ON AIRS, WATERS, AND PLACES - Περὶ ἀέρων, ὑδάτων, τόπων

1. Ἰητρικὴν ὅστις βούλεται ὀρθῶς ζητεῖν, τάδε χρὴ ποιεῖν· πρῶτον μὲν ἐνθυμεῖσθαι τὰς ὥρας τοῦ ἔτεος, ὅ τι δύναται ἀπεργάζεσθαι ἑκάστη· οὐ γὰρ ἐοίκασιν ἀλλήλοισιν οὐδέν, ἀλλὰ πολὺ διαφέρουσιν αὐταί τε ἐφ᾽ ἑωυτέων καὶ ἐν τῇσι μεταβολῇσιν· ἔπειτα δὲ τὰ πνεύματα τὰ θερμά τε καὶ τὰ ψυχρά, μάλιστα μὲν τὰ κοινὰ πᾶσιν ἀνθρώποισιν, ἔπειτα δὲ καὶ τὰ ἐν ἑκάστῃ χώρῃ ἐπιχώρια ἐόντα. δεῖ δὲ καὶ τῶν ὑδάτων ἐνθυ μεῖσθαι τὰς δυνάμιας· ὥσπερ γὰρ ἐν τῷ στόματι διαφέρουσι καὶ ἐν τῷ σταθμῷ, οὕτω καὶ ἡ δύναμις διαφέρει πολὺ ἑκάστου. ὥστε ἐς πόλιν ἐπειδὰν ἀφίκηταί τις, ἧς ἄπειρός ἐστι, διαφροντίσαι χρὴ τὴν θέσιν αὐτῆς, ὅκως κεῖται καὶ πρὸς τὰ πνεύματα καὶ πρὸς τὰς ἀνατολὰς τοῦ ἡλίου. οὐ γὰρ τωὐτὸ δύναται ἥτις πρὸς βορέην κεῖται καὶ ἥτις πρὸς νότον οὐδ᾽ ἥτις πρὸς ἥλιον ἀνίσχοντα οὐδ᾽ ἥτις πρὸς δύνοντα. ταῦτα δὲ χρὴ ἐνθυμεῖσθαι ὡς κάλλιστα καὶ τῶν ὑδάτων πέρι ὡς ἔχουσι, καὶ πότερον ἑλώδεσι χρέονται καὶ μαλθακοῖσιν ἢ σκληροῖσί τε καὶ ἐκ μετεώρων καὶ πετρωδέων εἴτε ἁλυκοῖσι καὶ ἀτεράμνοισιν· καὶ τὴν γῆν, πότερον ψιλή τε καὶ ἄνυδρος ἢ δασεῖα καὶ ἔφυδρος καὶ εἴτε ἔγκοιλός ἐστι καὶ πνιγηρὴ εἴτε μετέωρος καὶ ψυχρή· καὶ τὴν δίαιταν τῶν ἀνθρώπων, ὁκοίῃ ἥδονται, πότερον φιλοπόται καὶ ἀριστηταὶ καὶ ἀταλαίπωροι ἢ φιλογυμνασταί τε καὶ φιλόπονοι καὶ ἐδωδοὶ καὶ ἄποτοι.

1. Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces (for they are not at all alike, but differ much from themselves in regard to their changes). Then the winds, the hot and the cold, especially such as are common to all countries, and then such as are peculiar to each locality. We must also consider the qualities of the waters, for as they differ from one another in taste and weight, so also do they differ much in their qualities. In the same manner, when one comes into a city to which he is a stranger, he ought to consider its situation, how it lies as to the winds and the rising of the sun; for its influence is not the same whether it lies to the north or the south, to the rising or to the setting sun. These things one ought to consider most attentively, and concerning the waters which the inhabitants use, whether they be marshy and soft, or hard, and running from elevated and rocky situations, and then if saltish and unfit for cooking; and the ground, whether it be naked and deficient in water, or wooded and well watered, and whether it lies in a hollow, confined situation, or is elevated and cold; and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labor, and not given to excess in eating and drinking.

2. Καὶ ἀπὸ τούτων χρὴ ἐνθυμεῖσθαι ἕκαστα. εἰ γὰρ ταῦτα εἰδείη τις καλῶς, μάλιστα μὲν πάντα, εἰ δὲ μή, τά γε πλεῖστα, οὐκ ἂν αὐτὸν λανθάνοι ἐς πόλιν ἀφικνεόμενον, ἧς ἂν ἄπειρος ᾖ, οὔτε νοσήματα ἐπιχώρια οὔτε τῶν κοινῶν ἡ φύσις, ὁκοίη τίς ἐστιν· ὥστε μὴ ἀπορεῖσθαι ἐν τῇ θεραπείῃ τῶν νούσων μηδὲ διαμαρτάνειν· ἃ εἰκός ἐστι γίνεσθαι, ἢν μή τις ταῦτα πρότερον εἰδὼς προφροντίσῃ περὶ ἑκάστου· τοῦ δὲ χρόνου προϊόντος καὶ τοῦ ἐνιαυτοῦ λέγοι ἄν, ὁκόσα τε νοσήματα μέλλει πάγκοινα τὴν πόλιν κατασχή σειν ἢ θέρεος ἢ χειμῶνος, ὁκόσα τε ἴδια ἑκάστῳ κίνδυνος γίνεσθαι ἐκ μεταβολῆς τῆς διαίτης. εἰδὼς γὰρ τῶν ὡρέων τὰς μεταβολὰς καὶ τῶν ἄστρων τὰς ἐπιτολάς τε καὶ δύσιας, καθότι ἕκαστον τούτων γίνεται, προειδείη ἂν τὸ ἔτος ὁκοῖόν τι μέλλει γίνεσθαι. οὕτως ἄν τις ἐννοεύμενος καὶ προγινώσκων τοὺς καιροὺς μάλιστ᾽ ἂν εἰδείη περὶ ἑκάστου καὶ τὰ πλεῖστα τυγχάνοι τῆς ὑγιείης καὶ κατορθοίη οὐκ ἐλάχιστα ἐν τῇ τέχνῃ. εἰ δὲ δοκέοι τις ταῦτα μετεωρολόγα εἶναι, εἰ μετασταίη τῆς γνώμης, μάθοι ἄν, ὅτι οὐκ ἐλάχιστον μέρος συμβάλλεται ἀστρονομίη ἐς ἰητρικήν, ἀλλὰ πάνυ πλεῖστον. ἅμα γὰρ τῇσιν ὥρῃσι καὶ αἱ νοῦσοι καὶ αἱ κοιλίαι μεταβάλλουσιν τοῖσιν ἀνθρώποισιν.

2. From these things he must proceed to investigate everything else. For if one knows all these things well, or at least the greater part of them, he cannot miss knowing, when he comes into a strange city, either the diseases peculiar to the place, or the particular nature of common diseases, so that he will not be in doubt as to the treatment of the diseases, or commit mistakes, as is likely to be the case provided one had not previously considered these matters. And in particular, as the season and the year advances, he can tell what epidemic diseases will attack the city, either in summer or in winter, and what each individual will be in danger of experiencing from the change of regimen. For knowing the changes of the seasons, the risings and settings of the stars, how each of them takes place, he will be able to know beforehand what sort of a year is going to ensue. Having made these investigations, and knowing beforehand the seasons, such a one must be acquainted with each particular, and must succeed in the preservation of health, and be by no means unsuccessful in the practice of his art. And if it shall be thought that these things belong rather to meteorology, it will be admitted, on second thoughts, that astronomy contributes not a little, but a very great deal, indeed, to medicine. For with the seasons the digestive organs of men undergo a change.

3. Ὅκως δὲ χρὴ ἕκαστα τῶν προειρημένων σκοπεῖν καὶ βασανίζειν, ἐγὼ φράσω σαφέως. ἥτις μὲν πόλις πρὸς τὰ πνεύματα κεῖται τὰ θερμά — ταῦτα δ᾽ ἐστὶ μεταξὺ τῆς τε χειμερινῆς ἀνατολῆς τοῦ ἡλίου καὶ τῶν δυσμέων τῶν χειμερινῶν — καὶ αὐτῇ ταῦτα τὰ πνεύματά ἐστι σύννομα, τῶν δὲ ἀπὸ τῶν ἄρκτων πνευμάτων σκέπη, ἐν ταύτῃ τῇ πόλει ἐστὶ τά τε ὕδατα πολλὰ καὶ ὕφαλα, καὶ ἀνάγκη εἶναι μετέωρα, τοῦ μὲν θέρεος θερμά, τοῦ δὲ χειμῶνος ψυχρά· τούς τε ἀνθρώπους τὰς κεφαλὰς ὑγρὰς ἔχειν καὶ φλεγματώδεας, τάς τε κοιλίας αὐτῶν πυκνὰ ἐκταράσσεσθαι ἀπὸ τῆς κεφαλῆς τοῦ φλέγματος ἐπικαταρρέοντος· τά τε εἴδεα ἐπὶ τὸ πλῆθος αὐτῶν ἀτονώτερα εἶναι· ἐσθίειν δ᾽ οὐκ ἀγαθοὺς εἶναι οὐδὲ πίνειν. ὁκόσοι μὲν γὰρ κεφαλὰς ἀσθενέας ἔχουσιν, οὐκ ἂν εἴησαν ἀγαθοὶ πίνειν· ἡ γὰρ κραιπάλη μᾶλλον πιέζει. νοσήματά τε τάδε ἐπιχώρια εἶναι· πρῶτον μὲν τὰς γυναῖκας νοσερὰς καὶ ῥοώδεας εἶναι· ἔπειτα πολλὰς ἀτόκους ὑπὸ νούσου καὶ οὐ φύσει ἐκτιτρώσκεσθαί τε πυκνά· τοῖσί τε παιδίοισιν ἐπιπίπτειν σπασμούς τε καὶ ἄσθματα καὶ ἃ νομίζουσι τὸ παιδίον ποιεῖν καὶ ἱερὴν νοῦσον εἶναι· τοῖσι δὲ ἀνδράσι δυσεντερίας καὶ διαρροίας καὶ ἠπιάλους καὶ πυρετοὺς πολυχρονίους χειμερινοὺς καὶ ἐπινυκτίδας πολλὰς καὶ αἱμορροΐδας ἐν τῇ ἕδρῃ. πλευρίτιδες δὲ καὶ περιπνευμονίαι καὶ καῦσοι καὶ ὁκόσα ὀξέα νοσήματα νομίζονται εἶναι οὐκ ἐγγίνονται πολλά. οὐ γὰρ οἷόν τε, ὅκου ἂν κοιλίαι ὑγραὶ ἔωσι, τὰς νούσους ταύτας ἰσχύειν. ὀφθαλμίαι τε ἐγγίνονται ὑγραὶ καὶ οὐ χαλεπαί, ὀλιγοχρόνιοι, ἦν μή τι κατάσχῃ νόσημα πάγκοινον ἐκ μεταβολῆς μεγάλης. καὶ ὁκόταν τὰ πεντήκοντα ἔτεα ὑπερβάλωσι, κατάρροοι ἐπιγενόμενοι ἐκ τοῦ ἐγκεφάλου παραπληκτικοὺς ποιέουσι τοὺς ἀνθρώπους, ὁκόταν ἐξαίφνης ἡλιωθέωσι τὴν κεφαλὴν ἢ ῥιγώσωσι. ταῦτα μὲν τὰ νοσήματα αὐτοῖσιν ἐπιχώριά ἐστι. χωρὶς δέ, ἤν τι πάγκοινον κατάσχῃ νόσημα ἐκ μεταβολῆς τῶν ὡρέων, καὶ τούτου μετέχουσιν.

3. But how of the aforementioned things should be investigated and explained, I will now declare in a clear manner. A city that is exposed to hot winds (these are between the wintry rising, and the wintry setting of the sun), and to which these are peculiar, but which is sheltered from the north winds; in such a city the waters will be plenteous and saltish, and as they run from an elevated source, they are necessarily hot in summer, and cold in winter; the heads of the inhabitants are of a humid and pituitous constitution, and their bellies subject to frequent disorders, owing to the phlegm running down from the head; the forms of their bodies, for the most part, are rather flabby; they do not eat nor drink much; drinking wine in particular, and more especially if carried to intoxication, is oppressive to them; and the following diseases are peculiar to the district: in the first place, the women are sickly and subject to excessive menstrua- tion; then many are unfruitful from disease, and not from nature, and they have frequent miscarriages; infants are subject to attacks of convulsions and asthma, which they consider to be connected with infancy, and hold to be a sacred disease (epilepsy). The men are subject to attacks of dysentery, diarrhea, hepialus, chronic fevers in winter, of epinyctis, frequently, and of hemorrhoids about the anus. Pleurisies, peripneumonies, ardent fevers, and whatever diseases are reckoned acute, do not often occur, for such diseases are not apt to prevail where the bowels are loose. Ophthalmies occur of a humid character, but not of a serious nature, and of short duration, unless they attack epidemically from the change of the seasons. And when they pass their fiftieth year, defluxions supervening from the brain, render them paralytic when exposed suddenly to strokes of the sun, or to cold. These diseases are endemic to them, and, moreover, if any epidemic disease connected with the change of the seasons, prevail, they are also liable to it.

4. Ὁκόσαι δ᾽ ἀντικέονται τούτων πρὸς τὰ πνεύματα τὰ ψυχρὰ τὰ μεταξὺ τῶν δυσμέων τῶν θερινῶν τοῦ ἡλίου καὶ τῆς ἀνατολῆς τῆς θερινῆς, καὶ αὐτῇσι ταῦτα τὰ πνεύματα ἐπιχώριά ἐστι, τοῦ δὲ νότου καὶ τῶν θερμῶν πνευμάτων σκέπη, ὧδε ἔχει περὶ τῶν πολίων τούτων· πρῶτον μὲν τὰ ὕδατα σκληρά τε καὶ ψυχρὰ ὡς ἐπὶ τὸ πλῆθος ἐγγίνεται. τοὺς δὲ ἀνθρώπους εὐτόνους τε καὶ σκελιφροὺς ἀνάγκη εἶναι, τούς τε πλείους τὰς κοιλίας ἀτεράμνους ἔχειν καὶ σκληρὰς τὰς κάτω, τὰς δὲ ἄνω εὐροωτέρας· χολώδεάς τε μᾶλλον ἢ φλεγματίας εἶναι. τὰς δὲ κεφαλὰς ὑγιηρὰς ἔχουσι καὶ σκληράς· ῥηγματίαι τέ εἰσιν ἐπὶ τὸ πλῆθος. νοσεύματα δὲ αὐτοῖσιν ἐπιδημεῖ τάδε· πλευρίτιδές τε πολλαὶ αἵ τε ὀξεῖαι νομιζόμεναι νοῦσοι. ἀνάγκη δὲ ὧδε ἔχειν, ὁκόταν αἱ κοιλίαι σκληραὶ ἔωσιν· ἔμπυοί τε πολλοὶ γίνονται ἀπὸ πάσης προφάσιος. τούτου δὲ αἴτιόν ἐστι τοῦ σώματος ἡ ἔντασις καὶ ἡ σκληρότης τῆς κοιλίης. ἡ γὰρ ξηρότης ῥηγματίας ποιεῖ εἶναι καὶ τοῦ ὕδατος ἡ ψυχρότης. ἐδωδοὺς δὲ ἀνάγκη τὰς τοιαύτας φύσιας εἶναι καὶ οὐ πολυπότας· οὐ γὰρ οἷόν τε ἅμα πολυβόρους τε εἶναι καὶ πολυπότας· ὀφθαλμίας τε γίνεσθαι μὲν διὰ χρόνου, γίνεσθαι δὲ σκληρὰς καὶ ἰσχυράς, καὶ εὐθέως ῥήγνυσθαι τὰ ὄμματα· αἱμορροίας δὲ ἐκ τῶν ῥινῶν τοῖσι νεωτέροισι τριήκοντα ἐτέων γίνεσθαι ἰσχυρὰς τοῦ θέρεος· τά τε ἱερὰ νοσεύματα καλεύμενα, ὀλίγα μὲν ταῦτα, ἰσχυρὰ δέ. μακροβίους δὲ τοὺς ἀνθρώπους τούτους μᾶλλον εἰκὸς εἶναι τῶν ἑτέρων· τά τε ἕλκεα οὐ φλεγματώδεα ἐγγίνεσθαι οὐδὲ ἀγριοῦσθαι· τά τε ἤθεα ἀγριώτερα ἢ ἡμερώτερα. τοῖσι μὲν ἀνδράσι ταῦτα τὰ νοσήματα ἐπιχώριά ἐστι· καὶ χωρίς, ἤν τι πάγκοινον κατάσχῃ ἐκ μεταβολῆς τῶν ὡρέων· τῇσι δὲ γυναιξί· πρῶτον μὲν στερίφαι πολλαὶ γίνονται διὰ τὰ ὕδατα ἐόντα σκληρά τε καὶ ἀτέραμνα καὶ ψυχρά. αἱ γὰρ καθάρσιες οὐκ ἐπιγίνονται τῶν ἐπιμηνίων ἐπιτήδειαι, ἀλλὰ ὀλίγαι καὶ πονηραί. ἔπειτα τίκτουσι χαλεπῶς· ἐκτιτρώσκουσι δὲ οὐ σφόδρα. ὁκόταν δὲ τέκωσι, τὰ παιδία ἀδύνατοι τρέφειν εἰσί· τὸ γὰρ γάλα ἀποσβέννυται ἀπὸ τῶν ὑδάτων τῆς σκληρότητος καὶ ἀτεραμνίης· φθίσιές τε γίνονται συχναὶ ἀπὸ τῶν τοκετῶν. ὑπὸ γὰρ βίης ῥήγματα ἴσχουσι καὶ σπάσματα. τοῖς δὲ παιδίοισιν ὕδρωπες ἐγγίνονται ἐν τοῖσιν ὄρχεσιν, ἕως μικρὰ ᾖ· ἔπειτα προϊούσης τῆς ἡλικίης ἀφανί ζονται· ἡβῶσί τε ὀψὲ ἐν ταύτῃ τῇ πόλει.

4. But the following is the condition of cities which have the opposite exposure, namely, to cold winds, between the summer settings and the summer risings of the sun, and to which these winds are peculiar, and which are sheltered from the south and the hot breezes. In the first place the waters are, for the most part, hard cold. The men must necessarily be well braced and slender, and they must have the discharges downwards of the alimentary canal hard, and of difficult evacuation, while those upwards are more fluid, and rather bilious than pituitous. Their heads are sound and hard, and they are liable to burstings (of vessels?) for the most part. The diseases which prevail epidemically with them, are pleurisies, and those which are called acute diseases. This must be the case when the bowels are bound; and from any causes, many become affected with suppurations in the lungs, the cause of which is the tension of the body, and hardness of the bowels; for their dryness and the coldness of the water dispose them to ruptures (of vessels?). Such constitutions must be given to excess of eating, but not of drinking; for it is not possible to be gourmands and drunkards at the same time. Ophthalmies, too, at length supervene; these being of a hard and violent nature, and soon ending in rupture of the eyes; persons under thirty years of age are liable to severe bleedings at the nose in summer; attacks of epilepsy are rare but severe. Such people are likely to be rather long-lived; their ulcers are not attended with serious discharges, nor of a malignant character; in disposition they are rather ferocious than gentle. The diseases I have mentioned are peculiar to the men, and besides they are liable to any common complaint which may be prevailing from the changes of the seasons. But the women, in the first place, are of a hard constitution, from the waters being hard, indigestible, and cold; and their menstrual discharges are not regular, but in small quantity, and painful. Then they have difficult parturition, but are not very subject to abortions. And when they do bring forth children, they are unable to nurse them; for the hardness and indigestable nature of the water puts away their milk. Phthisis frequently supervenes after childbirth, for the efforts of it frequently bring on ruptures and strains. Children while still little are subject to dropsies in the testicle, which disappear as they grow older; in such a town they are late in attaining manhood. It is, as I have now stated, with regard to hot and cold winds and cities thus exposed.

