
and collar-bone to the chest, the head of the 
humerus would be seen to have a strongly marked 
projection forwards, though not dislocated. For the 
head of the humerus is naturally inclined forwards, 

1 Deltoid. 



Kw. omits tyu. 3 i,ic6 re Pq. * fi6yis. 

20I 



IIEPI AP0PHN 

/9pa%ioi'09 e? to e%w Kap,rrv\ov. 6pu\ei Be o 
ftpayiwv ra> kol\w rrj<i do/jLOTrXdri]? irXdyios, brav 
irapd t«9 irXevpa? irapaTeTapuevo^ 97. orav fievroi 
€5 Tovp-rrpoadev i/CTavvadfj f] avfiiraaa X ei P y 

30 tot€ ■>) fcecfra'X.r) tov /3/)a%ioi>o9 Kara rrjv I'^iv rr)<; 
oifioirXdrt]'; tw kol\g> ylverai kcu ovk en Ifeveti' 
e? TOvp-irpoaOev (fiaLverai. rrepl ov ovv \0709, 
ovBerroTe elBov ovBe €9 TOvpupoaOev eKTreaov' ov 
firjv lo-xvpielco ye ovBe irepl tovtov, el //.?) eKireaoi 
av oi)TW<i rj ov' orav ovv eKirecrr) 6 fipayiiov e'9 
ttjv p,ao'xa\'r)v ) are ttoWolcti eKTmrTOVTos, ttoWoi, 
eiriaTavTai ep,/3d\\eiv eviraLBevrov Be iart to 
elBevai irdvTas roi><; rpoirovs, outiv 01 njrpoi 
ep.{3dWovcri, koX &>9 av T/9 avrolai, tolcri rpoiroiai 

40 rovToiai xdWiara av XP* 01T0 ' 1 xpyjaOai Be XPV 
Tfti Kpariaro) twv Tpoircov, rjv rrjv laxvpordrr)v 
dvdy/crjv opas' KpaTtaros Be varaTos yeypa^o- 

43 p,evo<>. 

II. 'O/coo-oicri fiev ovv TTVKivd 2 eu'wi'mei 
<w^t09, ifcavol &>9 eVi to TrXeiarov 3 avrol acpiaiv 
avTolaiv e^fidWetv elalv ivdivres yap rrj<; erepr)<; 
Xeipbs tou9 kovBvXovs e'9 rrjv puxaxdX^jv dvay/cd- 
t^ovcnv dvco to dpOpov, rbv Be dy/cwva rrapdyovo-i 
irapa to ctt/}#09. rbv avrbv Be rporrov tovtov 
koX 6 hjrpbs av e/x^dWoi,, el ai/ro9 p-ev vrro 
ttjv p.ao-xd\t}v eo-wrepw tov apdpov tov eKTrerrTco- 
«6to9 vTTOTelvas tou9 BaKTvXov? drravay/cd^oi drro 

10 T(ov irXevpewv ep,/3d\\a>v ttjv ecovTov /ce<f)a\r)v €9 
to aKpdi/xiov dvTepelaios eveica, Tolcri Be yovvaai 
irapd tov dy/cwva e'9 tov ftpax'iova ep-ftaWtov, 
dvrcodeoi 717)09 Ta9 7r\evpd<; — crvp.(pepei Be icap- 
Tepds t«9 %e?yoa9 exeiv tov epb^dXKovra — 17 ei 
202 



ON JOINTS, i -ii. 

while the rest of the bone is curved outwards. The 
humerus, when extended along the ribs, meets the 
cavity of the shoulder-blade obliquely, but when 
the whole arm is extended to the front, then the 
head of the humerus comes in line with the cavity 
of the shoulder-blade, and no longer appears to 
project forwards. To return to our subject, I never 
saw a dislocation forwards, but do not want to be 
positive about this either, whether such dislocation 
occurs or not. When, then, the humerus is displaced 
into the axilla, many know how to reduce it since 
it is a common accident, but expertness * includes 
knowledge of all the methods by which practitioners 
effect reduction, and the best way of using these 
methods. You should use the most powerful one 
when you see the strongest need, and the method 
that will be described last is the most powerful. 

II. Those who have frequent dislocations of the 
shoulder are usually able to put it in for themselves. 
For by inserting the fist of the other hand into the 
armpit they forcibly push up the head of the bone, 
while they draw the elbow to the chest. And a 
practitioner would reduce it in the same way if, after 
putting his fingers under the armpit inside the head 
of the dislocated bone, he should force it away from 
the ribs, thrusting his head against the top of the 
shoulder to get a point of resistance, and with his 
knees thrusting against the arm at the elbow, should 
make counter-pressure towards the ribs — it is well 
for the operator to have strong hands — or, while he 

1 "Tis a skilful man's part" (Liddell and Scott). "An 
easy thing to teach " (Adams). 

1 niWinra XPV T0 ' ' °^ fft • • • "'<""'«■ * -woAu. 

203 



IIEPI AP0PDN 

clvtos fiev rfjai ^epai nai rfj /ce(pa\f} ovtco notour), 
aAA.09 1 Be Tt<? tov dy/cwva irapdyoi irapd to 

(TTl)do<i. 

"E<TTt Be efi/3o\r) wfxov /cat, e<? Toviricrco virep- 
ftdWovra tov irrfxyv eirl tt)v pdyiv, eireira rfj 

20 fiev eriprj %e/pt dva/cXdv e? to ava> tov ay/coopo 1 ? 
eyofievov, Trj Be eTeprj irapd to apOpov oiriadev 
ipeiBeiv. avrrj r) efi(3o\r), real r) irpoaOev elprjuevr), 
ov KdTa (pvaiv eovcrai, oficos dfi<f}io-<pdWovcrai to 

24 apdpov dvay/cd^ovaiv lpuiriiTTG.iv. 

III. 01 Be tt) iTTepvrj ireipcofievot, ififtdWeiv, 
ityyvi Ti tov kclto, (jbvcriv dvay k drover iv. %pr} Be 
tov fiev avO pwirov ^afial KaTaxXivai vtttiov, tov 
Be ep,/3d\\ovTa ^afial L^eaOai i<f> oiroiepa av to 
apdpov e/cireirTdotcrf eirena Xa/36fievov Tr\ai %f/3crt 
Tr\o~iv ecovrov t?}<? ^eipb<; tt}? o~ivapr}s, nctTaTeiveiv 
avTrjV, ttjv T€ iTTepvrjv €<? TrjV fiao-^dXrjv efifiaW- 
ovtci dvTioflelv, Tjj fiev Be^tfj e? ttjv Be%ir)v, tt} 
Be dptaTeprj e? ttjv dpiaTeprjv. Bel Be e<? to 

10 koTXov tt)<; p,ao"xd\r)<; evOelvai aTpoyyvKov ti 
ivdpfiocraov eirtTrjBetoTaTai Be al irdvv afiiKpat 
atyaipai real aicXripaL, olai iroXXai etc twv 
o-KVTecov 2 pdiTTovTar rjv yap fir] ti tolovtov 
ey/cer/Tai, ov BvvaTai r) irTepv-t] e^iKvelaOai irpos 
ttjv Ke(pa\->]v tov @pa%bOVO<i' KaTaTewofievt]^ yap 
rr)<i ^etpo? KOiXalveTai i) fiaa^aXr)' oi yap 
TevovTes ol evdev teat evdev t?}? fiaayaXr)<$ 
dvTicr<f)iyyovT€<; evaviioi elaiv. -ypr) Be Ttva eiri 
ddiepa tov KaTaTeivofievov /cadijfievov KO,Teyeiv 

20 KaTa tov vytea wfiov, d><? fir) irepieXrcifTai to 
aoifia, t>}<? X el P°' i T V I? °~ iva PVS e' 77 "' daTepa tciv- 

1 €T€pos. 2 4k iroWwv OKVTiaiv ttoikIKwv Weber. 

204 



ON JOINTS, ii.-iii. 

uses his hands and head in this way, an assistant 
might draw the elbow to the chest. 

There is also a way of putting in the shoulder 
by bringing the forearm backwards on to the spine, 
then with one hand turn upwards the part at the 
elbow, and with the other make pressure from 
behind at the joint. This method and the one 
described above, though not in conformity with 
nature, 1 nevertheless, by bringing round the head 
of the bone, force it into place. 

III. Those who attempt to put in the shoulder 
with the heel, operate in a way nearly conformable 
with nature. The patient should lie on his back 
on the ground, and the operator should sit on the 
ground on whichever side the joint is dislocated. 
Then grasping the injured arm with both hands he 
should make extension and exert counter-pressure 
by putting the heel in the armpit, using the right 
heel for the right armpit, and the left for the left. 
In the hollow of the armpit one should put some- 
thing round fitted to it, — the very small and hard 
balls such as are commonly sewn up from bits of 
leather are most suitable. For, unless something of 
the kind is inserted, the heel cannot reach the head 
of the humerus, for when extension is made on the 
arm the axilla becomes hollow and the tendons on 
either side of it form an obstacle by their con- 
traction. Someone should be seated on the other 
side of the patient undergoing extension to fix the 
sound shoulder so that his body is not drawn round 
when the injured arm is pulled the other way. 

1 "Because without traction," Apollon., referring to 
Fract. I. 

205 



IIEPI AP0PON 

opevw e-netra lpdvT0<; pakOaKov irXdros e^o^TO? 
ucavov, otclv 1} o-cfiaiprj ivTeOy e\ rrjv /j,aa^d\r]v , 
irepl rrjv o~(paipav ire pi ftefiXrjpevov tov lp,dvTo<;, 
Ka\ /ca,Te)(ovTO<i, \aj36pevov dpcpoTepoyv tcov 
dpyko&v tov ipidvTOS, avTiKararetveiv Tivd, vnep 
t?}? K€(f>aXt]<; tov Kcncneivopbevov Kadijpevov, tu> 
irooi 7rpocr/3avTa 77009 tov d/cpcopiov to 6gt€ov. 
rj oe acpatpa 009 lawTaTw /ecu a>9 pdXiaTa 77009 

30 TOiV nrXevpecov KeiaOai, ical yu,?) eVt ttj ice<pa\r) 

31 tov {3pa%iovo<;. 

IV. "EcrTi 8e zeal aXXy) ep/3o\7), 77 KaTcop.L^ovcriv 1 
€5 opdov pei^w pevTOi elvai %ph rov /caTa>p,i£ovTa, 
8ia\a/36vTa 8e ttjv x € ^P a virodelvcu tov wpov 
tov €(ovtov inro ttjv p,ao-yd\r)v 6%vv KiiireiTa 
v7roaTpe\lrai, 009 av ivity-jTai e'Sp-n, ovtco aToyaa- 
apuevov 07ro)9 ap(pi tov wpov tov ecovrov fcpepacrai 
tov dvOpwnov KdTa ti-jv paa^aXijv auTO? 8e 
ecovTov v^nfKoTepov iirl tovtov tov cbpiov TroieiTw 
rj em tov eTepov tov Be /cpepapevov tov 
10 f3pa%iova 77730? to ecovTov o~ty)9o<; irpoo-av- 
ajKa^eTco C09 pd\iaTa' iv tovto) 8e tw ayi'ip-aTi 
7rpoaavaaeieTco, ottotclv 2 p,€Te(oplar) tov dvdp- 
co7rov, a>9 avTippeTToi to :Wo crC)pa clvtw, dvTtot 

TOV fipCL^OVOS TOV KCLT6%OptivOV TjV &6 djCU, 

Kovcpos fi av6punros, irpoaeiTLKpepaad^Tco 2 
tovtov oinaOev Tf9 Kovcpos 7rat9. avTai 8e 
ep,j3o\ai, irdaai kclto, TraKaLoTpipj evy^prjaTol 

1 us KaTw/.d£ov(Tiv Galen, K\v. 2 orav — avTippiiTT). 

3 TrpocreKKpeuaaBrjTai. 

1 This is the common method of reducing the shoulder- 
joint, and seems to he that chiefly used in Creek gymnasia. 
Cf. Galen's account of what happened to him when he dis- 
206 



ON JOINTS, m.-iv. 

Take, besides, a fairly broad strap of soft leather, 
and after the ball is put into the armpit, the strap 
being put round and fixing it, someone, seated at 
the head of the patient undergoing traction, should 
make counter-extension by holding the ends of the 
strap, and pressing his foot against the top of the 
shoulder-blade. The ball should be put as far into 
the armpit and as near the ribs as possible, not 
under the head of the humerus. 1 

IV. There is another mode of reduction in which 
they put it right by a shoulder lift 2 : but he who does 
the shoulder lift must be the taller. Grasping the 
patient's arm, let the operator put the point of his 
own shoulder under his armpit, then make a turn 
that it may get seated there, the aim of the manoeuvre 
being to suspend the patient from his shoulder by 
the armpit. He should hold this shoulder higher 
than the other, and press in the arm of the 
suspended patient as far as possible towards his 
own chest. In this attitude let him proceed to 
shake the patient when he lifts him up, so that 
the rest of the body may act as a counterpoise to 
the arm which is held down. If the patient is very 
light, a boy of small weight should be suspended 
to him from behind. All these methods are very 
useful in the palaestra, since they do not require 

located his collar-bone. He rightly remarks that the little 
ball cannot be put between the ribs and the head of the 
bone. XVHI(l), 332. 

2 All editors who translate 4s opeSv make it mean "stand- 
ing." Foes-Erm : "in erecti et stantis humerum aeger ex- 
tollitur"; Littre-Adams, "performed by the shoulder of a 
person standing" ; Petrequin alone prefers the patient — 
" sur le malade debout. " But after all the expression seems 
to go beat with the verb. 

207 



IIEPI APGPaN 

elaiv, on ovBev dWolcov dppevwv BeovTai i7reiaev- 
19 e^dyjvar ^pyjaaiTO B' dv ti<; Kal aXkodi. 

V. Ata/) Kal ol irepl ra virepa avaytcd^ovres 
eyyv<i rt, tov Kara cpvcriv epfidWovaiv. ^PV Be 
to p,ev v-rrepov KaTeiXfydat, raiv'irj tivI p,a\0a/cr} 
— rjaaov yap dv inroXiaOdvoi — VTrrjvayKdadai Be 
fJL€o~t]yv twv ir\ev peaiv Kal tt}<? Ke(f>a\r)<i tov 
fipa-)(iovos' Kal rjv p,ev (Spayy y rb virepov, 
KadrjcrOai XPV T0V dvdpanrov eirl twos ft)? poXis 
tov fipayiova irepi/SdWeiv Bvvrjrai, irepl to 
vrrepov p.d\io~Ta Be ecrrco puaKporepov to vitepov, 
10 ft)? dv ecrrecb? o avdpanros KpepLaaOai pbiKpov Bey 
dpd>l rq> %v\<p. KaireiTa o pev fipayiwv Kal o 
Trfjxwi irapaTeTapbevos irapa to virepov eo~Ta>, to 
Be eirl Odrepa tov o~(op,aTos KaTavayKa^eTa) T£?, 
irepifidWcov Kara tov abykva irapd ttjv KXrjlBa 
Ta? yelpas. avTrj rj ep/3o\r) Kara (pvcriv iirieiKecos 
io~Ti Kal epfidWeiv Bvvarai, rjv Xprjo'T(a<; o~Kevd- 
17 acovTat avTr\v. 

VI. Arap Kal i) Bia tov KkipaKiov erepr] tj? 
Toiavrrj, Kal ert (3e\Tla>v, otl dacfraXeaTepwi 
dv to aw pa, to p.ev tj), to Be Ty uvTiarjKwOeo] 
p,eTea>pio~9ev irepl yap to vTrepoeiBes o (bpos 
tjv Kal KaTaTreirijyr}, Trepio-<j)(iX\.ecr@ai to acopa 
kIvBvvos tj ti] r) ry. %pr) pevrot, Kai eirl tw 
K\ip,aKTrjpt eTTiBeBeadac tl dvcoOev arpoyyvkov 
evdppoacrov e? to koTXov tt}? p^acrydXy;, o 
TTpoaBtavayKa^et ttjv KefyaXyv tov ^payiovo^ e? 

10 T7)v (pvcriv druevai. 

VII. K.paTicrTr) p,ei'Toi iraaewv tcov ep,j3oXS>v 
y Toi/jBe- %vXov XPV *wai TrXdros p,ev ft)? 
irevTeBaKTvXov, r) tct paBaKTvXov to eiwrav, 
208 



ON JOINTS, iv.-vii. 

further bringing in of apparatus, and one might 
also use them elsewhere. 

V. Again, those who reduce by a forcible move- 
ment round pestles come fairly near the natural 
method. The pestle should have a soft band 
wrapped round it (for this will make it less slippery) 
and be pressed in between the ribs and the head 
of the humerus. If the pestle is short the patient 
should be so seated on something that he can just 
get his arm over it, but as a rule the pestle should 
be rather long so that the patient when erect is 
almost suspended on the post. Then let the arm 
and forearm be pulled down beside the pestle, while 
an assistant putting his arms round the patient's neck 
at the collai*-bone forces the body down on the other 
side. This method is tolerably natural and able to 
reduce the dislocation if they arrange it well. 

VI. Again there is another similar method with 
the ladder, which is still better, since the body 
when lifted up is more safely kept in equilibrium 
on either side. For with the pestle, though the 
shoulder may be fixed, there is danger of the body 
slipping round to one side or the other. But on 
the ladder-step also something rounded should be 
fastened on the upper side, which, fitting into the 
hollow of the armpit, helps to force the head of the 
humerus back to its natural place. 

VII. The most powerful of all methods of reduc- 
tion, however, is the following. There should be 
a piece of wood about five, or four fingers in breadth 

209 



IIEPI AP0PHN 

?ra%o? he a><; hihaKTvXov rj Kal XenTOTepov, fifj/cos 
oe ot7r?/^u, rj Kai ohiyw x ekaaaov. earco oe 
eVt ddrepa to d/cpov 7repi(p€pe<; /cat cnevorarov 
ravTj] Kal Xerrrorarov dp,/3r)v he e'^ertw ap,iKpdv 
virepexovaav eVt tS> varaTm tov TTepufiepeos, ev 2 
to) /xepei, put] tw Trpbs ra? irXevpds, dXXd tG> 

10 73730? t^v Ke(f>aXr)v tov /3pa%Lovo<; €%ovti, &>? 
vcJKippLooaeie tt) p,aa^dXr) irapa rd<; TrXevpds vwo 
rtjv KecpaXrjv tov fipa^Loiios viroTidepLevov oOov'up 
he rj tclivLt) pLaXda/cf) KaTaK€KoXX)jad(o dicpov to 
£vXov, 67T&)? TrpocrrjveaTepov 77. eVeiTa XPV' 
vnooaai'Ta tijv Ke$>aXr)v tov %vXov v7to ti]V 
pLaa^dXrju a>? eacoTUTCo piearpyv twv irXevpeoov 
Kal Tr)<i Ke<paXr)<; tov fipayiovos, tt)v he oXrjv 
yelpa 7T/0O9 to tjvXov KaTaTeivavTa irpooicaTa- 
Brjcrai KaTa Te tov fipayiova, /caTa tc top Trrj-^vv, 

20 KaTa T€ tov Kapirov t?}? yeipos, <*>9 av aTpepifj oti 
p,dXio~Ta' rrepl TravTos he XPV iroieicrOai, oVa)? 
to dicpov tov £vXov &)<> eaeoTaTQ) t?}? pt,aa^dXr)<; 
eo~Tai, vir€p(3ej3rjico<; Trjv /cecpaXtjv tov fipaydovos. 
eireiTa XPV pLecnyyv hvo gtvXwv aTpooTijpa 
irXdjiov ev irpoahSjaat, 'iireiTa virepeveyiceZv tt)v 
X e ip a °~ vv r $> %vXa> virep tov aTpooTrjpos. 07ra)? 
r) piev X ei P ^ 7ri OaTepa $, cttI OaTepa he to acofia, 
KaTa he tt)v ptaaxdXijv OTpwTTqp' Karrena €ttI 
puev OaTepa ttjv X € ^P a K&TavayKa'C.eiv avv tu> 

30 %vX(p irepl tov aTpo)Tr)pa, eVi OaTepa he to aXXo 
cwfia. u\/ro9 he e%<wf 6 aTpu>Tr)p TrpoaheheaOco, 
coctt€ pieTecopov to aXXo acbpta elvai eV dxpcov 
twv irohoiv. ovto<; 6 t p ottos irapd iroXv KpaTia- 
to<? ep,/3oXr)<; wp.ov hiKaiOTaTa p,ev yap pboxXevei, 
i)v Kal pcovvov eacoTepa) r} to £vXov tj}? K€(paXi)<; 
210 



ON JOINTS, vii. 

as a rule, about two fingers thick or even thinner, 
and in length two cubits or a little less. Let it be 
rounded at one end and be thinnest and narrowest 
there, and at the extremity of the rounded end 
let it have a slightly projecting rim (ambe) not 
on the side towards the ribs but on that towards 
the head of the humerus, so as to fit into the arm- 
pit when inserted along the ribs under the head 
of the humerus, and the end of the wood should 
have linen or a soft band glued over it that it 
may be more comfortable. One should then insert 
the tip of the instrument as far as possible under 
the armpit between the ribs and the head of the 
humerus, and extending the whole arm along the 
wood, fasten it down at the upperarm, forearm and 
wrist, so as to be as immobile as possible. Above all, 
one should manage to get the tip of the instrument 
as far into the armpit as possible, up above the head 
of the humerus. Then a cross-bar should be firmly 
fastened between two posts and next one should 
bring the arm with the instrument over the bar, 
so that the arm is on one side, the body on the 
other and the cross-bar at the armpit. Then on 
one side press down the arm with the instrument 
round the beam, on the other side the rest of the 
body. The beam should be fastened at such a 
height that the rest of the body is suspended on 
tiptoe. This is by far the most powerful method 
for reducing the shoulder, for it makes the most 
correct leverage, if only the instrument is well on 



1 Omit icai. 
a iirl 

211 



IIEPI AP0PQN 

tov j3pw)^L0V0<i' hi/caiorarat he ai avrippoirai, 
dacpaXees he ra> barew rov ftpaxiovos. rd piev 
ovv veapd eparl-nrei. Odaaov r) a>9 dv Tt? oloiro, 
nrplv rj zeal KararerdcrOat hoicelv arap icai ra 

40 iraXatd p,ovvy] avrrj royv epb(3oXea>v oir\ re ep>l3i- 
fidcrai, i)v purj i)hrj vrrb ypovov o~ap% p,ev 
eTreXijXvdy eirl rrjv KorvXrjv, r)v he tcecpaXr) rod 
f3pa-)(iovo<; rjhrj rpl/3ov eoyvrfj nreivoiripuevr] y ev 
rw ycoplco, iva ei-e/cXidi]' ov p,rjv dXX ep.(3aXXeiv 
yap p.oc hotcel 1 fcal ovrco rreiraXaiwpievov eKTrrcopua 
rod j3payiovo<i — ri yap dv hi/calrj pibyXev <rt<? ovyl 
Kivr)<jeiev ; — pueveiv puevroi ov/c dv p.01 ho/ceoi Kara 
ywprjv, dXX* oXiaddveiv dv to? to 2 eOos. 

To avrb Be iroiel Kal irepl K~K.ip.a/CTr)pa kclt- 

50 avayfcd^eiv rovrov rbv rpoirov aicevao~avra. rravv 
p,rji> iica.v6)<i e^et /cal irepl pueya eSo? %ecraaXtKov 
dvay/cd£eiv, r)v veapbv 17 to oXiaOrjpLa. eatceva- 
crOai puevroi, yph to %vXov ovtcos, warrep elprjTat' 
drdp rbv dvdpwrrov KaOiaai jrXayiov ein tw 
Bicppcp' Kaireira rbv {SpayLova avv tg3 %v\a> 
v-irepfSdXXeiv virep rov dvaxXiapiov, tcai em pLev 
ddrepa to awpia icaravayicd^eiv, errl he ddrepa 
rbv ^pay^uova avv tw %vXo). to avrb he noiel 
Kal virep hiKXeihos 6vpr)<; dvay/cd£eiv yjpr\aQai 

60 he xph a lei rovroiaiv, a dv rvyrj irapeovra. 

VIII. YXhevai fiev ovv XPV ° T * <pv°~ie<; cpvaioov 

1 &v fiot SoKfOi. 2 is rb. 



1 An old-fashioned straight-backed chair, Galen. Adams 
is enthusiastic over this method For the am be fasten a 
jack towel above the patient's elbow : put your foot in the 
loop and gradually increase the tension. You will do the 



212 



ON JOINTS, vii.-vmi. 

the inner side of the head of the humerus. The 
counterpoise is also most correct and without risk 
to the bone of the arm. Indeed, recent cases are 
reduced more rapidly than one would believe, even 
before any apparent extension has been made, 
while, as for old standing cases, this method alone 
is able to reduce them, unless by lapse of time 
the tissues have already invaded the articular cavity 
and the head of the humerus has made a friction 
cavity for itself in the place to which it has slipped. 
Nevertheless I think it would reduce even so 
inveterate a dislocation of the arm — for what would 
not correct leverage move ? — but I should not 
suppose it would stay in position, but slip back to 
its old place. The same result is obtained by 
pressure round the rung of a ladder, arranging it 
in the same way. Also the operation is very 
effectively done on a large Thessalian chair, 1 if the 
dislocation is recent. In this case the wooden 
instrument should be prepared as directed while the 
patient is seated sideways on the chair. Then put 
the arm with the instrument over the chair-back, 
and press down the body on one side, and the arm 
with the instrument on the other. The same result 
is obtained by operating over (the lower half of) 2 
a double door. One should always make use of 
what happens to be at hand. 

VIII. One should bear in mind that there are 

job quickly, safely and almost pleasantly, if the arm and 
chair top arc properly padded. 

2 Apollonius strangely illustrates this by an ordinary 
vertical (folding) double door. Aa Galen points out, it 
refeiH to doors which open in two halves above aud below, 
usually with a cross-bar between, 

213 



IIEPI AP0PON 

peya 8ia<pepovaiv e? rb pr/iSlco? ipiriirreiv rk 
eKTvliTTOVTa' 8ieveyKot pev yap av n real KorvXr] 
KorvXrj<i, r) pev evvirepfSaros iovaa, rj 8e fjaaov' 
irXelarov 8e Biacpepei /cal rcov vevpcov 6 o~vv8eop,o<;, 
rolav p.ev €TTi86(Tia<i e^oov, rolci, 8e avvrera- 
p,evos [idov]. 1 tcai yap r) vyporrj^ rolcri dv9pd>- 
rroicn yiverai r) ck twv apdpcov, 8td roiv vevpcov 
rrjv dirdpnaiv, i)v yaXapd re rj cpvcrei KaX ras 

10 eirtrdaia^ evepopcos <pepy crv^vouf yap dv tj? 
I801, o'l oi/Tft)? vypoc elcnv, ware, birorav edeXcoai, 
rore eavroiai ra dpdpa e^iaravrat dvwhvvays, 
KaX Kadtaravrac dva>8vva><;. Biacpepei p,evroi n 
fcal a^eai<; rov ad)p,aro<i' rolcri p,ev yap ev e^ovai 
rb yvlov /cal o~eo~apKcop,evoicriv eKiriirrei re r)craov, 
ep,TTL7TT6L 8e 'xaXeirwrepov orav 8e avrol acpecov 
avrwv Xeirrorepoi KaX dcrapKorepoi ewcri, rore 
eKirirrrei re pLaXXov, epTriirrei Be paov. arjpbelov 
8e, on ravra ovru><i e%et, KaX tooV rolcri yap 

20 ftovcrl rore eKirnrrovai pidXXov ol p,r)pol £k rfjs 
KorvXr)?, i)viKa av avroi acpeayv avrwv Xeirrbraroi 
ecocriv yivovrai 8e /3oe9 Xeirrbraroi, rov %eipLcovo<; 
reXevrcovro<;' rore ovv ko\ e^apOpeovcri pdXiara, 
el 8ij tv KaX roiovro 8el ev IrjrpiKJ) ypdyfrai' 8el 8e' 
Ka\a><; yap ' Opijpos Karapep,adi'pcei, on ttuvtcov 
rcov irpofidrcov /3oe? p.dXicrra rroveovcri 2 ravr^v 
rrjv oyprjv, koX fiowv ol dporai, on [Kara] 3 t6v 
yeip,(bva epyd^ovrai. rovroiai toivvv Kal €k- 
rr'nrrei p,dXiara % ovroi yap p,dXtora Xeirrvvovrat' 

30 ra pev yap dXXa ,6ocrK)jpara 8vvarai {Spaye'i^v 
rrjv TroLtjv j36o~Kecr6ai' ftovs 8e ov p,dXa, irplv 
(3a9ela yevtjrai' rolai pev yap aWoialv eon 
Xenrr] -q TrpvjBoXrj rov yei\eo<i, Xenrrj 8e rj dva> 

314 



ON JOINTS, vm. 

great natural diversities as to the easy reduction 
of dislocations. There may be some difference in 
the sockets, one having a rim easy to cross, the 
other one less so ; but the greatest diversity is the 
attachment of the ligaments, which in some cases 
is yielding, in others constricted. For the humidity 
in individuals as regards the joints comes from the 
disposition of the ligaments which may be slack by 
nature and easily lend themselves to extensions. 
In fact one may see many persons of so humid a 
temperament that when they choose they can 
dislocate and reduce their joints without pain. The 
state of the body makes a further difference, for 
in those who are muscular and have the limb in 
good condition dislocation is rarer and reduction 
more difficult, but when they are thinner and less 
muscular than usual dislocation is more frequent and 
reduction easier. The following also shows that 
this is so. In the case of cattle the thigh bones 
get dislocated from the socket when they are at 
their thinnest. Now cattle are thinnest at the end 
of winter, and it is then especially that they have 
dislocations, if indeed such a matter should be cited 
in a medical work. And it should be, for Homer 
has well observed that of all farm beasts cattle 
suffer most during this season, and among cattle 
the ploughing oxen because they work in the 
winter. It is in these, then, that dislocation 
especially occurs, for they are especially attenuated. 
For other farm animals can graze on herbage while 
short, but cattle can hardly do so till it is long, 
since in the others the projection of the lip is thin, 

1 Omit Erin., Kw. 2 6.tov4ov<ti. 

3 Omit Erin., Kw. 



IIEPI AP0PDN 

yvdOos' /3o'i Be ira^eirj pev r) Trpo^o\rj tov X €i ~ 
Xeo9, irayeir) Be Kal dp,{3Xeia r) ava> yvd9o$- Bid 
ravra virofiaXXeiv virb rd<; ^pa\ela<; 7rota<? ov 
Svvarai. rd Be av pdyvvya twv £<oa)v, are dpufxo- 
BovTa eovTa, hvvarai pev aapKa^eiv, Bvvarai 
Be inrb rrjv $payeiv}v iroirjv viro^dXXeiv tou9 

40 oBoptcls, fcai r')8eTai rfj ovtg)<; ex°vcry Troiy pdXXov 
r) rfj paOein' Kal yap to eiriirav dpeivtov zeal 
arepewjepr) r) fipaxeiri tto'ii) tt}? @a9eirj<i ttotI 
Kal irplv eKKapirelv rrjv fiadeirjv. Bid tovto ovv 
eiroirjaev code Taoe ra €7rrj — 129 o ottot aenra- 
aiov cap i]Xv0e fiovalv eXi^iv — oti do~pev(OTaTT] 
[tolctiv] 1 avrolatv ?; /3a0etr] iron) (paLierat. arap 
/ecu oUw? 6 (3ovs j^aXapbv (pvaei rb dpOpov 
tovto e%et pdXXov twv dXXcov %toa>v Bid tovto 
kal elX'nrovv 2 e'o-Tt pdXXov tcov dXXcov ^cocov, teal 

50 p,d\icrTa OTav XetTTOV 3 koI yr/paXeov 4 17. Bid 
TavTa TTuVTa Kal eKTTiTTTei fio'i pdXiaTa. nrXeiw 
Be yeypaiTTai irepl avTod, oti ttuvtcov twv irpo- 
eipijpevov TavTa p,apTvpia eo~Tiv. 

Wepl ov ovv 6 X0705, Tolaiv 5 dadpKOiai p.aXXov 
€KTTi7TT€i Kal ddacrov ipnrnrTei r) Toicriv ev aeaap- 
Ku>p,evoiai' Kal r\aaov enri^Xeypaivei TOiai 
vypolai Kal toIgiv daapKOiaiv rj toicti o~K6- 
Xicppolai 6 Kal aecrapKcopevoiai, Kal r)aaov ye 
BeBeTai e'9 tov eneiTa xpovov' aTap Kal ei puv^a 

60 irXeiwv vireit] tov peTpiov pr) crvv <f)Xey- 
pbovf}, Kal ovTU)<i dv oXiadrjpbv elrj, puv^coBea- 

1 Omit Littre, Erm. Kw. 

* elAiirous: Erm.'s correction which Kw. follows as witli 
the other adjectives, but they surely go with £<l>ov. 
3 Ktirrbs. * yepaiv. 

2l6 



ON JOINTS, viii. 

as is also the upper jaw, but in the ox the projection 
of the lip is thick and the upper jaw thick and 
blunt, wherefore he cannot grasp the short herbage. 
But the solid-hoofed animals, having a double row 
of teeth, can not only browse but can also grasp 
the short herbage with their teeth, and they prefer 
this kind to the long grass. In fact the short grass 
is on the whole better and of more substance than 
the long, especially when the long is just going to 
seed. It is in allusion to this that he wrote the 
following verse : — 

" As when the season of spring arrives welcome 
to crumple-horned cattle," 1 

because the long grass appears most welcome to 
them. Moreover in the ox this joint is generally 
more lax than in other animals, and for this reason 
it has a more shambling gait than other animals, 
especially when it is thin and old. For all these 
reasons the joint is especially liable to dislocation 
in the ox, and more has been written about it 
because these facts testify to all the preceding 
statements. 

To return to the subject, dislocation occurs 
more easilv and is more quickly reduced in emaciated 
than in muscular persons, and inflammation more 
rarely supervenes in the moist and thin than in 
muscular subjects of a dry habit, but the joint is 
not so firm afterwards. Further, if an excess of 
mucous substance is engendered without inflamma- 
tion, this too will make it liable to slip, and, on 

1 Not in our Homer. 

217 



iiepi APGPnN 

repa yap Toviriirav ra dpdpa toIcti acrdpKoicn 
rj rolat aeaapKwpukvoialv eartv Kal yap avrai 
at adp/ces roov per) airb Te%vr)<; dpOcos 1 XeXi- 
p,ay)(r]p:ev(i)v, al rwv XeirT&v p,v%a>BecrTepai elaiv 
rj at twv irayewv. baoiai p-evToi avv cf)Xeyp,ov7] 
p,v^a vTroyiverai, r) <pXeyp,ovr) Btfaacra eve* to 
dpdpov Bid tovto ov pidXa eKiriTTTei to. viropiv^a, 
iKiriirTovra dv, el purj tl i) irXeov rj eXacraov 

70 <p\ey p,ovr)<; vweyeveTO. 

IX. Olcri p.€v ovv orav 2 epbirearr) to dpOpov Kal 
pLTj €TT icpXey p>i')vr) rd nrepieyovTa, ^prjadai re 
dvwBvvcos avtiKa tw a>p,(p hvvavrai, ovtoi p,ev 
ovBev vopLL^ovcri Belv ecovTcbv e7rip,eXeio~0ar ir/rpou 
purjv earl Karap^avrevaaaOav rdov toiovtcov rolcri 
toiovtoioi yap eKTriirTei Kal avdi<i p,aXXov rj 
olcriv dv iir ufiXey pLrjvr) rd vevpa. tovto Kara 
TtdvTa xa apOpa ouTcof e^ei, Kal pbdXiaTa xaT 
wfiov Kal Kara yovv pidXiara yap ovv Kal 

10 oXiaddvet TarjTa. olai 8' dv eTri<^Xeypji]vr) \rd 
ve.vpa\,^ ov BvvavTai y^pyjadai tw a>p,a)' KcoXvei 
yap r) oBvvrj Kal r) avvTacris t>}? cf}Xeyp,ovrj<;. 
Tou? ovv tolovtovs lijcrdai ^prj K^poiTfi Kal 
airX^veai Kal bdovioiai ttoXXolcti erriBeovTa' 
viroTidevai he e\ ttjv fiaay^dXrjv eipiov p,aX6aKov 
KaOapbv avveCXiaaovTa eKirXypcopa tov kolXov 
TToiovvTa iva dvTiaTtjpiyfia fiev ttj imBeo'ei 77, 
dvaKOOxd ^ e ro apOpov tov Be fipayiova ^prj e? 
to avo) peirovTa ta^etv t« irXelaTa- ovtco yap 

20 dv eKacrTUTO) eiij tov yutpiov e? wXiaOev r) 
KefyaXr) tov &[iov' xph ^> <> T av €TriB>]o-y<; tov 

1 6pQr}$. 2 ay, Littre's suggestion. 

8 Omit B, Kw. 
218 



ON JOINTS, vm.-ix. 

the whole, the joints of emaciated persons contain 
more mucus than those of muscular individuals. One 
sees, in fact, that these tissues in emaciated persons, 
who have not been normally reduced according to 
the principles of the art, have more mucosity than 
those of stout people. But in those in whom mucus 
develops along with inflammation, the inflammation 
keeps the joint firm. This is why the joints do 
not often get dislocated from a slight excess of 
mucus, though they would do so were there not 
more or less inflammation at the bottom of it. 

IX. Should, however, no inflammation of the 
surrounding parts supervene after the reduction of 
the joint, patients can at once use the shoulder 
without pain, and these persons think there is no 
further necessity to take care of themselves. It is, 
then, the practitioner's business to act the prophet 
for such, for it is in such that dislocation occurs 
affain, rather than in cases where inflammation of 
the ligaments may have supervened. This is the 
case with all joints and especially those at the 
shoulder and knee, for they are specially liable to 
dislocation. Those in whom inflammation may have 
supervened cannot use the shoulder, for the pain 
and inflammatory tension prevents it. One should 
treat such cases with cerate, compresses, and plenty 
of bandages, also put a soft roll of cleansed wool 
under the armpit, making a plug for the cavity 
that it may form a fulcrum for the bandage and 
prop up the head of the bone. The arm should 
be kept as far as possible pressed upwards, for so 
the head of the humerus will be furthest from 
the place into which it was dislocated. After 
bandaging the shoulder you should proceed to fasten 

219 



IIEPI AP0PDN 

wfxov, eireiTa TrpoaKaraSetv tov fipa^iova 71750? 
ra<; irXevpas Taivirj rivl kvkXw irepl ro o~a>pa 
irept^dXXovTa. XPV ^ Kai dvaTpifietv tov wpuov 
rjcrv^aLO}<; Kal Xnrapws' ttoXXwv ep/rreipov Bel 
elvat tov i*/Tpov, arap Br\ Kal avarpi^no<;' airb 
tov avTov ovopuxTos ov tcovto dirofialvei' Kal 
yap av B/]aeiev apdpov avdrpt^n<;, ^aXapcoTepov 
tov fcaipov iov, Kal Xvaeiev apdpov a/cXrjpoTepov 

30 tov fcaipov iov' dXXa Sioptelrac rjp.lv Trepl 
avaTpiyjrios iv dXXw Xoyq>. tov yovv toiovtov 
wjxov ixaXOaKrjai tc %epcrlv avaTplfieiv o~vp<pepei, 
koX aXX(o<; irpifew^' to Be apdpov BtaKivelv, fir] 
(3iy, dXXa too-ovtov baov dva)8vvco<i KtvrjcreTat. 
KadlaTaTai Be irdvTa, to, p.ev iv irXeovi ^povcp, tcl 

36 8' iv iXdcraovi. 

X. Tiyvcoa/ceiv Be el iKTrknTwicev 6 fipaxiwv 
TOioiaSe XPV T0 * ? o~rjfi.€ioto-r tovto fiev, i7rei&r) 
Si/caiov e^ovcr l to aoipua oi dvOpwuoi, koX t<z? 
yelpax zeal to, crxeXea, irapaBeiypiaTi -)(pr}aOai 
Bel T&) vyiel 7rpo? to p.rj vyies, Kal t£> pit] 
vyiel irpbs to vyies, pnrj tcl dXXoTpia dpOpa 
KadopoJvTa — aXXoi yap aXXwv pidXXov e^apdpoi 
•7Te(f)v/caaiv — dXXa tov avTov tov tcdpLVOVTos, i)v 
avbpoiov r) to vyies tS> /cdpLVOVTc. Kal tovto 

10 eip7]Tai p,ev bp65}<s, irapaavveoiv Be e^et irdw 
iroXXrjv £td to. TOiavTa, /ca) ovk dp/cel piovvov 
Xoyu> elBevat, ttjv Te\vr)v Taimjv, dXXa Kal 
opuXlr) bpiiXelv' ttoXXoi ydp, iiirb oBvvrp;, i) Kal 
vir dXXoirjf; Trpocpdaio^, ovk i^eaTed)Ta>v avTolai 
twv dpOpwv, o/xa>9 ov Bvvainai es tcl bp,oia 
o-%rj/j,aTa KaOeaTavai e? old trep to vyialvov 1 
awpia a^jpiaTi^eTai' irpoaavvievai piev ovv Kal 

220 



ON JOINTS, ix.-x. 

the arm to the side with some sort of band, passing 
it horizontally round the body, and the shoulder 
should be gently and perseveringly rubbed. The 
practitioner must be skilled in many things and 
particularly in friction (massage). Though called 
by one name it has not one and the same effect, 
for friction will make a joint firm when looser than 
it should be, and relax it when too stiff". But we 
shall define the rules for friction in another treatise. 
Now, for such a shoulder the proper friction is that 
with soft hands, and always gently. Move the joint 
about, without force, but so far as it can be moved 
without pain. All symptoms subside, 1 some in a 
longer, others in a shorter time. 

X. A dislocation of the humerus may be recog- 
nised by the following signs. First, since men's 
bodies are symmetrical as to arms and legs, one 
should use the sound in comparison with the un- 
sound, and the unsound with the sound ; not 
observing other people's joints (for some have more 
projecting joints than others), but those of the 
patient himself, to see if the sound one is dissimilar 
to the one affected. And though this is correct 
advice there is a good deal of fallacy about it. 2 
This is why it is not enough to know the art in 
theory only, but by familiar practice. For many 
persons owing to pain or some other cause, though 
their joints are not dislocated, cannot hold them- 
selves in the attitude which the healthy body 
assumes. One must, therefore, take this also into 

1 " All joints re-establish themselves." Pq. ;" Things get 
restored," Adams. 

2 K\v. punctuates after roiavTa. 

221 



IIEPI AP0PON 

evvoelv Kal to toiovSc o"%?]p,a XPV' aTap teal * 
ev irf fxao"%d\r) r) fce<f>a\r) tov ftpaytovos (pabvercu 

20 ey/ceifievr] iroXXu) fia.XX.ov tov eKTreirToyKOTos rj 
tov vyteos' tovto Se. dvcoOev tccna ttjv eiriofiioa 
■ koTKov (paiveTai to %wpioi>' Kal to tov a,Kpa>p,iov 
6o~Teov i^e^ov 2 (patveTat, <xt6 vjroSeSvKOTOS tov 
dpOpov e? to kcitco tov yoiplov — irapaavvecrtv 
fxr/v Kal ev tovtu> e%€t Tivd, dWd vaiepov irepl 
avTov yeypd\jreTat, tl^tov yap ypa(fir)<; eo~Tt — 
tovto Se, tov eKTreTTTu>KOTO<i 6 dyrcoov (patveTat 
tt^>eo"T6ftJ5 fiuWov diro tcov irXevpewv r) tov 
€T€pov' el ptevTOt Ti? irpoaavayKa^oi, irpoadyeTat 

30 ptev, €Ttitt6i'q)<; Se' tovto Se, avco ttjv X € ^P a ^P at 
evOelav irapa to ou<?, exTeTaptevov tov dyK&vos, 
ov fidXa SvvavTai, wairep tt)v vytea, ovSe 
irapdyeiv evda Kal evda o/ioi&)?. t<z t€ ovv 
arjfiela TavTa eo~Ttv, coptov e kit ctt tco kotos' at, 
Se ifij3o\al at yeypaptptevat at t<- laTpelat 

36 avTat. 

XI. 'Eird^iov Se to ptdOr/pta «o? XPV trjTpevetv 

TOV<i TTVKtvd eKTTtTTTOVTa<i WptOVS' TToXXol ptev 
yap i]8r) dycovii]^ eKmXvdrjaav Sta TavTrjv T)]V 
av/x<popi]v, TctWa irdvTa d^toxpijiot eovTes' 
TroWot Se ev iro\e/j,tKoio'iv dxpt]tot 3 eyevovTO 
KaX 8ie<p0dpr]aav Bid TauTr/v tt/v avp(pop7]v 
dpta T€ errd^tov Kal Sta tovto, oti ovSeva otSa 
6p9oi<i IrfTpevovTa, d\\d toi»? ptev pf>]8e ey^ei- 
peovTas, tou? Se TavavTta tov o-vptcpepovTos 
10 (ppoveovTas T€ Kal TroieovTa?. o~v%vol yap i]Srj 
trfTpui eKavaav wptow; eKiriiTTOVTas, «OTa Te ttjv 



1 roiro f.iv Apoll. B. Kw. 2 e^oxov. 

3 iroXf/xois axpeioi. 



222 



ON JOINTS, x.-xi. 

consideration and have such a position in mind. 
Now, first, 1 the head of the humerus is much more 
obvious in the armpit on the injured than on the 
sound side. Again, towards the top of the shoulder 
the part appears hollow, while the bone at the 
shoulder-point (acromion) is seen to project, since 
the articular end of the humerus has sunk to the 
lower part of the region. Yet there is some fallacy 
in this too, but it will be described later, for it 
merits description. Again the elbow of the dis- 
located limb obviously stands out more from the 
ribs than that of the other. If, indeed, one should 
forcibly adduct it, it yields, but with much pain. 
Further, the patient is quite unable to raise the arm 
straight alongside the ear, with the elbow extended, 
as he does with the sound one, or move it about in 
the same way. These, then, are the signs of a 
dislocated shoulder, the modes of reduction are 
the ones described, and these the methods of 
treatment. 

X I. The proper treatment of those whose shoulders 
are often being dislocated is a thing worth learning. 
For many have been debarred from gymnastic con- 
tests, though well fitted in all other i*espects, and 
many have become worthless in warfare and have 
perished through this misfortune. 2 Another reason 
for its importance is the fact that I know of no 
one who uses the correct treatment, some not even 
attempting to take it in hand, while others have 
theories and practices the reverse of what is ap- 
propriate. For many practitioners cauterize shoulders 

1 Reading tovto /xiv. 

* Cf. Airs Waters, XX. on flabby joints of Scythians and 
their use of cautery. 

223 



IIEPI AP0PQN 

€7ra>piBa, Kara re epiTxpoaOev, fj rj KecpaXrj rov 
(3pa%iovos i^oyKei, Kara re rb oiriaOev oXiyov 
t>";? 67r&)yutSo<?. avrai ovv ai Kavaeis, el pev e'<? 
to dvw e^errnrrev 6 ftpayiwv, rj e'9 rb epnrpoaOev 
i) e<? ro ornaoev, opuois av eKaiov vvv oe or), 
ore 6<? to Kara) eKiriirret, eK/3dXXovcriv avrai ai 
Kavcreis pidXXov r\ kcoXvovctiv arroKXeiovai yap 

20 t/)? avco evpvywplri^ rrjv KecpaXrjv rov /3pa%iovos. 
X/9^ he u>Be Kaieiv ravra' dnoXa^ovra rolai 
BaKrvXoiai Kara, rrjv p,acrxdXrjv to Bepjxa, d<peX- 
Kvaai Kar avrrjv rrjv i^iv pdXiara, KaO fjv rj 
K€<paXrj rov (3pa\iovo^ eKiriirrei' e-neira ovru><i 
dcpeiXKvo- pevov rb Beppa, BiaKavaai e? rb ireprjv. 
O'iBrjpioio'i Be %prj ravra l Kaieiv, p.rj 7ra%ecrt, 
p,rjBe Xirjv (paXaKpoiaiv, dXXd rrpop,SjKeo~i — rayy- 
iropcarepa y dp— Kal rfj \eipl errepeiBeiv xprj Be 
koX 8ia(paveo~i Kaieiv, &>? on rdyiara rrepaiwOrj 

30 Kara Bvvapiv rd yap rrayea ftpaBews irepaiov- 
p,eva 7rXarvrepa<; ra? eK7rrcoaia<; roi)v ecryapewv 
•jroieirai, Kal k'ivBwo<; av elrj avppayrjvai t«9 
wreiXds' Kal KaKiov p,ev ovBev av elrj, alayiov 
Be Kal dreyybrepov. orav BiaKavo~rj<; e? to ireprjv, 
r&v p,ev irXeiaroov iKavoix; av e%oi ev tw Kara 
p,epei Ta? eo~~%dpa<; ravra<; povvas Oeivar i)v Be 
p,rj kivSvvos cjyaivrjrai elvai avppayr/vai rat; 
wreiXd*;, dXXa ttoXv rb Bid peaov rj, virdXenrrpov 
XPV Xerrrbv Biepaai Bid rwv Kavpdrwv, en 

40 dvaXeXijppevov rov Bepparos, ov yap av aXXco<; 
Bvvaio Biepaar etC7}V Be Biepo-rj<;, dcpelvai ro 
Bepp,a, eireira piearjyv ruyv eayapoyv aXXijv 



224 



ON JOINTS, xi. 

liable to dislocation at the top and in front 
where the head of the humerus forms a promi- 
nence, and behind a little away from the top of 
the shoulder. Now these cauterizations would be 
properly done if the dislocations of the arm were 
upwards, forwards or backwards, but, as it is, since 
the dislocation is downwards, these cauterizations 
rather bring it about than prevent it, for they 
shut out the head of the humerus from the space 
above it. 

One should cauterize these cases thus : — Grasp 
the skin at the armpit between the ringers and 
draw it in the direction towards which the head 
of the humerus gets dislocated (i.e. downwards), 
then pass the cautery right through the skin thus 
drawn away. The cautery irons for this operation 
should not be thick nor very rounded, but elongated 
(for so they pass through more quickly), and pressure 
should be made with the hand. They should be 
white hot, so that the operation may be completed 
with all possible speed. For thick irons, since they 
pass through slowly, leave larger eschars to come 
away, and there is risk of the cicatrices breaking into 
one another. This indeed is no great evil, but 
looks rather bad and shows want of skill. When 
your cautery has gone right through, these two 
eschars in the part below will in most cases be 
sufficient by themselves. But if there seems no risk 
of the cicatrices breaking into one another, and 
there is a good interval between them, one should 
pass a thin spatula through the cautery holes, the 
skin being still held up, for otherwise you could not 
pass it. After passing it, let go the skin and then 
make another eschar between the others with a thin 

225 

VOL. III. 



IIEPI AP0PDN 

etrydpr\v i/xfidWeiv XeirTcp crihrjpLco, Kal Sta/cavcrai, 
d%pi<i av tw VTraXeiirrpa) eyKvpo-y. ottoltov hi 
ti XPV T0 hepp,a to diro t?)<? yu.acr^aA.779 diroXap,- 
fidveiv, roialhe %pr) T€Kp,alpeo~0ar dheves vireicriv 
rj eXaacrov*; rj //.ei£bu9 ttclgiv viro ttj piacr^dXr}, 
7ro\\ax?1 he Kal aXXy tov acopiaTos. dXXd ev 
aXXa> Xoyco irepl dhevcov ovXop.eXLr]<; yey pd^erai, 

50 o rt re eiat, Kai ola ev o'ioiai ar]piaivovai re Kal 
hvvavTai. tou? fiev ovv dhevas ov %pr) irpocr- 
airoXap-ftaveiv, ovh' oo~a eacoTepco tcov dhevcov 
pieyas <ydp o Kivhwos- rolac yap eiriKaipoTaToiai 
Tovoiat yeiTovevovraf oaov he eacoTepco tcov 
dhevcov eirl * irXelarov aTToXap,/3di'6iv dcrivea 
ydp. yivcoaiceiv he xpr) Kal Tahe, on r)v p,ev 
icr^vpco^ tov fipayiova dvaTeivys, ov hvvyjcrr) rov 
heppbaTos dTToXafieiv ovhev rov vtto rfj p,aa^dXrj, 
o Tt Kai d£tov Xoyov Karavaicri p,ovTai ydp ev 

60 tj) dvardaer oi he av tovoi, ovs ovhe/xifj p,rj%avf) 
hel TLTpu><jK€iv, ovroc Tcpoyeipoi ylvovrai Kal Kara- 
T€rap,evoL ev tovtco tco cr^piarr rjv he o~p,iKpbv 
eirdprjs rov (Spa^ova, iroXv p-ev tov heppiaTo? 
aTToXr^xfrrj, oi he tovoi tov hel Trpop.T]0ela$ai, eaco 
Kai TTpocrco tov %€ipio-p,aTO<; yivovTai. dp" ovv 
ovk ev irdcrrj tt} Te^vrj irepl iravTos XPV TroieltrOai, 
to. hiKaia a)(rjpbaTa e^eu pia Keiv icp' eKacTTOicri ; 
TavTa p.ev t« Kara ttjv p.aa^dXr}v, Kai iKaval 
avTai ai KaTaXij\frei<i, rjv opdtos TeOcoaiv ai 

70 eaydpai. eKToaOev he tt)<; /iacr^aX??? hiacrd 
pbovvd eaTi yjtop'ia, 'iva av rt? ecr^dpa^; Oeirj 
Tipjcopeovaa<i tco TraOtjpuiTi, p,lav p.ev ev tco 
epnrpoaOev jmeaijyv t/}? re KetpaXffi tov ^pa^iovo<i 

1 c 

1 mi. 
226 



ON JOINTS, xi. 

cautery, and burn through till you come on to the 
spatula. The amount of skin that one should take 
up from the armpit should be estimated thus : — All 
men have glands, smaller or larger, in the armpit 
and many other parts of the body. — But the whole 
structure of glands will be described in another 
treatise, both what they are, and their signification 
and function in the parts they occupy. 1 — The glands, 
then, must not be caught up with the skin, nor any 
parts internal to the glands. The danger, indeed, 
is great, for they lie close to cords of the utmost 
importance. But take up as much as possible of 
what is superficial to the glands, for that is not 
dangerous. One should also know the following, 
namely that if you stretch the arm strongly upwards 
you cannot take up any part of the skin under the 
armpit worth mentioning, for it is used up for the 
extension. The cords, again, which must by no 
means be wounded, come close to the surface and 
are on the stretch in this attitude ; but if you raise 
the arm slightly you can take up a good deal of 
skin, while the cords which are to be guarded lie 
within, and far from the field of operation. Ought 
we not then, in all our practice, to consider it of the 
highest importance to discover the proper attitudes 
in each case ? So much for the parts about the 
armpit, and these gathers (lit. interceptions) suffice 
if the eschars are properly placed. Outside the 
armpit there are only two places where one might 
put eschars efficacious against the malady ; one in 
front between the head of the humerus and the 

1 The extant treatise on glands ia an attempt bv a later 
writer to supply this vacancy. Galen XY1II (1), 379. 

227 



IIEPI AP0PDN 

Kal tov revovros tov kcltcl ttjv fiacr \a\r]V' Kal 
Tavrr) to Beppua TeXecos BiaKaUiv XP r b fta@vTepov 
Be ov Xpiy $\ey\r re yap iraye^ TrX^alt] /ecu 
vevpa, cov ov&erepa deppavTea. oiricrOev t€ av 
aXXrjv so~yap' r } v evfteyeriii evOelvai avunepoy p,ev 
o~vyyq> tou TevovTos tov fcctTci tt)V p,acrxdXr)v, 

80 KdTWTepw Be oXiya> t>}? KefyaXrjs tov (3pctYLOvo<i' 
/ecu to p,ev Beppa TeA.e&)9 XPV Bia/eaieiv, (3a6elriv 
Be pbi)Be KtxpTa rairniv irotexv nvoXepiov yap to 
irvp vevpoienv. IrjTpeveiv pev ovv xph Bid iraar]^ 
Trj<i lrjTpeiJ]<; t<x e\/cea, pbrjBerroTe lo-yyP^ avaTei- 
vovTa tov ftpayiova, dXXd peTpia><;, ocrov twc 
eX/eecov eViyu-eXen/? e'lvexa' — rjcro-ov pev yap dv 
Biatyvx 0170 — o-vp<f)ipei yap iravTa to, KavpaTa 
CKeireiv, a>? 1 errieiKeax; IrjTpeveiv — -r)o~crov B' av 
eKirXiaaoiTO' r/aaov B av aipop'payoir)' fjao-ov B 

90 dv aTraap,o<i emyevoiTo. oiroTav Be 8rj /caOapa, 
yevrjTai. to, k'X/eea, e9 wTeiXas tc I'tj, totc Brj Kal 
TravTiiiracn, XPV a ^ ei T0V fipaxiova Trpbs Trjart 
trXevpfjai irpoaBeBeaOai, zeal vvKTa kal i)pepr]v 
ciTap Kai orroTav vyiea yevrjTat tci eX/cea, opouos 
eirl 7roXvv XP^ V0V %PV irpoaBelv tov {SpayLova 
737309 t«9 TrXevpd<i' ovtco yap dv pdXicna e-nov- 
XwOeii] Kal diroXr/cfiOeir} i) evpvywpi'V* Ka @ V v 

98 pdXiGTa oXiaOdveo 6 ftpayitev. 

XII. "Ocoiai S' av wpos KaT^Trop^Ofj ep/3Xr)- 
dfjvai, 7}v pev eTi ev avtjijaet kcocriv, ouk edeXei 
avvau^eaOai to 6aTeov tov fipaylovos opolw; T<p 
vytel, aXXa av^eTai p,ev eiri ti, ftpayvTepov Be 
tov eTepov yiveTar Kal oi KaXovpevoi Be eK yeverj<i 
yaXidyKcoves, Bid Bio-ads avp(j>opd<; TavTas 

1 dij Kal. 
228 



ON JOINTS, xi.-xii. 

tendon at the armpit, 1 and here the cautery should 
go right through the skin, but no deeper, for there 
is a large blood vessel in the neighbourhood, and 
cords, none of which must be heated. Again, 
another eschar may be placed behind, well above 
the tendon at the armpit, but a little below the 
head of the humerus. Burn through the skin com- 
pletely but do not make this cauterization very deep 
either, for fire is hostile to nerves. During the whole 
treatment, the wounds must be dressed without ever 
lifting the arm up strongly, but only such moderate 
distance as the care of the wounds requires. They 
will thus be less exposed to cold — (it is well to cover 
all burns if they are to be treated properly) — less 
drawn apart, less liable to haemorrhage, and spasm 
will be less likely to supervene. When, finally, the 
wounds get cleansed and begin to cicatrize, then 
above all should the arm be kept continually bound 
to the side both night and day, nay, even when the 
wounds get healed, one should bind the arm to the 
side in the same way for a long time ; for so would 
the cavity into which the humerus is mostly displaced 
be best cicatrized up and cut off. 

XII. In cases where reduction of the shoulder 
has failed, if the patients are still adolescent, the 
bone of the arm will not grow like the sound one. 
It grows a little indeed, but gets shorter than the 
other. As to those who are called congenitally 
weasel-armed 2 , they owe this infirmity to two 

1 Pectoralis major tendon. 

2 Strictly weasel-elbowed. Galen in his Lexicon says they 
have shrivelled upper arms and swollen elbows "like the 
weasels," but he doubts the derivation. In his Commentary 
he is still more doubtful, but leaves " those who study such 
matters " to clear it up, which they have not yet done. 

229 



IIEPI AP0PON 

yivovrai, rjv ye ri roiovrov avrov<; e^dpOprjfia 
Kara\df3rj ev ry yaarpl eovras, hid re dWrjv 1 
avfMpopijv, nrepl 979 vcrrepov irore yeypdy\rerai' 

10 drap Kal olaiv en vr\irioi(Tiv eovai Kara rrjv 
K€(pa\r]v rov /3pa%iovo<; fiadelai Kal v-noftpv^ioi 
eKTTvrjcries yivovrai, Kal ovroi Trdvres ya\idyKwve<i 
yivovrai' Kal r)v re rpirjOoiaiv, rjv re /cavdcocrtv, 
rjv re avro/xarov o-<ptv iicpayfi, ev elhevai \prj 
on ravra ovra><i e^ef. \pr)o-9ai fievroi rrj X eL P l 
hvvarcoraroi 2 elaiv 01 e/c yever}<; ya\idyK(ove<;, 
ov p-r/v ovhe e/celvoi ye dvarelvai irapd rb 0S9 
rov /3pa%LOva eKravvaavre^ rov dyKoiva hvvavrai, 
dXXa 7ro\v ivheecrrepw^ rj rr/v vyiea yelpa. olai 

20 §' dv tfhrj dvhpdaiv eovaiv eKtrear] 6 (b/xo<; Kal p,rj 
e/x/3\7]0fj, r) eVcoyut? dcrapKoreprj yiverai, Kal rj 
e£i<; \e7rrr} rj Kara rovro rb //.e/509' brav /xevroi 
ohwoopievoi rravacovrai, birbaa fiev Bel ipyd^eaOai 
eiraipovras rov dyicwva dirb rcov irXevpecov 69 to 
rr\dyiov, ravra fxev ov hvvavrai d-rravra 0/101009 
epyd^eadar birocra he hel epyd^ecrOai, irapa- 
<f>epovra$ rov fipayiova rvapa ra<; irXevpds, rj 
6? rovntaco rj e'9 rov/jarpoadev, ravra he hvvavrai 
epyd^ecrdar Kal yap dv dpiha ekicvaaiev 3 /cal 

30 irpiova, Kal neXeKtjaaiev dv, real cr/cd'^raiev dv, 
pur) rcdpra avco al'povres rov dytcwva, Kal rdXXa 
baa Ik rwv roiovrcov a^pidrcov epyd^ovrai. 

XIII. 'Oaoiai §' dv rb aKp(x>jxiov diroairaady, 
rovroiat (paiverai i£evpv rb bareov rb air&m. ao~- 
pbivov eari he rovro 6 avvheo-p.o<; rrj<; KXr/ihof 
Kal t^9 &)/j.07rXaT»y9* erepoir/ yap r) (pvais 

23© 



ON JOINTS, xii.-xiii. 

separate causes. Either a dislocation of this kind 
has befallen them in the womb, or another accident 
which will be described somewhat later; 1 so, too, 
those in whom deep suppuration bathing the head 
of the humerus occurs while they are still children 
all become weasel-armed. And whether they are 
operated on by the knife or cautery, or the abscess 
breaks of itself, be sure that this will be the result. 
Still, those who are congenitally weasel-armed are 
quite able to use the arm, though they, too, cannot 
stretch the arm up by the ear with the elbow 
extended, but to a much less extent than the sound 
one. In adults, when the shoulder is dislocated and 
not reduced, its point is less fleshy than usual and 
this part assumes a lean habit. Still, when they 
cease to suffer pain, though as regards all such work 
as requires raising the elbow outwards from the 
side they are unable to do it as before, any work 
such as involves moving the arm either backwards 
or forwards along the side they can execute. For 
they might work a bow-drill 2 or saw, — and might 
use pick or spade without much raising of the elbow, 
and so with all other works which are done in such 
attitudes. 

XIII. In cases of avulsion of the acromion, the 
bone torn off makes an obvious projection. This 
bone is the bond between the clavicle and the 
shoulder-blade, for man's structure is here diverse 

1 As Galen remarks, if we deduct the dislocation and the 
disease from the two causes, it is difficult to see what 
remains. 

2 " File " most translators, "au^ei" Adams, but the apis 
was used to work the trephine. See Oribasius, XLVI. ii. 

2 3 x 



IIEPI AP0PHN 

avdpMTTOV ravTr/ r) tcov aWwv ^dxov ol ovv 

irjrpol p.aXioTa e^airarwvTai ev tovtw tw Tpco- 

fxan — are yap avaa^ovTos rov oareov rov airo- 

(nraaOkwo^, r) eircopiU <paiverat -^afiai^jXrj koX 

Koi\r] — ware 1 Kai Trpop-ydeladai twv w/mmv twv 

10 €K7T€7TTa>K6ra>v. iroXkoix; ovv olBa t,7]Tpqv$ raWa 

ov <f)\avpov<; iovTas, ot 7roX\a 77877 eXvpujvavTO, 

ififtdWeiv ireipcofievoi tou? tolovtov^ co/xovs, 

ovtq)<; olojxevot eKTreiTTcoKevai, Kai ov Trpoadev 

iravovrai irplv rj diroyvwvai rj airopr)crcu, ho- 

Kovvres avTol ac^ea? avrovs epifidWeiv rov (op-ov. 

Tovrotaiv lr)rpei,r) p,ev, rjirep Kai Tolatv aWoicnv 

Tolai roiovTOio'i, KTjpcoT?) real o~7r\r)v6<; Kai odovia.) 

Kai eV/Seo-*? roiavrr]. Karavayicd^eiv p,evTOi to 

virepexov XPV> Kai T °^ ? o-irXrjvas Kara tovto 

20 TiSkvai TrXelo-Tovs, Kai irie^eiv ravrrj p,d\io~Ta, 
Kai tov $pa~)(iova Trpos rycri ir\evpfjai irpoo-- 
i)pTt}p,kvov €9 to dvco yttepo? exeiv, ovtco yap av 
fidXiara irXrjaid^oi to direcnraa puevov. rdhe p.ev 
ev elhevai XP 7 h K< * h TrpoXeyeiv ol)? dcrcjiaXea, et 
aXXax; ideXeis, on fiXdfirj puev ov8ep,lr), ovtc 
o~p,iKprj ovt€ p,eyaXr), tm gj/xg> yiverai diro rovrov 
tov Tpaopbaro^, alcrx iov & e T0 X<*>p' l0V ' °v& e l a P 
tovto to ooTeov 69 tt)V apxai>V v eSprjv 6p.o(,(o<; av 
ihpwdeiri, wairep e7rc7re<pvKev, 2 dXX* dvdyKtj 

30 nXeov rj eXao-aov oyKrjporepov elvai es to ctva>. 
ovBe yap aXXo oaTeov ovSev e? twvto KaOiaTaTai 
6 Ti av Koivcoveov fj eTepw 6o~T€(p Kai irpocnre^vKo^ 
diroaTraaOr) onrb tt}? dpx^V^ 4>vo-io<;. dvd)8vvov 



1 Siairep ra>v i'/iaiJ 
S i)S iTT«f>VK«U 



232 



ON JOINTS, xiii. 

from that of animals. Thus practitioners are especi- 
ally deceived by this injury — since, the detached 
bone being raised up, the point of the shoulder 
looks depressed and hollow— even to the extent of 
treating the patients for dislocated shoulders. 1 I 
know many otherwise excellent practitioners who 
have done much damage in attempting to reduce 
shoulders of this kind, which they thought were 
dislocated : and who did not cease their efforts till 
they recognised either their error or their impotence 
if they still supposed they were reducing the 
shoulder-joint. The treatment in these, as in other 
like cases, consists of cerate, compresses, bandages 
and the like mode of dressing. The projecting part 
however should be forced down, the bulk of the 
compresses placed over it and strongest pressure 
made here. Also the arm should be fixed to the 
ribs and kept up, for so it will best be brought near 
the part torn off. For the rest, keep well in mind 
and predict with assurance, if you think proper, that 
no harm, small or great, happens to the shoulder 
from this injury, but the part will be deformed. 
This bone, in fact, cannot be fixed in its old natural 
position as it was, but there will necessarily be more 
or less of a tuberosity on the top. Nor, indeed, is 
any bone brought back to the same place, if, after 
forming an annex or outgrowth of another bone, it 
has been torn away from its old natural position. 

1 "Looks hollow " as when the shoulders are dislocated, 
(Kw.'s reading). 

233 



IIEPI AP0PDN 

re to a/cpco/Mov iv 6\iyrjo~iv rj/xepr/cri yiverai, r)v 

35 ^pr]aro)<; eiri8erjrai. 

XIV. K\rjl<; 8e /careayelcra, r)v jzev drpeKew^ 
airoKavXiaOfj, euir/rorepr) earlv rjv 8e rrapapjr]- 
/ceo)?, SvairjTOTepr}. rdvavrla 8e rovroialv ecrriv 
r] o>9 av Tf? o'ioito, rrjv pJev yap drpeKecos cnroieav- 
\ia6elo~av irpoaavayKaaeiev x av t*? fiaWov c? 
ttjv (f)vaiv iXOeiv ical yap el ttclvv ^po^ir/Or/delr/, 
ro avcorepco Karcorepw av rroiijaeie a^rj/iaal re 
iirirr)8eioiai teal eiri8eaei ap/uotovcr?]' el 8e p,rj re- 
Xeux; I8pvv0eir), aW' ovv rb virepeyov ye rod ocrreov 

10 ov Kapra d%v yiverai' u>v 8* av 7rapap,r/Ke<i rb 
ocrreov Kareayfj, iKeXr/ r) avfKpopr) yiverai rolcriv 
oareoiat roiai direo"7rao-p,evoiai, irepl wv irpbadev 
yeypa-nrar ovre yap I8pvvdfjvai avrb Trphs ecovrb 
Kapra eOekei, r) re v-rrepe^ovaa o/cpis rou bareov 
o£en] yiverai Kapra. rb p,ev ovv avfxirav, elhevat 
Xpi] on /3\d/3q ov8ep*lr/ ra> w/xw ov8e rro d\Xo) 
aoopiari yiverai 8id rr/v Kari)£tv rijs kXi]18o<;, rjv 
fir/ e7rto~(paKeXio-rf oXiyaKi<; 8e rovro yiverai. 
aio"%o<; ye p.r/v irpoaylverai irepl rrji> Karrjgiv rrjs 

20 K\rji8o<i, Kal rovroiai rb irpcorov aicr^iarov, 
eiretra pirjv eV« rjaaov yiverai. avp,(f>verai 8e 
ra^ew? kXt/l^ /cat raXXa irdvra baa %avva oarea' 
ra-^eirjv yap rrjv eTTirrojpwcnv Troietrai rd roiavra. 
brav piev ovv vecoarl Kareayfj, ol rerpwpiei'Oi 
o~Trov8d^ovai, olb/xevoi pie^ov rb KaKov elvai rj 
baov eo~riv ol re ir/rpol irpoOv/jieovrai 8rjdev 

1 •KpoaavayK&^oi. 