5. Περὶ μὲν οὖν τῶν θερμῶν πνευμάτων καὶ τῶν ψυχρῶν καὶ τῶν πολίων τούτων ὧδε ἔχει ὡς προείρηται. ὁκόσαι δὲ κέονται πρὸς τὰ πνεύματα τὰ μεταξὺ τῶν θερινῶν ἀνατολέων τοῦ ἡλίου καὶ τῶν χειμερινῶν καὶ ὁκόσαι τὸ ἐναντίον τούτων, ὧδε ἔχει περὶ αὐτέων· ὁκόσαι μὲν πρὸς τὰς ἀνατολὰς τοῦ ἡλίου κέονται, ταύτας εἰκὸς εἶναι ὑγιεινοτέρας τῶν πρὸς τὰς ἄρκτους ἐστραμμένων καὶ τῶν πρὸς τὰ θερμά, ἢν καὶ στάδιον τὸ μεταξὺ ᾖ. πρῶτον μὲν γὰρ μετριώτερον ἔχει τὸ θερμὸν καὶ τὸ ψυχρόν· ἔπειτα τὰ ὕδατα, ὁκόσα πρὸς τὰς τοῦ ἡλίου ἀνατολάς ἐστι, ταῦτα λαμπρά τε εἶναι ἀνάγκη καὶ εὐώδεα καὶ μαλθακὰ καὶ ἐρατεινὰ ἐγγίνεσθαι ἐν ταύτῃ τῇ πόλει· ὁ γὰρ ἥλιος κωλύει ἀνίσχων καὶ καταλάμπων. τὸ γὰρ ἑωθινὸν ἑκάστοτε αὐτὸς ὁ ἠὴρ ἐπέχει ὡς ἐπὶ τὸ πολύ. τά τε εἴδεα τῶν ἀνθρώπων εὔχροά τε καὶ ἀνθηρά ἐστι μᾶλλον ἢ ἄλλῃ ἢν μή τις νοῦσος κωλύῃ. λαμπρόφωνοί τε οἱ ἄνθρωποι ὀργήν τε καὶ σύνεσιν βελτίους εἰσὶ τῶν προσβορείων, ᾗπερ καὶ τὰ ἄλλα τὰ ἐμφυόμενα ἀμείνω ἐστίν. ἔοικέ τε μάλιστα ἡ οὕτω κειμένη πόλις ἦρι κατὰ τὴν μετριότητα τοῦ θερμοῦ καὶ τοῦ ψυχροῦ· τά τε νοσεύματα ἐλάσσω μὲν γίνεται καὶ ἀσθενέστερα, ἔοικε δὲ τοῖς ἐν τῇσι πόλεσι γενομένοις νοσεύμασι τῇσι πρὸς τὰ θερμὰ πνεύματα ἐστραμμένῃσιν. αἵ τε γυναῖκες αὐτόθι ἀρικύμονές εἰσι σφόδρα καὶ τίκτουσι ῥηϊδίως.

5. Cities that are exposed to winds between the summer and the winter risings of the sun, and those the opposite to them, have the following characters:- Those which lie to the rising of the sun are all likely to be more healthy than such as are turned to the North, or those exposed to the hot winds, even if there should not be a furlong between them. In the first place, both the heat and cold are more moderate. Then such waters as flow to the rising sun, must necessarily be clear, fragrant, soft, and delightful to drink, in such a city. For the sun in rising and shining upon them purifies them, by dispelling the vapors which generally prevail in the morning. The persons of the inhabitants are, for the most part, well colored and blooming, unless some disease counteract. The inhabitants have clear voices, and in temper and intellect are superior to those which are exposed to the north, and all the productions of the country in like manner are better. A city so situated resembles the spring as to moderation between heat and cold, and the diseases are few in number, and of a feeble kind, and bear a resemblance to the diseases which prevail in regions exposed to hot winds. The women there are very prolific, and have easy deliveries. Thus it is with regard to them.

6. Περὶ μὲν τούτων ὧδε ἔχει. ὁκόσαι δὲ πρὸς τὰς δύσιας κεῖνται καὶ αὐτῇσίν ἐστι σκέπη τῶν πνευμάτων τῶν ἀπὸ τῆς ἠοῦς πνεόντων τά τε θερμὰ πνεύματα παραρρεῖ καὶ τὰ ψυχρὰ ἀπὸ τῶν ἄρκτων, ἀνάγκη ταύτας τὰς πόλιας θέσιν κεῖσθαι νοσερωτάτην. πρῶτον μὲν γὰρ τὰ ὕδατα οὐ λαμπρά· αἴτιον δέ, ὅτι ὁ ἠὴρ τὸ ἑωθινὸν κατέχει ὡς ἐπὶ τὸ πολύ, ὅστις τῷ ὕδατι ἐγκαταμιγνύμενος τὸ λαμπρὸν ἀφανίζει· ὁ γὰρ ἥλιος πρὶν ἄνω ἀρθῆναι οὐκ ἐπιλάμπει. τοῦ δὲ θέρεος ἕωθεν μὲν αὖραι ψυχραὶ πνέουσι καὶ δρόσοι πίπτουσι· τὸ δὲ λοιπὸν ἥλιος ἐγκαταδύνων ὥστε μάλιστα διέψει τοὺς ἀνθρώπους, διὸ καὶ ἀχρόους τε εἰκὸς εἶναι καὶ ἀρρώστους, τῶν τε νοσευμάτων πάντων μετέχειν μέρος τῶν προειρημένων· οὐδὲν γὰρ αὐτοῖς ἀποκέκριται. βαρυφώνους τε εἰκὸς εἶναι καὶ βραγχώδεας διὰ τὸν ἠέρα, ὅτι ἀκάθαρτος ὡς ἐπὶ τὸ πολὺ αὐτόθι γίνεται καὶ νοσώδης· οὔτε γὰρ ὑπὸ τῶν βορείων ἐκκρίνεται σφόδρα· οὐ γὰρ προς έχουσι τὰ πνεύματα· ἅ τε προσέχουσιν αὐτοῖσι καὶ πρόσκεινται ὑδατεινότατά ἐστιν· ἐπεὶ τοιαῦτα τὰ ἀπὸ τῆς ἑσπέρης πνεύματα· ἔοικέν τε μετοπώρῳ μάλιστα ἡ θέσις ἡ τοιαύτη τῆς πόλιος κατὰ τὰς τῆς ἡμέρης μεταβολάς, ὅτι πολὺ τὸ μέσον γίνεται τοῦ τε ἑωθινοῦ καὶ τοῦ πρὸς τὴν δείλην.

6. But such cities as lie to the west, and which are sheltered from winds blowing from the east, and which the hot winds and the cold winds of the north scarcely touch, must necessarily be in a very unhealthy situation: in the first place the waters are not clear, the cause of which is, because the mist prevails commonly in the morning, and it is mixed up with the water and destroys its clearness, for the sun does not shine upon the water until he be considerably raised above the horizon. And in summer, cold breezes from the east blow and dews fall; and in the latter part of the day the setting sun particularly scorches the inhabitants, and therefore they are pale and enfeebled, and are partly subject to all the aforesaid diseases, but no one is peculiar to them. Their voices are rough and hoarse owing to the state of the air, which in such a situation is generally impure and unwholesome, for they have not the northern winds to purify it; and these winds they have are of a very humid character, such being the nature of the evening breezes. Such a situation of a city bears a great resemblance to autumn as regards the changes of the day, inasmuch as the difference between morning and evening is great. So it is with regard to the winds that are conducive to health, or the contrary.

7. Περὶ μὲν πνευμάτων, ἅ τέ ἐστιν ἐπιτήδεια καὶ ἀνεπιτήδεια, ὧδε ἔχει. περὶ δὲ τῶν λοιπῶν ὑδάτων βούλομαι διηγήσασθαι, ἅ τέ ἐστι νοσώδεα καὶ ἃ ὑγιεινότατα καὶ ὁκόσα ἀφ᾽ ὕδατος κακὰ εἰκὸς γίνεσθαι καὶ ὅσα ἀγαθά. πλεῖστον γὰρ μέρος συμβάλλεται ἐς τὴν ὑγιείην. ὁκόσα μὲν οὖν ἐστιν ἑλώδεα καὶ στάσιμα καὶ λιμναῖα, ταῦτα ἀνάγκη τοῦ μὲν θέρεος εἶναι θερμὰ καὶ παχέα καὶ ὀδμὴν ἔχοντα, ἅτε οὐκ ἀπόρρυτα ἐόντα· ἀλλὰ τοῦ τε ὀμβρίου ὕδατος ἐπιφερομένου αἰεὶ νέου τοῦ τε ἡλίου καίοντος ἀνάγκη ἄχροά τε εἶναι καὶ πονηρὰ καὶ χολώδεα, τοῦ δὲ χειμῶνος παγετώδεά τε καὶ ψυχρὰ καὶ τεθολωμένα ὑπό τε χιόνος καὶ παγετῶν, ὥστε φλεγματωδέστατα εἶναι καὶ βραγχωδέστατα. τοῖσι δὲ πίνουσι σπλῆνας μὲν αἰεὶ μεγάλους εἶναι καὶ μεμυωμένους καὶ τὰς γαστέρας σκληράς τε καὶ λεπτὰς καὶ θερμάς, τοὺς δὲ ὤμους καὶ τὰς κληῖδας καὶ τὸ πρόσωπον καταλελεπτύσθαι· ἐς γὰρ τὸν σπλῆνα αἱ σάρκες συντήκον ται, διότι ἰσχνοί εἰσιν· ἐδωδούς τε εἶναι τοὺς τοιούτους καὶ διψηρούς· τάς τε κοιλίας ξηροτάτας τε καὶ θερμοτάτας καὶ τὰς ἄνω καὶ τὰς κάτω ἔχειν, ὥστε τῶν φαρμάκων ἰσχυροτέρων δεῖσθαι. τοῦτο μὲν τὸ νόσημα αὐτοῖσι σύντροφόν ἐστι καὶ θέρεος καὶ χειμῶνος. πρὸς δὲ τούτοισιν οἱ ὕδρωπες πλεῖστοί τε γίνονται καὶ θανατωδέστατοι. τοῦ γὰρ θέρεος δυσεντερίαι τε πολλαὶ ἐμπίπτουσι καὶ διάρροιαι καὶ πυρετοὶ τεταρταῖοι πολυχρόνιοι. ταῦτα δὲ τὰ νοσεύματα μηκυνθέντα τὰς τοιαύτας φύσιας ἐς ὕδρωπας καθίστησι καὶ ἀποκτείνει. ταῦτα μὲν αὐτοῖσι τοῦ θέρεος γίνεται. τοῦ δὲ χειμῶνος τοῖσι νεωτέροισι μὲν περιπνευμονίαι τε καὶ μανιώδεα νοσεύματα, τοῖσι δὲ πρεσβυτέροισι καῦσοι διὰ τὴν τῆς κοιλίης σκληρότητα. τῇσι δὲ γυναιξὶν οἰδήματα ἐγγίνεται καὶ φλέγμα λευκόν, καὶ ἐν γαστρὶ ἴσχουσι μόλις καὶ τίκτουσι χαλεπῶς· μεγάλα τε τὰ ἔμβρυα καὶ οἰδέοντα. ἔπειτα ἐν τῇσι τροφῇσι φθινώδεά τε καὶ πονηρὰ γίνεται· ἥ τε κάθαρσις τῇσι γυναιξὶν οὐκ ἐπιγίνεται χρηστὴ μετὰ τὸν τόκον. τοῖσι δὲ παιδίοισι κῆλαι ἐπιγίνονται μάλιστα καὶ τοῖσιν ἀνδράσι κίρσοι καὶ ἕλκεα ἐν τῇσι κνήμῃσιν, ὥστε τὰς τοιαύτας φύσιας οὐχ οἷόν τε μακροβίους εἶναι, ἀλλὰ προγηράσκειν τοῦ χρόνου τοῦ ἱκνευμένου. ἔτι δὲ αἱ γυναῖκες δοκέουσιν ἔχειν ἐν γαστρί, καὶ ὁκόταν ὁ τόκος ᾖ, ἀφανίζεται τὸ πλήρωμα τῆς γαστρός. τοῦτο δὲ γίνεται, ὁκόταν ὑδρωπιήσωσιν αἱ ὑστέραι. τὰ μὲν τοιαῦτα ὕδατα νομίζω μοχθηρὰ εἶναι πρὸς ἅπαν χρῆμα· δεύτερα δὲ ὅσων εἶεν αἱ πηγαὶ ἐκ πετρέων — σκληρὰ γὰρ ἀνάγκη εἶναι — ἢ ἐκ γῆς, ὅκου θερμὰ ὕδατά ἐστιν, ἢ σίδηρος γίνεται ἢ χαλκὸς ἢ ἄργυρος ἢ χρυσὸς ἢ θεῖον ἢ στυπτηρίη ἢ ἄσφαλτον ἢ νίτρον. ταῦτα γὰρ πάντα ὑπὸ βίης γίνονται τοῦ θερμοῦ. οὐ τοίνυν οἷόν τε ἐκ τοιαύτης γῆς ὕδατα ἀγαθὰ γίνεσθαι, ἀλλὰ σκληρὰ καὶ καυσώδεα διουρεῖσθαί τε χαλεπὰ καὶ πρὸς τὴν διαχώρησιν ἐναντία εἶναι. ἄριστα δὲ ὁκόσα ἐκ μετεώρων χωρίων ῥεῖ καὶ λόφων γεηρῶν. αὐτά τε γάρ ἐστι γλυκέα καὶ λευκὰ καὶ τὸν οἶνον φέρειν ὀλίγον οἷά τέ ἐστιν. τοῦ δὲ χειμῶνος θερμὰ γίνεται, τοῦ δὲ θέρεος ψυχρά. οὕτω γὰρ ἂν εἴη ἐκ βαθυτάτων πηγέων. μάλιστα δὲ ἐπαινέω ὧν τὰ ῥεύματα πρὸς τὰς ἀνατολὰς τοῦ ἡλίου ἐρρώγασι καὶ μᾶλλον πρὸς τὰς θερινάς. ἀνάγκη γὰρ λαμπρότερα εἶναι καὶ εὐώδεα καὶ κοῦφα. ὁκόσα δέ ἐστιν ἁλυκὰ καὶ ἀτέραμνα καὶ σκληρά, ταῦτα μὲν πάντα πίνειν οὐκ ἀγαθά· εἰσὶ δ᾽ ἔνιαι φύσιες καὶ νοσεύματα, ἐς ἃ ἐπιτήδειά ἐστι τὰ τοιαῦτα ὕδατα πινόμενα, περὶ ὧν φράσω αὐτίκα. ἔχει δὲ περὶ τούτων ὧδε· ὁκόσων μὲν αἱ πηγαὶ πρὸς τὰς ἀνατολὰς ἔχουσι, ταῦτα μὲν ἄριστα αὐτὰ ἑωυτῶν ἐστι· δεύτερα δὲ τὰ μεταξὺ τῶν θερινῶν ἀνατολέων ἐστὶ τοῦ ἡλίου καὶ δυσίων, καὶ μᾶλλον τὰ πρὸς τὰς ἀνατολάς· τρίτα δὲ τὰ μεταξὺ τῶν δυσμέων τῶν θερινῶν καὶ τῶν χειμερινῶν· φαυλότατα δὲ τὰ πρὸς τὸν νότον καὶ τὰ μεταξὺ τῆς χειμερινῆς ἀνατολῆς καὶ δύσιος. καὶ ταῦτα τοῖσι μὲν νοτίοισι πάνυ πονηρά, τοῖσι δὲ βορείοισιν ἀμείνω. τούτοισι δὲ πρέπει ὧδε χρῆσθαι· ὅστις μὲν ὑγιαίνει τε καὶ ἔρρωται, μηδεν διακρίνειν, ἀλλὰ πίνειν αἰεὶ τὸ παρεόν. ὅστις δὲ νούσου εἵνεκα βούλεται τὸ ἐπιτηδειότατον πίνειν, ὧδε ἂν ποιέων μάλιστα τυγχάνοι τῆς ὑγιείης· ὁκόσων μὲν αἱ κοιλίαι σκληραί εἰσι καὶ συγκαίειν ἀγαθαί, τούτοισι μὲν τὰ γλυκύτατα συμφέρει καὶ κουφότατα καὶ λαμπρότατα· ὁκόσων δὲ μαλθακαὶ αἱ νηδύες καὶ ὑγραί εἰσι καὶ φλεγματώδεες, τούτοισι δὲ τὰ σκληρότατα καὶ ἀτεραμνότατα καὶ τὰ ὑφαλυκά· οὕτω γὰρ ἂν ξηραίνοιντο μάλιστα. ὁκόσα γὰρ ὕδατά ἐστιν ἕψειν ἄριστα καὶ τακερώτατα, ταῦτα καὶ τὴν κοιλίην διαλύειν εἰκὸς μάλιστα καὶ διατήκειν· ὁκόσα δέ ἐστιν ἀτέραμνα καὶ σκληρὰ καὶ ἥκιστα ἑψανά, ταῦτα δὲ συνίστησι μάλιστα τὰς κοιλίας καὶ ξηραίνει. ἀλλὰ γὰρ ψευσάμενοι εἰσὶν οἱ ἄνθρωποι τῶν ἁλμυρῶν ὑδάτων πέρι δι᾽ ἀπειρίην, καὶ ὅτι νομίζεται διαχωρητικά· τὰ δὲ ἐναντιώτατά ἐστι πρὸς τὴν διαχώρησιν· ἀτέραμνα γὰρ καὶ ἀνέψανα, ὥστε καὶ τὴν κοιλίην ὑπ᾽ αὐτῶν στύφεσθαι μᾶλλον ἢ τήκεσθαι.

7. And I wish to give an account of the other kinds of waters, namely, of such as are wholesome and such as are unwholesome, and what bad and what good effects may be derived from water; for water contributes much towards health. Such waters then as are marshy, stagnant, and belong to lakes, are necessarily hot in summer, thick, and have a strong smell, since they have no current; but being constantly supplied by rain-water, and the sun heating them, they necessarily want their proper color, are unwholesome and form bile; in winter, they become congealed, cold, and muddy with the snow and ice, so that they are most apt to engender phlegm, and bring on hoarseness; those who drink them have large and obstructed spleens, their bellies are hard, emaciated, and hot; and their shoulders, collar-bones, and faces are emaciated; for their flesh is melted down and taken up by the spleen, and hence they are slender; such persons then are voracious and thirsty; their bellies are very dry both above and below, so that they require the strongest medicines. This disease is habitual to them both in summer and in winter, and in addition they are very subject to dropsies of a most fatal character; and in summer dysenteries, diarrheas, and protracted quartan fevers frequently seize them, and these diseases when prolonged dispose such constitutions to dropsies, and thus prove fatal. These are the diseases which attack them in summer; but in winter younger persons are liable to pneumonia, and maniacal affections; and older persons to ardent fevers, from hardness of the belly. Women are subject to oedema and leucophlegmasiae; when pregnant they have difficult deliveries; their infants are large and swelled, and then during nursing they become wasted and sickly, and the lochial discharge after parturition does not proceed properly with the women. The children are particularly subject to hernia, and adults to varices and ulcers on their legs, so that persons with such constitutions cannot be long-lived, but before the usual period they fall into a state of premature old age. And further, the women appear to be with child, and when the time of parturition arrives, the fulness of the belly disappears, and this happens from dropsy of the uterus. Such waters then I reckon bad for every purpose. The next to them in badness are those which have their fountains in rocks, so that they must necessarily be hard, or come from a soil which produces thermal waters, such as those having iron,  copper, silver, gold, sulphur, alum, bitumen, or nitre (soda) in them; for all these are formed by the force of heat. Good waters cannot proceed from such a soil, but those that are hard and of a heating nature, difficult to pass by urine, and of difficult evacuation by the bowels. The best are those which flow from elevated grounds, and hills of earth; these are sweet, clear, and can bear a little wine; they are hot in summer and cold in winter, for such necessarily must be the waters from deep wells. But those are most to be commended which run to the rising of the sun, and especially to the summer sun; for such are necessarily more clear, fragrant, and light. But all such as are salty, crude, and harsh, are not good for drink. But there are certain constitutions and diseases with which such waters agree when drunk, as I will explain presently. Their characters are as follows: the best are such as have their fountains to the east; the next, those between the summer risings and settings of the sun, and especially those to the risings; and third, those between the summer and winter settings; but the worst are those to the south, and the parts between the winter rising and setting, and those to the south are very bad, but those to the north are better. They are to be used as follows: whoever is in good health and strength need not mind, but may always drink whatever is at hand. But whoever wishes to drink the most suitable for any disease, may accomplish his purpose by attending to the following directions: To persons whose bellies are hard and easily burnt up, the sweetest, the lightest, and the most limpid waters will be proper; but those persons whose bellies are soft, loose, and pituitous, should choose the hardest, those kinds that are most crude, and the saltiest, for thus will they be most readily dried up; for such waters as are adapted for boiling, and are of a very solvent nature, naturally loosen readily and melt down the bowels; but such as are intractable, hard, and by no means proper for boiling, these rather bind and dry up the bowels. People have deceived themselves with regard to salt waters, from inexperience, for they think these waters purgative, whereas they are the very reverse; for such waters are crude, and ill adapted  for boiling, so that the belly is more likely to be bound up than loosened by them. And thus it is with regard to the waters of springs.