1 This is probably dislocation of the clavicle at the outer 
end. The anatomy of the part was imperfectly understood 

234 



ON JOINTS, xiii.-xiv. 

The acromion becomes painless in a few days, if it 
is properly bandaged. 1 

XIV. A fractured collar-bone is more easily treated 
if broken straight across ; but if fractured obliquely, 
treatment is more difficult. In these cases matters 
are the reverse of what one would expect. For one 
will more readily force a collar-bone fractured 
straight across into its natural position, and by 
thoroughly careful treatment will succeed in adjust- 
ing the upper to the lower fragment by appropriate 
attitudes and suitable bandaging. And should it not 
be completely reduced, at least the projection of bone 
will not be very pointed. But those in whom the 
bone is fractured obliquely suffer an accident like the 
avulsions of bones described above ; for the fracture 
hardly lends itself to reduction, and the projecting 
ridge of bone becomes very sharp. Still, when all 
is said, one must bear in mind that no harm happens 
to the shoulder, or body generally, from a fractured 
collar bone, unless necrosis supervenes, and this 
rarely happens. Deformity, it is true, accompanies 
fracture of the clavicle, and this is very marked at 
first, but afterwards gets less. The collar-bone 
unites quickly, as do all spongy bones, for with such 
the formation of callus is rapid. Thus, when the 
fracture is recent, patients take it seriously, thinking 
the damage is worse than it is, and practitioners on 
their side are careful in applying proper treatment ; 

even in Galen's time, some saying that the acromion was a 
distinct bone found only in man ; while others thought 
there was a third bone or cartilage between the clavicle and 
acromion. The accident occurred to Galen when 35 years 
old, and he relates vividly how it was first mistaken for a 
dislocated shoulder, and how, by forty days' endurance of 
tight bandaging, ho recovered without any deformity. 

235 



IIEPI AP0PQN 

6pda><; Irjadai' rrpolovros Be rov \povov 61 rerpw- 
pevoi, are ovk oBvvcopevot ovSe KcoXvopevoi ovre 
6Soi7ropir)<; ovre eBwBrj?, KarapueXeovai' o'i re av 

30 Irjrpov, are ov Bvvdpevoi KaXa ra ywpia diroBetK- 
vvvai, vTrcnro8(8pdcrKovo~i, Kal ovk d^Oovrai rfj 
dp,eXeiij rwv rerpa>p,evcov ev rovrw re rj eTwroo- 
pcocns avvra^vverai,. 

'E7Tt5ecri09 p,ev ovv rpbrros Ka6earf]Ke rrapa- 
TT\rjcrio<i rocai TrXetaroiai Krjpcorfj Kal <nr\i]vecri 
Kal bOovloiai p,aX6aKo2aiv Irjrpeveiv' ical rdBe 
Bel Trpocrirjrpeveiv, Kal rdBe del rrpoacrvvievai Kal 
pudXicrra ev rovrw ra> yeipiapan, on rovs re 
arTrXrjvas irXelarovs Kara ro i^e^ov XPV TiOevai, 

40 Kal roiai eTri8eo-p,oicri 7rXeLO~roLO~i Kal p,d\tara 
Kara rovro XPV w*ۤ6tv; elal Be Brj rives, o'l 
eiTeao$>io~avro ijBrj p,oXvft8iov fiapv Trpocre'rriKara- 
Beiv, &>? KaravajKa^ot 1 to virepeyov avvidai 
p,ev ovv iccof ovBe ol dirXws eiriBeovres' drdp Si) 
ovB' ovros 6 rpoiros kXtjiSos Karrj^ios eariv ov 
ryap Bvvarbv ro vrrepiyov KaravayKa^eaOai ovBev 
6 n d^iov Xoyov. dXXoi S' av rives elcriv, oinves, 
Kara[ia96vre<i rovro, on avrai ai emBkaies 
irapdcpopoi elai Kal ov Kara <pvaiv KaravayKa- 

50 £ovai rd vrrepe-^ovra, einBeovai p,ev ovv avrov? 
airXrjveai Kal bOovloiai "£ped>p,evoi, wairep Kai oi 
aXXor ^coaavres Be rov dvQpwrrov rawly nvl, fj 
ev^waroraros avrbs ecovrov eariv, orav eiriOewat 
rovs airXrjvas eVt ra virepe^ovra rod Kar/jy- 
paros, e^oyKcoaavres eirl ra i$je%ovra, rrjv dp^rjv 
rov oOovlov npoaeBrjaav irpos ro £<i>apa e/c rov 
epnrpoadev, Kal ovrws eiuBeovaiv, eiri rrjv Itjiv 
rf]<; kXt)18o<; eiuravvovres, e? rovinaOev dyovre?' 
236 



ON JOINTS, xiv. 

but as time goes on the patients, since they feel no 
pain and are not hindered either in getting about or 
eating, neglect the matter, and physicians too, since 
they cannot make the parts look well, withdraw 
gradually, and are not displeased by the patients' 
carelessness, and meanwhile the callus formation 
quickly develops. 

Now, the established mode of treatment is like 
that used for most fractures, cerate, compresses, and 
soft bandages ; also the following extra treatment is 
required, and it must be kept in mind especially in 
handling this injury that one should put the bulk of 
the compresses on the projecting part and apply 
pressure with most of the bandages, especially at this 
point. There are some, indeed, who in their wisdom 
have contrived something further and bind on a heavy 
piece of lead as well, so as to press down the projec- 
tion. Perhaps those who use a simple bandage are 
no wiser, yet after all, this is not a suitable plan for a 
fractured collar-bone, for the projecting part cannot 
be pressed down to any extent worth mentioning. 
Again, there are certain others, who, recognizing a 
tendency to slip in these dressings and their inability 
to press down the projecting parts in a natural way, 
use compresses and bandages like the rest, but gird 
the patient with a belt at the most suitable part of his 
body. Then they put compresses on the part of 
the fracture that sticks up, piling them on to the 
projection, fix the end of the bandage to the belt in 
front and apply by stretching it vertically over the 
collar-bone and bringing it to the back. Then, 



237 



IIEPI AP0PON 

KcnreLTa TTepijSdXXovTes irepl to £d)crp,a, e? tov/jl- 

60 irpoadev ay overt, koX avOis e'9 TOviriaBev. 01 Be 
Tives ov'xl irepl to £d)crpLa Trepi/3aXXovo~i to 
oOovlov, dXXa irepl tov vepivaiov re icai irap 
avTi)v ri)v eBprjv /ecu irapa tj]v clkclvOclv /ev/cXev- 
ovt£9 to oOoviov, ovtci) TTik'C.ovoi to tcaTrjypa. 
ravra yovv direipu) p,ev aicovaai cpau'erai eyyuf 
Tt toO Kara cpvcuv elvai, ^peopuevw Be a^prjaja- 
ovt€ yap povip,a ovBeva %p6vov, ovB el Kara- 
KeoiTO ti<} — fcaiTOt iyyvTarco dv ovrcos — aXX 
bpcos, el real Karafceip,evo<i rj to cr/ceXos avytcap- 

70 tyeiev rj clvtos Kap<f)Betr), irdvTCL dv to, eVto'eV- 
paTa KiveoiTO' aXX(o<? ts dcrr)pi] 1) eTriBeaiv r) Te 
yap (-Spr/ diroXapfidveTaL, dOpba Te Ta odovia ev 
TavTr) Trj GTevoyjMpir} yiveTav Ta T€ av irepi ttjv 
^covrjv 7repi/3aXXopeva ov-)( ovtcos la")(yp(ii<; e^wcr- 
Tai, o>9 ovk dvaytcdo-ai 69 to dvw ttjv ^covrjv 
enravievai, teal out&)9 dvdyKi) av etrj ^aXav Ta 
eiriBeapaTa. ayyioTa B' dv Tt9 Boieeoi iroielv, 
Ka'iTrep ov pueydXa 7Toi6i)i', eo tolcti p,ev tictl tcov 
odovlwv irepl Trjv ^covr/v TrepiftdXXoi, Tolm Be 

80 TrXeiaToiai twv oOovioiv ttjv dpya'ir)v eiriBecnv 
iiriBeot' ovtco yap dv pbd\io~Ta Ta eiriBeap-aTa 
fiovipud Te eit] Kat dXXipXoLcri Tipcopeoi. 

Ta pev ovv irXelaTa eipi)Tai, daaa KaTaXap,- 
^dvei TOU9 T))v /cXr/lBa /caTayvvpevovs. Trpoa- 
avvievai Be ToBe XPV> 0Tt K ^V L ^ W eiriToiroXv 
KaTayvvTai, ojcttc to pev utto tov o~Ti]6eo<; 
Tre<pvKO<; oaTeov e'9 to dvw p,epo<i v-rrepe^eiv, to Be 
dirb Tr)<s die pco pirj<i ev tw kcito) ptepei elvai. aiTia 
Be tovtmv TaBe, otl to pev 0"tj}#09 ovtc tcaTiorepai 

90 dv ttoXv ovTe dvcoTepco yjop^o-eiev' api/cpos yap 6 

238 



ON JOINTS, xiv. 

passing it through the belt, they bring it to the front 
and again to the back. There are others who pass 
the bandage, not through a belt, but round the 
perineum near the fundament itself, and, completing 
the circle along the spine, thus make pressure on 
the fracture. To an inexperienced person these 
methods seem to come near the natural, but to one 
who uses them useless ; for they have no permanent 
stability, not even if the patient keeps his bed, 
though this would come nearest. Yet even if, 
when recumbent, he bends his leg or curves hi 



is 



body all the bandages will be deranged. Besides 
the dressing is troublesome, for the fundament is 
included, and all the bandages accumulate in this 
narrow part, while, as for those passed through the 
belt, it is impossible to gird it so tightly as not to 
yield to the force pulling upwards, and so the 
bandages will necessarily become lax. One would 
appear to be most effective, though without effecting 
much, by making some turns of bandage through the 
belt while applying most in the old fashion, 1 for 
so the bandages would best keep in place and 
support one another. 

Almost all then has been said on the subject of 
patients with broken collar-bones; but the following 
should also be borne in mind, namely, that the clavicle 
as a rule is so fractured that the part arising from the 
breast-bone is on the top and that from the shoulder- 
point (acromion) below. The reason of this is as 
follows : the breast- bone does not move much either 
downwards or upwards, for the range of the joint at 

1 Rome make apxa'n\v inlSea-iv = the under bandage, first 
applied, but cf. apxairj <pv<ris = vofj.lfj.ri, XIII. 33. 

2 39 



IIEPI AP0PDN 

fCiyfcXiafAOS tov dpdpov tov iv tu> GTijOei. avro 
re yap ecovTO awe^es e<nt, to o~Tr)do<t teal rfj 
pd^er dy^iara fx^v f] icXr/ls 7rpo<? to tov co/xov 
dpdpov 7r\oco8r)<; eaTtv r)vdy/caaTai yap itvkivo- 
KivrjTOS elvai Btd Tr/v Tr)<; dfcpco/xLrjs <fv%ev£iv. 
aWcos Te oTav Tpcodfj, cjyevyei e? to dvco /xepo<; to 
7rpo9 tco oTrjQei irpoaeyoixevov, real ov p,d\a e? to 
KaTco /xepos dvay/cd^eaOai eOeXet' ical yap 

100 7ri<fiv/ce /covefrov, 1 tcai r) evpu^wpirj auTco dva> 
irXeicov rj KaTco. o Be cbfxo'i /cal o fipayiwv real 
to, tt poar)pTi]jxeva TOVTOiaiv evarroXvTa eaTtv 
diro tcov irXevpecov teal tov aTrjOeos, ical Bid 
tovto BvvaTav tcaX dvcoTepco iroXv dvdyeaOai teal 
KaTcoTepco' OTav ovv /caTeayfj r) kXtjls, to irpos 
tco cii/xft) oaTeov e? to KaTcoTepco eirippeipei' e? 
tovto yap €7riTpo)£(OTepov avTO d/xa tw cop.ro icai 
tco ftpayiovi KaTco pe^rat, fidXXov rj e'9 to dvco. 
ottotb ovv TavTa TOiavTa eaTtv, davveTeovaiv 

110 oaot to vrrepe^ov tov oaTeov e? to kutco icaTavay- 
fedcrat otovTai olov Te elvai. dXXa BfjXov otl to. 
kutco 7rpo? to dvo) ivpoaaKTeov eaTiv tovto yap 
e%et /civi]o~Lv, tovto ydp eaTtv /cat, to airoarav 
diro T/79 cpvatos. BfjXov ovv oti aAA&j? ptev 
ov8ap,co<} eaTtv dvay/cdo-ai tovto — at t€ yap 
eTu8ecn€<; ovBev ti p,dXXov it poaavay/edfava iv rj 
diravay/cd^ovatv — el Be Tf? tov ftpax'tova 7rpo? 
t^<t4 irXevpf/at eovTa dvayKatpi &)? ptdXtaTa dvco, 
a>5 oti o^uTaTO? 6 cop,o$ cpatvrfTat 3 elvat, Brfkov 

120 oti ovtco<; dv dpptoaOeir) 77730? to oaTeov to diro 
tov aTrjdeo<; irecpvtcos, 69ev direairaaOri. et ovv 
ti? tjj fxev eiriBeaei %oeotTo Trj voptijxr) tov Ta^ew? 

1 \uph6v. 
240 



ON JOINTS, xiv. 

the sternum is slight and there is continuous con- 
nexion between the breast-bone and the spine, 
but the clavicle on the side of its connexion with 
the shoulder is especially 1 loose, for it has to have 
great freedom of movement owing to the acromial 
junction. Besides, when it is fractured, the part 
adherent to the breast-bone flies upwards, and can 
hardly be pressed down, for it is naturally light and 
there is a larger vacancy for it above than below. 
But the shoulder, upper arm and parts annexed are 
easily separated from the ribs and breast-bone and 
therefore can be moved through a large space up- 
wards and downwards. Thus, when the collar-bone 
is broken, the part towards the shoulder sinks down- 
wards, for with the shoulder and arm it is more 
readily disposed to move down than upwards. So 
whenever this state of things occurs, they are un- 
intelligent who think it possible to press the pro- 
jecting part of the bone downwards ; while it is 
obvious that one must bring the lower part up, for 
this is the moveable part, and this too is the one 
out of its natural place. It is obvious then that 
other methods are useless in reducing this fracture 
— for bandagings are no more likely to bring the 
parts together than to separate them — but if one 
presses the arm upwards as much as possible, keep- 
ing it to the side, so that the shoulder appears very 
pointed, it is clear that the fragment will thus be 
brought into connexion with the bone arising from 
the sternum from which it was torn. If, then, one 
should use the ordinary dressing for the sake of 

1 Krotian refers twice to this use of &yx i(TTa = ^dKicTra. 



* (palffrat, Galen. M. 

24 I 



IIEPI AP0PON 

<TvvaXOeo~0rjvai eive/ca, r)y?'jaacTO av TaXXa irdvTa 
fidrrjv eivai irapa to ayi)p,a to elptip,evov, bpOays 
re av avvioi, IrjTpevot, re av rd^iara /cat koX- 
\io~Ta. KaraKelaOai p^evToi rbv avOpcoirov p.eya 
to x 8id(f)op6v €<ttlv Ko\ rjpiepai l/caval Teaaapecr- 
127 icalheica, el drpepbeot, ei/coai 8e 7rdp,TroX\ai. 

XV. El puevToi Tivl errl Tavavrla r) fcXrjls 
/caTeayen], o ov p,dXa yiveTai, ware to p-ev dirb 
tov (TT>j06O'i uo~Teov v7ro8e8vxivai, to 8e dirb 
T^? aKpwjxl-))<i oareov vTtepkye.iv ko\ eiroyelaOai 
€TTi tov eTepou, ou8ep,irj<i p,eydXrj<; lr]Tpeirj<; TavTa 
y dv BeotTO' auTo? yap 6 w/ao? dcpLep,evo<; tcai 6 
fipayLcov ISpvoi av ra bcnea 717)09 aXXrjXa, koX 
(pavXrj av Ti? iTrl8ecri<i dpiceoi, zeal bXlyai i)p,epai 

9 T>}9 7ra>pa)o~io<; yevolaT av. 

XVI. Eil 8e pvr) tcaTeayeirj p,ev ovtcos, rrap- 
o\io~0dvot, oe e9 to -ir\dyiov r) rfj r) ttj, e? ttjv 
cpvcriv p,ev dirayayelv av 8eoi, avayaybvTa tov 
cop,ov trvv to> jipayLovi, toenrep teal •npboQev 
eiprjTar otov 8e I'^yTai 69 ttjv dpyatrjv cpvcriv, 
Tayen) av r) aXXt] inr'pei/tj etrj. to, p,ev ovv 
irXelcrTa tcov irapaXXayp,dTcov /caTopdol auTO? o 
fipayicov, dvayfca£6p.evo<; irpb<i to, avco. ocra 8k 
ex tcov dvcodev TrapoXiaddvovTa 69 to TrXdyiov 

10 rjX0ev, 7] €? to /caTcoTepco, crvpnropavvoi av ttjv 
/caTopdcocriv, ev o p,ev dv6pcoTro<; vittlos /ceoiTO, 
Kara 8e to p,ear/yv tcov cop.07rXaTecov vyjrrjXoTepov 
Tt, oXiycp InroKeoiTO, co? 7repipp?]8e<i r) to o~Tr}0o<; 
<W9 pidXicrTa' Kal tov fipayiova el dvdyoi tis 
irapd Ta9 irXevpd<; irapaTerapLevov, 6 8e lijrpb<i 
tt) p,ev eTepr) yeipi & T V V feipdXtjv tov ftpayiovos 
ip,/3aXtov to Oevap Tr)<> %e*/?09 dircodeoi,, Trj 8e 
242 



ON JOINTS, xiv.-xvi. 

getting a quick cure, and should consider everything 
else of no importance compared with the attitude 
described, his opinion would be right and his treat- 
ment most correct and speedy. Still, it makes a 
great difference if the patient lies down, and fourteen 
days suffice if he keeps at rest, while twenty are very 
many. 

XV. If, however, a man has his collar-bone broken 
in the opposite way, which rarely happens — so 
that the thoracic fragment is underneath and the 
acromial part projects and overrides the other — no 
complicated treatment will be required here, for 
the shoulder and arm left to themselves will bring 
the fragments together. Any ordinary dressing will 
suffice, and callus will form in a few days. 

XVI. If the fracture is not of this kind, but the 
displacement is to one side or the other, one must 
reduce it to its natural position by elevating the 
shoulder and arm as described before, and when 
it is set in its old natural place the rest of the cure 
will be rapid. Most lateral displacements are cor- 
rected by the arm itself when pressed upwards, 
but in cases where the upper (sternal) 1 fragment is 
displaced laterally or downwards adjustment will be 
favoured by the patient lying ffat on his back with 
some slightly elevated support between the shoulders, 
so that the chest falls away as much as possible at the 
sides. Let an assistant push the arm, kept stretched 
along the side, upwards, while the practitioner with 
one hand on the head of the humerus presses it 
back with his palm, and with the other adjusts the 

1 So Oaten. 



243 



IIEPI AP0PCSN 

ereprj rh brrrea ra KareijyoTa evOeri^oi, out&>9 dv 
paXioTa e<? Tr)v (pvoiv dyor drdp, wo-nep rjSrj 

20 eiprjrai, ev l pd\a to dvcoOev harkov 69 to kutco 
(f)i\et viroBvveiv. toIol pev ovv irXeloToioiv, orav 
eTrtBeOoioi, to (T^rjpa dpijyei, nap' aura's ra? 
Tr\evpa$ tov dyicSyva e^ovra outoo? e? to dvw 
tov wpov dvaytcd^eoOar eon Be 0X01 pev tov 
(opov dvayicd'Qeiv Set e? to avco, 009 eiprjrai, rov 
Be dyKwva 7rpo9 to oti)6o<s irapdyetv, d/cprjv Be 
tttjv X e ^P a Trupa T0 d/cpojptov tov vyteo? wpov 
co^eiv. t]v pev ovv KarafceioOai roXpa, dvn- 
OTtjpiypd n TrpoonOevai XPV' ***** ^ v ° &fio? 

30 avcoraro) rp rjv Be Trepti'rj, ocpevBovi]V XPV eK 
TaivLij<i irepl to 6%v tov dyKwvos Tronjoavra 

32 dva\ap/3dveiv irepl tov av^va. 

XVII. 'Ay/cwvos Be dpdpov irapdWa^av pev 
rj Trapap6pr)aav 777309 ir\evpr)v 1) e£a), pevovTo<; 

TOV 0^609 TOV €V Tffl KOlk(p TOV /9/3a^l0I'09, 69 

evdv KaTaTeivavTa, to e^e^ov dirwOelv orrloco koX 
5 69 to ir\dyiov. 

XVIII. To. Be Te\e&)9 e/ej3dvTa rj ev9a rj ev9a, 
KaTaTaois pev, ev rj plpax^v icaTeayels eVt- 
BecTai' ovtco yap dv to tcap,Trvkov tov dy/cwvcs 

OV KtoXvOei. €K7n7TT€L Be pdXlOTa 69 TO 7T/)09 

7r\evpa<; 2 pepos. t<X9 Be icaTopOoootas, dirdyovTa 
oti ttXcIotov, eo? pi) ■tyavr) t>}9 tcopd>vr]<; r) K€$>a\r), 
p,€Tea)pov ttepidyeiv koX irepiKap^iTTeLV^ /cat pi] e'9 

1 011 Littre, Erm., Kw. 2 ir\evp^v. 

3 iref>iKa/j.\pai. 

1 Reading ov. eS (Galen, Pq, and all MSS.) would accentu- 
244 



ON JOINTS, xvi.-xvm. 

broken bones ; in this way one will best bring them 
to the natural position ; but as was said before the 
upper (sternal) fragment is not 1 much wont to be 
displaced downwards. 2 In most cases, the position 
after bandaging with the elbow to the side suffices 
to keep the shoulder up, but in some it is necessary 
to press the shoulder up as described, bring the 
elbow towards the chest and fix the hand at the 
point of the sound shoulder. If, then, the patient 
brings himself to lie down one should supply a prop 
to keep the shoulder as far up as possible, but if he 
goes about one should suspend the part by a sling 
bandage round the neck to include the point of the 
elbow. 

XVII. 3 (Subluxation of the radius.) When there 
is displacement or subluxation of the elbow-joint 
towards the side or outwards, the point (olecranon) 
in the cavity of the humerus retaining its position, 
make direct extension and push the projecting part 
obliquely backwards. 4 

X V 1 1 1 . Complete dislocations of the elbow in 
either direction require extension in the position in 
which a fractured humerus is bandaged ; for so the 
curved part of the elbow will not get in the way. 
The usual dislocation is that towards the ribs. 4 For 
adjustment separate the bones as much as possible 
so that the head (of the humerus) may not hit the 
coronoid process, keep it up and use movements of 
circumduction and flexion, and do not force it back 

ate the statement that the sternal fragment may be dis- 
placed downwards. 

: Or, following Pq and the MSS. , "the upper fragment 
may very well bo displaced downwards." 

3 For the sources of XVI I — XXIX see Introduction, p. 86. 

4 = our forearm backwards, cf. Fradurts XLI. 

245 



IIEPI AP0PQN 

evOv fiui^eaOai, afia Be ooOetv ravavjla e'0' 
eK&repa /cai irapcoBelv e'9 y^i>pr\v' crvvw^>e\oit] 

10 S' av real eiriarpe^rii; dyicwvos iv tovtoictiv, iv 
ra> fiev e? to vtttiov, iv ra> Be e<? to Trprjves. 
?r)cn,<; Be, ay>]/u.aTO<i p.ev, okiyw dvcoTepco aicpr\v 
ttjv X e ^P a r °v dyicwvos eyeiv, ftpayiova KaTa 
ir\evpa<;' ovtoj Be tcai dvdXrjyjn^t /cal fleais' koX 
evcf)opov /cat (f)vai<i, /cal xprjais iv tw koivS), t)v 
apa fxij «ra/c&>9 irapwOf]- irwpovTai Be Ta^eo)9. 
lrjai<i Be odovioiai kcltcl t6v vop,ov tov apdpiTi/cov, 1 

18 kcu to 6£v 7rpoa€7riSeiv. 

XIX. HaXiyrcoTcoTciTov Be 6 dy/ccov irvpeTolcriv, 
oBuvrjaiv, dawBei, dKptjTo'yoXa), dy/ccovos Be p.d- 
\to~Ta Toviriaoo Bid to vap/cwBes, BevTepov Be 
Tov/xTrpoaOev. Lt]ai<i Be r\ avTr\' ifxfioXal Be, tov 
fiev oTTiao), ifCTeivavTa KaTaTetvac. o~rj/u,eiov Be- 
ov jap BvvavTac itCTeiveiv tov Be eptrpoaOev, ov 
BvvavTai crvyKapuTTTeiv. tovtw Be ivdevTa tl 
avvetXiypievov GKXrjpov, irepl tovto avyKa/xyp-ai 

9 i£ e/cTao-io? iijaicfrviis. 

XX. AiaaTdo-ios Be 6o~Teo)v crjfieiov, KaTa ttjv 
<f)Xe/3a Ttjv KaTa ftpayiova Gyj,%op,evr]v Bia- 

3 -^ravovTi. 

XXI. TavTa Be Ta%e&)? BiairaypovTai,' iic <ye- 
verj<; Be fipayyTepa ra KaTco tov aweo? ocnea, 
7r\elaTov ra iyyvTaTa tov TTifyeos' BevTepov 
Xeipov TpcTov BaKTvXoiv (Spayjiwv Be koI Sifios, 

1 Cf. Fract. XLVIII. 

1 "Evidently complete lateral luxation of the forearm," 
Adams. 

2 Our "external lateral." 

3 Internal lateral, but Adams "forwards or backwards.' 
246 



ON JOINTS, xviii.-xxi. 

in a straight line, but at the same time press on 
the two bones in opposite directions and bring them 
round into place. In these cases turning of the 
elbow sometimes towards supination, sometimes 
towards pronation will contribute to success. For 
after treatment, as regards position, keep the hand 
rather higher than the elbow, and the arm to the 
side : this applies both to suspension and fixation. 
The position is easy and natural and serves for 
ordinary use, if indeed the ankylosis [stiffening of 
the joint] is not unfavourable ; but ankylosis comes 
on quickly. Treatment with bandages according 
to what is customary with joints ; and include the 
point of the elbow in the bandaging. 1 

XIX. Elbow injury is very liable to exacerbation 
with fever, pain, nausea and bilious vomiting, 
especially the dislocation backwards 2 owing to the 
numbness [injury of the ulnar nerve], and secondly 
dislocation forwards. 3 Treatment is the same. 
Modes of reduction — for backward dislocation, 
extension and counter-extension : sign — they cannot 
extend the arm, while in dislocation forward they 
cannot flex it. In this case, when something rolled 
up hard has been put in the bend of the elbow, flex 
the arm suddenly upon it after extension. 

XX. Separation of the bones (of the forearm) is 
recognised by palpation at the point where the 
blood vessel of the upper arm bifurcates. 

XXI. In these cases there is rapid and complete 
ankylosis, and when it is congenital, the bones 
below the injury are shortened, those of the forearm 
nearest the injury most ; secondly, those of the 
hand, third those of the fingers; while the upper 
arm and shoulder are stronger because they get 

247 



IIEPI AP0P£JN 

eyKparecrrepa hia, rrjv rpocpijv f) he ereprj ^eXp 
hid Ta epya en rrXeia) ey/c parser re prj. pivvOrjcris 
Be crap/cwv, el pev e^co e^eirecrev, eawOev el he fir), 

8 e? TovvavTiov fj e^errecrev. 

XXII. Ajkoov he rjv ecrco r) ega> eKf3f}, /card- 
racrts fiev ev (T^vpari eyywvuo rw rrtj-^et, 717)0? 
fipaxiovcf tt)V fiev yap p,a(yyakr\v draXa/36vra 
rawly dvatcpepdaai, dy/ccovi he d/cprp viroOevra 
ri irapa ro dpQpov ftdpos, e/c/cpefidcrai, i) X e P ai 
KaravayKa^eiv vrrepaia>py]0evro<i he rod dpQpov, 
ai irapayioyai tolcti devapai a>9 rd ev yepaiv 
eiriheaif ev rovrco t&> a^ijpari, real dvdXr)\Jn<; 

9 zeal Oecris. 

XXIII. Ta he oiriadev, e^al<f)vrj<; eKrelvovra 
hiopdovv rocai Oevapat' dfia he hel ev rfj hi- 
opdcocrei /cal ev rolcn erepoiatv. i)v he epirpoadev 
d/j,<f)i odoviov cruveiXtypevov, evoy/cov avyKapir- 

6 rovra apa hiopOovv. 

XXIV. * Hv erepo/cXives y, ev rfj hiopOwaei 
dp.<porepa dpa Xprj irotelv. t*}? he peXerrj? rfj<; 
OepaTTt'lr]^ kolvov, /cal rb cr^P/fia koX r) eVt'Seo-t?. 
huvarai he /cal eie rr)<: hiaardcrios Kowr) avpiriiT- 

5 T€iv dixavra. 

XXV. Ta>v he i/LLf3o\e(t)v, ai pev it; inrep- 
aici)pyjcrio<i ipfSaXXovrai, at he €k /carardcrtos, 
ai he ife 7repicr(f)d\crto<;' aurai he e/c r&v virep- 

4 (SoXetov twv (T^ipdTdiv r) rfj rj rfj avv rw Ta^et. 

XXVI. Xeipos he dpdpov oXiaOdvei r) ecro) i) 
efja), eaoo he ra irXelara. arjpeia he euarjpa' 

1 XXII and XXIII are notes partly repeating XVIII 
and XIX. 

248 



ON JOINTS, xxi.-xxvi. 

more nourishment. The other arm is stronger still 
because of the work it does. Attenuation of the 
soft parts is on the inner side if the dislocation is 
outwards, otherwise on the side opposite to the 
dislocation. 

XXII. When the elbow is dislocated inwards or 
outwards, extension should be made with the fore- 
arm at right angles to the upper arm. Take up 
and suspend the armpit by a band, and hang a 
weight from the point of the elbow near the joint, 
or press it down with the hands. The articular end 
of the humerus being lifted up, adjustments are 
made with the palms, as in dislocations of the 
hand. Bandaging, suspension, and fixation in this 
attitude. 

XXIII. Backward dislocations, sudden extension 
and adjustment with the palms of the hands ; the 
actions must be combined as in the other cases. If 
the dislocation is forwards make combined flexion 
and adjustment round a large rolled bandage. 1 

XXIV. If there is deviation to one side, in the 
adjustment both movements should be combined. 
Position and bandaging follow the common rule of 
treatment. It is also possible to put in all these 
cases by the common method of double extension. 2 

XXV. Some reductions are brought about by a 
lifting over, others by extension, others by circum- 
duction ; and these are by exaggerations of attitude 
in one direction or another combined with rapidity. 

XX VJ. The wrist is dislocated inwards or out- 
wards, but chiefly inwards. 3 The signs are obvious, 

2 Partial lateral dislocations (cf. XVII), probably of radius. 

3 Partial dislocation of wrist, Celsus VIII. 17. 

249 



IIEPI AP0PHN 

avyKaprrreiv rovs BctKTvXovs ov Bvvavrar rjv Be 
et;a>, prj ifcrelveiv. epftoXrj Be, vrrep rparre^r]^ 
tow SatcrvXovs e%&)v, tovs pev relveiv, rovs Be 
dvriretveiv, ro Be e^e^ov i) Bevapi rj rrrepvr/ dpa 
drrcoOetv Kal coOeiv rrpoaw Kara), KarooOev Be 
Kara ro erepov oareov, oy/cov paXOaKov inrodels, 
rjv pev dvw, Karaarpe^a^ rrjv X € ^P a > V v & e Karoo, 
10 v7ttlt]v. Lrjcris Be oOovloiaiv. 

XXVII. r 'OXrj Be r) %ei/> bXiaQdvei rj eaco rj 
e£ft>, 17 ev6a rj ev6a, pdXiara Be eaoi' eari Be ore 
Kal r) enlivens e/civijOi]' eart S' ore ro erepov 
rtbv oareoov Biearrj. rovroiai Kardraai'i la^yprj 
Tronjrerp Kal to pev efje^ov drrcodeiv, to Be erepov 
dvrwOelv, Bvo ecBea dpa Kal e? rovrriaoo Kal e'9 
to rrXdyiov, rj %epo~lv eVl rparretyis rj rrrepvrj. 
rraXiyKora Be Kal ao~%jjp,ova' ra> Be xpovw 
Kparvverai €9 XP r ) (TiV ' trjaif, odovloiai crvv rfj 

10 %etpt Kal rS> 7rr^er Kal vdpdr\Ka<i pe)(pi BaKrv- 
Xcov riOevaV ev vdpdr/^i Be BeOevra ravra ttvkl- 
vorepov 1 Xveiv rj rd Karijypara Kal Karayyaei 

13 rrXeovi yjpijo-Qai. 

XXVIII. 'E/c yeverjs Be fipaxvrepr) rj X eL P 
yiverai Kal ptvv0i)cri<; aapKoiv pdXiara rdvavrla 
rj rj ro eKTTrwpa' rjv^pevw Be, ra oarea 

4 pevei. 

XXIX. AaKrvXou Be dpdpov, hXiaQov pev, 

1 TTVKvATepa. 

1 "In a great measure ideal," Adams. Seems connected 
with LXIV, but the enitomist may have seen lost chapters. 

2 Complete dislocation of wrist. Mochh XVII : cf. Fract. 
XIII. 

250 



ON JOINTS, xxvi.-xxix. 

if inwards they cannot flex the fingers, if outwards 
they cannot extend them. Reduction : placing the 
fingers on a table, assistants should make extension 
and counter-extension, while the operator with palm 
or heel presses the projecting part back, with a 
downward and forward pressure, having put some- 
thing thick and soft under the other bone. The 
hand should be prone if the dislocation is upwards 
and supine if it is downwards. Treatment with 
bandages. 1 

XXVII. The hand is completely dislocated, 
inwards, outwards, or to either side, but chiefly 
inwards, and the epiphysis is sometimes displaced 
[fracture of lower end of radius], sometimes one of 
the bones is separated. In these cases one must 
make strong extension. Press back the projecting 
part and make counter-pressure on the other side, 
the two kinds of movement backward and lateral 
being simultaneous, and performed on a table with 
the hands or heel. These are serious injuries and 
cause deformity, but in time the joints get strong 
enough for use. Treatment with bandages to in- 
clude the hand and forearm, and apply splints reach- 
ing to the fingers. When put up in splints change 
more frequently than with fractures and use more 
copious douching. 2 

XXVIII. When the dislocation is congenital the 
hand becomes relatively shorter, and there is at- 
tenuation of the tissues most pronounced on the 
side opposite the displacement, but in an adult the 
bones are unaltered. 3 

XXIX. Dislocation of a finger-joint is easily 

* Mochl. XVIII. These obscure accounts of elbow and 
wrist dislocations are discussed, p. 411, 

251 



IIEPI APGPnN 

evarjpov. ep/3u\,r} he, Karareivavra if Wv, to 
pev e^e^ov dircodelv, to he evavTiov avrcodelv 
trials he, Taivioiaiv oOovioiaiv. fxrj epireabv he, 
iimrcopovTai e^coOev. i/c yeverjs he r) ev av^rjaei 
e^apOpijaavra, to, barka ftpayyveTai tcl kcitco 
tov o\L(TuiijxaTOf, Kal adpKes pnvvdovai TavavTia 
[xdXujTa i) ft)? 1 to eKTTTCopa' rju^rjpevco he, tcl 

9 oared pe'vei. 

XXX. YvdOof he oXlyoiaiv r/hrj TeXecof e^r/p- 
Oprjaev oareov 2 re yap to cltto t/}? avco yvd£ov 
irecfiUKOf vire^vycoTai 7rpb<i tco vtto to ov<; oarew 
7rpoaTTe(j>v/coTi, oirep diroKkeiei ra? K€<f>a\a<i t?)? 
kutci) yvddov, tt}? pev dvcoTepco ebv, ttjs he 
Karcorepco tcov fcefyakewv Ta tg dfcpea ttjs Kara) 
yvdOov, to pev htd to p.y)tco$ ovk evwapeiahurov, 3 
to he av to Kopcovbv Te Kal virepe)(ov inrep tov 
^vycopaTOf ap,a tc air dpcporepcov tcov a/cpcov 

10 tovtcov vevpcoheif Tevovres TrecpvKaaiv, e£ cov 
e£r)pTr)VTai ol p-ves ol /cporacptTai Kal paar/rr}pe<i 
Ka\eop,ei'Ot. hid tovto he KaXeovrai Kal hid 
tovto KiveovTai, oti evTevOev i^rfprrjvTai' ev <yc\p 
ttj ehcohfj Kal ev Ty htaXcKTCp Kal ev ttj aWy 
Xptjaei tov aToparof, r) pev avco yvddos aTpepel' 
avvr\pTi^Tai yap tyj KecpaXf) Kal ov hirjpOpcorai' 
7) he KaTco yvdOof Kivelrai' dirr]p6pcoTai yap virb 
Tr)f avco yvddov Kal dirb Ttjf Ke<pa\fj<;. hioTi 
pev ovv ev airaapolai Te Kal Terdvoiai irpcorov 

20 tovto to dpdpov eiriai^paivei avvreTap-evoi', Kal 
hion 7r\rjyal Kaipioi Kal Kapovaai al KpoTacf>i- 
nhe<; yivovTai, iv dWco \6yco elprjaeTai. irepX 

1 $ Kw. Mochl. * rb barton Erm., K. 

* evirupeKlivTov Foes in note, Erm., Kw. ; evnapel<rb'vTot> MSS. 

252 



ON JOINTS, xxix.-xxx. 

recognised. Reduction : while extending in a direct 
line, press back the projecting part, and make 
counter-pressure on the opposite side. Treatment 
with tapes and as (narrow bandages). If not 
reduced, it gets fixed outside. When the dislo- 
cation is congenital or during growth, the bones 
below the laxation are shortened and the tissues 
waste, especially on the side opposite the displace- 
ment ; but in an adult the bones are unaltered. 

XXX. Complete dislocation of the lower jaw rarely 
occurs, for the bone which arises from the upper jaw 
forms a yoke x with that which is attached below 
the ear, and shuts off the heads of the lower jaw, 
being above the one and below the other. As to 
these extremities of the lower jaw, one of them is 
not easily dislocated 2 because of its length, while the 
other is the coronoid, and projects above the zygoma. 
And besides, ligamentous tendons arise from both 
these summits, into which are inserted the muscles 
called temporals and masseters. They derive their 
names and functions from being so attached ; for in 
eating, speech, and other uses of the mouth the 
upper jaw is at rest, being connected with the head 
directly, not by a joint. 3 But the lower jaw moves, 
for it is articulated with the upper jaw and the head. 
Now, the reason why the joint first shows rigidity in 
spasms and tetanus, and why wounds of the temporal 
muscles are dangerous and apt to cause coma will be 
stated in another treatise. 4 The above are the 

1 The "zygoma." 

2 "Accessible," MSS. reading. 

3 Or, " by synarthrosis, not diarthrosis" (Oalen). Some 
read cw^^Bpunai. 

* Pq. thinks tin's is W<miids in the hectd, but that seems to 
be the older treatise, and is written in a less finished style: 
also it hardly gives a full account of the matter. 

«5 3 



IIEPI AP0PQN 

Be tov prj KOLpra i^apdpelv, rahe ra a'lTia' acriov 
Be teal roSe, oti ov p,dXa KaTaXapfidvovat 
roiavrcu dvdy/cai ftpcofiaTGOV, ware tov dvOpcoirov 
yavelv p,e^ov rj ocrov BvvaTai' e/crreaoi B av air 
ovBevbs aXXov <x^///.iaT09 >; curb tov p,eya yavovTa 
irapayayetv ttjv yevvv iirl OaTepa. Trpocrcrvp,- 
ftaXXeTai p,evToi Kal toBc Trpb<; to iKwiTTTeiv' 

SO oTToaa yap vevpa /ecu oirbaoi p-ves irapd dpOpa 
elatv, i) dirb dpOpcov aft wv avvBeBevTai, tovtcov 
oaa iv ttj xpqaei 7rA.et<7Ta/a<? BiaKiveiTat, TavTa 
Kal e? Ta? /caTaTacrta? BvvaT(OTaTa i7riBiS6vai, 
coenrep Kal tcl BeppaTa tcl evBeyJnjTOTaTa 
7r\eiaTi)v iiriBoo-Lv e^ei. irepl ov ovv 6 Xoyos, 
eKiriiTTec pev yvdOos 6\tydtci<;, cryaTai pevToi 
7roWd/ci<i iv %aa p-r/o iv •, wairep xac dXXai iroXXat, 
pLVoiyv irapaXXayal Kal vevpcov tovto TToieovcriv. 
Bf]Xov p,ev ovv 6K Tcovoe p,dXLo~Ta iaTiv, ottotov 

40 iK7r€TTT(OK7}' n poio~yeTaL 1 yap r) KaTw yvd6o<? if 
Tovp,7rpoa0ev Kal nraprjKTai TavavTia tov oXlo~- 
0r']p,aTO<i Kal tov oo~t€ov to Kopcavov oyKr/poTepov 
(fyaiveTai irapd ttjv dvco yvddov Kai ^a\e7nw9 
o~vpj3dXXovaL ra? [kutci)] 2 yvdOovf. 

TovTOiai Be ipfioXr) 7rp68i]Xos, tjtls yivoiT' av 
dppbo^ovaa' xprj yap tov p,ev Tiva KaTe^eiv ttjv 
Ke<pa\i)v tov TeTpcopevov, tov Be irepiXaftovTa 
ttjv KaTa> yvddov Kal eao)dev Kal e^toOev toIo~l 
BaKTv\oLo-L KaTa to yeveiov, yciaKovTOf tov 

50 dvdpco7rov baov pLeTpicof BvvaTai, irpcoTov p,ev 
BiaKtvelv Ti]v [KaTco] 3 yvddov y^pbvov Tivd, ttj Kal 
Trj irapdyovTa ttj "^eip'i, Kal avTov tov dv9 pwirov 
KeXeveiv %a\api]V ttjv yvddov e%eiv, Kal avpirap- 
dyeiv Kal avvBiBovai a>9 paXto-ra' kiretTa i£- 
2 54 



ON JOINTS, xxx. 

reasons why the dislocation is rare ; and one may 
add this — that the necessities of eating are rarely 
such as to make a man open his mouth wider than 
is normally possible, and the dislocation would occur 
from no other position than that of lateral displace- 
ment of the chin while widely gaping. Still, the 
following circumstance also favours dislocation : 
among the tendons and muscles which surround 
joints or arise from them and hold them together, 
those whose functions involve most frequent move- 
ment are most capable of yielding to extension, just 
as the best tanned skins have the greatest elasticity. 
To come then to our subject, the jaw is rarely dis- 
located, but often makes a side-slip 1 in yawning, a 
thing which changes of position in muscles and 
tendons also often produce. When dislocation 
occurs, the following are the most obvious signs : 
the lower jaw is thrown forward and deviates to 
the side opposite the dislocation ; the coronoid 
process appears more projecting on the upper jaw, 
and patients bring the jaws together with difficulty. 
The appropriate mode of reduction in these cases 
is obvious. Someone should hold the patient's head, 
while the operator grasping the jaw with his 
fingers inside and out near the chin — the patient 
keeping it open as wide as he conveniently can — 
should move the jaw this way and that with his 
hand, and bid the patient keep it relaxed and assist 
the movement by yielding to it as far as possible. 

1 o-xnrai, a gymnastic term for a sudden lateral movement, 
Galen (XVIII (1), 438). 



1 Tiyo-fc/xfi K\v. 2 Omit K.w. 

8 Omit (Jalen, Erm., etc. 

255 



IIEPI AP0PON 

cnrlvris cr^acrai, Tpto~l a\f]p,aai o/xov irpocri^ovra 
tov voov' %pr) fiev yap irapdyeadai etc t% 
ScacTTpocpr)^ e? Trjv (pvaiv, 8el 8e e? tovttigw 
dircocrOrjvai rrjv yvddov rrjv ko.tco, Set 8e e-nopevov 
rovTOicri o~vp,/3d\\eiv to? yvddov*;, ical p.r) ydoneiv. 

60 ep,fio\rj puev ovv avTi), /cat oi/c av ykvoiTO air 
dWcov a^rjixaTcov. IrjTpelrj 8e ^pa^elr) dptceaei' 1 
airXrjva Trpoo~Ti6evTa KeKr\pwp,evov ya\apli> eirt- 
8io~p,w e7ri8elv. da(f>a\eaTepov 8e xeipi^eiv earlv 
vtttlov /caTatcXivavTa tov dvOpwrrov, epewravTa 
rrjv K€(f>a\r)V avTov eirl ctkvtlvov V7ro/ce(pa\(iiov 
cb? TrXijpearaTOU, iva to? r/KiaTa vireL/cr)' irpoaKar- 

67 ex eiV ^ tivcl ^pr/ tt)v rce<f)a\,r)V tov T€T pco/nevov. 

XXXI. *Hv 8e dp,<poTepai at yvdOoi if-* 
apdpr)o~wo~iv, i) p,ev ?r)o~i<; rjavTt], o~vfi/3dX\.etv 8e 
tl 2 r)Go~ov ovtoi to aTo/xa SvvavTaf koX yap 
TTpoTreTecFTepai ai yevves tovtolctl, do-Tpa/3ees 8e. 
to 8e do-Tpa/3e<i p,d\io~T av yvobr/s To'iatv opioiai 

TCOV 686vT(OV TO)V T€ dvdi teal TWV KaTCt) KO.T l£lV. 

TOVTOicn avp,cf)epei &>9 TayiGTa epbftdXkeiv' ep,/3o- 
\rj<i 8e Tpo7ro? Trpocrdev eipr/Tai. r)v 8e firj ep,irear), 
KLv8vvo<i irepl t% tyvXV'* wo irvpeTOiv avveyewv 

10 /cal va>6pr)<i Kapd>aio<; — fcapd>8ee<i yap oi yui/e? 
ovtoi, koX dWoiovfievoi rca) ivT€iv6p,evot irapa 
<pvaiv — (pi\ei 8e koX r) yaaTr/p viroj^wpelv tov- 
Toiai xo\d)8ea dfcprjTa okiya' xal i)v e/jieooaiv, 
dtcprjTa ipLeovo~Lv' ovtoi ovv real dvija/covai 

15 8e/caTacoi judXiaTa. 

XXXII. *Hv 8e KaTeayfj r) KaTco yvddos, rjv 
ptev fit) aTTOKavkicrOf) iravTanracnv, dWa avveyr\- 
tch to ocneov, eyfcefcXifievov 8e y, tcaTopOayaai 
p.ev xprj to oaikov, mapd ye Ti)V yXcoaaav 
256 



ON JOINTS, XXX.-XXXH. 

Then suddenly do a side-slip, having in mind three 
positions in the manoeuvre. For the deviation must 
be reduced to the natural direction, the jaw must 
be pressed backwards, and, following this, the patient 
must close his jaws and not gape. This, then, is 
the reduction, and it will not succeed with other 
manoeuvres. A short treatment will suffice. Apply 
a compress with cerate and a loose bandage over it. 
The safest way of operating is with the patient 
recumbent, his head being supported on a well- 
stuffed leather pillow, that it may yield as little as 
possible ; and someone should also keep the patient's 
head fixed. 

XXXI. If both lower jaws are dislocated [i.e both 
sides of the lower jaw], the treatment is the same. 
These patients are rather less able to close the 
mouth, for the chin is more projecting, though 
without deviation. You will best recognize the 
absence of deviation by the vertical correspondence 
of the upper and lower rows of teeth. It is well to 
reduce these cases as quickly as possible ; and the 
mode of reduction is described above. If not 
reduced there is risk of death from acute fever and 
deep coma — for these muscles when displaced or 
abnormally stretched produce coma — and there are 
small evacuations of pure bile ; if there is vomiting, 
it is also unmixed. These patients, then, die about 
the tenth day. 

XXXI I In fracture of the lower jaw, if it is not 
entirely broken across, but the bone preserves its 
continuity though distorted, one should adjust the 
bone by making suitable lateral pressure with the 



<X/)/C6». f £' fat. 

257 



VOL. III. 



I1EPI AP0PQN 

TTXayirjv vTreipavra tou? haxTvXovs, to he e%a)0ev 
avrepelhovra, a)? dv avpufaepy /cat i)v p.ev ht- 
€<TTpap,pLevoi e&)(Tiv ol oSovTes oi Kara to Tpwp-a 
zeal fcercivijpjvoi, oirorav 1 to 6<neov KaropOcodfj, 
^eu^at rovs ohovTas ^prj 737509 aXXrjXow;, //,?) 
10 p,ovvov toi>? hvo, dXXa real TrXeovas, 2 puiXicna 
p,ev hrj ^pvaiw, €<tt dv KpaTvvOfj to oareov, el 
he p./], Xivcp' eireira imhelv Krjpcorfj real cnrXip'eo-iv 
oXiyoicn teal oQovloiaiv oXiyoicn, fir) dyav 
epeohovra, dXXa ^aXapolaiv. ev yap elhevai 
%pv), otl eirihecrL<i 66oviwv yvdOw teaTeayelcrrj 3 
apuicpd pbev av dxfreXeoi, el ^/)i)<7TW? eirtheoLro, 
p.eydXa o° av fiXdirroi, el leatews eTriheoiro. 
irvKLvd he irapd rr)v yXwaaav io-p,articrdai \pi), 
teal ttoXvv xpovov dvre^eiv rolai hatervXoLai 

20 KaropOovvra rov oareov to etcteXidev* dpiarov 

21 he. el alel hvvairo' dXX oir^ oibv tc. 

XXXIII. "Hv he dwoKavXiaOf) Travrdiraaiv 
to oareov — 6Xt,ydtei<; he tovto yiveTai — tearopOovv 
p-ev XPV T0 oareov ovrui, teaOdirep el'pi]rat. orav 
he tcaropOwar)^, tou? ohovras XPV &vyvuvai, go? 
irpoadev etprjrai' p-eya yap av avXXapifidvoi e<? 
ttjv drpepLii]v, 5 rrpoaeri /cal el ti? 6p6a)i £ev£ei 
warrep %pr), ras dpyas pd~^a<;. dXXa yap ov 
pifthtov ev ypatpfj yeipovpy it]v iraaav Strjyelcrdai, 
dXXa real avrbv viroroTrelaOai 6 -%pi*i etc rwv 
10 yeypap,p,evcov. erreira xprj hepp.aro<; K.qp%rj- 
hoviov rjv p,ev vijiucorepos 7 7) 6 Tp&0&?, dp/eel 
ra> Xoirw xpfjcrdai, r)v he reXeiorepos jj, avrcp 
ra> hepp,aTf rap.6vra he xph evpos o>? rpt- 
hdtervXov, i) 07ra)? av dpp,6±r), vrraXef^ravra. 

1 orav. s e/r) TtKeiovas. a ytadov icaTeuyeiaijs. 

258 



ON JOINTS, xxxii.-xxxm. 

fingers on the tongue side, and counter-pressure 
from without. If the teeth at the point of injury 
are displaced or loosened, when the bone is adjusted 
fasten them to one another, not merely the two, 
but several, preferably with the gold wire, but failing 
that, with thread, till consolidation takes place. 
Afterwards dress with cerate and a lew compresses 
and bandages, also few, and with no great pressure, 
but lax. For one should bear in mind that 
bandaging a fractured jaw will do little good when 
well done, but will do great harm when it is done 
badly. One should make frequent palpation on the 
tongue side, and hold the distorted part of the bone 
adjusted with the fingers for a long time. It would 
be best if one could do so throughout ; but that is 
impossible. 

XXXIII. If the jaw is broken right across, which 
rarely happens, one should adjust it in the manner 
described. After adjustment you should fasten the 
teeth together as was described above, for this will 
contribute greatly to immobility, especially if one 
joins them up properly and fastens off the ends as 
they should be. For the rest, it is not easy to give 
exact and complete details of an operation in writing; 
but the reader should form an outline of it from the 
description. Next, one should take Carthaginian 
leather; if the patient is more of a child, the outer 
layer is sufficient, but if he is more adult, use the 
skin itself. Cut a three-finger breadth, or as much 
as may be suitable, and, anointing the jaw with 



* viroTuire?(T0ai MSS. : viroTOTruodai Eiot., Littt'ci. 



7 yeUnepos 



259 



1IUPI AP0PQN 

KOfifii ttjv yvddov — ev /neve are pov yap koXXt/s — 1 
TTpoGKoWrjaai Tr]v heppiv a/cpov irpos to diro- 
K6KavXio-fiei>ov t?}? yvddov, diroXeiTrovTa oj? 
hd/CTvXov lltto tov Tpd>paTo<; rj oXiyrp rrXeov. 
tovto fiev e<? to Kciroi fiepos' ey^erw he evrofirjv 
20 Kara ttjv i^iv tov yevetov 6 Ifids, &>9 dfi(pi/3e/3))KT) 
dficpl to o%v tov yevetov. eWepov he ipdvTa 
tolovtov, rj oXuyo) irXaTVTepov, 7rpoaKoXXr)o~ai 

%pl] 7T/309 TO CIVO) fl£pO<i TTfi yvdOoV, UTToXetTTOVTa 

koX tovtov dub tov Tpd>fiaTOs, oaovirep o erepos 
aTTeXiirev ea^iaOw he Kal ovtos o I fids ttjv dficpl 
to ovs irepifSaaiv. diro^ees he ecrTOiaav ol 
IfidvTes dfi<pl T\)v avva<pr]v \ev0a avvwrrTeaOat 
re /ecu avvheladai e? to. rrepaTa TOiv t pdvTa)v~] 2 
ev he Tjj KoXXr/aei r) adpt; tov aicvTeos -rrpos tov 

30 ^oojto9 ecTTO), e-^etcoXXoTepov yap ovtcos. eueiTa 
KaTaTelvavTa ^prj teal tovtov tov ifidvTa, fidXXnv 
he ti tov Trepl to yevetov, &)<? oti ptdXtaTa fir] 
aTTOfivXXaivrj 3 r) yvddos, o~vvd^\rai tovs ifidvras 
KaTa ttjv /copv(p7jv fcdneiTa ire pi to pteTwrrov 
60ovta> KaTahrjcrai, Kal KaTaf3Xi]fia %pr) etvat, 
tbenrep vofi't^eTat, o>? aTpefier) tu heaptd. T7]i> he 
KaTd/cXiaiv TrotetaOo) tVt Tr]v vyiea yvdQov, fir) 
Trf yvdOcp epr)petafievos, dXXa ttj icecpaXr}. to"^- 
vaivetv he ^pr) T ^ vdtpa dy^pts r]fiepa>v hena, eirena 

40 dvaTpecpeiv fir) fipahew i)v he ev Trjcrt- irpOTeprfai 
r)fiepr)ai fir] (pXeyfi)]rr), ev e'lKoaiv r)p,epr]atv r) 
ryvdOos /cpaTvveTar ra^'w? yap eirnrcopovTai, 
(AGTvep Kal Ta dXXa Ta apatd oo~Tea., ))v fit] 
eirio^aKeXicnj. dXXa yap irepi acpaxeXiapcov 
T(ov crvfnrdi'Tctiv oaTecov aXXos fia/cpos Xoyos 

1 evfitveo'Tepoi' yap «(5AAtjs i>. ; /coAAp M.V. 
260 



ON JOINTS, xxxm. 

gum — for it is more agreeable than glue — fasten the 
end of the leather to the broken-off part of the jaw 
at a finger's breadth or rather more from the fracture. 
This is for the lower part ; and let the strap have a 
slit in the line of the chin, so as to include the chin 
point. Another strap, similar or a little broader, 
should be gummed to the upper part of the jaw at 
the same interval from the fracture as the former 
one ; and let it also be split for going round the ear. 
Let the straps taper off at their junction, where the 
ends meet and are tied together. In the gumming, 
let the fleshy side of the leather be towards the 
skin ; for so it adheres more firmly. One should 
then make traction on the thong, but rather more 
on the one that goes round the chin, to avoid so far 
as possible any distortion l of the jaw. Fasten the 
straps together at the top of the head, and after- 
wards pass a bandage round the forehead ; and 
there should be the usual outer covering to keep 
the bands steady. The patient should lie on the 
side of the sound jaw, the pressure being not on the 
jaw, but on the head. Keep him on low diet for 
ten days, and afterwards feed him up without delay ; 
for if there is no inflammation in the first period, 
the jaw consolidates in twenty days, since callus 
forms quickly as in other porous bones, unless 
necrosis supervenes. Now, necrosis of bones 
generally remains to be treated at length elsewhere. 

1 Erotian s.v. : probably "snout-like distortion." "In 
acutuni " (Fob's). 

* Omit K\v. and most MSS. 

3 airuff/j-iKaluft Galen ("draw to a point"); curonvAA^vT) 
Erot. ("be distorted"). 

261 



IIEPI AP0PON 

Xeiirerai} avrrj r) BiaTaai<; r) airb tojv xoWrj- 
/jlutcov evfievr)? /ecu evrafilevTO*;, teal €9 iroXXd 
real 7ro\\a)(ov Biopdd>p,aTa euxprjaTos. twv Be 
irjTpcov 01 fir) avv voa> eu^etpe? ical iv aXXoiat 

50 Tpw/xaat tolovtoL elen real iv yvddcov Kadr^eaiv 
iirtBeovat, yap yvdOov Kareayelaav ttoik'iXws, kcu 
Ka\w<i zeal /ca/ews- irdaa yap iTriBeais yvddov 
ovT(o<i KaTeayeiarjs i/crcX/vet 2 rd oarea to. e'9 to 

54 tcdTrjyfia peirovTa fidXXov ■>} e'9 ttjv (pvaiv dyei. 

XXXIV. ' Hv Be r) kutco yvddov tcard rrjv 
avp.<pvcnv rr)v Kara to yeveiov Biaairaadrf — 
p,ovvr\ Be avrrj r) avp.cpvai'i iv rfj kutco yvdOw 
ianv, iv Be ttj ctvco TroXXat' d\A,' ov /3ouXop,ai 
diroirXavdv rov Xoyov, iv dXXoiai ydp ecBeai 
vocn)p,dro)v irepl tovtcov Xe/CTeov — rjv ovv Btaarrj 
r) Kara to yeveiov avp,(f)vat<i, /caropdwaai /nev 
7ravrb<i dvBpo? icrriv. to fiev ydp e£eo~Teo9 
iawdelv xpr) e? to earn fiepos, irpoafiaXovTa rovs 

10 BaKTvXov;, to 6° eaco peirov dvdyeiv e'9 to e^o) 
/i.e/309, ivepeiaavTa tovs BatCTvXovs. e'9 BidaTaaiv 
fievToi BiaTeivdfievov TavTa xprj nroielv paov yap 
oi/tg>9 69 Ti)v (jjvcriv t]^et rj e% Tt9 iyXP l i x ' JT ' TOVra 
€9 aXXrjXa Ta oaTea Trapavaytcd^eiv ireipaTar 
tovto irapd nrdvTa Ta ToiavTa [vTro/u,vrjp,aTa] 3 
yapLzv elBevai. oiroTav Be KaTop9toar)<;, ^ev^ai 
p.ev xpr) tou9 oS6Wa9 to 1)9 evOev /cal evOev irpb<; 
dXX)']Xov9, coarrep real irpocrdev eiprjTai. ifjaa'al 

1 Cf. LXIX. 2 iyickivei B Kw. 

* KaTt)y^ara Littre. Erin, omits the whole sentence. 

262 



ON JOINTS, xxxm.-xxxiv. 

This mode of extension by straps gummed on is 
convenient, easy to manage, and very useful for a 
variety of adjustments. Practitioners who have 
manual skill without intelligence show themselves 
such in fractures of the jaw above all other injuries. 
They bandage a fractured jaw in a variety of ways, 
sometimes well, sometimes badlv ; but any bandag- 
ing of a jaw fractured in this way tends to turn the 
fragments inwards 1 at the lesion rather than bring 
them to their natural position. 

XXXIV. When the lower jaw is torn apart at the 
symphysis which is at the chin 2 — this is the only 
symphysis in the lower jaw, while in the upper 
there are many, but I do not want to digress, for 
one must discuss these matters in relation to other 
maladies. When, therefore, the symphysis at the 
chin is separated, anyone can make the adjustment. 
For one should thrust the projecting part inwards, 
making pressure with the fingers, and force out that 
which inclines inwards, using the fingers for counter- 
pressure. This, however, must be done while the 
parts are separated by tension ; for they will thus be 
reduced more easily than if one tries to force the 
bones into position while they override one another 
(this is a thing it is well to bear in mind in all such 
cases 3 ). After adjustment, you shou'd join up the 
teeth on either side as described above. Treat with 



1 Kw.'s reading; Adams prudently has " derange." 

2 The idea that the lower jaw consists of two bones with 
a symphysis at the chin is corrected in Celsus VIII I, hut 
repeated by Galen (perhaps out of respect for Hippocrates), 
though he admits that it is hard to demonstrate. 

3 Perhaps an insertion, but read by Galen. 

263 



IIEPI AP0PDN 

Be %p?) KTjp(orfi zeal o~ir\i]veo~Li> oXljokti real 

20 bOovioiaiv. eirlBeaiv Be fipaye'iT)V rj *• iroiKiXrjv 
pdXiara tovto to x w P iOV eiriBexerat, iyyv? yap 
ti tov laoppoirov eo~TLv, &><? Brj firj laoppoTTOv eov. 
tov Be oOoi'lou ti)v irepifioXiiv Troieladai. XPV> 
fjv pev 7] oegir) yvewo^ e^eaTijKr], em oegia {ein 
Be^td yap vo/xi^erai elvai, r)v i) Be^ir) X^P 7r /°°" 
rjyrjrat tt}? eTrtBeo-ios)' r)v Be r) erepr) yvddos 
e^eari]Kr), eo? eTepcos \pr) rrjv eiriBealv dyeiv. Ktjv 
fiev opOws Tt9 KaropOcocrrjTai, /cal eTrarpeprjar) 
&)9 XP 7 1> Ta X e ^V f 1 ^ V dxOe^is, ol Be oBovtcs 

30 daivees yivovraf rjv Be prj, xpovKorepi] r) dXOetjis, 
Biaarpocpyjv Be lo~xovo~iv ol oBovtcs, koX atvapol 

32 Kal dxpeioi ytvovrai. 

aaav. iiv oe rj pis Kareayj), rpoiros fiev ovx 
el? earl Kari]£to<;' arap troXXd pev Bt) Kal aXXa 
XcofSeoinai ol x a lp ovre< > Trjat KaXf/atv eiriBeaeaiv 
dvev voov, ev Be rolai irepl ttjv piva p,dXio~Ta' 
eiriBecriwv yap ecniv avrr] 7roiKi\o)Tdrr] Kal 
tt\€i<ttov<; p.ev aKeirapvov; exovaa, Biappcoya? 
Be Kal BiaXei-^ria<i irotKiXwrdras tov ^/x»to? 
popfBoeiBeas. &>? ovv eipijTai, ol ttjv dvorjTov 
evxeipw €TTiTi]Bevovre<i da/xevoL pivos Karer)yvir)<; 

10 eirirvyxdvovai, &>? e7riB/]o-o)cnv. pir/v pev ovv 
rjfiepav r) Bvo dydWerai pev 6 li]Tp6$, x ai P ei ^ 
6 e7riBeBepei'0<;' eireira Tax^S pev 6 iTriBeBe/mevos 
KoplaKerat, darjpbv yap to cjyopTjpa' dpKel Be tw 
IrjTpw, e7reiBr) e7re8ei£ev on err'to-raTai ttoiklXq)? 
piva e-ntBelv. iroiel Be r) eTrlBecns rj Toiavrii 

1 " Rather than " ; cf. Surg. XIV, Luke 17. 2. "Simple 
rather than complex"; but cf. Galen, who says that the 

264 



ON JOINTS, xxxiv.-xxxv. 

cerate and a few pads and bandages. A simple 
dressing rather than a complicated one is specially 
suited to this part, for it is nearly cylindrical x 
without actually being so. The bandage should be 
carried round to the right if the right jaw sticks 
out (it is said to be " to the right " if the right 
hand precedes in bandaging 2 ) : while if the other 
jaw projects, make the bandaging the other way. 
If the bandaging is well done and the patient keeps 
at rest, as he should, recovery is rapid, and the 
teeth are not damaged ; if not, recovery is slow, 
and the teeth remain distorted and become damaged 
and useless. 

XXXV. If the nose is broken, which happens in 
more than one way, those who delight in fine 
bandaging without judgment do more damage than 
usual. For this is the most varied of bandagings, 
having the most adze-like turns and diverse rhomboid 
intervals and vacancies. 3 Xow, as I said, those who 
devote themselves to a foolish parade of manual skill 
are especially delighted to find a fractured nose to 
bandage. The result is that the practitioner rejoices, 
and the patient is pleased for one or two days ; after- 
wards the patient soon has enough of it, for the 
burden is tiresome ; and as for the practitioner, he 
is satisfied with showing that he knows how to apply 
complicated nasal bandages. But such bandaging 

1 l(r6p(>mros=" cylindrical " (Galen). "Semicircular" is 
perhaps clearer. 

- I.e.. to the surgeon's right, but from right to left of the 
patient's jaw (Galen). 

3 5iaAa,ui^as (Kvv. , Apollon. ). 

lower jaw is the part on which students exercised their skill 
in complex forms of bandaging. (XVIII. (1) 4G2). 

265 



IIEPI AP0PQN 

TTavra Taiavria tov oeovTos' tovtg pev 'yap, 
oirocroL atfiovvrai Sid rr/v Kcirrj^tv, StjXovoti el 
dvwOev tis /xaWov irte^oi, aipcoTepoi av en elev 
tovto Be, ocroiai irapaarpe^erai r) evda r) evda 

20 r) pis, i) Kara top ^ovSpov i) dvooTepco, Si]Xov6ti 
ovSev avTovs r) dvwOev eVtSecrt? axpeXijaeiev, 1 
dXXa koX flXd^ete 2 pd\Xov oy^ ovtco jap ev 
avvappoaei airX^veai to eVt daTepov Trjs pivos' 

24 kcl'itoi ov&e tovto TToieovaiv 01 eirtBeovTe 1 ;. 

XXXVI. "Ay^tcrTa Be r) eirlBeais poi Borcel 
dv ti iroielv, el kcltci peaip> tijv piva kcito, to 
6£v dp<f>Kp\aa6et7) i) adp^ /cctTa to ocneov, rj el 

KCtTCL TO OO-TeOV Q-p,lK.pOV Tl CTLVOS €17), 3 KCU pLTj 

pLeyw toIctl yap tolovtoicfiv eirnroopoypa tcr^ei rj 
pes, /cal oKpioeiSeaTepr/ tivI yiveTar dXX opboos 
ovBe TOVTOicn 8?/ ttov 7ro\Xov o%Xov BeiTat r) 
eiTLoecns, et b)) ti Kai bei eirioeiv. apicei oe eiri 
pev to cf)\do~pa cnrXrjviov eiriTeivavTa KeKr/poo- 

10 puevov, eireiTa &)? dirb Buo dpyewv eTrtBeiTai, 
OUTGO? oOcviut e? cnra% irepifidXXeiv. dplaTt) 
pbkvToi h]Tpeii]T(p aXr/Top, t5> crrjTavwp, t&> ttXvtw, 
y\io"%pip, irecpvppevrp, oXiyw, KaTawXdaaeiv to, 
TOiavTW ypi] Be, r)v piev if- dyadrov rj tojv Trvpdov 
to aXr/TOv koX evoX/ctpov, tovtu> y^prjnOai e? 
irdi'Ta tc\ ToiavTW rjv Be /x>; irdvv bX/cip,ov r), e? 
oXlyy]v pdvvr/v vBaTC &)? XeioTUT>]v BievTa. tovtm 
(pvpdv to d\i]Tov, y) Kop^pa irdvv oXiyov coaavTox; 

19 piayeiv. 

XXXVII. 'O-rroaoicn p,ev ovv pis e? to kutco 



1 i><pe\-fi<rei. 2 @Ari\pft. 

3 eX"«- 



266 



ON JOINTS, xxxv.-xxxvn. 

acts in every way contrary to what is proper ; for 
first, in cases where the nose is rendered concave 
by the fracture, if more pressure is applied from 
above, it will obviously be more concave, and again 
in cases where the nose is distorted to either side, 
whether in the cartilaginous part or higher up, 
bandaging will obviously be useless in either case, 
and will rather do harm ; for so one will not arrange 
the pads well on the other side of the nose, and in 
fact those who put on bandages omit this. 

XXXVI. Bandaging seems to me to be most 
directly x useful where the soft parts are contused 
against the bone in the middle of the nose at the 
ridge, or when, without great damage, there is some 
small injury at the bone ; for in such cases the nose 
gets a superficial callus and a certain jagged outline. 
But not even in these cases is there need of very 
troublesome bandaging, even if it is required at all. 
It suffices to stretch a small compress soaked in 
cerate over the contusion and then take one turn of 
bandage round it, as from a two-headed roller. 
After all, the best treatment is to use a little fresh 
flour, worked and kneaded into a glutinous mass, as 
a plaster for such lesions. If one has wheat flour 2 
of good quality forming a ductile paste, one should 
use it in all such cases ; but if it is not very ductile, 
soak a little frankincense powdered as finely as 
possible in water, and knead the flour with this, or 
mix a very little gum in the same way. 3 

XXXVII. In cases where the nose is fractured with 

1 &yx"TTa = ixtLhiara (Erolian). 

* <rr}T&vws may lie either summer wheat or a special kin<l 
rich in gluten ((Jalen). 
4 fidi'va = powder of frankincense (Dioscorules 1.68). 

267 



IIEPI AP0PQN 

teal e<? to crifiov pewouaa tcarayf], rjv jxev ite tov 
epLirpocrOev piepeos Kara tov %6vhpov i'^rat, olov 
re iart teal evTiOevai ti ^lopOcofia e? tovs 
fiu/crr/pas' rjv Be paf), dvopOovv p,ev XPV Travra 
ra TOiaura, rovs 8arcTv\ov<; e? tov<; /j,vteT))pa^ 
ivTiOevTa, rjv evBexv Tai > rjv Be pbrj, irdy^y vird- 
XeiTTTpov, [xi] e? to epbirpoaOev tt}? pivbs dvdyovTa 
Toiat BateTvXoiat, aW* fj IBpuTar etjcoOev Be t?i<; 

10 ptvbs evOev teal evOev dfi<pi\a/j./3dvuvTa Tolat, 
BatcTvXoiat,, avvavayted^eiv tc a/na teal dva<pepeiv 
e9 to dvco. teal rjv fiev irdvv ev rS> efnrpoaOev to 
fcdrrjy/jia r), 1 olov re n teal eaco tcov fivteTt'jpcov 
ivTiOevai, coairep rjBr-j elprjrai, rj dyyriv Tr)v a<£>' 
rjfXiTV^LOv rj d\Xo ti toiovtov, ev oOovico elXia- 
aovTa, fiaWov Be ev KapxrjBovlw Bepp-an 
ippdyjravTa- ax^P-dTiaavTa to dpjxoaaov a^r/fia 
tw ^wptft), iv a eytcefaeTai. rjv fiemoi irpoacoTepco 
77 to KaTriypua, ovBev olov tg eaco evTiBevar ical 

20 yap el ev tco epbirpoa6ev darjpbv to cf>6pr)p,a, 7rco? 
ye Br) ov/c ev tm eacoTepco ; to p.ev ovv irpcoTOv 
teal e^coOev dvairXdaaaQai teal eacoOev dcpeiBrj- 
cravTa XPV dvayayelv e? Tr)v cipx a ^V v <pv o ~ lv Ka ^ 
BiopOcoaaadai. tcdpTa yap o'li) t€ pis teaTayeiaa 
dvairXdaaeaQai, p,d\iaTa p.ev avO>]p,epov, 2 rjv 
Be fiij, oXlyco vaTepov dXXd KaTaftXaicevovaiv 
01 hiTpoi, teal diraXcoTepcos to rrpcoTov diTTOVTai 
rj a>9 XP'l' TrapafidWovTa yap tou? BatcTvXov? 
XPV GvO'ev teal evOev teaTci Trjv <f>vaiv tt}<? pivos 

30 C09 tcaTcoTc'iTco, tcc'iTcoBev avvavayed^eiv, kcu ovtco 
fidXicTTa dvopQovadai 3 avv Trj tacodev BiopOcoaet 

1 el . . . efij. 2 av0-f)/xtpos. * kvopBovvra. Kw. 

268 



ON JOINTS, xxxvn. 

depression and tends to become snub, if the depres- 
sion is in the front part of the cartilage, it is possible 
to insert some rectifying support into the nostrils. 
Failing this, one should elevate all such cases, if 
possible by inserting the finger into the nostrils, but 
if not, a thick spatula should be inserted, directing 
it with the fingers, not to the front of the nose, but 
to the depressed part : then getting a grip on each 
side of the nose outside with the fingers, combine the 
two movements of compression and lifting. If the 
fracture is quite in front, it is possible, as was said, to 
insert something into the nostrils, either lint from 
linen or something of the kind, rolling it up in a rag, 
or better, sewing it up in Carthaginian leather, 
adapting its shape to fit the part where it will lie. 
But if the fracture be further in, nothing can be 
inserted ; for if it is irksome to endure anything in 
front, how should it not be more so further in? 
The first thing, then, is to reshape it from outside, 
and internally to spare no pains in adjusting it and 
bringing it to its natural position ; for it is quite 
possible for a broken nose to be reshaped, especially 
on the day of the accident, or, failing that, a little 
later. But practitioners act feebly, and treat it at 
first mo'-e gently than they should. For one ought 
to insert 1 the fingers on each side as far as the 
conformation of the nose allows, and then force it 
up from below, thus best combining elevation with 
the rectification from within. Further, no practi- 

1 Editors discuss the obscurity of this passage at great 
length. The main point is whether the fingers are inserted 
or applied to the outside of the nose. I follow Krmerins and 
Petrequin an against Li tire- Adams : though there is much 
to he said on buth sides. 

269 



IIEPI AP0PQN 

[BiopOovvTa]- 1 eireira Be e'<? ravra Irjrpb? ovSefc 
dXXo? iarl toiovtos, el edeXoi koX peXerdv ical 
ToXp,dv, to? oi Bd/crvXot aurov oi Xi^avoL' ovroi 
yap Kara (bvaiv paXtcrTa elcnv. irapafiaXXovTa 
yap XPV T(OV octKTvhiov e/carepov, irapa iracrav 
tt)V plva epelBovTa, r)au)(0)<; ourais e%eiv, p,dXtaTa 
p.ev, el olbv re ecrj, alei, ear dv Kparuvdfj- el Be 
prj, a>9 irXelarov xpovov, avTov, &><? ecptjTaf el 

40 Be p,i], rj iralSa rj yvvalicd Tiva' paXda/ca? jap 
Ta<? xeipas Sec elvai' outgo yap dv KaXXtcna 
IrjTpevOeit) oreat r) pis pi) e\ to ctkoXiov, aXX e? 
to kutco IBpvpevr), laoppoTTOs eh], eyu> pev ovv 
ovBepirjv ttov plva elBov i]ra ovrco Karayetaa 
ovy o'Cr) re BiopOojdrjvac avrlxa irplv irwpwO^vai 
avvavayKa^opevq eyevero, el tj? bpdws eOeXoi 
IrjTpeveiv dXXd yap oi dvOpoirroi aia^poi, p,ev 
elvai 7roXXov diroTipbSiai, peXerav Be dpa pev ovrc 
iirlaTavrac, dpa Be ou ToXp,wcni', rjv p,rj oBvvwv- 

50 rat, rj ddvarov BeBotK(oo-w /cairoi oXtyoxpovios 
r) ircopwo-ts rrjq pivos' ev yap Be/ca r)pep;jai 

52 Kparvverai, rjv prj iruacfraKeXicrrj. 

XXXVIII. 'O-ttoo-oio-i Be to bo-Teov h to 
•nXdyiov Kardyvvrai, r) pev h]ais r) avTiy Tr\v Be 
BiopOwo-iv Br)XovoTL yph TTOtelo-Qai. ouk laoppoirov 
dp,(f>OTepu}0ev, dXXd to tc e/c/ce/cXipevov 2 <o0elv 
e? tt)v (f)i>o-iv, eKToaOev dvayicdtovTa koX ecrpa- 
Tevopevov e'<? tou? pvKT?)pa<s, teal t« ecra> pe\fraiTa 
BiopOovv do/cvaxi, ear dv fcaTopOioo-yi, ev elBora 
oti, rjv purj avTL/ca KaTop0d)ai)Tai, ovx, olbv Te prj 
ou%t Siecnpdif)0ai Trjv plva. orav Be dydygs 6S 

1 Galen. Omit most MSS., Littre, etc. 
270 



ON JOINTS, xxxvii.-xxxvni. 

tioner is so suitable for the job as are the index 
fingers of the patient himself, if he is willing to 
be careful and courageous, for these fingers are 
especially conformable to the nose. He should 
insert the fingers alternately, 1 making pressure 
along the whole course of the nose, and keeping it 
steady ; especially let him continue it, if he can, till 
consolidation occurs, failing that, as long as possible. 
As was said, he should do it himself; but if not, a 
boy or woman must do it, for the hands should be 
soft. This is the best treatment when the nose is 
not distorted laterally, but keeps evenly balanced 
though depressed. Now, I never saw a nose fractured 
in this way which could not be adjusted by immediate 
foix-ible manipulation before consolidation set in, if 
one chose to treat it properly. But while men will 
give much to avoid being ugly, they do not know 
how to combine care with endurance, unless they 
suffer pain or fear death. Yet the formation of 
callus in the nose takes little time, for it is con- 
solidated in ten days, unless necrosis supervenes. 

XXX VII I. In cases where the bone is fractured 
with deviation, the treatment is the same. Adjust- 
ment should obviously not be made evenly on both 
sides, but press the bent-out part into its natural 
position by force from without, and, introducing the 
finger into the nostrils, boldly rectify the internal 
deviation till you get it straight, bearing in mind 
that, if it is not straightened at once, the nose will 
infallibly be distorted. And when you bring it to 

1 This seems the surgical implication of eKdreonv. Cf. 
Sur.j. X. 



271 



IIEPI AP0PHN 

10 tt)v cpvtriv, Trpoa(3dWovTa %pr) e? to %coptov r) 
rouf 8a/crvXov<; i) tov eva Sd/cruXov, rj i^ecr^ev 
dvaKco^elv i) aijTov r) aXXov rtvci, ear av 
KparvvOfj to TpSifxa. aTap /cat e? tov ptVKTqpa 
tov apttKpbv hdtcTv\ov airoideovTa aXXoTe Kal 
aXXoTe BiopOovv xprj ra 6yK.Xt9e.VTa. 6 ti S' av 
cpXeyptovfo VTroytv)]Tat tovtoicti, Set tco OTatTi 
y^pr\aBai' Tolat ptevTOi SaKTvXotcri irpotre^etv 
bptolca Kal tov aTatTo<i eiriKetptevov. 

*Hr Se ttov KaTa tov %6vSpov e? ra nrXayia 

20 icaTayfj, avdy/c-rj ttjv plva d/cpyv irapeo-Tpd(p6at. 
■%pr) ovv Total toiovtoictiv e? tov ptvKTr)pa dicpov 
SiopOtoptd tl tcov elpiiptevcov i) 6 ti tovtokjlv 
eoiKev ivTiOevat. iroXXd 8' av Tt? evpot to, 
eiriTijSeta, oaa p^ipre 6Sptr)v tercet, aXXws Te Kal 
TTpoo~rjvea ecntv iyco Se ttotc TrXevptovos irpo- 
ftaTOV air ot ptT] pta ireOr/Ka, tovto ydp 7r&>9 
irapeTV^ev ol yap trrroyyoi evTiOeptevot vypdtr- 
ptaTa Se^ovTai. eiretTa ^pr) Kap^Soviov Sep- 
ptaTos Xoitov, 7rXaTo<? a>$ tov pteydXov SaKTvXov 

30 TeTptrj^tevov, r\ ottcos civ avptcpepr), Trpoo~KoXXr)aat 
e? to eKToaOev 777309 tov ptvKTqpa tov ckkckXi- 
pevov. ndireiTa icaTaTeivat tov IptdvTa o7ra)? 
dv avptcpepr)' ptdWov Se oXtyrp Teiveiv XP'h wffT6 2 
opOrjv Kal dirapT)} 3 ttjv plva eivai. eiretTa— 
ptaKpbs yap eaTw o ifxd$ — KaTwQev 4 tov goto? 
dyayovTa auTov avayayelv irepl ttjv KecpaXijv 
Kat e^ecTTt ptev KaTa to pteTcowov irpoo-KoXXrtaat 
ttjv TeXevTrjv tov iptavTos, e^eaTi Se Kal ptaKpo- 
Tepov [dyetv , eireiTa] 7repieXiaaoiTa 5 irepl ry-jv 

40 K€(pa\?)v KaTabetv. tovto apta ptev SiKatyjv ttjv 

1 ty/cc/cAiyue'eor. z ^ ware. 

272 



ON JOINTS, xxxviii. 

the normal, one or more fingers should be applied at 
the place where it stuck out, and either the patient 
or someone else should support it till the lesion is 
consolidated. One should also insert the little 
finger from time to time into the nostril and adjust 
the depressed part. If inflammation arises in these 
cases, one should use the dough, but keep up the 
finger application as before, even when the dough is 
on. 

If fracture with deviation occurs in the cartilage, 
the end of the nose will infallibly be distorted. In 
such cases, insert one of the internal props men- 
tioned above, or something of the kind, into the 
nasal opening. One could find many suitable sub- 
stances without odour and otherwise comfortable. 
I once inserted a slice from a sheep's luno- which 
happened to be handy ; for when sponges are 
put in, they absorb moisture. Then one should 
take the outer layer of Carthaginian leather, cut a 
strip of a thumb's breadth, or what is suitable, and 
gum it to the outer part of the nostril on the bent 
side. Next, make suitable tension on the strap 
—one should pull rather more than suffices to make 
the nose straight and outstanding. 1 Then — the strap 
should be a lung one — bring it under the ear and 
up round the head. One may gum the end of the 
strap on to the forehead. One may also carry it 
further, and after making a turn round the head, 
fasten it off'. This gives an adjustment which is at 

1 anaprririiv Kw. inapr?] (ialen, Littre, vulg. 



8 aTraprrjTiif. 4 it to KonuOiV. 

5 l-KiirepuKiooovTa, Littre, K\V., who omit &yetv, *7r«=iTa. 



273 



1IEPI AP0PAN 

SiopBaxTiv e^ei, afia Be evrafxievrov, Kal fiaXXov, 
rjv ideXy, Kal rjacrov rrjv dvTippo7rii]v ■non)(jeTai 1 
ttjs pivos. cnap Kal onoaoicnv is to irXdyiov rj 
pis Kardyvvrai, ra, /xev dXXa IrjTpeveiv \pr] cos 
irpoeiprjTar TrpoaSeiTai Be rolai TrXetcrToiai Kal 
tov lp,dvTOS irpbs aKprjv ttjv plva irpoa KoXXrjO r\vai 

47 Tr\s dvTippoTTii)? eipcKa. 

XXXIX. Ottocomti Be aw rfj KaTi'jfjei Kal 
ek,Kea irpoaylveTai, ovBev Bel TapdaaeaOat Bed 
tovto' aXX,' eVt p.ev ra ekKea iirinOevaL r) 
Tn<j<jr)pi)v rj tcov evaljxwv Tf evaXdea yap tcov 
tolovtcov ra TrXelard ecniv ofxolcos, Krjv oarea 
fieXXrj dirievai. ttjv Be BiopOcoaiv ttjv TrpcoTrjv 
uokvcos y(pr) ■noieladat, fxi]Bev eTTiXeiTrovTa, Kal 
Tas BtopOcoatas rolai BaKrvXoiai iv tco eVetTa 
Xpova) 2 yjaXapwrepoLcri p,ev -%peofxevov, ^peop.evov 

10 Be' euTrXaaTorarov ydp tl iravTos tov crcopaTos 
t) pis iaTiv. tcov Be lp.dvTCOv Tj} KoXX-qcret Kal 
Tfj dvTip'poTTtr) TravTairaaiv ovBev KcoXvet ^pt)a- 
vai, ovt rjv eKKOS y, ovt r)v e7ricpXey/jLi]vrj' 

14 dXvTTOTaTai ydp eiaiv. 

XL. *Hv Be ovs KaTayfj, emBeaies fiev Ttdoai 
7roXep,iar ov ydp ovtco tis x a ^ a P 0V 7repi/3dXXor 3 
rjv Be /jluXXov Trie^y, irXeov Kaxov ipydasTar 
eirel Kal bytes ovs, eV/ Secret irie\6ev, bBvvr)pbv 
koX a(f)vyp,aTCoBes Kal TrvpeTcoBes yiveTai. ciTap 
Kal ra eirnrXdcTpLaTa, KaKiaTa fiev Ta (3apv- 
Tara to eimrav aTap Kat TrXeloTa cpXavpa 
Kal diroaTaTiKa, Kal fiv^av Te inroiroiel [V/Vet'co], 4 

I TTuiriaat. 2 to7(tiv . . . x_i>6i'oii. 

II nt^LfidWa. * Omit. 

274 



ON JOINTS, xxxviii.-xl. 

once normal and easily arranged ; and one can make 
the counter-deviation of the nose more or less as 
one chooses. Again, when the [bone of the] nose is 
fractured with deviation, besides the other treat- 
ment mentioned, it is also necessary in most cases 
that some of the leather should be gummed on to 
the tip of the nose to make counter-deviation. 1 

XXXIX. In cases where the fracture is compli- 
cated with wounds, there should be no alarm on 
that account, but one should apply an ointment 
containing pitch or some other remedy for fresh 
wounds ; for the majority of such cases heal no less 
readily, even if bones are going to come away. The 
first adjustment should be made without delay and 
with completeness ; the later rectifications with the 
fingers are to be done more moderately, yet they 
are to be done, for of all parts of the body the nose 
is most easily modelled. There is absolutely no 
objection to the gumming on of straps and counter- 
deviation, not even if there is a wound or inflam- 
mation supervening, for the manipulations are quite 
painless. 

XL. If the ear is fractured, all bandaging is harm- 
ful, for one cannot apply a circular bandage so as to 
be lax ; and if one uses more pressure one will do 
further damage, for even a sound ear under pressure 
of a bandage becomes painful, throbbing, and heated. 
Besides, as to plasters, the heaviest on the whole 
are the worst ; they have also for the most part 
harmful qualities producing abscess, excessive for- 
mation of mucus, and afterwards troublesome dis- 

1 Galen found this gummed leather method very unsatis- 
factory ; " if you pull hard enough to do any good, it conns 
off" (XVIII ^1) 481). 

275 



IIEPI AP0PQN 

KarreiTa etcirvrja las darjpds' rovrcov Be rjKiaTa 
10 01)9 /ccnayev it poaBelTar ayxtara p*t]v, elirep 
Xpi], to yXia^pov aXyrov, XP*) ^ p,r)Be tovto 
/3dpo<; e^eiv. tyaveiv Be 009 r\K.iaTa avpxpep&i' 
dyadbv <ydp (pdpp,a/c6v eartv evlore /cat to p,rjBev 
irpoacfyepeiv, Kal 77/309 to ou? Kal 77-/309 dXXa 
iroXXd. %ph Be teal ttjv eiriKOipirjaiv <f)vXda- 
aeadai- to Be awp.a lo-yyaiveiv, Kal /.idXXov <x> 
dv klvBvvos fj epbirvov to ovs yeveaOai- dp.eivov 
Be teal p,aXddtjai ttjv kolXitjv • rjv Be teal evrfpueTO 1 ; 1 
fj, ep,eiv €K avpp.aiap.ov. rjv Be e'9 eparv^aiv eXdrj, 
20 Ta^ew? fxev ov XP r l aropovv TroXXa yap teal 
tS)v Bo/ceovTcov etcirveladat dvairlveiai ttotc, 
ktjv p,r]Bev Ti9 KarairXdaar). r)v Be dvayKaaOfj 
aropLtoaai, Ta^CTa p^ev vyies yiverai, r\v T£9 
irepyv Biatcavarj- elBevai p.evroi XPV cra<p6o<i oti 
kvXXov karat rb o5?, teal p,elov rov erepov, 
rjv Treprjv BiaKavdfj. r)v Be p,r) ireptjv KairjTai, 
rdp-veiv xprj to p-erewpov, p,r) ttuvv aputcpijv 
rop.i]v Bid 7raxvTepov Kal to ttvov evpuatcerai, 
rj &)? dv t*9 Botceoi- &>9 B ev Ke(paXaia> elireiv, 2 
30 Kal iravra TaXXa rd p,v%u>Bea teal /xv^OTroid, 
aT€ yXiaxpa ebvra, inro0iyyav6p.eva BioXiaddvei 
Ta;^eft>9 vtto TOL19 BareTuXovs Kal evOa Kal evOa' 
Bid tovto Bid Tra^vTepov ebp'iaKOvai ra Toiaina oi 
lijTpol rj ft)9 o'iovTar iirel Kal tosv yayyXicoBecov 
evia, oaa dv irXaBapd rj, Kal p,v£ooBea adpKa 
^XV* iroXXol aTop.ovaiv, olo/xevoi pevp-a dvevp?}- 
aeiv e'9 rd ToiavTa' r) p.ev ovv yvd)p,r} tov LtjTpov 
e^airaTdrar tw Be irpy]yp.aTi tu> toiovtco ovBeuia 
j3Xd(Br) aTop.coOevTi. oaa Be vBaTooBea ^a>/Jta 

1 evtjxeTrjs K.W. * fipijcOai. 

276 



ON JOINTS, xi.. 

charges of pus. A fractured ear is far from needing 
these as well. If need be, the best application is 
the glutinous flour plaster ; but even this should 
not be heavy. It is well to touch the part as 
little as possible, for it is a good remedy some- 
times to use nothing, both in the case of the ear 
and many others. Care must be taken as to the 
way of lying. Keep the patient on low diet, the 
more so if there is danger of an abscess in the ear. 
It is also good to loosen the bowels, and, if he 
vomits easily, cause emesis by "syrmaism." 1 If it 
comes to suppuration, do not be in a hurry to open 
the abscess, for in many cases when there seems to 
be suppuration, it is absorbed, and that without any 
application. If one is forced to open an abscess, it 
will heal most quickly by cauterising right through ; 
but bear well in mind that the ear, if cauterised 
right through, will be deformed and smaller than 
the other. If it is not cauterised through, one 
should make an incision in the swollen part, not very 
small, for the pus will be found under a thicker 
covering than one would expect. And, speaking 
generally, all other parts of a mucous nature, or 
which secrete mucus, being viscous slip about readily 
hither and thither when palpated, wherefore practi- 
tioners find them thicker to penetrate than they 
expected. Thus, in the case of some ganglionic 
tumours which are flabby and have mucoid flesh, 
many open them, thinking to find a flux of humours 
to such parts. The practitioner is deceived in his 
opinion; but in practice no harm is done by such 
a tumour being opened. Now, as to watery parts, 

1 An emetic of radishes and salt water (Erotian): cf. 
Herod IT. 83. 

277 



IIEPI AP0PON 

SO ecrrlv r) lAvfyi's 7re7rXr)pcop.eva, Kal iv oioicri 
'XoopLoiGLv eKacrra ddvarov cpepei aTop.ovp.eva r) 
Kal dXXoias /3Xa/3a?, trepl tovtcov iv dXXco Xoyco 
yeypdyjreTai. orav ovv rd/ny 779 to ovs, ttuvtcov 
fiev /caTaTrXaafidrcov, 7rao"»/? Be /xorooaios d-ne- 
yeadai XP 7 ')' lv T P e ^ €lv Be i) ii'aip.cp r) dXXco tw 
o Tt /jli']T€ ftdpos /xt'jTe itovov irapaayijaei' r)v yap 
6 ~x,6vhpo<i dp^irai tyiXovadai, Kal inrocrrdcnas 
tiTYfj [irvpcoBea^ r) ^oXcoSea<?], 1 o^Xco6*e<? 2 [«-at] p-oyj- 
Orjpov ylverai Be tovto 6Y e'/cetVa? t«9 Itfaias. 

50 ttuvtcov Be tcov iraXtyKOTrjadvTcov r) ireprjv Bid- 

51 Kavais avrapicecnaTov. 

XLI. XrrovBvXoi Be oi Kara pdyiv, daoiai p-ev 
inro voarj/ndrcov eXKOvTai e? to Kvcpov, ra p,ev 
ifXelara dhvvara XveaOai, ttotI Kal baa dvcoTepco 
tcov cppevcov t?)9 irpoacpvaio^ KvcpouTai. tcov Be 
KaTcoTepco p,eTe%eTepa Xvovai Kipaol yevopievoi iv 
rot? GKekecn, pidXXov B' eVi eyyivojxevoi Kipaol 
iv ttj «ara iyvvr\v cpXeffi' olai 8' dv to Kvcpcopia'ia 
Xi/y]Tai, iyytvovTai Be iv Tjj KaTa /3ov/3cova' i]Brj 
Be Tiaiv eXvae Kal BvaevTepirj iroXvypovio^ yevo- 
10 p.evr). Kal dial puev KvcpovTai pd%i$ nraialv iovai, 
irplv r) to acop,a TeXeicoOfjvai e? av^rjaiv tovtoloi 
p.ev ouBe avvav^eaOai iOeXet KaTa ttjv pdyiv to 
acopba, dXXa cTKeXea p.ev Kal yelpes TeXeiouvTar 
TavTa Be ivBeeaTepa yiveTai. Kal baoiaiv dv r} 
dvcoTepco tcov cppevcov to Kvcpos, TovTOiac fiev ai 
Te irXevpal ouk ideXovaiv e? to evpu av^eaOai, 
dXXa e? Tovpurpoadev, to Be cnr]0o<i 6%v yiveTai, 
278 



ON JOINTS, xL.-xLi. 

or those filled with mucus, and in what parts 
severally opening brings death or other damage, 
these matters will be discussed in another treatise. 1 
When, then, one incises the ear, all plasters 2 and 
all plugging should be avoided. Treat with an 
application for fresh wounds, or something else 
neither heavy nor painful. For if the cartilage begins 
to get denuded and has troublesome abscesses, 3 it 
is bad, and this is the result of that treatment [viz. 
plasters and plugging with tents]. Perforating 
cautery is most effective by itself for all supervening 
aggravations. 

XLI. When the spinal vertebrae are drawn into a 
hump by diseases, most cases are incurable, especially 
when the hump is formed above the attachment of the 
diaphragm. Some of those lower down are resolved 
when varicosities form in the legs, and still more 
when these are in the vein at the back of the knee. 
In cases where curvatures resolve, varicosities may 
also arise in the groin ; and, in some, prolonged 
dysentery causes resolution. When hump-back 
occurs in children before the body has completed its 
growth, the legs and arms attain full size, but the 
bodv will not grow correspondingly at the spine; 
these parts are defective. And where the hump is 
above the diaphragm, the ribs do not enlarge in 
breadth, but forwards, and the chest becomes pointed 

1 Not extant. 

2 "Plasters bandaged on": cf. Wounds in the Hea./' 
XVII. 

8 Kw.'s reading. 

1 Littiv, Kw. omit. 

* ox^Seas, Kw The M.SS. are very confused. 

279 



IIEPI AF0PDN 

aXX ov irXaTv, avroi re hvairvooi yivovTai /ecu 
Kepxvwhee<;' r)aaov yap evpvxcopitjv typvaiv al kol- 

20 Xiai ai to irvevpa oexopevat Kal irpoirkpiTovaai. 
/cal yap 8tj /cai dvayKa^ovTai Kara tov pueyav 
cnrovSvXov XopSov zeal 1 av^eva e%eif, a>9 p,rj 
7rpo7reT?)? y avTolai r) KecpaXiy o-Tevoywpii]v piev 
ovv ttoXXtjv rfi (pdpvyyi irape^ei, /cat tovto e? 
to earn penov teaX yap Tolatv bpdolai cpvaei Sva- 
irvoiav Trapexei tovto to OTaeov, i)v eaco pe^y, 
ear' dv dva-mex^f}- ^' ovv ro toioutov axvpa 
igexefipoyxoi ol toiovtol tmv dvdpdoirwv pdX- 
Xov (palvovTai r) ol vyiees' (pvpaTcai tc go? e-rrl to 

30 ttoXv KaTa tov irXevpovd eiaiv ol tolovtoi cr/cA.77- 
poiv cpvpaTcov Kal d-TreTTTcov zeal yap 1) irpd<f>aai<; 
tov Kv<fid>paTos Kal r) avvTaai<; Tolai irXe'iaToiai 
8id ToiavTas avaTpocpd? ytveTai, f/aiv dv koivcovij- 
acoaiv 01 tovoi ot avveyyvs. baocai 8e KaTcoTepco 
twv (ppevwv to Kvcpu>p,d ia-Ti, TOVToiai voarjpaTa 
p,ev evloiai irpoayiveTai vecppiTiKa Kal KaTa 
kvcttiv aTap Kal diroaTu cries epLirvrjpaTtKal 
KaTa Kevem>a<i Kal KaTa j3ovj3oyvas, XPoviac Kal 
8vaa~\0ee<;, Kal tovtcov ovherepr) Xvei to, Kvcpca- 

40 p,aTa' Lo-x ia &£ TOiovToiaiv en daapKOTepa ytve- 
Tai r) Tola iv dvwBev Kvcpolaiv rj pAvToi avpiraaa 
pax^S paKpoTeprj TovToiatv rj Tolaiv dvcoOev 
KV(f>olaiv. rjftrj 8e Kal yeveiov fipaSvTepa Kal 
UTeXeaTepa, Kal dyovooTepoi ovtoi tcov dvwdev 
Kvcpcov. oiai 8 dv i]v£>)pevoiai yBr} to acopa 
7) Kvcjxoai? yevr\Tai, TovTocai d-navTLKpv pev t^? 
vovaov Tr;? Tore irapeovai]<; Kplaiv nuiel r) 



1 rbv. 
280 



ON JOINTS, xli. 

instead of broad ; the patients also get short of 
breath and hoarse, for the cavities which receive 
and send out the breath have smaller capacity. 
Besides, they are also obliged to hold the neck con- 
cave at the great vertebra, 1 that the head may not 
be thrown forwards. This, then, causes great con- 
striction in the gullet, since it inclines inwards ; for 
this bone, if it inclines inwards, causes difficult 
breathing even in undeformed persons, until it is 
pushed back. In consequence of this attitude, such 
persons seem to have the larynx more projecting 
than the healthy. They have also, as a rule, hard 
and unripened 2 tubercles in the lungs; for the 
origin of the curvature and contraction is in most 
cases due to such gatherings, in which the neigh- 
bouring ligaments take part. Cases where the 
curvature is below the diaphragm are sometimes 
complicated with affections of the kidneys and parts 
about the bladder, and besides there are purulent 
abscessions in the lumbar region and about the 
groins, chronic and hard to cure ; and neither of 
these causes resolution of the curvatures. The hips 
are still more attenuated in such cases than where 
the hump is high up; yet the spine as a whole is 
longer in these than in high curvatures. But the 
hair on the pubes and chin is later and more defec- 
tive, and they are less capable of generation than 
those who have the hump higher up. When curva- 
ture comes on in persons whose bodily growth is 
complete, its occurrence produces an apparent 3 crisis 

1 Axis or second cervical, according to Galen, hut perhaps 
the seventh. Of. XLV. 

* IT n matured or softened. 

* Or, "to begin with": most translators, "obviously." 

281 



IIEPI AP0PDN 

Kvfywaw avd ypovov /uevroi eTnarjp.aivei n rcov 
avrcov, (bairep tcaX rolcn veMrepoicriv, 1 r) nrXeov r) 
50 eXaaaov rjcraov he kcikoiJOcos o>9 to iiriirav p,rjv 
roiavra rrdvra eariv. rroXXol p,evroi rjhrj kcu 
eixpopax; rjvey/cav /cal vyieivcos 2 rrjv Kvcpcoaiv 
a%pi yrfpaos, pidXicrra he ovrot, olaiv av e? to 
evaapicov teal mpLeXcohef Trporpdir^rai. to acop-a' 
oXiyoi p,r)v 7]hi) /cal rwv roiovrcov vTrep e£?]K0VTa 
e77) efSLoaaav oi Be TrXeiaroi /3payv^id>repoL 
elaiv. eart, 8' olcri /cal e? to irKayiov a/coXiovvrai 

aTTOvhvXoi rj TT) f) Tjj' TTaVTCl pLTjV Tj TO. irXeiara 

ra roiavra yiverai hid avarpoipwi ra<; eawOev 
60 t?}? patios' tt poaav pu^dXXerai he evioicri crvv rfj 
vovcrcp /cal ra aryij/xara, e<§> onoia av eOicrdewai 
Ke/cXiadai. dXXd irepl p,ev rovrwv iv rolcn 
■%povioio~i Kara TrXevp-ova voarjpuacriv elp^aerai' 
creel yap elaiv avrcov yapiecrrarat. Trpoyvcocries 
05 irepl TOiv pueXXovrwv eaeadai. 

XLII. "Ocroicri h i/c KaTaTTTuxrio^ pdyis 
KV(f)OUTai, oXiya hr) rovrcov €Kpari]0rj wore 
i£i0v@ijvai. rovro p.ev yap, ai iv rfj icXip,aia /ca- 
raaeicrie<; ovheva irco i^idvvav, Siv ye eyto oiha' 
ypeovrai he oi Itjrpol p,dXiara avrfj oi eVt- 
dvpieovres eK^auvovv rbv ttoXvv oyXov rolcn, 
yap ToiovToiai ravra Qavp,daid icrriv, rjv i) 
Kpep.dp.evov ihcoaiv rj pnrreopuevov, r) bo~a rolcn 
roiovroiaiv eoi/ce, /cal ravra KXip^ovcnv alel, 
10 /cal ov/cert avrolcn pieXei oirolovn dtrefSr) diro tov 
■%et pier pharos, elre /carcbv elre dyaOov. oi p.evroi 
Irjrpol oi ra roiavra e7rtri]hevovre<; atcaioi eicnv, 
ov<? ye eyoo eyvcov to p,ev yap irrivorj/xa apx^lov, 
real eTratveco 670)76 crcpohpa rbv rvpwrov tin- 
2S2 



ON JOINTS, xli.-xlii. 

in the disease then present. In time, however, 
some of the same symptoms found in younger 
patients show themselves to a greater or lesser 
degree ; but in general they are all less malignant. 
Many patients, too, have borne curvature well and 
with good health up to old age, especially those 
whose bodies tend to be fleshy and plump ; but few 
even of these survive sixty years, and the majority 
are rather short-lived. There are some in whom 
the vertebrae are curved laterally to one side or the 
other. All such affections, or most of them, are 
due to gatherings on the inner side of the spine, 
while in some cases the positions the patients are 
accustomed to take in bed are accessory to the 
malady. But these will be discussed among chronic 
diseases of the lung ; for the most satisfactory 
prognoses as to their issue come in that department. 
XLII. When the hump-back is due to a fall, 
attempts at straightening rarely succeed. For, to 
begin with, succussions on a ladder never straightened 
any ease, so far as I know, and the practitioners who 
use this method are chiefly those who want to make 
the vulgar herd gape, for to such it seems marvellous 
to see a man suspended or shaken or treated in such 
ways ; and they always applaud these performances, 
never troubling themselves about the result of the 
operat : on, whether bad or good. As to the prac- 
titioners who devote themselves to this kind of 
thing, those at least whom I have known are in- 
competent. Yet the contrivance is an ancient one, 
and for my part I have great admiration for the 



1 vioiffi. 
■ vyirjput. 



28.1 



nEPI AP0PDN 

voi]<javra kcu tovto iea\ aXXo irav 6 ti fnfydvrjfia 
Kara (pvaiv eirevoi'idiy ovBev yap p,oi aeX-rrrov, 
el rt<i #a\<y? crfcevdcras tcaXcos KaracreLcreie, k&v 
iijiOvvdijvcu evict. avTos p,evTot KaTrjo-)(yv6i)v irdv- 
tcl rd ToiovTOTpoira hiTpevetv ovtw, Bid tovto oti 

20 7roo? aTTdTeoovoov pcdWov oi toiovtoi Tporrot. 

XLIII. 'Oiroaoiai pev ovv eyyix; tou av^evo^ 
rj Kv<p(oai<i yiveTai, rjaaov et'/co? a>(pe\elv t«? 
KaTaTacna's Taina? ra? eirl ttjv Ke(paki)V apiKpov 
yap to /3apo? 7) Ke<f>a\r) real t« d/cpoopia rcaTap- 
peTTovTa' aXXa tou? ye toiovtovs ec/ebs irrl 
[tojj?] x 7roSa? KaTaaeia6evTa<; p.dXkov e^iOvv- 
Ofjvai' pe^cov yap ovtoos tj KaTapp07rtr} 1) eVt 
ravTa' oaoiai Be tcaTWTepw to vficopa, TOVTOiaiv 
et/co? pdWov eVl Kecf)a\i)v KaTaae'ieadai. el ovv 

10 tis iOeXot tcaTaaeieiv, opBws av (bBe o~Kevd^ot' ttjv 
p,ev tcXipafca \pr) ctkvt'ivoio'iv viroKeipaXacocai 
TrXayloiaiv, rj epiveotat, /caTaaTpcoaai ev irpoaBe- 
8ep,evoio~iv, 6\lycp irXeov ical eVt p,PjKos /cal evOev 
Kai evdev, i) oaov av to awpa tov dvdpdnrov KaTa- 
cyoi' eiretTa tov dvOpwirov vtttiov /caTa/cXlvat 
eirl tt)v /c\tp,a/ca XP 7 ')' ^direLTa TrpoaBrjaai pev 
tov<; 7roSa? irapd to, a(pvpa 77750? t?)v /cXipatca 
p,r] 8ia/3ej3wTas, 8eapG> evo^w pev, pa\8a/cS> Be 
Trpoahfjcrai Be /caTCOTepco e/caTepov twv yovvaTCOi 

20 /cat, dvcoTepo)' 7rpoaof]aat Be /cal KaTa Ta Zcr^ta 
KaTa he Toy? /cevecovas /cat KaTa to crTnOof 
%a\apf)crL Tati'lrjo-i 2 7repi/3a\e2v ovtws, 07ra>? prj 
KwXvwai 3 Tip' fcaTaaeiaiv' Ta? Be %e?/oa? rrapd 
Ta? irXevpd'; irapaTelvavTa it poa KaTa\a(3eZv 7roo? 
avTO to acop,a, /cal prj 77730? tjjv icktpatca. QTav 

1 Omit Erm., Kw. 
284 



ON JOINTS, xlii.-xlui. 

man who first invented it, or thought out any other 
mechanism in accordance with nature; for I think 
it is not hopeless, if one has proper apparatus and 
does the succussion properly, that some cases may 
be straightened out. For myself, however, I felt 
ashamed to treat all such cases in this way, and 
that because such methods appertain rather to 
charlatans. 

XLIII. In cases where the curvature is near the 
neck, extension of this kind with the head downwards 
is naturally less effective ; for the downward-pulling 
weight of the head and shoulders is small. Such 
cases are more likely to be straightened out by 
succussion with the feet downwards ; for the down- 
ward pull is greater thus than in the former position. 
Cases where the hump is lower may more appropriately 
undergo succussion head downwards. If then one 
desires to do succussion, the following is the proper 
arrangement. One should cover the ladder with 
transverse leather or linen pillows, well tied on, to a 
rather greater length and breadth than the patient's 
body will occupy. Next, the patient should be laid 
on his bach upon the ladder; and then his feet 
should be tied at the ankles to the ladder, without 
being separated, with a strong but soft band. 
Fasten besides a band above and below each of the 
knees, and also at the hips ; but the flanks and 
chest should have bandages passed loosely round 
them, so as not to interfere with the succussion. Tie 
also the hands, extended along the sides, to the body 
itself, and not to the ladder. When you have 



3 ,ii,'u'~(i,. 



*8 5 



IIEPI AP0PQN 
Be ravra KaraaKevdarjs oi/t&>?, aveXiceiv rrjv 

KklflCLKCL T] 7T/909 TVpCTlV TIVCL VyjrrjXrjV T) 7T/309 

aercofia olkov' ro Be ywp'iov iva KaraaeleLS 1 
avrirvnov harw' row; Be dvrireivovra<; evrraiBev- 

30 toi"? XP 7 1 elvai, oVo)? 6p,aXa><; [/cal «aX.(y<?] 2 ical 
iGOppoTTws teal i£cnrivaLG)<; dcp/jaovai, /cal pbrjre 
17 fc\2pLa% erepoppoiros eirl rrjv yrjv d$>l%erai, 
fxrjre avrol rr poir er e'e? ecrovrai. enro p,evrot rvp- 
(rio<i (Icpiels rj iitto larov KaraTre7rrjy6ro<i icap- 
yJ}aiov eXovTOs ere KaXXiov dv rt? crKevdaairo, 
ware utto t po^iX(,ii<i ra ^aXoo/iem elvai oirXa r) 
drrb bvov. drjBe'i p,r)v ical piaKpoXoyelv Trepl 
rovrtov' opLayq Be i/c rovroav dv rwv fcaraafcevcov 

39 KaXXiar' 3 dv ri<; KaraaetaOetrj. 

XLIV. Et /xevrui fedpra avco eirj to vf3a>pa, 
Beoi Be tcaraaeieiv 7rdvro)<;, cttI rroBas Karaaeieiv 
XvaireXel, warrep r]8rj eiprjrar TrXeicov yap ovrco 
yiverai r) /carappoTrti] eirl ravra. eppbdaai Be 
XPV Kara p.ev to crrr/Bos 7T/90? rrjv Kktjiakd 
rr poaBrja avr a iaj^ypw, Kara Be rbv avx^va on 
XdXapcordrrj raivtrj, bcrov rov KaropOovaOai 
eiveKa' Kal avrrjv rijv KecfcaXrjv Kara rb p,ero)7rov 
irpoaBrjo-ai rrpb<i rrjv KXlpuaKa' rd<i Be x^pcts 

10 iraparavvaavra rrpbs rb aa>p,a rrpoaBijaai, Kal 
p.rj 7T/0O? rtjv KXipbaKa' rb fievroi aXXo o"&j/za 
dBerov elvai XP'h 7T ^V lJ > o&ov rov xaropOovaOai 
eiveKa, aXXrj Kal aXXy raivirj x a ^ a PV ^epi- 
/3e{3X))G0ai' oVo)? Be p.r) kcoXvwctiv ovroi oi 
Bea/xol rrjv Kardaeiaiv, aKoireiv' ra Be GKeXea 
77009 plv rrjv /cXt/xa/ca /j.rj TrpoaBeBeaOa), 777)09 
aXXijXa Be, a>9 Kara rrjv payw Wvp'porra 17. 
ravra p.evroi roiovroTpoTrax; Trunjrea, el irdvrwi 
286 



ON JOINTS, xliii.-xliv. 

arranged things thus, lift the ladder against some 
high tower or house-gahle. The ground where you 
do the succussion should be solid, and the assistants 
who lift well trained, that they may let it down 
smoothly, neatly, vertically, and at once, so that 
neither the ladder shall come to the ground unevenly, 
nor they themselves be pulled forwards. When it is 
let down from a tower, or from a mast fixed in the 
ground and provided with a truck, it is a still better 
arrangement to have lowering tackle from a pulley 
or wheel and axle. It is truly disagreeable to enlarge 
on these matters ; but all the same, succussion would 
be best done by aid of this apparatus. 1 

XLIV. If the hump is very high up and succus- 
sion absolutely required, it is advantageous to do it 
towards the feet, as was said before ; for in this 
direction the downward impulsion is greater. One 
should fix the patient by binding him to the ladder 
firmly at the chest, but at the neck with the loosest 
possible band sufficient to keep it straight ; bind the 
head itself also to the ladder at the forehead. 
Extend the arms along, and fasten them to, the body, 
not to the ladder. The rest of the body should not 
be tied, except in so far as is requisite to keep it 
vertical with a loose band round it here and there. 
But see that these attachments do not hinder the 
succussion. Do not fasten the legs to the ladder, 
but to one another, that they may hang in a straight 
line with the back. This is the sort of thing that 

1 Surgeons will remember that methods no less violent 
than these and those described below were practised for a 
time on high authority at the end of last century. 

1 KaTaaticras. 2 Apoll., Galen, but most omit. 

28 7 



IIEP1 AP0PHN 

heoi ev KXifxaKt Karaaei a 0i)vaf ala^pbv pAvroi 

20 zeal ev rrdcrrj reyyr), kcu ov% r\Kiara ev larpiKjj, 
iroXvv 6~)(Xov feat TroWrjv 6\jriv teal tto\vv Xoyov 

22 •irapaayovTa, e-neira pi/hev axpeXrjcrai. 

XLV. X.pi) he rrpodrov piev yivuxTKetv ri)v (pvo-w 
tt)? patios, oirj rl<i earuv 69 7roA,Xa yap vovatj- 
puara irpoaheoi av avrrjs. rovro puev yap, to 
irpos rr)v koCKi^v peirov oi o~7rovhv\oi evro<; apriot 
elaiv aWi]\oio~i, ica\ hehevrai Trpbs aWrjXois 
heo~p,&> p,v^oohec koX veupcohei, cltto ^ovhpcov airo- 
irecfyvKOTi dy^pi irpbs rbv vcortatov. aWoi he 
rives rovoi vevpeohees hiavraloi irpocr^vroi irapa- 
reravrai evOev teal evOev avrSiv. al he (f)\e/3(bv 

10 teal dprrjplcov KOLVwviat ev erepwXoyco hehr/\d>o-ov- 
rai, 6o~ai re koX olai, ical bdev <hpp,i]p,evai, /cat 
ev oXoicriv 1 ola hvvavrai, avrbs he 6 vwriaios 
olaiv eXvrpcorai iXvrpoiaiv teal odev wpp.rjp.evoiat, 
real ottt] fCpalvov'&i real olcriv Koivcoveovai, /cat ola 
hwapuevoLcriv ev he ru> eire/ceiva ev apOpoiai ye- 
yiyyXvpcovrai 7rpb$ dW/]\.ov<; oi o-iTovhv\oL. rovoi 
he kolvoI rrapd jrdvras kcl\ ev rolaiv e%(o piepeai 
teal ev rolaiv eaw irapareravrai' ajrocpvais re 
eanv oareov e'<? to e%w pbepos drrb irdvrcov ra>v 

20 airovhvXwv, p.ia diro evbs e/caarov, airo re rwv 
pie^ovcov diro re rwv eXaaaovcov eirl he rfjaiv 
dnrocfrvaeai ravrrjai ^ovhpicov eTTicfyvaies, tcai an 
e/ceii'cov vevpcov a7ro/3\«crT?;o"t? r)he\<fiio~pLevri rolaiv 
e^cordro) rbvoiaiv. irXevpal he irpoarre^vKaaiv, 
e? to eaa> /zepo? t<z? K€<fca\d<; perrovaai p.dWov i) 
is to e%w icaO^ eva he eicaarov rwv airovhvKwv 
TrpocnjpBpcovrai' Kap,irvXoi)rarai he ifkevpai av- 

1 oil. 

288 



ON JOINTS, xliv.-xlv. 

must be done if succussion on a ladder is absolutely 
required; but it is disgraceful in any art, and 
especially in medicine, to make parade of much 
trouble, display, and talk, and then do no good. 

XLV. One should first get a knowledge of the 
structure of the spine ; for this is also requisite for many 
diseases. Now on the side turned towards the body 
cavity, the vertebrae are fitted evenly to one another 
and bound together by a mucous and ligamentous 
connection extending from the cartilages right to the 
spinal cord. 1 There are also certain ligamentous cords 
extending all along, attached on either side of them. 
The communications of the veins and arteries will be 
described elsewhere as regards their number, nature, 
origin, and functions ; also the spinal cord itself 
with its coverings, their origin, endings, connec- 
tions and functions. Posteriorly, the vertebrae are 
connected with one another by hinge-like joints. 
Cords common to them all are stretched alon«; both 
the inner and outer sides. 2 From every vertebra 
there is an outgrowth (apophysis) of bone pos- 
teriorly [lit. " to the outer part "], one from 
each, both the larger and smaller ; upon the 
apophyses are epiphyses of cartilage, and from these 
there is an outgrowth of tendons, which are in relation 
with the outermost cords. The ribs are articulated 
severally with each of the vertebrae, their heads 
being disposed rather inwards (forwards) than out- 
wards (backwards). Man's ribs are the most curved, 

1 Intervertebral cartilage : reference to its mucous centre 
and cartilaginous anterior layer. 

2 Both these and those mentioned above seem to be the 
anterior and posterior common ligaments. "Inner" and 
"outer " = our " front " and " back." 

289 

VOL. III. L 



IIEPI AP0PQN 

dpcoirov eltrl patftoeiSea rpoirov. to he fiearjyv 
tcov irXevpecov /cat tcov ocxrecov tcov diroTretpv/coTcov 

30 airb tcov o~TTOvhvXcov aTTOTrXrjpeovcnv e/caTepcoOev 
ol p,ve<; curb tov av%evo<; dp^dpevoi, d^pi tt}? 
irpoa<pvaio<i. avrrj he rj pd^w Kara yu,?)/co<f I6v- 
o~tc6\i6<> icrTiv a.7ro p,ev tov lepov oareov a^pi 
tov peydXov cnrovhvXov, nap ov 7rpoai)pT7)Tai 
tcov tr/ceXecov r) Trpocnfivtris, d^pi pev tovtov /cv<p?)' 
kvcttis t$ yap teal yoval/cal dp%ov to y^aXapbv ev 
tout co €KTio~Tai. curb he tovtov d^pc ippevcov irpoa- 
apTijaios, IdvXopSr)' /cal Trapatpvcrias e^et pvcov 
tovto p,ovvov to ywpiov e/c to)v kacodev p,epcov, a? 

40 Si) /caXovaiv yfroas. airb he tovtov d%pi tov peyd- 
\ov cnrovhvXov tov virep rai' eircopihcov, I6v/cv<piy 
€Tt he pdXXov ho/cel J] Icttiv rj yap d/cavda /caTa 
puecrov vy\nfXoTaTa$ Ta? e/ccpvcrias tmv ocrTecov 
e^ei, evuev oe icai evuev eXacrcrovq. avTO be to 

45 dpOpov to tov av%evo<; Xophbv eaTiv. 

XLVI. 'OTroaoiat p,ev ovv KvcpoopaTa yiveTai 
KaTa T0v<i crnovhvXovs, efjcoais pev peydXr) arrop- 
payetcra dnrb T779 aupcpvo-Los rj evbs crirovhiiXov f) ical 
irXeovcov ov p,dXa TroXXolai yiveTai, dXX 0X1- 
yoiai. ovhe yap t<x TpcopaTa Ta TOiavTa prphiov 
yiveaOar ovtc yap es to e^co e%coo~6?)vai prjihtov 
eo~Tiv, el p.rj e/c tov ep-rrpoaOev la^vpcp tlvI TpwQen) 
hid T779 koiXlijs (ovtco 6" civ uttoXoito), rj el ti<; d<p 
vyjrr)Xov tov yooplov ireacov epeicreie Tolaiv tcr^ioi- 

10 aiv rj TOLaiv copoiaiv (dXXa /cal ovtws av diro- 
Odvoi, irapa^prjpa he ov/c av diroddvoi)' e/c oe 
tov OTTiodev ov prj'ioiov toiovttjv e^aXcriv yevetr- 
6ai e'9 to eaco, el pr/ inrepfiapv tl d^Bos epntecroi' 
tcov T€ yap ocTTecov tcov e/cireipvicoTcov ei^co ev 
290 



ON JOINTS, xlv.-xlvi. 

and they are bandy-shaped. As to the part between 
the ribs and the bony outgrowths (apophyses) of the 
vertebrae, it is filled on each side by the muscles 
which begin at the neck and extend to the attach- 
ment x [of the diaphragm]. The spine itself is curved 
vertically through its length. From the sacrum to 
the great vertebra, 2 near which the origin of the legs 
is inserted, all this is curved outwards ; for the 
bladder, generative organs, and loose part of the 
rectum are lodged there. From this point to the 
attachment of the diaphragm it curves inwards ; and 
this part only of the inside has attachments of 
muscles, which they call " psoai." From this to the 
great vertebra 3 over the shoulder-blades it is curved 
outwards, and seems to be more so than it is ; for the 
ridge has the outgrowths of bone highest here, while 
above and below they are smaller. The articulation 
of the neck itself is curved inwards. 

XLVI. In cases then of outward curvature at the 
vertebrae, a great thrusting-out and rupture of the 
articulation of one or more of them does not very 
often occur, but is rare. Such injuries, indeed, are 
hard to produce ; nor is it easy for outward thrust- 
ing to be brought about, unless a man were 
violently wounded from the front through the 
body cavity — and then he would perish — or if a 
man falling from a height came down on his buttocks 
or shoulders — but then he would die also, though he 
might not die at once. And from behind it would 
not be easy for such sudden luxation to take place 
inwards, unless some very heavy weight fell on the 
spine ; for each of the external bony epiphyses is of 



1 "To their attachment" ( lVtnquin). 
8 Fifth lumbar. a Seventh cervical. 



291 



IIEPI AP0PQN 

etcaarov roiovrov eariv, ware rrpoadev av avrb 
/carayrjvai irplv r) p:eydXi]v poirijv eaoo iroirjaai, 
tov<; re avv8eap,ov<$ ftirjadpievov ical rd dpOpa 
rd evrfXXaypLeva. 6 re av vcoriaios rrovolrj av, el 
e£ oXiyov ^copiov rrjv •nepi/cap.Tri^v eyoi, roiavrrjv 

20 ktjaXaiv e^aXXopievov arrovBvXov 6 re e/c7rt]Brjaa<; 
airovBvXos me^oi av rov vcoriatov, el per) /cal 
drroppi'i^eiev. nrieydeX^ 8' av /cal diroXe\apipievo<i 
rroXXayv av /cal pueydXcov /cal eTrc/calpcov enrovdp- 
KOicnv rroi^aeiev ware ovk av pieXoi tw Irjrpu) 
07r&)9 XPh rov ctttovBvXov /caropOcoaai, ttoXXujv 
/cat, fiiaiodv aXXoiv /ca/c6)i> vape6vra>v. ware Br) 
ovB' epL,6a~\.elv olov re 7rp68)]Xov rov roiovrov ovre 
/caraaeiaei ovre aXXw rpoirtp ovBev!, el p,?j Tt<? 
Biarapicov rov avOpawrov, erreira eapaadpevo? 

30 e? rrjv /coiXup', etc rov eawdev rfj X €l P l €? T0 ^ m 
avrwOeoi' /cal rovro ve/cpro p,ev olov re iroielv, 
^(ovri Be ov rrdvv. Sid ri ovv ravra ypdcfxo ; on 
o'iovrat rive*; i))rpev/cevai dvOpdcnrovs olaiv eacoOev 
eveireaov arrovBvXoi, reXeu><i imepl3dvre<; rd dpOpa' 
/cairoi ye prjtarrjv e<? to irepiyeveaOai rd>v Bia- 
crrpcxpecov ravrrjv evioi vopii^ovai /cal ovBev BeiaOai 
ep,/3oXr)<;, aXXa avropiara vyiea yiveadai rd 
roiavra. dyvoeovai Brj rroXXoi, /cal /cepBaivov- 
criv on dyvoeovai' rrelQovai yap rods 7reXa?. 

40 e^arrarCovrai Se Bia roBe' o'lovrai yap rnv 
d/cavOav rr)v i%e)(ovoav /card ri~jv pdj^tv 
ravrrjv rov<i a7rov8vXov<; avrovs eivai, bri 
arpoyyvXov avrcov e/caarov (paiverai yjravop.evov, 
dyvoevvres on ra oarea ravra iari rd airo tojz^ 
airovBuXcov 7recf)V/cora, rrepl mv 6 Xoyos oXiyro 
irpoadev eopyjrar ol Be atrovBvXoi rroXv rrpoau)- 
292 



ON JOINTS, xlvi. 

such a nature as to be fractured itself before over- 
coming the ligaments and interconnecting joints and 
making a great deviation inwards. The spinal cord, 
too, would sutt'er, if the luxation due to jerking out 
of a vertebra had made so sharp a curve ; and the 
vertebra in springing out would press on the cord, 
even if it did not break it. The cord, then, being 
compressed and intercepted, would produce complete 
narcosis of many large and important parts, so that 
the physician would not have to trouble about how 
to adjust the vertebra, in the presence of many 
other urgent complications. So, then, the impossi- 
bility of reducing such a dislocation either by 
succussion or any other method is obvious, unless 
after cutting open the patient, one inserted the hand 
into the body cavity and made pressure from within 
outwards. One might do this with a corpse, but 
hardly with a living patient. Why then am I 
writing this? Because some think they have cured 
patients whose vertebrae had fallen inwards with 
complete disarticulation ; and there are even some 
also who think this is the easiest distortion to 
recover from, not even requiring reduction, but that 
such injuries get well of themselves. There are 
many ignorant practitioners ; and they profit by their 
ignorance, for they get credit with their neighbours. 
Now this is how they are deceived. They think 
that the projecting ridge along the spine represents 
the vertebrae themselves, because each of the pro- 
cesses feels rounded on palpation ; not knowing 
that these bones are the natural outgrowths from the 
vertebrae which were discussed a little above. But 



293 



IIEPI AP0PDN 
repco aireiatv arevoTaTi^v yap ttcivtcov tcov t^oocov 

COV0pCOTTO<; KOlXtrjV €)(€l, &)<? eVl TCp Ll€ye0€l, CITTO 

rov 6-madev e? to efxirpoadev, itotI real Kara to 
50 arrjdos. brav ovv rt tovtcov tcov barecov tcov 
virepe^ovTCov lo"%vpu)<; Karayfj, rjv re ev r\v re 
TrXeico, Tavrrj Taireivbrepov to ywpiov yiverai rj 
to evdev Kai evdev, kcu 8ia tovto e^airaTcovTai, 
oto/xei'oi rot"? cnrovSuXovs eaco olyeaQai. irpoae^a- 
irara 8e en avrovs ical to, a^pLara tcov rerpco- 
Lievcov r)v Ltev yap ireipcovTai /cap,7rvX\ea0ai, 
oovvcovTai, Trepneveos yivop,evov Tavrrj tov hep- 
/xaTO? fj Terpcovrai, Kai a/xa to, barea to, KaTer}- 
yora evdpdaaei ovtco liciXXov tov xpeora. rjv 8e 
60 XopSaivcoai, paov<; elaiv ^aXapcorepov yap to 
hepLta «aia to rpcoLta rainy ylverai, Kai tcl 
borea rjaaov evQpdaaei' drap ical rjv rif -^ravy 
avrcov, Kara tovto vweiKovai XopSovvre<; , /cal TO 
^copiov Kevebv ical LiaXdaKov yfravoLievov ravrrj 
(paiverai. ravra irdvra to, elpi]p.eva rrpoae^a- 



eec Se 



\ > 



rrara rov<; or/rpovi. vyiee<i 6e ra%eco<; Kai aaivees 
avTOLiaTOi ol tolovtol yivovTar Ta^eco? yap 
Tavra tcl roiavra barea iimroipovTai, oaa 
69 yavvd eariv. 

XLVII. %KoXialverai Ltev ovv pd^i? /cal vyiat- 
vovoi Kara iroXXov? rpbirov^' /cal yap ev rfj 
cf)vaei /cal ev rfj ^prjaei ovrcos e%er drap ical biro 
yr]pao<i ical inrb bSvvrjLuircov 1 avv&OTLKij eariv. 
ai Be &rj tcvcpwaies a! ev rolai rrrcoLLaaiv &>? eirl 
to iroXv ylvovrai, rjv rj rolaiv layioiaiv epeiarj r) 
eVl Toy? wllovs near). dvdyicr\ ydp e^co (paiveaOai 
ev tw KvcpooLiaTi k'va Liev Tiva v-^rijXbrepov tcov 
arrovSvXcov, tous <$e evdev Kai evQev eirl rjaaov 
294 



ON JOINTS, xlvi.-xi.vii. 

the vertebrae are much farther in front ; for man has 
the narrowest body cavity of all animals relatively to 
his size and measured from behind forwards, especially 
in the thoracic region. Whenever, therefore, there 
is a violent fracture of these projecting processes, 
either one or more, the part is more depressed there 
than on either side ; and therefore they are deceived, 
and think the vertebrae have gone inwards. And 
the attitudes of the patients help to deceive them 
still more ; for if they try to bend forwards, they 
suffer pain, the skin being stretched at the level of 
the injury, while at the same time the fractured 
bones disturb the flesh more ; but if they hollow 
their backs, they are easier, for thereby the skin gets 
more relaxed at the wound, and the bones cause less 
disturbance. Again, if one feels them, they shrink 
at the part, and bend inwards ; and the region 
appears hollow and soft on palpation. All these 
things contribute to deceive the physicians, while 
such patients recover of themselves quickly and 
without damage ; for callus forms rapidly on all 
bones of this kind, by reason of their being porous. 

XI AT I. Curvature of the spine occurs even in 
healthy persons in many ways, for such a condition 
is connected with its nature and use ; and besides, 
there is a giving way in old age, and on account 
of pain. But the outward curvatures due to falls 
usually occur when the patient comes down on his 
buttocks or falls on his shoulders; and, in the 
curvature, one of the vertebrae necessarily appears 
to stand out more prominently, and those on either 



1 oSvvrjs Kw. 

295 



IIEPI AP0PHN 

10 ovkovv et<? em ttoXv d7T07re7rr)hrjKo><i arrb twv 
dXXcov iaTLV, dXXa crp,iicpbv erccto-Tos avvhihol, 
aOpoov he ttoXv cfraiverai. hid ovv tovto kcu 6 
vooTialo<i pveXb<; evcpopros <pepet Ta? Toiavras 
&iacrTpo(f)d<;, oti kvkXgoStjs avra> i) Siaarpocprj 
ytveTai, dXX 01/ yu>VLO)hr]<;. 

Xyo?) he rrjv icarae tcevrjv tov hiavayicao~p,ov 
roiijvhe Karaa Kevaaai. e^eari p,ev £vXov la^vpov 
zeal ttXcltv, evTop.7]V irapapijKea ex ov > fcaropv^at' 

20 e^ecrrt he avrl tov %vXov ev tol^u) evTopJr\v irapa- 
fxrjKea evrap,elv, r) Trrj-^ei dvcoTepw tov ehdcpeos, r) 
07T&J9 dv pL6rptco<i e'x?7' eirena olov o~tvXov hpvivov 
rerpdycovov irXdyiov TTapafidXXeiv, diroXe'nrovTa 
diro tov to'l^ov oaov irapeXOelv Tivd, i)v herj' xal 
€7rl pev tov cttvXov eiriaTopeaaL r) ^Xaivas r) 
aXXo ti, paAua/cov p,ev ecrTai, viret^ei oe p,rj 
peya' tov he dvdpwnov irvpirjaat, rjv evhe^rjTai, r) 
•jtoXXw 0€pp,(0 Xovaat' /cdireiTa irprjvea icaTa- 
KXlvac KaTCLTeTap,€vov, zeal Ta$ puev %elpa<i avTov 

30 -napaTeivavTa «aTa <pvaiv irpoahrjcraL 7rpo? to 
awpa, IpdvTi he paXdaKw, ifcavox; irXaTei tc teal 
puaKpcp, €K hvo SiavTcdayv o-vp.ftefiXrifie'vw p.ea<£>, 
KaTa p,eaov he to ctt^o? his 7repif3ef3Xrjo-0ai %pr) 
a>? eyyvTaTco toov pao~xaXe(ov eirena to irepio-- 
crevov twv lp,dvTwv KaTa ttjv paa^dXijv e/caTepov 
Trepl Tou? wpov<; ireptj3e^Xi)0'6w' erretTa at ap%a\ 
wpbs ^vXov virepoeches ti irpoaheheaOwcrav, dpp,6- 
%ovo~ai to p,r]Kos tu> i;vXw T(p viroTeTapbevw, Trpbs 
6 tl -npocrfSaXXov to vTrepoeihes dvTiaTrjpi^ovTa 

40 KaTaTeiveiv. tolovtw he tlvi eTepw heap,w %pr) 
dvwOev twv yovvaTwv h/jaavTa koX dvwOev twv 
TTTepvecov xa? dp^ds twv ifidvTcov Trpo? toiovtov 
296 



ON JOINTS, xlvii. 

side less so. It is not that one has sprung out to 
a distance from the rest; but each gives way a 
little, and the displacement taken altogether seems 
great. This is why the spinal marrow does not 
suffer from such distortion, because the distortion 
affecting it is curved and not angular. 1 

The apparatus for forcible reduction should be 
arranged as follows. One may fix in the ground a 
strong broad plank having in it a transverse groove. 
Or, instead of the plank, one may cut a transverse 
groove in a wall, a cubit above the ground, or as 
may be convenient. Then place a sort of quad- 
rangular oak board parallel with the wall and far 
enough from it that one may pass between if 
necessary ; and spread cloaks on the board, or some- 
thing that shall be soft, but not very yielding. 
Give the patient a vapour bath if possible, or one 
with plenty of hot water; then make him lie 
stretched out in a prone position, and fasten his 
arms, extending them naturally, to the body. A 
soft band, sufficiently broad and long, composed of 
two strands, should be applied at its middle to the 
middle of the chest, and passed twice round it as 
near as possible to the armpits ; then let what 
remains of the (two) bands be passed round the 
shoulders at each side, and the ends be attached 
to a pestle-shaped pole, adjusting their length to 
that of the underlying board against which the 
pestle-shaped pole is put, using it as a fulcrum to 
make extension. A second similar band should 
be attached above the knees and above the 
heels, and the ends of the straps fastened to 

1 In spite of this, the strange contradiction "angular 
curvature " has come to be the technical term for hump-back. 

297 



IIEPI AP0PDN 

tl £vXov 7rpoaSf]aar ciXXrp Be iptdvTi irXarel Kal 
fiaXda/ea) Kal BuvaTco, raivioeiSet, 7r\aT0? eyovTi 
Kal fijjxos Ikclvov, la^vpcbs irepl ra<; l£va<; kvkXw 
TrepiBeBeaOai go? eyyvrara twv lo-^iwv eireira to 
irepiaaevov t?}? TaivioeiBeos, dfia dp,rf>0Tepa<; ras 
dp%d<; rcov Ifidvrcov, 77/909 to £vXov TrpooSrjcrai to 
7Tpb<; tmv ttoBcov tcaireiTa KaTaTelvetv iv tovtq) 

f>0 t5> o-^rjpiaTt ev6a Kal evOa, a/xa p,ev laoppoTrws, 
ap,a Be e? I6v. ovBev yap av p:e<ya kclkov r) 
TOcavTT] kclto-tclo-is iroirjcreiei', el XPV°" r ^ crKevaa- 
Oeirj, 1 el pbrj dpa egeTrLTrjBis Tt? /3ovXoito aiveadai. 
rbv Be IrjTpbv ^pr] i) aXXov, oaTis la^ypos Kal p,r) 
a/u,ad>j$, irnOevTa to devap t% ^eipos eirl to 
v{3(opLa, Kal tt)v €Tept]v ^elpairpoaeTrtd evTa eirl tt)v 
€T€p7)v, KaTavayK(i^eii>, irpoaavvievTa i']V T6 69 tdv 
6<> to kiito) 7recf)VKi] kclt ava<y /cd^eoS 'at, tjv Te 777)09 
tt}? K€<f>aXrj<;, r)v Te ■npbs tmv lo")^i(ov. Kal 

GO do-LvecTTaTT) p,ev auTrj r) dvdyKrp derives Br] Kal 
e r niKa6kt l eo'6ai Tiva eVt to Kvcfxopa, avTOv apua 
KaTaT€ivop,evou, Kal evaelaai /xeTecopiadevTa. aTap 
Kal €Tri/3r)i'at to> ttoBI Kal o^rjOrjvai eVt to 
Kixpcofia' ?;<ru^&>9 re eirevaelaai, ovBev KwXver to 
tolovtov Be irotrjaai pueTpiux; iiriTrfieios av ti$ etrj 
tow dp,(pl iraXalcrTpriv el6iapLev(ov. BvvaTcoTaTr) 
p,evToi T(bv dvajKeo)v eaTiv, el o fiev tol^o? evre- 
T/xr)p.evos r) to Be tjvXov to KaTa)puyp,evor, rj 
ivTeTfirjTai, KaTooTepo) eh] T7/9 pdx 10 ^ tou dv9pu>- 

70 7rov, OTTocroi av Bokt) /zeTOi&x? e^eiv, aavls Be 
<f)iXvpiv7), jjirj XeiTTrj, evetrj, i) Kal aXXov tivos 
%vXov eneiTa iirl p,ev to vficopa eTriTeOetrj i) 

JfiVYlOV Tl TTOXVITTW^OV 7] GpilKpOV Ti 0~KVTIV0V 

vTTOKecpdXaiov &>? eXd^iaTa p,t/v eTrtKeiadai 
298 



ON JOINTS, xlvii. 

a similar pole. With another soft, strong strap, 
like a head-band, of sufficient breadth and length, 
the patient should be bound strongly round the 
loins, as near as possible to the hips. Then fasten 
what is over of this band, as well as the ends of 
both the other straps, to the pole at the foot end ; 
next, make extension in this position towards either 
end simultaneously, equally and in a straight line. 
Such extension would do no great harm, if well 
arranged, unless indeed one deliberately wanted 
to do harm. The physician, or an assistant who 
is strong and not untrained, should put the palm of 
his hand on the hump, and the palm of the other 
on that, to reduce it forcibly, taking into consider- 
ation whether the reduction should naturally be made 
straight downwards, or towards the head, or towards 
the hips. This reduction method also is very harm- 
less ; indeed, it will do no harm even if one sits 
on the hump while extension is applied, and makes 
succussion by raising himself; nay, there is nothing 
against putting one's foot on the hump and making 
gentle succussion by bringing one's weight upon 
it. A suitable person to perform such an operation 
properly would be one of those habituated to the 
palaestra. But the most powerful method of re- 
duction is to have the incision in the wall, or that 
in the post embedded in the ground, at an appro- 
priate level, rather below that of the patient's spine, 
and a not too thin plank of lime or other wood inserted 
in it. Then let many thicknesses of cloth or a small 
leather pillow be put on the hump. It is well that 



aKtuaady. 