8. Καὶ περὶ μὲν τῶν πηγαίων ὑδάτων ὧδε ἔχει. περὶ δὲ τῶν ὀμβρίων καὶ ὁκόσα ἀπὸ χιόνος φράσω ὅκως ἔχει. τὰ μὲν οὖν ὄμβρια κουφότατα καὶ γλυκύτατά ἐστι καὶ λεπτότατα καὶ λαμπρότατα. τήν τε γὰρ ἀρχὴν ὁ ἥλιος ἀνάγει καὶ ἀναρπάζει τοῦ ὕδατος τό τε λεπτότατον καὶ κουφότατον. δῆλον δὲ οἱ ἅλες ποιέουσι. τὸ μὲν γὰρ ἁλμυρὸν λείπεται αὐτοῦ ὑπὸ πάχεος καὶ βάρεος καὶ γίνεται ἅλες, τὸ δὲ λεπτότατον ὁ ἥλιος ἀναρπάζει ὑπὸ κουφότητος· ἀνάγει δὲ τὸ τοιοῦτο οὐκ ἀπὸ τῶν ὑδάτων μοῦνον τῶν λιμναίων, ἀλλὰ καὶ ἀπὸ τῆς θαλάσσης καὶ ἐξ ἁπάντων ἐν ὁκόσοισι ὑγρόν τι ἔνεστιν. ἔνεστι δὲ ἐν παντὶ χρήματι. καὶ ἐξ αὐτῶν τῶν ἀνθρώπων ἄγει τὸ λεπτότατον τῆς ἰκμάδος καὶ κουφότατον. τεκμήριον δὲ μέγιστον· ὅταν ἄνθρωπος ἐν ἡλίῳ βαδίζῃ ἢ καθίζῃ ἱμάτιον ἔχων, ὁκόσα μὲν τοῦ χρωτὸς ὁ ἥλιος ἐφορᾷ, οὐχ ἱδρῴη ἄν· ὁ γὰρ ἥλιος ἀναρπάζει τὸ προφαινόμενον τοῦ ἱδρῶτος· ὁκόσα δὲ ὑπὸ τοῦ ἱματίου ἐσκέπασται ἢ ὑπ᾽ ἄλλου του, ἱδροῖ. ἐξάγεται μὲν γὰρ ὑπὸ τοῦ ἡλίου καὶ βιάζεται, σῴζεται δὲ ὑπὸ τῆς σκέπης, ὥστε μὴ ἀφανίζεσθαι ὑπὸ τοῦ ἡλίου. ὁκόταν δὲ ἐς σκιὴν ἀφίκηται, ἅπαν τὸ σῶμα ὁμοίως ἰδίει· οὐ γὰρ ἔτι ὁ ἥλιος ἐπιλάμπει. διὰ ταῦτα δὲ καὶ σήπεται τῶν ὑδάτων τάχιστα ταῦτα καὶ ὀδμὴν ἴσχει πονηρὴν τὸ ὄμβριον, ὅτι ἀπὸ πλείστων συνῆκται καὶ συμμέμικται, ὥστε σήπεσθαι τάχιστα. ἔτι δὲ πρὸς τούτοισιν ἐπειδὰν ἁρπασθῇ καὶ μετεωρισθῇ περιφερόμενον καὶ καταμεμιγμένον ἐς τὸν ἠέρα, τὸ μὲν θολερὸν αὐτοῦ καὶ νυκτοειδὲς ἐκκρίνεται καὶ ἐξίσταται καὶ γίνεται ἠὴρ καὶ ὀμίχλη, τὸ δὲ λαμπρότατον καὶ κουφότατον αὐτοῦ λείπεται καὶ γλυκαίνεται ὑπὸ τοῦ ἡλίου καιόμενόν τε καὶ ἑψόμενον. γίνεται δὲ καὶ τἄλλα πάντα τὰ ἑψόμενα αἰεὶ γλυκύτερα. ἕως μὲν οὖν διες κεδας μένον ᾖ καὶ μήπω συνεστήκῃ, φέρεται μετέωρον. ὁκόταν δέ κου ἀθροισθῇ καὶ συστραφῇ ἐς τὸ αὐτὸ ὑπὸ ἀνέμων ἀλλήλοισιν ἐναντιωθέντων ἐξαίφνης, τότε καταρρήγνυται, ᾗ ἂν τύχῃ πλεῖστον συστραφέν. τότε γὰρ ἐοικὸς τοῦτο μᾶλλον γίνεσθαι, ὁκόταν τὰ νέφεα ὑπὸ ἀνέμου στάσιν μὴ ἔχοντος ὡρμημένα ἐόντα καὶ χωρέοντα ἐξαίφνης ἀντικόψῃ πνεῦμα ἐναντίον καὶ ἕτερα νέφεα· ἐνταῦθα τὸ μὲν πρῶτον αὐτοῦ συστρέφεται, τὰ δὲ ὄπισθεν ἐπιφέρεταί τε καὶ οὕτω παχύνεται καὶ μελαίνεται καὶ συστρέφεται ἐς τὸ αὐτὸ καὶ ὑπὸ βάρεος καταρρήγνυται καὶ ὄμβροι γίνονται. ταῦτα μέν ἐστιν ἄριστα κατὰ τὸ εἰκός. δεῖται δὲ ἀφέψεσθαι καὶ ἀποσήπεσθαι· εἰ δὲ μή, ὀδμὴν ἴσχει πονηρὴν καὶ βράγχος καὶ βῆχες καὶ βαρυφωνίη τοῖς πίνουσι προσίσταται.

Τὰ δὲ ἀπὸ χιόνος καὶ κρυστάλλων πονηρὰ πάντα. ὁκόταν γὰρ ἅπαξ παγῇ, οὐκ ἔτι ἐς τὴν ἀρχαίην φύσιν καθίσταται, ἀλλὰ τὸ μὲν αὐτοῦ λαμπρὸν καὶ κοῦφον καὶ γλυκὺ ἐκκρίνεται καὶ ἀφανίζεται, τὸ δὲ θολωδέστατον καὶ σταθμωδέστατον λείπεται. γνοίης δ᾽ ἂν ὧδε· εἰ γὰρ βούλει, ὅταν ᾖ χειμών, ἐς ἀγγεῖον μέτρῳ ἐγχέας ὕδωρ θεῖναι ἐς τὴν αἰθρίην, ἵνα πήξεται μάλιστα, ἔπειτα τῇ ὑστεραίῃ ἐσενεγκὼν ἐς ἀλέην, ὅκου χαλάσει μάλιστα ὁ παγετός, ὁκόταν δὲ λυθῇ, ἀναμετρεῖν τὸ ὕδωρ, εὑρήσεις ἔλασσον συχνῷ. τοῦτο τεκμήριον, ὅτι ὑπὸ τῆς πήξιος ἀφανίζεται καὶ ἀναξηραίνεται τὸ κουφότατον καὶ λεπτότατον, οὐ τὸ βαρύτατον καὶ παχύτατον· οὐ γὰρ ἂν δύναιτο. ταύτῃ οὖν νομίζω πονηρότατα ταῦτα τὰ ὕδατα εἶναι τὰ ἀπὸ χιόνος καὶ κρυστάλλου καὶ τὰ τού τοισιν ἑπόμενα πρὸς ἅπαντα χρήματα.

8. I will now tell how it is with respect to rain-water, and water from snow. Rain waters, then, are the lightest, the sweetest, the thinnest, and the clearest; for originally the sun raises and attracts the thinnest and lightest part of the water, as is obvious from the nature of salts; for the saltish part is left behind owing to its thickness and weight, and forms salts; but the sun attracts the thinnest part, owing to its lightness, and he abstracts this not only from the lakes, but also from the sea, and from all things which contain humidity, and there is humidity in everything; and from man himself the sun draws off the thinnest and lightest part of the juices. As a strong proof of this, when a man walks in the sun, or sits down having a garment on, whatever parts of the body the sun shines upon do not sweat, for the sun carries off whatever sweat makes its appearance; but those parts which are covered by the garment, or anything else, sweat, for the particles of sweat are drawn and forced out by the sun, and are preserved by the cover so as not to be dissipated by the sun; but when the person comes into the shade the whole body equally perspires, because the sun no longer shines upon it. Wherefore, of all kinds of water, these spoil the soonest; and rain water has a bad spot smell, because its particles are collected and mixed together from most objects, so as to spoil the soonest. And in addition to this, when attracted and raised up, being carried about and mixed with the air, whatever part of it is turbid and darkish is separated and removed from the other, and becomes cloud and mist, but the most attenuated and lightest part is left, and becomes sweet, being heated and concocted by the sun, for all other things when concocted become sweet. While dissipated then and not in a state of consistence it is carried aloft. But when collected and condensed by contrary winds, it falls down wherever it happens to be most condensed. For this is likely to happen when the clouds being carried along and moving with a wind which does not allow them to rest, suddenly encounters another wind and other clouds from the opposite direction: there it is first condensed, and what is behind is carried up to the spot, and thus it thickens, blackens, and is conglomerated, and by its weight it falls down and becomes rain. Such, to all appearance, are the best of waters, but they require to be boiled and strained; for otherwise they have a bad smell, and occasion hoarseness and thickness of the voice to those who drink them. Those from snow and ice are all bad, for when once congealed, they never again recover their former nature; for whatever is clear, light, and sweet in them, is separated and disappears; but the most turbid and weightiest part is left behind. You may ascertain this in the following manner: If in winter you will pour water by measure into a vessel and expose it to the open air until it is all frozen, and then on the following day bring it into a warm situation where the ice will thaw, if you will measure the water again when dissolved you will find it much less in quantity. This is a proof that the lightest and thinnest part is dissipated and dried up by the congelation, and not the heaviest and thickest, for that is impossible: wherefore I hold that waters from snow and ice, and those allied to them, are the worst of any for all purposes whatever. Such are the characters of rain-water, and those from ice and snow.

9. Περὶ μὲν οὖν ὀμβρίων ὑδάτων καὶ τῶν ἀπὸ χιόνος καὶ κρυστάλλων οὕτως ἔχει. λιθιῶσι δὲ μάλιστα ἄνθρωποι καὶ ὑπὸ νεφριτίδων καὶ στραγγουρίης ἁλίσκονται καὶ ἰσχιάδων, καὶ κῆλαι γίνονται, ὅκου ὕδατα πίνουσι παντοδαπώτατα καὶ ἀπὸ ποταμῶν μεγάλων, ἐς οὓς ποταμοὶ ἕτεροι ἐμβάλλουσι, καὶ ἀπὸ λίμνης, ἐς ἣν ῥεύματα πολλὰ καὶ παντοδαπὰ ἀφικνεῦνται, καὶ ὁκόσοι ὕδασιν ἐπακτοῖσι χρέονται διὰ μακροῦ ἀγομένοισι καὶ μὴ ἐκ βραχέος. οὐ γὰρ οἷόν τε ἕτερον ἑτέρῳ ἐοικέναι ὕδωρ, ἀλλὰ τὰ μὲν γλυκέα εἶναι, τὰ δὲ ἁλυκά τε καὶ στυπτηριώδεα, τὰ δὲ ἀπὸ θερμῶν ῥεῖν. συμμισγόμενα δὲ ταῦτα ἐς τωὐτὸ ἀλλήλοισι στασιάζει καὶ κρατεῖ αἰεὶ τὸ ἰσχυρότατον. ἰσχύει δὲ οὐκ αἰεὶ τωὐτό, ἀλλὰ ἄλλοτε ἄλλο κατὰ τὰ πνεύματα· τῷ μὲν γὰρ βορέης τὴν ἰσχὺν παρέχεται, τῷ δὲ ὁ νότος, καὶ τῶν λοιπῶν πέρι ωὑτὸς λόγος. ὑφίστασθαι οὖν τοῖσι τοιούτοισιν ἀνάγκη ἐν τοῖς ἀγγείοις ἰλὺν καὶ ψάμμον· καὶ ἀπὸ τούτων πινομένων τὰ νοσήματα γίνεται τὰ προειρημένα· ὅτι δὲ οὐχ ἅπασιν, ἑξῆς φράσω.

Ὁκόσων μὲν ἥ τε κοιλίη εὔροός τε καὶ ὑγιηρή ἐστι καὶ ἡ κύστις μὴ πυρετώδης μηδὲ ὁ στόμαχος τῆς κύστιος συμπέφρακται λίην, οὗτοι μὲν διου ρεῦσι ῥηϊδίως, καὶ ἐν τῇ κύστει οὐδὲν συστρέφεται. ὁκόσων δὲ ἂν ἡ κοιλίη πυρετώδης ᾖ, ἀνάγκη καὶ τὴν κύστιν τωὐτὸ πάσχειν. ὁκόταν γὰρ θερμανθῇ μᾶλλον τῆς φύσιος, ἐφλέγμηνεν αὐτῆς ὁ στόμαχος. ὁκόταν δὲ ταῦτα πάθῃ, τὸ οὖρον οὐκ ἀφίησιν, ἀλλ᾽ ἐν ἑωυτῇ συνέψει καὶ συγκαίει. καὶ τὸ μὲν λεπτότατον αὐτοῦ ἀποκρίνεται καὶ τὸ καθαρώτατον διιεῖ καὶ ἐξουρεῖται, τὸ δὲ παχύτατον καὶ θολωδέστατον συστρέφεται καὶ συμπήγνυται. καὶ τὸ μὲν πρῶτον μικρόν, ἔπειτα δὲ μέζον γίνεται. κυλινδεύμενον γὰρ ὑπὸ τοῦ οὔρου, ὅ τι ἂν συνίστηται παχύ, συναρμόζει πρὸς ἑωυτό, καὶ οὕτως αὔξεταί τε καὶ πωροῦται· καὶ ὁκόταν οὐρῇ, πρὸς τὸν στόμαχον τῆς κύστιος προσπίπτει ὑπὸ τοῦ οὔρου βιαζόμενον καὶ κωλύει οὐρεῖν καὶ ὀδύνην παρέχει ἰσχυρήν· ὥστε τὰ αἰδοῖα τρίβουσι καὶ ἕλκουσι τὰ παιδία τὰ λιθιῶντα· δοκεῖ γὰρ αὐτοῖς τὸ αἴτιον ἐνταῦθα εἶναι τῆς οὐρήσιος. τεκμήριον δέ, ὅτι οὕτως ἔχει· τὸ γὰρ οὖρον λαμπρότατον οὐρέουσιν οἱ λιθιῶντες, ὅτι τὸ παχύτατον καὶ θολωδέστατον αὐτοῦ μένει καὶ συστρέφεται. τὰ μὲν πλεῖστα οὕτω λιθιᾷ· γίνεται δὲ παισὶν καὶ ἀπὸ τοῦ γάλακτος, ἢν μὴ ὑγιηρὸν ᾖ, ἀλλὰ θερμόν τε λίην καὶ χολῶδες. τὴν γὰρ κοιλίην διαθερμαίνει καὶ τὴν κύστιν, ὥστε τὸ οὖρον συγκαιόμενον ταῦτα πάσχειν. καί φημι ἄμεινον εἶναι τοῖς παιδίοισι τὸν οἶνον ὡς ὑδαρέστατον διδόναι· ἧσσον γὰρ τὰς φλέβας συγκαίει καὶ συναυαίνει. τοῖσι δὲ θήλεσι λίθοι οὐ γίνονται ὁμοίως· ὁ γὰρ οὐρητὴρ βραχύς ἐστιν ὁ τῆς κύστιος καὶ εὐρύς, ὥστε βιάζεσθαι τὸ οὖρον ῥηϊδίως. οὔτε γὰρ τῇ χειρὶ τρίβει τὸ αἰδοῖον ὥσπερ τὸ ἄρσεν, οὔτε ἅπτεται τοῦ οὐρητῆρος· ἐς γὰρ τὰ αἰδοῖα ξυντέτρηνται, οἱ δὲ ἄνδρες οὐκ εὐθὺ τέτρηνται, καὶ διότι οἱ οὐρητῆρες οὐκ εὐρεῖς· καὶ πίνουσι πλεῖον ἢ οἱ παῖδες.

9. Men become affected with the stone, and are seized with diseases of the kidneys, strangury, sciatica, and become ruptured, when they drink all sorts of waters, and those from great rivers into which other rivulets run, or from a lake into which many streams of all sorts flow, and such as are brought from a considerable distance. For it is impossible that such waters can resemble one another, but one kind is sweet, another saltish and aluminous, and some flow from thermal springs; and these being all mixed up together disagree, and the strongest part always prevails; but the same kind is not always the strongest, but sometimes one and sometimes another, according to the winds, for the north wind imparts strength to this water, and the south to that, and so also with regard to the others. There must be deposits of mud and sand in the vessels from such waters, and the aforesaid diseases must be engendered by them when drunk, but why not to all I will now explain. When the bowels are loose and in a healthy state, and when the bladder is not hot, nor the neck of the bladder very contracted, all such persons pass water freely, and no concretion forms in the bladder; but those in whom the belly is hot, the bladder must be in the same condition; and when preternaturally heated, its neck becomes inflamed; and when these things happen, the bladder does not expel the urine, but raises its heat excessively. And the thinnest part of it is secreted, and the purest part is passed off in the form of urine, but the thickest and most turbid part is condensed and concreted, at first in small quantity, but afterwards in greater; for being rolled about in the urine, whatever is of a thick consistence it assimilates to itself, and thus it increases and becomes indurated. And when such persons make water, the stone forced down by the urine falls into the neck of the bladder and stops the urine, and occasions intense pain; so that calculous children rub their privy parts and tear at them, as supposing that the obstruction to the urine is situated there. As a proof that it is as I say, persons affected with calculus have very limpid urine, because the thickest and foulest part remains and is concreted. Thus it generally is in cases of calculus. It forms also in children from milk, when it is not wholesome, but very hot and bilious, for it heats the bowels and bladder, so that the urine being also heated undergoes the same change. And I hold that it is better to give children only the most diluted wine, for such will least burn up and dry the veins. Calculi do not form so readily in women, for in them the urethra is short and wide, so that in them the urine is easily expelled; neither do they rub the pudendum with their hands, nor handle  the passage like males; for the urethra in women opens direct into the pudendum, which is not the case with men, neither in them is the urethra so wide, and they drink more than children do. Thus, or nearly so, is it with regard to them.