2Q0 



IIEPI AP0PON 
avpcpepei, ptovov Trpoptydeoptevov &>9 urj r) cravlq 

VTTO (TfC~\.7}pOT7)TO<; 6hvvr]V TTCLpa KClipoV IT pO(T7T ape- 

yr}' /car t^iv he earco <09 ptdXtara rfj evroptfj 

rfj 69 TOV TOiyOV TO vficOJLUl, CO? CLV Tj GaVt<i, Tj 

ptdXtara e^earrjKe, ravrr] ptdXtara rrte^r) eirtre- 
80 Oelcra. orav he emredfi, rbv ptev rtva fcara- 
vayfcd^eiv XPV T ° clfcpov rr)<; aavihos, fjv re eva 
her] rjv re hvo, T01/9 he Karareiveiv 1 to aoipta Kara 
fiij/ccx;, a)? irpbaQev etprjrat, tou? ptev rfj, rov<; he 
rfj. e^eari he icai ov'kjkokti, ri]v Kardraaiv 
rroielaOat, rj irapaKaropv^avra rrapa rb £vXov, r) 
ev aurcp tw g v\a> rds <pXid<i row ov'wtkwv evre/crrjvd- 
pievov, rjv re 6pda<; eOeXys, eKarepcodev apttxpov 
virepeyovaas, rj re Kara KOpvcp-qv rou £vXov evOev 
teal evOev. avrat at dvdytcat evrapttevrov elai 
90 Kai is to layyporepov /cat e*9 to rjaaov, koX ia)(yv 
eyovcri TOiaLTT)v, ware /cal et ris eVt Xvptrj 
fiovXoiro, dXXa ptrj eVt Irjrpetrj, e*9 rotavras 
avdy/cas dyayetv kolv 2 to^tcd layypois hvvaadai' 
/cat yap av Kararetvwv Kara ptrJKOs ptovvov evOev 
/cal evOev ovrco /cal aXXrjv dvdy/cijv ovhepttrjv rrpocr- 
Tidet<i, option Karareivetev av Tt9' dXXd ptr/v ical 
rjv ptrj /carareivcov, avrfj he ptovvov rfj aavthi ouroi<i 
liroirj rts, /cal ovrax; av [ifcavws] 3 /caravay/cdcreiev. 
KaXal ovv at rotavrav to-yves elatv, fjaiv etjeart 
100 /cal dadevearepijai /cat layvporeprjai ypr/adat 
avrbv ra/xtevovra. /cat ptev hrj ical Kara (pvatv 
ye dvayKa^ovar ret ptev yap e^earetora es rqv 
yd>pi]v dvayKa^ei i) tiraxris tevat, ra he cruveXrj- 
Xvdora Kara cpvaiv Karareivouai at Kara 4>vaiv 
Karardates. ovkow [e'7&>] 4 e^a) rovrcov dvdyKas 

1 Kararavveiv. 2 kol\ £v. 

8 Kw. omits. ' Kw. omits. 

300 



ON JOINTS, xlvii. 

it should be as small as possible, only sufficient to 
prevent the plank from causing needless additional 
pain by its hardness. Let the hump come as nearly 
as possible in line with the groove in the wall, so 
that the plank, when in place, makes most pressure 
on the most projecting part. When it is put in 
place, an assistant, or two if necessary, should press 
down the extremity of the plank, while others 
extend the body lengthwise, some at one end, some 
at the other, as was described above. But it is 
possible to make extension by wheel and axle, 
either embedded in the earth by the board, or with 
the supports of the axle carpentered on to the board 
itself; either projecting upwards a little, if you like, 
or on the top of the board at each end. 1 This 
reduction apparatus is easy to regulate as regards 
greater or less force, and has such power that, if 
one wanted to use such forcible manoeuvres for 
harm and not for healing, it is able to act strongly 
in this way also. For even by making traction 
lengthwise, only at both ends and without any 
other additional force, one would produce extension. 
On the other hand, if, without making traction, 
one only pressed downwards with the plank in this 
way, one would get reduction thus also. Such 
forces, then, are good where it is possible for the 
operator to regulate their use as to weaker or 
stronger, and, what is more, they are exerted in 
accordance with nature ; for the pressure forces the 
protruding parts into place, and the extensions 
according to nature draw asunder naturally the 
parts which have come together. For my part, 
then, 1 know no better or more correct modes of 

1 (?) Projecting horizontally. 

30 T 



IIEPI AP0PHN 

icaWlovs ovhe hiicaioTepas' r) yap icar aurrjv ttjv 
aicavOav lOvcoptrj t/}? Karardaio<; KUTcoOev re ical 
Kara to iepbv oareov KaXeop,evov ovk e^ei eiri\a- 
ftr)v ov8ep.L>]v avrodev he Kara tov av^eva ical 

110 Kara, tt)v tce<fia\i)v eTriXafirjv p-ev e%et, aW 
eaiheeiv ye airpeirri^ Tavrrj roc ycvopevr] r) Kard- 
Tacrt? koX dWa<; /3Xa/3a? av TrpoGTrapeyoi 
Tr\eovacr0elaa. eireipi'jO^v he hi) ttotc vtttlov tov 
avdpwitov KCLTaieLveiv, daicbv d(f)VGi/TOV V7ro0e\<; 
vtto to v/3a)p,a' Kcnreira av\a> ix %a\.Keiov e? tov 
do~fcbv tov viroKeipLevop ivtevai (pvcav dWd p.01 
ovk ev-rropelTO' OT6 p-ev yap ev /caTareivoip,i tov 
dvOpcoTTOV, rjaadTO 6 darfcos, ical ovk rjhvvaTO i) 
(pvaa eaavay/cd^eo-tfar ical a\\oi<; €Toip,ov Trepto- 

120 \iaddveiv rjv, are e? to avTO dvayKa^6p,evov 
to Te toO dvOpcoTTOV vj3cop.a Kal to tov dcr/cov 
7rXr]povp,evov /cvpTcopia. 6Ve 8 av /j,i] ndpra 
KaTaTelvotp,L tov dvOpwTrdv, 6 p,ev da/cbs vtto t//9 
(frvo-rjs eKvprovTO' 6 he dv0pco7ro<; irdvTrj fiaWov 
eXophaiveTO rj f/ avvecpepev. eypa\jra he e7riTrjhe<^ 
tovto' rcaXd yap icai TavTa ra uad/jptaTa eaTiv, 
a ireip^OevTa aTropr/devTa e(pdvr), ical hi dooa 

128 i)TTopi)0yi. 

XLVUI. 'Oiroaoicri he e'<? to haw o~Ku\ialvovTai 

01 0"TTOvhv\oi VTTO 7TTCOyU,aTO?, 1] KO.I epLTT€(j6vT0<i 

Tivbs fiapeos, eh p,ev ovhel? tcov cnrovhvXwv 
p,eya e^iaTaTai tcdp~a &>? inl to tto\v ck tcov 
aXXcov, yv he eico~Tfi p,e'ya i) els r) irXeioves, 
0dvaTov (pepovar wairep hi] ical irp6o~0ev eiprjrai, 
KuicXoohyjs ical avTi] ical ov ywvuohr/s ylveTai r) 
TTupaWayip ovpa p,ev ovv Tolai ToiovTOtai ical 
a,7ro7raTO? p,dXXov iaraTat /) toIgiv ktja) Kvcpolcn, 
302 



ON JOINTS, xLvii.-xLvm. 

reduction than these. For straight-line extension 
on the spine itself, from below, at the so-called 
sacred bone (sacrum), gets no grip ; from above, 
at the neck and head, it gets a grip indeed, but 
extension made here looks unseemly, and would 
also cause harm if carried to excess. I once tried 
to make extension with the patient on his back, 
and, after putting an unblown-up bag under the 
hump, then tried to blow air into the bag with a 
bronze tube. But my attempt was not a success, 
for when I got the man well stretched, the bag 
collapsed, and air could not be forced into it; it 
also kept slipping round at any attempt to bring the 
patient's hump and the convexity of the blown-up 
bag forcibly together; while when I made no great 
extension of the patient, but got the bag well blown 
up, the man's back was hollowed as a whole rather 
than where it should have been. I relate this on 
purpose; for those things also give good instruction 
which after trial show themselves failures, 1 and show 
why they failed. 

XLVIII. In cases where the vertebrae are curved 
inwards from a fall or the impact of some heavy weight 
no single vertebra is much displaced from the others 
as a rule ; and if there is great displacement of one 
or more, it brings death. But, as was said before, this 
dislocation also is in the form of a curve and not 
angular. In such cases, then, retention of urine and 
faeces is more frequent than in outward curvatures; 

1 "On essay show there's no way'' might indicate the 
play on words. 



TIEPI AP0PQN 

10 fcal 7rdSe? Kal o\a to, aKeXea ^rv^erai [idXXov, 
Kal 0avaT7)(f)opa ravra /idXXov e/ceivcov, Kal rjv 
TreptyevcovTai Be, pvtoBees ra ovpa fidXXov ovtoi, 
/cat roiv a/ce\ecov aKparearepoi, Kal vapKcohecr- 
repor rjv Be Kal ev too avco piepei fxdXXov to 
XopBco/xa yevrjTai, TravTos tov o~d>fiaTo<; cbKpar&es 
Kal vevapKcofievoi yivovTai. fir^avrfv Be ovk e\a> 
ovBe/anjv eyiaye, 6V g>? ^p?; tov toiovtov e? to 
avTo KaTaaTrjaai, el fjurj Tiva r) KaTa 1 t?}? 
K~k.LfxaKO<; KaTaaeiais axfieXelv oirj t€ eirj, rj Kal 

20 aXXr/ ti$ TOiavTT) h]o~i<i rj KaTaTacns, olryrrep 
oXiyw irpoaOev eipr/Tai. KaTavdyKaatv Be avv 
Tjj KaTaTaaet ovBepbi^v e^&>, ?/Tt9 dv yivotTo 
wairep tS> KV(p(o/jLaTi ttjv KaTavdyKaatv r) aavls 
eiroieiTO. 7rco? yap dv Tt<? ck tov e/jbirpoadev 
Bid t/)<? KoiXii]<; dvayKaaau BvvaiTo ; ov yap 
olov Tf. dXXd fjbrjv ovt€ /3>};\;e? ot/Te inapp-ol 
ovSe/uiirjv Bvvaju.iv eyovaiv, coaTe ttj KaTaTaaet 
aWTCfxcopeiv ov fir)v ovB' eveais (filial]? evie/u.evi]S 
e<i tt)v koiXijjv ovBev dv Bvvr)9etii. Kal jxrjv ai 

30 jxeydXat aiKvai irpoaj3aXX6p,evai dvaairdaiof 
e'lveKa Br)dev twv eaco peirovTwv airovBvXayv 
fieydXrj d/xapTa<; yvco/j,r)<i eaTiv dircoOeovai yap 
/xdXXov r) dvacnroicnv Kal ovB^ avTo tovto 
yiyvooaKovat oi 7rpoa/3dXXovTe<;- bau> yap dv 
Tt? fte^co 7Tpoa/3dXXr}, ToaovTfp /xdXXov XopBovv- 
Tai oi 7rpoa/3Xr]6evT€'i, avvavayKa^ofievov avco 
tov 8epp,aTO$. TpoTTovs T€ aXXov? KaTaTaatcov, 2 
r) oloi irpoaQev e'iprjVTai, e^ot/xi dv eliretv dpp.6- 
aat 3 ovs av tj? Bokcoi 4 tu> iraB^jxaTt p,dXXov 

40 dXX 1 ov KapTa nriaTevw avToiar Bid tovto ov 
ypd(j>(i). dOpoov Be avvtevat ^ph "Jr^pl tu>v toiov- 
3°4 



ON JOINTS, xlviii. 

the feet and lower limbs as a whole more usually 
lose heat, and these injuries are more generally fatal. 
Even if they survive, they are more liable to in- 
continence of urine, and have more weakness and 
torpor of the legs ; while if the incurvation occurs 
higher up, they have loss of power and complete 
torpor of the whole body. For my part, I know 
of no method for reducing such an injury, unless 
succussion on the ladder may possibly be of use, or 
other such extension treatment as was described a 
little above. I have no pressure apparatus com- 
bined with extension, which might make pressure 
reduction, as did the plank in the case of hump- 
back. For how could one use force from the front 
through the body cavity ? It is impossible. Certainly 
neither coughs nor sneezings have any power to 
assist extension, nor indeed would inflation of air 
into the body cavity be able to do anything. Nay 
more, the application of large cupping instruments, 
with the idea of drawing out the depressed verte- 
brae, is a great error of judgment, for they push in 
rather than draw out ; and it is just this which those 
who apply them fail to see. For the larger the 
instrument applied, the more the patients hollow 
their backs, as the skin is drawn together and up- 
wards. I might mention other modes of extension, 
besides those related above, which would appear 
more suitable to the lesion ; but I have no great 
faith in them, and therefore do not describe them. 
As to cases like those summarily mentioned, one 



8i«k. 2 So Knn., Kw. Karaffeiaiwv Littr^, Pq. 



3°S 



IIEPI AP0PQN 

T(ov, mv ev KefyaXaLw etprjrai, on rd puev e'9 
to Xophov pe^fravra oXedpid eartv Kai crivdfiropa, 
ra he e? to KV(f>bv dacvea Oavdrov, Kai ovpcov 
ayecriddv Kai aTrovapKcoatcov to eitirrav ov yap 
ivretvei Tov<i 6%erov<; rov<; Kara, rr)v koiXltjv, 
ovhe KwXvei evpoovs elvai r) e? to e%ay KvcpwcrLS' 
r) he XophwaLs ravrd re dp,(porepa iroiel zeal e? 
ra dXXa 7roXXa irpoayiverai. errei rot rroXv 

50 irXeoves o~KeXea>v re /cal '\eipaiv d/cparees ylvovrai, 
Kai KaravapKOvvrat to aoy/xa, /cal ovpa io~yerai 
avrolaiv olaiv av jxi] eKarfj p,ev to vfioopia pirjre 
eaco fxrjTe e^o), aeiaOewai he lo~~%vpQ><; e? rr)v 
WucopiTjv t/}<? pa^iov olcrc h' av eKarfi to vfico/xa, 

55 r)o~oov roiavra irdayovai. 

XLIX. IloA.Xa he /cal dXXa ev IrirpiKrj av ri<; 
roiavra Karihoi, oiv ra piev icr^vpa daivea earl 
/cal /caO' eoivrd rrjv /cp'iaiv oXrjv Xapufidvovra rod 
voai]/xaro^, rd he daOevearepa crivd/xcopa, Kai 
diroroKOVs voar/ixaTOiv %poviov<; rroieovra /cal 
KOivwveovra tw dXXa) o-(op.ari errl irXeov. eirel 
Kai irXev pecov Karrj^i^ roiovrbv n treirovBev olcrt 
/xev jap dv Karayfj rvXevpr], i) p.irj rj 7rXiov€<i, &>? 
roiai 7rXeio~roiai Kardyvvrai, pur) hiaayovra rd 

10 barea e\ to eaw /iepo<; p-rjhe ■^riXu>6evra, bXiyoi 
fiev rjhrj eirvperrivav drdp ovhe alfia iroXXol i'jhrj 
eTTTvaav, ovhe epnrvoi rroXXol ylvovrai, ovhe ep,p,o- 
roi ovhe eTTLn^)aKeXiat,e<i rcov oarecov hiaird re 
<f>avXri dpKel' i)v yap fit) Trvperos avve^rj<i eTuXap,- 
f3dvr/Tai avrov<i, Keveayyelv kukiov rolai roiovroi- 
aiv rj p.}] Keveayyelv, Kai encohwearepov Kai irvpe- 
rcohiarepov Kai ^i)^cohearepov' to yap 7rX/)pa>p:a 

1 J. j. 

306 



ON JOINTS, xi.viii.-xlix. 

must bear in mind generally that inward deviations 
cause death or grievous injury, while those in the 
form of a hump are not as a rule injuries which 
cause death, retention of urine, or loss of sensation ; 
for external curvature does not stretch the ducts 
which pass down the body cavity, nor does it hinder 
free flow, while inward curvature does both these 
things, and has many other complications. In fact, 
many more patients get paralysis of legs and arms, loss 
of sensation in the body, and retention of urine when 
there is no displacement either inwards or outwards, 
but a severe concussion in the line of the backbone ; 
while those who have a hump displacement are less 
liable to such affections. 

XLIX. One may observe in medicine many similar 
examples of violent lesions which are without harm, 
and contain in themselves the whole crisis of the 
malady, 1 while slighter injuries are malignant, pro- 
ducing a chronic progeny of diseases and spreading 
widely into the rest of the body. Fracture of the 
ribs is such an affection ; for in cases of fractured ribs, 
whether one or more, as the fracture usually occurs, 
the bones not being separated and driven inwards 
or laid bare, we rarely find fever ; neither does it 
come to spitting of blood in many cases, nor do they 
get empyema or wounds requiring plugs, neither is 
there necrosis of the bones. An ordinary regimen 
suffices ; for if the patients are not attacked by 
chronic fever, it is worse to use abstinence in such 
cases than to avoid it; and it involves greater liability 
to pain, fever, and coughing ; for a moderate fullness 

1 I.e. it is confined to the injury itself, and steady recovery 
ensues. 

3°7 



ITEPI AP0PQN 

to fierpiov t?}? KocXirjq, htop6u>p.a twv ifXevpewv 
ylverai' r) 8e fcevoocri'i Kpep.aap,ov jxev Trjcri irXev- 

20 pf/cri TToiel' 6 he Kpe/xaafios, ohvvqv. e^coOev 
re av (pauXrj emBeai^ tocctl toiovtoktiv dp/cel' 
Kr^pwrfi /cal airX^veai Kal oQqviomjiv rjav^(o<: 
epelhovra, opbaXrjv rrjv e-nlheaiv TvoielaOai icai 
epiwhes n irpocreiuOevTa. Kparvverai, he irXevprj 
ev eiKoatv r/fiipyo-iv ra^etat yap al eTrnrcopooaies 

26 rcop toiovtwv oarecov. 

L. ' Ap,(puf)\a(T0€Lo-Ti<; pukvTOt tt}? aaptco<i dpucpl 
TyaL irXevpfjaiv rj vtto 7rXr)yfj<i i) vtto 7TTco/xaTO? 
i) vtto dvT€peiaio<i i) aXXov Tti^o? ToiovTOTpoirov, 
irdXXol -ifir) ttoXv al/xa et'Tuaav' ot yap bj^erol ol 
Kara to Xairapov rr)<; irXevpr)<; e/cao"T?/? TrapareTa- 
jievoi, teal ol tovoi curb rcov eTriKaipordrcov tosv ev 
Tftj ad>p,ari Ta<? d<f>opp.d<; eyovaiv' ttoXXoI ovv rjSr) 
/3>/%co8ee<? Kal <pvp,aTiai /cal epvrrvoi eyevovro Kal 
ep^fioroi, Kal r) irXevpr) iirecrcpa/ceXio-ev avrolaiv. 

10 drap Kal olaiv p-rjhev toiovtov irpoaeyevero, dp,<pi- 
(fiXacrOeicrris t?)? crap/co? dp,(pl rfjaL irXevpfjaiv, 
6'yU.ft)? he fipahvrepov 6hvvcop,evoi iravovrai ovtoi rj 
olcriv dv irXevprj Karayfj, Kal VTroaTpo(f)d<i /xdXXov 
Xayei ohwr/fidrcov to ^coplov ev rotai toiovtoio~i 
Tpcop,aaii' i) rolai erepotenv. pudXa p,ev ovv p.ere- 
%€T€poi KarapueXeovaiv t(ov toiovtcov aivewv, 
fxaXXov rj rjv rrXevpr) Karayfj avrolaiv' drap 
Kal Irjaios o-KeOpoTepr/s ol toiovtoc heovrai, el 
acocppovolev' rfj re yap hiairr) avpucpepet avve- 

20 ardXdai, aTpe/xelv re tw o-copuaTi a>? p,dXicrTa, 
dcppohiaiayv re direyeadai /3pcop,drcov re Xnrapcov 
Kal Kep-)(ycoheo)v, Kal Icryypwv irdvrwv, (pXefia 
re Kar' dyKcova Tep.vea0ai, aiydv re a)? fxaXiara, 

308 



ON JOINTS, xlix.-l. 

of the body cavity tends to adjust the ribs, while 
emptiness leaves them suspended, and the suspension 
causes pain. Externally, a simple dressing suffices in 
such cases, with cerate, compresses and bandages, 
applying them smoothly with gentle pressure, 
adding also a little wool. A rib consolidates in 
twenty days, for callus forms rapidly in bones of 
this kind. 

L. When, however, the flesh is contused about 
the ribs, either by a blow, fall, encounter, or some- 
thing else of the sort, we find that many have con- 
siderable haemoptysis. For the canals extending 
along the yielding part of each rib, and the cords, 1 
have their origin in the most important parts of the 
body. Thus we find that many get coughs, tubercles, 
and internal abscesses, and require plugging with lint ; 
also necrosis of the rib is found in these patients. 
Besides, when nothing of this kind occurs after con- 
tusion of the flesh about the ribs, still these patients 
get rid of the pain more slowly than in cases where 
a rib is broken ; and the part is more liable to 
recurrences of pain after such injuries than in the 
other cases. It is true that many neglect such 
injuries, as compared with a broken rib; yet such 
need the more careful treatment, if they would be 
prudent. It is well to reduce the diet, keep the 
body at rest as far as possible, avoid sexual inter- 
course, rich foods and those which excite coughing, 
and all strong nourishment j to open a vein at the 
elbow, observe silence as much as possible, dress 

1 Nerves. 

3°9 



IIEPI AP0PQN 

eiriBeiaOai re to ^coptov rb (}>Xaadev aTrXrjveai 
pr] 7ro\vTTTV)(OLai, av^voiat Be real rroXv irXa- 
rvrepoLai iravrrj rov <bXaa fxar o<? , Kijpwrrj re 
viroxpieov, 1 oBoviotai re irXareau avv raivlrjai 
irXareiriai teal paXOaKfjat eTTiBelv, epeiBetv re 
perpuwi, ware pr) Kcipra Treme^Oai cfrdvai rov 

30 e7u8eoep,evov, p>]B' av %aXapov' ap^eaOai Be rov 
eTTiheovra Kara, rb (pXdapba, zeal eprfpeio Oai 
ravrp p,dXiara, rrjv Be eirLBeaLV iroieladai, to? 
dirb Bvo d/j^ewi', ernBetv re, iva p,r) TTepippeires 
ro Beppa rb ire pi Ta? irXevpds ij, dXX* labpposrov' 
eiriBetv Be r) kciO exdarrjv r)pepr]v rj trap erepr/v. 
dpeivov Be /cal KoiXirjv paXOd^ai /covefxp rivl 
bo~ov Kevwaios eive/cev rov airov, /cal eirl pev 
Se/ca rjpLepas la^vati eiv, eireLra dvaftpe\Isai rb 
awpia Kal diraXdvai' rfj Be eiriBeaei, ear' av p,ev 

40 Lo-%vaivr)<i, epripeiapevrj puaXXov ^prjadai, birbrav 
Be e<? rbv diraXvapbv ayr/s, eiri^aXapcorepr}. Kal 
tjv pev alpa diroirivarj Karap\ds, reaaapaKov- 
dr'lp.epov ri]v p.eXe'ri)v Kal rr)v eiriBeaiv rtoieiaQai 
XP 7 )' V v & e M'V TTTvar) to alpa, dpKet ev eiKoaiv 
j)p,epr/aiv rj peXerrj co? errl rb ttoXv' rfj icryjbi Be 
rov rpebparos robs ■y.pb' vov ^ TTporexpaipeadai 
%prj. baoi S' av dpeXrjaroai rebv roiovrcov 
apcpKpXaapdrcov, rjv Kal aXXo prjBev avrolai 
(pXavpov pe^ov yevrjrai, opcos ro ye ywplov 

50 apcpubXaaOev pv^coBearepr/v rrjv adpKa ta^et rj 
irpoaQev eXyev* oirov Be ri roiovrov eyKara- 
Xeiirerai, Kal p,r/ ev e^nrovrai rfj ye dXOe^et, 
(f)avXorepov p.ev, rjv Trap* avrb rb bareov eyKara- 
Xei<bOfj rb pv^wBes' ovre yap en rj adpt; 
opouos arrrerai rov bareov, ro re bareov voarj- 
310 



ON JOINTS, l. 

the contused part with pads not much folded, but 
numerous, and extending in every direction a good 
way beyond the contusion. Anoint first * with 
cerate, and bandage with broad, soft linen bands, 
making them suitably firm, so that the patient says 
there is no great pressure, nor on the other hand is 
it slack. The dresser should begin at the contusion, 
and make most pressure there ; and the bandaging 
should be done as with a two-headed roller, in such 
a way that the skin may not get in folds at the ribs, 
but lie evenly. Change the dressing every day or 
every other day. It is rather a good thing to relax 
the bowels with something mild, sufficiently to clear 
out the food, and give low diet for ten days. Then 
nourish the body and plump it up. During the 
attenuation period, use rather tighter bandaging, 
but more relaxed when you come to the plumping 
up. If there is haemoptysis to begin with, the 
treatment and bandaging should be kept up for 
forty days ; if there is no haemoptysis a twenty-day 
course of treatment usually suffices. The forecast 
as to time should be made from the gravity of the 
wound. In cases where such contusions are neglected, 
even if nothing worse happens to them, still the 
tissues in the contused part contain more mucus 
than they did before. When anything of this kind 
is left behind and not well squeezed out by the 
curative process, it is worse if the mucoid substance 
is left in the region of the bone itself; for the flesh 
no longer adheres so closely to the bone, and the 

1 Of. Fract. XXI for l>iro X pl<»- 

1 OiraAti'pety. 

•ill 



IIEPI AP0PfiN 

poTepov yiverai, acpazceXiapiot re ^povioi oaTeov 
iroXXolaiv i"]8rj diro tcov toiovtcov Trpocpaatcov 
ejevovTO. drap zeal rjv pa) irapa to oaTeov, aXX 
avrr) r) adp£ p.v$jcoBr)<i y, o/i&>9 VTroarpocpai 
30 yivovTai zeal 6Bvvai dXXoTe zeat ciWore, rjv Ti? 
tco crcop,ari ti>XV trovrjaas' zeal Bia tovto rfj 

eTTiBeaei xP r ) a @ ai XP 7 h ^■h ia P Lev "J^V' "■z ua & e 
tirl 7to\v irporjKovarj, ea>9 av ^rjpavOfj p,ev zeal 
avairoOfi to e/c^u/zeo/Aa to iv ttj cpXdaei eyyevo- 
fievov, avfyidfi Be aapzel vyzei to ^(opiov-, dyp-r/Tai 
Be tov oaTeov i) adpP,. olai S' av dp:e\r]0elai 
XpovLcoOfj zeal oBvvcoBes to x u> P lov yevijTai, zeat 
7] adpP vTropLv^os [jj], 1 tovtoigi zeavais 070-/9 
dpiaTr). zeal rjv p,e.v avT?) r) adpP, p.v^coBrj<; rj, 

70 d)(pi tov oaTeov zeaieiv XPV> P'V P b V v BiaOepp,av- 
Brjviii to oaTeov rjv Be p.eai]jv tcov irXevpcov rj, 
eiriTroXfj^ p,ev ovBe ovtco XPV ^aieiv, (pvXaaaeauat, 
p.evT0i firj Sia/cavays ireprjv. rjv he irpo<i tw 6o~T6&> 
Bo/erj elvai to cpXdapia, zeal eVt veapov r), zcai /x7]ttco 
acpazceXiar) to oaTeov, rjv fiev zcdpTa oXljov rj, ovtco 
zcateiv XPV &o"nep ecprjTaf rjv pievroi irapapbr]ici]<; 
fj 6 p.eT€(i)pta/.i6$ 6 zcciTa to bareov, irXeovas 
eaxdpas e/xfidXXeLV XPV' rrr€ P t § e ocpazeeXiap.ov 

79 irXevprjs dp,a rfj tcov epupoTcov Ir/Tpetj] ecprjaeTai. 
LI. *Hi> Be /xr]pov dpOpov e% lax^ov i/areay, 
i/cTTLTTTei Be zona Teaaapas Tpoirov^, 69 p,ev to 
eaco ttoXv TrXeiaTi'iKi^, e'9 Be to etjco tcov aXXcov 
irXeiaTazci^' e9 Be to otuaOev zeal to eparpoadev 
eKTrl-TTTei fiev, bXtydzeis Be. oiroaoiat fiev ovv av 
izcfif) e9 to eaco, fiazcpoTepov to cr«:eXo9 cpatveTai, 
irapafSaXXofievov 77/309 to kWepov, 81a Biaaas irpo- 

1 U Kw. and most WSS. omit 
312 



ON JOINTS, L.-U. 

latter becomes more subject to disease. Chronic 
necroses of bone are found to arise in many cases 
from causes like these. Besides, even if the mucoid 
part is not along the bone, but involves the flesh 
itself, still relapses occur, and periodical pains, when- 
ever one happens to have bodily trouble ; and there- 
fore one should use bandaging, both careful and 
prolonged, for some time, till the exudation formed 
in the bruise is dried up and consumed, the part 
filled with healthy flesh, and the flesh firmly attached 
to the bone. In neglected cases which have become 
chronic, when the part is painful and the flesh rather 
mucous, the best treatment is cauterising. If the 
flesh itself is mucous, one should cauterise down to 
the bone, but avoid greatly heating the latter. If it 
is intercostal, the cauterisation should, even so, not 
be superficial ; yet one should take cai - e not to burn 
right through. If the contusion appears to have 
reached the bone, and is still fresh, and the bone 
not yet necrosed, if it be quite small, one should 
cauterise as directed ; but if there is an elongated 
tumefaction over the bone, one should make several 
eschars. Necrosis of a rib will be considered along 
with the treatment of patients with discharging 
abscesses. 

LI. When the head of the thigh-bone is dislocated 
from the hip, it is dislocated in four ways, far most 
frequently inwards ; and of the others the most 
frequent is outwards. Dislocation backwards and 
forwards occurs, but is rare. In cases where it is 
displaced inwards, the leg appears longer when 
placed beside the other, naturally so, for a double 



3 J 3 



riEPI AP0PftN 

(f)daia<i et«oT&)?* iirt re yap to dirb tov io-yiov 
Treefrv/ebs bcneov, to dvco (f)ep6pevov 717309 top 

10 KTeva, errl tovto 77 €7ri/3aai<; rfjs /ee<paXrj<s tov 
pypov ytverai, zeal 6 av^rjv tov dpOpov eVi t% 
kotv\i]S b^eiTar e^coOev Te av 7A.01/T09 tcolXos 
(fiaivsTai, are eaco peifrdai]? tt;? /ee&aXrjs tov 
prjpov, to tc av /ectTa rb <yovv tov prjpov d/epov 
avay/cd^eTai e£a> peireiv, zeal fj /evijpT) real ttoik; 
a>o~avT(o<i. <XT6 ovv e£a> peirovTos tov 7ro£o9, oi 
IrjTpol oY cnreipirjv tov vyiea irbBa 737309 tovtov 
TTpoaioyovcriv, afOC ov tovtov 777309 tov vyiea' 
Bid tovto iroXv pa/cporepov cfyalveTai to atvapbv 

20 tov vyieos' iroXXa^fj Be zeal aXXrj ra toiclvtcl 
irapaavveaiv e'xet. ov ptjv ovBe avyzedpTTTeiv 
hvvavTai /card tov fiovftwva opoicos tw vyier 
d,Tap zeal yfravopei'r) t) zeecfraXt] tov pr/pov /card 
rbv irepivaiov virepoy/ceovo-a 61/877X09 eaTiv. ra pev 
ovv arjpela tclvtu ccttiv, olaiv dv eaco itcneTTTcoKr) 

26 6 p,rjpb<i. 

LII. Olai pev ovv dv izeveacov p,rj epirearj, 
dXXd KarairopriOf] teal dpeXi]9fj, r'] Te oBonroplt] 
TrepKpopdSyjv tov crtceXeot; oiairep Tolai fioval 
yiveTai, zeal r) o^ais TrXeiaTT] avrolaiv iirl tov 
vyieo<i azeeXeos eaTiv. teal dvayzcd^uvTai zeard 
tov zeevecova zeal /card to dpOpov to ezeTreirTcozebs 
koIXoi /cal azeoXiol elvai' Kara Be to vyies €9 to 
efjco 7X0UT09 dvayzed^eTai irepupeprj^ elvai' el 
ydp Tt9 e^co too ttoBI tov vyieo? azeeXeos Baivoi, 

10 dircodeoi dv to acopa to dXXo £<; to atvapbv 
a/ceXos T7]v o^aiv iroieiaOai' to Be aivapbv ovte 

1 kcCl = ?). Cf. Thucyd. II. 35. 
3 T 4 



ON JOINTS, li.-i.ii. 

reason ; for the dislocation of the head of the femur 
takes place on to the bone arising from the ischium 
and passing up to the pubes, and its neck is sup- 
ported against the cotyloid cavity. 1 Besides, the 
buttock looks hollow on the outer side, because the 
head of the femur is turned inwards ; again, the end 
of the femur at the knee is compelled to turn out- 
wards, and the leg and the foot likewise. Thus, as 
the foot inclines outwards, practitioners through 
inexperience bring the foot of the sound limb to it, 
instead of bringing it to the sound one. This makes 
the damaged limb appear much longer than the 
sound one ; and this sort of thing causes misappre- 
hension in a variety of other ways. The patients, 
moreover, cannot bend at the groin so well as one 
with a sound limb ; and for the rest, on palpating 
the head of the femur, it is manifest as an abnormal 
prominence at the perineum. 2 These then are the 
signs in cases of internal dislocation of the thigh. 

LI I. In cases where the dislocation is not reduced, 
but is given up or neglected, progression is accom- 
plished, as in oxen, by bringing the leg round ; and 
they throw most of their weight on the sound leg. 
They are also of necessity curved in and distorted in 
the region of the loin and the dislocated joint, while 
on the sound side the buttock is necessarily rounded 
outwards. For if one were to walk with the foot 
of the sound leg turned out, he would thrust the 
body over, and put its weight on the injured leg ; 

1 I.e. lower rim of the acetabulum ; so Littre, Pq. Adams 
suggests the perforation below the pubic bone (thyroid). As 
already remarked the frequency and nature of this dislocation 
are hard to understand. 

2 Evidently understood in a wide sense, to include inner 
part of groin. 

3'5 



IIEPI AP0PQN 

dv SvvaiTO 6%etv* 7r<y<? yap ; dvay/cd&Tai ovi 
ovrco Kara tov vyieos a/ceXeos T(p ttoSI ecrco 
/3aiveiv, dXXa prj etjco' ovtw yap 6%ei p,d\iara 
to cr«e'Xo? to vyies koI to ccovtov uepo? tov 
aeofiaTOS /cat, to tov atvapov cr/ceA-eo? p,epo<;. koi- 
Xaivopevoi he Kara tov /cevecova kol /caTa to, 
dpOpa, ap,i/cpol fyaivovTai /cal x avTepelheadau 
avay/cd^ovTat TrXdyioi /caTa to vyies a/ceXos' 

20 SeovTai yap avTi/covTcoawi TauTrf eVt tovto 
yap ol yXovTol peirovai, /cal to d\9o^ tov 
awp-aTO*; oyeiTai 2 eirl tovto. dvay/cd^ovTac he 
/cat, eTTLKvirTetv T)]v yap yelpa rqv /caTa to 
cr/ceXos to atvapov dvay/cd^ovTai /caTa irXdytov 
tov puripov epeihetv' ov yap hvvaTat to crivapbv 
a/ceXos oxetv to crwpta ev Ttj peTaXXayr} tmv 
a/ceXewv, r)v p,r/ icaTeyr}Tai irpos ttjv yr)v -rne^o- 
pevov. ev TOtovTotcrt 3 ovv Total a^ixaaiv 
avay/ca^ovTat ea^i]paTLa0at, otatv dv ecrw e/cj3dv 

30 to cipdpov pi] ipTrearj, ov 7rpo/3ov\evaavTO<i tov 
dv&pooirov oVco? dv ptjiaTa eo~)(rip,aTio-p,evov' 1 r), 
aXX avTt) r) o~vpt<popi] hthaa/cei e/c tcov trapeovTcov 
to. ptj'iaTa alpelaOai. eirel /cal Giroaot 6 eX/cos 
exovTes ev ttoBI rj /cvypr/ ov /cdpTa hvvavTat 
entfiatveiv to> a/ceXet, TrdvTes, ical ol v/jirtoi, 
oi/t&>9 oSotTTopovaiv' e^w yap j3aivovat tw criva- 
pS> a/ceXef /cat htaad /cepoatvovai, htaawv yap 
BeovTaf to tc yap awpta ovtc o^etTat 6polco<; iirl 
tou e£a> airofBaivoptevov wairep enl tov ecrco' 

40 oi/Be yap /caT tOvwpir/v avTcp y'tveTai to d%0o<;, 
aXXa iroXv p,aXXov iirl tov virofiaivopevov «ar' 
Wvwplriv yap avTu> yiveTai to d~)(do<i, ev tc ainfj 
Trj ooonroplr) /cal tjj pteTaXXayy twv a/ceXeoov. 
316 



ON JOINTS, lii. 

and the injured limb could not carry it. How 
should it? He is thus obliged to walk with the foot 
of the sound leg turned in and not out; for in this 
way the sound limb is best able to carry both its 
own share of the body and that of the injured one. 
But, owing to the inward curvature at the loin and 
at the joints, they appear short, and patients have to 
support themselves laterally on the side of the sound 
leg with a crutch. They want a prop there, because 
the buttocks incline that way, and the weight of the 
body lies in that direction. They are also obliged to 
stoop ; for they have to press the hand on the side 
of the injured leg laterally against the thigh, since 
the injured limb cannot support the body during 
the change of legs, unless it is kept down on the 
ground by pressure. Such then are the attitudes 
which patients are obliged to assume in unreduced 
internal dislocation of the hip — not as a result of 
previous deliberation by the patient as to what 
will be the easiest attitude ; but the lesion itself 
teaches him to choose the easiest available. So 
too those who, when they have a wound on the 
foot or leg, can hardly use the limbs — all of them, 
even young children, walk in this way. They turn 
the injured leg out in walking, and get a double 
boon to match a double need ; for the body is not 
borne equally on the Limb brought outwards and 
on that brought in, since the weight is not per- 
pendicular to it, but comes much more on the limb 
that is brought under; the weight is perpendicular 
to the latter both in actual walking and in the 

1 ^6\<f) T(f> K. t<£ ^u\cf> Li It iv. Pq. omits. 

3'7 



IIEPI APQPftN 

iv tovto) tS> a^fxan rd^ara av BvvaiTO vito- 
TiBevai 10 vyies aKeXos, rjv 1 ra> p,ev aivap&> 
i^coTepto fiaiwu, rro Be vyiel iacorepco. irepl ov 
ovv o Xoyos, dyaObv evpicrtceodai avrb ewvTO) to 
awp,a if ra pipaTa twv a^rjpaTcov. baoiai pev 
ovv p,7)TTQ) TeTeXeiwpevoiaiv e? av^rjatv iK7reau>v 

50 p,i) ipbTrear/, yviovrai prjpbs Kal r) Kv/]p,rj teal 
it ovf ovre yap t« ocrrea e<? to /irjfco<; 6p,oioo<; 
au^eTai, dXXa fipayyTepa yiveTai, pdXiaia Be 
to tov fitjpov, daapKov T€ drcav to oKeXos /ecu 
apivov Kal ifCTeOi]\vo-pLevov Kal XeiTTOTepov yive- 
Tai, ap,a p,ev Bia, ttjv aTeprjaiv Trjs ^coyo?;<? tov 
apdpov, ap.a Be oti dBvvaTov %prjaOai iaTiv, 
oti ov /caTa (fivaiv KeiTai' ^pr)ai<i yap peTe- 
i;eTepr] pveTai Tr)<; ayav iK6rfXvvaio<;' pveTai Be 
ti Kal t?)? irrl pbrJKO<i dvav£i')aio<;. tca/eovTai pev 

60 ovv pdXiaTa olaiv av ev yaaTpl iovaiv i^ap- 
6pr)0-ri tovto to apdpov, BevTepov Be olaiv av &)? 
vrjTTKOTaTOiaiv iovaiv, fjKiaTa Be TOiai TereXeui)- 
p,evoiaiv. toIctl p,ev ovv TeTeXeicopievoiaiv elpr/Tai 
oXrj Ti<? r) oBonropirf yiveTai' olai B' av vrjirioiaiv 
iovaiv 1) avp(j)op>) avTrj yevrjTai, 01 p,ev irXeiaToi 
/caTaf3\a/cevovai 2 tijv BiopOwaiv tov acbpaTOs, 
dXXa [«ra/c(y9] 3 elXenvTai iirl to vyies atceXos, 
Trj %eipl rrpos tt)v yr)v direpeiBopievoi Ty icaTa to 
vyies cr/ce'Xo?. KaTa{3\a/cevovai Be kvioi Ti]V e? 

70 bpdbv oBonropitjv Kal olaiv av TeTeXeicopevoiai 
avTrj r) avp(f)opr) yevrjTai. oiroaoi §' av vi']irioi 
iovTes TavTjj tt} avpupopy y^pi]adpievoi bpOoo? 
iratBayroyyjdeGoai,* tw pev vyiei aKeXei xpeoinai 5 
€9 bpdbv, vrrb Be ti)v paa^dXr/v ttjv KaTa to 

1 €i. 2 Ka,Tafift\aK€vov(Ti bis. 

3«8 



ON JOINTS, lii. 

change of legs. It is in this attitude, with the 
injured leg rather outwards and the sound one 
rather inwards, that one can most rapidly put the 
sound limb under. As regards our subject, then, 
it is good that the body finds out for itself the easiest 
posture. When it is in persons who have not yet 
completed their growth that the hip remains un- 
reduced after dislocation, the thigh is maimed, and 
the leg and foot also. The bones do not grow to 
their normal length, but are shorter, especially that 
of the thigh ; while the whole leg is deficient in flesh 
and muscle, and becomes flaccid and attenuated. 
This is due at once to the head of the bone being 
out of place and to the impossibility of using it in its 
abnormal position ; for a certain amount of exercise 
saves it from excessive flaccidity, and in some degree 
prevents the defective growth in length. Thus the 
greatest damage is done to those in whom this joint 
is dislocated in utero ; next, to those who are very 
young ; and least to adults. In the case of adults, 
their mode of walking has been described ; but when 
this accident occurs in those who are very young, 
for the most part they lack energy to keep the body 
up, but they crawl about [miserably] on the sound 
leg, supporting themselves with the hand on the 
sound side on the ground. Some even among those 
to whom this accident happens when adult lack the 
energy to walk standing up; but when persons are 
afflicted by this accident in early childhood and are 
properly trained, they use the sound leg to stand up 

3 Kw. omits ; also B and the best MSS. 

4 Kw.'s correction for waiBaywyriduxTi codd. 
6 Xpi<>>vTai Kw. 

319 



IIEPI AP0PQN 

vyies cr/eeA.09 aKL7rrova ireptfiepovcri, fxere^erepoi 
he koI l>7t' dpfyoTepas ras %elpa<;' to he aivapov 
<TKe\o<; puerewpov e^ovai, /cal toctovtg) prjtov? 
elaiv, oa(p dv avTolaiv eXaaaov to er/ceA-09 to 
aivapov fy to he vyies layyei avToiaiv ovhev 

80 rjaaov rj el /ecu dp<p6repa vyiea rjv. dr/XvvovTai 
Be irdai TOiai ToiovToiai ai adpKe<; tov aKeXeos, 
p,dXXov he ti OrjXvvovTai ai etc tov e£a) piepeos r) 

83 ai eK tov haw &>9 eVt ttoXv. 

LIII. MvOoXoyovai 1 he Tive$, otc ai 'Apafavi- 
he<; to dpaev yevos to ecovTwv avTiica vrjiriov eov 
e%ap9peovaiv, ai pev KaTa [tA] 2 youvaTa, ai he 
KUTa to, layia, &>9 hfj0ev %a>Xa yivoiTO, /cat pr) 
etrifiovXevoi to dpcrev yevos tu> OtjXer yeipwvafyv 
dpa TOVTOiai y^peovTai? oiroaa rj aKUTe'n]<i epya rj 
■%aXKeit]<;, rj dXXo ti ehpaiov epyov. el puev ovv 
dXrjOea TavTa eaTiv, eya> pev ovk olha- ori he 
yivoiTO dv ToiavTa olha, el Tt9 efjapOpeoi avTixa 

10 vi'jTria eovTa. KaTa pev ovv to, layia p,e%ov to 
hidfpopov eaTiv e<? to eaco rj e? to €%a> itjapOpfjcrai' 
Kara he Ta yovvaTa hiafyepei puev ti, eXaaaov he 
ti hia<pepei. TO07T09 he e/eaTepov tov %o)X(tipaTO'i 
ihios eariv' KvXXovvTai 4 p,ev yap p,dXXov olaiv av 
e*9 to e%a) i^apdpijai]' opOol he rjaaov laTavTai 
olaiv dv 69 to eaco i^ap0p)]a>j. d>aavT(o<; he teal 
rjv irapd to acpvpbv e^apOp^arj, rjv pev e'9 to h%w 
pepos, kvXXoI pev yivovTai, eardvai he hvvavTai' 
rjv he 69 to eaco pepos, ftXaiaol p-ev yivovTai, 

20 rjaaov he eaTavai hvvavTai. i] ye pr)v avvav^rjais 
tcov oaTecov Tonjhe yiveTar olai pev av to KaTa ro 

1 MvOokoyeovo-t Kw. 

2 Little's insertion, but Galen also has it. 

* XpioivTai Kw. * Erm. Pq. for yvtovvrai vulg. 

320 



ON JOINTS, ui.-lui. 

on, but carry a crutch under the armpit on that 
side, and some of them under both arms. As for 
the injured leg, they keep it off the ground, and do 
so the more easily, because in them the injured leg 
is smaller; but their sound leg is as strong as 
if both were sound. In all such cases the fleshy 
parts of the leg are flaccid ; and, as a general rule, 
they are more flaccid on the outer than on the 
inner side. 

LI 1 1. Some tell a tale how the Amazons dislocate 
the joints of their male offspring in early infancy 
(some at the knees and some at the hips), that they 
may, so it is said, become lame, and the males be in- 
capable of plotting against the females. They are 
supposed to use them as artisans in all kinds of 
leather or copper work, or some other sedentary 
occupation. For my part, I am ignorant whether this 
is true ; but I know that such would be the result 
of dislocating the joints of young infants. At the 
hips there is a marked difference between inward 
and outward dislocation ; but at the knees, though 
there is a certain difference, it is less. In each case 
there is a special kind of lameness. Those in whom 
the dislocation [at the knee] is outwards are more 
bandy-legged, while those in whom it is inwards 1 are 
less able to stand erect. Similarly, when the dis- 
location is at the ankle, if it is outwards, they be- 
come club-footed, 2 but are able to stand ; while if it 
is inwards, they become splay-footed, and are less 
able to stand. As regards growth of the bones, the 
following is what happens: when the bone of the 

1 I.e. the knock-kneed. 

2 I.e. leg outwards and foot inwards, and vice versa. The 
knock-kneed and splay-footed are worse oil" than the bandy- 
legged and club-footed. 

321 

VOL. III. M 



IIEPI APGPftN 

acfivpbv oareov rb tt}<? KVijprjs l e/carf), rovroiai 
fiev ra rov ttoBos oarea rjKiara avvav^erai, ravra 
yap eyyvrdio) rod rpcopar6<; eariv, ra Be rfj? 
Kvr)p.T]<i oarea av^erai p,ev, ov woXv Be evBeea- 
repo)<i, at fxevroi adp/ces pivvBovai. olai £' av 
Kara piev ro acpvpov pevrj rb a pdpov Kara <pvaiv, 
Kara Be rb yuvv e^eari'jKij, rovroiai to rf)<; Kv>jp,y}<i 
oareov ovk iOeXei avvav^dveaOai opoiw^, dXXa 

30 fipayyrepov ylverai, rovro yap eyyvrdrai rov 
T/oco/xaro? eartv, rov pevroi -noBbs ra oarea 
pnvvOei piev, drdp ov% op-oiax;, coairep bXiyov rt 
rrpoadev eiprjrai, on rb dpOpov rb irapd rbv iroBa 
aa>6v eari. el Be oi -y^prjaOai r/Bvvavro, warrep 
KaXrw kvXXS), en av rjaaov epuvvQei ra rov 770809 
oarea rovroiaiv. olai S' av Kara rb la^iov ?; 
ef;dp0pi]ai<; yevrjrat, rovroiai rov prjpov rb oareov 
ovk iOeXei avvav^dveadai 6p,oia)$, rovro yap 
iyyvrdro) rov rpooparos iariv, dXXd ^pa^vrepov 

40 rov vyieos yiverai' ra pevroi rrjs Kvnp,y]<; oarea 
ou% opoloos rovroiaiv dvav^ea yiverai, ovBe ra 
rov 7ToSo?, Bid rovro Be, on rb rov prjpov dpdpov 
rb irapd rrjv Kvrjp^iv ev rfj ecovrov (f>vaei pevei, 
KaX rb tj}<? fci>rjp,r)<? rb irapd rov rroBa- adp/ces 
puevroi pLivvdovai iravros rov afce'Xeos rovroiaiv. 
el p,evroi ^pPjaOai ru> atceXei rjBvvavro, en av 
paXXov ra oarea awi]v^avero, &><? real irpoaOev 
eiprjrai, rrXi)v rov prjpov, xav rjaaov daap/ca elr), 
daap/corepa Be ttoXXw i) el vyiea r]V. ar\pelov Be 

60 OTt ravra roiavrd eartv oiroaoi ydp, rov /3pa- 
%iovo<; eKTreaovros, yaXiayicwves eyei ovro eK 
yeveT]<i, rj ical ev av%>)aei rrpiv 2 reXeicodrjvat, ovroc 
rb pev oareov rov fipa^ovos /3pa%v la^ovai, rbv 
322 



ON JOINTS, liii. 

leg at the ankle is dislocated, the bones of the foot 
show least growth, for they are nearest the injury, 
but growth of the leg- bones is not very deficient ; the 
tissues however are atrophied. In cases where the 
ankle-joint keeps its natural position while there is 
dislocation at the knee, the bone of the leg will not 
grow like the other, but is shortened ; for this is 
nearest the injury. The bones of the foot are 
atrophied, but not to the same extent as was noticed 
a little above, because the joint at the foot is intact ; 
and should they be able to use the part, as is the case 
even in club-foot, the bones of the foot in their case 
would be still less atrophied. When the dislocation 
occurs at the hip, the thigh-bone will not grow like 
the other, for it is nearest the injury ; but it gets 
shorter than the sound one ; the bones of the leg, 
however, do not stop growing in the same way, nor 
do those of the foot, because the end of the thigh- 
bone at the knee keeps its natural place, also that of 
the leg at the foot ; but the tissues of the whole leg 
are atrophied in these cases. But if they were 
able to use the leg, the bones would correspond in 
growth to a still greater extent, the thigh excepted, 
as was said before ; and they would be less deficient 
in flesh, though much more so than if the limb were 
sound. Here is a proof that these things are so : 
those who become weasel-armed owing to dislocation 
of the shoulder either congenital ty or during adoles- 
cence, and before they become adults, have the 
bone of the upper arm short, but the forearm and 

1 This is curious phrasing. Of. remarks on the astragalus 
in Introduction and notes on ankle dislocation, Mocht. 
XXX. 

2 koX Ttplv Kw. 

3 2 3 



nEPl AP0P£2N 

Be 7r?ix,vv Kal ctfcpr)v rijv x e ^P a oXiyw evBeeaTeprjv 
tov vyieos, Bid Tavras ras 7rpo<fidaias t«9 elprj- 
p-evas, oti 6 p.ev /3pa%i(0v eyyvraTco [tov dpOpov] 

TOV TpOOpLCLTOS €CTTW, OiaTS Bid TOVTO j3pCL)(yTepOS 

eyeveTO' o Be av Tri)xv<i Bid tovto oi>x ofAOLws 
evaicovei rij? avfufropt]?, oti to tov fipaxiovos 

6U apOpov to 777)0? tov 7r?/'^;eo? ev ttj ap^atrj <f>vaei 
fieyei, rj t€ av %et/> ® K PV ^ Tt TijXoTepoo direaTiv 
i) r 7T^X V '* airo t?}? avpLcfiopr/s. Bid tclvtcls 
ovv t«9 eiprjfxevas irpocpdaias, twv baTecov rd t€ 
fir) avvav^avop-eva ov avvavfjaverai, to, t€ avvav- 
^avopieva avvav^dveTai. e? Be to evaapKov ttj 
%eipl /cal too fSpax^ovi r) TaXanrtopirj t?}<? x el P°S 
p,eya TrpoaaxfreXer baa yap x^iptov epya iaTi, t« 
•nXelaTa TcpoOvp,eovTai oi yaXidyKwves epyd^eaOai 
tt] X^ipl TavTr], baa irep xal tt) €Tepi] BvvavTai 

70 ovBev evBeeaTepwi t?}? datveos' ov yap Bel bx^iaOai 
to aSypia eirl tcov %ei l p&v &>? eVi tcov aKeXecov, 
dXXa Kovcpa avTolai to, epya iarlv. Bid Be tt)v 
XPV<tiv ov /xivvdovaiv al adp/ces al /caTO, Trjv 
X^ipa Kal KaTa tov ir?)X vv folai yaXidyKcoaiv' 
dXXa Kal 6 $pax'i<£V tl tt poaoxpeXetTai e<? evaap- 
Kirjv Bid TavTa' 1 brav Be lax^ov e/cTraXes yevr]Tai 
€5 to eato p,epo<i ifc yever/s, rj Kal eVt vrprriw ebvTi, 
puvvOovaiv al adpKes Bid tovto fxdXXov rj tt)s 
Xeipos, oti ov BvvavTaL xp") a ^ at ' r <P aKeXei. 

80 puapTvpiov ev 2 Be Tt eveaTai Kal ev Toiaiv bXiyov 

81 vaTepov elprjaofievoiai, oti TavTa TOiavTa Iotiv. 

L1V. 'Otroaoiai 3 8' av e? to e£co r) tov piifpov 
KecpaXi) eKfSr}, TOVToiai /Spaxvrepov fj.lv to aKeXo<i 



1 Tavrrjv. 2 K\v. omits. 

8 Olat. 



3 2 4 



ON JOINTS, liii.-liv. 

hand little inferior to those on the sound side, for 
the reasons that have been given, viz., that the 
upper arm is nearest the injury, and on that account 
is shorter. 1 The forearm, on the contrary, is not 
equally influenced by the lesion, because the 
end of the humerus which articulates with the 
ulna retains its old position. And the hand, again, 
is still further away from the lesion than is the 
forearm. For the aforesaid reasons, then, the bones 
which do not grow normally are defective in growth, 
and those which do grow maintain their growth. 
Manual exercise contributes greatly to the good 
flesh-development in hand and arm. In fact, taking 
all sorts of handiwork, the weasel-armed are ready 
to do with this one most of what they can do with 
the other arm, and do the work no less efficiently 
than with the sound limb ; for tt is not necessary for 
the body weight to be supported on the arms as on 
the legs, and the work done by them [i.e. the 
weasel-armed] 2 is light. Owing to use, the flesh of 
the hand and forearm is not atrophied in the weasel- 
armed ; and even the upper arm gains some further 
development from this. But when the hip is dis- 
located inwards, either congenitally or in one still a 
child, there is more atrophy of flesh than in the arm, 
just because they cannot use the leg. A special 
piece of evidence that this is the case will be found 
in what is about to be said a little below. 

LIV. In cases where the head of the thigh bone 
is dislocated outwards, the leg is seen to be shorter, 

1 Kw. puts rod &pf)pov in brackets. It appears a needless 
gloss. 

Littro, Adams, Erm. read avTrj<ri and refer it to the 
hands. But hands and arms may do hard work. 

325 



nEPI AP0PQN 

(fxuverai irapareivbfievov irapd rb erepov, eiKorw^' 
ov yap eir bareov r) eirifSacris; t% KecpaXrjs rov 
firjpov eartv, a>? ore kara) evireirrcoKev, dXXa Trap" 
oareov 7rapeyK€te\ifj,evr)v rijv (pucriv eyov, ev craptci 
he o~rr)pi%erai vypj} Kal vireiKovatj' hia rovro pev 
fipa^vrepov (f>aiverai. eacoOev he 6 /A77/J09 irapa 
rrjv irXi^dha KaXeopievrjv KOtXorepos Kal acrap- 

10 /corepos (f)aiverat' 1 e^wOev he 6 yXovrbs Kvprorepos, 
are e'9 rb e%a> ri)<; /cecfyaXfjs rov p,rjpov a>Xiadi)Kvtr]<;' 
arap Kai avwrepw {frawerai yXovros are virei- 
Zdarjs rr)<; aap/c6<; rrjs evravda rrj rov fxrjpov 
ice<j)a\f)' to he irapa to ybvv rov firjpov aicpov 
ecrco peirov tyaiverai, Kal 1) KV)]/xr) Kal 7rou9" 
arap ovhe avytcdfiirreiv coairep to vyies o~/c€\o$ 
hvvavrai. ra puev ovv arjp,ela ravra rov e£a> 

18 eKireirrwKoro^ fiijpov elaiv. 

LV. Qlo~t fiev ovv av rereXeiwpLevoiaiv r)hrj 
eKTreaov rb apOpov per) ep,irearj,rovroi.cn ^pa\vre- 
pov [lev Qatverai ro avpcirav crKeXos, ev he rfj 
bhonroplrj rfj fxev irrepvr/ ov hvvavrai KadiKvela- 
6ai [eirl] 2 t?}? 7*79, rS> he arijOei rov irohb<; 
(Baivovai eirl rrjv yrjv bXiyov he 69 to ecrco p.epo<i 
peirovai rolat, haKrvXoiau a/cpoiaiv. b^elv he 
hvvarai ro aebfia rb aivapbv o~KeXos rovroiai 
iroXXco p,dXXov fj olcriv av e? to ecrco fiepo^ eicire- 

10 irrd)K)], dp,a p,ev on r) Ke<fiaXr) rov pujpov Kal 
av%l)V rov dpOpov irXdyios (f>vaei ire(f)v/cco<i inro 
av)(ySi p.epei rov la^iov rrjv viroaracriv ireiroir\- 
rai, ap.a he on a/cpo<; irov<i ov/c e? to e^w fiepos 
dvay KaX,er ai efCKe/cXiaOai, aXX* 677179 tt)? WvcopLrjs 
rr/s Kara rb acb/xa Kal reivei Kal iaoorepoo. brav 
ovv rpij3ov ptev Xci/Srj ro dpOpov ev rrj aapK,l e\ i)v 

326 



ON JOINTS, liv.-lv. 

when put beside the other. Naturally so, for it is no 
longer on bone that the head of the thigh-bone has 
its support, as when it was displaced inwards ; but it 
lies along the natural slope of the hip-bone, and is 
sustained by soft and yielding flesh ; wherefore it is 
seen to be shorter. The thigh on the inside at what 
is called the fork appears more hollow and less fleshy, 
while the buttock is rather more rounded on the 
outside, since the head of the bone is displaced 
outwards ; besides this, the buttock is seen to be 
higher, since the flesh at that part gives way before 
the head of the thigh-bone. But the end of the 
bone at the knee is seen to turn inwards, and with 
it the leg and foot ; for the rest, they cannot bend it 
in the same way as the sound leg. These then are 
the signs of dislocation of the thigh outwards. 

LV. In cases of adults, when the joint is not 
reduced after dislocation, the whole leg is seen to be 
shorter; and in walking they cannot reach the 
ground with the heel, but go on the ball of the foot, 
and turn the toes a little inwards. But the injured 
leg can bear the weight of the body much better 
in these cases than where there has been dislocation 
inwards, partly because the head and neck of the 
thigh-bone, being naturally oblique, have got a 
lodging under a large part of the hip, and partly 
because the foot is not obliged to incline outwards, 
but is near the vertical line of the body, and even 
tends rather inwards. As soon, then, as the articular 
part forms a friction-cavity in the flesh where it is 

1 yl'fTcu. * Omit B K\v. 

327 



IIEPI AP0PON 

if;€/c\idr), r) Be adp^ yXia^pavOfj, dvcoBwov tm 
^povw yuvercev orav Be dvcoBvvov yevr/Tai, Bvvav- 
Tai fiev oBot-nopelv dvev £v\ov, rjv aAAw? ftovXwv- 

20 rar SvvavTai Be 6%eiv to aci)p:a iirl to oivapov 
o~Ke\o<;. Bid ovv Trjv y^prjaiv r/craov toicti 
TOtovToiai exOrjXvvovTcti al o~ apices rj olaiv bXiyov 
TTpoadev e'iprjTar i/c8>]\vvoi>Tai Be rj TrXelov rj 
eXaaaov pdXXov Be ti eKOrfXvvovTai KaTa to 
eaco pbepos rj KaTa to e^co cl)9 cttI to ttoXv. to 
puevToi inroBrjfia p,eTe£eTepoi tovtwv viroBeiaOai 
ov BvvavTai, Bid ttjv d/capnrLrjv tov o~/ce\eo<;, 01 Be 
Tives zeal BvvavTai. olacv 8' dv ev yaaTpl eovaiv 
i^apOpijarj tovto to dpOpov, r) eTi ev av^r\aei 

30 eovai j3irj e/cireaov fir/ ifXTrearj, rj /cal vtto vovaov 
e%ap6py']o-r] tovto to dpOpov /cal eKTraXyjarj — 
iroXXa yap TOiavTa ytveTai — /cal evicov p,ev tmv 
toiovtcov rjv eiTiacfiaKeXiar) p,rjpo<i, ep,irvr)puaTa 
Xpovta Kal efifxoTa ytveTai, real oaTecov \lriXcoaie<i 
evloiaiv 6p.oico<i Be Kal olcriv eiriacpaKeXi^ei Kal 
olai firj eTTiac^aKeXi^ei, tov pirjpov to oaTeov 
ttoXXo) ftpayvTepov ytveTai, Kal ovk edeXei 
awav^eaOai wairep tov vyieo^' Ta pievToi Trjs 
Kvr']pLi)<i ^pa\VTepa fiev yiveTai rj Ta Trj<; eTeprjs, 

40 6X176) Be, Bid Ta? avTas 7rpo<pdaia<; at Kal 
TTpoadev elpi]VTar oBoiiropeiv tc BvvavTai 01 
ToiovTOi, ol p.ev Tives avTO>v tovtov tov Tpb-nov 
foairep olai TeTeXetwpievoiaiv e^eireae Kal fir) 
everreaev, ol Be Kal fia'ivovai pAv iravTl tS> iroBL, 
Biapperrovai Be ev Trjai oBonropiyaiv, dvayKa- 
^opievoi Bid Trjv /3pa)(VTi]Ta tov aKeXeos. TavTa 
Be * TOtaiiTa yiveTai, rjv e mpieXewi p,ev iraiBayw- 
yrjOecoaiv 2 ev Tolai a%ijp.aai Kal bp6o><i ev olai 
328 



ON JOINTS, lv. 

dislocated, and the flesh gets lubricated, it in time 
becomes painless; and when it becomes painless, 
they can walk without a crutch, at least should they 
wish to do so, and can put the weight of the body on 
the injured leg. Owing to the exercise, the flesh 
becomes less flaccid in such cases than in those 
mentioned just above; yet it does get more or less 
flaccid ; and as a rule there is rather greater flaccidity 
on the inner than on the outer side. Some of these 
patients are unable to put on a shoe, owing to the 
stiffness of the leg; but some manage it. In cases 
where this joint is dislocated before birth, or is 
forcibly put out and not reduced during adolescence, 
or when the joint is dislocated and started from its 
socket by disease — such things often happen — if 
necrosis of the thigh-bone occurs in some of these 
cases, chronic abscesses are formed, requiring tents ; x 
and in some there is denudation of bone. Likewise, 
both where there is and where there is not necrosis 
of the bone, it becomes much shorter, and will not 
grow correspondingly with the sound one. The 
bones of the lower leg, however, though shorter than 
those of the other, are but slightly so, for the same 
reasons as those given above. These patients can 
walk, some of them in the aforesaid fashion, like 
adults who have an unreduced dislocation; while 
others use the whole foot, but sway from side to side 
in their gait, being compelled to do so through the 
shortness of the leg. But such results are only 
attained if they are carefully instructed in the correct 

1 I.e.. drainage apparatus. 

1 HtfTot kw. a Kw.'b correction. 

329 



IIEPI AP0PQN 

hei, irpiv Kpcnvvdrjvai e? tt}v ohonropirjv, e-rri- 

50 pieXecos he /cal bpBcos, e-rrrjv KparvvOwcriv. irXeiGTiy; 
he e7rip,eXeiT}<; heovTai olaiv av vt]7rici)rdroL(Tiv 
iovaiv avrrj rj o-vpufroprj yevrjrar r)v yap dp,eXrj- 
Odyai v 1)17101 eovres, d^ptjiov TravTaTTaai /cal 
avavtjes oXov to o-/ci\o<; yiveTai. at he adpices 
tou avfAiravros atceXeos putvvdovai piaXXov r) rod 
vyieo<i' trdvv p,ev 7roXX& rj<T<rov tovtohti p,ivv8ovai 
7] olaiv av ko-(i) itCTreTTToofcr), hid ttjv ^prjaiv real ttjv 
TaXanrwpnjv, oiov evOews hvvaaOai XprjaOai tw 
cr/ceXei, oj? Kai irpoaOev bXiyq> irepl tcov yaXiay- 

60 kcovcov eiprjTai. 

LVI. Et'crt he Ttve?, wv Total p-ev etc yever)<; 
avTL/ca, rolai he teal vtto vovaov dpifyoTepwv twv 
(T/ceXewv e'^ecrT>; rd apQpa e? to e£&> p.epos. 
tovtoioiv ovv ra p,ev barea ravra 7rad}j/u,ara 
irdcryei- at puevrot cr apices r^Ktara eicOtpXvvovrai 
Tolat Toiovroiaiv' evaapica * he /cal rd criceXea 
yiveTai, TrXyjv ei ti dpa Kara to ecrco p.epo<; 
eXXetTTOi 2 oXiyov. hid tovto he evaapica eartv, 
otl dpufioTepoicri rolai axeXeai o/aoi&k i) ^pr/cri? 

10 yiverai' opioiwi yap craXevovaiv ev rf) bhonropir] 
evOa koX ev9a' e£e%eyXovToi he ovtoi lo"^vpo)<; 
(paivovrai 3 hid rr]v e/caraaiv to)i< dpOpwv. i)v he 
p,ij eTTia(paiceXiar] avrolcri rd barea, prjhe /evefioi 
dvcoTepco twv lo"%i(dV yevcovrat — iviovs yap teal 
roiavra KaraXap,j3dvei — rjv ovv p,?j tolovtov ti 
yevtjrai, i/cavcos vyiiipol rdXXa hia<pepovrai' 
dvav^'tcrrepoi pukvToi to irdv aojpia ovtoi yivov- 

18 Tai, ttXi)v tt)? Ke(f)aXi)<i. 

LVII. Oaotai h av e<? Tovmadev rj /ce<paXr) 
rov [njpov eKirear) — bXiyoiai he etar'tinei — ovtoi 
33o 



ON JOINTS, lv.-lvii. 

attitudes before they have acquired strength for 
walking, and carefully and rightly guided when they 
are strong. The greatest care is required in cases 
where this lesion occurs when they are very young ; 
for if they are neglected when infants, the whole 
leg gets altogether useless and atrophied. The 
flesh is attenuated throughout the leg, compared 
with the sound one ; but the attenuation is much less 
ill these cases than where the dislocation is inwards, 
owing to use and exercise, since they can use the leg 
at once, as was said a little before concerning the 
weasel-armed. 

LVI. There are some cases in which the hip- 
joints of both legs are dislocated outwards, either 
immediately at birth or from disease. Here the 
bones are affected in the same way as was described, 
but there is very little flaccidity of the tissues in such 
cases; for the legs keep plump, except for some 
little deficiency on the inner side. The plumpness 
is due to the fact that both legs get exercised alike ; 
for they have an even swaying gait to this side and 
that. These patients show very prominent haunches, 
because of the displacement of the hip-joints; but if 
no necrosis of the bones supervenes, and they do not 
become humped above the hips — for this is an 
affection which attacks some — if nothing of this sort 
occurs, they are distinguished by very fair health in 
other respects. Still, these patients have defective 
growth of the whole body, except the head. 

LVI I. In cases where the head of the thigh-bone 
is dislocated backwards — this is a rare dislocation — 



1 afxa -)ap ti'«iapKa. 2 (Wdiret. 

8 Ka\ jiaifidl ol /xripol. 



33 1 



IIEPI AP0PQN 

eKravveiv ov hvvavrai ro cr/ceXos, ovre Kara to 
apdpov to i/cnreaov ovre rt Kapra Kara rrjv 
lyvvrjv dX)C ■yJKiara rwv iKnaXr/a loyv ovroi 
[fiaXXov] 1 eKTavvovcri Kal rb Kara rbv f3ov/3a>va 
Kal to Kara rrjv lyvvrjv apdpov. irpoa-avvievat, 
fiev ovv teal r68e xpij — evy^p^arov yap teal ttoXXov 
a^iov iarc /cat tow? rrXeiarovs Xrjdet, — on ovS" 

10 vyiaivovres hvvavrat Kara rrjv lyvvrjv eKravveiv 
to apdpov, rjv p,rj avveKravvacoat Kal rb Kara 
rov fiovftwva apdpov, irXrjv rjv fir) rravv avw 
aeipwai rov iroSa, ovrco 8' av hvvaivro' ov roivvv 
ov8e avyKapurreiv hvvavrai rb Kara, rrjv lyvvrjv 
apdpov o/xot&)9, dXXa rroXv j^aXeTToorepov, rjv p,rj 
o-vyKap,\jr(oai Kal ro Kara, rbv /3ovj3S)i>a apdpov. 
rroXXa Se Kal dXXa Kara ro acopa roiavras 
dSe\<pl^ia<; e^ei, Kal Kara vevpcov crvvTcicnas 
Kal Kara puvwv cr^/jpara, Ka\ rrXeio-rd re Kal 

20 rfXeiarov d^ia yivcoaKeadai rj W9 rt<? olerai, 
Kal Kara rrjv rov evrepov (pvaiv Kal rrjv t>}<? 
avp,rrdarj^ KOiXirjs, Kal Kara ras roiv varepcov 
irXdvas Kal avvrdma^' dXXa irepl fiev rovrcov 
krepoidi \6yos ecrrai r)8eX(f)icrp,evos roiai vvv 
Xeyofxevoiai. rrepl ov he 6 Xoyos eariv, ovre 
eKravveiv Svvavrai, wairep rjSrj e't'pr/rai, /3pa- 
yvrepov re rb aKeXos (fralverai, Bid Siacrds irpo- 
(f)dcua<;' on re ovk eKravverai, on re 77009 rrjv 
adpKa d)Xiad)]Ke rrjv rov irvyaiov rj yap (pvo~i<i 

30 rov la^iov rov bareov ravrrj, fj /cat r) KefyaXrj 
Kal 6 av%i]v rov prjpov yiverai, orav 8e e^apdprjcrrj, 
Karafyepi'js ri rrecpvKev errl rov irvyaiov rb e^co 
pLepos. avyKap^rrreiv puevroi Svvavrai, brav p,rj 
r) bbvvrj KwXvrj' Kal r) Kvr'jpirj re Kal 7701)9 bpda 

33 2 



ON JOINTS, lvii. 

the patients cannot extend the leg at the dislocated 
joint, nor indeed at the ham ; in fact, of all dis- 
placements, those who suffer this one make least 
extension, both at the groin and at the ham. One 
should also bear the following in mind — it is a useful 
and important matter, of which most are ignorant — 
that not even sound individuals can extend the joint 
at the ham, if they do not extend that at the groin 
as well, unless they lift the foot very high ; then 
they could do it. Nor can they as readily flex the 
joint at the ham, unless they flex that at the groin 
as well, but only with much greater difficulty. 
Many parts of the body have affinities of this kind, 
both as regards contraction of cords and attitudes of 
muscles ; and they are very numerous, and more 
important to recognise than one would think, both 
as regards the nature of the intestine and the whole 
body cavity, also the irregular movements and 
contractions of the uterus. But these matters will 
be discussed elsewhere in connection with the 
present remarks. To return to our subject — as 
already observed, the patients cannot extend the leg, 
also it appears shorter, for a double reason ; both 
because it is not extended, and because it has 
slipped into the flesh of the buttock; for the hip- 
bone, at the part where the head and neck of the 
femur lie when dislocated, has a natural slope 
towards the outer side of the buttock. They can 
however flex the limb, when pain does not prevent 
it; and the lower leg and foot appear fairly straight, 

1 Omit Galen, Liltre, Erin. 

333 



IIEPI AP0PftN 

eVte/zcft)? (fraiveTai, Kal ovre tT) ovt€ tt} tto\v 
eKfce/c\i/jLevcf Kara 8e tov /3ov{3(bva BoKel ti rj 
o~ap£ XcnrapaiTepi) elvai ttotI Kal "yfravofievr), are 
tov dpdpov e'<? ra eVt ddrepa pLeprj u>\iadt]KOTO^' 
Kara 8e avrb to irvyalov 8ia^\ravopiev)i t) KecpaXrj 

40 tov pLijpov Sofcei ti e^oy/ceiv real pudWov. to. puev 
ovv ar\ field TavTa eo~Tiv, a> dv e\ to oiriaOev 

42 €Kir€7rT(jOKr} 6 ptrjpos. 

LVIII. "Otco) fxev ovv av TeTe\euop,eva) 7]8rj 
eKireabv fir) epuirecrrj, ohoiiropelv puev hvvcnai, otclv 
6 Xpo vo< > iyyevqrai Kal t) 68vvi] iravarjTai, Kal 
ediaOfj to dpdpov ev Ty aapKi evaTpaxpdaOai. 
avay/cd^eTat jxkvToi iayypws o~vy/cdp,TrT€iv * 
KaTa tou? /3ovf3oi)va<; bhonroperov, 2, Sid 8iaad<i 
Trpo(pdaia<i, dpa ptev oti ttoWo) {3pa%i>Tepov to 
o~Ke\o<i yiveTai 8ia to, Trpoeip^pieva, Kal Ty p,ev 
irTepvrj Kal irdvv iroWov 8eiTai tyaveiv t/}? yr/<;- 3 

10 el yap TreipiqrxaiTO Kal eir oklyov tov 7ro6"6s 
by^i)0?)vai, firjoevi d\Xo) avTio-Trj/ii^opievo*;, e<? 
TOVTTLaco dv ireaoi- r) yap poTTrj ttoXXt) dv elrj, 
TOiv io-yiwv errl 7ro\v e? tovttictw VTrepe^bvTwv 
inrep tov 7toSo? t% [3do~io<; Kal t?}? pantos e'<? ra 
i>o-%ia peTT0var)<;. poXa 8e tgo o~Tt']0ei tov 7toSo? 
KaOiKi'etTai, Kal ou8e oilrw?, rjv /x?; Kapb^rj auTO? 
eoovTov KaTa tovs ftovftcbvas, Kal tw eTepa) crKeXei 
KaTa ttjv iyvvi~\v erriavyKdp,\^rj. errl he tovtoiglv 
dvayKa^eTai cocrTe Ty %e</al t?) KaTa to aivapbv 

20 o~Ke\o<i epeiSeaOat, e<? to dvco tov firjpov e<f> f 
eKaaTT] crvp.f3do~ei. dvayKa^ei ovv Tt Kal tovto 
avTO wcrTe KapLirTeaOat KaTa tou? /Sovfiwvas- ev 
yap tjj pieTaWayf) twv o~Ke\eoov ev tt) ohoiirop'r) 

ovyna.iJ.-mwi/. s dooiiro^tiy. 

334 



ON JOINTS, Lvn.-LViii. 

without much inclination to either side. At the 
groin the flesh seems rather relaxed, especially on 
palpation, since the joint 1 has slipped to the other 
side; while at the buttock itself the head of 
the bone seems, on deep palpation, to stick out 
abnormally. These then are the signs in a case of 
dislocation of the thigh backwards. 

LVIil. When the dislocation occurs in an adult, 
and is not reduced, the patient can walk, indeed, 
after an interval, when the pain subsides, and the 
head of the bone has become accustomed to rotate in 
the tissues ; but he is obliged in walking to flex his 
body strongly at the groin, for a double reason, both 
because the leg is much shorter, owing to the causes 
above mentioned, and is very far from touching the 
ground with the heel ; for if he should try even for 
a moment to have his weight on the foot with no 
opposite support, he would fall backwards, as there 
would be a great inclination that way, the hips 
coming far beyond the sole of the foot behind, and 
the spine inclining towards the hips. 2 He hardly 
reaches the ground with the ball of the foot, and 
cannot do this without a simultaneous flexure of 
the other leg at the ham. Besides, he is forced at 
every step to make pressure with the hand at the 
side of the injured leg on the upper part of the 
thigh. This of itself would compel him to bend the 
body somewhat at the groin ; for at the change of 

1 "Joint" here means "articular head." 

2 L. and Erm. put the above from "for if he should try" 
after "displaced backwards at the hip." It gives better 
sense, but has no authority. 

3 LittnS, followed by Eriiicrins, rearranues the text in an 
arbitrary manner. 

335 



JIEPI AP0PQN 

ov Bvparai to aco/xa byeloOai eirX tov crivapov 
aieeXeos, r)v fir) irpocrKaTepelBiiTai to crivapov 
7rpo? rrjv <ypjv vtto trfi yeipbs, ovy 1 vfyeo-rewTOS 
tov apOpov vtto tw acopLcni, dXX* es to oiricrdev 
e^ear€0)To<; Kara to icrylov. civev p,ev ovv tjvXov 
BvvavTai tfboLTTopelv ol tolovtoi, rjv aXXcos 
30 idiaOecoaiv, Bia tovto, otl r) j3dcri<; tov ttoSos 
Kara ttjv dpxai>]v Wvoypniv ecrTiv, aAA' ovk e? to 
e^co eKtceic\ip,evr)- Bid tovto ovv ovBev BeovTai 
Tr)<i a.VTi/covT(t)crio<i. ocroi fievTOi fSovXoi'Tai O.VTI 
rr)<i tov p,i]pov eTTiXa{3r)<; vtto tt)v p,aa^(aXr]V rrjp 
Kara to crivapov o~KeXo<; vTTOTidep,evoi crKiTrwva 
dvTepeiBeiv, i/celvoi, i)v 2 piev fiafcpoTepov tov 

CTKLTKtiVa VTTOTlOkoiVTO, 6p0OT€pOV pi€V 68oiTTOpOVCri, 

tw Be ttoSI 7rpo<i tttjv yrjv ovk ipeLBovTar el 8' av 
ftovXovTai epeiBecrdai t<£ ttoBI, ftpayvTepov p,ev 

40 to tjuXov (fcopyjreov, tccnd Be tou? /3ov/3(bva% 
eTTiavy/cdfiiTTeaOat av Beoi ai>TOV<;. twv Bt 
crap/cwv ai pLivvdrjcries Kara, Xoyov ylyvovTai /cai 
tovtoictiv, cbairep xa\ irpoadev eiprjTar toIoi piev 
yap p,eTeu>pov eyovcri to a/ceXos real pn]8ev TaXai- 
uwpeovoi, TovToiai /cat p,dXio~Ta pivvOovaiv ol 
B av irXelo'Ta ypecovTai tt} €TTi/3dcrei, tovtoiuiv 
i]KicrTa piivvOovai. to p,evTOi vyies a"/ceA,o? ovk. 
axfieXeiTai, dXXd piaXXov 3 /cal dayrpxovecrTepov 
ylveTai, rjv ypeojvTai tw aivapw a/ceXei inl Tr)v 

50 yrjv crvvvrrovpyeov yap eKelvw etziayibv Te 
duavayKa^eTai eivai, /cat KaTa ttjv lyvvrjv 
(jvyKapbTTTeiv, r']v ye 4 pJr) 7rpoayper]Tai tw aivapw 
eirl ttjv yrjv, dXXa pierewpov eycov ctkittwvi 
dvTepelBtjrai, ovtw Be KapTepbv ylveTai to vyies 
a/ceXos' ev Te yap Trj (pvaei Biandrai, xal to, 
3& 



ON JOINTS, lviii. 

legs in walking, the body weight cannot be carried 
by the injured leg unless it be further pressed to 
the ground by the hand, the articular head not 
being in line under the body, but displaced back- 
wards at the hip. 1 Still, such patients can walk 
without a crutch, at any rate after practice, for this 
reason, viz., that the sole of the foot keeps its old 
straight line, and is not inclined outwards ; where- 
fore they have no need for counter-propping. Those 
who prefer, instead of the grasp on the thigh, to 
have the support of a crutch under the arm on 
the side of the injured leg, if they have a rather 
long crutch, walk more erect ; but they do not press 
witli the foot on the ground. But if they want to 
make pressure with the foot, a shorter crutch must be 
carried ; and they must also flex the body at the 
groin. Wasting of the flesh takes place in these 
cases also according to rule, as was said before ; in 
those who keep the leg off the ground and give it no 
exercise the wasting is greatest, while in those who 
use it most in walking it is least. Still, the sound 
leg gets no benefit, but rather becomes also some- 
what deformed, if patients use the injured leg on 
the ground ; for in giving assistance to the latter, it 
is forced outwards at the hip, and bends at the ham ; 
but if one does not use the injured leg on the 
ground as well, but, keeping it suspended, gets 
support from a crutch, the sound limb thus becomes 
strong; for it is employed in the natural way, and 

1 See previous note. 

1 art oi>X- * el, 

3 Omit. * 1jv 5e. 

337 



nEPI AP0PHN 

yvpvdaia TrpoaKparvvei avro. (pair) p,ev ovv dv 
Tt9, e£(o lrjTpiter)$ ra roiavra elvai' Tt yap 
Brjdev Bel irepl tcov yjBrj dvrjKecrTwv yeyovoTWv eri 
Trpoaavvievai ; iroXXov Be Bel ovtms e^eiv Trjs 

60 yap avrfjs yvd)f\itj<i Kal ravra avvievar ov yap 
olov re aTraWoTptwOrjvai drr aXXyXcov. Bel p,ev 
yap 69 ra d/ceara p,rjyavdao~9ai, 07r<w9 prj dvrj- 
Keara earai, avvievra oirrj dv pdXiaTa KwXvTea 
69 to dvrjKeoTOv eXdelv Bel Be tcl dvrjKeara 
avvievai, &!)9 fir) paTijv Xvpaivrjrai' ra Be 
irpop'prjpara Xaparpa Kal dywviari/ca diro rov 
BiayivooaKew oTrrj e/caarov real oi&>9 Kal oirore 
TeXevTi'jaei, rjv re 69 to a/cearov TpaTrrjrai, rjv 
T6 6*9 to dvr']K€o~TOV. oirocroMTi B' dv e/c yeverjs 

70 rj koX dXXcos irco? ev av^t'jcrei eovcriv ovru><i oXiaOrj 
to dpdpov OTnaw Kal p,rj epirearj, rjv Te fSirj 
oXiaOrj, rjv Te Kal vtto vovoov — iroXXa yap 
roiavra e^apOprjpara ylverai ev vovaoicriv olai 
Be Tive<i elcriv al vovaot, ev fjaiv e^apOpelrai ra 
roiavra, varepov yeypdyfrerai — rjv ovv eKcndv 
prj ep,7recrr), rov p,ev pajpov rb oareov (ipayy 
yiverai, KaKovrai Be Kal irav to cr/ceXo9, Kai 
dvav^ecrrepov yivei at Kal daapKOTepov iroXXw 
Bed to p,rjBev TTpoa^pfjaOai avTU>' KaKOVTai yap 

80 TOVTOicri Kal to Kara ttjv lyvvrjv dpQpov tcl yap 
vevpa evTeTapeva yiveTai Bia Ta irpoaOev eiptj- 
peva. Bio ov Bvvavrai to Kara Trjv lyvvrjv 
dpdpov eKravveiv, olaiv dv ovtcos la^iov eKirearj. 
oj9 yap ev KefyaXalw elprjo-dat, irdvTa Ta ev tw 
o-d)pLaTi, birbcra eVt "£prjo~ei yeyove, y^peopevoio~i 
p,ev peTpia Kal yvp.va£opevoiaiv iv Tjjai TaXai- 
Trwpirjoiv, ev fjaiv eKaara eWiaiai, ovrco p,ev 
338 



ON JOINTS, lviii. 

the exercises strengthen it more. One might say 
that such matters are outside the healing art. Why, 
forsooth, trouble one's mind further about cases 
which have become incurable ? This is far from the 
right attitude. The investigation of these matters 
too belongs to the same science ; it is impossible to 
separate them from one another. In curable cases 
we must contrive ways to prevent their becoming 
incurable, studying the best means for hindering 
their advance to incurability ; while one must study 
incurable cases so as to avoid doing harm by useless 
efforts. Brilliant and effective forecasts are made by 
distinguishing the way, manner and time in which 
each case will end, whether it takes the turn to 
recovery or to incurability. In cases where such a 
dislocation backwards occurs and is not reduced, 
whether congenitally or during the period of growth, 
and whether the displacement is due to violence or 
disease — many such dislocations occur in diseases, 
and the diseases which cause such dislocations will 
be described later — if, then, the displacement is 
unreduced, the thigh-bone gets short, and the 
whole leg deteriorates, and becomes much more 
undeveloped and devoid of flesh, because it gets no 
exercise. For in these cases, the joint at the ham 
is also maimed, since the ligaments get contracted, 
for the reasons given above ; and therefore patients 
in whom the leg is thus dislocated cannot extend 
the joint at the ham. Speaking generally, all parts 
of the body which have a function, if used in 
moderation and exercised in labours to which each 
is accustomed, become thereby healthy and well- 



339 



IIEPI AP0PHN 

vyirjpa Kal av^t/na Kal evyrjpa yiveTar pur) 
■Xpeo/jLevoicri 84, aW* iXivvovai, voarjpoTepa yive- 
90 rat teal avav^ea kcu Ta\vyrjpa. ev 8e tovtoictiv 
ou^ rjKiara ret, apBpa tovto ireirovOe kcu ra 
vevpa, fjv p.ij t<9 avTolcn xperjTCU' KaKovvrai puev 
ovv Bia, TavTCi<i Tea Trpofydaias paXXov tl ev 

TOVTO) TW T/0O7T&) TOV 6XlO~01]p,aTO'i 7] iv Tolai 

dXXoiaiv bXov yap to o-KeXo$ avav^es yiveTat, 
Kal Trj ultto TOiv baTecov cpucrei. Kal tjj a-no twv 
crapKwv. oi ovv toiovtov oiroTav avhpwdoiicn, 
fieTecopov Kal avyKeKap.p.evov to aKeXos ta^ovaiv, 
em 8e tov eTepov o^eovTai, Kal tG> ^vXw 
100 avTiaTt]pi^6p,evoi, oi puev evi, oi 8e 8vaiv. 

LIX. Oio~i 8' civ e? TOvpurpoaOev r) K6(f)a\r) 
tov p,rjpov eKTreaj] — oXiyoiai 8e tovto yiveTat — 
ovtoi, eKTavveiv p,ev to aKeXo<; 8vvavTai TeXew?, 
avyKa/XTTTeiv 8e rjKicrTa ovtoi BvvavTai to, KaTa. 
tov fiovfiwva' TTovkovot 8e, Kal rjv KaTa ttjv 
iyvv<]v avayKa^covTai avyKapirTeiv. pf)KO<i 8e 
tov aKe\eo<i irapaTrXi'jaiov cfyaiveTac, KaTa fiev 

T7]V 7TT6pV?]V Kal TTCLVV ClKpOS 8e 6 7TOVS T}aaOV 

tl 7rpoKVTTT€Lv ideXei- 1 bXov 8e to aKeXos ^X €t 
10 Trjv Wvu>pii]v Tr)v KaTa (pv<riv, Kal ovt€ tjj ovtc 
ttj peirei. 68vvcovTai 8e aiiTLKa ovtoi pLaXicrTa, 
Kal ovpov i'cr^eTcu to irpwTov tovtoicl pbdXXov 
Tt i] TOiaiv ctXXotaiv e^apQ pi)p.aaiv' eyKeiTai yap 
r) KecpaXrj tov fxrjpov eyYUTaTft) tovtoich, tcov 
tovcov tmv eTTiKaipoov. Kal KaTa puev tov /3ov- 
fifjdva i^oyKeov T€ Kal KaTaTeTa/xevov to -ywpiov 
(paiverai, Kara 8e to irvyalov o , ToXi8u>8eaTepov 
Kai aaapKOTepov. TavTa fiev ovv o~r)p,eui eo~Ti 
19 Ta €ip?)/jLei'a, wv av ovtco<; iKTreirTooKr) 6 p,i]pos. 
34° 



ON JOINTS, lviii.-lix. 

developed, and age slowly ; but if unused and left 
idle, they become liable to disease, defective in 
growth, and age quickly. This is especially the 
case with joints and ligaments, if one does not use 
them. For these reasons, patients are more troubled 
by this sort of dislocation than by the other ; for the 
whole leg is atrophied in the natural growth both of 
bone and flesh. Such patients, then, when they 
become adults, keep the leg raised and contracted, 
and walk on the other, supporting themselves, some 
with one and some with two crutches. 

LIX. Those in whom the head of the thigh-bone 
is dislocated forwards — a rare occurrence — can extend 
the leg completely, but are least able to flex it at the 
groin ; and they suffer pain even if they are compelled 
to bend it at the ham. The length of the leg seems 
about equal, and quite so at the heel ; but there is 
less power of pointing the foot. The whole leg 
preserves its natural straight line, inclining neither 
to one side nor the other. It is in these cases that 
the immediate pain is greatest, and retention of 
urine occurs from the first more than in other 
dislocations ; for the head of the femur in these 
cases lies very close to important cords. The region 
of the groin appears prominent and tense ; but at 
the buttock it is rather wrinkled and fleshless. The 
above-mentioned signs, then, occur in patients whose 
thigh is put out in this way. 

1 idi\ti = hvva.ia.i, sa^ a Galen, comparing Iliad XXI. 
3GG. 

341 



IIEPI AP0PQN 

JLA. Unocroicu pev ovv av t)orj r/vopcopevoiai 
rovro to apdpov eKirecrbv prj epmeo-rj, ovroi, 
oirorav avrolaiv rj bhvvrj Travarjrai fcai rb apdpov 
ediaOf) iv rS> %(op[(p rovrw o-rpaxfracrOai, iva 
i^eireaev, ovroi Bvvavrai ayehbv evdvs x bpdol 
bhoirropelv civev ^vXov, Kal rrdvv pkvroi evdea, 
iirl Be 2 rb aivapbv, are ovre Kara rbv /3ov,8(bva 
evKapirroi eovres, ovre Kara rrjv lyvvrjv Bia, ovv 
rod fiovfttovos rrjv aKapirirjV ev6vrepa> oka 

10 to> crKeXei iv rfj oBonroplp y^peovrai 3 r; 6t6 
vyiaivov. zeal avpovai Be ivtore irpos rtjv yr)v 
rbv nrroBa, are ov pyjiBiayt; avyKapirrovre^ ra dvu> 
apOpa, Kal are rravrl ftaivovres tw ttoSI' ovBev 
yap i)o-aov rfj irrepvij ovroi f3alvovo~iv fj rep 
eprrpoaOev el he <ye fjBvvavro peya irpofiaiveiv, 
Kav ttclvv irrepvoftdrai r/aav Kal yap 01 vyiai- 
vovre'i, ba(p av pe^ov 7rpo/3aivovre<; oBonropewai, 
roaovra) paXXov irrepvojBdrai elen, ridevres rov 
rroBa, atpovres rbv ivavriov. oiroaoiat Be Brj 

20 ovr(o<; eKireirrcoKe, Kal en paWov rfj irrepvrj 
it poaey^pipirrovaiv fj r& epirpoaOev ro yap 
eprrpoaOev rov tt<>B6<;, oirorav eKrerapevov fj ro 
aXXo aKeXos, ov^ opoiws Bvvarai is to irpoaw 
KapirvXXeadai, wairep brav avyveKappevov rj to 
o~Ke\o<;' ovk av aipovaOai Bvvarai o ivovs, 
avyKtKapperov 4 toD aKeXeos, &)? orav eKrera- 
pievov fj to aKeXo?. vytaivovad re ovv fj <pvai<i 
ovrco TTtcfrvKep, coenrep eiptjrat' brav Be exireaov 
pr] epireatj rb apdpov, ovr(o<; oBonropeovaiv &>? 

30 eiprjrai, Bia ra<j it po<p da ias ravras ra<? eipij- 
peva<i' daapKorepov pkvroi rb o-KeXot rov erepov 
yiverai, Kara re rb irvyalov, Kara re rr/v 
342 



ON JOINTS, lx. 

LX. In cases where this dislocation occurs in those 
already adult and is not reduced, these patients, when 
their pain subsides and the heat! of the bone has got 
accustomed to turning in the locality where it was 
displaced, are able to walk almost at once erect 
without a crutch, and even quite straight up, so far 
as the injured part is concerned, seeing that it 
cannot easily bend either at the groin or ham. Thus, 
owing to the stiffness at the groin, they keep the 
whole leg straighter in walking than when it was 
sound. And sometimes they drag the foot along 
the ground, seeing that they cannot easily flex the 
upper joints, and that they walk on the whole foot. 
In fact, they walk as much on the heel as on the 
front part ; and if they could take long strides, they 
would be purely heel-walkers. For those with sound 
limbs, the longer the strides they take in walking, 
the more they go on their heels when putting down 
one lejr and raising the other ; but those who have 
this form of dislocation press upon the heel even more 
than on the front of the foot. For the front of the 
foot cannot be so well bent down when the leg is 
extended as when it is flexed ; nor, on the other hand, 
can the foot be bent upwards when the leg is flexed 
so well as when it is extended. This is what happens 
in the natural sound condition, as was said ; but when 
the joint is dislocated and not reduced, they walk in 
the way described, for the reasons given above. The 
leg, however, becomes less fleshy than the other, both 



1 K\v. omits. * tvt yt. 



343 



IIEPI AP0PDN 

<yao~T potevr)p.ir)v , teal Kara tt)v oiriadev ?%iv. olai 
8' av V7}7rloi(Tiv en eovai to dpdpov [ovtws] 
oXiaObv fir) ifirreap, rj teal ete yeverjs ovtco yevrjTai, 
teal TOVTOiai ro tov fir/pov oareov fidXXov ti 
fiivvdei rj to, t/}<> Kvijfir]^ teal ra, tov ttoBos. 
rjKiara firrv ev tovtw tu> rpoircp tov oXiadr/fiaTos 
6 fir)pb<i p,eioi>Tai. fiivvdovai fievTOi at adptee<; 

40 iravrr], fidXiaTa Be Kara ttjv oiriaOev X^iv, coavep 
rjBrj teal irpoadev eiprjrai. oiroaot fiev ovv av 
Ti9>p>}i9euHTiv 6pdoi)<i, ovtoi fiev BvvavTai irpoa- 
y^prjadai tu> ateeXei av^avbfievoi, /3pa%VTep(p fiev 
tlvi tov eTepov eovTi, Ofiu><i Be epeiBbfievoi i;vX<p 
eirl TavTa, r) to aivapov ateeXos' ov jap tedpTa 
BvvavTat dvev t?)? iTTepvi)^ tw <TT7)9ei tov 7roSo? 
XpijcrOat, eTrtteaOievTes (ioarrep ev erepoiai ^&)\eu- 
fiaai evioi Bvvainai' aliiov Be tov fir) BvvaaOai 
to bXiyw irpoadev elpr/p,evov Bia ovv tovto 

50 TrpoaSeovTai £vXov. btrbaoi 8' av tcaTafieXrf- 
dewai teal purjBev y^pe'ovT ai eirl ttjv <yr)v tw a/eeXei, 
()XXa pueTewpov k^roai, tovtolci fiivvflei fiev t« 
oo~Tea e\ av^rjatv fidXXov rj Tolat y^peofievotaiv 
fiivvdovai Be [/cat] ai adptee<; ttoXv fidXXov rj 
Tolai ^peofievoiar teaTci Be ra dpdpa e? to ev9v 
irripovTai tovtolctl to a/eeXo<; fidXXov ti rj olai 

57 av dXXwi ite7re7TT(o/er]. 

LXI. '12? fiev ovv ev teecpaXaiw elprjaOai, Ta 
dpdpa to, eKTTLTTTovTa teal to, oXiaOdvovTa 
dvicreos avTa eeoinoiaiv eteTrnrTei teai bXiaOavei, 
aXXoTe fiev 7roXv irXeov, ciXXotg Be ttoXv eXaaaov' 
teal olai fiev av [ttoXv] * irXeov oXiadrf ti iteirear], 
^aXeTTcoTepa en/3d\Xeiv to eirnrav eaTi, teai rjv 
fir) ifif3tf3aa9rj, fie^ovi teal iniByfXoTepas tcl<; 

344 



ON JOINTS, lx.-lxi. 

at the buttock and calf and all down the back of it. 
In those cases too where it is dislocated in childhood 
and not reduced, or where dislocation occurs con- 
genially, the thigh bone is rather more atrophied 
than the bones of the leg and foot; but atrophy of 
the thigh-bone is least in this form of dislocation. 
The tissues are atrophied in the whole limb, but 
especially down the back of it, as was said before. 
Those, then, who are properly cared for are able to 
use the leg when they grow up, though it is a little 
shorter than the other ; yet they do it by having a 
support on the side of the injured limb, for they have 
not much ability to use the ball of the foot without 
the heel, bringing it down, as some can do in other 
forms of lameness. The reason of their not being 
able is that mentioned a little above ; and this is why 
they require a staff. In those who are neglected, 
and never use the leg to walk with, but keep it in 
the air, the bones are more atrophied than in those 
who do use it ; and the tissues are much more 
atrophied than in those who use the leg. As regards 
the joints, the lesion keeps the leg straighter in these 
patients than in those who have other forms of 
dislocation. 

LXI. To sum up — dislocations and slipping [separa- 
tion] l of joints vary among themselves in amount, 
and are sometimes much greater, sometimes much 
less. In cases where the slipping or dislocation is 
greater, it is, in general, harder to reduce ; and, if 
unreduced, the resulting lesions and disabilities are 

1 It is usual to make oAiaflad'co, oXiaO^fxa. refer to " partial 
dislocation"; but tins hardly suits the context, or tlie 
reference to shoulder and hip-joints. 

1 Kw. omits. 

345 



IIEPI AP0PHN 

Trr/pcocrias teal KaKcocria<i tercet to, roiavra, Kal 
derreoiv Kal aapKiov teal ayr\p,dTwv orav Be pelov 

10 eteirearr) Kal bXterdrj, prj'iBiov p.ev ep,/3dXXeiv to. 
roiavra tcov irepcov yiverai' r)v Be tear an opi)df) r) 
apueXrjdf) eprreaelv, pieiovs Kal deriveerTepai ai 
irr)pcoerie<; yivovTat tovtoigiv rj oleriv bXiyco 
irpboOev eiprjrai. ra pev ovv aXXa apOpa Kal 
irdvv iroXv Biacfaepei e\ to ore piev pielov, ore Be 
pbe^ov to 6Xia0t]pa iroieierOaf p,i]poi) Be Kal 
/3pa%iovo<; K€(f>a\al irapairXrjcricoTaTa bXierOdvov- 
eriv avTij ecovTrj eKareprj' are yap arpoyyvXai 
piev ai Ke<paXal eovaai, dirXr)v tt/v o~t poyyvXcoa iv 

20 Kal cpaXaKprjv kyovai, KVKXoTepels he ai KoiXiai 
eovaai ai Be^ppevai Ta? KecpaXds, dpp,6£ovcri Be 
t fieri KecpaXfjeriv' Bid tovto ovk eerriv a\.n fieri to 
rjpicrv eKerrrjvai tov dpdpov' bXicrOdvoi yap dv 
Bid rr/v irepicpepeirjv, i) e? to e^co r) e\ to eaco. 
irepl ov ovv 6 Xoyos, eKTriirroveri TeXecos rjBr/, enel 
aXXcos ye ovk eKiriiTTOvai' opco<; Be Kal ravra ore 
pev irXeiov diroinjBa diro t% efcvcrios, ore Be 
eXacrcrov' p,dXXov Be ri pir/phs tovto /3/oa^tovo? 

29 ireirovdev. 

LXII. 'E7T€i evia Kal tcov ck yeverjs bXiaOr/- 
p,aT(cv, r)v pbiKpbv bXiaOrj, old tc 69 rr)V cpvaiv 
dyeaOai, Kal pdXierTa t<z irapa tov iroBbs dpQpa. 
biroeroi €K yevei) 1 ; kvXXoI yivovTai, Ta irXelcrra 
tovtcov iyercpd eerTiv, r)v prj irdvv peydXt] t) 
eKKXiai<; f/, r) Kal irpoav^ecov yeyoi'OTcov ?/S»; tcov 
iraiBicov avpififi. dpiaTov piev ovv &>9 rd^io-ra 
IrjTpeveiv Ta TOiavTa, irplv irdvv peydXr/v tijv 
evBeiav tcov ocrTecov tcov ev tco iroBl yevecrOai, 

10 irpiv re irdvv p,eydXrjv ttjv evBeiav tcov aapKcov 
346 



ON JOINTS, lxi.-lxii. 

greater and more manifest in the bones, the soft parts, 
and the attitudes. When there is less displacement, 
either with dislocation or separation, reduction is easier 
than in other cases ; and if they are not reduced, owing 
to inability or neglect, the resulting deformities are 
smaller and less serious than in the cases just 
mentioned. Joints in general, then, differ very 
much in having their displacements sometimes less 
and sometimes greater ; but the heads of the thigh 
and arm-bones each slip out in very similar ways ; 
for the heads, being rounded, have a smooth and 
regular spherical surface, and the cavities which 
receive them, being also circular, fit the heads. 
Wherefore it is impossible for them to be put half 
out; for owing to the circular rim, it would slip either 
out or in. As regards our subject, then, they are 
put quite out, since otherwise they are not put out 
at all. Yet even these joints spring away, some- 
times more, sometimes less, from the natural position. 
This is more pronounced in the thigh-bone than in 
the arm. 

LXII. There are certain congenital displacements 
which, when they are slight, can be reduced to their 
natural position, especially those at the foot-joints. 
Cases of congenital club-foot are, for the most part, 
curable, if the deviation is not very great or the 
children advanced in growth. It is therefore best to 
treat such cases as soon as possible, before there is 
any very great deficiency in the bones of the foot, and 

3*7 



IIEPI AP0PQN 

rwv Kara rrjv /cvr\pjr)v elvai. Tpbiros [xev ovv 
/cvXXcoatos ov% els, dXXa trXeioves, ra irXeiara 
firjv ov/c e^r/pOpipcora iravTairaaiv, dXXa 81 eOos 
(T^i]fiaTo<i ev tlvl aTroXijyjrei rod ttoBos /ce/cvXXa>- 
fxeva. 7rpoai)(eLv Be ical ev rfj Irfrpeorj TOiaLBe 
XPV' dircoOelv fiev /cal /earopoovv t/}? /cvijftr/s to 
Kara to acfivpbv bcrreov to e^coOev is to ecrco 
puepos, avTtoOeiv Be is to e£&) puepos to t?;<? Trrepvrjs 
to Kara tt]v tt;iv, bircos dXXrjXois airavTi'icrr) to 

20 bcrrea ra e^layovra Kara, fiecrov re /cal irXdyiov 
rbv TToha' tovs 5' av Ba/crvXovs dOpbovs avv rq> 
pueydXa) BatcrvXq) is to ecrto pepos iy/cXlveiv /cal 
irepiavay/cd^eiv ovtws' irnBelv Be /cr/pcoTp epprj- 
Tivw/xevrj ev, /cal (nfki]veo-i zeal bOovloiai p-aXOa- 
Kolai pur] bXtyoiai, /i?;Se dyav irie^oina' ovrw Be 
ras irepiaywyds iroieladcu rfjs iiriBeaios, wairep 
/cal Trjai yepaXv r) /caropOcoaLs f)v rod ttoBos, ottcos 
6 7roi)? bXiya> /xdXXov is to ftXcuabv pencov (paivrj- 
TCti. i%vo<; Be Tt XPV TTOLelcrdai rj Beppiaros p,r/ 

30 ciyav o-/cXr)pov, rj poXvftBii'ov, 1 irpoaeTriBelv Be, p,rj 
77-009 rbv xpwra TiOevra, dXX' orav i}Bi] rolcri 
vcrrdrotaiv bdovloiai /xeXXrf? iiriBelv orav Be i]Brj 
iiriBeBep^evos r), evbs tlvos tmv bOovlwv XPV> olaiv 
irnBelrai, rrjv dpxv 1 ' Trpoapd^rai 77009 ra Kara 
tov ttoBos eTTi8ecrp,CLTa Kara rrjv c%tv rod pi/cpov 
Ba/CTvXou' eireira is to ctva> reivovra bircos av 
Bo/cr} pberpiuis eX eiV > rrepi^dXkeiv aveoOev rr)s 
ya<TTpoKV^p,irjs, d>s fiovipbnv 77, /caraTera/xevov 
ovtm?. <77rX&) Be Xoyrp, wawep /07 porrXacrr eovra, 

40 xph & T '] v <pvo~iv ti]V BiKaiijv ayeiv /cal id i/c/ce- 
/cXip,eva Kal to auvTera/xeva irapd ttjv <pvcru>, 

1 (ioAufldLou. 

348 



ON JOINTS, lxii. 

before the like occurs in the tissues of the leg. Now 
the mode of club-foot is not one, but manifold ; and 
most cases are not the result of complete dislocation, 
but are deformities due to the constant retention 
of the foot in a contracted position. 1 The things to 
bear in mind in treatment are the following : push 
back and adjust the bone of the leg at the ankle 
from without inwards, making counter-pressure out- 
wards on the bone of the heel where it comes in line 
with the leg, so as to bring together the bones which 
project at the middle and side of the foot; at the 
same time, bend inwards and rotate the toes all to- 
gether, including the big toe. Dress with cerate well 
stiffened with resin, pads and soft bandages, sufficiently 
numerous, but without too much compression. Bring 
round the turns of the bandaging in a way corre- 
sponding with the manual adjustment of the foot, so 
that the latter has an inclination somewhat towards 
splay-footedness. 2 A sole should be made of not too 
stiff leather or of lead, and should be bound on as 
well, not immediately on to the skin, but just when 
you are going to apply the last dressings. When the 
dressing is completed, the end of one of the band- 
ages used should be sewn on to the under side of 
the foot-dressings, in a line with the little toe; then, 
making such tension upwards as may seem suitable, 
p;iss it round the calf-muscle at the top, so as to keep 
it firm and on the stretch. 3 In a word, as in wax 
modelling, one should bring the parts into their true 
natural position, both those that are twisted and 

1 I.e. "an unnatural contraction of the muscles, ligaments 
and fasciae." 

- I.e. valgus (outward distortion). 

8 I.e. so as to hold up the outer side of the foot. 

349 



IIEPI AP0PQN 

/cal rfjaL yepalv ovtco BiopdovvTa, /cal rfj eTriBeaet 
a)cravTQ)<;, irpocrdyeiv Be ov /3mi&)9, aX.X,a irapriyo- 
pi/ca)<f TrpoapdirTeiv Be to, 696via, 6V&)9 dv av/j,- 
<fiepr) Ta<; dvaXrj\jna<i iroulaOai' aXXa yap dXXrjs 
tcov yayXuypuaTwv Seirai dvaXr]\Jno<>. V7ro8i]/xdTiov 
Be Troietadai 1 p.oXv/3Bivov, e^coOev Trj<} e7TiBeaio<; 
eiriBeBep-evov, olov ai Xtat \_Kpr)irlBe^] 2 pv0p,bv 
elyov dXX* ovBev avTov Bet, tjv t*9 6p6a)s fiev 
50 Trjcri yepal BiopOcocrr), 6p0(o<; Be rolcriv bdovioiaiv 
eTTiBeri, 6p0(o<; Be /cal ra? dvaXt^yfriwi ttoioito. 5 rj 
jxev ovv h]ai<; avrt], /cal ovt€ Top,?)? ovt€ Kavaios 
ovBev Bel, ovt a\\?;9 Troi/ciXlr/s- Odacrov yap 
evaicovei ra roiavra tt}<? lr)Tpeii)<> rj 009 dv ris 
ototTO. Trpoavitcav p.evToi ypr) rq> xpovw, ecof av 
av^rjdfj to awp,a ev Total Bi/caioioi o-yj]uao~iv. 
orav Be €9 viro8i]p:aTO<; Xoyov it], dpftvXai iiriTi}- 
BeioTarat ai TnjXoTrariBes /caXeop,evac tovto 
yap V7roBrjp,drcov rj/cidTa /cparetrai vtto tov 

60 7roSo9, dWa /eparel pbdXXov eTriTtjBeios Be /cat 6 

61 }^p7]TlK0<; T/0O7TO9 TO)V VTroBTJ/bLaTCOV. 

LXIII. 'Onr6cro/.cri S' dv /cvrjp,"t]<; ocnea e£ap- 
dpijaavTa zeal eX/cos Trot/jaavra TeXecos etjio'XV 
Kara to. trapd rbv iroBa dpdpa, eure ecrw peyfravTa, 
eire puevTOi /cal e£(o, ra ToiavTa p,r) 4 ep,/3dXXeiv, 
dXX" eav tov /3ouXop,evov tcov Ir/Tpcov i/x^aXXeiv. 
aacfiecos yap elBevai %pr) oti diroOaveiTac a> dv 
ep,/3\r)0evTa ep,p,elvr), /cal rj £&)r) Be oXiyrjp,epo<; tov- 
toicti yevijcreTai' 5 oXiyoi yap av ai/Tcov Ta9 ewTa 
rjp,epa<> virepftaXXoiev aTracrp,6<; yap 6 KTeivwv 

1 iroifiv. 

2 /cpijTr^Ses Galen : omit Kw. and MSS. As Kw. shows, it 
is inserted from the Commentary. 

3 TronjTot. 4 ou xph- b ylverau, 

35° 



ON JOINTS, lxii.-lxiii. 

those that are abnormally contracted, adjusting them 
in this way both with the hands and by bandaging 
in like manner; but draw them into position by 
gentle means, and not violently. Sew on the band- 
ages so as to give the appropriate support ; for 
different forms of lameness require different kinds of 
support. A leaden shoe shaped as the Chian 1 boots 
used to be might be made, and fastened on outside 
the dressing; but this is quite unnecessary if the 
manual adjustment, the dressing with bandages, and 
the contrivance for drawing up are properly done. 
This then is the treatment, and there is no need for 
incision, cautery, or complicated methods ; for such 
cases yield to treatment more rapidly than one would 
think. Still, time is required for complete success, 
till the part has acquired growth in its proper position. 
When the time has come for footwear, the most 
suitable are the so-called "mud-shoes," for this kind 
of boot yields least to the foot ; indeed, the foot 
rather yields to it. The Cretan form 2 of footwear 
is also suitable. 3 

LXIII. In cases where the leg-bones are dislocated 
and, making a wound, project right through at the 
ankle-joint, whether it be towards the inner or outer 
side, do not reduce such a lesion ; but let any 
practitioner who chooses do so. 4 For you may be 
certain that where there is permanent reduction the 
patients will die, and life in such cases lasts only 
a few days. Few go beyond seven days. Spasm 

1 Erotian says it was a "woman's boot." In Galen's time 
it was quite forgotten. 

2 " Reaching to the middle of the leg." Galen. 

* "The most wonderful chapter in ancient surgery." 
Adams. 
4 I.e. leave it to anyone reckless enough. 

35' 



IIEPI AP0PON 

10 iarlv arap Kal yayypaivovaOai i/cvelrai rrjv 
Kvrnxrjv Kal rov rroBa. ravra /3e/3ai&)<? elBevai 
XPV oi/Tft)? ecropeva- Kal ovk dv /jloi Bokci ovBe 
eXXe/3opo<; cocpeXijaeiv 1 av0t]p.ep6v re BoOels Kal 
av0i<i TTivopLevos, ay^iara Be elirep ti toiovto[v\' 2 
ov pevTOL ye ovBe tovto BoKeco. f)v Be pr) 
ep/3Xt]0f), p^Be air apyi)^ p.rjhei's Treipjjdfj ep[3dX- 
Xeiv, ireptyivovTat ol TrXelaroi, avTcov. %p7] Be 

r)ppLO(jQai pikv TTJV KVl']pi]V Kal TOV 7r68a OVTCOS, ft)? 

avro<i eOeXeL, povvov Be p-i] diratcopevpeva prjBe 
20 Ktveupeva eoTco. IrjTpeveiv Be 7Tiacnjpr} Kal 
airXijveaiv ocvrjpolaiv bXiyoiai, pr) ayav ^^%- 
polai' ■yfrv'^o'i yap iv rolac toiovtohtl airaapbv 
iiriKaXelrai. imTrjBeia Be Kal cpvXXa aevrXcov 
rj j3i]~%Lov rj aXXou tivos tcov toiovtcov iv olvm 
peXavi avaTr/pcp lipLe<pQa iiriTiOevTa Irjrpeveiv 
eVt Te to I-Xkos irri re ra, TrepieyovTa, krjptoTf} Be 
■)(Xiepf) iiri^pteiv 3 avrb to eXKos' rjv Be rj copr/ 
jgeifiepivr) j), Kal epia pvirapa o'ivw Kal iXaiw 
KarappaivovTa y\iepolaiv dvcodev eircTeyyeiv 
30 KaraBelv Be pr/Bev p>/8evL, 4 prjBe irepi-nXdaaeLV 
firjBevi' ev yap elBevai %p)j oti Triers Kal a\6o- 
(popirj ttclv KaKov Tolai Toiovrotalv eo~Tiv. iiri- 
TVjBeia Be irpos ra TOiavra Kal tcov ivalpcav pere- 
Ijerepa, baoiaiv avTcov o~vp(peper epia Be iiriTi- 
OevTa, oivco eiTLTeyyovTa, rcoXvv y^pbvov idv to, 
Be oXiyr/pepcoTaTa to>v ivaipcov Kal baa pr/Tivp 
77 poo KaTaXap,{3dveTai ov% opoltos irrn^Beia 
eKelvoialv io~Tiv. y^povif) ?/ KaOapais tcov e\Keeov 
ylverai tovtcov' ttoXvv yap %povoi> irXaBapr) yive- 
40 Tab' Tivds Be tovtcov xpi]arbv ciriBelv. elBevai 

1 uxpiKijaai. 
352 



ON JOINTS, Lxnr. 

(tetanus) is the cause of death ; but gangrene of the 
leg and foot is also a sequel. It should be well 
known that this will happen ; and I do not suppose 
that even hellebore, given on the day of the accident 
and repeated, would do good. If anything would 
help, something of this kind would come nearest ; but 
I have no confidence even in that. But if there is 
no reduction or attempt at reduction to begin with, 
most of them survive. The leg and foot should be 
disposed as the patient himself wishes, only avoiding 
an unsupported position or movement. Treat with 
pitch cerate and a few compresses steeped in wine, 
not too cold ; for cold in such cases evokes spasm. 
Other suitable applications are leaves of beet or 
colt's- foot or something similar, half-boiled in dark 
astringent wine, and applied both to the wound and 
the parts around it. Anoint the wound itself with 
warm cerate, and, if it is winter, apply an upper moist 
dressing of crude wool, sprinkling it with warm wine 
and oil ; but avoid all bandaging and dressing with 
plasters, for one must bear well in mind that pressure 
and weight do nothing but harm in such cases. Some 
of the applications for fresh wounds are also suitable 
for these injuries, in cases where they are useful. 
Cover with wool, moistening it with wine, and leave 
on a long time. The wound remedies which last 
a very short time, and those incorporated with resin, 
are not so suitable for those patients ; for the cleans- 
ing of these wounds then takes more time, since the 
flabby moist stage is prolonged. Bandaging is good 
for some of these cases, finally, one should bear 



* toiovtov ( lalen. 3 iiruxpUty. 

* Omit Kw. and many MSS. 



vol.. in. w 



353 



nEPI AP0PQN 

fiev hrj irov <rd(f)a \pr) on dvdytcr) tov dvdpanrov 
^coXov atu^pw? yeveadar koX yap 6 ttov<; i<t to 
dvco dveairaaTai twv tolovtwv, kcli ra oared ra 
hioXia6ijaavTa e£o) e^eyovTa (jmiverar ovtc yap 
iffiXovrat, twv tolovtoov ocneaiv ovhev a>? eiriTO- 
ttoXv, el fir) Kara. {Spayy ti, ovhe a$>io~TaTai, 
dXXa irepuoTeiXovTai XeirTyaiv u>TetXfjai /cal 
dadeveai, koX ravra rjv aTpefiL^coat ttoXvv 
Xpovov rjv 1 Be fiij, eXicvhpiov eyKaTaXeitydrfvai 

50 icivhvvos dvaXOes. 6pco<i Be, irepl ov 6 Xoyos, ovria 
fiev lr)Tpev6fievoi aco^ovrai, efi^Xrj8evTO<i he tov 

52 dpOpov koX efifielvavTOS, diroOvifaKOvaiv. 

LXIV. Huto? he X070? outo?, rjv koX rd tov 
7rrj^eo<i ocnea ra irapd tov /capirov rrj? ^eipo<i 
eX/cos TToirjaavra efyayr), rjv re e? to eaco fiepos 
T % X €l P^' *l v T€ e<? T0 ^ (0 ' o~a<pa yap eiriaTaa- 
dai xpr) oTi aTToOavelrai iv oXlyrjaiv rjfieprfat, 
Toiovro) davdrw, ouorrep koX irpoadtv e'ipr/Tat^ 
otco av epipMjuevTa ra oarea ep,fievy. otai 6 
av fir) €fi/3\r]df) firjhe ireipr/Ofj epfSdXXeaOai, ovtoi 
ttoXv TrXeloves irepiy'ivovrai. IrjTpeirf he TOiavTif 

10 rolai roiovroiaiv erriTrjheLr), oh]7rep etprjrar ro 
he o~%rjfia alo-^pbv tov %(oXoofiaTO<; dvay/a] eivai, 
koI rov<i hafcrvXovs Trjs xeipbs daOerea? icai 
d^peiovf rjv fiev yap e'<? to eaco fiepof oXiadrj ra 
oaTea, avy/cd/nrTeiv ov hvvavTai tow ha/cTvXovs' 

15 rjv he e<? to e£ro fiepos, eicTavveiv ov hvvavTai. 

LXV. "Oaoiai S' dv KV7]firj<i baTeov, eXicos 
it triad fiev ov irapd to yovv, e^co e^layrf, rjv T€ 
if to e^oo fiepos, rjv T€ e'9 to haar, TOVTOiaiv rjv 
fiev tis ififSdXrj, eVt €ToifioTepo<; Bwdotos eaTiv 
rj-nep Tolaiv eTepoiaiv, Ku'nrep tcaiceivoiaiv kroifiof 
354 



ON JOINTS, lxiii.-lxv. 

clearly in mind that the patient will necessarily be 
deformed and lame ; for the foot is drawn up, and 
the projection of the dislocated bones is obvious. 
There is no denudation of the bones as a rule, except 
to a slight extent, nor do they come away ; but they 
get scarred over with thin and weak tissue — that is, 
if the patients keep at rest for a long time ; other- 
wise there is risk of a small incurable ulcer being 
left. However, to return to our subject, those thus 
treated are saved ; but if the joint is reduced and 
keeps its place, they die. 

LXIV. The same remarks apply to cases where 
the bones of the forearm make a wound and stick 
out at the wrist, whether on the inner or outer side 
of the hand. 1 Fur one should understand clearly 
that the patient will die in a few days in the way 
which was mentioned above, if the bones are reduced 
and keep in place ; but if there is no reduction or 
attempt at reduction, the great majority survive. 
The suitable treatment in such cases is such as was 
described, but the lesion is necessarily a deformity, 
and the fingers are weak and useless; for if the 
bones are displaced inwa ds, they cannot flex the 
fingers, if outwards, the)' cannot extend them. 2 

LXV. In cases where a bone of the leg makes a 
wound at the knee and projects either to the outer 
or inner side, death is more imminent, if one reduces 
the dislocation, than in the other cases, though it is 

1 Our " forwards or l>ack wards." 

2 See note on wrist dislocation. 



5 •r'/U./.ltlJ'J}. 

355 



IIEPI AP0PON 

€(ov. rjv Be fir) epL/3aXcov ii)Tpevr)<;, eXirtBe<; p.ev 
crooTrjpii]? ovto) fiovw<s eiaiv KivBvvcoBearepa Be 
ravra tg>v erepcov ytverai kcu oa<p av dvcorepco 
koX o<j(£> av la^vporepa fj teal enrb la^vporepcov 

10 a)\ia0rjfC7). r)v Be to bateov to toO p,rjpov to 
7rpo? toO yovaros eXtco<; iroL^adpievov e^oXlaOrj, 
ep./3Xr)9ev p,ev /cal ep,p.elvav, en fiiaibrepov ical 
daaaov rbv Odvarov iroirjaei tmv trpoaOev elprj- 
pLevcov 1 pur) epbfiX^dev Be ttoXv KivBvvwBearepov r) 

15 ra irpoadev 6p,a><i Be puovvi) eXiTls avrrj aoirypirj^. 
LXVI. fluTo? Be \6yo<> /cal rrepl rcov /card rbv 
dy/ccova dpdpcov, /cal irepl tcov tov irfyeos /cal 
fipaxiovos' ocra yap av tovtcov i^apBp/jaavra 
iijicrXV ^ K0< > TroirjadpLeva, irdrra, r)i> ep,/3Xr)@7}, 
Odvarov (f>epei, p,7j epb^Xi^devra 2 Be, eXirlBa awrrj- 
pLr)<i' ^&)X,&)cri9 Be eroipir] rolai irepiyivopievoiaiv. 
davarwBearepa Be roiaiv ip.f3aXXop,evoio~iv £<tti 
ra dvcoTepoy twv dpdpcov, drdp real toIcti p,t] 
ep</3aXXopievoio-t, KivBuvcoBearepa avrd ravra. el 

10 Be revt ra dvcorara dpOpa e^apOp/jaavTa eX/cos 
Troiijaavra e'£/o-%ot, ravra 8' av en /cat ep,6aX- 
Xopteva TaxyOavaTcorara dv 3 eirj teat p,i] ep,/3aX- 
Xopueva KLvBuvcoBearara' Irjrpeir) Be JjBi] eiprjTat, 
olt] ti<? ep,ol Bo/cel iircTyjBeioTdTi) elvai rcov 

15 tolovtcov. 

LXVII. "Oaoicn Be dpdpa BciktvXcov, r) ttoBos 
V X ei P^' itjapOpycravTa eXxos 7roi7]adp,eva 

1 fj ra vpocrBev elpr)/j.4va. 

2 4/xBa.K\6[ieva. 

3 Use of double bv characteristic. Even a triple h.v is found 
(J. XLVI). Cf. Vul. Cap. IV., Acut. I, Fract. XXVIII, 
and (for triple &«/) Thuc. II. 94.— Pq. 

356 



ON JOINTS, lxv.-lxvii. 

imminent in them too. If you treat it without re- 
duction, this method, and this only, gives hope of 
recovery. These cases are the more dangerous, the 
higher the joint is, and the stronger the dislocated 
parts and those from which they are dislocated. If 
the thigh-bone at the knee makes a wound and is 
dislocated through it, when reduced and kept in 
place it will cause still more prompt and violent 
death than in the cases mentioned above; when not 
reduced, there is far more danger than in the former 
cases, yet this is the only hope of safety. 

LXVI. The same remarks apply to the bones 
forming the elbow-joints, both those of the forearm 
and upper arm ; for if any one of them is dislocated 
and projects, making a wound, they all bring a fatal 
issue if reduced ; but if not reduced, there is hope 
of recovery, though those who survive are certain to 
be maimed. More fatal when reduced are com- 
pound dislocations of the more proximal joints ; and 
they too involve greater danger even when unre- 
duced. If anyone has the uppermost joints dislocated 
and projecting through the wound made, it is there 
that reduction brings swiftest death ; and there too 
is most danger, even without reduction. 1 The kind 
of treatment which seems to me most suitable in 
such cases has already been described. 

LXVI I. When the joints of the fingers or toes 
are dislocated and project through a wound, the 

1 These two sentences seem to he of general application, 
not confined to the olbow — as in Littre'a and Petreqnin'B 
versions. 

357 



IIEPI AP0PQN 

e£e<7%e, fxrj Karerjyoro^ rov bareov, a\Xa icar 
avrrjv rr/v o-vp.<pvo~iv airo<nraa6evTO<5, rovroiaiv 
r)v ifJLJB\rj6evra ejifxeivrj, eve [xev Tt? klv8vvo<; 
airaajxov, r)v p,rj XPI " 1 '***? hirpevcavrar o/a&>9 8e 
n d^iov epL/3dWeiv, rrpoeirrovra on (pv\aKi)$ 
7roWf]<i /ecu p,e\err}<; Belrai. e/nftdWeiv /xevroi 
prjiarov Ka\ 8vvaru>rarov Kal re^viKcorarov ian 

10 tw p,o-)(\iaKcp, coenrep Kal rrpoaOev e'lprjrai ev rolcri 
Karayvvp^evoiai Kal kfyayoven oareoiaiv' eTrecra 
arpepuelv eo9 pLakiara XPV> Kai KaraKelaOai /cat 
oXiyoairelv dpceivov 8e /cal cpapp,aKevaai avoo 
Kovcfxp nvl (papfidfcco, to 8e eX/co? lr/r peveiv l puev f} 
€vai/~ioicri rolaiv errireyKroiai r) rro\vo(p6 dXpoia lv 
t} olai KecpaXr)*; oared Karetjyora Irjrpeverai, 
Kardifrvxpov he tedpra p,i]8ev rrpoacpepeiv. rJKLara 
p,ev ovv ra irpwTa dpdpa Kiv8vvd>8ed ecrri, rd 8e 
en dvwrepo) 2 KLv8vv(o8ecrrepa. epbfidWeiv 8e 

20 XPV avOr/puepov r) rfj varepairj, rpiralco 8e 
/cat rerapratw rJKtara' reraprala yap eovra 
eiricrripLaivei rrjerc TraXiyKorLr/ai p,d\iara. olaiv 
dv ovv per) avr'iKa eyyevrjrai epifidWeiv, inrep- 
fialveiv XPV favras t«? elpr/pevas t)p.epas' 6 n 
yap dv kerb) 8e/ca r)p,epeo)V ep./3dWr)<i, airdv tcara- 
Xrjjrreov. 3 tjv 8e dpa epi/3e/3\r]p,eva> enrao' ytto? 
ernyevr]rai, e/c/3dX\.eiv to dpdpov 8el Tayy, teal 
6epp,£> reyyeiv &>9 rrXetaraKi,^, /cal to 6\ov o~wp,a 
6epp,6}<i /caiXnrapws /cal p:a\0a/cw<; eyeiv, pudXiara 

30 Kara rd apOpa' /ce/cdp.<p0ai 8e pidXXov r) e/crerda- 
dai rrdv to crwpua XPV- 7rpo<r8ex ea @ at pevroi XPV 
Kara rov<; BaKrvXovs ra dpdpa rd ep,/3aXX6p.eva 
diroarariKa ecreaOai' rd yap rrXelara ovrco 
yi'verat, *)v /cal oriovv cpXeyp,ovrj<; viroytv^rai, a>9, 

358 



ON JOINTS, lxvii. 

bone being not fractured, but torn away at the 
connection, in these cases reduction and fixation 
involve some danger of spasm, if they are not skil- 
fully treated ; still, it is worth while to reduce the 
dislocation, giving warning beforehand as to the 
necessity for great caution and care. The easiest 
and most powerful reduction, and that most in accord 
with art, is that with the small lever, as described 
before in relation to fractured and protruding bones. 
Afterwards the patient should keep as quiet as 
possible, lie down, and take little food. It is rather 
advantageous to give a mild emetic. Treat the 
wound either with moist applications for fresh cuts, 
chamomile, 1 or remedies used for head fractures; 
but do not apply anything very cold. The distal 
joints, then, are least dangerous, the higher ones 
more so. One should make reduction on the first or 
following day, but not on the third or fourth, since 
the onset of exacerbations occurs mostly on the 
fourth day. In cases, then, where immediate reduc- 
tion fails, one should pass over the aforesaid days. 
Any case you reduce within ten days is liable to 
spasm. If spasm supervenes after reduction, one 
ought to dislocate the joint quickly, make frequent 
warm affusions, and keep the whole body warmly, 
comfortably and softly at rest, especially at the 
joints. The whole body should be rather flexed than 
extended. In any case one must expect the articular 
ends of the phalanges to come away after reduction ; 
for this happens in most cases, if there is any amount 
of inflammation. So, were it not that the surgeon 

1 "Ox eve." Galen. 



1 de pair fit ii'. 2 to. 6' iirivu. 

* wav KaraKwrrSv K\v. : K dpra i\Tvr6v Reinlinld. 



359 



IIEPI AP0PON 

el fxr) hi <)/JLa0Lr)v tmv Srjporecov iv airly e/xe\Xev 
o lr)rpb<; eaeadai, ouSev av irdvTws ou8' ip,{3d\\eiv 
e8ei. rd fxev ovv /card rd dpQpa ocnea i^la^ovra 
(38 ip.fiaWbp.eva ovtco KtvSvvwBed iariv, go? e'iprjrai. 
LXVIII. "Oaa he Kara rd dpBpa rd Kara 
tou? 8a/CTv\ov<; diroKOTTTerai reXeo)?, ravra 
daivea rd rrXeiard iariv, el p,tf Tt? iv avrfj 
rfj rpoocrei \enro6vp,i]aa<; /3\a/3eiT)' Kal Irfrpelrj 
<f>av\r) dptcecrei rwv toiovtwv e\/cerov. drap Kal 
oaa pL7] Kara ra dpOpa, aXXd tear dWrjv rivd l^iv 
tQ>v barecov diroKOTTTeTai, Kal Tavra daivea earl, 
Kal en evaXdearepa twv erepcov Kal oaa Kara 
rou<i BaKTv\ov<; barea KaTer/ybra 1 eQayei p,rj Kara 

10 to dpdpov, koX TavTa daivea iariv ip,/3aX\.bp,eva. 
aTro/coyp-ies Be reXetai barewv /cai /card ra dpOpa 
real iv irohl zeal iv %6fpt Kal iv Kvi]p,r), roiai 
Trapd ra a<f>vpd Kal iv irifyei, roiai nrapa tou? 
Kaprrov<i, roiai irXeiaToiaiv diroKOTrrop,evoiaiv 
daivea yiverai, oaa av /-trj avrlica \enro0vp,ir) 
dvarpeyjrij rj Terapraioiaiv iovai irvpejos avve- 

17 ^77? iiriyevyrai. 

LXIX. 'ATToacpa/ceXiaies pievroi aapxcov, Kal 
iv Tpcop,aaiv alpuoppboiai yevopevoiaiv rj airo- 
a(j)iy^eaiv layypais, Kal iv barecov Karrjypiaai 
yevopevoiai 2 TriexPelat p,d\\bv n tov Kaipov, 
Kal iv dWoiai heap,olai ftialoiaiv, d-7ro\r)(f)0evTa 3 
d-Koivl'TTTei iroWolai, Kal 01 ttoWoI Trepiycvomai 
rcov toiovtcov, Kal olai pnjpov piepos ri airo- 
TriTnei Kal t5>v aapKcov Kal tov bareov, Kal 
olai ftpaxlovo?, rjaaov* hi' irifyebs re Kal 

1 narayivra. a Kw. omits. 

3 airo/.i.e\avdeVTU. 4 1)0<t6v<»$. 

360 



ON JOINTS, i.xvn.-Lxix. 

is likely to incur blame owing to the ignorance of the 
vulgar, he should by no means make the reduction. 
The dangers, then, of reducing bones which project 
through the skin at the joints are such as have been 
described. 1 

LXVIII. Cases of complete amputation of fingers 
or toes at the joints are usually without danger — 
unless a patient suffers from collapse at the time of 
injury — and ordinary treatment will suffice for such 
wounds. Again, where the amputation is not at a 
joint, but somewhere in the line of the bones, these 
cases also are not dangerous, and heal even more 
readily than the former; and if the projection of 
fractured ringer- bones is not at a joint, reduction 
is without danger in these cases also. Complete ampu- 
tations even at the joints both of the foot and hand, 
or of the leg at the ankle, and of the forearm at 
the wrist, are in most cases without danger, unless 
syncope overcomes them at once, or continuous 
fever supervenes on the fourth day. 2 

LXIX. As for gangrene of the tissues occurring 
in wounds with supervening haemorrhage, or much 
strangulation, and in fractures which undergo greater 
compression than is opportune, and in other cases of 
tight bandaging, the intercepted 3 parts come away in 
many cases. The majority of such patients survive, 
even when a part of the thigh comes away with the 
soft parts and the bone, also part of the arm, but 
these less frequently. When the forearm or leg 

1 .Surgeons such as Antyllus and Heliodorus probably 
performed amputation or resection in these eases. Even 
Paulus (VI. 121) is surprised at the timidity of Hippocrates. 

2 This chapter seems to refer to cases of injury, not 
surgical "resection" as Adams. 

3 Or "blackened" (inofit\av84vra, Kw.). 

361 



IIEPI AP0PQN 

10 Ki']]/xy]<; cnroTreaovGT)*;, real en evcfaopcorepws irepi- 
yivovrat,. olcri pev ovv Kareayevrwv twv barewv 
a,7roa(f>ly^i€<i avTLKa eyevovro ical peXaap.01, rov- 
roiai pev ra^elat at irepippi^ia yivovrai tov 
acopaTos, /cal ra aTroTTLTTTOVTa ra^eax; airo- 
Tr'nt-rei, V7S77 t&v barewv TrpoevSeBcoKorcov olai 
Be vyiecov eovTWV tcov oarecov oi p.eXaapol yivov- 
rai, ai p.ev adp/ce? Ta^eiw? dvrjaKOvac kclI rouroiai, 
ra Be oared fipahews d^iaTarai, rj dv rd opia 
rov p,eXaap,ov yevrjrai zeal r) yfr[Xcoai<; tov bareov. 

20 %pi] Be, oaa dv /caTCOTepco tov aooparos twv 
oplcov tov pueXaap-ov fj, ravra, orav i'jBrj irapvirav 
TeOvrjKr] teal dvaXyea f/, d(f)aipelv Kara to dpdpov, 
irpoprjdeopevov 07r&)9 p,rj ti Tpcoarj 1 ;' rjv yap 
bBvvrjdrj diroTa/xvopevos real p^Tfirw Kvpr^arj to 
awpa Tedvebs ravrrj y aTroTep-verai, Kapra k'lv- 
Bvvo<; virb Tr}<; bBvvr)<; Xenrodvprjaar at Be toi- 
avrat Xenro6vp,iai ttoXXovs irapa^prj p,a ?';£?/ 
aTrwXeaav. p,7]pov pev ovv oaTeov, -^nXcoOev etc 
toiovtov TpoTTOV, byBotj/coaTalov elhov eyu> diro- 

30 ardv 7) p,evTOi fcvijpi] tovtw tw dvOpcoTrw Kara 
to ybvv d(f)T)pe0i] kiKO&T&iri, e&o/cei Be p,oi koX 
eyyvTepw ov yap dpua, dXX' eirl to rrpoprj- 
Oearepov eBo^e puoi ti iroieiv. 1 Kv>]pr]<; he barea 
eic toiovtov p,eXaapov, p,dXa Kara p,eat]v ttjv 
KV7]pt]v ebvra, e^iiKoarald p,oi direireaev, baa 
ey^riXdiOrj ai/Tcov. Bierey/coi pev yap dv ti ical 
IrjTpeii] Irjrpeirif e? to ddaabv re ica\ /3paBinepov 
rd barea -tytXovpLeva diron iiTTeiv Bievey/coi 8' 

1 Kw. 1S6ksi ; omit a/na and 1x01. Reinhold's emendation : 
ov yap fta /xe . . . *Ta£e /xoi. 

362 



ON JOINTS, lxix. 

comes away, they survive still more easily. Now, in 
cases of fractured bones, when strangulation sets in 
at once with lividity, lines of demarcation are rapidly 
developed on the part, and that which is coming 
away does so quickly, the bones having already 
yielded ; but in cases where the lividity comes on 
while the bones are sound, the flesh dies rapidly 
here also, but the bones separate slowly along the 
border of the lividity and denudation of the bone. 
As regards parts of the limb which are below the 
limit of mortification, when they are quite dead and 
painless, they should be taken off at the joint, taking 
care not to wound any live part. For if the patient 
suffers pain during the amputation, and the limb 
happens to be not yet dead at the place where it is 
cut away, there is great risk of collapse from pain ; 
and collapses of this kind have brought sudden 
death to many. I have seen a thigh-bone, denuded 
in this way, separate on the eightieth day. The 
leg in this patient was removed at the knee on the 
twentieth day, and I thought it might have been 
done higher up — not all at once, of course — but 
I resolved to act rather on the safe side. 1 The bones 
of the leg in a similar case which I had of gangrene 
just in the middle of the leg came away on the 
sixtieth day, so far as they were denuded. One or 
another kind of treatment would make a great 
difference in the rapidity or slowness with which the 
denuded bones come away. So too pressure, if 

1 Seems to he the sense of a very obscure passage. 
"Sooner" gives best sense, but is a curious meaning for 
iyyvripti). " Too early, for it appeared to nic that this should 
be done more guardedly" (Adams, Littre) docs violence to 
the text. Galen apparently understood " higher up " ; for he 
sa3 - s II. means that it is safer to amputate at a joint. 