10. Περὶ μὲν οὖν τούτων ὧδε ἔχει ἢ ὅτι τούτων ἐγγύτατα. περὶ δὲ τῶν ὡρέων ὧδε ἄν τις ἐνθυμεύμενος διαγινώσκοι, ὁκοῖόν τι μέλλει ἔσεσθαι τὸ ἔτος, εἴτε νοσερὸν εἴτε ὑγιηρόν· ἢν μὲν γὰρ κατὰ λόγον γένηται τὰ σημεῖα ἐπὶ τοῖς ἄστροισι δύνουσί τε καὶ ἐπιτέλλουσιν, ἔν τε τῷ μετοπώρῳ ὕδατα γένηται, καὶ ὁ χειμὼν μέτριος καὶ μήτε λίην εὔδιος μήτε ὑπερβάλλων τὸν καιρὸν τῷ ψύχει, ἔν τε τῷ ἦρι ὕδατα γένηται ὡραῖα καὶ ἐν τῷ θέρει, οὕτω τὸ ἔτος ὑγιεινότατον εἰκὸς εἶναι. ἢν δὲ ὁ μὲν χειμὼν αὐχμηρὸς καὶ βόρειος γένηται, τὸ δὲ ἦρ ἔπομβρον καὶ νότιον, ἀνάγκη τὸ θέρος πυρετῶδες γίνεσθαι καὶ ὀφθαλμίας καὶ δυσεντερίας ἐμποιεῖν. ὁκόταν γὰρ τὸ πνῖγος ἐπιγένηται ἐξαίφνης τῆς τε γῆς ὑγρῆς ἐούσης ὑπὸ τῶν ὄμβρων τῶν ἐαρινῶν καὶ ὑπὸ τοῦ νότου, ἀνάγκη διπλόον τὸ καῦμα εἶναι, ἀπό τε τῆς γῆς διαβρόχου ἐούσης καὶ θερμῆς καὶ ὑπὸ τοῦ ἡλίου καίοντος, τῶν τε κοιλιῶν μὴ συνεστηκυιῶν τοῖς ἀνθρώποις μήτε τοῦ ἐγκεφάλου ἀνεξηρασμένου — οὐ γὰρ οἷόν τε τοῦ ἦρος τοιούτου ἐόντος μὴ οὐ πλαδᾶν τὸ σῶμα καὶ τὴν σάρκα — · ὥστε τοὺς πυρετοὺς ἐπιπίπτειν ὀξυτάτους ἅπασιν, μάλιστα δὲ τοῖσι φλεγματίῃσι. καὶ δυσεντερίας εἰκός ἐστι γίνεσθαι καὶ τῇσι γυναιξὶ καὶ τοῖς εἴδεσι τοῖς ὑγροτάτοισι. καὶ ἢν μὲν ἐπὶ κυνὸς ἐπιτολῇ ὕδωρ ἐπιγένηται καὶ χειμὼν καὶ οἱ ἐτησίαι πνεύσωσιν, ἐλπὶς παύσασθαι καὶ τὸ μετόπωρον ὑγιηρὸν γενέσθαι· ἢν δὲ μή, κίν δυνος θανάτους τε γενέσθαι τοῖσι παιδίοισι καὶ τῇσι γυναιξίν, τοῖσι δὲ πρεσβύτῃσιν ἥκιστα, τούς τε περιγενομένους ἐς τεταρταίους ἀποτελευτᾶν καὶ ἐκ τῶν τεταρταίων ἐς ὕδρωπας. ἢν δ᾽ ὁ μὲν χειμὼν νότιος γένηται καὶ ἔπομβρος καὶ εὔδιος, τὸ δὲ ἦρ βόρειόν τε καὶ αὐχμηρὸν καὶ χειμέριον, πρῶτον μὲν τὰς γυναῖκας, ὁκόσαι ἂν τύχωσιν ἐν γαστρὶ ἔχουσαι καὶ ὁ τόκος αὐτῇσιν ᾖ πρὸς τὸ ἦρ, ἐκτιτρώσκεσθαι· ὁκόσαι δ᾽ ἂν καὶ τέκωσιν, ἀκρατέα τὰ παιδία τίκτειν καὶ νοσώδεα, ὥστε ἢ αὐτίκα ἀπόλλυσθαι, ἢ ζῶσι λεπτά τε ἐόντα καὶ ἀσθενέα καὶ νοσώδεα. ταῦτα μὲν τῇσι γυναιξί· τοῖσι δὲ λοιποῖσι δυσεντερίας καὶ ὀφθαλμίας ξηρὰς καὶ ἐνίοισι καταρρόους ἀπὸ τῆς κεφαλῆς ἐπὶ τὸν πνεύμονα. τοῖσι μὲν οὖν φλεγματίῃσι τὰς δυσεντερίας εἰκὸς γίνεσθαι καὶ τῇσι γυναιξὶ φλέγματος ἐπικαταρρυέντος ἀπὸ τοῦ ἐγκεφάλου διὰ τὴν ὑγρότητα τῆς φύσιος· τοῖσι δὲ χολώδεσιν ὀφθαλμίας ξηρὰς διὰ τὴν θερμότητα καὶ ξηρότητα τῆς σαρκός· τοῖσι δὲ πρεσβύτῃσι καταρρόους διὰ τὴν ἀραιότητα καὶ τὴν ἔκτηξιν τῶν φλεβῶν, ὥστε ἐξαίφνης τοὺς μὲν ἀπόλλυσθαι, τοὺς δὲ παραπλήκτους γίνεσθαι τὰ δεξιὰ ἢ τὰ ἀριστερά. ὁκόταν γὰρ τοῦ χειμῶνος ἐόντος νοτίου καὶ θερμοῦ τοῦ σώματος μὴ συνιστῆται ὁ ἐγκέφαλος μηδὲ αἱ φλέβες, τοῦ ἦρος ἐπιγενομένου βορείου καὶ αὐχμηροῦ καὶ ψυχροῦ ὁ ἐγκέφαλος, ὁπηνίκα αὐτὸν ἔδει ἅμα καὶ τῷ ἦρι διαλύεσθαι καὶ καθαίρεσθαι ὑπό τε κορύζης καὶ βράγχων, τηνικαῦτα πήγνυταί τε καὶ συνίσταται, ὥστε ἐξαίφνης τοῦ θέρεος ἐπιγενομένου καὶ τοῦ καύματος καὶ τῆς μεταβολῆς ἐπιγινομένης ταῦτα τὰ νοσεύματα ἐπιπίπτειν. καὶ ὁκόσαι μὲν τῶν πολίων κέονταί τε καλῶς τοῦ ἡλίου καὶ τῶν πνευμάτων ὕδασί τε χρέονται ἀγαθοῖσιν, αὗται μὲν ἧσσον αἰσθάνονται τῶν τοιούτων μεταβολέων· ὁκόσαι δὲ ὕδασί τε ἑλείοισι χρέονται καὶ λιμνώδεσι κέονταί τε μὴ καλῶς τῶν πνευμάτων καὶ τοῦ ἡλίου, αὗται δὲ μᾶλλον. κἢν μὲν τὸ θέρος αὐχμηρὸν γένηται, θᾶσσον παύονται αἱ νοῦσοι· ἢν δὲ ἔπομβρον, πολυχρόνιοι γίνονται· καὶ φαγεδαίνας κίνδυνος ἐγγίνεσθαι ἀπὸ πάσης προφάσιος, ἢν ἕλκος ἐγγένηται. καὶ λειεντερίαι καὶ ὕδρωπες τελευτῶσι τοῖσι νοσεύμασιν ἐπιγίνονται· οὐ γὰρ ἀποξηραίνονται αἱ κοιλίαι ῥηϊδίως. ἢν δὲ τὸ θέρος ἔπομβρον γένηται καὶ νότιον καὶ τὸ μετόπωρον, τὸν χειμῶνα ἀνάγκη νοσερὸν εἶναι καὶ τοῖς φλεγματίῃσι καὶ τοῖς γεραιτέροισι τεσσαράκοντα ἐτέων καύσους γίνεσθαι εἰκός, τοῖσι δὲ χολώδεσι πλευρίτιδας καὶ περιπνευμονίας. ἢν δὲ τὸ θέρος αὐχμηρὸν γένηται καὶ βόρειον, τὸ δὲ μετόπωρον ἔπομβρον καὶ νότιον, κεφαλαλγίας ἐς τὸν χειμῶνα καὶ σφακέλους τοῦ ἐγκεφάλου εἰκὸς γίνεσθαι, καὶ προσέτι βράγχους καὶ κορύζας καὶ βῆχας, ἐνίοισι δὲ καὶ φθίσιας. ἢν δὲ βόρειόν τε ᾖ καὶ ἄνυδρον καὶ μήτε ὑπὸ κύνα ἔπομβρον μήτε ἐπὶ τῷ ἀρκτούρῳ, τοῖσι μὲν φλεγματίῃσι φύσει συμφέρει μάλιστα καὶ τοῖς ὑγροῖς τὰς φύσιας καὶ τῇσι γυναιξί· τοῖσι δὲ χολώδεσι τοῦτο πολεμιώτατον γίνεται. λίην γὰρ ἀναξηραίνονται καὶ ὀφθαλμίαι αὐτοῖσιν ἐπιγίνονται ξηραί, καὶ πυρετοὶ ὀξέες καὶ πολυχρόνιοι, ἐνίοισι δὲ καὶ μελαγχολίαι. τῆς γὰρ χολῆς τὸ μὲν ὑγρότατον καὶ ὑδαρέστατον ἀναξηραίνεται καὶ ἀναλίσκεται, τὸ δὲ παχύτατον καὶ δριμύτατον λείπεται καὶ τοῦ αἵματος κατὰ τὸν αὐτὸν λόγον· ἀφ᾽ ὧν ταῦτα τὰ νοσεύματα αὐτοῖσι γίνεται. τοῖσι δὲ φλεγματίῃσι πάντα ταῦτα ἀρωγά ἐστιν. ἀποξηραίνονται γὰρ καὶ ἐς τὸν χειμῶνα ἀφικνέονται οὐ πλαδῶντες, ἀλλὰ ἀναξηραινόμενοι.

10. And respecting the seasons, one may judge whether the year will prove sickly or healthy from the following observations:- If the appearances connected with the rising and setting stars be as they should be; if there be rains in autumn; if the winter be mild, neither very tepid nor unseasonably cold, and if in spring the rains be seasonable, and so also in summer, the year is likely to prove healthy. But if the winter be dry and northerly, and the spring showery and southerly, the summer will necessarily be of a febrile character, and give rise to ophthalmies and dysenteries. For when suffocating heat sets in all of a sudden, while the earth is moistened by the vernal showers, and by the south wind, the heat is necessarily doubled from the earth, which is thus soaked by rain and heated by a burning sun, while, at the same time, men’s bellies are not in an orderly state, nor the brain properly dried; for it is impossible, after such a spring, but that the body and its flesh must be loaded with humors, so that very acute fevers will attack all, but especially those of a phlegmatic constitution. Dysenteries are also likely to occur to women and those of a very humid temperament. And if at the rising of the Dogstar rain and wintery storms supervene, and if the etesian winds blow, there is reason to hope that these diseases will cease, and that the autumn will be healthy; but if not, it is likely to be a fatal season to children and women, but least of all to old men; and that convalescents will pass into quartans, and from quartans into dropsies; but if the winter be southerly, showery and mild, but the spring northerly, dry, and of a wintry character, in the first place women who happen to be with child, and whose accouchement should take place in spring, are apt to miscarry; and such as bring forth, have feeble and sickly children, so that they either die presently or are tender, feeble, and sickly, if they live. Such is the case with the women. The others are subject to dysenteries and dry ophthalmies, and some have catarrhs beginning in the head and descending to the lungs. Men of a phlegmatic temperament are likely to have dysenteries; and women, also, from the humidity of their nature, the phlegm descending downwards from the brain; those who are bilious, too, have dry ophthalmies from the heat and dryness of their flesh; the aged, too, have catarrhs from their flabbiness and melting of the veins, so that some of them die suddenly and some become paralytic on the right side or the left. For when, the winter being southerly and the body hot, the blood and veins are not properly constringed; a spring that is northerly, dry, and cold, having come on, the brain when it should have been expanded and purged, by the coryza and hoarseness is then constringed and contracted, so that the summer and the heat occurring suddenly, and a change supervening, these diseases fall out. And such cities as lie well to the sun and winds, and use good waters, feel these changes less, but such as use marshy and pooly waters, and lie well both as regards the winds and the sun, these all feel it more. And if the summer be dry, those diseases soon cease, but if rainy, they are protracted; and there is danger of any sore that there is becoming phagedenic from any cause; and lienteries and dropsies supervene at the conclusion of diseases; for the bowels are not readily dried up. And if the summer be rainy and southerly, and next the autumn, the winter must, of necessity, be sickly, and ardent fevers are likely to attack those that are phlegmatic, and more elderly than forty years, and pleurisies and peripneumonies those that are bilious. But if the summer is parched and northerly, but the autumn rainy and southerly, headache and sphacelus of the brain are likely to occur; and in addition hoarseness, coryza, coughs, and in some cases, consumption. But if the season is northerly and without water, there being no rain, neither after the Dogstar nor Arcturus; this state agrees best with those who are naturally phlegmatic, with those who are of a humid temperament, and with women; but it is most inimical to the bilious; for they become much parched up, and ophthalmies of a dry nature supervene, fevers both acute and chronic,  and in some cases melancholy; for the most humid and watery part of the bile being consumed, the thickest and most acrid portion is left, and of the blood likewise, when these diseases came upon them. But all these are beneficial to the phlegmatic, for they are thereby dried up, and reach winter not oppressed with humors, but with them dried up.

11. Κατὰ ταῦτά τις ἐννοεύμενος καὶ σκοπεύμενος προειδείη ἂν τὰ πλεῖστα τῶν μελλόντων ἔσεσθαι ἀπὸ τῶν μεταβολέων. φυλάσσεσθαι δὲ χρὴ μάλιστα τὰς μεταβολὰς τῶν ὡρέων τὰς μεγίστας καὶ μήτε φάρμακον διδόναι ἑκόντα μήτε καίειν ὅ τι ἐς κοιλίην μήτε τάμνειν, πρὶν παρέλθωσιν ἡμέραι δέκα ἢ καὶ πλείονες· μέγισται δέ εἰσιν αἵδε αἱ τέσσαρες καὶ ἐπικινδυνόταται· ἡλίου τροπαὶ ἀμφότεραι καὶ μᾶλλον αἱ θεριναὶ καὶ αἱ ἰσημερίαι νομιζόμεναι εἶναι ἀμφότεραι, μᾶλλον δὲ αἱ μετοπωριναί· δεῖδὲ καὶ τῶν ἄστρων τὰς ἐπιτολὰς φυλάσσεσθαι καὶ μάλιστα τοῦ κυνός, ἔπειτα ἀρκτούρου, καὶ ἔτι πληϊάδων δύσιν. τά τε γὰρ νοσεύματα μάλιστα ἐν ταύτῃσι τῇσιν ἡμέρῃσιν κρίνεται. καὶ τὰ μὲν ἀποφθίνει, τὰ δὲ λήγει, τὰ δὲ ἄλλα πάντα μεθίσταται ἐς ἕτερον εἶδος καὶ ἑτέρην κατάστασιν.

11. Whoever studies and observes these things may be able to foresee most of the effects which will result from the changes of the seasons; and one ought to be particularly guarded during the greatest changes of the seasons, and neither willingly give medicines, nor apply the cautery to the belly, nor make incisions there until ten or more days be past. Now, the greatest and most dangerous are the two solstices, and especially the summer, and also the two equinoxes, but especially the autumnal. One ought also to be guarded about the rising of the stars, especially of the Dogstar, then of Arcturus, and then the setting of the Pleiades; for diseases are especially apt to prove critical in those days, and some prove fatal, some pass off, and all others change to another form and another constitution. So it is with regard to them.

12. Περὶ μὲν τούτων οὕτως ἔχει. βούλομαι δὲ περὶ τῆς Ἀσίης καὶ τῆς Εὐρώπης δεῖξαι ὁκόσον διαφέρουσιν ἀλλήλων ἐς τὰ πάντα καὶ περὶ τῶν ἐθνέων τῆς μορφῆς, ὅτι διαλλάσσει καὶ μηδὲν ἔοικεν ἀλλήλοισιν. περὶ μὲν οὖν ἁπάντων πολὺς ἂν εἴη λόγος, περὶ δὲ τῶν μεγίστων καὶ πλεῖστον διαφερόντων ἐρέω ὥς μοι δοκεῖἔχειν. τὴν Ἀσίην πλεῖστον διαφέρειν φημὶ τῆς Εὐρώπης ἐς τὰς φύσιας τῶν συμπάντων τῶν τε ἐκ τῆς γῆς φυομένων καὶ τῶν ἀνθρώπων. πολὺ γὰρ καλλίονα καὶ μέζονα πάντα γίνεται ἐν τῇ Ἀσίῃ, ἥ τε χώρη τῆς χώρης ἡμερωτέρη καὶ τὰ ἤθεα τῶν ἀνθρώπων ἠπιώτερα καὶ εὐοργητότερα. τὸ δὲ αἴτιον τούτων ἡ κρῆσις τῶν ὡρέων, ὅτι τοῦ ἡλίου ἐν μέσῳ τῶν ἀνατολέων κεῖται πρὸς τὴν ἠῶ τοῦ τε ψυχροῦ πορρωτέρω. τὴν δὲ αὔξησιν καὶ ἡμερότητα παρέχει πλεῖστον ἁπάντων, ὁκόταν μηδὲν ᾖ ἐπικρατέον βιαίως, ἀλλὰ παντὸς ἰσομοιρίη δυναστεύῃ. ἔχει δὲ κατὰ τὴν Ἀσίηνοὐ παν ταχῇ ὁμοίως, ἀλλ᾽ ὅση μὲν τῆς χώρης ἐν μέσῳ κεῖται τοῦ θερμοῦ καὶ τοῦ ψυχροῦ, αὕτη μὲν εὐκαρποτάτη ἐστὶ καὶ εὐδενδροτάτη καὶ εὐδιεστάτη καὶ ὕδασι καλλίστοισι κέχρηται τοῖσί τε οὐρανίοισι καὶ τοῖς ἐκ τῆς γῆς. οὔτε γὰρ ὑπὸ τοῦ θερμοῦ ἐκκέκαυται λίην οὔτε ὑπὸ αὐχμῶν καὶ ἀνυδρίης ἀναξηραίνεται, οὔτε ὑπὸ ψύχεος βεβιασμένη οὔτε νοτία τε καὶ διάβροχός ἐστιν ὑπό τε ὄμβρων πολλῶν καὶ χιόνος· τά τε ὡραῖα αὐτόθι πολλὰ εἰκὸς γίνεσθαι, ὁκόσα τε ἀπὸ σπερμάτων καὶ ὁκόσα αὐτὴ ἡ γῆ ἀναδιδοῖ φυτά, ὧν τοῖς καρποῖσι χρέονται ἄνθρωποι, ἡμεροῦντες ἐξ ἀγρίων καὶ ἐς ἐπιτήδειον μεταφυτεύοντες· τά τε ἐντρεφόμενα κτήνεα εὐθηνεῖν εἰκός, καὶ μάλιστα τίκτειν τε πυκνότατα καὶ ἐκτρέφειν κάλλιστα· τούς τε ἀνθρώπους εὐτραφέας εἶναι καὶ τὰ εἴδεα καλλίστους καὶ μεγέθει μεγίστους καὶ ἥκιστα διαφόρους ἐς τά τε εἴδεα αὐτῶν καὶ τὰ μεγέθεα· εἰκός τε τὴν χώρην ταύτην τοῦ ἦρος ἐγγύτατα εἶναι κατὰ τὴν φύσιν καὶ τὴν μετρι ότητα τῶν ὡρέων. τὸ δὲ ἀνδρεῖον καὶ τὸ ταλαί πωρον καὶ τὸ ἔμπονον καὶ τὸ θυμοειδὲς οὐκ ἂν δύναιτο ἐν τοιαύτῃ φύσει ἐγγίνεσθαι οὔτε ὁμοφύλου οὔτε ἀλλοφύλου, ἀλλὰ τὴν ἡδονὴν ἀνάγκη κρατεῖν ...... διότι πολύμορφα γίνεται τὰ ἐν τοῖς θηρίοις.