3 6 3 



IIEPI AP0PQN 

av ri kcu Tuetjis Trietjio? teal eirl to la^vporepov 

40 re kcli aaBevearepov, teal e'9 to Odaabv re teal 
fipaovrepov diropeXavOevra diroOavetv ra vevpa 
teal ra<i adp/cas teal t«? dprr\plas teal to? (f)\e/3a<;' 
eirec baa pur) ta%vpco<; d7roXr](f)devTO)V Ovtjatcet, 
evia twv rotovrcov ovtc dcpi/cvelrai e? barewv 
yjriXcopaTa, aW eiriTroXatoTepa etcirlTrTec evia 
tie ovtie e? vevpoov -^nXcopara dcpttcveiTai, aW' 
€7Ti7To\aioTepa eitirLirTei. tita ovv ravras to? 
etprjperas irpo^datas ovtc ecniv ev ovvopa dpiO- 
fiov to) yjpovw deadai, ev oiroatp eteaara tovtwv 

50 tcpLverai. 

UpoaSe^eadai Se pudXa %pr) roiaina Irjfiara' 
eaitieLv yap <po{3epcoT€pd eariv rivi rj Irjrpevew' 
tcai Lt]rpeu] irpaeii) dp/eel ttclcti roiovroiaiv' aura 
yap ewvrd tcptvei puovvov. rr\<i tie tiiaiTr/s etu- 
p,eXeia$ai %pr} 0)9 Kara tivvapiv dirvpeTos y, /cal 
ev a^rj/jbacri tiiteaioiai evOerl^eiv to aa>p,a' Si/caia 
tie ravra pr)8e pierewpov iroielv, p,r)tie e'9 to /card) 
peirov, aXXa pdXXov e'9 to dvw, ttotI /cat, ear av 
re\eo}<{ Trepippayfj' alpoppayteayv yap ev rovrw 

60 tw xpovq) tclvSvvos' Sid rovro ovv ov XPV Kardp- 
poira ra rpojpara iroielv, dXXa rdvavTia. eirel 
orav ye ^povos eyyevyTai irXeiwv icaX tcaOapd 
ra eXtcea yevrjrai, ovtc en ra avrd * a^rjpara 
eirnrjtieia ecrriv, aXX rj evueca treats, icai einore 
etri to KardppoTTov penovra' dvd y^pbvov yap 
evioiai tovtwv dTroardaief irvov yivovrai, teal 
inrotieapbitioyv Seovrai. irpoahe^eaOai tie \pr] 
tou9 toiovtovs dvd "fcpbvov VTTo tivaevT€pLT)<; 
TTie^eaOai' /cal yap eVt rolai pueXaivopevoiat, 

70 roiai TrXeLaroiaiv iiriyiveTCti tivaevrepir), teal eVi 
3 6 4 



ON JOINTS, lxix. 

stronger or weaker, would make a difference in the 
rapidity or slowness of the blackening and mortifica- 
tion of the ligaments, flesh, arteries and veins. For 
where the parts perish without great strangulation, 
the denudation sometimes does not extend to the 
bones, but the more superficial tissues are thrown 
off; sometimes the denudation does not even extend 
to the ligaments, but the more superficial parts are 
thrown off. For the said reasons, then, one cannot 
fix on one definite time in which each of these cases 
is determined. 

One should be quite ready to treat such cases, for 
they are more formidable to look at than to cure ; 
and mild treatment is sufficient, for they determine 
their own process. One must be careful as to diet, 
so that the patient may be, so far as possible, without 
fever, and place the limb in a correct attitude. 
Correct attitudes are neither elevated nor sloping 
downwards, but rather upv/ards, especially before the 
line of demarcation is fully developed ; for there is 
danger of haemorrhage in this period. Wherefore 
do not keep the injured part dependent, but the 
reverse. When a considerable time has elapsed, and 
the wounds are cleansed, the suitable attitude is no 
longer the same as before, but the horizontal position, 
and sometimes one sloping downwards ; for in time 
purulent collections form in some of these cases, and 
they require under-bandages. 1 One must expect 
such patients to be troubled, after a time, with 
dysentery ; for dysentery supervenes in most cases 

1 See Introduction. 



365 



IIEPI AP0PHN 

Trjaiv alpoppayirjcnv 1 e'£ eX/cewi'' iiriyiverai, 
he (09 eVt to ttoXv /ce/cptpevcov 7]h>] twv peXacr- 
ficov /cat t?}? aipop'payiti<i, /cal oppbdrac p,ev 
Xavpcos /cal laxypo)?' drap ovre iroXvijpepos 
yLvercu oure OavaToohrj*;' ovre yap p,aXa airo- 
airoc ytvovrat oi toiovtol, ovre aXXw; avpufiepei 

76 iceveayyelv. 

LXX. Mr/pov he bXiadijpa icaT Icryiov whe 
%pr] ep,(3d\Xeiv, r)v e? to eo~co pepos d}XtaO>j/crj' 
dyaflr) pev i)he /cal hi/cauij teal Kara cpvaip r) 
ep,p3oXi], tcai hrt ri /cal dycovcari/cou eyovaa, oaTi? 
ye Tolai toiovtoigiv r)heTac /copu^evofievos. /cpe- 
puaaai y^pt] tov dvOpwnov T(bv irohSyv 7rpb<> pe- 
crohpajv heo-pbw hvvaTW pev, p,a\6aic<p he /cal 
irXaros eyovTi' tou9 he Tr6ha<z htiyeiv yp>j baov 
Teaaapas ha/cruXovs d-n dXXijXcov, rj ical eXaa- 

10 crov yprj he kcxX eirdvwBev twv eTriyovvihwv 
Trpocnrept^e/SXTjadai TrXarel IpdvTi /cal paXdatcw, 
dvareivovri e<? 2 rr)v p,eabhpui]V to he cr«eXo? to 
aivapbv evrerdadai ypr] <*>? hvo ha/crvXovs p,dX- 
Xov tov eTepov' dirb t/}? 7% ttjv /cecfiaXijv dire- 
X €T( ° <*><; hvo irtjyeas, i) oXiyqt irXeov rj eXaacrov' 
Ta<i he yelpas nrapaTeTapeva^ irapd tcls irXevpas 
irpoahehep,evo<i eo~TO) p,aX6a/cu> tlvL' irdvTa he 
TavTa vtttlo) /caTa/ceip,ev(p /caTaa/cevaad '»;t<w, a>9 
6t* eXayiaTov ypovov /cpep,i]Tai. OTav he /cpe- 

20 paaBfj, di'hpa XPV eviraloevTov /cal p,r) acrdevea, 
eveipavTa top irfj-yvv peaiiyv twv piipwv, etTa 
OeaOai tov irr/yyv p,ecrr]yv tov tc irepivalov /cal 
T779 /ce(f)aXr}<; tov pur/pod Tr)<i e^eaTr]/cvlr/<;, eVetTa 
avva^jravTa ttjv kf4pf]v yelpa jrpbs ti)v hir/pp,evt]v, 
irapaaTavTa bpdbv irapd to ocopa tov /cpepa- 
366 



ON JOINTS, lxix.-lxx. 

of mortification, and in haemorrhage from wounds. 
It comes on as a rule when the mortification or 
haemorrhage has been determined, and is copious 
and violent at the start, but neither lasts long nor is 
dangerous to life. The patients in such cases do 
not lose their appetite much, nor is there any 
advantage in a restricted diet. 

LXX. Dislocation of the thigh at the hip should 
be reduced as follows, if it is dislocated inwards. It 
is a good and correct method, and in accord with 
nature, and one too that has something striking 
about it, which pleases a dilettante in such matters. 
One should suspend the patient by his feet from a 
cross-beam with a band, strong, but soft, and of good 
breadth. The feet should be about four finjrers 
apart, or even less. He should also be bound round 
above the knee-caps with a broad, soft band stretch- 
ing up to the beam ; and the injured leg should be 
extended about two fingers' breadth further than the 
other. Let the head be about two cubits, more or 
less, from the ground. The patient should have his 
arms extended along the sides and fastened with 
something soft. Let all these preparations be made 
while he is lying on his back, that the period of 
suspension may be as short as possible. When he is 
suspended, let an assistant who is skilful and no 
weakling insert his forearm between the patient's 
thighs, and bring it down between the perineum and 
the head of the dislocated bone. Then, clasping 
the inserted hand with the other, while standing 
erect beside the suspended patient, let him suddenly 



1 TinaL aifj.opl'u.yiiaaati'. 
* *pbs. 



307 



IIEPI AP0PAN 

p.evov, e^cnrlvTis eKtcpepLacrQevTa fierewpov alfopr/- 
6i]vat &)9 lo-oppOTTCDTCtTov. ai>T7] Be f) ip,/3o\r] 
irapkyerai iravra ocra ^prj Kara cfrvaiv' avro re 
yap to croj/xa. Kpep.ap.evov t&> ecovrov (SdpeL fcaTci- 

30 raaiv iroielrai, 6 re €KKpep,aaOel<; dp,a p,ev rfj 
Karardaei dvay/cd^ei virepaicopelaOai rrjv /cecfia- 
\rjv tov pLrjpov virep t?)? kotvXijs, dpa Be tw 
barew tov 7r?/%eo? aTrop.o)(Xevei /cal dvayicd^ei 
e<? t?)i> dpyair\v (pvacv bXiaOdveiv. ^prj Be 
Tray/cdXw; p.ev lolai Beapiolaiv ea/cevdaOai, 
(ppoveovra Be /cal a>? la^vporarov 1 tov e^aiw- 

37 povp,evov elvai. 

LXXL 'ft^ piev ovv Kai Trpoadev eiprjrcu, pteya 
to Sicupepov earl twv <pvatcov roiat dvQpd>nroio~iv 
e<? to evepuj3X7)Ta elvai /cal Bvo~ep./3Xr)Ta [to, 
dpdpa]- 2 /cal Bion p,eya Biacpepei, ei'pijrai nrpbo-Qev 
ev toicti irepl cop,ov. evioiai yap 6 p,r)pb<; epLTr'nr- 
rei cltt ovSepLirjs irapacr/cevrj^, aXA,' 0X/7779 pev 
/caTaTaaios, bcrov Tjjai %ep<xl /caTiOvvai, fipayeir]<i 
he. Kiy/c\iaio<;' TroXXolai Be avyKap^aai to 
a/ceXos Kara to dpdpov eveireaev, i]Bi) dpufciacpaX- 

10 aiv iron]0"dp,evov. dXXa yap to, ttoXv irXeioy ov/c 
eva/covei t^9 tv^ovo-tj^ TTapaaKevrjs' Bia tovto 
eTTiaraadai puev %pr) Ta fcpdnara irepl e/cdo~rov 
ev 7rdar) t?) t£X v V' xprjaOai Be olaiv dv Bo^rj 
eicdo-TOTe. etpr/vrai p,ev ovv Tpbiroi Kararaaiwv 
/cal ev Toiaiv epnrpoaOev yey papbpevoiaiv, woTe 
XpfjaOac tovtcov ogtis dv irapaTv^tl- Bel yap 

1 According to Littre" and Petrequin, the patient is 
meant ; but Littre 1 emends to (x vc '^ TaT01 '- The ical favours 
reference to the assistant ; as in the Latin interpreters and 
Ermerins. 

2 Omit Galen, Littr6. 
368 



ON JOINTS, lxx.-lxxi. 

suspend himself from him, and keep himself in the 
air as evenly balanced as possible. This mode of 
reduction provides everything requisite according to 
nature, for the body itself when suspended makes 
extension by its own weight ; the assistant who is 
suspended, while making extension, forces the head 
of the bone to a position above the socket, and at 
the same time levers it out with the bone of his 
forearm, and makes it slip into its old natural place. 
But the bandages must be perfectly arranged, and 
care taken that the suspended assistant is the 
strongest available. 1 

LXX1. Now, as Avas said before, there is a great 
difference in the constitution of individuals, as regards 
ease and difficulty in reducing their dislocated 
joints ; and the reason of this great difference was 
given before in the part about the shoulder. Thus 
in some, the thigh is put in without any apparatus, 
by the aid of slight extension, such as can be 
managed with the hands, and a little jerking ; while 
in many, flexion of the leg at the joint and making a 
movement of circumduction is found to reduce it. 
But the great majority do not yield to ordinary 
apparatus; wherefore one should know the most 
powerful methods which the whole art provides for 
each case, and use them severally where they seem 
appropriate. Now methods of extension have been 
described in previous chapters, so that one may use 
any one of them which happens to be available. 2 

1 Pq. renders, " the patient very strongly suspended," so 
also Littre ; but there are surely two injunctions. Adams, 
"the person suspended along with the patient [should] have 
a sufficiently strong hold." Littre's ixvpuTurov applied to the 
assistant. 

1 Cf. V H. 

369 



IIEPI AP0PHN 

avriKaTareTaaOaL laxvpws, eirl ddrepa pev tov 
a/ceXeos, eirl ddrepa 8e tov ad)p.aro<;- r}v yap ev 
KaTaradfi, vTrepaiayp^O/'/aeTai t) /cecpaXrj tov 

20 pb-rjpov virep tt}? dp^ai>]<; eSprjs- /cal rjv p,ev virep- 
aicopi]6fj ovrais, ov8e /ccoXvaai en prj(8iov i^eaBac 
avrr]v e? rr/v eu>vrrj<i eSprjp, ware r)8rj nraaa dp/cel 
/j,6)(\€val<i re fcal KaTopOuxjw aKXa yap eWei- 
irovaiv ev tt} KaTardaer 8ia tovto 6%\ov irXelo) 
irapeyei t) ip,/3o\i']. XPV ovv 1 ov p,ovvov irapd tov 
TroSa rd oW/za e^rjpTrjaOat, dWd /cal avu>6ev tov 
yovvaTOS, oVoj? 2 p.r) Kara to tov yovvaTO<i dpdpov 
iv tt) ravvaei r) eirl8oai<i 3 fj p,d\\ov rj Kara to 
tov la^tov dpdpov. ovtw p,ev ovv XPV Trjv Kardra- 

30 o~iv Trjv irpbs to tov iro8o<i /zepo? ea /cevdcrdai' 
arap /cal tijv eWi ddrepa Kardraaiv, p,rj p,ovvov e/c 
tt)? irepl to gttjOos /cal rd? /xacr^aXa? irepipJoXr}? 
avTiretveadai, dXXa /cal [p,dvri pLa/cpu>, Sitttv^O), 
io")(vp(p, irpocnjvet, irapd tov irepivaiov pleplXTj- 
fievqy, irapaTerapevw, eirl p,ev rd oniaOev irapd 
Trjv pd^tv, eirl Be rd epurpoadev irapd tt)v /cXr]28a, 
irpoo-ripTrj/.iev(p irpb<i ttjv dp-^rjv Trjv dvTi/cara- 
TCLVOvaav, ovtco 8iavay/cd£ea0ai, Total p,ev evda 
8iaT€ivap,evoiai, toio~i 8e evda, oircos 8e 6 ip,d<; 6 

40 irapd tov Tteplvaiov p,r) irepl tt)v /cecpaXrjv tov 
pbripov irapaTerap,ivo<i earai, dXXa p,eo~r)yv Tijf 
Ke<paXi}<> /cal tov irepivaiov, ev 8e tt} Karardaei, 
Kara p,ev tijv ice(paX7]v tov ptjpov epelo~a<; tt)v 
irvyp,ijv e? to e^co d)6eiTa>. i)v 8e pieTecopityTai 
e\/c6pLevo<;, 8iepaa<i Tr\v \eipa /cal eiriavvd-^a<; tt} 
crept) X €l P L "-pa avy/carareiverco, dpua 8e e? to etjo) 
o-vvavay/ca^eTw aAAo? 8e Tf? to irapd to ybvv 

48 tov p,T)pov /ycrir^ty? €? to eaa> piepo<; /caropOovro). 
370 



ON JOINTS, lxxi. 

There must be strong extension both ways, of the leg 
in one direction, and of the body in the other ; for 
if good extension is made, the head of the thigh- 
bone will be lifted over its old seat, and when so 
brought up, it becomes difficult even to prevent it 
from settling into its position, so that any leverage 
and adjustment suffices ; but it is in extension that 
operators fail, and that is why the reduction gives 
more trouble. One should attach the bands, not 
only at the foot, but also above the knee, so that, in 
stretching, the giving way may not occur at the 
knee-joint rather than at the hip. This then is how 
the extension towards the foot end should be 
arranged ; but there should be also counter-extension 
in the other direction, not only from a band round 
the chest and under the armpits, but also from a 
long double strap, strong and soft, passed round the 
perineum and stretched behind along the spine, and 
in front by the collar-bone attached to the source of 
the counter-extension. With the cords so arranged, 
some are stretched in one direction, some in the 
other, taking care that the strap at the perineum is 
not stretched over the head of the thigh-bone but be- 
tween it and the perineum. During extension, let the 
fist be pressed against the head of the thigh-bone and 
thrust it outwards. If the pulling lifts up the patient, 
insert one hand between the thighs and, clasping 
it with the other, combine extension with pressure 
outwards. Let another person make adjustment by 
pushing the knee end of the bone gently inwards. 



1 5*. 2 'Ira. 

3 iniStcris LitLie, l'eLiequin, and codd. , except 1$. iirlSocris 
B, Erin., Kw. 

37* 



IIEPI AP0PftN 

LXXII. YjlprjTcu Be Kal irpoaQev i)Br) on 
irrd^iov, oo"Ti9 ev iroXei iroXvavO poiirai Irjrpevei, 
£vXov K6KT?i<j9ai rerpayoyvov a>9 e^drrrj-^v, r) 
oXlyw p,e£ov, eupos Be o!>9 Biifffxy, ird~fco<; he aptcei 
airidapnalov eireira Kara yu.?}/co9 p,ev evdev Kal 
evdev evTOftrjv eye iv XP 1 !* ^ f 17 ) vyfr-ijXoTepr) tov 
fcaipov rj fir)xdv7)(ri<; rj- eneira (f)Xia<; /3/3a%eta9, 
lo"Xypd<; fcal icr^fpco? ev>]pp.oapeva<i, oviaKov eyeiv 
e/carepcodev eireira dptcel pbev ev ra> i)plaei tov 

10 £vXov — ovBev Be KcoXvei Kal Bia ttclvtos — eWe- 
Tprjadai &)9 K.atre70v<i paKpds irevre r) e£, BiaXet- 
7rovo~a<i dtr aXXijXwv &)9 Teoo~apa<$ BarcTvXous, 
avTas Be dpicel evpo? TpiBaKTvXovs elvac fcal 
jSd6o<; ovtcos. e^eiv & € KaT ^ /*eo~ov to %vXov Kal 
/caTayXv<f)r)v ^prj /3aduTepj]V, eirl Terpdycovov, a>9 
TpLwv BatcTvXcov Kal e? pev Tr)v KaTayXv(p>)i> 
ravTi]v, orav Bo/cf) irpoaBelv, £vXov epuinqyvvvai 
evdppo^ov rfj fcarcvyXvcpfi, to Be dvco arpoyyvXov 
e purify vvv at Be, eirrjv ttots Boktj avp,(pepeiv, p,earjyij 

20 tov irepivaiov Kal t?}? /ee<£aA,% tov p,ijpov. tovto 
to £vXov ecrTeo? KcoXvei ttjv eiriBoaLV enriBiBovai 
to cra>p,a Tolai 777309 ttoBcov eXKovaiv evioTe yap 
dpicel aiiTO to £vXov tovto clvtI t>79 dvwdev dvTi- 
KaTaTdaio<i' evioTe Be Kal KaTaTeivop,evov tov 
o-KeXeos evdev Kal evdev, avTo to £vXov tovto, 
%aXapov eyKeipevov fj ttj r) ttj, eKpo)(Xeveiv eiri- 
Tt]Beiov av eli) tt)v KetyaXrjv tov pLijpov e'9 to e^w 
pepos. Bia tovto yap val al KaireToi evTeTpeaTai, 
C09 Ka0 y OTToirpi av avrecov appoarj, ep{3aXX6pevo<i 
30 fjvXivos po\Xo^ pt-o^Xevoi, rj irapa Ta9 KecfraXa? 
to)v apdpcov, r) /cara KefiaXas TeXecos epeiB6pevo<{ 
a[xa ttj KUTaTaaei, yv tc e9 to e^co p,epos avp<peprj 
372 



ON JOINTS, lxxii. 

LXXI1. It was said before J that it is worth while 
for one who practises in a populous city to get a 
quadrangular plank, six cubits long or rather more, 
and about two cubits broad ; while for thickness a 
span is sufficient. Next, it should have an incision 
at either end of the long sides, that the mechanism 
may not be higher than is suitable. 2 Then let there 
be short strong supports, firmly fitted in, and having 
a windlass at each end. It suffices, next, to cut 
out five or six long grooves about four fingers' 
breadth apart; it will be enough if they are three 
fingers broad and the same in depth, occupying 
half the plank, though there is no objection to their 
extending the whole length. The plank should also 
have a deeper hole cut out in the middle, about three 
fingers' breadth square ; and into this hole insert, 
when requisite, a post, fitted to it, but rounded in 
the upper part. Insert it, whenever it seems useful, 
between the perineum and the head of the thigh- 
bone. This post, when fixed, prevents the body 
from yielding when traction is made towards the 
feet ; in fact, sometimes the post of itself is a 
substitute for counter extension upwards. Some- 
times also, when the leg is extended in both direc- 
tions, this same post, so placed as to have free play 
to either side, would be suitable for levering the 
head of the thigh-bone outwards. It is for this 
purpose, too, that the grooves are cut, that a wooden 
lever may be inserted into whichever may suit, and 
brought to bear either at the side of the joint-heads 
or right upon them, making pressure simultaneously 
with the extension, whether the leverage is required 

1 Frost. XIII. The Sramnum or "Bench " of Hippocrates. 
8 I.e. the supports should be " let in," not fixed on the top. 

373 



nEPI AP0PAN 

eKp.o^XevecrOai, i]v re e? to ecrco, Kal v\v re crTpoy- 
yvXov tov po^Xov crvp,(f>eprj elvai, r\1> re irXdros 
e^ovra' aXXo<; yap dXXqy twv dpOpcov dpp,6^ei. 
€vXpr)<TTO<; 8e icrriv eVt ttcwtcov tcov dpOpcov 
ep,/3oXr)<; twv Kara rd crKeXea avrrj r) po^Xevcris 
crvv rfi Karardaei. irepl ov ovv 6 A070? eo"Ti, 
crTpoyyvXos dppo^ei 6 po%\b<; elvai' ru> p,evToi 

40 e^co iKireiTTWKOTt dpOpro izXaTv^ dpp.6o~ei elvai. 
diTo TovT(ov twv p,i)yavewv /cal dvay/cewv ouSev 
dpOpov puOi Soxei olov re elvai a7ropr)0f]vai ep,- 

43 ireaelv. 

LXXIII. Kvpoi 8 dv Ti<i Kal aXXovs rpoirovs 
tovtov tov dpdpov ep/3oXr]q m el yap to fjvXov to 
p,eya tovto e%oi icaTa peaov Kal ik TrXaylcov 
cf)Xid<i 8vo 009 TroSialas, 1 vijros 8e 6ttco<; dv 80/ceoi 
o~vp<f)epeiv, Tt)v p,ev evOev, tijv Be evdev' eireiTa 
£i)Xov irXdyiov eveir) iv Trjai cfrXtfjcriv ft)? fcXip,a/c- 
Tijp, eireiTa Biepaai 2 to vyie<; cr/ce'A.09 p,ecn]yv twv 
<f)Xieo)V, to 8e aivapbv dvwOev tov /cXipa/CTrjpo'i 
e%eti> 3 evdppio^ov arrapTi irpbi to v\}ro<; Kal 7Ty0o? 

10 to dpdpov, fj eKireTTTWKev' prjihiov he [%/3^J 4 
dppo^eiv' tov yap KXipaKTrjpa v\lrr)XoTep6v Tivt 
Xpr) iroielv tov peTplov, Kal ipbaTiov itoXv-tttv^ov, 
&)? dv appboar), viroTeiveiv virb to acbpa. e-neiTa 
XP 7 ) £vXov ex ov T0 ""A-aTO? p,eTpiov, Kal p,rjKO<; 
d\pi tov atpvpov vTTOTeTap,evov, v-nb to cr/ceA.09 
elvai, licvevpevov eireKeiva tyjs KetfiaXrjs tov pbr/pov 

1 irobks /xTikos Paulus VI. 118. 
2 (l SUjxrsicv Kw., i^elcett Apoll. 8 e^ot. * Omit. 

374 



ON JOINTS, lxxii.-lyxiii. 

outwards ov inwards, and whether the lever should 
be rounded or broad, for one form suits one joint, 
another another. This leverage, combined with ex- 
tension, is very efficacious in all reductions of the 
leg- joints. As regards our present subject, it is 
proper that the lever be rounded ; but for an 
external dislocation of the joint, a flat one will be 
suitable. It seems to me that no joint is incapable 
of reduction with these mechanical forces. 

LXXIII. One might find other ways of reducing 
this joint. This big plank might have two props 
at the middle and to the sides, 1 about a foot long 
— height as may seem suitable — one on one side, 
the other on the other; then a crossbar of wood 
should be inserted in the props like a ladder-step. 
One might then insert 2 the sound leg between 
the props, and have the injured one on the top of 
the bar, fitting exactly to its height and to the 
joint where it is dislocated. This is easily arranged ; 
for the crossbar should be put somewhat higher than 
is sufficient, and a folded garment spread under the 
patient, so that it fits. Then a piece of wood of 
suitable breadth and of a length sufficient to reach to 
the ankle should be extended under the leg, going 
up as far as possible beyond the head of the thigh- 

1 These props seem to have been removable and at the 
sides of the hole for the perineal post, which was icara jueVof ; 
not fixtures at the sides of the " bench," as usually figured. 
See the description in Paulas (VI 118). The wooden cross- 
piece must have been either very thick or much shorter than 
three feet, to stand the pressure required. It could lie put 
either at the top, when the whole resembled the Letter pi, 
or lower down, when it resembled Sta (II). This also shows 
that the arrangement was not very wide. 

2 Tiitpatitv surely implies that the props were not far 
apart. 

375 



IIEPI AP0PQN 

ft)? olop re' TrpoaKaraheherrOai 8e XP*1 7r / 9 09 to 
o"«eXo<?, 07T&)9 av /xerptw? £'%??• Kairena Kararei- 
vofievov rov a/ceXeos, eire %v\(p virepoeiBei, eire 

20 toi'tcov Tivl rSiv Kararadiwv, opiov XPV /caravay- 
/cd^eadai to a/ceXos rrepi rov K\ipbaKrr)pa e<? to 
KaTO) yu.e/30? avv ru> %v\cp ru> 7rpoa8e8epevq)' rov 
8e riva Kare^eiv rov dvOpcorrov dvcorepco rov 
dpOpou Kara to Io-)^lov. Kal yap outws ap.a p.ev 
r) Kardraa-i'i vrrepaipoiro 1 rr\v Ke(pa\rjv rov 
pbrjpov inrep rr)<i Korv\r/<;, dpua 8e r) p.o^Xevaif; 
airwOeot, rr/v Ke<pa\rjv rov p,r\pov e? rrjv ap^air/v 
(f)V<riv. avrai rrdaai ai etprjpiivat dvdyicai, lo")(y- 
pal teal irdaai Kpeaaov; t/}<? avp,(popr}<;, r\v ris 

30 opOayq xal «a\o)? afcevd^r). 2 uxnrep 8e real rrpoa- 
Oev 7]8>] eiprjtcu', iro\v tl d-rrb daOevearepcov 
Kararaauov Kal (pavXoreprjs Karao~Kevr)<; toicti 

33 rr\etoaiv 3 i/xiriTrrei. 

LXXIV. 'Hv 8e 6? rb e£c0 K€(pa\r) p,rjpov 
oXiadj), rd$ p,ev Karardaias evda ical evda ovrco 
XPV 7Toi€to~dai locnrep el'ptjrai, rj roiovrorpoTrw^' 
rr/v Be. p,o-^X.evaiv rrXdro^ eyovri p.o^Xo) p,o%\eveiv 
-%pi] dfia rfj Karardaei, ck toO e£a> p,epov<; e? rb 
eaco dvay/cd^ovra, Kara ye avrbv rov yXovrbv rt- 
6ep,evov rov puoyXov xal 6\iy(p ava>Tepa>* iirl to 
vyies layiov Kara rov yXovrbv dvriar>]pt^er(o ri<; 
rf/ai ^epalv a>9 /tr; inrel/cr} to aa>p,a, r) erepep rivl 

10 ToiovTtp uo)(\(p v7ro/3dWcov real epeio-as, i/c 4 roiv 
KaireTWv rr/v dpp.6^ovaav dvriKare^erco' rov Be 
firjpov rov e^r/pO pi] acoto? to rrapd to 70^1; eatoOev 
e£co TrapayeTco i)av^a)S' r) 8k Kpep.aai<i ovy^ 

* VTttpaiwpioi &f. 
376 



ON JOINTS, lxxiii.-lxxiv. 

hone ; it should he attached to the leg in a suitable 
manner. Then, while the leg is being extended 
either by a pestle-shaped rod or any of the above 
modes of extension, one should simultaneously force 
the leg with the wood attached to it downwards 
over the crossbar ; while an assistant holds down 
the patient at the hip above the joint. For thus the 
extension will raise the head of the thigh-bone over 
its socket, while the leverage will thrust it back into 
its natural place. 1 All these forcible methods of 
reduction are strong, and all are able to overcome 
the lesion, if one makes a proper and good applica- 
tion of them ; but, as was said before, in the majority 
of cases the joint is put in with much weaker 
extensions and more ordinary apparatus. 

LXXIV. When a thigh-bone head slips outwards, 
extension should be made in both directions 
as described, or in similar fashion. The leverage 
should be done with a broad lever simultaneously 
with the extension, forcing it from without inwards, 
the lever being applied to the buttock itself and a 
little above it. Let someone give counter-support 
to the hip on the sound side at the buttock with his 
hands, that the body may not yield, or make counter- 
pressure by slipping a similar lever under the joint, 
using a suitable groove as fulcrum. Let the bone of 
the dislocated thigh be gently brought from within 
outwards at the knee. The suspension method will 

1 An imitation of the method of reducing the shoulder- 
joint (VII). 



* T»ceua(,"i7Tai, as Apollonius. * TrAtlmoiaiy. 

* is for iic Kw., following Erm.'s conjecture. 



377 



IIEPI AP0PDN 

dppuoaei tovtco tw Tpoirw tt)<; oXiaOijaios tov 
dpdpov' o yap Trrj^vf tov ite/epepLapLevov dirwdeoL 1 
av rrjv teecpaXrjv rod pur)pov airb tt/9 kotvXt}<;. ttjv 
pLevrot aw rq> fcvXw t&> inroTetvopievcp p:6"^Xevaiv 
pLrp%avr)aaiT av Tt<? wcttc dpp,6£eiv teal tovtw t5> 
rpoiro) tov oXia6?]p,aTO<i, efjwOev trpoaapTewv. 

20 dXXa Tt teal Bel \rrXeiw Xeyeiv] ; 2 rjv yap 6p6w<i 
p:ev teal ev KaraTeLvijraL, 6p6w<; Be piO^XevrjTai,, t£ 

22 ovte av epureaoi dpdpov ovtws eteireTTTWKo'i ; 

LXXV. ' Hv Be e? TOutrtaOev puepos eKireiTTcoKr) 
o pLrjpos, t«? p,ev Karardaia<i teal dvTiTaaias ovtco 
Bel TTOteladat, teaQairep 3 el'prjrai' etriaTopeaavTa 
Be eVt to IjvXov IpcdTiov iroXinrTV^ov, &J9 piaXa- 
Kwrarov fj, irprjvea teaTa/cXivavTa tov dvdpwirov, 
ovtco leaTaTeiveiv' dpba Be Ty teaTaTaaei y^pr) tt} 
aavlBi teaTavajKa^eiv tov avTov Tpoirov &>9 to, 
v/3co/j-aTa, teaT i^iv tov irvyaiov Troir/adptevov ttjv 
aaviBa, teal piaXXov e'9 to koltco pLepos rj 69 to 

10 avco tcov la^twv' teal i) eWo/zr; r) ev tw Toiyjp tt) 
aavlBi p,r) evOela kaTco, aW' oXiyov tcaTacpepr)<; 
7T009 to twv ttoBwv pcepos. avTT) r) epifioXr) teaTCL 
cpvaiv T€ pidXicTTa tco Tpotrco tovtw tov oXcaOtjpia- 
T09 eaTi teal ap,a layvpoTaTT]. dpieeaeie 8' av 
iaw<; dvTi t% aavlBos teal ecpe^opievov Tiva, rj 
Tfjai yepalv ipeiadpcevov i) ewtplavTa e^aTTLvrjs 
op,oico<i eTTaicuprjOrjvai ap,a tt) teaTaTaaei. aUt; 
Be ovBepLirj ep-BoXr) twv irpdaOev elprjpievwv tcaTa 

19 cpvaiv eaTt tw Tpoirw tovtco tov 6XiadrjpLaTO<;. 

LXXVI. "Hv Be 69 to ep-irpoaOev oXlaOrj, twv 
piev teaTaTaatwv 6 avTO<; Tpoiros 7roir/T609' dvBpa 
Be %pr) fo>9 layypoTaTOv airo twv j(€ipwv teal a>9 
6L'7rat86i'TOTaToi', evepeiaavTa to derap rfy )(eipb<s 
378 



ON JOINTS, lxxiv.-lxxvi. 

not suit this form of dislocation, for the forearm of 
the person who hangs himself on would push the 
head of the thigh-bone away from its socket ; but 
one might arrange the leverage with the board at- 
tached so as to suit this form of dislocation also, fitting 
it to the outside. But what need is there [to say 
more] ? For if the extension is correct and good, and 
the leverage correct, what dislocation of this kind 
would not be reduced ? 

LXXV. If the thigh is dislocated backwards, 
extension and counter-extension should be made in 
the way described. Spreading a folded cloak on 
the plank, so that it may be as soft as possible, with 
the patient lying prone, one should make extension 
thus, and simultaneously make downward pressure 
with the plank, as in cases of hump-back, putting 
the board in a line with the buttock, and rather 
below than above the hip. Let the groove in the 
wall for the board be not level, but sloping a little 
down towards the feet. This mode of reduction is 
most naturally in accord with this form of dislocation, 
and at the same time very powerful. Instead of the 
board it would, perhaps, suffice for someone to sit on 
the part, or make pressure with his hands or with 
the foot, in each case bringing his weight suddenly 
to bear at the moment of extension. None of the 
other modes of reduction mentioned above is in 
natural conformity with this dislocation. 

LXXVI. In dislocation forwards, the same exten- 
sions are to be used ; and the strongest-handed and 
best-trained assistant available should make pressure 



a-nwdoiij. * Omit Kw. and a few MSS. 

379 



8 ws. 



IIEPI AP0PHN 

Trj<; ereprjs irapa tov ftovfitova, icai ttj eTeprj %et/ot 
ttjv ecovrov %€tpa TrpocncaTaXafiovTa, apa pev es 
to Karoo (oOelv to oXtaOrj/xa, apa he e'<? to eparpoa- 
6ev tov yovaros pepos. ovtos yap 6 rpoTros tt}? 
ip,/3oXrj<; paXicrra Kara (frvcrtv tovtm tG> oXicr- 

10 Oi'iparl eariv. arap icai 6 icpepacrpbs iyyvs tl 
tov kclto, <fivcriv' hel pevroi tov eiacpepdpevov 
epireipov elvai, o>9 p,rj e/cp^oxXevrj t<m 7T/;^et to 
apBpov, dXXa irepl peaov tov irepivaiov kcu 

14 Kara to iepbv 6o~t£ov ttjv efacpepaaiv 7rou)Tai. 

LXXVII. Evho/cip,el he oV; /cal [6 ireipaOeU] * 
ao~K(p tovto to apQpov ep.f3dXXeadai 4 /cal ^orf 
p,ev Tivas eihov OLTives vno cpavXoTrjTOS /cat to, 
e^co e/CKercXip,eva icai to, oiriaOev aaicw e-neipMVTO 
ipfidXXeiv, ov yiyi'coaKovTa oti ei^eftaXXov 
avTO pdXXov r/ ireftaXXov 6 pevTOc irpoiTO^ 
€TTivorjaa<i hfjXov oti 7r/3o? to, ecrco coXiadrjKOTa 
ao~K(p ip.f3(iXXeiv eireip^aaTO. eirLaTaoOai pev 
ovv XPV ^ Xpi]o-ikov dcnctp, el heoi yjpr\aQai' 

10 hiayivcoa/ceiv Be yph 2 oti 6Tepa iroXXa aaicov 
Kpeaaa) eo~Tiv. %p>) oe tov p,ev aa/cov icaTa- 
detvai 3 e'9 toi>9 prjpom d<^varjTOV eovTa, &>9 av 
hvvatTO dvcdTaToo 7rpo9 toi> irepivacov dvdyovTa' 
airb he twv eiriyov vihiov dp^dpevov, Taivirj irpos 
dXXtpXovi toi>? p,r}pov<; KaTahrjcrai aypi T0 ^ 
i]piaeo<i twv pbrjpwv eireiTa e'<? eva tmv Trohwv* 
tov XeXvpevov, evOevTa avXbv e/c y_aXKetov, (f>vaav 
eaavayicd^eiv e'9 tov clo-kov tov he avQpwnov 
ivXayiov KaTa/ceiadai, to aivapbv o-/ceXo<; eiri- 

20 iToXr)<i e^ovTa. rj puev ovv Trapao-/cevr) auTt] 

1 Omit Kw. and most MSS. * 5d. 

^580 



ON JOINTS, lxxvi.-lxxvii. 

at the groin with the palm of one hand, grasping it 
with the other, and pushing the dislocated part 
downwards, while at the same time the part at the 
knee is brought forwards. 1 This mode of reduction 
is in most natural accord with this dislocation. For 
the rest, suspension rather approaches the natural 
method ; but the man who hangs himself on must 
be experienced, so as not to lever out the joint with 
his arm, but make the suspension weight act at the 
middle of the perineum, and over the sacrum. 

LXXVII. Finally, there is an approved method of 
reducing this joint also with a bag ; 2 and I have 
seen some who, through incompetence, kept trying 
to reduce even external and posterior dislocations 
with a bag, not knowing that they were putting it 
out rather than putting it in. The first inventor of 
the method, however, obviously used the bag in 
trying to reduce inward dislocations. One ought, 
therefore, to know how to use it, if required, while 
bearing in mind that many other methods are more 
effective. The bag should be applied to the thighs 
uninflated, and brought up as close as possible to the 
perineum. Bind the thighs to one another with a 
band extending from above the knee-caps half-way 
up the thighs ; then, inserting a brass tube into one 
of the feet 3 which has been untied, force air into the 
bag. The patient should lie on his side with the 
injured leg on top. This, then, is the arrangement; 

1 Tii the " Apollonius" illustration he makes pressure with 
one hand on top of the other. 

2 I.e. wineskin. Cf. use for spine (XLVII). 

3 Of the wine-skin. 



8 tvduvoii. * Tro8twvwv Weber, Kw. 

38 x 



IIEPI AP0PON 

early a/cevd^ovrai Be /cd/ciov ol ifKelaTOt rj cos 
eyio elprj/ea' ov yap icaTaBeovai tovs prjpovs eirl 
avyyov, aXXa povvov ra yovara, ovBe teara- 
Teivovav ^ph & e Kat Trpo&kaTareiyeiv opoos Be 
i]Sr/ Tives eve(3a\ov pipBiov irpi'iypaTos eVfrf- 
^6vre<;. eu(p6pco<; Be ov Ttdvv e%et Biavay/cd^ea- 
6at ovtws' 6 re yap da/cos epcpvacop-evos ov ra 
oyKTjporaTa avrov e^et 7T/30? tw dpdpco t% 
K€(ba\r)S, r)v Bel p,dXiaTa e/epo^Xevaaadat, aWa 

30 /caG" kcovTov auTO? peaos ical tcov p,r)pcov laws 
r) Kara to pbiaov i) ext /eaTWTepw oi Te av prjpoi 
cfrvaei yavaol necpv/caaiv, dvwOev yap aap/cwBees 
re teal avppijpoi, is Be to kutw vTro^rjpoi, ware icai 
r) tcov prjpwv cpvais eTravay/ed^ec top aaKOV airo 
tov eiriKatpordrov ywpiov. el Te ovv ris api/cpov 
ev0r\aei rov da/eov, api/cpr) i) la^ys eovaa dBv- 
vaTos earai dvay/cd^etv to dpOpov. el Be Bel 
da/ew ■xprjaOaL, eirl tto\v ol prjpoi avvBeTeoi 
77/309 dXktfXovs, teal dp,a ttj /caraTaaei tov 

40 awpaTos 6 daubs cpvar/Teos' Ta Be aiceXea ap,- 
cpoTepa opov teal tcaTaBelv ev tovtw tco Tpoirto 

42 tt)s epfioXrjs em tt)v TeXevrrjv. 

LXXVI1I. Xpr) Be 7repl irXeiaTov pev Troiela- 
6ai ev Trdarj tt) Te^yrt ottws vytea TroLijays rov 
voaeovra- el Be iroXXolai Tpoiroiai olov Te elt] 
vyiea iroielv, tov doxXoTaTOv XPV alpeladar 
teal yap dvBpayadnccorepov tovto /ecu TexyL/cco- 
repov, oaTis p,r} eiriOvpel Br]p,oeiBeos /cifiBijXlrjs. 
irepl ov ovv 6 Xoyos eaTi, ToialBe av Tives 
/caToi/ciBioi /caTaTaaies elev tov acopaTos, ware 
e/c tcov irapeovTwv to eviropov evpia/ceiv tovto 

10 pev el tcl Beap,d tcl Ipdvriva p,i] Trapeo) Ta 
382 



ON JOINTS, Lxxvii.-Lxxvni. 

but most operators make less suitable preparation 
than that which I have described. They do not 
fasten the thighs together over a good space, but 
only at the knees ; nor do they make extension, 
though there should be extension as well. Still, 
some are found to have made reduction, chancing 
upon an easy case But the forcible separation is by 
no means lightly accomplished thus ; for the inflated 
bag does not present its largest part at the articular 
head of the bone, which it is especially requisite to get 
levered out, but at its own middle, and perhaps at 
the middle of the thighs, or still lower down. The 
thighs, too, have a natural curve ; for at the top 
they are fleshy and close together, but taper ofi 
downwards, so that the natural disposition of the 
thighs also forces the bag away from the most 
opportune place. If one inserts a small bag, its 
power being small, it will be unable to reduce the 
joint. So, if one must use a bag, the thighs are to 
be bound together over a large space, and the bag 
inflated simultaneously with the extension of the 
body ; also tie both legs together at their extremity, 
in this form of reduction. 

LXXVIII. What you should put first in all the 
practice of our art is how to make the patient well ; 
and if he can be made well in many ways, one 
should choose the least troublesome. This is more 
honourable and more in accord with the art for anyone 
who is not covetous of the false coin of popular ad- 
vertisement. To return to our subject — there are 
certain homely means of making extension, such as 
might readily be found among things at hand. 
First, supposing no soft supple leather holdfasts are 

383 



IIEPI AP0PDN 

fiaXOarca Kal irpoatpyea, a)OC r) crihrjpea* r) 07rXa 
7) ayoivia, raivtrjai ^prj rj eKpr)ypiacn rpvyicov 
epivecov rrepLeXtaaeiv ravTr/ p.d\iara fj peXXei 
rd heo~p,d /caOetjeiv, Kal en eirl rrXeov' eireira 
ovrco heiv rolai hecrpoiaiv' rovro he, €ttI KXivr/s 
XPV »?tj? la^vporaTrj Kal peylarr) rcov irapeov- 
aecov KararerdaOai KaXco<; tov dvdpcoirov' rr)<; 
he kXIvt/s toi)<? ir6ha<i, r) tol"? irpbs Ke<paXr)<; i) 
rov? 7Tyoo? irohcov, eprjpeZcrOai irpo<i rbv ovhbv, el 

20 re e^codev avp,(pepei, el re eacoOev irapa Be tou? 
erepovi 7roSa<? Trapep/3e/3\r}o-0ai £vXov rerpdyco- 
vov rrXdyiov, hirjKOV cirrb rov rroSbs irpo<; rov 
TroSa, /cal r)v puev Xerrrbv r) rb £vXov, irpoahehecrOco 
rrpos tow? 7roSa? T% kXivtjs, r)v he ira^v r), 
p,rjhev 2 enreira t<z<? dp%d<; ^pi] rcov hecrpucov Kal 
rcov 7rpb<i rr)<i K€(f>aXr}<; /cal rcov 7rpo? rcov rrohcov 
rr poo-hrjaai e/ccnepas rrpb? vrrepov i) rrpbs aXXo 
ri tolovtov' 6 he hecrpbs e^erco Wvcopirjv Kara 
rb era) pa r) /cal oXcyco dvcorepco, avpperpco<i he 

30 eKrerdaQco 7rpb<; rd inrepa, &>?, 6p0d earecora, 
to p,ev rrapd rbv ovhbv epeihtirai, to he irapa 
to %vXov to 7rapa/3e/3Xr]pevov' Kaireira ovrco 
ra virepa dva/cXwvra XP 7 1 TT ) V Kardracriv iroielv. 
dpKet he Kal KXlpat; laj(ypov<i eyovtra rov? 
KXipaKTPjpa<i, vrroreTapbevrj vrrb rr)v kXlvtjv, dvri 
tov ovhov re Kal £v\ov rov iraparerapevov, a>? 
rd vrrepa, irpos rcov fcXipLa/crijpwv rov<; dppo- 
£ovra<; evOev Kal evOev it poaepijpeia p.eva, dva- 
KXcop,eva, ovtco rrjv Kardracriv iroifJTai tcov 

40 hecrpcov. 

'E/x/3aWerat he purjpov dpOpov Kal rovhe rbv 

1 ffeipal. 
384 



ON JOINTS, lxxviii. 

available, one might still wrap up iron chains, ship's 
tackle, or cords, in scarves, or torn woollen rags, 
especially at the part where they are fastened on, 
and somewhat further, and then proceed to bind 
them on as holdfasts. Again, one should use a bed, 
the strongest and largest available, for making good 
extension ; 1 the legs of the bed either at the head or 
foot should press against the threshold, outside or 
inside, as is opportune, and a quadrangular plank 
should be laid crosswise against the other legs, 
reaching from one to the other. If the plank is thin, 
let it be fastened to the legs of the bed ; but if thick, 
this is unnecessary. Next, one should tie the ends 
of the bands, both those at the head and those at the 
feet respectively, to a pestle, or some other such piece 
of wood. Let the bands be in line with the body, or 
slanting a little upwards, and evenly stretched to 
the pestles, so that, when they are vertical, one is 
pressed against the threshold, the other against the 
plank laid across ; and then one should make the 
extension by drawing back the pestles thus arranged. 
A ladder with strong crossbars stretched under the 
bed is a good substitute for the threshold and cross- 
brain, so arranged that the pestles may get their 
fulcra at either end against suitable crossbars, and, 
when drawn back, may thus make extension on the 
bands 

The thigh-joint is also reduced in the following 

1 Littro and Petrequin render KaraTerdaOai simply 
"coueher " ; but the word is used throughout for surgical 
"extension." Adams: "the patient should be comfortably 
laid." 

* ov Set (Kw.'s conjecture from oirSej' of BMV). 

385 
VOL. III. o 



IIEPI AP0PON 

rpoTroVy r)v e? to ecrco doXiaOrjKr/ koX e\ to epirpoa- 
6ev /eXtpaKa yap y^pi] fcaropu^avra iirtKaOiaai 
tov avOpunrov, eireira to pev byte? G/ceXos rjav- 
%o>9 KcnareivavTa TrpoaBPjcrai, ottov dv dppocrrj' 
Ik Be tov aivapov e\ /cepd/xiov vScop ey"%ea<; e/c- 
tcpepdaai, r/ e? crfyvplha \l6ov$ epfiaXcov. erepos 
Tp07ro<> ep{3oXr/<;, tjv e\ to ecrio 0iXia6i]Kr}' arpu>- 
Trjpa XPV fcara8i]<rat pera^v 8v r o otvXwv y-v^ro? 

50 eyovra avpperpov' irpoe^eTca 8e tov aTpwTrjpo^ 
Kara to ev pepo<; oixoaov to irvyalov' x irepi- 
hi]o-a^ 8e irepl to o-ttjOos tov dvOpcoTrov ipaTLov, 
iiriKaOiaai tov avdpwirov eirl to irpoe^ov tov 
crTpo)Trjpo<i' eiTa TrpoaXafBelv to aTr/6o<; Trpos tov 
o-tvXov irXaTei tivl' eirena to pev vyie<; atceXos 
KaT€X€T(o Tt?, a)? pri TrepiacfydXXijrai' i/c 8e tov 
aivapov etacpepdaai j3dpos, baov av dppo^rj, &>? 

58 /cal irpoaOev 7]8rj elprjTai. 

LiAAl A. llpwTOv pev ovv osl etoevai otl ttuvtuiv 
t<ov 6o~t€(i)v at o~vp/3oXai eiaiv &)<? eVt ttoXv t) 
Ke(f>a\r) zeal 7) kotvXtj' icf) wv he ical t) %a>pa 
KOTvXoei87i<; teal eirLpatcpos' eviai 8e tS>v -^(opecov 
yXrjvoetBees elcriv. del 8e epfidXXeiv 8et irdvTa 
tu eKiriTTTovTa dpOpa, pdXtaTa pev evOus irapa- 
%pr)pa €Ti Oeppcov eovTtov el 8e pij, &>? Ta^iaTW 
ical yap tw epfidXXovTi pi](Tepov teal Odaaov 
ecrTiv ep/3dXXeiv, ical to> daOtveovTi 7roXv arco- 

10 vcoTept] 7) epfioXr) r; irplv 8ioi8elv eaTtv. Set 8e 

1 ir7Jxua?or Littio ; irvy fiaiiov P<j. ; iruyaiov vulg. , Kw. 
336 



ON JOINTS, lxxviii.-lxxix. 

manner, if it is dislocated inwards or forwards. One 
should fix a ladder in the ground, and seat the 
patient upon it ; then, gently extending the sound 
leg, fasten it at a suitable point, and from the 
injured limb suspend a jar and pour in water, or a 
basket and put in stones. Another way of reducing 
it, if dislocated inwards :— Fasten a crossbar between 
two props at a moderate height, and let one end of 
it project a buttock's length. 1 After passing a cloak 
round the patient's chest, seat him on the projecting 
crossbar, and then fasten his chest to the upright 
with a broad band. Let an assistant hold the sound 
leg, to prevent him from slipping round, and hang 
a suitable weight from the injured one, as has 
already been described. 2 

LXXIX. One must know, to begin with, that 
the connections between all bones are as a rule the 
head and the socket. In some, the cavity is large 
and cup-shaped ; but in others, the cavities are 
shallowly concave. One must always reduce any 
dislocated joint, preferably at once, and while the 
parts are still warm ; failing that, as soon as possible, 
for reduction before swelling sets in is accomplished 
much more easily and quickly by the operator, and 
is much less painful for the patient. When you are 

1 "What a measure!" says Petrequin, and suggests 
nvyixcuov. Littre reads vnxvaiov, "a cubit." The reading 
of the MSS. is supported by Apollonius (both text and 
illustration), though it is hard to see why the patient 
should not sit between the posts. 

* According to Galen, the treatise ended here. The rest 
is a sort of appendix of fragments, some of them (e.g. LX.W) 
perhaps genuine parts which were lost and subsequently 
rediscovered. Most is from Mvchlicon, as explained in the 
Introduction. 

387 



I1EPI AP0PDN 

del Travra ra dpOpa, oirorav p,eXXr)<; ipL^dXXeiv, 
7rpoavap,aXd£ai teal htatciy/cXio-ai' paov yap 
iOeXet ipftaXXeaOat. irapa irdaas he t<z? tcov 
ctpOpcov ep,{SoXd<; lo~X va ' Lveiv ^ e * rov dvOpcotrov, 
fiaXiara p,ev rrepl rd piyiara apOpa real %aA.e- 
TrcoTara ep,(3dXXea0ai, y/ciaTa he irepl rd eXa^toTa 

17 teal prpihia. 

LXXX. Aa/crvXcov he i)v eicnearj dpdpov tl t6)v 
Trj<i ^eipof, 1]V re to wpcoTOv, r\v re to hevTepov, r)V Te 
to TptTOv, (ovtos [zeal Laos] * T/307TO? t^<? e/J-/3o\r/<i' 
-y^aXeircoTepa p.evToi de\ Ta ijeytaTa tmv dpOpwv 
ep./3dXXeiv. eKiriinei he fcctTa Tecrcrapa? Tpoirovi, 
r) dva> i) kutco r) e? to TrXdyiov eKaTepwdev, /.ui- 
XiaTa p,ev 69 to dvw, r/KiaTa he e? Ta irXdyui, ev t& 
crcpohpa KivelaQai. eKarepoiOev he Tt}<; ^oop?/?, ov 
eKp3ep3rjKev, (iiairep dp,/3i) eaTiv. rjv puev ovv e? to 

10 dvw eicTTecrr) r) e? to KaT(o hid to XeioTeprjv elvai 
Tavri]V Ti]v ■)(d>pr)v, i] e'/c tmv TrXayicov, /cai dp,a 
pLL/cp?]<i eovcrij'i ttjs VTrepfidaios, i)v p,6TaaTrj to 
dpdpov, prjihtov iaTiv ep.p3dXXeiv. T/307ro? he t?)? 
ep,/3oX>'i<; bhe' TrepieXiP'ii tov hd/CTvXov dicpov i) 
e7rtSe'cr/.iaTt tivi i) aXXm Tpuirco toiovtco tlv'i, 
07r&)5, OTroTav tcaTaTe'anis d/cpov XafiopLevos, p.fj 
<jLTToXio-8dvy OTav he TrepieXu^j^, tov p.ev Tiva 
hiaXafSeaBat, dvwQev tov icapirov T779 xeipo?, tov 
he tov KaTeiXi)p.pLevov 2 eireiTa rcaTaTelveiv 7T/30? 

20 eoiVTOv dpi(f)OTepovs ev p,dXa, teal apLa aTrcoaai to 
e£eo-Ti]tcb<i dpdpov e? ttjv -yd>pr]v. i)v he e? Ta 
irXdyia eKirearj, tt}<? p-ev /caTaTaavo? cdvto*; Tpo- 
7T09' bWav he hrj ho/cr} aoi v7rep/3ef3i]Kevat, Tipy 
ypaj.hpL>')v, z apLa ^pi] /caTaTeu'avras diro>aai es 
tt)v yd>p\]v ev0v<t, eiepov he tlvu en tov eTepov 
388 



ON JOINTS, lxxix.-lxxx. 

going to put in any joint, you must always first make 
it supple and move it about, for it will thus be more 
easily reduced. In all cases of reduction, the patient 
must be put on restricted diet, especially when the 
joints are very large and very difficult to put in, and 
least so when they are very small and easy. 

LXXX. If any of the finger-joints, whether first, 
second, or third, is dislocated, the mode of reduction 
is identically the same, though the largest joints are 
always the hardest to put in. Dislocation takes 
place in four ways, up or down a or to either side ; 
chiefly upwards, most rarely to the sides, in some 
violent movement. On each side of the part whence 
it is displaced there is a sort of rim. Thus, if the 
displacement is upwards or downwards, it is easier 
to reduce, because this part is smoother than that 
at the sides, and the obstacle to get over is small, 
if the joint is dislocated. The mode of reduction is 
as follows : — Wrap a bandage or something of the 
kind round the end of the finger, in such a way that 
it will not slip off when you grasp the end and make 
extension. When it is applied^ let one person take 
hold of the wrist from above, the other of the part 
wrapped up. Next, let each make vigorous exten- 
sion in his own direction, and at the same time push 
back the projecting joint into place. In case of 
lateral dislocation, the mode of extension is the same. 
When you think it has passed over the line of the 
joint, push it at once into place, while keeping up 
the extension ; an assistant should keep guard over 

1 Or " hack wards" or "forwards." 



1 Omit B, Kw. 2 KCTuKv/atmo Weber. 

anjiiiv (Kw.'s conjecturo). 



j 



3»9 



IIEPI AP0PftN 

pepeo<i rov ha/crvXov tyvXdaaeiv /cal dvwQelv, 
07T&)9 pi] irdXiv etceWev cnroXiadr). epftdXXovoi 
he eTTieifcea)*; /cal al aavpcu ai etc rwv (potvl/ccov 
irXe/cbpevai, rjv Karareivr]^ evBev /cal evOev rov 

30 hd/crvXov, XafBopevos rfj pev crept) rrj<; <ravpr)<;, 
rfj he ereprj rov /capirov rij<; ^eipo<;. orav he 
ep,/3dXXr]<;, eirihelv hel oQov'ioktiv <w? rdyivra, 
Xeirrordroio'i /ce/crjpeopevotat /cr/pwrfj p,i]re Xir/v 
paXa/<fj pr]re Xirjv a/cXrjpfj, dXXa perpui)*; e^ovar/. 
r) p,ev yap cr/cXi]pr) d(f)eo~rr]fcev drro rov ha/crvXov, 
r) he arraXi] /cal vypij hiari]/cerai teal airoXXvraL, 
Oeppaivopkvov rov ha/crvXov. Xveiv he dpOpov 
ha/crvXov rpiraiov rj rerapralov' rb he oXov, rjv 
pev cf)Xeypr]vrj, rrv/cvorepov Xveiv, rjv he pi], dpaio- 

40 repov' Kara rrdvrcov he tw^ dpdpayv ravra Xeyco. 
/cadlcrrarai he rov ha/crvXov rb dpdpov recr- 
o~apeo~/caihe/caraloi>. 6 avros he ear/, Qepaireir]<i 

43 rpoiros ha/crvXwv ^etpo? re zeal 7roSo?. 

LXXXI. Uapd rrdo~a<$ he rd<i T<yy apQpcov 
epfioXds hel la)(yaivetv /cal Xtpay-^ovelv ical 
d^pi efthopi]*;' /cat el <f>Xeypatvoi, irv/cvorepov 
Xveiv, el he pi], dpaiorepov r]av)(ir]v he hel 
eyeiv del ro iroveov dpdpov, ical co? /caXXiara 
6 ecyjqparia pevov /celaOai. 

LXXXII. Tow he evt]6earepov dy/coivos hid 
rr)v evaraXlrjv zeal rrjv ev(f)vt>}v, hio /cal eKirtirrei 
/cal epirirrrei paov' e/cir'nrrei he 7rXeto~Td/ci<i earco, 
drap /cal e£a> ical omadev. ep/3oXal he, e/c rov 
39° 



ON JOINTS, lxxx.-lxxxii. 

the other side of the finger and make counter- 
pressure, to prevent another dislocation to that side. 
The "lizards" 1 woven out of palm tissue are satis- 
factory means of reduction, if you make extension 
of the finger both ways, grasping the " lizard " at 
one end and the wrist at the other. After reduction 
you must apply at once very light bandages soaked 
in cerate, neither too soft nor too hard, but of 
medium consistency ; for the hard gets detached 
from the finger, while the soft and moi.-t is melted 
and disappears as the finger gets warm. Change 
the dressing of a finger-joint on the third or fourth 
day ; in general, if there is inflammation, change 
it oltener ; if not, more rarely. I apply this rule 
to all joints. A finger-joint is healed in fourteen 
days. The mode of treatment is the same for 
fingers and toes. 

LXXXI. 2 In all reductions of joints, the patient 
should have attenuating and starvation diet up to 
the seventh day ; if there is inflammation, change 
the dressing oftener ; if not, more rarely. The 
injured joint should be kept always at rest, and be 
placed in the best possible attitude. 

LXXXI I. 3 The knee is more favourable for treat- 
ment than the elbow, because of its compact and 
regular form, whence it is both dislocated and 
reduced more easily. It is most often dislocated 
inwards, but also externally and backwards. Modes 

1 Hollow cylinders of plaited material which contract on 
being pulled out. Once a well-known toy. Also mentioned 
by Diocles, who calls them "the lizards which the children 
plait." Aristotle {P. A. IV. 9) falls them TrAe-yuana, and 
compares thorn with the suckers of cuttle fisbi 

2 An insertion repeated from §§ IAXIX (end) and LXXX. 

3 From Fract. XXXVIII and Muchl, XXVI 

39' 



IIEPI AP0PON 

crvyrc€fcdp(f)Oai rj e/c\atCTLo-ai o£e«9, rj avve\[^a<i 
raivujf oyicov, ev rfj lyvvrj 6el<$, dp,<p\ tovtov 
e£aL<f)vi]<; e? okXcutlv d<pievai to aw/ua. Suvarai 
he real Karareivo/xevov fierpLcos, cocnrep dyrcdtv, 
ifiiriTTTeiv ra oiriadev' ra he ev6a kclI evda, eie 

10 tov avytceKap,<p6ai rj ifc\aKTL<rac, arap teal e/c 
KaTcndcrios p€Tpiij<i. r) hiopOcocris diracri Koivr]. 
rjv he p,i) epirecrr) Tolai pev oiriadev, avyKapLTnetv 
ov hvvavTai, drdp ouhe rotcri aWoiai irdvv. 
/xivvOei he pujpov koI Kvi)p,i]<; TouprrpocrOev' rjv 
he e<? to eaw, /3\ataoTepoi, puivvQet, he ra etja). 
rjv he e? to ef&>, yavaorepoi, ywXol he. fjaaov' 
Kara yap to irayvTepov bareov 6%ei, pbivvOec he 
to, eaa). etc yeverjs he /cal iv av^7](rec /card \6yov 

19 tov rrpoaOev. 

LXXXIII. To, he icaTa Ta acpvpa KaTaTaaio<i 
lo~Xvpf]<; helTai, rj Trjai y^epalv rj aWoiai toiov- 
roiai, 1 /caTopOooatos he dpxt dp,<poTepa iroieovcn]*;' 
4 koivov he tovto ditacnv. 

LXXXTV. Ta he ev iroSl a>? /ecu tcl ev X eL P l 

2 vyiee<i. 

LXXXV. Ta he ti)<; /cvi)p,rj<; avy/coivcoveovTa 
real eKireaovTa 3 e/c yeverj<;, rj ical ev au^tjaei 

3 e^apOp))cravTa, xaura a ical ev X ei P L ' 

LXXXVI. 'O/coaoi he Trr)h/)o-avT€<i dvwOev 



1 rotffi. 3 vyio Mochl. 

8 /mi-) ifji-maSvra Mochl. 



392 



ON JOINTS, lxxxii.-lxxxvi. 

of reduction : by flexion or a sharp kick upwards l 
(? jerking the leg upwards), or placing a rolled 
bandage in the ham, on which the patient brings 
the weight of his body by crouching suddenly. 
Suitable extension can reduce backward dislocations, 
as with the elbow. Those to one or the other side 
are put in by flexion or leg-jerking, and also by 
suitable extension. Adjustment 2 is the same for 
all. If there is no reduction, in posterior cases 
patients cannot flex the limb, but they can hardly 
do so in the others ; there is atrophy of the thigh 
and leg in front. If inwards, they are more knock- 
kneed, and there is atrophy of the outer side ; if 
outwards, they are more bandy, but not so lame, 
for the weight comes on the larger bone ; the inner 
side atrophies. Cases which occur congenitally or 
during adolescence follow the rule given above. 

LXXXIII. 3 Dislocations at the ankle require 
strong extension, either with the hands or other 
such means, and a rectification involving the two 4 
combined. This is common to all. 

LXXXIV. Dislocations in the foot heal in the 
same way as those in the hand. 

LXXXV. The bones connecting the foot with 
the leg, whether dislocated from birth or put out 
during adolescence, follow the same course as those 
in the hand. 

LXXXVI. Those who in leaping from a height 

'In Hippocrates Coacac Prenotiones 108 it is applied to 
involuntary "jerking of the legs.'' 

2 Theriight variation in Mochl. XXVI seems tofavour Pq.'s 
rendering. "This {i.e. extension) is common to all cases." 

3 Partly repeated in § LXXXV1I. 

4 Extension and counter-extension? Extension ^ and 
adjustment? It seems an obscure nummary of Frari. XIII. 

393 



IIEPI AP0PHN 

earripL^avTO rfj irTepvr), ware Biaarrjvai ra 
bcrrea /cat, (f)\e/3a<; e.Kyi<jxw9r]vai /cal vevpa dp,(f)t- 
(pXacrOPjvai, oirorav yevrjrac ola rd Beivd, k'iv- 
Bvvos fxev acfxi/ceXLcravTa rbv alwva irpipipuara 
Trapaa-yeiv' poiooBrj pev ra barea, rd Be vevpa 
aXXijXotai /cotvcoveovra. eirel zeal olenv av pud- 
Xicrra tcarayelacv rj vtto rpcoparo? rj ev /cvijprj 
7j ev p,7]pa>, rj vevpniv diroXvOevrcov a /cotvcovel 
10 rovrwv, rj etc /cara/cXiaios dpeXeos, epeXdvOrj r/ 
rrrepvrj, /cal rovroicn ra rraXiyicoreovra e/c rCov 

TOlOVTOdV. €<JTIV OTC /Cal 7TpO? Tft> 0~<pa/CeXl(T/J,'p 

yivovrai irvperol 6£ee? XvyfAcoBets, yvcojiijs dir- 
ropevoi, rayyddvaroi, /cal en (fiXejSeov aipop-' 
poiecov TreXucoies. crrjpela Be tcov TraXty/corr)- 
aavroiv, i)v ra e/c ^vpco para ical ra peXdapara 
/cat rd irepl ravra viroa/cXrjpa /cal vrrepvOpa^ 
r\v Be aw a/cXrjpvapari ireXiBvcoOfj, /clvBvvos 
peXavOrjvar r)v Be vTrorreXia rj, rj /cal ireXia 

20 pidXa /cal e/c^vpoopeva, 2 rj vrro')(\(opa /cal paXa- 
/cd, ravra ewl rrdai roiai rotovroiaiv dyadd. 
fajais, rjv pev dirvpero^; 17, eXXe/3opov' rjv Be prj, 
p.r)' dXXd irorbv o^vyXv/cv, el Beoi. escheat? Be 
dpOpcov' eVi Be rrdvra, pidXXov roiai (pXuapaaiv, 
bOovioiai rrXeioai /cal paXOa/corepoiatV rrle^is 
r)aaov' irpoarrepi^aXXeiv Be rd irXelara rfj irrep- 
vrj. ro a^rjjxa, orrep rj eTriBeais, &>? jirj e\ rijv 

28 rtrepvrjv drvome^rai' vdpOr/^L Be prj ^pPjaOai. 

LXXXVII. Olai B av e/cfifj 6 ttovs rj avrbs 
rj avv if] eTTKpuaei, e/cTriirrei /uev pdXXov e<; ro 
eaw ijv Be jjlij eprrear/, Xeirrvverai dvd %povov 

1 {mepvOpa y Mochl. 

394 



ON JOINTS, lxxxvi.-lxxxvii. 

come down on the heel, so that the bones are 
separated, and there is extravasation of blood and 
contusion of ligaments — when grave injuries such 
as these occur, there is danger of necrosis and life- 
long trouble ; for the bones slip easily, and the liga- 
ments are in connection with one another. Further, 
when in cases of fracture especially, or a wound 
either of leg or thigh, or when the ligaments joining 
up with these parts are torn away, or from careless- 
ness as to position in bed, mortification of the heel 
has set in, in these patients also such causes give 
rise to exacerbations. Sometimes acute fevers 
follow the necrosis, with hiccoughs, affecting the 
mind and rapidly fatal ; there are also lividities from 
haemorrhage. Signs of exacerbation are ecchymoses, 
blackenings of the skin with some induration and 
redness of the surrounding parts. If the lividity is 
accompanied with hardness, there is danger of 
mortification ; but if the part is sublivid or even 
very livid after ecchymosis, or greenish yellow and 
soft, these are good signs in all such cases. Treat- 
ment : if there is no fever, hellebore, otherwise not, 
but let him drink oxymel, if required. Bandaging : 
that used for joints ; over all, especially in con- 
tusions, use plenty of soft bandages ; pressure, rather 
slight; additional bandaging, especially round the 
heel. Attitude : the same object as in bandaging, 
so as to avoid pressure on the heel. Do not use 
splints. 

LXXXVII. In cases where the foot is dislocated, 
either by itself or with the epiphysis, it is usually 
displaced inwards; and if not reduced, the hip, 

395 



IIEPI AP0PON 

TO T€ Icr^iov kcu 6 /LLtjpos, KCU kvi'iiatis TO CLVTLOV 
rou 6\ia6)]/J,aTO<i. e/xf3o\r) 8e aXXrj, 1 wairep 
Kap-rrov, KaraTacrLs 8e layypr]' Li]ai<; 8e, vofioq 
dpOpwv. 7ra\iyfC0T€L, rjaaov Be /capirov, rjv 
rjcrv^dcr 01 a u>. hiana fAeiwv iXivvovai. to 8e 
9 e/c yeverjs fj ev av^rjcret,, Kara Xoyov tov irporepov. 

1 5« ixWr] omit Mochl. aud translators, except Pq. 



396 



ON JOINTS, lxxxvii. 

tliitrh and lejr become in time attenuated on the 
side opposed to the dislocation. Reduction in other 
respects as for the wrist ; but strong extension is 
required. Treatment : that customary for joints. 
Exacerbation occurs, but less than in wrist cases, 
if the patients keep at rest. Diet more reduced ; 
they do no work. Congenital and adolescent cases 
follow the rule given before. 1 

1 See notes on these chapters in Mochlicon, pp. 425-429. 



397 



MOXAXKON* 

I. Oorewv (f)vcri<;' haKTvXwv piev ci-rrXa /eat 
oared xal apOpa, ^eipo<; he Kal rrohos rroXXd, 
aXXa aXXoiWi avpypOpcop-eva' pueyiara he rd 
avcoTaTco. Trrepvris he ev, olov e£co (palverai, -npo^ 
he avrr/v oi b-nladioi revovres TeLvovoiv. Kvrjpvqs 
he hvo, dvcoOev Kal KarcoOev avve\opeva, Kara 
p.eaov he hie^ovra a/xiKpov to e%a>6ev, Kara tov 
apUKpov hci/cTuXov XeirTOTepov /3pa%ei, rrXelaTOv 
he ravrrj hiexovarj Kal a/xiKporeprj potrfj Kara 

10 <yovv, Kal 6 revwv e£ avrov irecpVKev, 6 irapa rrjv 
l<yvv7]v e^to. eyovoi he Kcirwdev koivi]v 67rt,<f>v<Tiv 
7rpo<i fjv o ttovs KLveiTar ciXXr)i> he dvcoOev 
eyovaiv €7Ti(f)uacv, ev fj ro tov p.)]pov apOpov 
Kivelrai, dirXbov Kal evo~TaXe<; a>? eirl pn'jKer 
eihos KovhvXcohes, €%ov eirip,vXiha' avrbs he 
eyKvpros k^w Kal ep.irpoadev' ?/ he Ke<f)aXr) 
eTTL(j)vat<i eon arpoyyvXr], e^ rjs to vevpov to ev 
rf) kotvXt) tov iayiov ire<^vK6V inroTrXdyiov he 
Kal tovto TrpoaijpTijTat., r/aaov he /3pa%Lovo<;. 

20 to he Io")(lov irpoa Lateral 777309 tw pieydXw airov- 
hvXw tw irapa to lepbv bareov "xpvhpovevputhei 
heo~p*w. 

1 MOXAIKOS Littre ; and the word is used as a synonym 
for fioxMo-itos in XLII. : but MOXAIKON is supported by the 
MSS. , and by the analogy of riPOrNftSTIKON and rJPOP- 
PHTIKON. Cf. also Galen XVI1I.(2) 327. 

398 



INSTRUMENTS OF 
REDUCTION 

I. Nature of bones. In the fingers and toes, 
both bones and joints are simple ; but in hand and 
foot they are diverse and diversely articulated, the 
uppermost being largest. The heel has a single 
bone which appears as a projection, and the hind 
tendons pull upon it. There are two leg-bones 
joined together above and below, but slightly 
separated in the middle. The outer one, towards 
the little toe, is rather more slender, most so in the 
separated part; and in the smaller inclination at the 
knee ; l and the tendon on the outer side of the ham 
has its origin from it. They have below a common 
epiphysis on which the foot moves ; and above they 
have another epiphysis, in which the articular end 
of the thigh-bone moves. This is simple and com- 
pact, considering the length of the bone ; it is 
knuckle-shaped, and has a knee-cap. The bone 
itself is curved outwards and forwards ; its head is 
a spherical epiphysis, from which the ligament arises 
which has its attachment in the cavity 2 of the hip 
this (tendon) 3 is inserted rather obliquely, but less 
so than that of the arm. 4 The hip-bone is attached 
to the great vertebra 5 next the sacrum by a fibro- 
cartilaginous ligament. 

1 Or. "with tlie greatest deviation (from the vertical) at 
this point, and less at the knee" ; hut the passage is obscure. 

* Acetabulum. s Ijigamentum teres. 

* Long head of the biceps. * Fixth lumbar. 

399 



MOXAIKON 

Pa\<9 he a7ro \xkv rov tepov bareov p>e%pi rov 
p,eyd\ov airovhvXov KV(pi). kvgtls re icah yovrj 
teal dpyov to iyKe/c~A.ifievov ev rovrro. airb he 
rovrov dypt ^p^v&v rfkOev rj WvXophos, /cal al 
yjroai Kara rovro' evrevOev he ay^pi rod pueydXov 
arrovhvXov rov virep r(bv eTrco^ilhcov IdvKvcfyijs' 
en he pidWov oofcel jj eariv' al yap ornaOev rcov 

30 arrovhvXwv a7TO(pvaie<; ravrp v^rrfKorarat' rb 
he rov avy^evos dpOpov \ophov. arrbvhvXoL Be 
eo~M0ev dprioi 7T/50? dW)j\ov ?, drro he tu>v e%a>6ev 
yovhpcov vevpa) avveyopevoi' 7) he o~vvdpdpci)ai<; 
avroiv ev rS> ornaOev rov vcoriaiov' oiriadev he 
eyovcnv qk^volv b^eiav eyovaav eirl^vaiv %oi'S- 
pcoSea' evOev vevpcov air 6(fi vats Karacpep/]*;, wairep 
/cal oi /xue? Traparre(pvKao'iv cirrb aiV^evo? e? 
ba(f)vv, TrXijpovvres he rr~kevpea>v teal dicdvdi}<$ rb 
fxecrov. 7r~\evpal he Kara, Ta? hta(pvata<i rcov 

40 arrovhvXaiv vevpiw TTpoarre^vKaaiv an av-^evo^ 
e? bacfyvi' kcrcoOev, eirirrpoadev he Kara ro arfjdo<i 
yavvov koX p*a\9aKov ro ctKpov eyovaai' elho$ 
pai/3oetheararov rebv ^cocov arevoraros yap 
ravrrj 6 avdpanro*; 67r' oyKOv' fj he /.»; irXevpai 
elaiv, eK<f>vcn<: rr\ayirj, jSpwyela Ka\ irXareia' e'<£' 
eKaarcp aTrovhvXw vevpuo rrpocnre^vKaaLV. 

XrP/do<; he awe-yes avrb ewvrw, htacf>vaia<; 
eyov irXayias, fi ir\evpal rrpoarjprrjvrai, yavvov 
he Kal yovhpwhe<;. K\r/iht<; he 7repi(pepee<; e? 

60 rov pen poa 6 ev, eyovaai rrpbs p,ev rb arrjdos 
fipayelas Ktvijaias, tt/jo? he rb dxpoopLiov avyyo- 
repa<;. dicponpaov he e£ oyp^orrXarewv irefyvKev, 
dvopLoiws he rolai rrXelaroiai. oop.07r\drrj he 

1 " The ensemble of the articulations." I\j. 
400 



INSTRUMENTS OF REDUCTION, i. 

The spine from the end of the sacrum to the great 
vertebra is convex backwards. The bladder, genera- 
tive organs, and inclined portion of the rectum are 
in this part. From here to the diaphragm it ascends 
in a forward curve, and there are the psoa-muscles ; 
but thence up to the great vertebra above the 
shoulders it rises in a curve backwards, and seems 
more convex than it is, for the backward processes 
of the vertebrae are here at their highest. The 
neck-joint l is concave behind. The vertebrae on 
the inside are fitted to one another, being held 
together by a ligament from the outer side of the 
cartilages ; but their jointing (synarthrosis) is behind 
the spinal cord, and they have posteriorly a sharp 
process with a cartilaginous epiphysis. Hence arise 
the ligaments which pass downwards, just as muscles 
also are disposed at the side from neck to loins, 
filling up the part between the ribs and the spinal 
ridge. The ribs are attached by a ligament at the 
intervals between the vertebrae from neck to loins 
behind, but in front to the breast-bone, having the 
termination spongy and soft. In shape they are the 
most curved of any animal ; for man is flattest here 
in proportion to his size. Where there are no ribs, 
there is a short and broad lateral process ; they are 
connected with each vertebra by a small ligament. 

The sternum is a continuous bone, having lateral 
interstices where the ribs are inserted ; it is spongy 
and cartilaginous. The collar-bones are rounded in 
front, having slight movements at the sternal end, 
but more extensive ones at the acromion. The 
acromion has its origin from the shoulder-blades in 
a different way from that in most animals. 2 The 

1 See notes on Joints XIII. 

4.01 



MOXAIKON 

%ovSpcoBr)<; to 7rpo? pdyiv, to <T aXXo ^civvr), to 
dvoopaXov e%a> k\ov<Ta, avyeva Be ical KorvXr/v 
e^ovaa x ov ^P^ 6a > e '£ V^ ai vrXevpal klvtjctiv 
e^ofcrt, €vcnr6\vTO<s eouaa bo-rewv, irXr)v fipa- 
%iovo<i. tovtov Be i/c tt)? kotvXijs vevp'iw rj 
Ke4>a\r) i^/)pT7)Tai, ^bvBpov yavvov irepifyepr) 

60 &TTi(pvcnv e^ovaa' avrb? 8' eytcvpros egco ical 
epirpoaOev TrXdyios, ovk bpObs 77-/909 kotvXijv' to 
Se 7T/509 dyicwva avrov 7rXa,TV ical tcovBvXwBtt; 
teal fiaXftiBcoSe*} ical a-repeov, eytcoCXov OTuaOev, 
ev to r) Koptovi) 1) ere rov 7n')^eo<i, brav i/crccdr} r) 
X ei P> tveariv' e? toOto ical to vap/ccbBes vevpov, 
b l etc Ti)<i Biafivaios iSiv rod 7r?^eo? barecov, e/c 

67 pcecrwv etcirefyvKe ical ire pair erai. 

II. Pt9 he icareayelaa dvairXdaaeaOat oit] re 
avdu>pov. ktjv pev ovv 6 %6vBpo<;, evTtOeaOai 2 
dxv>W bOoviov, ivairoBeovTa XottS) K-ap^Boviw, 
r) ev aXXrp b p,r/ epediel' ¥q> Xott& Be to.? irapaX- 
Xd^ias irapcucoXXav ical dvaXapftdveiv' ravra 
oe eTTLoeai? kclkci iroiei. iqcris aXXiy apa be t&) 
&vp,/3aXeiv avv pLavvrj 4 rj Oeiw avv Krjpcorf}' 
avrlica dvairXdaaetv, eiretra dvaKW^/jaetv, rolat 
Ba/CTvXoiai eaparevoptevov ical irapaarpe^ovra' 

10 teal ro Kap^r)BovLOv' Trwpolro av /cal r)v eXicos 
evrf ical r)v barea dirievai yu.eX.A-?; — ov yap 

12 iraXiyKOTtorara — ovtw iroirjTea. 

1 rb. 2 h'TiBii'ai Littrd, Kw. 

3 KaTairoiei codd. ; Kcrno-Koul M marg. ; /ca/ca troUti Lit. conj. 

4 aKrjTai avv fxdvvp. 

1 Long tendon of the biceps. 

2 Galen U.P. II. 14. Our " olecranon." Both processes 
of the ulna were called Kopmv6v, because of their semicircular 
shape. 

402 



INSTRUMENTS OF REDUCTION, i.-n. 

shoulder-blade is cartilaginous in the part towards 
the spine, and spongy elsewhere ; it lias an irregular 
shape on the outer side, and the neck and articular 
cavity are cartilaginous. Its disposition allows free 
movement to the ribs, since it is not closely con- 
nected with the bones, except that of the upper 
arm. The head of this bone is attached to its socket 
by a small ligament, 1 and has a rounded epiphysis 
of spongy cartilage. The bone itself is convex out- 
wards and oblique in front, and does not meet the 
cavity at right angles. Its elbow end is broad, 
knuckle-shaped, and grooved ; it is also solid, and 
has a hollow at the back, in which the coronoid 
process 2 of the ulna is lodged when the arm is 
extended. Here too the cord which stupefies, 3 
arising from the interstice between the bones of the 
forearm, has its issue and termination. 

II. A fractured nose is a thing to be adjusted at 
once. If the cartilage is the part affected, introduce 
lint, rolling it up in thin Carthaginian leather, or in 
some other non-irritant substance. Glue strips of 
the leather to the distorted parts, and raise them 
up. Bandaging does harm 4 in these cases. Another 
treatment : while bringing the parts together, apply 
frankincense or sulphur with cerate ; adjust at once. 
Afterwards keep it up by inserting the fingers, 
feeling for and reducing the deviation ; also the 
Carthaginian leather. It will consolidate, even 
though there be a wound ; and if bones are going 
to come away —for there are no very grave exacerba- 
tions — this is the treatment to use. 

3 Surely our ulnar nerve (funny-bone), though Foe's and 
others call it "a ligament void of Bens"alion." 

4 Pn. renders " depresses," reading Kara-iratei, as opposed to 
avaTr\ri.(T<Tftv. 

403 



MOXAIKON 

III. OS? Kareayev ptrj eirtBeiv, fir/Be /cara- 
•nXdaaeiv' rjv Be ri Bey, rlx? K0V(p6raT0V, 1) Kypcorrp 
/cal 9ei(p KaratcoWav. wv Be e/xirva ra wra Bin 
7ra^eo<? cupicr/cerai, irdvra Be rd inrofiv^a /cal 
tt) vypr} aap/cl TrXrjpea e^aTrara' ov pt7] /3Xd/3r) 
[yevr)Tat~\ 1 crroficoOev to tolovtov' ko~Tt yap 
daap/ca koI vBarooBea, pLvfyis irXea' ottov Be ical 
ola eovra OavarwBed eaTt, irapedevra. 2 oyrwv 
icavcris nreprjv, rd^Lcrra vytd^et' kvXXov Be /cal 

10 fielov yiverai rb o5?, rjv rrepr/v /cavOrj. rjv Be 

11 cnop.(t)9r}, Kovcpo) evaiptw Be/jaet y^prjaOat. 

IV. YvdOoi Be /caracnrwi'Tai ptev TroXXdrcfi /cal 
KaOicTTavraf e kit Lit t overt Be bXiyd/cts, pbdXiora 
ptev ^aapLwpuevoiaiv' ov yap eKiriirret, rjv ptrj Tt<i 
yavoov fieya irapaydyor etcn-'nnet Be ptdXXov, brt 
ret vevpa ev irXaylw koX XeXvyiapteva cvvBiBot. 
arjpuela- Trpotayet r) /cdro) yvdOos /cal TTapearpaiT- 
rai rdvavria tov e/cTrroop.aTO'i' o~vpL(3dXXetv ov 
Bvvavraf rjv Be d/MpoTepat, Trpoto-ypvai pidXXov, 
avpt^aXXovcrtv r)aaov, do~Tpa/3ee<>' BrjXot Be to, 

10 opia to)v oBovtcov ra ava> rolat kutco /car i^tv. 
rjv ovv dpicporepat eKTreaovcrai pci) avrtica epu- 
ireo-coai, Ovija/covat Be/caratot ovtol ptdXiara 
TTvperco crvvex^t t coOpfj re /capcoaet' at yap puves 
ovTOt TOtovrot. yao~ri]p eirtrapdaaeTat bXtya 
d/cprjTa' /cat rjv e/necoat, roiavra epteovatv r) B 
ereprj denveo-reprj. ep,/3o\i] Be )) avr>) dpKpOTepoov' 
fcaranetpievov rj Kadrfpuevov rov dvO pooirov, T/y? 

1 Kvv. omits. 2 Cf. Art. XL. irapeiTai. 

404 



INSTRUMENTS OF REDUCTION, m.-iv. 

III. Do not bandage a broken ear, and do not 
apply a plaster. If one is required, let it be cerate 
plaster as light as possible, and agglutinate with 
sulphur. When there is suppuration of the ears, it 
is found at a depth ; for all pulpy tissues and those 
full of moisture are deceptive. There is certainly 
no harm in opening such an abscess, for the parts 
are fleshless and watery, full of mucus ; but the 
position and nature of abscesses which cause death 
are not mentioned. Perforating cautery of the ears 
cures a case very quickly ; but the ear becomes 
mutilated and smaller if it is burnt through. If an 
abscess is opened, a light wound application must 
be used. 

IV. The jaw is often partially displaced, and 
reduces itself. It is rarely put out, and that chiefly 
when yawning ; for it is not put out unless it is 
drawn to one side during a wide yawn ; and dis- 
location occurs the more because the ligaments, 
being oblique and twisted, give way. Symptoms : 
the lower jaw projects and deviates to the side 
opposite the dislocation ; patients cannot close the 
mouth. If both sides are dislocated, the projection 
is greater, ability to close the mouth less, no devia- 
tion ; this is shown by the upper row of teeth 
corresponding in line with the lower. If, then, 
bilateral dislocation is not reduced immediately, 
these patients usually die in ten days with con- 
tinuous fever, stupor and coma ; for such is the 
influence of the muscles in this region. The bowels 
air affected, and there are scanty, undigested 
motions; if there is vomiting, it is of a similar nature. 
One sided dislocation is less harmful. Reduction is 
the same in both cases; the patient being either 

405 



MOXAIKON 

/ce(pa\rj<> ixo/xevov, irepiXa^ovra ra? yvddovs 
afxtyoTepas aiuborkpyai yepaiv eacoOev /cal e£a>0ev, 

20 rpia dfia jroirjcrar &aai e> bp6bv zeal e'<? tovtt'kjw} 
/cal (Tvayeiv rb cnopba. I'^o-t?" fxaXdy/xaai ical 
aXVP'dai /cal dvaXij-^rei yeveioV irotovai ravTa 1 

23 rfj e/xfioXf). 

V. 'O/zo? he eKiriTTTei Karoo' dWrj he oinro) 
rjtcovcra. ho/ceZ p,ev yap e? TovjiirpoaQev eKimr- 
reiv, &v al crdp/ce<; at irepl to dpBpov pep-ivvdi]- 
icaai hia rr/v <$>6Laiv, 2 olov /cal roZai fioval 
%et / u.a>i>o? (paiverai hia XeirTOTrjTa. /cal e/cminec 
fjbdWov Tolai he XeirroZaiv rj lo~x vo ^°~ lv rj ^r/polai 
teal roZaiv vypdcr/jiaTa Trepl ra dpdpa eypvaiv 
dvev (f)\ey/j,ovr)$' avrrj yap avvheZ' ol he /cal 
ftovcrlv e/j,/3d\\ovre^ /eat diroTrepovwvre'i e^a/nap- 

10 rdvovcri, /cal on hid rijv ^pT/o-t)', &)? XPV Tai /S0O9 
a/ceXei, \7jOd, /cal otl kolvov /cal dvOpcoirto ovtws 
eypvu to cr%7}yu,a tovto' to t€ 'OfitfpetoV /cal 
hiorc XeTTTOTarot /3oe<? r>]vitcavTa. oaa re rbv 
TTrjyyv tfKayiov dirb irXevpecov apavres 8pa>aiv, 
ov irdvv hvvavrai hpdv, olaiv av /jltj ifiirear). 
otttl p.ev ovv e/CTriTrrei fidXicrra, /cal go? kxovcriv, 
etprjfai. olai he e/c yeverjs, rd eyy vrara fidWov 
ftpaXyverai barea, olov ev tovtm ol yaXidy/coovev 
7r^%u? he rjaaov, X €L P ^ ^ Tl h°~°~ ov > ra & avcodev 

20 ovhev' /cal daapKorara eyyu<i' fiivvOei he fidXto-ra 



2 Littre's correction. <pi<riv MSS. would give sense, but 
the writer is evidently copying Joints I. 

1 The safety-pin was a very ancient instrument. Cf. 
Iliad XIV. 180. It is strange that there is no other mention 

406 



INSTRUMENTS OF REDUCTION, iv.-v. 

lying down or seated, his head fixed, take hold of 
both sides of the jaw with both hands, inside and 
out, and perform three actions at once — get it 
straight, thrust it back, and shut the mouth. Treat- 
ment : with emollients, position, and support of the 
chin ; these things co-operate in the reduction. 

V. The shoulder is dislocated downwards. I have 
no knowledge of any other direction. It appears 
indeed to be dislocated forwards in cases where the 
tissues about the joint have diminished through 
wasting disease, as one observes also with cattle in 
winter, because of their leanness. Dislocation occurs 
preferably in thin and slight subjects, or those of 
dry habit; also those who have the region of the 
joints charged with moisture without inflammation, 
for this braces them up. Those who use reductions 
and fixations with fibulae x in oxen are in error, and 
forget that the appearance is due to the way the ox 
uses its leg, and that this attitude is common also 
to man in the same condition — also the Homeric 
quotation, and the reason why oxen are very thin 
at that time. Actions requiring lateral elevation 
of the arm from the ribs are quite impossible for 
patients in whom the joint is not reduced. The 
subjects, then, most liable to dislocation, and their 
condition, have been described. In congenital cases, 
the proximal bones are shortened most, as is the 
case with the weasel-armed ; the forearm less than 
the arm, the hand still less, and parts above the 
lesion not at all ; the most fleshless parts are near 
the lesion. Atrophy occurs especially on the side 

of it in tlie Hippocratio surgical works. That it was then 
in surgical use for closing wounds seems indicated l>y Eur. 
Bacchae 97. 

407 



MOXAIKON 

ra evavria rcov bXtaOij/ndrcor, ical ra ev av^ijcrei, 
rjcrcrov Be nvi rcov etc yeverjs. ical ra TrapaTrvrj- 
fiara, ra Kar dpOpov J3a0ea, veoyeveai fidXicrra 
Trap cbp,ov yiverai, Kal rouroiaiv coenrep ra 
e^apdp/joavra rroiel. rjv Be rjvi;-T)/j,ivottTi, ra p.ev 
barea ov p,ewvrai, ouBe yap e%et y a\\a ov 
avvav^erai opinions, al Be pivv9>']crie<; rcov aapKcov. 
rovro yap na6' rjpbiprjv real av^erai /cal fieiovrai, 
/cal tca6 y i)\iKia<;. ical a, Bvvarai cryj)p,ara, icaX 

30 av arjp,elov rb irapa rb arcpcop,iov Kareo it aa pevov 
ical koiXov, Biori orav rb ciicptop,iov an oair aa 6 '/} 
teal koTKov y, oiovrai rov (Bpax^ova eK-rreirrcoKevai' 
KecpaXi) Be rov f3pa%iovos ev rrj p:aa^d\r} epalve- 
rai' aipeiv [yap] 1 ov Bvravrai, ovBe rrapdyeiv 
ev9a Kal ev9a 6p,clco<;' 6 erepo<; cop,o<i pL-qvvei. 
ipbftoXal Be- avrbs p,ev r?)v 7rvypLijv vrrb fiaa^uXrjv 
virodels rijv Ke<fia\r]i> dvcoQelv, rrjv Be %et/)a 
eirnrapdyew eVi to art}9o<;. aXXiy e? roviriaco 
ireptavay federal, go? dpLcpicrcfcaXf}. aWt]' icecpaXr) 

40 p,ev 7T/009 to dtcpoopLiov, %e/30"l Be inrb p,aaxdXrjv, 
tcecfiaXijv virdyeiv /3/3a^to^o?, yovvaeri Be dyiccova 
dircodelv, i) dvrl rcov yovvdrcov rov dyiccova rov 
erepov rrapdyeiv &)? to rrporepov' i) Kar wp.ov 
'i^eaOai, viroOels rfj p,ao-^d\rj rov cbp,ov' r\ rfj 
irrepvrj ivOevra eie7rXijpcop,ara rfj p,ao-y^d\r), Be^ifj 
Be^LoV rj rrepl vwepov r) rrepl icXipLaKrPjpa' i) 
rrepioBos crvv rco £v\co rco vrrb X e ^P a Teivopevco. 
h)cri<f rb ayj)pa, rrpcx; irkevprjtri fipax'uov, X €l P 
40S 



INSTRUMENTS OF REDUCTION, v. 

opposite to the dislocations, and when they occur 
during adolescence, but is somewhat less than in 
congenital cases. Deep suppurations at a joint occur 
in infants, especially at the shoulder, and have the 
same effect as dislocations. In adults there is no 
shortening, for there is no opportunity for one bone 
to have less growth than another ; but there is 
atrophy of the tissues ; for in the young there is 
increase and decrease, both daily and according to age. 
[Consider] too the effect of attitudes, and also what 
is indicated by the hollow at the point of the shoulder, 
due to avulsion ; for when the acromion is torn away 
and there is a hollow, people think the humerus has 
been dislocated. If so, the head of the humerus is 
found in the armpit, the patients cannot lift the 
arm, nor move it to either side equally ; x the other 
shoulder is an index. Modes of reduction : let the 
patient put his fist in the armpit, push up the head 
of the bone, and bring the arm to the chest. Another 
method : force the arm backwards, so as to make a 
movement of circumduction. Another : with the 
head against the point of the shoulder, and the 
hands under the armpit, lift the head of the humerus, 
and push back the elbow with the knees, or, instead 
of using the knees, let the assistant bring the elbow 
to the side, as above ; or suspend the patient on the 
shoulder, putting it under the armpit, or with the 
heel, putting plugs into the armpit, using the right 
heel lor the right shoulder, or on a pestle or ladder; 
or make a circular movement with the wood (lever) 
fixed under the arm. Treatment ; position ; arm to 

> Or, "as before." 

1 Omit. 

409 



MOXAIKON 

a/cpr) avo), w/jlos dva>' ovtcos eTrt'SeoT,?, dvdXr)yfri<;. 
50 rjv Be fir) efiirearj, ctKpcofiiov Trpoo-XeiTTVveTai. 

VI. Axpcofiiov aTrocnraaOkv, to fiev ethos 
(pawerat olov irep cofiov eKireaovTo*;, GTep'iGKeTai 
Be ovBeroi, e? Be to avrb ov KaOlaraTai. a^rjfia 
to avTO co *■ fcal eKirecrovTi, ev eTTiBtcrei /ecu clva- 

5 Xrjyfrer eTri$eo~i<; fcal a>9 v6p.o<>. 

VII. * Ay'ttcoyof dpOpov irapdXXa^av fiev 2 rj 
7T/309 irXevprjv rj e£co, fievovTos tov o£eo<i tov ev 
tco /cot \ fo tov fSpa^iovos, e? 19 v 3 KarareivovTa, 

4 tcl i^e^ovra dvcoOelv 4 ottlctco Kal e\ to irXdyiov. 

VIII. Td Be TeXeoos eicfidvTa. r) evOa rj evOa' 
/caTciTacTis fiev ev fj 6 /3pa)(Lcov 5 eirihelrai' 
ovtco yap to KafiirvXov rov dytccovos ov KcoXvcrei. 
efCTTLTnei Be fiuXiciTa e? to irpos irXevpea 6 fiepo<$. 
Ta? Be fcciTop@oocna<i, dirdyovTa oti irXeiaTov, &)<? 
fiij "tyavcrr) tt}? icopcovrjs r) KecpaXij, fieTecopov Be 
irepidyeiv teal Trepi/cci/nyfrai, fcal fir) e'<? Wv 7 
fSid^eaOai, cifia Be coOelv TavavTia ecf)' eKciTepa, 
Ka\ TcapcoOelv e<? y^coprjv. avi'cocfieXoir) S' av Kal 

10 eTTLCTTpc\\ri<; dyKcoi'OS ev tovtoictiv, ev tco fiev e\ 
to vtttlov, cv tco Be e'<? to Trpr/ves. ifif3oXrj Be' 8 
0"%r']p,aT0<; fiev oXiyov 9 dvcoTepco d/cprjv "^elpa 
ay/can>o<i 10 eveiv, (^pa^lova Be icaTa t«9 n -rrXevpciS' 
ovtco Be rj diulXij^jri^, 12 koX evepopov, Kal ^pPjais ev 
tco ico iv co, rjv dpa firj /ca/cco? ircopcoOf}' ircopovTai 
Be Tor^e'ft)?. t^crt?* 13 oQovLoicri KaTa tov vbfiov tov 

17 dpOpiTiKov, ical to ofjv TrpoaeiTiBelv. 

IX. UaXtyKOTcoTaTOV Be dyKcov 14 irvpeTolai, 

oBvvt], 1 ^ dcTtoBei, ciKprjTO^oXcp' dyKO)vo<; Be fidXiaTa 

ottIctcjo Bid to vapKcoBes, BevTepoi' to efiirpoadev. 

tr/crt? r) avTij' 16 ififSoXal Be tov fiev bulcjco ck- 

410 



INSTRUMENTS OF REDUCTION, v.-ix. 

ribs, hand elevated, shoulder elevated ; bandaging 
and support in this attitude. If not reduced, the 
point of the shoulder atrophies as well. 

VI. Avulsion of the acromion (process of the 
shoulder-blade), appears in form like a dislocation 
of the shoulder, but there is no loss of function ; 
yet it does not stay in place when reduced. Position 
as regards bandaging and support the same as in a 
case of dislocation ; the bandaging follows the 
customary rule. 

VII-XIX. Mochlicon VII-XIX corresponds verbally 
(except a few " various readings " such as occur in 
different MSS.) * with Joints XVL1-XXIX. Instead of 
repeating the translation, we may, therefore, attempt 
a few explanatory notes ; for dislocation of the elbow 
has always been an obscure subject, owing to the 
complicated form of the joint, and the presence of 
three bones. 

All the chief surgical commentators, Apollonius, 
Adams, Petrequin, agree that VII represents disloca- 
tion of the radius only, in directions which we call 
" forwards " and " backwards " ; though Galen says 
that Fractures XXXVIII, of which it is an epitome, 
refers to partial lateral dislocations of the ulna. 
" Diastasis " (X) can hardly mean anything else than 
dislocation of the radius in the other possible 
direction — outwards, or away from the ulna. 

1 These are given in the notes. 



1 


b. 


2 Add r) TtapapOpTioav. 




8 fvdb. 






t 


airu<6c7v. 


6 Add Karayds. 




6 irAeupas. 






7 


evdu. 


8 trtais 8 6 (so Kw, here) 




9 oAty-ii. 






10 


roil aynSivos. ll Omit tos. 


11 


Add Ka\ Oecrir 






13 


trjcis 6«. 


14 6 ayKwv. 
13 triais St airr). 


It 


oSwiiat. 


4 


I F 



MOXAIKON 

tsLvovtcl 1 xarcLTelvai. arjfielov he' ov yap hvvav- 
rai ifcrelveiv' rov he epbrrpoadev ov hvvavrai 
avyKapaneiv. tovtw he evOevra rt aKXrjpov 
avvei\iyp.evov, irepl touto crvy/cdp-^rat, e'£ eKTacno<; 

9 e^aicpv)]?. 

X. AmcrTtt<7409 he barecov arj/xelov Kara rrjv 
(f)\e/3a ttjv Kara rov /3pa%iova <7^i£b/xei>»;i> 

3 hca^ravovTi. 

XL Tavra he ra^ecot hiairatpovrai' e/c yeverjs 
hi, (3pa%VTtpa rd kutco Sarea rov eriVeo?, 2 
irXelarov ra eyyvrara 7r?;^eo?, hevrepov %eip6<$, 
rp'nov ha/crvXcov. j3pa)(lo}v he teal co/Lto? eyfepa- 
rearepa hid rijv rpo(p>]V' rj £' erepr] X ei P ^ L ^ T< * 
epya TrXetco eVt eyfcpaTearepi). pnvvOrjait he 
aapKwv, el p.ev e^w e^eireaev, ectw* 3 el he ft/], e? 

8 TOvvavTtov r) fj e^eneaev. 

XII. 4 ' ' Aytcoov he r)v fi-ev 5 eaco r) etja> e/cftrj, 
Kardraai^ fiev ev a^fiari eyya>VLq>, koivco tu> 
Trij^et 72730? /Spa^lova- /cai fxaa^dXrjv dvaXa/3a>v 6 
raivLj} dva/cpefidaai, dy/casvi he atcpta vTroQeis 7 
Tt irapd to apdpov ftdpo? eKKpe/xdaai, r) %epo"l 
/caTavay/cdaat. v r nepaiwpr\Qev , TO<i he rov apdpov, 
al irapaycoyal rolai devapcriv, <w? ra ev ^epaiv. 
eTTihecris ev tovtw T(p a^p.ari, /cat dvdXi]\jn<i real 

9 Beats. 

XIII. 8 Ta he OTTiaOev, e£ai<£>/'>79 eicTeivovra 

hiopdovv Tolai devapoiv" d/xa he hel ev rfj hiop- 

dcaaei, koX Tolatv erepctaiv. i]v he irpuadev, 

d/u.(f)l oOoviov avveiXiyfievov, evoyKOV, o~vy/cd/J,7T- 

5 rovra a/ma hiopdovadai. 9 



ZKTtLiavra. 2 rov alvtos oaria. 

8 <EffU)6tV. 



412 



INSTRUMENTS OF REDUCTION, ix.-xiil 

As regards complete dislocations, Littre and 
Adams refer those in VIII to lateral cases, and those 
in IX to dislocation forwards and backwards ; while 
Petrequin, turning the bend of the elbow inwards, 
takes the opposite view. The most frequent and 
mildest form of complete dislocation is that of the 
forearm backwards (or the humerus forwards), and 
the Hippocratic writers can only be got to agree 
with this by assuming the Petrequin attitude ; for 
they evidently describe this form as a dislocation of 
the humerus inwards (cf. Fract. XL, XLI). The 
dislocation " backwards " which specially affects the 
ulnar nerve would thus be our external lateral dislo- 
cation of the forearm. 

Still, the accounts remain obscure and often diffi- 
cult to accommodate with facts ; nor do we get 
much help from the existence of a sort of double 
epitome, XII and XIII repeating VIII and IX from 
a more practical standpoint, while XIV refers to the 
radius dislocations noticed above in VII and X. 

The account of wrist. dislocation (XVI, XVII) com- 
bines theoretic clearness with even greater practical 
obscurity. As Adams says, " in the wrist, nothing 
is more common than fracture, and nothing more 
rare than dislocation." Yet the epitomist gives us a 
neat schematic arrangement of dislocation in all four 
directions, and says nothing of fracture, unless we 
take "with the epiphysis" to imply this. The 
original account is lost ; but its essence is doubtless 
contained in Joints LXIV, on compound dislocations 
of the wrist. 

* Variant of VIII. 5 Omit juev. 
avahafiSvTa. 7 vir'jdtvra.. 

* Cf. IX 9 Stopdudf. 

4»3 



MOXAIKON 

XIV. 1 *Hv he erepo/cXives y, ev rf) hiopOcoaet 
apxporepa XPV iroielv T779 he p,e\eTrj<; 2 kolvov Kal 
to a^pua Kal rj €TTiheai<i' hvvarai yap 3 i/c t?/? 
4 hiaTaaios Koivf) avpLTTLiTTeiv iravra^ 

XV. Twv he ep,/3oXea)v al p,ev e£ inrepatwp^ato^ 
ip,{3dXXovTai, al he etc KaTardaios, al he Ik irepi- 
acpdXaios' avrai he e/c twv virep(3oXea>v twv 

4 crfflp-drcov rj rfj rj rrj avv tm Tayei. 

XVI. "Keipos he dpQpov oXiaOdvei r) haw rj e^w, 
haw he ra irkelara. ar)p,ela 6" euai]/ma' rjv p,ev 
haw, avjKcip,7rrecv oXw<; acfiwv 5 toi><? haKTvXovi 
ov hvvavraf rjv Be e£w, eK.7eLve.1v. ip,/3oXrj he' 
virep TpaTretyis rovs haKTvXovs eywv, tou? p,ev 
retvetv, tou$ he avrneiveiv' to he e£ex ov r) devapt 
t] Trrepvy dp,a dirwdeiv 6 irpoaw Kal KarwOev, 7 
Kara to erepov ocrreov ojkov re 8 pcaXOaKov viro- 
6eL<$, kyjv 9 p,ev dvw, KaTaarpetyas ri]v %eipa, i)v 

10 he kcltw, VTTTirjv. Lrjo~is, 10 bdovioiaiv. 

XVII. "OXrj he X ei P oXiaddvei rj eaw i) efjco, 
liaXitTTa oe e^w, rj evoa rj evua. ecrri 6 ore r) 
€Tri<pvai<; " eKivYjui] eart o ore to erepov twv 
oarewv hieaTrj. Tovroiai Kardraai^ layypr) ttoit}- 
rerj, Kal to p.ev e%e%pv dirwOelv, to he erepov 
dvTwdeiv, hvo elhea dp,a Kal e'9 Toviriaw Kal e? to 
TrXdyiov, r) yepolv eirl Tpairetyis i] TTTepvrj. iraXiy- 
KOTa he Kal do-%i)p,ova, tu> xrovw he Kparvverat 
€9 xprjatv. irjais, bOovloiai avv Trj X el P L /ca * T V 

10 /r>;^et' Kal vdpdr)Kas p-^XP 1, hciKTvXwv TiBevat' ev 
vdpOrj^i he Tede'vra 13 Tavra irvKvoTepov Xveiv r) to, 
12 KaTi'jjp.aTa, Kal Karaxvaei irXeovi xPV a @ al " 



1 Cf. VII. 2 Add tvs eepavetvs. 

8 Add Kal. * airavre.. 



414 



INSTRUMENTS OF REDUCTION, xiv.-xvn. 

Here the writer evidently describes dislocation of 
the bones of the forearm from the wrist ; while the 
epitomist (unless, with Littre and Petrequin, we 
put some strain on the Greek) speaks of dislocation 
of the hand, but follows Hippocrates in saying that 
" when the dislocation is inwards (our ' forwards '), 
they cannot flex the fingers, when outwards, they 
cannot extend them." 

This is the view of Celsus (VIII. 17), and is most 
in accordance with modern experience — when the 
hand is dislocated backwards, the flexor tendons are 
on the stretch and the fingers cannot be extended, 
and vice versa, though exceptions have been observed, 
and the accidents are too rare and complicated for 
the establishment of neat rules. The typical "dis- 
location" of the wrist is the fracture of the end of 
the radius, known as Colles's fracture. 

The brief account of congenital dislocation (XVIII) 
may have been added to complete the picture. The 
results described are those of all congenital disloca- 
tions, as frequently given in Joints. Perhaps, how- 
ever, " nothing can show more remarkably the 
attention which our author must have paid to the 
subject than his being acquainted with a case of such 
rarity " (Adams). 1 

1 Littre treats these subjects at length in his Introductions, 
and Petrequin at still greater length in his Notes and 
Excursus. They con linn the observation of Adams that a 
full discussion would lead to no conclusion, and would be 
tedious even to professional readers. 



6 Omit ohwi ff<pa>v. • Add k<A l<9e'ii>. 

7 Tt\>6iT(i3 icaToo, KaTuiOev. 8 Si. * J)v. 
10 h)ms U. ll % ivOa t) ti'Oa, /xaKitrra oe iau. 
12 Kat 7) £-nl<pv<riS. 13 {>. ihina. 

4iS 



MOXAIKON 

XVIII. E/c yeverjs he, {SpayyTepr\ ?/ %eto 7^" 
verai, /cal rj 1 ixivv6t](Ti<$ crapKwv p,dXio-Ta rdvav- 
Tia rj a)? 2 to e/cTTTcofia' 7]v^7)p.ev(p he ra oaTea 

4 fxevet. 

XIX. Aa/cri/Xov he dpdpov oXiaQov pcev evcrrj- 
fj,ov \ov hel ypd(f>ecv]. 3 epL/3oX?) he avrov rj8e' 4 
Karareivavra e? 10 v to ftev e^ey^ov cnrwOelv, to 
he ivavrlov dvTcodeiv. Li)cri<i he rj 7rpocr/]Kovaa, 5 
Total odovtoiai 6 e7rtoWt<?. 7 p.i) epLireaov yap eVt- 
Trcopovrai efjoodev. etc yevefjs he ?) ev av^i'/aet 
e^ap9py]aavra ra oared ftpayyveTai kutw s tov 
6Xia6ijp,aT0<i* /cat adptces fiivvflovcri rdvavTia 
pidXcara i) a><? 9 to e/C7TT(op,a' ijv^/xevcp he rd 

10 oarea p,evei. 

XX. Mijpov dpOpov eKiriirrei Kara rpoTrovs 
Teacrapas' ecra) TrXeiara, e£a> hevrepov, rd he dXXa 
o/iot&)9. ar/p,ela' kolvov p,ev to erepov a/ceXos' 
thiov he tov p,ev eaeo. irapa tov irepivaiov 10 yjrave- 
rai y) /cecpaXi]' avyKaparTovai ov% o/iotw?, ho- 
Kel he pLctfcporepov n to crKeXos, /cat rroXv, r\v /a?) 
e<> puecrov dp,(poT€pa dycov TrapaTelvrj^' /cal yap ovv 
kijco 6 7T0U? Kal to yovv perrei. r)v pbev ovv i/c 
yever)^ i) ev av^/jaei i/cirea?}, fipayvTepos 6 p,r)po<;, 

10 rjaaov he Kv^pui], Kara Xoyov he TaXXa' pivvOovai 
he o-dp/ces, pudXioTa he k^co. ovtol /caTotcveovaiv 
opBovoQai, /cal elXeovrai eVt to vyies' rjv he dvay- 
Ka^covTai, o-Kip,Trovi evl rj hvalv ohonropeovo-i,, 
to he o-/ceXo<; aipovariv 6a<p yap p,eiov, Toaco 
pauv. t)v he i]v£>ipLevoio~i, ra p,ev barea pLevei, ai 

1 Omit t). s fj ft. s Omit ('■ probably a gloss." Kw.). 
4 Omit avrov !}5e. 6 Oinitij irpocn')Kou<ra. 

416 



INSTRUMENTS OF REDUCTION, xvm.-xx. 

The problem of the knee (XXVI) seems insoluble. 
All writers, from the author of Mochlicon to Ambroise 
Pare, copy the statement of Hippocrates (Fract. 
XXXVII) that dislocation is frequent and of slight 
severity. We know that it is rare and requires 
great violence which usually has serious results. 
Suggestions such as confusion with ". internal de- 
rangement," or displacement of the knee-cap, seem 
unsatisfactory. The existence of some peculiar 
grip in wrestling which dislocated the knee without 
further injury seems the most probable explanation. 
One of the modern causes — being dragged in the 
stirrup by a runaway horse — was absent in antiquity. 

XX. The thigh-joint is dislocated in four ways, 
most frequently inwards, secondly outwards, in the 
other directions equally. Symptoms : in general, 
comparison with the other leg. Peculiar to internal 
dislocation : the head of the thigh-bone is felt 
towards the perineum ; they do not flex the thigh 
as on the other side ; the leg appears longer, especi- 
ally if you do not bring both legs to the middle line 
for comparison, for the foot and knee incline out- 
wards. If then the dislocation is congenital, or 
occurs during adolescence, the thigh is shortened, 
the lower leg less so, and the rest in proportion. 
There is atrophy of the tissues, especially on the 
outer side. These patients shrink from standing 
erect, and wriggle along on the sound leg. If they 
have to stand up, they walk with a crutch or two, 
and keep the leg up, which they do more easily the 
smaller it is. In adults the bones are unaltered, but 

8 rawlmcri odovioioi. ' Omit eirlSecris. 

8 TO ICOLTdl. * /loAltTTO, ^ j;. 



10 irt/iviov. ll vo\v /j.aKf>6Tff)oy. 

VOL. III. I 



417 



MOXAIKON 

Be crdptce<; pnvvO overt, ro? nrpoeiprirai. 6801- 
Tcopeovat Be TT6pi(TTpO($>dhr)v, &>? /3oe?, iv Be 
tcevewvi 1 tcapirvkoi, itrl to vyies ifyo-y^ioi iovT€<i' 
to> p,ev yap dvdytci] viro(3aiveiv &>? c>XV> T0 2 ^ 

20 dirofialveiv (ov yap Bvvarat o^etV), wcrirep oi iv 
ttoBI eAvecx? e^0VT€<i. Kara Be to vyies, rrXdytov 3 
£v\(p too croopaTi dvTiKOVTOvai, to Be aivapov tjj 
X ei P L vTrep tov yovaTos tcaTavaytcd^ovai co? o^elv 
iv ttj p,eTa/3daet, to crcop.a' lo-%irp tcaTtodev 4 el 
XprjTai, KaTwOev 5 rjcrcrov puvvOei teal ia boTea, 

26 pdWov Be a dp ices. 

AAl. lov be ego) TavavTta tcai Ta cn]peia tcai 
al o-Tdaies' /cal to yovv teal 71-01/? e£co peirei 
(Spa^y. Tolav Be iv avfjijaei rj e'/c yever)<; iraQovoiv 
ov% opoLcos avvav^eTat 6 /caTa tov avTov Xoyov' 
laytov dvcoTepco tivv, ov^ opuoiax;. olai Be irvteiva 
eKirliTTei e\ to e^co dvev <p\eyp,ovr)$, vypoTepcp tw 
atceXei xpcoinai, wemep 6 peyas Tr)<; ^e//oo? 
8dtcTv\o<;' p,d\i<TTa Be outo? itcTUTTTei cpvcrei' ot? 
p,ev eKiriTTTei pdWov ?} fjcrcroi', koX 049 fiev iteij'iix- 

10 Tei xaXeTTWTepov rj prjiov, koX olaiv ekirl<; ddaaov 
ipireaelv, real olaiv ovtc dter/ tovtov, teal olcri 
TroWd/cis itcTrnnei, "rjai^ tovtov. etc yei'efjs Be rj 
etr av^r]aei rj iv vovaw (pdXiaTa yap eV vovaov) 
ecu pev [ovv] 7 olaiv i-niafyaKeXL^ei to oaTeov, 
aTap teal olai pi), 7rda)(ei pev irdvTa, rjaaov Be r) 
to herd), rjv ^p?;cttco9 677 1 peXrjB ] wa iv , cogtc teal o\o) 
fiaivovTas tu> ttoBI BiappijrTetv' Bid peXeTrjs 

1 rif KiveSivi. * t$. Tr\dytoi. 

* 'ktx'iw KarwTepO). 6 kcxtoi re. 

6 K\v. puts colon after <rwav£tTcu. 7 Omit. 

1 Cf. /. LIV. 
418 



INSTRUMENTS OF REDUCTION, xx.-xxi. 

there is atrophy of the tissues in the way described. 
They walk with shambling gait, like oxen, bent in at 
the loin and projecting at the hip on the sound side ; 
for they have to bring the leg under to serve as sup- 
port, and keep the other leg out (for it cannot give 
support), like people with a wound on the foot. On 
the sound side they use a staff as a lateral prop, and 
press down the injured limb with the hand above 
the knee, so as to support the body in the change of 
step. If the part below the hip is used, there is less 
atrophy of the bones (below). It occurs more in the 
tissues. 

XXI. In outward dislocation, both symptoms and 
attitudes are the reverse. Knee and foot incline 
slightly inwards. In adolescent or congenital 
patients there is inequality of growth, in the same 
proportion (as with inward dislocation). Hip some- 
what elevated, not corresponding. 1 Those in whom 
outward dislocation is frequent without inHammation 
have the limb more charged with humours, as is the 
case with the thumb ; for this is by its nature most 
liable to dislocation. In some the dislocation is 
more or less complete ; in some it takes place with 
more or less difficulty; in some there is hope of 
speedy reduction : in some there is no cure for the 
condition ; in cases of frequent dislocation there is a 
treatment. In congenital and adolescent cases, and 
those due to disease (for disease is the principal 
<:ause), in some cases there is necrosis of bone, but in 
others not. They have all the affections above 
mentioned, but to a less degree than those with 
internal dislocation, if they are well cared for, so as 
to balance themselves and walk on the whole foot. 
The youngest require the greatest care. Left to 

419 



MOXAIKON 

7r\eto"T7?9 Tolcrivi]7no)TdTOiaiV eaOevTci Ka/covrat, 
e7rip,e\r)0evTa Be docpeXeiTar Totaiv okocatv, r/aaov 
20 Be Tt, fAivvdovai. 

XXII. Olcri B' av cijx^orepa ovtcos e/cirea-r], twv 
6crrea>v ravra TraO^fxara' evaapicoi pcev, rrrXrjV 
ecrcodev, i^e^eyXovroi, poi/col fitjpoi, rjv /i?; eTricrcpa- 
/ceXicrr/. el rcvcpol ra dvcodev IcryLwv yevoivTO, vytrj- 

5 pol puev, avav^ees Be to acop,a, irXrjv KecpaXr/s. 

XXIII. Ola Be oiriaOev, o~)]p,eia' epbirpocrdev 
\airapd>Tepov, oiriaQev £%ex ov > 7rov ^ opOos' avy- 
Ka,/j.7TTeiv ov BvvavTai, el p,r/ pier 6Bvvi)<$,eKTeLveiv 
rjtcLGTa" TovTOiai cr/ce'Xo? fipayvTepov. arap ovh^ 
etcravveiv BvvavTai /car lyvvrjv i) 1 Kara /Bov/Scova, 
rjv pur) iravv alpwaiv, ov&e avytcdfATneiv. rjyelrai 
ev toIgi TrXeiaroiai ro dvco dpOpov to Trpcorov' 
koivov tovto apOpoicri, vevpotai, p.vcnv, evrepoiaiv, 
iHTTeprjaiv, aWoiaiv tovtois tov la^iov to 

10 ocneov Karacpeperai et? tov yXovToV Bid tovto 
/3/oa^y, zeal oti eicTelveiv ov BvvavTai. crdpiees 
iravTO^ tov o~Ke\eo<; ev irdai pnvvOovaiv' i(p' olai 
Be p,d\io~Ta, real ol, 2 etprjTcu' Ta epya Ta ewvTov 
e/cao~Tov tov atopLaTOS epya^opevov p,ev tayyei, 
dpyeov Be /ca/covTai, 7r\t)v kottov, irvpeTov, (pXey- 
p:ovfj<;. zeal to e^u>, oti e<? crdpfca virelicovaav, 
/3pa^vTepov' to Be eoa>, oti eV 6o~Teov irpoeypv, 
piaKpoTepov. rjv p,ev ovv rjv^rjpLevotai /.ir] epureat], 
eVt /3of/3cocrt Kap.7rv\oi oBonropeovai, ical r) eTeprj 

1 ^ = " and not " (cf. Surg. XIV) ; but Kw. reads <^> 
fill, from J. LVII. 

2 I.e. "to what extent" (?) ; but Kw. (M) has fi 

1 Hardly intelligible without reference to J. LVII. 
420 



INSTRUMENTS OF REDUCTION, xxi.-xxm. 

itself, the lesion gets worse ; if cared for, it improves. 
There is atrophy of all the parts, but somewhat less 
(than in dislocation inwards). 

XXII. When both hips are thus dislocated, the 
bones are similarly affected. The patients have 
well-nourished tissues, except on the outer side ; 
they have prominent buttocks, and arched thighs, 
unless there is also necrosis of the bone. If they 
become hump-backed above the hips, they retain 
health ; but the body ceases to grow, except the 
head. 

XXIII. Symptoms of posterior dislocation: an- 
terior region rather hollow, posterior projecting, foot 
straight ; they cannot flex the thigh without pain, 
nor extend it at all ; the limb is shorter in these 
cases. Note also that people cannot do extension at 
the knee and not at the groin unless they lift it 
quite high, nor can they flex. 1 In most cases the 
proximal joint takes precedence (in function) ; this 
applies to the joints, ligaments, muscles, intestines, 
uterus, and other organs. 2 In these dislocations, 
the hip-bone is carried to the buttock, which causes 
the shortening and inability to extend the joint. 
In all cases there is atrophy of the tissues through- 
out the leg ; in which cases tin's occurs most, and 
where, has been explained. Each part of the body 
which performs its proper function gets strong ; but 
when idle, it deteriorates, unless the inaction is due 
to fatigue, fever, or inflammation. External dis- 
location, because it is into yielding tissue, produces 
shortening : internal, because it is on to projecting 
bone, lengthening. If then it is unreduced in 
adults, they walk in a bent attitude at the groins, 

* I.e. movements, including contractions, start from above. 

421 



MOXAIKON 

20 lyvvrj /cdfiTTTeTCU' arijOeat poXis 1 KaOtKveirai' 2 
%etpl T0 GKeXos Kara\a/m/3dvei, dvev %v\ov, rjv 
edeXwaiv r/v ptev yap ptaKpbrepov tj, ov firjaerai' 
rjv Be ftaivrj, /3pa%v. p,ivv0>]ai<; Be aapKwv, olai 
irovoi, Kal f) t^i? eprrpoadev, Kal rS> vyiei Kara 
\6yov' olai Be etc yever/<; i) av^opevoiat r) virb 
vovaov evoa^ae teal e^apOpa eyevero (ev al$, 
elprjaerai), ovtoi pdXiara KaKovvrat Bid rrjv rwv 
vevpoiv Kal dpOpwv dpytr/v' teal to ybvv Bid rd 
elpij/xeva avyKaKovvrat. avyKexappevov ovtoi 

30 e^ovTe? bBotrropeovaiv errl £v\ov, evbs r) Bvo' to 

31 Be vyies, evaap/cov Bid ^pfjaiv- 

XXIV. Olai e? rovpirpoadev, arjpeia rdvav- 
ria- oiriadev Xairapbv, epirpoadev el^eyov' rJKtara 
avyKapirrovaiv ovtoi to ov<:eA,o<?, pdXtara Be 
eKreivovai' bpObs irov<i, (7/ceXo? taov, irrepva' 
/3pa%ei atcpax; dvearaXrai. [?}] 3 iroveovat pd\i- 
o~ra ovtoi avTi/ca, Kal ovpov 'lateral ptdXiara ev 
rovroiai Tola iv el^apQ pr)p*aaiv' ev yap rbvoiaiv 
eyxeirai roiatv eiriKatpoiaiv. Ta epnrpoaOev 
Kararerarai [dvav^ea, voacoBea, raxvyrjpa]'* rd 
10 SiriaOev aro\iBcoBee<;' olaiv r/v^r/fievotaiv, oBonro- 
peovai opdol, irrepvr) ptdWov fiaivovres' el Be 
rjBvvavTO pteya irpofiaiveiv, Kav irdvv' avpovai Be. 
pttvvdei Be rjKiara, rovroiai Be r/ ^pyjaiq atria" 
ptdXiara Be oiriadev' Bia iravrbs rov aiceXeos, 
bpObrepoi rov pterptov, %v\ov Beovrai Kara to 

1 fi6yis. 

2 Kiveirai codd. ; iKveirai Littre. 

8 Kw. deletes. Perhaps ^ emphatic. 

4 Words from J. LVIII referring to effects of disuse, 
evidently out of place here. 

422 



INSTRUMENTS OF REDUCTION, xxm.-xxiv. 

and the sound knee is flexed. The ball of the foot 
barely reaches the ground ; they hold the leg with 
the hand if they choose to walk without a crutch. 
A crutch for walking should be short ; if too long, 
he will not use the foot. There is wasting of the 
flesh in painful cases 1 down the front, and on the 
sound side in proportion. In congenital and adoles- 
cent patients, or where the dislocation follows disease 
(what the diseases are will be explained), these cases 
especially go to the bad through disuse of the sinews 
and joints ; and the knee shares in the deterioration, 
for the reasons given. They walk with the leg 
flexed, on one or two crutches ; but the sound limb 
is well nourished, because it is used. 

XXIV. In cases of dislocation forwards the 
symptoms are reversed ; hind region depressed, 
front projecting. These patients are least able to 
flex the leg, but have most power to extend it. The 
foot is straight, and the leg equal to the other, if 
measured to the heel ; the foot is a little drawn 
up at the tip. Now these patients suffer especially 
at first, and there is a special liability to retention of 
urine in these dislocations ; for the bone lies upon 
cords of vital importance. The parts in front are 
stretched [cease to grow, and are liable to disease and 
premature age] ; the hinder parts are wrinkled. In the 
case of adults, they walk erect, chiefly on the heel, and, 
if they could take long strides, would do so entirely ; 
but they drag the leg. There is very little atrophy 
in these cases on account of the exercise, and it is 
chiefly in the hinder parts. Because the whole leg 
is straighter than it should be, they require a crutch 

1 Pq. renders "in those who exercise the limb ** (!) ; surely 
the sense is, " where it is too painful to use." 

423 



MOXAIKON 

aivapbv. olcri he e/c yeverjs i) av^ofievoiai, xprj- 
ctco? fiev e7ri/jLe\i]6el(riv r) ^prjcri*;, wairep idiaiv 
rjv^Tjfievoicriv' dp,e\rjOetai he /3pa%v, e/creTapbevov' 
Trcopovrai x jap rovroiai, pudXicna he e'9 Wv to, 

20 dpdpa' at he rwv ocrrecov fieiGoaies /cal at rcov 

21 aap/caw fuvv6?)crie<i Kara \byov. 

XXV. Wiiipov he KCLTaracns p.ev loyvpr)' kcu 
r) hiopOwais koivy], rj xepalv rj aaviht i) /xo)(Xa), 
ra fiev e<ra> arpoyyvXw, ra he e£co irXarel, 
pbdXicrra he rd k^co. /ecu ra piev eaco aa/colaiv 
aKeadp,evov €9 to virb^pov rov purjpov, iccna- 
rdcrio? he Kal avvheatos cr/ceXecov' Kpeficicrai 
hiaXeirrovra apwepov tou<? Trohas, eTzeira irXe^avra 
€KKpepLaaOi)vaL riva, ev rfj hiopOcoaei dpucporepa 
dpua Troievvra. Kal ra> epbirpoaOev rovro t/cavbv 

10 kcu roicriv erepoicrtv, iJKtcrra he r& k^co. r) rov 
£vXov UTroo-Taais, 2 (aairep w/iw, vtto rr)v ^eipa, 
ol<s eaco' roiac yap aXXoiaiv rjacrov Karavay- 
Kdaeis he puerd hiardenos, pudXicrra t5>v 
epLTrpoaOev i] omoQev, rj irohl i) X ei P t €(pi^€(Tdai 

15 rj aavihi. 

XXVI. Tow he ew]6iarepov dy/ccovos hid rr)v 
evcrraXirjv /cal evcpvi7]v, hio /cal eKirnrTei, Kal 
ip,7riTTT€i paov. i/cTTLTTTei he 7r\eiard/ci<i eaco, 
drap /cal e^co /cal oirtaOev. ipi{3oXal he' rj e/c 
rov o~vy/c€/cdp,(f)0ai, i) e/c\a/cTLcrai 6£ea)9, 77 avve- 
Xt^a? raivirj^ oy/cov, ev lyvvrj 6ei<;, dp,<bl rovrov 
ii;al(f)vr}<i 69 b/cXacriv dcpelvai ro aosfia, [p,d\to-ra 



1 Trr\povTai, perhaps the correct reading, as in/. LX. Foes, 
Littre\ Kw. 

2 virSraois. 
424 



INSTRUMENTS OF REDUCTION, xxiv.-xxvi. 

on the injured side. In congenital and adolescent 
cases, if exercise is well managed, they get on like 
adults ; but in neglected patients, the leg is short 
and extended. Ankylosis occurs in these cases, 
with the joints usually in an extended position. The 
shortening of the bones and atrophy of the tissues 
are according to rule. 

XXV. For the thigh strong extension is required, 
and the adjustment in all cases is with the hands or 
a board or lever, rounded for internal, flat for ex- 
ternal dislocations. The external cases want it most. 
As to internal cases, there is a treatment with bags 
to the tapering part of the thigh, with extension 
and binding together of the legs. Suspend the 
patient with his legs slightly parted ; then let some- 
one be suspended from him, twisting [his arms 
between the patient's legs], 1 performing both acts 
of adjustment at once (extension and leverage out- 
wards). This suffices in anterior dislocation and the 
rest, but is no good in the external form. The plan 
with wood beneath the limb, as under the arm in 
shoulder dislocation, suits internal cases, but is not 
so good in the others ; you will succeed in reducing 
anterior and posterior cases especially by double ex- 
tension, using foot or hand or a plank to make 
pressure from above. 

XX VT-XXXI. In these chapters we have an epi- 
tome of an obscure subject already given verbally 
(with a few various readings) in Joints LXXXII- 
LXXXVII. Instead of repeating the English ver- 
sion, we may therefore attempt some explanation of 
the difficulties. 2 The chief of these are : — Why is 
there no mention of the astragalus in ankle dis- 

1 Cf. .7. LXX. 2 For note on § XXVI, see p. 417. 

425 



MOXAIKON 

ev tt) to)v owiadev] 1 Buvarai Be kcu Kara- 

retvofxeva /xerpMos, wcrirep ay/coov, epLTriiTTeiv ra 

10 OTriaSeV ra Be kvOa i) evda, €k rov avyKeKafitfrOai 

r) i/cXa/crurai i) [eV] Karaiaaei, [/ndXiara Be auTt) 2, 

to OTTiadev]. arap Kal i/c KaTardcrios p,€rpirjs, r) 

BiopOcocris diraai KOivrj. rjv Be /aij ifiTreaij, rotai 

fxev OTTHToev av<yK(ifiTTT€LV ou hvvavrai, arap ovBe 

roloiv dXXoiaiv irdvv Tt. fxivvBei Be firjpov Kal 

KV7]/uLri<; to efiirpocrOev. r)v Be e? to eaco, ftXai- 

aorepoi, yavvuei oe ra e£&r r)v oe e? to e£<w, 

yavaorepoi, ^coXol Be r)aaov Kara yap to 

irayvrepov bareov b%el' /xivvOei Be to, eaco. e« 

20 yeverjt; Be rj ev av^qcrei, KaraXoyovTOv ep,ir poaOev. 

XXVII. Ta Be Kara, acfovpa KaTaTaatof la- 

X V P^ BeiTai, i) rfjcri ^epalv rj aXXoicri toiovtoioi, 

KaropOdxTios Be dfxa dp,<$>oTepa Troievo")]*;' koivov 

4 Be iraaiv. 

1 XXVIII. Ta. Be ev ttoBl, ax? ra ev yeip'i, vytrj. 
AA1A. la oe ev tt) KVtjfirj avy/coiveoveovTa 
Kal p,r) ip-ireaovTa, e/c yeverjt Kal ev av^rjaei 
3 e^apdpijaavra, Tavrd a Kal ev yeipi. 

XXX. "Oaoi Be ir7]B7)aavT€<i dvcoOev eaTTj- 
pi^avTO tt) Trrepvrj, ware BiaaTrjvat to, oarea Kal 
<£A,e/3a? eK^ypbw6?]vai Kal vevpa djucpicfyXaaOfjvai, 
OTav yevrjTat, ola Ta BeivoTara, kivBvvo<; p,ev 
acpaKeXlcravTa tov alwva Trptjy/xaTa irapao-^elv' 
Kal poiKooBt] 3 /nev tcl oarea, to, Be vevpa dX- 
XrjXoiGi KOLvwveovTa. eirel Kal otaiv dv Karea- 
yeloiv rj vtto rpcop-aro*;, ola ev Kvrjfir), rj iiripfo, 
vevpcov airoXvOevTcov a KOivcovel Touroiaiv, i) i£ 
10 aXXrjs KaTaKXio~io<; dfieXeos e/xeXdvOri 4 r) irrepvr), 
Kal Touroiai iraXiyKOTa €K toiovt<ov. eaTCv 6t€ 
426 



INSTRUMENTS OF REDUCTION, xxvi.-xxx. 

locations ? and, What is meant by the epiphysis of 
the foot and leg ? 

We are told (Frnct. XII, Mochl. I) that the leg- 
bones towards the foot have "a common epiphysis" 
against which (vrpos r/v) the foot moves. The bones 
may be dislocated with the epiphysis, or the epiphy- 
sis only may be displaced (Fract. XIII). In the 
epitome, however, the epiphysis is considered part 
of the foot, which may be dislocated either with or 
without it. Littre discusses the subject at great 
length, 1 and concludes, somewhat doubtfully, that 
the epiphysis is " la reunion des deux malleoles 
considerees comme une seule piece." Its dislocation 
is the separation of the two bones. But Hippocrates 
has a special word for each of these, cru/x^uas for the 
union and Siacn-ao-19 for the separation ; and he uses 
neither here. Adams, 2 following a suggestion by 
Gardeil, confines the term to the lower end of the 
fibula ; dislocation of the epiphysis is fracture or 
displacement of the fibula. He admits, however, 
that a full discussion would be futile and tedious 
even to the professional reader. The chief argu- 
ment in favour of this view is that fracture of the 
lower end of the fibula frequently accompanies 
ankle dislocation. On the other hand Fract. XIII 
seems to distinguish clearly between the epiphysis 
and either of the leg-bones. 

A third view, hardly bolder than that of Adams, 

1 in. 303 ff. ; iv. 45 ff. Petrequin agrees with Littre\ 

2 11. 522, also 5(14. 



1 J. LXX.XII .units here and below. * avrij. 



4*7 



MOXAIKON 

7T/DO? a<$>aKe\iap,$) yivovrai Trvperol vrrepb^ees, 
\vyyu>hee<$, rpopuaSees, yvcofir]^ dirroptevoi, tayy- 
Odvaroi, Kal eVt <fiXe/3a)v aiptop'powv ireXiooates Kal 
yayypaivd>ates. arj/neta twv iraXcyKOTrjaavTcov 
rjv rd eKyypud)p.aTa Kal ra pte\dap,ara teal ra 
rrepl ravTO. vTToaKXripa Kal virepudpa r)' rjv yap 
avv aKXripvaptari ireXiwOfj, Kivhvvos pteXavdfjvai' 
rjv he vTroireXta y, /cal rreXtd ptd\a ical Keyypteva, 1 

20 rj vTroyXcopa Kal ptaXOaKa, iavra iv a nraai rolat 
roiovroiaiv ayaOd. hi a is he' rjv ptev dirvperoL 
ecoaiv, eXXeftopt^etv' 3 rjv he ptr], ptij' dXXa tcotov 
hthbvat btjvyXv/cv, el heoi. eiriheais he r) dpOpcov 
avvdeais' en he 4 irdvra ptdXXov rolai <p\da- 
ptaar Kal bOovioiai irXeoai /cat p,a\9aKu>repotai 
yprjadai' irie^is rjaaov' vhwp rrXeov' 5 it poairept- 
fidXXeiv ra, TrXetara rfj Tnepvr)' to ayrjp.a oirep 
r) eTriheats, d>s ptij is Trjv 7rrepvr]v diroTue^riTai' 
dvcoTepu) yovvaros earco evOeros' vdpdrj^i pirj 

30 xp}]craa@ai. 6 

XXXI. "Orav he iiccnfi 6 ttovs, rj ptovvos 7 r) 
avv rfj eTTKpuaei, eKTr'nrrei p,d\\ov es to eaco' el s 
he ptr) epLTrear), XeirrvveTai dvd y^pbvov layiov Kal 
pbijpov Kal KV)jptr/s to avriov too bXiaO ))paro<i. 
ep,f3oX?j, d>s r) Kap-nov, Kardraats he tayvporeprj. 
trials, voptos dpBpwv' iraXtyKOTet rjaaov Kapnov, 
rjv rjav^dar). hiana pieimv, eXivvovai yap. rd 
he eK yeverjs ptev r) ev av^rjcret, Kara \oyov rbv 

9 irporepov. 

XXXII. 'E7rel rd aptiKpbv wXiaOr/Kora ck 
yeverjs, evia old re hiopdovaOat. ptdXtara he 

s a-nvpeTos ff, eWt&opov. 
428 



INSTRUMENTS OF REDUCTION, xxx.-xxxn. 

is that the epiphysis is our astragalus, looked upon 
either as an annex to the leg-bones or an epiphysis 
of the foot. This would explain much, e.g., the 
fact that Hippocrates speaks of dislocation of the 
leg from the foot {Fract. XIII, Joints LIII, LXIII); 
for, with the astragalus, the leg-bones would have 
a convex end ; so too the foot is said to move on 
(71-pos) not in this joint. VVe may also note that 
the epitomist, taking the epiphysis as part of the 
foot, adopts the modern view, dislocating the foot 
from the leg, yet retains the language of his original 
{Fract. XIV) in saying that the commonest disloca- 
tion is inwards. The commonest dislocation is that 
of the leg inwards and the foot outwards, so we can 
only make him correct by a bold translation such 
as that of Gardeil, who renders 6 ttovs (.Kiti-mii /xaAAov 
cs to eo-a>, " la partie superieure de l'astragale se 
place communement en dedans." 

The other Hippocratic account of the ankle-joint 
(Loc. Horn. VI) says, "towards the foot the leg has 
a joint at the ankles and another below the ankles." 
The put between is the astragalus; and it is left 
doubtful whether this belongs to the foot or the 
leg.i 

XXXII. Among slight congenital dislocations, 
some can be put straight, and especially club-foot. 2 

1 So, too, in Jointn LIII, we hear of a "bone of the leg at 
the ankle" which seems distinct from the leg-bones proper, 
and more closely connected with those of the foot. 

2 An almost ludicrous epitome of J. LXII. 

' iniSfcrts 5f, dtpfyaip avi/Sfffis' iiriZtlv K.W. 
6 Omit. « xP'iaO*'- 

' ainbs. ' %v. 

429 



MOXAIKON 

rroBbs KvWwcris' Kv\\a>(Jio<i yap oi>x els earl 
T/907TO?. rj Be irjaif rovrov, KrjporrXaarelv' 
K7]pcoTT) prjrivdiBrj?, 1 bObvia av%vd, rj ireXpa rj 
p,o\v(3Biov irpoaernBelv, p,-q XP WTl ' dvd\7]yjri<i, rd 
7 re cr^para opoXoyeirco. 