12. I wish to show, respecting Asia and Europe, how, in all respects, they differ from one another, and concerning the figure of the inhabitants, for they are different, and do not at all resemble one another. To treat of all would be a long story, but I will tell you how I think it is with regard to the greatest and most marked differences. I say, then, that Asia differs very much from Europe as to the nature of all things, both with regard to the productions of the earth and the inhabitants, for everything is produced much more beautiful and large in Asia; the country is milder, and the dispositions of the inhabitants also are more gentle and affectionate. The cause of this is the temperature of the seasons, because it lies in the middle of the risings of the sun towards the east, and removed from the cold (and heat), for nothing tends to growth and mildness so much as when the climate has no predominant quality, but a general equality of temperature prevails. It is not everywhere the same with regard to Asia, but such parts of the country as lie intermediate between the heat and the cold, are the best supplied with fruits and trees, and have the most genial climate, and enjoy the purest waters, both celestial and terrestrial. For neither are they much burnt up by the heat, nor dried up by the drought and want of rain, nor do they suffer from the cold; since they are well watered from abundant showers and snow, and the fruits of the season, as might be supposed, grow in abundance, both such as are raised from seed that has been sown, and such plants as the earth produces of its own accord, the fruits of which the inhabitants make use of, training them from their wild state and transplanting them to a suitable soil; the cattle also which are reared there are vigorous, particularly prolific, and bring up young of the fairest description; the inhabitants too, are well fed, most beautiful in shape, of large stature, and differ little from one another either as to figure or size; and the country itself, both as regards its constitution and mildness of the seasons, may be said to bear a close resemblance to the spring. Manly courage, endurance of suffering, laborious enterprise, and high spirit, could not be produced in such a state of things either among the native inhabitants or those of a different country, for there pleasure necessarily reigns. For this reason, also, the forms of wild beasts there are much varied. Thus it is, as I think, with the Egyptians and Libyans.

13. Περὶ μὲν οὖν Αἰγυπτίων καὶ Λιβύων οὕτως ἔχειν μοι δοκεῖ. περὶ δὲ τῶν ἐν δεξιῇ τοῦ ἡλίου τῶν ἀνατολέων τῶν θερινῶν μέχρι Μαιώτιδος λίμνης — οὗτος γὰρ ὅρος τῆς Εὐρώπης καὶ τῆς Ἀσίης — ὧδε ἔχει περὶ αὐτῶν· τὰ δὲ ἔθνεα ταῦτα ταύτῃ διάφορα αὐτὰ ἑωυτῶν μᾶλλόν ἐστι τῶν προδιηγημένων διὰ τὰς μεταβολὰς τῶν ὡρέων καὶ τῆς χώρης τὴν φύσιν. ἔχει δὲ καὶ κατὰ τὴν γῆν ὁμοίως ἅπερ καὶ κατὰ τοὺς ἄλλους ἀνθρώπους. ὅκου γὰρ αἱ ὧραι μεγίστας μεταβολὰς ποιέονται καὶ πυκνοτάτας, ἐκεῖ καὶ ἡ χώρη ἀγριωτάτη καὶ ἀνωμαλωτάτη ἐστί, καὶ εὑρήσεις ὄρεα τε πλεῖστα καὶ δάσεα καὶ πεδία καὶ λειμῶνας ἐόντας. ὅκου δὲ αἱ ὧραι μὴ μέγα ἀλλάσσουσιν, ἐκείνοις ἡ χώρη ὁμαλωτάτη ἐστίν. οὕτω δὲ ἔχει καὶ περὶ τῶν ἀνθρώπων, εἴ τις βούλεται ἐνθυμεῖσθαι. εἰσὶ γὰρ φύσιες αἱ μὲν ὄρεσιν ἐοικυῖαι δενδρώδεσί τε καὶ ἐφύδροισιν, αἱ δὲ λεπτοῖσί τε καὶ ἀνύδροις, αἱ δὲ λειμακεστέροις τε καὶ ἑλώδεσι, αἱ δὲ πεδίῳ τε καὶ ψιλῇ καὶ ξηρῇ γῇ. αἱ γὰρ ὧραι αἱ μεταλλάσσουσαι τῆς μορφῆς τὴν φύσιν εἰσὶ διάφοροι. ἢν δὲ διάφοροι ἔωσι μέγα σφέων αὐτέων, διαφοραὶ καὶ πλείονες γίνονται τοῖς εἴδεσι.

13. But concerning those on the right hand of the summer risings of the sun as far as the Palus Maeotis (for this is the boundary of Europe and Asia), it is with them as follows: the inhabitants there differ far more from one another than those I have treated of above, owing to the differences of the seasons and the nature of the soil. But with regard to the country itself, matters are the same there as among all other men; for where the seasons undergo the greatest and most rapid changes, there the country is the wildest and most unequal; and you will find the greatest variety of mountains, forests, plains, and meadows; but where the seasons do not change much there the country is the most even; and, if one will consider it, so is it also with regard to the inhabitants; for the nature of some is like to a country covered with trees and well watered; of some, to a thin soil deficient in water; of others, to fenny and marshy places; and of some again, to a plain of bare and parched land. For the seasons which modify their natural frame of body are varied, and the greater the varieties of them the greater also will be the differences of their shapes.

14. Καὶ ὁκόσα μὲν ὀλίγον διαφέρει τῶν ἐθνέων παραλείψω, ὁκόσα δὲ μεγάλα ἢ φύσει ἢ νόμῳ, ἐρέω περὶ αὐτῶν ὡς ἔχει. καὶ πρῶτον περὶ τῶν Μακροκεφάλων. τούτων γὰρ οὐκ ἔστιν ἄλλο ἔθνος ὁμοίας τὰς κεφαλὰς ἔχον οὐδέν· τὴν μὲν γὰρ ἀρχὴν ὁ νόμος αἰτιώτατος ἐγένετο τοῦ μήκεος τῆς κεφαλῆς, νῦν δὲ καὶ ἡ φύσις συμβάλλεται τῷ νόμῳ. τοὺς γὰρ μακροτάτην ἔχοντας τὴν κεφαλὴν γενναιοτάτους ἡγέονται. ἔχει δὲ περὶ νόμου ὧδε· τὸ παιδίον ὁκόταν γένηται τάχιστα, τὴν κεφαλὴν αὐτοῦ ἔτι ἁπαλὴν ἐοῦσαν μαλθακοῦ ἐόντος ἀναπλάσσουσι τῇσι χερσὶ καὶ ἀναγκάζουσιν ἐς τὸ μῆκος αὔξεσθαι δεσμά τε προσφέροντες καὶ τεχνήματα ἐπιτήδεια, ὑφ᾽ ὧν τὸ μὲν σφαιροειδὲς τῆς κεφαλῆς κακοῦται, τὸ δὲ μῆκος αὔξεται. οὕτως τὴν ἀρχὴν ὁ νόμος κατειργάσατο, ὥστε ὑπὸ βίης τοιαύτην τὴν φύσιν γενέσθαι· τοῦ δὲ χρόνου προϊόντος ἐν φύσει ἐγένετο, ὥστε τὸν νόμον μηκέτι ἀναγκάζειν. ὁ γὰρ γόνος πανταχόθεν ἔρχεται τοῦ σώματος, ἀπό τε τῶν ὑγιηρῶν ὑγιηρὸς ἀπό τε τῶν νοσερῶν νοσερός. εἰ οὖν γίνονται ἔκ τε φαλακρῶν φαλακροὶ καὶ ἐκ γλαυκῶν γλαυκοὶ καὶ ἐκ διεστραμμένων στρεβλοὶ ὡς ἐπὶ τὸ πλῆθος, καὶ περὶ τῆς ἄλλης μορφῆς ὁ αὐτὸς λόγος, τί κωλύει καὶ ἐκ μακροκεφάλου μακροκέφαλον γίνεσθαι; νῦν δὲ ὁμοίως οὐκέτι γίνονται ὡς πρότερον· ὁ γὰρ νόμος οὐκέτι ἰσχύει διὰ τὴν ὁμιλίην τῶν ἀνθρώπων.

14. I will pass over the smaller differences among the nations, but will now treat of such as are great either from nature, or custom; and, first, concerning the Macrocephali. There is no other race of men which have heads in the least resembling theirs. At first, usage was the principal cause of the length of their head, but now nature cooperates with usage. They think those the most noble who have the longest heads. It is thus with regard to the usage: immediately after the child is born, and while its head is still tender, they fashion it with their hands, and constrain it to assume a lengthened shape by applying bandages and other suitable contrivances whereby the spherical form of the head is destroyed, and it is made to increase in length. Thus, at first, usage operated, so that this constitution was the result of force: but, in the course of time, it was formed naturally; so that usage had nothing to do with it; for the semen comes from all parts of the body, sound from the sound parts, and unhealthy from the unhealthy parts. If, then, children with bald heads are born to parents with bald heads; and children with blue eves to parents who have blue eyes; and if the children of parents having distorted eyes squint also for the most part; and if the same may be said of other forms of the body, what is to prevent it from happening that a child with a long head should be produced by a parent having a long head? But now these things do not happen as they did formerly, for the custom no longer prevails owing to their intercourse with other men. Thus it appears to me to be with regard to them.

15. Περὶ μὲν οὖν τούτων οὕτως ἔχειν μοι δοκεῖ. περὶ δὲ τῶν ἐν Φάσει· ἡ χώρη ἐκείνη ἑλώδης ἐστὶ καὶ θερμὴ καὶ ὑδατεινὴ καὶ δασεῖα, ὄμβροι τε αὐτόθι γίνονται πᾶσαν ὥρην πολλοί τε καὶ ἰσχυροί· ἥ τε δίαιτα τοῖς ἀνθρώποις ἐν τοῖς ἕλεσίν ἐστιν, τά τε οἰκήματα ξύλινα καὶ καλάμινα ἐν τοῖς ὕδασι μεμηχανημένα· ὀλίγῃ τε χρέονται βαδίσει κατὰ τὴν πόλιν καὶ τὸ ἐμπόριον, ἀλλὰ μονοξύλοις διαπλέουσιν ἄνω καὶ κάτω· διώρυγες γὰρ πολλαί εἰσι. τὰ δὲ ὕδατα θερμὰ καὶ στάσιμα πίνουσιν ὑπό τε τοῦ ἡλίου σηπόμενα καὶ ὑπὸ τῶν ὄμβρων ἐπαυξόμενα. αὐτός τε ὁ Φᾶσις στασιμώτατος πάντων τῶν ποταμῶν καὶ ῥέων ἠπιώτατα. οἵ τε καρποὶ οἱ γινόμενοι αὐτόθι πάντες ἀναλδέες εἰσὶ καὶ τεθηλυσμένοι καὶ ἀτελέες ὑπὸ πολυπληθείης τοῦ ὕδατος· διὸ καὶ οὐ πεπαίνονται. ἠήρ τε πολὺς κατέχει τὴν χώρην ἀπὸ τῶν ὑδάτων. διὰ ταύτας δὴ τὰς προφάσιας τὰ εἴδεα ἀπηλλαγμένα τῶν λοιπῶν ἀνθρώπων ἔχουσιν οἱ Φασιηνοί· τά τε γὰρ μεγέθεα μεγάλοι, τὰ πάχεα δ᾽ ὑπερπάχητες, ἄρθρον τε κατάδηλον οὐδὲν οὐδὲ φλέψ· τήν τε χροιὴν ὠχρὴν ἔχουσιν ὥσπερ ὑπὸ ἰκτέρου ἐχόμενοι· φθέγγονταί τε βαρύτατον ἀνθρώπων, τῷ ἠέρι χρεώμενοι οὐ λαμπρῷ, ἀλλὰ νοτώδει καὶ θολερῷ· πρός τε τὸ ταλαιπωρεῖν τὸ σῶμα ἀργότεροι πεφύκασιν. αἵ τε ὧραι οὐ πολὺ μεταλλάσσουσιν οὔτε πρὸς τὸ πνῖγος οὔτε πρὸς τὸ ψῦχος. τά τε πνεύματα τὰ πολλὰ νότια πλὴν αὔρης μιῆς ἐπιχωρίης. αὕτη δὲ πνεῖ ἐνίοτε βίαιος καὶ χαλεπὴ καὶ θερμή· καὶ κέγχρονα ὀνομάζουσι τοῦτο τὸ πνεῦμα. ὁ δὲ βορέης οὐ σφόδρα ἀφ ικνεῖται· ὁκόταν δὲ πνέῃ, ἀσθενὴς καὶ βληχρός.

15. As to the inhabitants of Phasis, their country is fenny, warm, humid, and wooded; copious and severe rains occur there at all seasons; and the life of the inhabitants is spent among the fens; for their dwellings are constructed of wood and reeds, and are erected amidst the waters; they seldom practice walking either to the city or the market, but sail about, up and down, in canoes constructed out of single trees, for there are many canals there. They drink the hot and stagnant waters, both when rendered putrid by the sun, and when swollen with rains. The Phasis itself is the most stagnant of all rivers, and runs the smoothest; all the fruits which spring there are unwholesome, feeble and imperfect growth, owing to the redundance of water, and on this account they do not ripen, for much vapor from the waters overspreads the country. For these reasons the Phasians have shapes different from those of all other men; for they are large in stature, and of a very gross habit of body, so that not a joint nor vein is visible; in color they are sallow, as if affected with jaundice. Of all men they have the roughest voices, from their breathing an atmosphere which is not clear, but misty and humid; they are naturally rather languid in supporting bodily fatigue. The seasons undergo but little change either as to heat or cold; their winds for the most part are southerly, with the exception of one peculiar to the country, which sometimes blows strong, is violent and hot, and is called by them the wind cenchron. The north wind scarcely reaches them, and when it does blow it is weak and gentle. Thus it is with regard to the different nature and shape of the inhabitants of Asia and Europe.

16. Καὶ περὶ μὲν τῆς φύσιος τῆς διαφορῆς καὶ τῆς μορφῆς τῶν ἐν τῇ Ἀσίῃ καὶ τῇ Εὐρώπῃ οὕτως ἔχει. περὶ δὲ τῆς ἀθυμίης τῶν ἀνθρώπων καὶ τῆς ἀνανδρείης, ὅτι ἀπολεμώτεροί εἰσι τῶν Εὐρωπαίων οἱ Ἀσιηνοὶ καὶ ἡμερώτεροι τὰ ἤθεα αἱ ὧραι αἴτιαι μάλιστα, οὐ μεγάλας τὰς μεταβολὰς ποιεύμεναι οὔτε ἐπὶ τὸ θερμὸν οὔτε ἐπὶ τὸ ψυχρόν, ἀλλὰ παραπλησίως. οὐ γὰρ γίνονται ἐκπλήξιες τῆς γνώμης οὔτε μετάστασις ἰσχυρὴ τοῦ σώματος, ἀφ᾽ ὅτων εἰκὸς τὴν ὀργὴν ἀγριοῦσθαί τε καὶ τοῦ ἀγνώμονος καὶ θυμοειδέος μετέχειν μᾶλλον ἢ ἐν τῷ αὐτῷ αἰεὶ ἐόντα. αἱ γὰρ μεταβολαί εἰσι τῶν πάντων αἱ ἐπεγείρουσαι τὴν γνώμην τῶν ἀνθρώπων καὶ οὐκ ἐῶσαι ἀτρεμίζειν. διὰ ταύτας ἐμοὶ δοκεῖ τὰς προφάσιας ἄναλκες εἶναι τὸ γένος τὸ Ἀσιηνὸν καὶ προσέτι διὰ τοὺς νόμους. τῆς γὰρ Ἀσίης τὰ πολλὰ βασιλεύεται. ὅκου δὲ μὴ αὐτοὶ ἑωυτῶν εἰσι καρτεροὶ οἱ ἄνθρωποι μηδὲ αὐτόνομοι, ἀλλὰ δεσπόζονται, οὐ περὶ τούτου αὐτοῖσιν ὁ λόγος ἐστίν, ὅκως τὰ πολέμια ἀσκήσωσιν, ἀλλ᾽ ὅκως μὴ δόξωσι μάχιμοι εἶναι. οἱ γὰρ κίνδυνοι οὐχ ὁμοῖοί εἰσι. τοὺς μὲν γὰρ στρατεύεσθαι εἰκὸς καὶ ταλαιπωρεῖν καὶ ἀποθνῄσκειν ἐξ ἀνάγκης ὑπὲρ τῶν δεσποτέων ἀπό τε παιδίων καὶ γυναικὸς ἐόντας καὶ τῶν λοιπῶν φίλων. καὶ ὁκόσα μὲν ἂν χρηστὰ καὶ ἀνδρεῖα ἐργάσωνται, οἱ δεσπόται ἀπ᾽ αὐτῶν αὔξονταί τε καὶ ἐκφύονται, τοὺς δὲ κινδύνους καὶ θανάτους αὐτοὶ καρποῦνται. ἔτι δὲ πρὸς τούτοισι τῶν τοιούτων ἀνθρώπων ἀνάγκη ἐρημοῦσθαι τὴν γῆν ὑπό τε πολεμίων καὶ ἀργίης, ὥστε καὶ εἴ τις φύσει πέφυκεν ἀνδρεῖος καὶ εὔψυχος, ἀποτρέπεσθαι τὴν γνώμην ὑπὸ τῶν νόμων. μέγα δὲ τεκμήριον τούτων· ὁκόσοι γὰρ ἐν τῇ Ἀσίῃ Ἕλληνες ἢ βάρβαροι μὴ δεσπόζονται, ἀλλ᾽ αὐτόνομοί εἰσι καὶ ἑωυτοῖσι ταλαιπωρεῦσιν, οὗτοι μαχιμώτατοί εἰσι πάντων· τοὺς γὰρ κινδύνους ἑωυτῶν πέρι κινδυνεύουσι, καὶ τῆς ἀνδρείης αὐτοὶ τὰ ἆθλα φέρονται καὶ τῆς δειλίης τὴν ζημίην ὡσαύτως. εὑρήσεις δὲ καὶ τοὺς Ἀσιηνοὺς διαφέροντας αὐτοὺς ἑωυτῶν, τοὺς μὲν βελτίονας, τοὺς δὲ φαυλοτέρους ἐόντας. τούτων δὲ αἱ μεταβολαὶ αἴτιαι τῶν ὡρέων, ὥσπερ μοι εἴρηται ἐν τοῖς προτέροισι.

16. And with regard to the pusillanimity and cowardice of the inhabitants, the principal reason the Asiatics are more unwarlike and of gentler disposition than the Europeans is, the nature of the seasons, which do not undergo any great changes either to heat or cold, or the like; for there is neither excitement of the understanding nor any strong change of the body whereby the temper might be ruffled and they be roused to inconsiderate emotion and passion, rather than living as they do always in the state. It is changes of all kinds which arouse understanding of mankind, and do not allow them to get into a torpid condition. For these reasons, it appears to me, the Asiatic race is feeble, and further, owing to their laws; for monarchy prevails in the greater part of Asia, and where men are not their own masters nor independent, but are the slaves of others, it is not a matter of consideration with them how they may acquire military discipline, but how they may seem not to be warlike, for the dangers are not equally shared, since they must serve as soldiers, perhaps endure fatigue, and die for their masters, far from their children, their wives, and other friends; and whatever noble and manly actions they may perform lead only to the aggrandizement of their masters, whilst the fruits which they reap are dangers and death; and, in addition to all this, the lands of such persons must be laid waste by the enemy and want of culture. Thus, then, if any one be naturally warlike and courageous, his disposition will be changed by the institutions. As a strong proof of all this, such Greeks or barbarians in Asia as are not under a despotic form of government, but are independent, and enjoy the fruits of their own labors, are of all others the most warlike; for these encounter dangers on their own account, bear the prizes of their own valor, and in like manner endure the punishment of their own cowardice. And you will find the Asiatics differing from one another, for some are better and others more dastardly; of these differences, as I stated before, the changes of the seasons are the cause. Thus it is with Asia.