XXXIII. "Hy Be e^apOpijaavra eX/cos rroir)- 
adp,eva el;i'0'X!l> £<*>peva dp,eivw, ware Bi) p/rj 
diraicopeladai p-t)B aTTavaytcd^eaOai. trjalk Be' 
TTiaaripf) rj arrX/jveaiv olvrjpolai 8epp,olaiv — drtaai 
<ydp TOVTOiai to yjrv){pbv kcikov — Kal (pvXXoiaiv' 
VjSifiQtyos Be, eipioiai pepvnwpLevoiai ri)<i cncein]*; 
e'lveica' p,rj xarairXdaaecv, //.?;&' eiriBeiv' Biaira 
Xerrri)' yfrv^of, dx@o<; iroXv, rrie^i^, dvdy/cr], 
0"%?7 paros ranis' elBevat pev ovv ravra rrdvra 

10 6Xe0pia. pierpiws Be depcnrevOevres, ^&>Aot 
alcrXpws' rjv <ydp irapd rrbBas yevrjrai, ttovs 
dvaa-rrdrai, Kal ?]v tttj dXXrj, Kara Xoyov. barea 
ov pdXa d^iararat' pLiKpd yap \jriXovrai, rrepiw- 
reiXourai XeTrrws. rovrcov rd peytara kivBvvw- 
Bea-rara, ical ra avwrdror. eXirls Be p,ovvr) 
<Ta>Ti]pLT)<i, eav prj epfidXXr/, ttXtjv ra /card 
Ba/crvXovs real X e ^P a ^ K P 7 > V ' ravra Be rrpoenrera) 2 
TOU9 KivBvvovs. eyx^tpeiv ep,/3dXXeiv rj rfj rrpwrr) 
rj rfj Bevreprj, rjv Be pr'j, 777209 rd Befca' rJKiara 

20 reraprala. epftoXr] Be, 01 poxXiaKOi. ltjctk; Be, 
a>9 Ke(j>a\rj<; barecov, /cal deppr]' eXXeftopco Be Kal 
avTL/ca erreira 3 rolaiv epfiaXXopevoiai fieXnov 
ypr)a"#at. rd B' aXXa ev elBevai Bel on ep,f3aX- 
~Xop,eva)P OdvaroV ra peytara Kal ra avoordrco 

* KTypcurfj prjTtvuodei. * Tcpoet 

43° 



INSTRUMENTS OF REDUCTION, xxxn.-xxxin. 

Now there is more than one kind of club-foot. 
Here is the treatment of it : moulding, resined 
cerate, plenty of bandages, a sandal or sheet of lead 
bound in with the bandaging, not directly on the 
flesh ; let the slinging up and attitude of the foot be 
in accordance. 

XXXIII. If dislocated bones make a wound and 
project, they are best let alone, seeing, of course, 
that they are not left unsupported or subject to 
violence. Treatment with pitch cerate, or com- 
presses soaked in warm wine (for cold is bad in all 
these cases), also leaves, and, in winter, crude wool 
as a protection ; do not use a plaster application or 
bandaging ; low diet ; cold, heavy weight, constric- 
tion, violence, a forcibly ordered attitude — bear in 
mind that all these are pernicious. Suitably treated, 
they survive badly maimed ; for if the lesion is 
near the foot, the foot is drawn up ; and if anywhere 
else, there is a corresponding deformity. Bones do 
not usually come away, for only small surfaces are 
denuded, and a thin scar forms. In these cases 
there is greatest danger with the largest and 
proximal joints. The only hope of safety is not to 
reduce them, except the fingers and bones of the 
hand. In these cases let the surgeon explain the 
risks beforehand. Perform reduction on the first or 
second day; failing that, about the tenth; by no 
means on the fourth. Reduction : the small levers. 
Treatment: as for bones of the head; warmth; it 
is rather a good thing to give a dose of hellebore 
to the patients immediately after reduction. As to 
other bones, one must bear well in mind that 
their reduction means death, the quicker and more 
certain the larger and higher up they are. In the 

43 1 



MOXAIKON 

fidXtara icai Tcl^tara. ttovs he eicfias, <nraap,os, 
ydyypaiva' fcal yap r)v ifi/3\i]0evTi iiriyevr\Tal n 
tovtwv. eicfiaWovTi ekirLS, el Tt? apa e'A.7n,9' ov 
yap utto tcov ^aXcovrcov ol cnraapLOt, dXX diro 
29 Tcov ivreivovrcov. 

XXXIV. At he uTTOKOTrai rj iv ap0p<p r) Kara 
rd barea, p,r) dvco, aXA,' rj irapd to) ttoBI f) nrapd 
rfj Xeipl iyyu? irepiyivovTai, i)v firj avTL/ca p,dXa x 
XeiTroOup,lrj dirbXcovrai. 'irjcns, a)? /ce(paXrj<i, 

5 OeppLrj. 

XXXV. A7ro<T(f)aKe\i(Tio<; p.evrot aap/ccov, kcu 
iv Tpwpia(Ti alp,opp6ois diroac^iyydev, koX iv 
bcrrecov Karrjypiaat irieyQev, kcl\ iv heapLols drro- 
fieXavOev. icai olcrt p,t]pov p,epo<; diro7Ti7rTet kcu 
jSpa^ovo^, 6a rea re real cr apices aTroTTLTTTOvai, 
7roWol Trepiylvovjai, co? rd ye aXXa ev(popd>repa- 
olat p,ev ovv Kareayeinwv oaTecov, at p-ev ireptp- 
py^ies ra")(elai, ai he tcoi> barecov diro'nT(i)(Tie<i, 
fi dv rd opia rrjs yjriX(0(Tios r), ravrr) diroTTCTrrovai, 

10 fipahvrepov he. hel 2 he rd /caTcoTepco rod rpco- 
/xaTo? 7rpoaacf)aip€iv teal rov <Tcop,aTO<; tou vytios 
— Trpo6vr)<TKei ydp — (^vXaa<yop,evov' z oovvij ap,a 
yap \ecTTo6vfiir] Ov/ja/couaiv. p,r/pov deneov dire- 
Xvdrj e/c toiovtov oyhoifKoaralov, t) he KVijp,rj 
d<f>r)pidr) el/coarabrj' Kvt]p,i]<; he barea /card pLear/v 
e^rjKnarala direXvdif. i/c toiovtcov Ta^y koX 

43* 



INSTRUMENTS OF REDUCTION, xxxm.-xxxv. 

case of a (compound) dislocation of the foot, spasm 
and gangrene (are to be expected). If anything of 
this kind supervenes on reduction, there is hope 
from dislocation, if indeed there is hope at all ; for 
spasms do not come from relaxation of parts, but 
from their tension. 

XXXIV. Amputations at a joint or in the length 
of the bones, if not high up, but either near the 
foot or near the hand, usually l result in recovery, 
unless the patients perish at once from collapse. 
Treatment : as for the head ; warmth. 

XXXV. (Causes) of gangrene of the tissues are: 
constriction in wounds with haemorrhage, compres- 
sion in fractures of bones, and mortification from 
bandages. 2 Even in cases where part of the thigh 
or arm falls off and bones and flesh come away, 
many survive ; and in other respects this is rather 
well borne. In cases of fractured bones, lines of 
demarcation form quickly ; but the falling off of the 
bones (it is where the limit of the denudation occurs 
that they fall off) occurs more slowly. One must 3 
intervene to remove the parts below the lesion and 
the sound part of the body (for these parts die first), 
and be careful ; 4 for patients die from pain and 
collapse combined. A thigh-bone separated in such a 
case on the eightieth day, but the leg was removed on 
the twentieth ; leg-bones separated at the middle 
on the sixtieth day. In such cases the compression 

1 iyyvs corresponds to rols ir\tioToi<Tt, J. LXV1II ; but it 
is a curious use. 

2 J. LXIX. 3 "Should" (Kw.). 
4 "Avoid pain" — Kw.'s punctuation. 

3 <pvKaoo6n*vov absolute : cf. Head Wounds XVIII. Kw. 
follows a conjecture of i^ocs and reads <pvXo.ao6ii.ivov dbvvriv. 

433 



MOXAIKON 

/3paBeio<;, al Trie£ie$ at Ir/rpiKaL rd S' dXXa daa 
r]crv^aiois, t<x p.ev oared ov/c aTroTrtiTTei ovBe 
crap/CMP yfriXovrai, dXX" iiwroXaioTepov. 1 rrpoa- 

20 BeyeaOai TavTa^pi'y rd yap irXecara (po/Sepcorepa 
17 tca/CLO). r) it](ti<; irpaela, 0epp,f) Biairy afcpi/3et' 
klvBvvos alp,oppayt5iv, yj/vxeos' ayrj/uara Be cw? 
p.ev dvdppoira, eirena v7roaTaaio<i ttvou e'lveica e£ 
taov rj oaa avp,(pepet. eirl rolai roiovroiat Kal 
cttI Tolai p,e\aap,otaiv, aipLoppayiai, Buaevrepiai, 
irept, Kpiaiv, \avpoi p,ev, oXiyrjpepoi Be. ov/c 
diroanoi Be irdvv ovBe 7rvpeTcoBee<;, ovBe ri 

28 Keveayyr/reov. 

XXXVI. "T(3wai<;, r) p,ev earn eiriOdvaros, 
ovpa>v a^iaio?, a7rovap/cd)aio<i^ rd Be e^u>, tovtwv 
daivea ra ir\elcna, iroXv p.dXXov rj daa aeia- 
devra p,h e^earr). avrd puev eoivrolat Kpiaiv 
7roi7)adp.eva, fcciva Be eVt irXeov rat adap-aii 
iiriBiBovra, Kal ev eiTiKaipois eovra. 

Oiov irXevpal Kareayetaai p.ev, oXtyat Trvpe- 
TcoBees Kal aip,aTO<> ttt vaio<i /cai a(paKeXiap,ov, 
tfv re p,ia, rjv re 7rXeL0v$ p,rj fcarayf) kao) Be' 3 

10 Kav ir/ais (fjavXrj, p,t) tceveayyovvra, rjv drrvpeTO<; 
rj. eiriBeai^ w? vop.o<;' rj Be TraopcdaL? ev ec/coaiv 
?)p,epriaLV, yavvov ydp. rjv 5' dp,(pi(f)Xaa0r], (pu- 
p-ariai, Kal /3>/^&;8ee?, KaL ep.pLOTOi, Kal irXevpas 
ea<paKeXiaav" irapd ydp irXevpiiv eKaarr/v utto 

15 trdvrwv tovoi elaiv. 

XXX VII. To, Be diro KaraTTTcoaio^ rjaaov 

1 eirnroKaiSTepa. 2 e'lveKa understood. 

3 nv Kara-yeTo-ai St . . . Kw. He suspects a mutilation in 
the text. 

1 " Which have been gently constricted." Littre (Adams). 
434 



INSTRUMENTS OF REDUCTION, xxxv.-xxxvii. 

used during treatment makes it quick or slow. For 
the rest, in cases of mild character * the bones do 
not come away, nor are they denuded of flesh ; but 
the mortification is more superficial. One should 
take on these cases, for they are most of them more 
terrifying than dangerous. Treatment : gentle, with 
warmth and strict diet ; dangers : haemorrhage, 
chill ; attitudes rather elevated ; afterwards, be- 
cause of collection of pus, on a level, or whatever 
suits. Haemorrhage supervenes in such cases, 
also in mortification, and dysentery at the crisis, 
copious, but of short duration. Patients do not lose 
their appetites much, nor are they feverish ; and 
there is no reason why one should starve them. 

XXXVI. Spinal curvature : inwards it is fatal, 
from retention of urine and loss of sensation ; ex- 
ternal curvatures are most of them without serious 
lesions, much more so than cases of concussion 
without displacement, for they make their own 
crisis ; but the latter have a greater effect on the 
body and on parts of vital importance. 

So, too, fractured ribs rarely give rise to fever, 
spitting of blood, or necrosis, where there is one 
or more fractured, if it is not broken inwards ; 2 and 
the treatment is simple, without starvation diet, if 
there is no fever. Bandaging as customary. Callus 
forms in twenty days, for the bone is spongy. But 
if there is great contusion, tubercles, chronic coughs 
and suppurating wounds supervene, with necrosis of 
the ribs ; for along each rib there are cords coming 
from all parts. 

XXXVII. Curvatures due to a fall are less sus- 

2 Of, li if not splintered,'' Li tire (Adams) ; "if they are 
not broken (but contused)," K.W. 

435 



MOXAIKON 

Bvvarav e^iOvveaOat' ^aXeTrdirepa Be rd dvco 
(ppevcov i^idvveaOai. oio~i Be Traialv, ov crvv- 
av^erai, aXX rj o~KeXi] Kal yelpes Kal KetyaXiy 
r)v£i]/A6Voiat,v v/3(oais, Trapa^prjpLa p,ev rr)$ vovaov 
pverai, ava yjpovov £' e7Tiar]p,alverai Bi 1 oivirep 
Kai roccri veoorepoiaiv, t)(T(tov Be KarcoijOcos. elal 
Be ol ev(f)op(i)<i jjvey/cav, olcriv av e? evaapKov /cal 
irtpLeXcoBes rpdrryraf oXtyoi Be rovrwv rrepl 

10 e^/jKovra erea efilcoaav. drdp tcai e? rd rrXdyia 
Biaarpep.p,ara ylverai' avvalria Be Kal rd 
0")(r]pLara ev olaiv av KaraKewvraf teal e%et 
Trpoyvwaias. 

HoAAol Be Kal alp,a errrvcrav ical epurvoi 
eyevovro. r] Be pueXerr/, tffCt^, eTrLBecris oj? vop,o<i' 
BiatT7]<i rd irpobra arpe/cecos, erreira drraXvveiv 
r)o-vfcir), o-iyfj' a^fiara, kolXli], atypoBiaia. drdp 
ols avaipua, erroiBvvcorepa rcov Karayvvpbivcov Kal 
<pi\v7ro(TTpo<pcoTepa 'xpovoiaiv' olo~i Be KaraXelrre- 

20 rat pbv^6i)Be<i, vTrop,ip,v/]o~Kei ev irovoiaiv. trjO'w 
/cavais, rolai piev air oareov, p,e%pi<; 2 oareov, 
piT) avrb Be' fjv Be puera^v, p^rj rreprpj, /.irjBe ern- 
7roX))?' a(pa/ce\icrp,6'i. Kal rd ep,p,ora rreipdadai' 
elpijaerai drravra rd erreaiovra. opard, Xbyois 
B? ov puyp fipwpuara, rrbp,ara, OdXrros, - r r v)(ps, 
cryj'pxa' on Kal (pdppuaKa, rd puev ^i)pd, rd Be 
vypa, ra Be rrvp'pd, rd Be p-eXava, rd Be XevKa, 

28 rd Be arpvefrvd, errl eXKr/, ovrw Kal Biatrai. 

XXXVIII. No/xo? epb/3oXr)<i Kal BtopOooaios' 
01/09, pLOXXos, acfirjviaKOS, ottos' ovos puev dvdyetv, 
p,o%Xo<; Be irapdyeiv. rd Be epbfiXijrea r) Biop- 

1 emcrri/i'Ai'eTai ti (as in J. XLI). a /ue'xp' to5. 

436 



INSTRUMENTS OF REDUCTION, xxxvn.-xxxvin. 

ceptible to rectification ; and those above the dia- 
phragm are the more difficult to straighten. In the 
case of children, there is cessation of growth, except in 
the legs, arms, and head. Curvature in adults delivers 
from the disease at the moment ; but in time the 
same symptoms appear as in younger patients, but 
in less malignant form. There are some who bear 
the affection well, those in whom there is a tendency 
to fulness of flesh and fat; but few of these reach 
sixty years. Lateral distortions also are produced, 
and the positions in which patients lie are accessory 
causes; they also serve for prognosis. 

Many patients spit blood, and get an abscess. 1 
Care and treatment ; bandaging as usual. Diet : at 
first strict, then feed him up ; repose and silence, 
position, the bowels, sexual matters. But where 
there is no show of blood, the parts are more painful 
than in fractured cases, and there is more tendency 
to relapse later. Where the tissue is left in a 
mucous state, there is a return of pains. Treatment : 
cautery, where bone is involved, down to the bone, 
but not of the bone itself; if between the ribs, not 
right through, yet not superficial. Necrosis : try 
also the treatment with tents; all that concerns this 
will be described. Things are to be seen — don't 
trust to words; food, drink, warmth, cold, attitude. 
As to drugs also, some are dry, some moist, some 
ruddy, some black, some white, some astringent, 
used for wounds; so too (various) diets. 

XXXVIII. Usage for reduction and adjustment: 
windlass, lever, wedge, press; windlass for stretch- 
ing, lever for bringing into place. Parts to be 

1 This passage seems out of place here, and T.ittiv boldly 

joins it on to XXXVI ; but we now have to do with odd notes. 

437 



MOXAIKON 

OtoTea Biavayicdaai Bel efCTeivovra, ev cS av 
e/caara o-yJ)p,a.Ti /xiWrj vTrepaMoprjdijaeadai' to 
o etcfidv, 1 virep tovtov 66ev e£e/3rj. tovto Be, 
r) xepcrlv r) Kpefiaafi(p r) ovoiaiv r) irepl tl. X € P ai/ 
fiev ovv opOcos Kara fiepecf Kapirov Be /ecu 
ay/ewva aTro^pyj Biavayicd^eiv, Kapirbv p.ev et? 
10 Wv dy/ewvos, dy/ewva Be eyywviov 777509 ftpci- 
ylova eyovTa, olov irapd t<w fipayiovi to virb 
rrjv yelpa inroTetvopLevov. ev oXai Be 8a/cTv\ov, 

7ToS6<i, %€ip6<i, KCtpTTOV, U/ScO/ZaTO? TO €^0), 2 BlCtVCiy- 

tcdaai 8ei teal /caTavay/cdaai, rd p,ev a\Xa viro 
yeipwv at Biavay/edaies i/eavai, /caTavay/cdcrcu 
Be rd vTrepe^ovTa e? e'Bprjv Tnepvy r) Qevapi eiri 
tivo<;' ware Kara p,ev to e^eyov viro/eelaOai 
oy/eov avp,p,eTpov p.a\0a/eov /card Be to erepov 
[/(.ir/cr to) pa] S' dv 3 yprj wOelv oiriaoi teal kotos, 

20 rjv Be haw r)v Be e£&> e/c7re7rT(t)/cy T(i Be e/e Tr\a- 
yL(ov, tcl p,ev diroideiv, t« £e dvTwOetv ott'igw 
dficjiOTepa KaTa to eTepov. t<x Be vftwfiaTa, t« 
p.ev eaco, outc iTTappuw ovTe ftriyi, ovts cpvcn]<; 
evecret, ovts ai/cuy Bet Be ti, r) /eaTdcnaaLS' r) 
Be diraTt], oti olov Te 4 7roTe /caTeayevTcov twv 
o~7rov8v\a)v /cal rd \op8d>p,aTa Bid ttjv 6Bvvi]v 
BokcI eaoi d>\ia@rj/cevai' Tavra Be Tayvcpva zeal 
paBia. Ta Be k^co, KaTaTaais, to, pev avco iirl 
TroBas, Ta 8e tcaTco TavavTia' /caTavdy/caais Be 

30 avv KaTaTaaei, r) eBprj i) ttoBI r) craviBi. rd 8' 

1 Itxfiav Ap. a es rb *tw Ap. 

* firicrTaip (= "skilled assistant") 5' av vulg. ; jut) <nopi- 
travra Lit. ; jur)<rropa a/xa Kw, 
4 olovrai Kw., Littre. 

1 I.e. hand-power is strong enough. 
438 



INSTRUMENTS OF REDUCTION, xxxvm. 

reduced or adjusted must be separated by extension, 
till each comes into an attitude of sufficient eleva- 
tion, the dislocated part above that from which it 
was dislocated; this is done with the hands, or 
suspension, or a windlass, or round something. 
Proper use of the hands varies with the part ; in 
the case of the wrist and ankle, it suffices 1 to 
separate the parts, the wrist being in line with the 
elbow, but the elbow at right angles to the upper 
arm, as when the forearm is in a sling. In the case 
of finger or toe, foot, hand, wrist, humpback, double 
extension and forcing down the projection are re- 
quired ; in the other cases, separation by hand- 
power is enough, but one must force projecting 
parts into position with the heel or palm over some- 
thing, taking care that a suitable soft pad is placed 
under the projection. On the other side, a skilled 
assistant should simultaneously press backwards and 
downwards, if the dislocation is either inwards or 
outwards ; in lateral cases, press one side away and 
the other side back to meet it, bringing both together. 
As to curvatures, internal ones are not (reducible) 
by sneezing, coughing, injection of air, or a cupping 
instrument ; a mode of restoration is wanting. 2 The 
deception people fall into when vertebrae are frac- 
tured, and incurvings due to pain simulate dislocation 
inwards ; these heal quickly, and are not serious. 
Outward curvatures : extension, 3 towards the feet if 
the lesion is high up, if low down, the reverse ; 
forcing into place, simultaneously with extension, 
by sitting on it, or by using the foot or a plank. 

2 Or "If anything, extension," reading /.aTaTaais, as Littre 
(Adams). 

8 Kardotiffis, " suceussiou." Liltre. 

439 



MOXAIKON 

evOa rj evBa, ei ns KaTaraa^, Kal en ra 0~XV~ 
fxara iv rj) hiaiTrj. 

Ta ap/xeva iravra eivai ir\area, trpoarjvea, 
lo-%vpd, ei her)' /X7] x hel pdvecrt, ir poKareCki^d ai. 
iaKevdaOai nrplv rj iv rfjaiv dvdy/crjcriv iravra 
avpLp,epLeTprjp,evu)<i rd p,i]/cea Kal vtyea Kal evpea. 
hidraais, olov pajpov, to irapd acpvpbv hehecrOai 
Kal dvco rov yovvaros, ravra p,ev e? to avrb 
Teivovra' irapd he l%vi 2 Kal rrepl pLaa^dXa^, 

40 Kal Kara irepivatov teal pbrjpov, Ta 3 p.era$jv rr}<; 
"PXVSy TO ptv tirl cnrjOos, to he iirl vcotov 
Teivovra, ravra 6"' e? to avrb diruvTa^ Teivovra, 
irpoaheOevTa rj 7rpb<; vrrepoeihea rj rrpb<i bvov. 
iirl p,ev ovv teXivr)<i iroieovTi, tovto puev tcov 
irohwv 7Ty0O9 ouhbv XPV ipeiaai, irpbs he to eTepov, 
IjvXov la'xypbv irXdyiov 7rapa(3ep3Xr)a9at, Ta he 
virepOev virepoethea 7r/)o? Tavra dvTiaTrjpi^ovTa 
hiaTeiveiv, rj irXi'ipLvas teaTopv^avra, rj KkipLatea 
hiaOevTa, dp.(poTepoiOev u>8eiv. to he kolvov, 

50 aavls e^dTrrj^ys, evpos hiiri]X^y 7ra^o? aTn8ap,r)^, 
eypvaa ovovs hvo TaTreivoix; evOev teal evdev, 
e^ovaa he teard p.eo~ov aTvXia/eovs avpup-eTpov^, 
ei; 5 wv (w? teXi,p.ateTr]p eirkoTai e? Ti]v virbcrTaaLv 
t&) %vXrp, wairep iCo tcaT wpiov' teaTayXvcpovs he 
MO-irep Xrjvovs Xeia? e%ett', TeT pahatCTvXovs eupos 
teal p3d0o<{, Kal hiaXnreiv toctovtov baov avTJ) 
tt) p,oxXeucrei e? htopOooaiv' iv p.eo~<p he TCTpd- 
ywvov KaTayXvcprjv oiaTe aTvXiaKov iveivai, o? 
irapd rrepivaiov icov Trepipperreiv T€ KcoXvaet id>v 

1 (I 5e fit, Littr^s conjecture, Kw. Cf. J. LXXVIII. 

2 i{i>i'. 3 firtpccy rb. 



* 4s ra aircvavricL s i<p\ 



44° 



INSTRUMENTS OF REDUCTION, xxxvm. 

Curvatures to this side or that ; one may use some 
extension, also postures with regimen. 

The tackle should all be broad, soft, and strong, 
otherwise 1 they must be previously wrapped in rags ; 
all should be suitably prepared as to length, height, 
and breadth before use in the reductions. In double 
extension of the thigh, for example, make attach- 
ments at the ankle and above the knee, drawing 
these in the same direction ; at the loin and round 
the armpits ; also at the perineum and between the 
thighs, 2 drawing one end over the chest, the other 
over the back, but bringing these in the opposite 
direction; 3 they should be fixed either to a pestle- 
pole or to a windlass. If one operates on a patient 
in bed, its legs at one end should press against the 
threshold, and a strong plank should be laid across 
the other end ; then, using these as fulcra, draw 
back the pestle-like poles from above ; or fix wheel- 
naves in the ground ; or lay a ladder along, and 
apply force at both ends. For all cases : a nine- 
foot plank, three feet broad, a span thick, having 
two windlasses set low down at each end, and also 
having at the middle suitable props, on which is 
placed a sort of crossbar to act as fulcrum for the 
board, like that used for the shoulder. 4 It should 
have fossae like smooth troughs, four fingers broad 
and deep, with sufficient intervals between for ad- 
justment by actual leverage. In the middle (there 
should be) a quadrangular excavation for a prop to 
fit into, which, when it is at the perineum, will 
prevent the patient from slipping, and when it is 

1 Reading ti Se ix-S). " Sufficiently strong ; it should not be 
necessary to wrap'' (Pq.'s rendering of the text). 

2 Kw.'s reading. 8 Kw.'e reading. 
« I.e. the ambe; cf. J. LXX1I1. 

44T 



MOXAIKON 

60 re vTTO^dXapo^ vrrofxo-^Xevcrei. XPV &* T % aa ' 
vlSos, rj ev tg> tolXV t0 a-Kpov KO.TayeyXvppuevov 
ti e%ovari<;, tov %v\ov waai to a/cpov, eVt Se 
Odrepa KaTarajKci^eiv, VTroridevra p,a\0aKci riva 

64 avp,p,erpa. 

XXXIX. Olcnv bareov anb inrepa>r)<; cnrf/Xde, 
p,eo-q i^et >'} pis tovtolctlv. oi he <f)\(i)p,evoi ks- 
(fiaXas dvev eXKeos, fj TreaovTos i] vard^avTo^ fj 
TTieaavro<i, tovtwv evioicn ra Bpi/xea epx erai dirb 
Ke<f>a\f)'i Kara ra? (frdpuyyas, Kal dirb rpd>paTO<; 
ev ttj K€(f)a\fj /cal e> to fjirap Kal e'9 tov p,rjp6v. 
XL. ^r/pela irapaWayfiaTcov /cal eKirTcopid- 
tcoV teal fj Kal oVto? Kal baov Biacj)epei ravra irpos 
dWrfKa' Kal olcnv fj KorvXrj irapeaye, Kal olcri 
vevpiov aTrecnrdcrOrj, Kal olen eiri^vcn^ direaye, 
Kal olai Kal &>?, Kal ev fj 8vo, cbv ovo ecniv' irrl 
TovTOiai klvSvvoi, eXmBe'i olai KaKai, Kal ore 
KaKfoaies davdrov, vyietrj^, ao"(£a\ei>7<?- Kal a 
e/x^XrjTea fj x eL P l(TT ^ a KCtl ore > KaL a ov fj ore ov' 
€7rl tovtoictiv eXmhes, klvSvvoi' ola Kal ore %ei- 

10 picrrea, Kal rd €K yeverjs e^apOpa, ra av^avbfieva, 
rd r}v£i)/j,eva, Kal ti Odacrov, Kal ti ftpaSvre- 
pov, Kal 6 ti ^fyA,ov, Kal a>? Kal ov' Kal Siort Kal 
6 ti fiivvOtjaei, Kal fj Kal co? Kal olcnv fjacrov 
Kal OTi Ta KaTayevTa Odcraov Kal (SpahvTepov 
<f)v6p,eva, fi al 8iaaTpo<pal Kai iiwraypajo-ies 
ylvovTai, Kal ukt) tovtcov. otcnv e\Kea avTLKa 

1 This is condensed from J. XLVII and LXXV, on pressing 
down a hump by bringing a plank across it, one end being 
in a groove in a post or wall. The translation makes the 
epitomiser say this ; but in the Greek he seems to confuse 
the plank with the ambe, which had a sort of excavation at 
its end. Littre omits % and the first tI &itpov, 

442 



INSTRUMENTS OF REDUCTION, xxxviii.-xl. 

rather loose will serve as a lever. Use of the plank : 
one should push it in at one end ; the end should 
occupy an excavation in a post or in a wall j 1 press 
down at the other end, putting some suitable soft 
substance underneath. 

XXXIX. In cases where a bone comes away from 
the roof of the mouth, the nose falls in in the 
middle. 2 Patients with contused heads without a 
wound, due to a fall, fracture, or compression ; some 
of them have a flow of acrid humour from the head 
down to the fauces, and from the lesion in the head 
to both liver and thigh. 3 

XL. Symptoms of subluxations and dislocations : 
their difference from one another in position, nature, 
and extent, where the socket is fractured, where a 
small ligament is torn away, where the epiphysis is 
broken off. In what cases and how either one or 
two bones (are broken), when there are two ; dangers 
and expectations in these cases ; in which cases they 
are bad, and when injuries are mortal, or when there 
is more hope of recovery. Also what cases are to 
be reduced or treated surgically, and when, and 
which not, and when not ; the expectations and 
dangers in these cases. In what cases and at what 
time one should treat congenital dislocations or those 
occurring during and after adolescence. Which case 
is quicker and which slower to recover where a 
patient is (permanently) lame, and how, and when 
not ; and why, and in what oases, there is atrophy ; 
on which side, and how, and the cases in which it 
is less; and that fractured bones are quicker or 
slower to consolidate, where distortions and accumu- 
lation of callus occur, and the cure for these. Cases 

» Epul. IV. 1. 9, VI. 1. 3. 8 Epid. II. 5. 4. 

443 



MOXAIKON 

7} varepov ylvovrai' olcri Kal ocrrea Karayetai 
fi€L(o, olcriv ov' o\<JL Karayevra i£ecrX €v > Kat V 
e%L<JX €l ftaWov' olaiv e/c{3di>Ta rj dpOpa ifyayjia' 

20 dirarcovrai x Kal hi a, iv oiaiv opwaiv, iv olaiv 
hiavoevvrai, d/x(pl rd iraOii'ifxara, dfitpl rd Oepa- 

22 Trev/xara. 

XLI. No/aoktl rotai vop.ifi.oiai r /repl iiriheaw 
irapaaKevt], irdpe^L^, Kardraai<i, SiopOooais, dvd- 
rpityis, iirlhecn<;, dvd\rjy]ri<;, Oeais, a-)(Tjp-a, %/3o- 
voi, hlairai. rd %avvorara rdyjiara (jii/erai, rd 
oe ivavria, ivavriws' Siaarpocpat, rj Kvproi 
aaapKot,, dvevpoi. ro ipareaov &>9 irpoawrcirw 2 
rj to iKireaov earai rov %6>pioi> ov itjeneaev. 3 
vevpcov, rd fiev iv Kivijaei Kal iv ttXuSm, irri- 
SoTiKa' rd &e fit], r)aaov' dpiarov r) dv ixTrearj, 

10 el i/jLTreaot rdyicrra' 1 ^ irvperalvovri fxrj ip,/3d\- 
\eiv, firjSe rerapraia, ire/xirrala, rJKiara dyicwva. 
Kal rd vapKcoSea irdvra, a>? rdyjio'ra dpiara, rj 
rrjv (pXeypbovrjv rrapevra. to air o o -n do f.iev a, rj 
vevpa rj xovSpta rj iinipvaies, rj 8uardp,eva Kara 
avpLCpvaias, dSvvara opoifoQ^vat' SiaTrcopovrai, 
Ta^etu? toIcti TrXetarotaiv' ?) Se %p?}o"t9 aco^erai. 
iKf3dvruiv, ra eayara, paov' rd paara iKireaovra 
i]Kiara cf)\e<yp.atvei' rd Be rjKiara Oeppuaivovra, 
Kal pur) iirideparrevdevra, pudXiara avdis e/C7rt- 

20 rrrei. Kararelveiv iv o-yJ]}xari roiovra), iv co 

1 & a.TTaTa>vrai Kw. a kKacrTaTU). 

s Obscure ; seems to bo taken from J. IX. 
* Cf. J. LXXIX. 

1 Apparently "intervals" between changes of dressing 
and the like. 

444 



INSTRUMENTS OF REDUCTION, xl.-xli. 

where wounds occur at once or later ; where the 
fractured bones are shortened, and where they are 
not. In what cases fractured bones project, and at 
what part they chiefly do this. The confusion 
between dislocations and prominent joints, causes of 
deception in what men see, and conjecture concerning 
maladies and treatments. 

XLI. Recognised usages as regards bandaging: 
preparation, presentation, extension, adjustment, 
friction, bandaging, suspension, putting up, attitude, 
periods, 1 diets. The most spongy bones consolidate 
quickest, and vice versa ; distortions on the side 
towards which they curve ; atrophy of flesh and 
sinews. The reduced bone shall be (kept) as far 
as possible from the place where it was dislocated. 2 
Of ligaments, those in mobile and moist parts are 
yielding ; those which are not are less so. Wherever 
a dislocation may be, prompt reduction is best. Do 
not reduce when a patient has fever, or on the 
fourth or fifth days, least of all in an elbow case. 
All cases with loss of sensation, the quicker the 
better; or wait till inflammation has subsided. Parts 
torn away : ligaments, cartilages, epiphyses or separa- 
tions at symphyses cannot be made the same as 
before; in most cases there is rapid ankylosis, but 
the use of the limb is preserved. Of dislocated 
joints, the most distal are the more easily (put 
out?); 3 those most easily put out suffer least in- 
flammation ; but where there is least heat and no 
after-treatment, there is greatest liability to another 
dislocation. Make extension in such a posture that 

2 "Force used in reduction to be applied at as great a 
distance as possible" (Adams). 

3 Or "treated" ; but it seems best to follow the context. 

445 



MOXAIKON 

fiaXiara inrepaKoprjOrjaeTai, atceTTTo/uevov e<? ttjv 
(f>vaiv real tov tottov fj e^e/3)]. BiopOioai^' 
OTTioa) e? bpQov /cal e? TrXdyiov irapwdeiv' tcl 
Be Ta/^eco? avTicnracravTa avricnrdaai T<z^e&>? rj 
Br/ e/c Trepiaycoyrjs' ra Be trXeio~Tdici<i e/cn'iTTTOVTa 
paov ip,7wrTei' alriov vevais rj vevpcov rj ocrrefov, 
vevpcov p,ev p,rj/co<; rj iinhoais' oarecdv Be, KOTvXrjs 
6pua\oTT)<;, K€(f)a\rj<; cfraXa/cpoTris' to e#o? rpifiov 
iroiel' alriT] koX cr%ecri9 /cal eg is /cal i)XiKirj. to 

30 viropuv^ov d(p\ijfiavrov. 

XLII. Olaiv eX/cea eyeveTO, rj ai/Ti/ca i) barecov 
e^iayovTU>v, rj eireiTa, rj /cvr\o~pGiV i) Tprj^vapcou, 
tclvtcl pev r)v alaOrj, evdetos Xvaas, Tricrar)pr}v 
eiri to eA.KO'i eiriUeis, eirioeiv to? em to e\/co<; 
irpoyTov Tr]v dp^rjv /3aXXop,evo<;, /cal TaXXa &j? 
ov TavTij tov aiveos eovTOf' ovtw yap avTO T€ 
io~"xyoTaTOv /cal e/CTrvrjaei Tci^ccrTa koX irepip- 
prj^eTai, /cal icaOapOevTa TayiCTTa tpvaeTai. vdp- 
6>j/ca<; Be p,i]T€ «ot avTo tovto irpoadyeiv pi)T€ 

10 Trie^eiV /cal wv oaTea p,r) pieydXa arreicnv, &v 
Be pueydXa, ovtco iroielv 1 iroXXr) yap epLirvrjo-is 
Kal tout ov/c €Ti ovtws, dXX , dve^rvKTai TWV 
viroo~TaaL(ov eXve/cct. t« Be ToiavTa birbaa e£e- 
o"X,e, /cat e't T€ ip,/3Xr)0{} el T€ paq, eiriheais piev 
ov/c iiTLTrjBeiov, BiaTaais Be. o~<fiaipai iroir]- 
deicrai oXai TreBais, r) p,ev irapa o~(f)vp6v, r) Be 

1 Littre joins ovtw iro/eiV to &ireio~ti> and adds ov after 
/xeyaAa, de suo : &ireto-iv waavruis- Siv 5e /xeyd\a b~7J\ov, Kw. M. 

1 Second fj perhaps added for sake of symmetry ; there are 
only two classes of wounds, "immediate" and "later." 

2 Adopting Kw.'s reading, which has some support from 
the MSS. 

446 



INSTRUMENTS OF REDUCTION, xli.-xlii. 

the (dislocated bone) will be best lifted above (the 
socket), having regard to its conformation and the 
place where it is dislocated. Adjustment : push 
backwards, either straight or obliquely ; where there 
has been a rapid twist, make a rapid twist (back- 
wards), or at any rate by circumduction. Often 
repeated dislocations are more easily reduced ; they 
are due to the disposition of the ligaments or bones — 
in the former, to length or yielding character ; in 
the latter, to flatness of the socket and rounded 
shape of the head. Use makes a friction-joint ; it 
depends on the state of the patient, his constitution 
and age. Rather mucous tissue does not get 
inflamed. 

XLII. In cases where wounds occur either at 
once, with projection of the bones, 1 or afterwards, 
from irritation or roughnesses, when you recognise 
these latter, at once remove the dressing, and apply 
pitch cerate to the wound. Bandage, putting the 
beginning of the roll first on the wound, and the 
rest as though there were no lesion there, for so 
there will be least swelling at the part ; suppuration 
and separation will be most prompt, and the cleansed 
parts heal up most rapidly. As to splints, do not 
apply them to this part, and do not make pressure. 
This treatment applies to cases where small pieces 
of bone come away; when large it is clear 2 (what 
to do), for there is much pus formation, and this 
treatment is no longer suitable, but the wound 
is left open because of the accumulations. But in 
all such cases as have bones projecting, whether 
they are reduced or not, bandaging is not suit- 
able ; what is required is stretching. Rounds are 
made like fetters, one at the ankle, the other 

447 



MOXAIKON 

trapd <yovu, e<? Kv?]p.rjv TrXarelai, trpoarivees, 
tayvpai, Kpifcovs eyovaai' pdfihoi T€ avpifierpot 
Kpavirj'i /cal pLpj/cos /cal 7ra^o?, ware hiareivetv' 

20 i/jLcivTia he i% aicprov dp.(f)orepco0€v eyovra e? 
rov<i /cpi/covs evheheaOai, a)? rd atcpa e'<? t«9 
afyaipas evarr)pi^op,eva hiavay/cd^r}. fojais he, 
Triacnjpi] dep/x/]' 1 a%i'ip,ara /cal 7roSo? Beats /cal 
layiov' hiaira drpe/cijs. ijufidWeiv rd oarea 
rd virepiaypvra av0>)p.epa i) hevrepala' rerap- 
rala he i) Tre/xirrala, pu'], d\}C iiriju iayyd ■/). t) 
he ep,/3u\r) roiav p,oy\iicolaLV' rj to ep,/3aW6pLevov 
rov oareov, r)v pur) eyr) aTroar/jpi^iv, diroirplaaL 
rwv kcoXvovtcow drdp /cal oj? rd ■^rt\u>0evra airo- 

30 rreaelrai, /cal (Spayvrepa rd p,e\ea. 

XLIII. Ta he dpBpa, rd p,ev irXeov, rd he 
puelov okiaddvei' /cal Ta p:ev puelov ep,/3d\Xeiv 
pdhiov' ra he p,e^ov<i Troiel rds /catcd)aia<; /cal 
oarecov /cal vevpcou zeal dpOpwv /cal aap/cwv /cal 
ay^pidrwv. /ar;/30? he /cal ftpayioav 6p,oi6rara 

6 e/CTTLTTTOVaiV. 

1 iciaar\}>y 06p,u}}. 



448 



INSTRUMENTS OF REDUCTION, xlii.-xliii. 

at the knee, flattened on the leg side, soft and 
strong, provided with rings ; rods of cornel-wood, 
suitable in length and thickness, to keep the limb 
stretched ; leather thongs adapted at each end to the 
extremities (of the rods) are fastened to the rings, 
so that the ends of the rods, being fixed to the 
rounds, make extension both ways. Treatment : 
warm pitch cerate, attitude, position of foot and 
hip, strict diet. Reduce projecting bones on the 
first or second day, not on the fourth or fifth, but 
when swelling has gone down. The reduction with 
small levers : if the fragment to be reduced does 
not afford a fulcrum, saw off what is in the way. 
For the rest, shortening of the limbs is proportional 
to the denuded bone which comes away. 

XLIII. Joints are dislocated, some to a greater, 
some to a less extent ; and the less are easy to 
reduce, but the greater produce more serious lesions 
of bones, ligaments, joints, flesh, and attitudes. The 
thigh and upper arm are very similar in their manner 
of dislocation. 1 

1 I.e. completely, or not at all. See J. LXI. 



449 
vor. ru. iupp *- 



APPENDIX 

NOTES ON JOINTS LXXX 

We have seen that, according to Galen, Chapter LXXVIII 
is the vararos \6yos, or " final discourse," of Joints. His 
commentary ends rather abruptly in the middle of it, but he 
has already intimated that he is not going to say much, and 
he can hardly have gone beyond, though some manuscripts 
contain the rest of the Hippocratic treatise. Of this appendix 
the most interesting part is Chapter LXXX. It looks like, 
and has always been considered, the original Hippocratic 
account of finger-joint dislocation, which somehow got dis- 
placed and replaced by the very poor substitute, Chapter 
XXIX, identical with Mochlicon XIX. 

But there are difficulties in this view. No ancient writer, 
till we get back to Diodes, early in the fourth century B.C., 
seems aware of its existence. Galen excludes it from Joints, 
but had he known that Hippocrates anywhere mentioned 
" lizards" as surgical instruments he would surely not have 
left them to puzzle succeeding generations till Diels happened 
to visit a toy shop. He would have explained it in his 
Hippocratic Glossary. Even Erotian, who tells us twice 
over that aeipd in Hippocrates means ifxds (strap), would 
hardly have left aavpo. unexplained. The analogous but less 
peculiar use of ripffts {Joints XLIII) is explained twice over 
both by Erotian and Galen. 

Apollonius obviously knew nothing about it. He apolo- 
gises for the poverty of XXIX, and supplements it by an 
extract from Diocles, but seems quite unaware that this 
extract is an abbreviation of the genuine Hippocratic 
account. Apollonius was the chief Alexandrian surgeon of 
his day (first century B.C.), so we may safely conclude that 
the chapter was not in the Alexandrian edition of Hippocrates. 

45 1 



APPENDIX 

One would hardly add a poor account of a matter to a 
treatise which already contained a good one ; it is therefore 
improbable that Joints contained Chapter LXXX when it got 
separated from Fractures, and had its more glaring omissions 
made up by insertions from Mochlicon. We thus get back to 
the author of Mochlicon. Did he abbreviate his Chapter 
XIX (XXIX ,/.) from LXXX? Able editors such as Littre, 
Adams, Petrequin say he did. I venture to think that the 
reader will find no evidence of this, but will discover without 
much trouble that XXIX is practically made up of stock 
phrases taken from the three previous chapters, one of them 
(" the flesh wastes chiefly on the side opposite to the dis- 
location ") being dragged in rather absurdly. Unusual 
words, e&ffwiuov avTcvdeii' HfcTTTaifxa eimrupovTat, are all absent 
from LXXX, but have been just used or seen by the epi- 
tomist (iimroopovTai F. XXXVIII whifth he has just abridged), 
while the peculiar words and expressions of LXXX are all 
absent. 

Coming to the Diodes quotation we find a great contrast. 
The correspondence of words and phrases is so close, that, 
though the hand is looked at from a different position, it 
seems almost certain that the two passages are connected. 
The natural view is that Diocles is cop3'ing Hippocrates, and 
this seems confirmed by Galen's assertion that he para- 
phrased other parts of Joints. On the other side there is the 
ignorance of Apollonius ; the difficulty in believing that 
Chapter LXXX could have been so entirely lost and so 
entirely recovered after many centuries, and another fact 
which perhaps turns the balance against the accepted 
theory. Besides aavpi the writer uses another word in a 
peculiar sense, x^'P a == "joint socket." This occurs no less 
than six times in the two chapters LXXIX-LXXX, which 
is strong evidence that they are by the same author, and 
against the view that he is identical with the author of 
Fractures-Joints : for though the old writer uses x^P a * occa- 
sionally, it always has its natural sense of "place," whereas 
in LXXIX-LXXX the "natural" and sometimes necessary 
sense is "socket." The remaining Chapter (LXXXI) is 
made up largely of passages taken from the two previous 

1 Usually with Io-vtoO, cf. F. IX, XIV. In J. LXXIX- 
LXXX this word is omitted in all six cases. 

452 



APPENDIX 

ones, with the highly un-Hippocratic addition that all dis- 
location patients should be starved for seven days ( !). Even if 
we soften this down by inserting ical (" even for seven days") 
as do some manuscripts, it is still inconsistent with the rules 
given by the author of Fractures- Joints. We conclude there- 
fore that these three chapters are probably a late addition. 
Perhaps a surgeon who had read the apology and supplement 
of Apollonius, and believed, as we do, that the latter is 
really taken from Hippocrates, thought it no forgery to try 
to rewrite the latter in an expanded form and in Hippo- 
cratic style. While he was about it, he might also wish to 
remedy another defect in Joints, which, as he justly observes, 
should first tell us what joints are. He therefore composed 
Chapters LXXIX-LXXX and probably LXXXI which 
became firmlv attached to the end of the treatise. 



THE DIOCLES SUPPLEMENT TO XXIX 

AafTu\eu (lev &p8pov &v re irutibs &v re x ei P^s iicitetrri, re- 
rpax&s eKirinrei, t) eirbs t) eKrbs 7) els to trKdyia. ottqjs 5' b.v 
eKireari, f>d*)iov yvwvai nphs rb h^wvvpiov ical rb vyies dewpovvra. 
4/xBdWnv 5* Kararelvovra evdv dirb x^'P^v, irepie\i£ai 5e oitois 
fj.r) e£o\i<T0di>i}. darelov 8e ko.1 toj aravpas, &J 01 7rai5e* -nXeKOvtrt, 
tre^idevra irepl &>cpot> rbv SaKrv\ov Kararelveiv, 4k Se rov eirl 
ddrepa rais x^P^- 

A joint either of a toe or finger may be put out. It is put 
out in four ways, inwards, outwards, or to the sides. The 
way it is put out is easy to distinguish by comparing it with 
the sound and corresponding joint. l'ut it in by making 
extension in a straight line with the hands, but wrap a band 
round it that it may not slip away. It is also ingenious to 
put the lizards, which children plait, round the end of the 
finger and make extension, pulling in the opposite direction 
with the hands. 

THE HIPPOCRATIC BENCH 

Though we have three complete accounts of the Hippo- 
cratic Bench, by "Hippocrates," 1 Rufus (or Heliodorua), 1 

Joints LXXII-LXXIII. * Oribasius XLIX. 26 ff. 

453 



APPENDIX 

and Paulus ^Egineta 1 respectively, attempts at restoration 
have been unfortunate. Till the time of Littre they were 
based on that of Vidus Vidius (1544), who read fMcpds for 
naxpds in Joints LXXII and produced a bench with a row 
of square holes down the middle. He represented the 
perineal peg as angular and pointed, and made the corner 
supports so high that the patient would be lifted as well as 
stretched. 

Littre pointed out that the nanreroi were long grooves 
parallel to one another. He also reduced the height of the 
corner posts, and was on the point of making them project 
horizontally lengthways, so sunk into the bench that the 
axles would come below its surface. 2 This view, which 
seems admitted as an alternative in Joints XLVII, is still 
supported by Schone. 

On the whole, however, Littre's figure, including the un- 
comfortable form of perineal peg which he retained, is still 
generally accepted : but there are serious doubts as to the 
intermediate supports. Littre like his predecessors repre- 
sented them as fixtures at the sides of the bench, though 
.Scultetus had suggested that they were movable, a view 
adopted by Petrequin, who, however, still keeps them well 
to the sides. The chief object of this note is to suggest 
that they were not only movable, but were inserted when 
required into the grooves not more than a foot apart. 

Paulus in his renovated text is clear as to the first point. 3 
" As a last resort in internal dislocation of the thigh, let the 
perineal peg be removed and let two other pieces of wood be 
inserted on either side of its position " — iic irXayiov t>)s tovtov 
6e<reu>s eKaripoidev erepa Svo {uAa ire irrj \- du>. This seems in- 
tended for a paraphrase of the Hippocratic Kara, fxioov km 4k 
irKayitov .* for Kara fxicrov has just been used to describe the 
position of the peg. A cross-piece is then inserted " so that 
the shape of the three resembles the letter pi (n), or eta (H) 
if the cross piece is a little below the top. Then, with 
the patient lying on his sound side, we may bring (aydyoopav) 
the sound leg between these supports." 

In Rufus the apparatus is apparently in one piece, a 
pi-shaped prop. 6 It is noticed first merely as "another 

« VI. US. 2 IV. 46. 3 VI. 118. 5. 

* LXXIII. * jr«m5)is <p\id. 

454 



The Eippocratic Bench or Scamnum 
i. According to Vidius. 1.144 




ii. According to Littrc. 1844 
c 




VJ 



"^jYASPS^ 



f= 



P D 

A 



2- Cubits - - * 

\. Plank. BB. Corner Supports. C. Axle. l>l>. Grooves 
E. Perineal Peg. FF, Intermediate Supports. 6. Crossbar. 

To face p. lf>4. 



APPENDIX 

central contrivance besides the perineal peg." ] In describing 
the use of the bench for thigh dislocation he adds that it was 
especially contrived for the internal form ; " the perineal peg 
is taken out, the patient laid on his sound side, and the sound 
leg is arranged (ravo-erai) under the prop." It is also called a 
nriyaa or framework, and perhaps could stand on the bench 
wiuiout being inserted. Anyhow, it can hardly have been 
a fixture occupying the breadth of the bench, for it would 
then not have been very pi-shaped, would have been in the 
way on all other occasions, and the patient could not lie on 
the bench without having his legs beneath it. 

This fact seems alone suflicient to prove our points — that 
the props were not only movable, but, when inserted, were 
so close as just to admit one leg. 

The terms used by Hippocrates are the strongest of the 
three, whether we read Sitixrai neir-qyv (" insert between "), a 
term just employed for inserting an arm between the thighs, 2 
or ffxicreie fifcrriyv ("press between"), as read by Apollonius. 
Even the mildest of the expressions used for bringing the 
sound leg between the props would surely be absurd if they 
were so far apart that the patient could not lie on the bench 
without having it there already ! 

This view enables us to give -KoSialas 3 its natural meaning : 
the supports were "a foot long " in order to stand firmly in 
the grooves. So, too, the wooden crossbar, instead of being 
three feet long and expected to resist immense pressure at 
its middle, was only about a foot in length and the pressure 
distributed throughout. 

The illustrations of Apollonius are disappointing ; the one 
thing we learn from them is that the grooves sometimes went 
the whole length of the bench. The wheel and axle arrange- 
ments at the ends are apparently separate from it, and there 
is no trace of any intermediate supports, though the perineal 
peg is represented. The Wellman Museum of Medical 
History contains an interesting example of the Vidian 
restoration, though the supports had been cut down when 
it was discovered. 

1 TT^iairnrK6i. 2 LXXI. 

3 LXXIII. 



455 



THE LOEB CLASSICAL 
LIBRARY 



VOLUMES ALREADY PUBLISHED 



LATEST AUTHORS 



Ammianus Marcellinus. Translated by J. C. Rolfe. 3 Vols. 
Apuleius: The Golden Ass (Metamorphoses). W. 

Adlington (1566). Revised by S. Gaselee. 
St. Augustine: City of God. 7 Vols., Vol. I. G. H. 

McCracken. Vol. VI. W. C. Greene. 
St. Augustine, Confessions of. W. Watts (1631). 2 Vols. 
St. Augustine, Select Letters. J. H. Baxter. 
Ausonius. H. G. Evelyn White. 2 Vols. 
Bede. J. E. King. 2 Vols. 
Boethius: Tracts and De Consolatione Philosophiae. 

Rev. H. F. Stewart and E. K. Rand. 
Caesar: Alexandrine, African and Spanish Wars. 

A. G. Way. 
Caesar: Civil Wars. A. G. Peskett. 
Caesar: Gallic War. H. J. Edwards. 
Cato and Varro: De Re Rustica. H. B. Ash and W. D. 

Hooper. 
Catullus. F. W. Cornish ; Tibullus. J. B. Postgate ; 

Pervigilium Veneris. J. W. Mackail. 
Celsus: De Medicina. W. G. Spencer. 3 Vols. 
[Cicero]: Rhetorica ad Herennium. H. Caplan. 
Cicero: Brutus and Orator. G. L. Hendrickson and 

H. M. Hubbell. 
Cicero :DeFato; ParadoxaStoicorum; DePartitione 

Oratoria. H. Rackham. (With De Oratore, Vol. IT.) 
Cicero: De Finibus. H. Rackham. 
Cicero: De Inventions, etc. H. M. Hubbell. 

1 



THE LOEB CLASSICAL LIBRARY 

Cicero: De Natura Deorum and Academica. H. 

Rackham. 
Cicero: De Officiis. Walter Miller. 
Cicero: De Oratore. E. W. Sutton and H. Rackham. 

2 Vols. 

Cicero: De Republica and De Legibus. Clinton W. 

Keyes. 
Cicero: De Senectute, De Amicitia, De Divlnatione. 

W. A. Falconer. 
Cicero: In Catilinam, Pro Murena, Pro Sulla, Pro 

Flacco. Louis E. Lord. 
Cicero: Letters to Atticus. E. O. Winstedt. 3 Vols. 
Cicero: Letters to his Friends. W. Glynn Williams. 

3 Vols. 

Cicero: Philippics. W. C. A. Ker. 

Cicero: Pro Archia, Post Redittjm, De Domo, De 

Haruspictjm Responsis, Pro Plancio. N. H. Watts. 
Cicero: Pro Caecina, Pro Lege Manilia, Pro Cluentio, 

Pro Rabirio. H. Grose Hodge. 
Cicero: Pro Milone, In Pisonem, Pro Scauro, Pro 

Fonteio, Pro Rabirio Postumo, Pro Marcello, Pro 

Ligario, Pro Rege Deiotaro. N. H. Watts. 
Cicero: Pro Quinctio, Pro Roscio Amerino, Pro Roscio 

Comoedo, Contra Rullum. J. H. Freese. 
Cicero: Pro Sestio, In Vatinium. R. Gardner. 
Cicero: Tttsculan Disputations. J. E. King. 
Cicero: Verrine Orations. L. H. G. Greenwood. 2 Vols. 
Claudian. M. Platnauer. 2 Vols. 
Colume; la: De Re Rustica, De Arboribus. H. B. Ash, 

E. S. Forster and E. Heffner. 3 Vols. 
Curtius, Q: History or Alexander. J. C. Rolfe. 2 Vols. 
Florus. E. S. Forster; and Cornelius Nepos. J. C. Rolfe. 
Frontinus: Stratagems and Aqueducts. C.E.Bennett 

and M. B. McElwain. 
Fronto: Correspondence. C. R. Haines. 2 Vols. 
Gellius. J. C. Rolfe. 3 Vols. 
Horace: Odes and Epodes. C. E. Bennett. 
Horace: Satires, Epistles, Ars Poetica. H. R. 

Fairclough. 
Jerome: Select Letters. F. A. Wright. 
Juvenal and Persius. G. G. Ramsay. 

2 



THE LOEB CLASSICAL LIBRARY 

Livy. B. O. Foster, F. G. Moore, Evan T. Sage and A. C. 

Schlesinger and R. M. Geer (General Index). 14 Vols. 
Lucan. J. D. Duff. 
Lucretius. W. H. D. Rouse. 
Martial. W. C. A. Ker. 2 Vols. 
Minor Latin Poets: from Publilius Syrus to Rutilius 

Namatianus, including Grattius, Calpurnius Siculus, 

Nemesianus, Avianus, with " Aetna," "Phoenix " and 

other poems. J. Wight Duff and Arnold M. Duff. 
Ovid: The Art of Love and Other Poems. J. H. Mozley. 
Ovid: Fasti. Sir James G. Frazer. 
Ovid : Heroides and Amores. Grant Showerman. 
Ovid : Metamorphoses. F. J. Miller. 2 Vols. 
Ovid: Tristia and Ex Ponto. A. L. Wheeler. 
Petronius. M. Heseltine; Seneca Apocolocyntosis. 

W. H. D. Rouse. 
Plautus. Paul Nixon. 5 Vols. 
Pliny: Letters. Melmoth's translation revised by W. M. 

L. Hutchinson. 2 Vols. 
Pliny: Natural History. H. Rackham and W. H. S. 

Jones. 10 Vols. Vols. I-V and IX, H. Rackham. Vols. VI 

and VII W. H. S. Jones. 
Propertius. H. E. Butler. 
Prudentius. H. J. Thomson. 2 Vols. 
Quintilian. H. E. Butler. 4 Vols. 
Remains of Old Latin. E. H. Warmington. 4 Vols. Vol. I. 

(Ennius and Caccilius.) Vol. II. (Livius, Naevius, 

Pacuvius, Accius.) Vol. III. (Lucilius, Laws of XII 

Tables.) Vol. IV. (Archaic Inscriptions.) 
Sallust. J. C. Rolfe. 

Scriptores Historiae Augustae. D. Magie. 3 Vols. 
Seneca: Apocolocyntosis. Cf. Petronius. 
Seneca: Epistulae Morales. R. M. Gummere. 3 Vols. 
Seneca: Moral Essays. J. W. Basore. 3 Vols. 
Seneca: Tragedies. F. J. Miller. 2 Vols. 
Sidonius: Poems and Letters. W. B. Anderson. 2 Vols. 
Silius Italicus. J. D. Duff. 2 Vols. 
Statius. J. H. Mozley. 2 Vols. 
Suetonius. J. C. Rolfo. 2 Vols. 

Tacitus: Dialogus. Sir Win. Peterson; and Agricola 
and Germania. Maurice Hutton. 

3 



THE LOEB CLASSICAL LIBRARY 

Tacitus: Histories and Annals. C. H. Moore and J. 

Jackson. 4 Vols. 
Terence. John Sargeaunt. 2 Vols. 
Tertullian: Apologia and De Spectaculis. T. R. 

Glover; Minucius Felix. G. H. Rendall. 
Valerius Flaccus. J. H. Mozley. 
Varro: De Lingua Latina. R. G. Kent. 2 Vols. 
Velleius Paterculus and Res Gestae Divi Augusti. 

F. W. Shipley. 
Virgil. H. R. Fairclough. 2 Vols. 
Vitruvius: De Architectura. F. Granger 2 Vols. 



greek authors 



Achilles Tatius. S. Gaselee. 

Aelian: On the Nature of Animals. 3 Vols. Vols. I. II. 
and III, A. F. Scholfield. 

Aeneas Tacitus, Asclepiodotus and Onasander. The 
Illinois Greek Club. 

Aeschines. C. D. Adams. 

Aeschylus. H. Weir Smyth. 2 Vols. 

Alciphron, Aelian and Philostratus: Letters. A. R. 
Benner and F. H. Fobes. 

Apollodorus. Sir James G. Frazer. 2 Vols. 

Apollonius Rhodius. R. C. Seaton. 

The Apostolic Fathers. Kirsopp Lake. 2 Vols. 

Appian's Roman History. Horace White. 4 Vols. 

Aratus. Cf. Callimachus. 

Aristophanes. Benjamin Bickley Rogers. 3 Vols. Verse 
trans. 

Aristotle: Art op Rhetoric. J. H. Freese. 

Aristotle: Athenian Constitution, Eudemian Ethics, 
Virtues and Vices. H. Rackham. 

Aristotle: Generation of Animals. A. L. Peck. 

Aristotle: Metaphysics. H. Tredennick. 2 Vols. 

Aristotle: Meteorologica. H. D. P. Lee. 

Aristotle: Minor Works. W. S. Hett. "On Colours", "On 
Things Heard", "Physiognomies", "On Plants", "On 
Marvellous Things Heard", "Mechanical Problems", "On 
Indivisible Lines", "Situations and Names of Winds", 
"On Melissus, Xenophanes, and Gorgias". 

Aristotle: Nicomachean Ethics. H. Rackham. 



THE LOEB CLASSICAL LIBRARY 

Aristotle: Oeconomica and Magna Moralia. G. C. 

Armstrong. (With Metaphysics, Vol. II.) 
Aristotle: On the Heavens. W. K. C. Guthrie. 
Aristotle: On the Soul, Parva Naturalia, On Breath. 

W. S. Hett. 
Aristotle: Organon — Categories, On Interpreta- 
tion, Prior Analytics. H. P. Cooke and H. Tredennick. 
Aristotle: Organon — Posterior Analytics, Topics. 

H. Tredennick and E. S. Forster. 
Aristotle: Organon — On Sophistical Refutations, 

On Coming to be and Passing Away, On the Cosmos. 

E. S. Forster and D. J. Furley. 
Aristotle: Parts of Animals. A. L. Peck; Motion and 

Progression of Animals. E. S. Forster. 
Aristotle: Physics. Rev. P. Wicksteed and F M. 

Cornford. 2 Vols. 
Aristotle: Poetics and Longinus. W. Hamilton Fyfe; 

Demetrius on Style. W. Rhys Roberts. 
Aristotle: Politics. H. Rackham. 
Aristotle: Problems. W. S. Hett. 2 Vols. 
Aristotle: Rhetorica ad Alexandrum. H. Rackham. 

(With Problems. Vol. II.) 
Arrian: History of Alexander and Indica. Rev. E. 

Iliffe Robson. 2 Vols. 
Athenaeus: Deipnosophistae. C. B. Gulick. 7 Vols. 
St. Basil: Letters. R. J. Deferrari. 4 Vols. 
Callimachus: Fragments. C. A. Trypanis. 
Callimachus and Lycophron. A. W~. Mair; Aratus. 

G. R. Mair. 
Clement of Alexandria. Rev. G. W. Butterworth. 
Colluthus. Cf. Oppian. 
Daphnis and Chloe. Cf. Longus. 
Demosthenes I: Olynthiacs, Philippics and Minor 

Orations. I. -XVII. and XX. J. H. Vince. 
Dkmosthenes II: De Corona and De Falsa Legatione. 

C. A. Vince and J. H. Vince. 
Demosthenes III: Meidias, Androtion, Aristocrates, 

Timocrates, Aristogeiton. J. H. Vince. 
Demosthenes IV- VI: Private Orations and In 

Neaeram. A. T. Murray. 
Demosthenfs VII: Funeral Speech, Erotic Essay, 

Exordia and Letters. N. W. and N. J. DeWitt. 



THE LOEB CLASSICAL LIBRARY 

Dio Cassius: Roman History. E. Cary. 9 Vols. 

Dio Chrysostom. J. W. Cohoon and H. Lamar Crosby. 

5 Vols. 
Diodorus Siculus. 12 Vols. Vols. I. -VI. C. H. Oldfather. 

Vol. VII. C. L. Sherman. Vols. IX. and X. R. M. Geer. 

Vol. XI. F. Walton. 
Diogenes Laertius. R. D. Hicks. 2 Vols 
Dionysius of Halicarnassus: Roman Antiquities. 

Spelman's translation revised by E. Cary. 7 Vols. 
Epictetus. W. A. Oldfather. 2 Vols. 
Euripides. A. S. Way. 4 Vols. Verse trans. 
Eusebius: Ecclesiastical History. Kirsopp Lake and 

J. E. L. Oulton. 2 Vols. 
Galen: On the Natural Faculties. A. J. Brock. 
The Greek Anthology. W. R. Paton. 5 Vols. 
The Greek Bucolic Poets (Theocritus, Bion, Moschus). 

J. M. Edmonds. 
Greek Elegy and Iambus with the Anacreontea. 

J. M. Edmonds. 2 Vols. 
Greek Mathematical Works. Ivor Thomas. 2 Vols. 
Herodes. Cf. Theophrastus: Characters. 
Herodotus. A. D. Godley. 4 Vols. 

Hesiod and the Homeric Hymns. H. G. Evelyn White. 
Hippocrates and the Fragments or Heracleitus. W. H. 

S. Jones and E. T. Withington. 4 Vols. 
Homer: Iliad. A. T. Murray. 2 Vols. 
Homer: Odyssey. A. T. Murray. 2 Vols. 
Isaeus. E. S. Forster. 

Isocrates. George Norlin and LaRue Van Hook. 3 Vols. 
St. John Damascene: Barlaam and Ioasaph. Rev. 

G. R. Woodward and Harold Mattingly. 
Josephus. H. St. J. Thackeray and Ralph Marcus. 9 Vols. 

Vols. I. -VII. 
Julian. Wilmer Cave Wright. 3 Vols. 
Longus: Daphnis and Chloe. Thornley's translation 

revised by J. M. Edmonds; and Parthenius. S. Gaselee. 
Lucian. Vols. I.-V. A. M. Harmon ; Vol. VI. K. Kilburn. 

Vol. VII, M. D. Macleod. 8 Vols. 
Lycophron. Cf. Callimachus. 
Lyra Graeca. J. M. Edmonds. Vols. 
Lysias. W. R. M. Lamb. 

C 



THE LOEB CLASSICAL LIBRARY 

Manetho. W. G. Waddell: Ptolemy: Tetrabiblos. 

F. E. Robbins. 
Marcus Aurelius. C. R. Haines. 
Menander. F. G. Allinson. 
Minor Attic Orators. K. J. Maidment and J. O. Burtt. 

2 Vols. 
Nonnos: Dionysiaca. W. H. D. Rouse. 3 Vols. 
Oppian, Colluthus, Tryphiodorus. A. W. Mair. 
Papyri. 5 Vols. Non-Literary Selections. A. S. Hunt 

and C. C. Edgar. 2 Vols. Literary Selections Vol. I. 

(Poetry). D. L. Page. 
Parthenius. Cf. Longus. 
Pausanius: Description of Greece. W. H. S. Jones. 5 

Vols, and Companion Vol. arranged by R. E. Wycherley. 
Philo. 10 Vols. Vols. I.-V. F. H. Colson and Rev. G. H. 

Whitaker; Vols. VI. -IX. F. H. Colson. 
Philo. 2 supplementary Vols. (Translation only.) Vols. I. 

and II. R. Marcus. 
Philostratus: The Life of Apollonitjs of Tyana. 

F. C. Coneybearo. 2 Vols. 
Philostratus: Imagines; Callistratus: Descriptions. 

A. Fairbanks. 
Philostratus and Eunapius: Lives of the Sophists. 

Wilmer Cave Wright. 
Pindar. Sir J. E. Sandys. 
Plato: Charmioes, Alcibiades, Hipparchus, The 

Lovers, Theages, Minos and Epinomis. W. R. M. Lamb. 
Plato: Cratylus, Parmenides, Greater Hippias, 

Lesser Hippias. H. N. Fowler. 
Plato: Euthyphro, Apology, Crito, Phaedo, Phaed- 

rus. H. N. Fowler. 
Plato: Laches, Protagoras, Meno, Euthydemus. 

W. R. M. Lamb. 
Plato: Laws. Rev. R. G. Bury. 2 Vols. 
Plato: Lysis, Symposium, Gorgias. W. R. M. Lamb. 
Plato: Republic. Paul Shorey. 2 Vols. 
Plato: Statesman, Philebus. H. N. Fowler; Ion. 

W. R. M. Lamb. 
Plato: Theaetetus and Sophist. H. N. Fowler. 
Plato: Timaeus, (kitias, Clitopho, Menexenus, Epis- 

tulae. Rev. R. G. Bury. 

7 



THE LOEB CLASSICAL LIBRARY 

Plutarch: Moralia. 14 Vols. Vols. I.-V. F. C. Babbitt; 
Vol. VI. W. C. Helmbold; Vol. VII. P. H. De Lacy and 
B. Einarson; Vol. IX. E. L. Minar, Jr., F. H. Sandbach, 
W. C. Helmbold; Vol. X. H. N. Fowler; Vol. XII. H. 
Cherniss and W. C. Helmbold. 

Plutarch: The Parallel Lives. B. Perrin. 11 Vols. 

Polybius. W. R. Paton. C Vols. 

Procopius: History ofthe Wars. H.B. Dewing. 7 Vols. 

Ptolemy: Tetrabiblos. Cf. Manetho. 

Quintus Smyrnaeus. A. S. Way. Verse trans. 

Sextus Empiricus. Rev. R. G. Bury. 4 Vols. 

Sophocles. F. Storr. 2 Vols. Verse trans. 

Strabo: Geography. Horace L. Jones. 8 Vols. 

Theophrastus: Characters. J. M. Edmonds. Herodes, 
etc. A. D. Knox. 

Theophrastus: Enquiry into Plants. Sir Arthur Hort. 
2 Vols. 

Thucydides. C. F. Smith. 4 Vols. 

Tryphiodorus. Cf. Oppian. 

Xenophon: Cyropaedia. Waltor Miha . 2 Vols. 

Xenophon: Hellenica, Anabasis, Apology, and Sym- 
posium. C. L. Brownson and O. J. Todd. 3 Vols. 

Xenophon: Memorabilia and Oeconomicus. E. C. 
Marchant. 

Xenophon: Scripta Minora. E. C. Marchant. 



VOLUMES IN PREPARATION 



GREEK AUTHORS 



Aristotle: History of Animals. A. L. Peck. 
Plotinus. A. H. Armstrong. 

latin authors 

St. Augustine: City of God. 
Babrius and Phaedrus. B. E. Perry. 

descriptive prospectus on application 

london william heinemann ltd. 

cambridge, mass. harvard university press 

8 



Hippocrates 

Kipi ocrates 



PA 
hOU, 

.A2 
J6. 

v.3