17. Καὶ περὶ μὲν τῶν ἐν τῇ Ἀσίῃ οὕτως ἔχει. ἐν δὲ τῇ Εὐρώπῃ ἔστιν ἔθνος Σκυθικόν, ὃ περὶ τὴν λίμνην οἰκεῖ τὴν Μαιῶτιν διαφέρον τῶν ἐθνέων τῶν ἄλλων. Σαυρομάται καλεῦνται. τούτων αἱ γυναῖκες ἱππάζονταί τε καὶ τοξεύουσι καὶ ἀκοντίζουσιν ἀπὸ τῶν ἵππων καὶ μάχονται τοῖς πολεμίοις, ἕως ἂν παρθένοι ἔωσιν. οὐκ ἀποπαρθενεύονται δέ, μέχρι ἂν τῶν πολεμίων τρεῖς ἀποκτείνωσι, καὶ οὐ πρότερον συνοικέουσιν ἤπερ τὰ ἱερὰ θύσωσιν τὰ ἔννομα. ἣ δ᾽ ἂν ἄνδρα ἑωυτῇ ἄρηται, παύεται ἱππαζομένη, ἕως ἂν μὴ ἀνάγκη καταλάβῃ παγκοίνου στρατείης. τὸν δεξιὸν δὲ μαζὸν οὐκ ἔχουσι. παιδίοις γὰρ ἐοῦσιν ἔτι νηπίοις αἱ μητέρες χαλκίον τετεχνημένον ἐπ᾽ αὐτῷ τούτῳ διάπυρον ποιέουσαι πρὸς τὸν μαζὸν τιθέασι τὸν δεξιὸν καὶ ἐπικαίεται, ὥστε τὴν αὔξησιν φθείρεσθαι, ἐς δὲ τὸν δεξιὸν ὦμον καὶ βραχίονα πᾶσαν τὴν ἰσχὺν καὶ τὸ πλῆθος ἐκδιδόναι.

17. In Europe there is a Scythian race, called Sauromatae, which inhabits the confines of the Palus Maeotis, and is different from all other races. Their women mount on horseback, use the bow, and throw the javelin from their horses, and fight with their enemies as long as they are virgins; and they do not lay aside their virginity until they kill three of their enemies, nor have any connection with men until they perform the sacrifices according to law. Whoever takes to herself a husband, gives up riding on horseback unless the necessity of a general expedition obliges her. They have no right breast; for while still of a tender age their mothers heat strongly a copper instrument constructed for this very purpose, and apply it to the right breast, which is burnt up, and its development being arrested, all the strength and fullness are determined to the right shoulder and arm.

18. Περὶ δὲ τῶν λοιπῶν Σκυθέων τῆς μορφῆς, ὅτι αὐτοὶ αὐτοῖσιν ἐοίκασι καὶ οὐδαμῶς ἄλλοις, ωὑτὸς λόγος καὶ περὶ τῶν Αἰγυπτίων, πλὴν ὅτι οἱ μὲν ὑπὸ τοῦ θερμοῦ εἰσι βεβιασμένοι, οἱ δὲ ὑπὸ τοῦ ψυχροῦ. ἡ δὲ Σκυθέων ἐρημίη καλευμένη πεδιάς ἐστι καὶ λειμακώδης καὶ ψιλὴ καὶ ἔνυδρος μετρίως. ποταμοὶ γάρ εἰσι μεγάλοι, οἳ ἐξοχετεύουσι τὸ ὕδωρ ἐκ τῶν πεδίων. ἐνταῦθα καὶ οἱ Σκύθαι διαιτεῦνται, Νομάδες δὲ καλεῦνται, ὅτι οὐκ ἔστιν οἰκήματα, ἀλλ᾽ ἐν ἁμάξῃσιν οἰκεῦσιν. αἱ δὲ ἅμαξαί εἰσιν αἱ μὲν ἐλάχισται τετράκυκλοι, αἱ δὲ ἑξάκυκλοι· αὗται δὲ πίλοις περιπεφραγμέναι· εἰσὶ δὲ καὶ τετεχνασμέναι ὥσπερ οἰκήματα τὰ μὲν διπλᾶ, τὰ δὲ τριπλᾶ. ταῦτα δὲ καὶ στεγνὰ πρὸς ὕδωρ καὶ πρὸς χιόνα καὶ πρὸς τὰ πνεύματα. τὰς δὲ ἁμάξας ἕλκουσι ζεύγεα τὰς μὲν δύο, τὰς δὲ τρία βοῶν κέρως ἄτερ. οὐ γὰρ ἔχουσι κέρατα ὑπὸ τοῦ ψύχεος. ἐν ταύτῃσι μὲν οὖν τῇσιν ἁμάξῃσιν αἱ γυναῖκες διαιτεῦνται. αὐτοὶ δ᾽ ἐφ᾽ ἵππων ὀχεῦνται οἱ ἄνδρες. ἕπονται δὲ αὐτοῖς καὶ τὰ πρόβατα τὰ ἐόντα καὶ αἱ βόες καὶ οἱ ἵπποι. μένουσι δ᾽ ἐν τῷ αὐτῷ τοσοῦτον χρόνον, ὅσον ἂν ἀποχρῇ αὐτοῖσι τοῖς κτήνεσιν ὁ χόρτος· ὁκόταν δὲ μηκέτι, ἐς ἑτέρην χώρην ἔρχονται. αὐτοὶ δ᾽ ἐσθίουσι κρέα ἑφθὰ καὶ πίνουσι γάλα ἵππων. καὶ ἱππάκην τρώγουσι· τοῦτο δ᾽ ἐστὶ τυρὸς ἵππων.

18. As the other Scythians have a peculiarity of shape, and do not resemble any other, the same observation applies to the Egyptians, only that the latter are oppressed by heat and the former by cold. What is called the Scythian desert is a prairie, rich in meadows, high-lying, and well watered; for the rivers which carry off the water from the plains are large. There live those Scythians which are called Nomades, because they have no houses, but live in wagons. The smallest of these wagons have four wheels, but some have six; they are covered in with felt, and they are constructed in the manner of houses, some having but a single apartment, and some three; they are proof against rain, snow, and winds. The wagons are drawn by yokes of oxen, some of two and others of three, and all without horns, for they have no horns, owing to the cold. In these wagons the women live, but the men are carried about on horses, and the sheep, oxen, and horses accompany them; and they remain on any spot as long as there is provender for their cattle, and when that fails they migrate to some other place. They eat boiled meat, and drink the milk of mares, and also eat hippace, which is cheese prepared from the milk of the mare. Such is their mode of life and their customs.

19. Τὰ μὲν ἐς τὴν δίαιταν αὐτῶν οὕτως ἔχει καὶ τοὺς νόμους· περὶ δὲ τῶν ὡρέων καὶ τῆς μορφῆς, ὅτι πολὺ ἀπήλλακται τῶν λοιπῶν ἀνθρώπων τὸ Σκυθικὸν γένος καὶ ἔοικεν αὐτὸ ἑωυτῷ ὥσπερ τὸ Αἰγύπτιον καὶ ἥκιστα πολύγονόν ἐστι, καὶ ἡ χώρη ἐλάχιστα θηρία τρέφει κατὰ μέγεθος καὶ πλῆθος. κεῖται γὰρ ὑπ᾽ αὐτῇσι τῇσιν ἄρκτοις καὶ τοῖς ὄρεσι τοῖς Ῥιπαίοισιν, ὅθεν ὁ βορέης πνεῖ. ὅ τε ἥλιος τελευτῶν ἐγγύτατα γίνεται, ὁκόταν ἐπὶ τὰς θερινὰς ἔλθῃ περιόδους, καὶ τότε ὀλίγον χρόνον θερμαίνει καὶ οὐ σφόδρα· τὰ δὲ πνεύματα τὰ ἀπὸ τῶν θερμῶν πνέοντα οὐκ ἀφικνεῖται, ἢν μὴ ὀλιγάκις καὶ ἀσθενέα, ἀλλ᾽ ἀπὸ τῶν ἄρκτων αἰεὶ πνέουσι πνεύματα ψυχρὰ ἀπό τε χιόνος καὶ κρυστάλλου καὶ ὑδάτων πολλῶν. οὐδέποτε δὲ τὰ ὄρεα ἐκλείπει· ἀπὸ τούτων δὲ δυσοίκητά ἐστιν. ἠήρ τε κατέχει πολὺς τῆς ἡμέρης τὰ πεδία, καὶ ἐν τούτοισι διαιτεῦνται· ὥστε τὸν μὲν χειμῶνα αἰεὶ εἶναι, τὸ δὲ θέρος ὀλίγας ἡμέρας καὶ ταύτας μὴ λίην. μετέωρα γὰρ τὰ πεδία καὶ ψιλὰ καὶ οὐκ ἐστεφάνωνται ὄρεσιν, ἀλλ᾽ ἢ ἀνάντεα ἀπὸ τῶν ἄρκτων· αὐτόθι καὶ τὰ θηρία οὐ γίνεται μεγάλα, ἀλλ᾽ οἷά τέ ἐστιν ὑπὸ γῆν σκεπάζεσθαι. ὁ γὰρ χειμὼν κωλύει καὶ τῆς γῆς ἡ ψιλότης, ὅτι οὐκ ἔστιν ἀλέη οὐδὲ σκέπη. αἱ δὲ μεταβολαὶ τῶν ὡρέων οὔκ εἰσι μεγάλαι οὐδὲ ἰσχυραί, ἀλλ᾽ ὁμοῖαι καὶ ὀλίγον μεταλλάσσουσαι· διότι καὶ τὰ εἴδεα ὁμοῖοι αὐτοὶ ἑωυτοῖς εἰσι σίτῳ τε χρεώμενοι αἰεὶ ὁμοίῳ ἐσθῆτί τε τῇ αὐτῇ καὶ θέρεος καὶ χειμῶνος, τόν τε ἠέρα ὑδατεινὸν ἕλκοντες καὶ παχύν, τά τε ὕδατα πίνοντες ἀπὸ χιόνος καὶ παγετῶν, τοῦ τε ταλαιπώρου ἀπεόντες. οὐ γὰρ οἷόν τε τὸ σῶμα ταλαιπωρεῖσθαι οὐδὲ τὴν ψυχήν, ὅκου μεταβολαὶ μὴ γίνονται ἰσχυραί. διὰ ταύτας τὰς ἀνάγκας τὰ εἴδεα αὐτῶν παχέα ἐστὶ καὶ σαρκώδεα καὶ ἄναρθρα καὶ ὑγρὰ καὶ ἄτονα, αἵ τε κοιλίαι ὑγρόταται πασέων κοιλιῶν αἱ κάτω. οὐ γὰρ οἷόν τε νηδὺν ἀναξηραίνεσθαι ἐν τοιαύτῃ χώρῃ καὶ φύσει καὶ ὥρης καταστάσει, ἀλλὰ διὰ πιμελήν τε καὶ ψιλὴν τὴν σάρκα τά τε εἴδεα ἔοικεν ἀλλήλοισι τά τε ἄρσενα τοῖς ἄρσεσι καὶ τὰ θήλεα τοῖς θήλεσι. τῶν γὰρ ὡρέων παραπλησίων ἐουσέων φθοραὶ οὐκ ἐγγίνονται οὐδὲ κακώσιες ἐν τῇ τοῦ γόνου συμπήξει, ἢν μή τινος ἀνάγκης βιαίου τύχῃ ἢ νούσου.

19. In respect of the seasons and figure of body, the Scythian race, like the Egyptian, have a uniformity of resemblance, different from all other nations; they are by no means prolific, and the wild beasts which are indigenous there are small in size and few in number, for the country lies under the Northern Bears, and the Rhiphaean mountains, whence the north wind blows; the sun comes very near to them only when in the summer solstice, and warms them but for a short period, and not strongly; and the winds blowing from the hot regions of the earth do not reach them, or but seldom, and with little force; but the winds from the north always blow, congealed, as they are, by the snow, ice, and much water, for these never leave the mountains, which are thereby rendered uninhabitable. A thick fog covers the plains during the day, and amidst it they live, so that winter may be said to be always present with them; or, if they have summer, it is only for a few days, and the heat is not very strong. Their plains are high-lying and naked, not crowned with mountains, but extending upwards under the Northern Bears. The wild beasts there are not large, but such as can be sheltered underground; for the cold of winter and the barrenness of the country prevent their growth, and because they have no covert nor shelter. The changes of the seasons, too, are not great nor violent, for, in  fact, they change gradually; and therefore their figures resemble one another, as they all equally use the same food, and the same clothing summer and winter, respiring a humid and dense atmosphere, and drinking water from snow and ice; neither do they make any laborious exertions, for neither body nor mind is capable of enduring fatigue when the changes of the seasons are not great. For these reasons their shapes are gross and fleshy, with ill-marked joints, of a humid temperament, and deficient in tone: the internal cavities, and especially those of the intestines, are full of humors; for the belly cannot possibly be dry in such a country, with such a constitution and in such a climate; but owing to their fat, and the absence of hairs from their bodies, their shapes resemble one another, the males being all alike, and so also with the women; for the seasons being of a uniform temperature, no corruption or deterioration takes place in the concretion of the semen, unless from some violent cause, or from disease.

20. Μέγα δὲ τεκμήριον ἐς τὴν ὑγρότητα παρέξομαι. Σκυθέων γὰρ τοὺς πολλούς, ἅπαντας ὅσοι Νομάδες, εὑρήσεις κεκαυμένους τούς τε ὤμους καὶ τοὺς βραχίονας καὶ τοὺς καρποὺς τῶν χειρῶν καὶ τὰ στήθεα καὶ τὰ ἰσχία καὶ τὴν ὀσφῦν δι᾽ ἄλλ᾽ οὐδὲν ἢ διὰ τὴν ὑγρότητα τῆς φύσιος καὶ τὴν μαλακίην. οὐ γὰρ δύνανται οὔτε τοῖς τόξοις συντείνειν οὔτε τῷ ἀκοντίῳ ἐμπίπτειν τῷ ὤμῳ ὑπὸ ὑγρότητος καὶ ἀτονίης. ὁκόταν δὲ καυθέωσιν, ἀναξηραίνεται ἐκ τῶν ἄρθρων τὸ πολὺ τοῦ ὑγροῦ, καὶ ἐντονώτερα μάλλον γίνεται καὶ τροφιμώτερα καὶ ἠρθρωμένα τὰ σώματα μᾶλλον. ῥοϊκὰ δὲ γίνεται καὶ πλατέα, πρῶτον μὲν ὅτι οὐ σπαργανοῦνται ὥσπερ ἐν Αἰγύπτῳ οὐδὲ νομίζουσι διὰ τὴν ἱππασιην, ὅκως ἂν εὔεδροι ἔωσιν· ἔπειτα δὲ διὰ τὴν ἕδρην· τά τε γὰρ ἄρσενα, ἕως ἂν οὐχ οἷά τε ἐφ᾽ ἵππου ὀχεῖσθαι, τὸ πολὺ τοῦ χρόνου κάθηνται ἐν τῇ ἁμάξῃ καὶ βραχὺ τῇ βαδίσει χρέονται διὰ τὰς μεταναστάσιας καὶ περιελάσιας· τὰ δὲ θήλεα θαυμαστὸν οἷον ῥοϊκά ἑστι τε καὶ βραδέα τὰ εἴδεα. πυρρὸν δὲ τὸ γένος ἐστὶ τὸ Σκυθικὸν διὰ τὸ ψῦχος, οὐκ ἐπιγινομένου ὀξέος τοῦ ἡλίου. ὑπὸ δὲ τοῦ ψύχεος ἡ λευκότης ἐπι καίεται καὶ γίνεται πυρρή.

20. I Will give you a strong proof of the humidity (laxity?) of their constitutions. You will find the greater part of the Scythians, and all the Nomades, with marks of the cautery on their shoulders, arms, wrists, breasts, hip-joints, and loins, and that for no other reason but the humidity and flabbiness of their constitution, for they can neither strain with their bows, nor launch the javelin from their shoulder owing to their humidity and atony: but when they are burnt, much of the humidity in their joints is dried up, and they become better braced, better fed, and their joints get into a more suitable condition. They are flabby and squat at first, because, as in Egypt, they are not swathed (?); and then they pay no attention to horsemanship, so that they may be adepts at it; and because of their sedentary mode of life; for the males, when they cannot be carried about on horseback, sit the most of their time in the wagon, and rarely practise walking, because of their frequent migrations and shiftings of situation; and as to the women, it is amazing how flabby and sluggish they are. The Scythian race are tawny from the cold, and not from the intense heat of the sun, for the whiteness of the skin is parched by the cold, and becomes tawny.

21. Πολύγονον δὲ οὐχ οἷόν τε εἶναι φύσιν τοιαύτην. οὔτε γὰρ τῷ ἀνδρὶ ἡ ἐπιθυμίη τῆς μείξιος γίνεται πολλὴ διὰ τὴν ὑγρότητα τῆς φύσιος καὶ τῆς κοιλίης τὴν μαλθακότητά τε καὶ τὴν ψυχρότητα, ἀφ᾽ ὅτων ἥκιστα εἰκὸς ἄνδρα οἷόν τε λαγνεύειν· καὶ ἔτι ὑπὸ τῶν ἵππων αἰεὶ κοπτόμενοι ἀσθενέες γίνονται ἐς τὴν μεῖξιν. τοῖσι μὲν ἀνδράσιν αὗται αἱ προφάσιες γίνονται, τῇσι δὲ γυναιξὶν ἥ τε πιότης τῆς σαρκὸς καὶ ὑγρότης· οὐ γὰρ δύνανται ἔτι συναρπάζειν αἱ μῆτραι τὸν γόνον· οὔτε γὰρ ἐπιμήνιος κάθαρσις αὐτῇσι γίνεται ὡς χρεών ἐστιν, ἀλλ᾽ ὀλίγον καὶ διὰ χρόνου, τό τε στόμα τῶν μητρέων ὑπὸ πιμελῆς συγκλείεται καὶ οὐχ ὑποδέχεται τὸν γόνον· αὐταί τε ἀταλαίπωροι καὶ πίεραι καὶ αἱ κοιλίαι ψυχραὶ καὶ μαλθακαί. ὑπὸ τούτων τῶν ἀναγκέων οὐ πολύγονόν ἐστι τὸ γένος τὸ Σκυθικόν. μέγα δὲ τεκμήριον αἱ οἰκέτιδες ποιέουσιν· οὐ γὰρ φθάνουσι παρὰ ἄνδρα ἀφικνεύμεναι καὶ ἐν γαστρὶ ἴσχουσιν διὰ τὴν ταλαιπωρίην καὶ ἰσχνότητα τῆς σαρκός.

21. It is impossible that persons of such a constitution could be prolific, for, with the man, the sexual desires are not strong, owing to the laxity of his constitution, the softness and coldness of his belly, from all which causes it is little likely that a man should be given to venery; and besides, from being jaded by exercise on horseback, the men become weak in their desires. On the part of the men these are the causes; but on that of the women, they are embonpoint and humidity; for the womb cannot take in the semen, nor is the menstrual discharge such as it should be, but scanty and at too long intervals; and the mouth of the womb is shut up by fat and does not admit the semen; and, moreover, they themselves are indolent and fat, and their bellies cold and soft. From these causes the Scythian race is not prolific. Their female servants furnish a strong proof of this; for they no sooner have connection with a man than they prove with child, owing to their active course of life and the slenderness of body.

22. Ἔτι τε πρὸς τούτοισιν εὐνουχίαι γίνονται οἱ πλεῖστοι ἐν Σκύθῃσι καὶ γυναικεῖα ἐργάζονται καὶ ὡς αἱ γυναῖκες διαιτεῦνται διαλέγονταί τε ὁμοίως· καλεῦνταί τε οἱ τοιοῦτοι Ἀναριεῖς. οἱ μὲν οὖν ἐπιχώριοι τὴν αἰτίην προστιθέασι θεῷ καὶ σέβονται τούτους τοὺς ἀνθρώπους καὶ προσκυνέουσι, δεδοικότες περὶ ἑωυτῶν ἕκαστοι. ἐμοὶ δὲ καὶ αὐτῷ δοκεῖ ταῦτα τὰ πάθεα θεῖα εἶναι καὶ τἄλλα πάντα καὶ οὐδὲν ἕτερον ἑτέρου θειότερον οὐδὲ ἀνθρωπινώτερον, ἀλλὰ πάντα ὁμοῖα καὶ πάντα θεῖα. ἕκαστον δὲ αὐτῶν ἔχει φύσιν τὴν ἑωυτοῦ καὶ οὐδὲν ἄνευ φύσιος γίνεται. καὶ τοῦτο τὸ πάθος ὥς μοι δοκεῖ γίνεσθαι φράσω· ὑπὸ τῆς ἱππασίης αὐτοὺς κέδματα λαμβάνει, ἅτε αἰεὶ κρεμαμένων ἀπὸ τῶν ἵππων τοῖς ποσίν· ἔπειτα ἀποχωλοῦνται καὶ ἑλκοῦνται τὰ ἰσχία, οἳ ἂν σφόδρα νοσήσωσιν. ἰῶνται δὲ σφᾶς αὐτοὺς τρόπῳ τοιῷδε. ὁκόταν γὰρ ἄρχηται ἡ νοῦσος, ὄπισθεν τοῦ ὠτὸς ἑκατέρου φλέβα τάμνουσιν. ὁκόταν δὲ ἀπορρυῇ τὸ αἷμα, ὕπνος ὑπολαμβάνει ὑπὸ ἀσθενείης καὶ καθεύδουσιν. ἔπειτα ἀνεγείρονται, οἱ μέν τινες ὑγιέες ἐόντες, οἱ δ᾽ οὔ. ἐμοὶ μὲν οὖν δοκεῖ ἐν ταύτῃ τῇ ἰήσει διαφθείρεσθαι ὁ γόνος. εἰσὶ γὰρ παρὰ τὰ ὦτα φλέβες, ἃς ἐάν τις ἐπιτάμῃ, ἄγονοι γίνονται οἱ ἐπιτμηθέντες. ταύτας τοίνυν μοι δοκέουσι τὰς φλέβας ἐπιτάμνειν. οἱ δὲ μετὰ ταῦτα ἐπειδὰν ἀφίκωνται παρὰ γυναῖκας καὶ μὴ οἷοί τ᾽ ἔωσι χρῆσθαί σφισιν, τὸ πρῶτον οὐκ ἐνθυμεῦνται, ἀλλ᾽ ἡσυχίην ἔχουσι. ὁκόταν δὲ δὶς καὶ τρὶς καὶ πλεονάκις αὐτοῖσι πειρωμένοισι μηδὲν ἀλλοιότερον ἀποβαίνῃ, νομίσαντές τι ἡμαρτηκέναι τῷ θεῷ, ὃν ἐπαιτιῶνται, ἐνδύονται στολὴν γυναικείην καταγνόντες ἑωυτῶν ἀνανδρείην. γυναικίζουσί τε καὶ ἐργάζονται μετὰ τῶν γυναικῶν ἃ καὶ ἐκεῖναι.

Τοῦτο δὲ πάσχουσι Σκυθέων οἱ πλούσιοι, οὐχ οἱ κάκιστοι ἀλλ᾽ οἱ εὐγενέστατοι καὶ ἰσχὺν πλείστην κεκτημένοι, διὰ τὴν ἱππασίην, οἱ δὲ πένητες ἧσσον· οὐ γὰρ ἱππάζονται. καίτοι ἐχρῆν, ἐπεὶ θειότερον τοῦτο τὸ νόσευμα τῶν λοιπῶν ἐστιν, οὐ τοῖς γενναιοτάτοις τῶν Σκυθέων καὶ τοῖς πλουσιωτάτοις προσπίπτειν μούνοις, ἀλλὰ τοῖς ἅπασιν ὁμοίως, καὶ μᾶλλον τοῖσιν ὀλίγα κεκτημένοισιν, εἰ δὴ τιμώμενοι χαίρουσιν οἱ θεοὶ καί θαυμαζόμενοι ὑπ᾽ ἀνθρώπων καὶ ἀντὶ τούτων χάριτας ἀποδιδόασιν. εἰκὸς γὰρ τοὺς μὲν πλουσίους θύειν πολλὰ τοῖς θεοῖς καὶ ἀνατιθέναι ἀναθήματα ἐόντων χρημάτων πολλῶν καὶ τιμᾶν, τοὺς δὲ πένητας ἧσσον διὰ τὸ μὴ ἔχειν, ἔπειτα καὶ ἐπιμεμφομένους ὅτι οὐ διδόασι χρήματα αὐτοῖσιν, ὥστε τῶν τοιούτων ἁμαρτιῶν τὰς ζημίας τοὺς ὀλίγα κεκτημένους φέρειν μᾶλλον ἢ τοὺς πλουσίους. ἀλλὰ γάρ, ὥσπερ καὶ πρότερον ἔλεξα, θεῖα μὲν καὶ ταῦτά ἐστιν ὁμοίως τοῖς ἄλλοις· γίνεται δὲ κατὰ φύσιν ἕκαστα. καὶ ἡ τοιαύτη νοῦσος ἀπὸ τοιαύτης προφάσιος τοῖς Σκύθῃσι γίνεται οἵην εἴρηκα. ἔχει δὲ καὶ κατὰ τοὺς λοιποὺς ἀνθρώπους ὁμοίως. ὅκου γὰρ ἱππάζονται μάλιστα καὶ πυκνότατα, ἐκεῖ πλεῖστοι ὑπὸ κεδμάτων καὶ ἰσχιάδων καὶ ποδαγριῶν ἁλίσκονται καὶ λαγνεύειν κάκιστοί εἰσι. ταῦτα δὲ τοῖσι Σκύθῃσι πρόσεστι, καὶ εὐνουχοειδέστατοί εἰσιν ἀνθρώπων διὰ ταύτας τε τὰς προφάσιας καὶ ὅτι ἀναξυρίδας ἔχουσιν αἰεὶ καί εἰσιν ἐπὶ τῶν ἵππων τὸ πλεῖστον τοῦ χρόνου, ὥστε μήτε χειρὶ ἅπτεσθαι τοῦ αἰδοίου, ὑπό τε τοῦ ψύχεος καὶ τοῦ κόπου ἐπιλήθεσθαι τοῦ ἱμέρου καὶ τῆς μείξιος, καὶ μηδὲν παρακινεῖν πρότερον ἢ ἀνανδρωθῆναι.

22. And, in addition to these, there are many eunuchs among the Scythians, who perform female work, and speak like women. Such persons are called effeminates. The inhabitants of the country attribute the cause of their impotence to a god, and venerate and worship such persons, every one dreading that the like might befall himself; but to me it appears that such affections are just as much divine as all others are, and that no one disease is either more divine or more human than another, but that all are alike divine, for that each has its own nature, and that no one arises without a natural cause. But I will explain how I think that the affection takes its rise. From continued exercise on horseback they are seized with chronic defluxions in their joints owing to their legs always hanging down below their horses; they afterwards become lame and stiff at the hip-joint, such of them, at least, as are severely attacked with it. They treat themselves in this way: when the disease is commencing, they open the vein behind either ear, and when the blood flows, sleep, from feebleness, seizes them, and afterwards they awaken, some in good health and others not. To me it appears that the semen is altered by this treatment, for there are veins behind the ears which, if cut, induce impotence; now, these veins would appear to me to be cut. Such persons afterwards, when they go in to women and cannot have connection with them, at first do not think much about it, but remain quiet; but when, after making the attempt two, three, or more times, they succeed no better, fancying they have committed some offence against the god whom they blame for the affection, they put on female attire, reproach themselves for effeminacy, play the part of women, and perform the same work as women do. This the rich among the Scythians endure, not the basest, but the most noble and powerful, owing to their riding on horseback; for the poor are less affected, as they do not ride on horses. And yet, if this disease had been more divine than the others, it ought not to have befallen the most noble and the richest of the Scythians alone, but all alike, or rather those who have little, as not being able to pay honors to the gods, if, indeed, they delight in being thus rewarded by men, and grant favors in return; for it is likely that the rich sacrifice more to the gods, and dedicate more votive offerings, inasmuch as they have wealth, and worship the gods; whereas the poor, from want, do less in this way, and, moreover, upbraid the gods for not giving them wealth, so that those who have few possessions were more likely to bear the punishments of these offences than the rich. But, as I formerly said, these affections are divine just as much as others, for each springs from a natural cause, and this disease arises among the Scythians from such a cause as I have stated. But it attacks other men in like manner, for whenever men ride much and very frequently on horseback, then many are affected with rheums in the joints, sciatica, and gout, and they are inept at venery. But these complaints befall the Scythians, and they are the most impotent of men for the aforesaid causes, and because they always wear breeches, and spend the most of their time on horseback, so as not to touch their privy parts with the hands, and from the cold and fatigue they forget the sexual desire, and do not make the attempt until after they have lost their virility. Thus it is with the race of the Scythians.

23. Περὶ μὲν οὖν τῶν Σκυθέων οὕτως ἔχει τοῦ γένεος. τὸ δὲ λοιπὸν γένος τὸ ἐν τῇ Εὐρώπῃ διάφορον αὐτὸ ἑωυτῷ ἐστι καὶ κατὰ τὸ μέγεθος καὶ κατὰ τὰς μορφὰς διὰ τὰς μεταλλαγὰς τῶν ὡρέων, ὅτι μεγάλαι γίνονται καὶ πυκναί, καὶ θάλπεά τε ἰσχυρὰ καὶ χειμῶνες καρτεροὶ καὶ ὄμβροι πολλοὶ καὶ αὖτις αὐχμοὶ πολυχρόνιοι καὶ πνεύματα, ἐξ ὧν μεταβολαὶ πολλαὶ καὶ παντοδαπαί. ἀπὸ τούτων εἰκὸς αἰσθάνεσθαι καὶ τὴν γένεσιν ἐν τῇ συμπήξει τοῦ γόνου ἄλλοτε ἄλλην καὶ μὴ τῷ αὐτῷ τὴν αὐτὴν γίνεσθαι ἔν τε τῷ θέρει καὶ τῷ χειμῶνι μηδὲ ἐν ἐπομβρίῃ καὶ αὐχμῷ. διότι τὰ εἴδεα διηλλάχθαι νομίζω τῶν Εὐρωπαίων μᾶλλον ἢ τῶν Ἀσιηνῶν καὶ τὰ μεγέθεα διαφορώτατα αὐτὰ ἑωυτοῖς εἶναι κατὰ πόλιν ἑκάστην. αἱ γὰρ φθοραὶ πλείονες ἐγγίνονται τοῦ γόνου ἐν τῇ συμπήξει ἐν τῇσι μεταλλαγῇσι τῶν ὡρέων πυκνῇ σιν ἐούσῃσιν ἢ ἐν τῇσι παραπλησίῃσι καὶ ὁμοίῃσι. περί τε τῶν ἠθέων ὁ αὐτὸς λόγος· τό τε ἄγριον καὶ τὸ ἄμεικτον καὶ τὸ θυμοειδὲς ἐν τῇ τοιαύτῃ φύσει ἐγγίνεται. αἱ γὰρ ἐκπλήξιες πυκναὶ γινόμεναι τῆς γνώμης τὴν ἀγριότητα ἐντιθέασι, τὸ δὲ ἥμερόν τε καὶ ἤπιον ἀμαυροῦσι. διὸ καὶ εὐψυχοτέρους νομίζω τοὺς τὴν Εὐρώπην οἰκέοντας εἶναι ἢ τοὺς τὴν Ἀσίην. ἐν μὲν γὰρ τῷ αἰεὶ παραπλησίῳ αἱ ῥᾳθυμίαι ἔνεισιν, ἐν δὲ τῷ μεταβαλλομένῳ αἱ ταλαιπωρίαι τῷ σώματι καὶ τῇ ψυχῇ. καὶ ἀπὸ μὲν ἡσυχίης καὶ ῥᾳθυμίης ἡ δειλίη αὔξεται, ἀπὸ δὲ τῆς ταλαιπωρίης καὶ τῶν πόνων αἱ ἀνδρεῖαι. διὰ τοῦτό εἰσι μαχιμώτεροι οἱ τὴν Εὐρώπην οἰκέοντες καὶ διὰ τοὺς νόμους, ὅτι οὐ βασιλεύονται ὥσπερ οἱ Ἀσιηνοί. ὅκου γὰρ βασιλεύονται, ἐκεῖ ἀνάγκη δειλοτάτους εἶναι. εἴρηται δέ μοι καὶ πρότερον. αἱ γὰρ ψυχαὶ δεδούλωνται καὶ οὐ βούλονται παρακινδυνεύειν ἑκόντες εἰκῇ ὑπὲρ ἀλλοτρίης δυνάμιος. ὅσοι δὲ αὐτόνομοι — ὑπὲρ ἑωυτῶν γὰρ τοὺς κινδύνους αἱρεῦνται καὶ οὐκ ἄλλων — προθυμεῦνται ἑκόντες καὶ ἐς τὸ δεινὸν ἔρχονται. τὰ γὰρ ἀριστεῖα τῆς νίκης αὐτοὶ φέρονται. οὕτως οἱ νόμοι οὐχ ἥκιστα τὴν εὐψυχίην ἐργάζονται.

23. The other races in Europe differ from one another, both as to stature and shape, owing to the changes of the seasons, which are very great and frequent, and because the heat is strong, the winters severe, and there are frequent rains, and again protracted droughts, and winds, from which many and diversified changes are induced. These changes are likely to have an effect upon generation in the coagulation of the semen, as this process cannot be the same in summer as in winter, nor in rainy as in dry weather; wherefore, I think, that the figures of Europeans differ more than those of Asiatics; and they differ very much from one another as to stature in the same city; for vitiations of the semen occur in its coagulation more frequently during frequent changes of the seasons, than where they are alike and equable. And the same may be said of their dispositions, for the wild, and unsociable, and the passionate occur in such a constitution; for frequent excitement of the mind induces wildness, and extinguishes sociableness and mildness of disposition, and therefore I think the inhabitants of Europe more courageous than those of Asia; for a climate which is always the same induces indolence, but a changeable climate, laborious exertions both of body and mind; and from rest and indolence cowardice is engendered, and from laborious exertions and pains, courage. On this account the inhabitants of Europe are than the Asiatics, and also owing to their institutions, because they are not governed by kings like the latter, for where men are governed by kings there they must be very cowardly, as I have stated before; for their souls are enslaved, and they will not willingly, or readily undergo dangers in order to promote the power of another; but those that are free undertake dangers on their own account, and not for the sake of others; they court hazard and go out to meet it, for they themselves bear off the rewards of victory, and thus their institutions contribute not a little to their courage. Such is the general character of Europe and Asia.

24. Τὸ μὲν οὖν ὅλον καὶ τὸ ἅπαν οὕτως ἔχει περί τε τῆς Εὐρώπης καὶ τῆς Ἀσίης. ἔνεισι δὲ καὶ ἐν τῇ Εὐρώπῃ φῦλα διάφορα ἕτερα ἑτέροισι καὶ τὰ μεγέθεα καὶ τὰς μορφὰς καὶ τὰς ἀνδρείας. τὰ δὲ διαλλάσσοντα ταὐτά ἐστιν, ἃ καὶ ἐπὶ τῶν πρότερον εἴρηται. ἔτι δὲ σαφέστερον φράσω. ὁκόσοι μὲν χώρην ὀρεινήν τε οἰκέουσι καὶ τρηχεῖαν καὶ ὑψηλὴν καὶ ἔνυδρον, καὶ αἱ μεταβολαὶ αὐτοῖσι γίνονται τῶν ὡρέων μέγα διάφοροι, ἐνταῦθα εἰκὸς εἴδεα μεγάλα εἶναι καὶ πρὸς τὸ ταλαίπωρον καὶ τὸ ἀνδρεῖον εὖ πεφυκότα, καὶ τό τε ἄγριον καὶ τὸ θηριῶδες αἱ τοιαῦται φύσιες οὐχ ἥκιστα ἔχουσιν. ὁκόσοι δὲ κοῖλα χωρία καὶ λειμακώδεα καὶ πνιγηρὰ καὶ τῶν θερμῶν πνευμάτων πλέον μέρος μετέχουσιν ἢ τῶν ψυχρῶν ὕδασί τε χρέονται θερμοῖσιν, οὗτοι δὲ μεγάλοι μὲν οὐκ ἂν εἴησαν οὐδὲ κανονίαι, ἐς εὖρος δὲ πεφυκότες καὶ σαρκώδεες καὶ μελανότριχες, καὶ αὐτοὶ μέλανες μᾶλλον ἢ λευκότεροι, φλεγματίαι δὲ ἧσσον ἢ χολώδεες· τὸ δὲ ἀνδρεῖον καὶ τὸ ταλαίπωρον ἐν τῇ ψυχῇ φύσει μὲν οὐκ ἂν ὁμοίως ἐνείη, νόμος δὲ προσγενόμενος ἀπεργάζοιτ᾽ ἄν. καὶ εἰ μὲν ποταμοὶ ἐνείησαν ἐν τῇ χώρῃ, οἵτινες ἐκ τῆς χώρης ἐξοχετεύουσι τό τε στάσιμον καὶ τὸ ὄμβριον, οὗτοι ἂν ὑγιηροί τε εἴησαν καὶ λαμπροί. εἰ μέντοι ποταμοὶ μὲν μὴ εἴησαι, τὰ δὲ ὕδατα λιμναῖά τε καὶ στάσιμα πίνοιεν καὶ ἑλώδεα, ἀνάγκη τὰ τοιαῦτα εἴδεα προγαστρότερα καὶ σπληνώδεα εἶναι. ὁκόσοι δὲ ὑψηλήν τε οἰκέουσι χώρην καὶ λείην καὶ ἀνεμώδεα καὶ ἔνυδρον, εἶεν ἂν εἴδεα μεγάλοι καὶ ἑωυτοῖσι παραπλήσιοι· ἀνανδρότεραι δὲ καὶ ἡμερώτεραι αἱ γνῶμαι. ὁκόσοι δὲ λεπτά τε καὶ ἄνυδρα καὶ ψιλά, τῇσι μεταβολῇσι τῶν ὡρέων οὐκ εὔκρητα, ἐν ταύτῃ τῇ χώρῃ τὰ εἴδεα εἰκὸς σκληρά τε εἶναι καὶ ἔντονα καὶ ξανθότερα ἢ μελάντερα καὶ τὰ ἤθεα καὶ τὰς ὀργὰς αὐθάδεάς τε καὶ ἰδιογνώμονας. ὅκου γὰρ αἱ μεταβολαί εἰσι πυκνόταται τῶν ὡρέων καὶ πλεῖστον διάφοροι αὐταὶ ἑωυτῇσιν, ἐκεῖ καὶ τὰ εἴδεα καὶ τὰ ἤθεα καὶ τὰς φύσιας εὑρήσεις πλεῖστον διαφερούσας. Μέγισται μὲν οὖν εἰσιν αὗται τῆς φύσιος αἱ διαλλαγαί, ἔπειτα δὲ καὶ ἡ χώρη, ἐν ᾗ ἄν τις τρέφηται καὶ τὰ ὕδατα. εὑρήσεις γὰρ ἐπὶ τὸ πλῆθος τῆς χώρης τῇ φύσει ἀκολουθέοντα καὶ τὰ εἴδεα τῶν ἀνθρώπων καὶ τοὺς τρόπους. ὅκου μὲν γὰρ ἡ γῆ πίειρα καὶ μαλθακὴ καὶ ἔνυδρος, καὶ τὰ ὕδατα κάρτα μετέωρα, ὥστε θερμὰ εἶναι τοῦ θέρεος καὶ τοῦ χειμῶνος ψυχρά, καὶ τῶν ὡρέων καλῶς κεῖται, ἐνταῦθα καὶ οἱ ἄνθρωποι σαρκώδεές εἰσι καὶ ἄναρθροι καὶ ὑγροὶ καὶ ἀταλαίπωροι καὶ τὴν ψυχὴν κακοὶ ὡς ἐπὶ τὸ πολύ. τό τε ῥᾴθυμον καὶ τὸ ὑπνηρὸν ἔνεστιν ἐν αὐτοῖς ἰδεῖν· ἔς τε τὰς τέχνας παχέες καὶ οὐ λεπτοὶ οὐδ᾽ ὀξέες. ὅκου δ᾽ ἐστὶν ἡ χώρη ψιλή τε καὶ ἄνυδρος καὶ τρηχεῖα καὶ ὑπὸ τοῦ χειμῶνος πιεζομένη καὶ ὑπὸ τοῦ ἡλίου κεκαυμένη, ἐνταῦθα δὲ σκληρούς τε καὶ ἰσχνοὺς καὶ διηρθρωμένους καὶ ἐντόνους καὶ δασέας ἴδοις. τό τε ἐργατικὸν ἐνεὸν ἐν τῇ φύσει τῇ τοιαύτῃ καὶ τὸ ἄγρυπνον, τά τε ἤθεα καὶ τὰς ὀργὰς αὐθάδεας καὶ ἰδιογνώμονας, τοῦ τε ἀγρίου μᾶλλον μετέχοντας ἢ τοῦ ἡμέρου, ἔς τε τὰς τέχνας ὀξυτέρους τε καὶ συνετωτέρους καὶ τὰ πολέμια ἀμείνους εὑρήσεις· καὶ τἄλλα τὰ ἐν τῇ γῇ φυόμενα πάντα ἀκόλουθα ἐόντα τῇ γῇ. αἱ μὲν ἐναντιώταται φύσιές τε καὶ ἰδέαι ἔχουσιν οὕτως. ἀπὸ δὲ τούτων τεκμαιρόμενος τὰ λοιπὰ ἐνθυμεῖσθαι, καὶ οὐχ ἁμαρτήσῃ.

24. And there are in Europe other tribes, differing from one another in stature, shape, and courage: the differences are those I formerly mentioned, and will now explain more clearly. Such as inhabit a country which is mountainous, rugged, elevated, and well watered, and where the changes of the seasons are very great, are likely to have great variety of shapes among them, and to be naturally of an enterprising and warlike disposition; and such persons are apt to have no little of the savage and ferocious in their nature; but such as dwell in places which are low-lying, abounding in meadows and ill ventilated, and who have a larger proportion of hot than of cold winds, and who make use of warm waters- these are not likely to be of large stature nor well proportioned, but are of a broad make, fleshy, and have black hair; and they are rather of a dark than of a light complexion, and are less likely to be phlegmatic than bilious; courage and laborious enterprise are not naturally in them, but may be engendered in them by means of their institutions. And if there be rivers in the country which carry off the stagnant and rain water from it, these may be wholesome and clear; but if there be no rivers, but the inhabitants drink the waters of fountains, and such as are stagnant and marshy, they must necessarily have prominent bellies and enlarged spleens. But such as inhabit a high country, and one that is level, windy, and well-watered, will be large of stature, and like to one another; but their minds will be rather unmanly and gentle. Those who live on thin, ill-watered, and bare soils, and not well attempered in the changes of the seasons, in such a country they are likely to be in their persons rather hard and well braced, rather of a blond than a dark complexion, and in disposition and passions haughty and self-willed. For, where the changes of the seasons are most frequent, and where they differ most from one another, there you will find their forms, dispositions, and nature the most varied. These are the strongest of the natural causes of difference, and next the country in which one lives, and the waters; for, in general, you will find the forms and dispositions of mankind to correspond with the nature of the country; for where the land is fertile, soft, and well-watered, and supplied with waters from very elevated situations, so as to be hot in summer and cold in winter, and where the seasons are fine, there the men are fleshy, have ill-formed joints, and are of a humid temperament; they are not disposed to endure labor, and, for the most part, are base in spirit; indolence and sluggishness are visible in them, and to the arts they are dull, and not clever nor acute. When the country is bare, not fenced, and rugged, blasted by the winter and scorched by the sun, there you may see the men hardy, slender, with well-shaped joints, well-braced, and shaggy; sharp industry and vigilance accompany such a constitution; in morals and passions they are haughty and opinionative, inclining rather to the fierce than to the mild; and you will find them acute and ingenious as regards the arts, and excelling in military affairs; and likewise all the other productions of the earth corresponding to the earth itself. Thus it is with regard to the most opposite natures and shapes; drawing conclusions from them, you may judge of the rest without any risk of error.

ON THE ARTICULATIONS - Περὶ ἄρθρων

1. Ωμου δὲ ἄρθρον ἕνα τρόπον οἶδα ὀλισθάνον, τὸν ἐς τὴν μασχάλην ἄνω δὲ οὐδέποτε εἶδον, οὐδὲ ἐς τὸ ἔξω οὐ μέντοι διισχυριείω ἔγωγε, εἰ ὀλισθάνοι ἂν, ἢ οὒ, καίπερ ἔχων περὶ αὐτοῦ ὅ τι λέγω. Ἀτὰρ οὐδὲ ἐς τὸ ἔμπροσθεν οὐδπω ὄπωπα, ὅ τι ἔδοξέ μοι ὠλισθηκέναι. Τοῖσι μέντοι ἰητροῖσι δοκέει κάρτα ἐς τοὔμπροσθεν ὀλισθάνειν, καὶ μάλιστα ἐξαπατέονται ἐν τουτέοισιν, ὧν ἂν φθίσις καταλάβῃ τὰς σάρκας τὰς περὶ τὸ ἄρθρον τε καὶ τὸν βραχίονα φαίνεται γὰρ ἐν τοῖσι τοιουτέοισι παντάπασιν ἡ κεφαλὴ τοῦ βραχίονος ἐξέχουσα ἐς τοὔμπροσθεν. Καὶ ἔγωγέ ποτε τὸ τοιοῦτον οὐ φὰς ἐκπεπτωκέναι, ἤκουσα φλαύρως ὑπό τε τῶν ἰητρῶν, ὑπό τε τῶν δημοτέων, διὰ τοῦτο τὸ πρῆγμα ἐδόκεον γὰρ αὐτοῖσιν ἠγνοηκέναι μοῦνος, οἱ δὲ ἄλλοι ἐγνωκέναι, καὶ οὐκ ἠδυνάμην αὐτοὺς ἀναγνῶσαι,

εἰ μὴ μόλις, ὅτι τόδ’ ἐστὶ τοιόνδε εἴ τις τοῦ βραχίονος ψιλώσειε μὲν τῶν σαρκέων τὴν ἐπωμίδα, ψιλώσειε δὲ ᾗ ὁ μῦς ἀνατείνει, ψιλώσειε δὲ τὸν τένοντα τὸν κατὰ τὴν μασχάλην καὶ τὴν κληῗδα πρὸς τὸ στῆθος ἔχοντα, φαίνοιτο ἂν ἡ κεφαλὴ τοῦ βραχίονος ἐς τοὔμπροσθεν ἐξέχουσα ἰσχυρῶς, καίπερ οὐκ ἐκπεπτωκυῖα πέφυκε γὰρ ἐς τοὔμπροσθεν προπετὴς ἡ κεφαλὴ τοῦ βραχίονος τὸ δ’ ἄλλο ὀστέον τοῦ βραχίονος ἐς τὸ ἔξω καμπύλον. Ὁμιλέει δὲ ὁ βραχίων τῷ κοίλῳ τῆς ὠμοπλάτης πλάγιος, ὅταν παρὰ τὰς πλευρὰς παρατεταμένος ἔῃ ὅταν μέντοι ἐς τοὔμπροσθεν ἐκτανυσθῇ ἡ ξύμπασα χεὶρ, τότε ἡ κεφαλὴ τοῦ βραχίονος κατ’ ἴξιν τῆς ὠμοπλάτης τῷ κοίλῳ γίνεται, καὶ οὐκ ἔτι ἐξέχειν ἐς τοὔμπροσθεν φαίνεται. Περὶ οὗ οὖν ὁ λόγος, οὐδέποτε εἶδον οὐδὲ ἐς τοὔμπροσθεν ἐκπεσόν οὐ μὴν ἰσχυριείω γε οὐδὲ περὶ τούτου, εἰ μὴ ἐκπέσοι ἂν οὕτως, ἢ οὔ. Ὅταν οὖν ἐκπέσῃ ὁ βραχίων ἐς τὴν μασχάλην, ἅτε πολλοῖσιν ἐκπίπτοντος, πολλοὶ ἐπίστανται ἐμβάλλειν εὐπαίδευτον δέ ἐστι τὸ εἰδέναι πάντας τοὺς τρόπους, οἷσιν οἱ ἰητροὶ ἐμβάλλουσι, καὶ ὡς ἄν τις αὐτοῖσι τοῖσι τρόποισι τούτοισι κάλλιστα χρῷτο. Χρέεσθαι δὲ χρὴ τῷ κρατίστῳ τῶν τρόπων, ἢν τὴν ἰσχυρονάτην ἀνάγκην ὁρᾷς κράτιστος δὲ ὁ ὕστατος γεγραψόμενος.

1. I am acquainted with one form in which the shoulder-joint is dislocated, namely, that into the armpit; I have never seen it take place upward nor outward; and yet I do not positively affirm whether it might be dislocated in these directions or not, although I have something which I might say on this subject. But neither have I ever seen what I considered to be a dislocation forward. Physicians, indeed, fancy that dislocation is very apt to occur forward, and they are more particularly deceived in those persons who have the fleshy parts about the joint and arm much emaciated; for, in all such cases, the head of the arm appears to protrude forward. And I in one case of this kind having said that there was no dislocation, exposed myself to censure from certain physicians and common people on that account, for they fancied that I alone was ignorant of what everybody else was acquainted with, and I could not convince them but with difficulty, that the matter was so. But if one will strip the point of the shoulder of the fleshy parts, and where the muscle ( deltoid? ) extends, and also lay bare the tendon that goes from the armpit and clavicle to the breast ( pectoral muscle? ), the head of the humerus will appear to protrude strongly forward, although not dislocated, for the head of the humerus naturally inclines forward, but the rest of the bone is turned outward. The humerus is connected obliquely with the cavity of the scapula, when the arm is stretched along the sides; but when the whole arm is stretched forward, then the head of the humerus is in a line with the cavity of the humerus, and no longer appears to protrude forward. And with regard to the variety we are now treating of, I have never seen a case of dislocation forward; and yet I do not speak decidedly respecting it, whether such a dislocation may take place or not. When, then, a dislocation into the armpit takes place, seeing it is of frequent occurrence, many persons know how to reduce it, for it is an easy thing to teach all the methods by which physicians effect the reductions, and the best manner of applying them. The strongest of those methods should be used when the difficulty of reduction is particularly great. The strongest is the method to be last described.

2. Ὅσοισι μὲν οὖν πυκινὰ ἐκπίπτει ὁ ὦμος, ἱκανοὶ ὡς ἐπὶ τὸ

πλεῖστον αὐτοὶ σφίσιν αὐτοῖσιν ἐμβάλλειν εἰσίν ἐνθέντες γὰρ τῆς ἑτέρης χειρὸς τοὺς κονδύλους ἐς τὴν μασχάλην, ἀναγκάζουσιν ἄνω τὸ ἄρθρον, τὸν δὲ ἀγκῶνα παράγουσιν ἐπὶ τὸ στῆθος. Τὸν αὐτὸν δὲ τρόπον τοῦτον καὶ ὁ ἰητρὸς ἂν ἐμβάλλοι, εἰ αὐτὸς μὲν ὑπὸ τὴν μασχάλην ἐσωτέρω τοῦ ἄρθρου τοῦ ἐκπεπτωκότος ὑποτείνας τοὺς δακτύλους, ἀπαναγκάζοι ἀπὸ τῶν πλευρέων, ἐμβάλλων τὴν ἑωυτοῦ κεφαλὴν ἐς τὸ ἀκρώμιον, ἀντερείσιος ἕνεκα, τοῖσι δὲ γούνασι παρὰ τὸν ἀγκῶνα ἐς τὸν βραχίονα ἐμβάλλων, ἀντωθέοι πρὸς τὰς πλευράς ξυμφέρει δὲ κρατερὰς τὰς χεῖρας ἔχειν τὸν ἐμβάλλοντα. Ἢ αὐτὸς μὲν τῇσι χερσὶ καὶ τῇ κεφαλῇ οὕτω ποιοίη, ἄλλος δέ τις τὸν ἀγκῶνα παράγοι παρὰ τὸ στῆθος. Ἐστὶ δὲ ἐμβολὴ ὤμου, καὶ ἐς τοὐπίσω ὑπερβάλλοντα τὸν πῆχυν ἐπὶ τὴν ῥάχιν, ἔπειτα τῇ μὲν ἑτέρῃ χειρὶ ἀνακλᾷν ἐς τὸ ἄνω τοῦ ἀγκῶνος ἐχόμενον, τῇ δὲ ἑτέρῃ παρὰ τὸ ἄρθρον ὄπισθεν ἐρείδειν. Αὕτη ἡ ἐμβολὴ, καὶ ἡ πρόσθεν εἰρημένη, οὐ κατὰ φύσιν ἐοῦσαι, ὅμως ἀμφισφάλλουσαι τὸ ἄρθρον, ἀναγκάζουσιν ἐμπίπτειν.

2. Those who are subject to frequent dislocations at the shoulder-joint, are for the most part competent to effect the reduction themselves; for, having introduced the knuckles of the other hand into the armpit, they force the joint upward, and bring the elbow toward the breast. The physician might reduce it in the same manner, if having introduced his fingers into the armpit on the inside of the dislocated joint, he would force it from the ribs, pushing his own head against the acromion, in order to make counter-pressure, and with his knees applied to the patient’s elbow pushing the arm to the sides. It will be of advantage if the operator has strong hands, or the physician may do as directed with his head and hands, while another person brings the elbow toward the breast. Reduction of the shoulder may also be effected by carrying the fore-arm backward to the spine, and then with the one hand grasping it at the elbow, to bend the arm upward, and with the other to support it behind at the articulation. This mode of reduction, and the one formerly described, are not natural, and yet by rotating the bone of the joint, they force it to return.

3. Οἱ δὲ τῇ πτέρνῃ πειρώμενοι ἐμβάλλειν, ἐγγύς τι τοῦ κατὰ φύσιν ἀναγκάζουσιν χρὴ δὲ τὸν μὲν ἄνθρωπον χαμαὶ κατακλῖναι ὕπτιον, τὸν δὲ ἐμβάλλοντα χαμαὶ ἵζεσθαι ἐφ’ ὁκότερα ἂν τὸ ἄρθρον ἐκπεπτώκῃ ἔπειτα λαβόμενον τῇσι χερσὶ τῇσιν ἑωυτέου τῆς χειρὸς τῆς σιναρῆς, κατατείνειν αὐτὴν, τὴν δὲ πτέρνην ἐς τὴν μασχάλην

ἐμβάλλοντα ἀντωθέειν, τῇ μὲν δεξιῇ ἐς τὴν δεξιὴν, τῇ δὲ ἀριστερῇ ἐς τὴν ἀριστερήν. Δεῖ δὲ ἐς τὸ κοῖλον τῆς μασχάλης ἐνθεῖναι στρογγύλον τι ἐναρμόσσον ἐπιτηδειόταται δὲ αἱ πάνυ σμικραὶ σφαῖραι καὶ σκληραὶ, οἷαι ἐκ τῶν πολλῶν σκυτέων ῥάπτονται ἢν γὰρ μή τι τοιοῦτον ἐγκέηται, οὐ δύναται ἡ πτέρνη ἐξικνέεσθαι πρὸς τὴν κεφαλὴν τοῦ βραχίονος κατατεινομένης γὰρ τῆς χειρὸς, κοιλαίνεται ἡ μασχάλη οἱ γὰρ τένοντες οἱ ἔνθεν καὶ ἔνθεν τῆς μασχάλης, ἀντισφίγγοντες, ἐναντίοι εἰσίν. Χρὴ δέ τινα ἐπὶ θάτερα τοῦ κατατεινομένου καθήμενον κατέχειν κατὰ τὸν ὑγιέα ὦμον, ὡς μὴ περιέλκηται τὸ σῶμα, τῆς χειρὸς τῆς σιναρῆς ἐπὶ θάτερα τεινομένης ἔπειτα ἱμάντος μαλθακοῦ πλάτος ἔχοντος ἱκανὸν, ὅταν ἡ σφαίρη ἐντεθῇ ἐς τὴν μασχάλην, περὶ τὴν σφαίρην περιβεβλημένου τοῦ ἱμάντος, καὶ κατέχοντος, λαβόμενον ἀμφοτερέων τῶν ἀρχέων τοῦ ἱμάντος, ἀντικατατείνειν τινὰ, ὑπὲρ κεφαλῆς τοῦ κατατεινομένου καθήμενον, τῷ ποδὶ προσβάντα πρὸς τοῦ ἀκρωμίου τὸ ὀστέον. Ἡ δὲ σφαίρη ὡς ἐσωτάτω καὶ ὡς μάλιστα πρὸς τῶν πλευρέων κείσθω, καὶ μὴ ἐπὶ τῇ κεφαλῇ τοῦ βραχίονος.

3. Those who attempt to perform reduction with the heel, operate in a manner which is an approach to the natural. The patient must lie on the ground upon his back, while the person who is to effect the reduction is seated on the ground upon the side of the dislocation; then the operator, seizing with his hand the affected arm, is to pull it, while with his heel in the armpit he pushes in the contrary direction, the right heel being placed in the right armpit, and the left heel in the left armpit. But a round ball of a suitable size must be placed in the hollow of the armpit; the most convenient are very small and hard balls, formed from several pieces of leather sewed together. For without something of the kind the heel cannot reach to the head of the humerus, since, when the arm is stretched, the armpit becomes hollow, the tendons on both sides of the armpit making counter-contraction so as to oppose the reduction. But another person should be seated on the other side of the patient to hold the sound shoulder, so that the body may not be dragged along when the arm of the affected side is pulled; and then, when the ball is placed in the armpit, a supple piece of thong sufficiently broad is to be placed round it, and some person taking hold of its two ends is to seat himself above the patient’s head to made counter-extension, while at the same time he pushes with his foot against the bone at the top of the shoulder. The ball should be placed as much on the inside as possible, upon the ribs, and not upon the head of the humerus.

4. Ἔστι δὲ καὶ ἄλλη ἐμβολὴ, ᾗ κατωμίζουσιν ἐς ὀρθόν μείζω μέντοι εἶναι χρὴ τὸν κατωμίζοντα, διαλαβόντα δὲ τὴν χεῖρα, ὑποθεῖναι τὸν ὦμον τὸν ἑωυτοῦ ὑπὸ τὴν μασχάλην ὀξύν κἄπειτα

ὑποστρέψαι, ὡς ἂν ἐνίζηται ἕδρῃ, οὕτω στοχασάμενον ὅκως ἀμφὶ τὸν ὦμον τὸν ἑωυτοῦ κρεμάσαι τὸν ἄνθρωπον κατὰ τὴν μασχάλην αὐτὸς δὲ ἑωυτὸν ὑψηλότερον ἐπὶ τοῦτον τὸν ὦμον ποιεέτω, ἢ ἐπὶ τὸν ἕτερον τοῦ δὲ κρεμαμένου τὸν βραχίονα πρὸς τὸ ἑωυτοῦ στῆθος προσαναγκαζέτω ὡς τάχιστα ἐν τούτῳ δὲ τῷ σχήματι προσανασειέτω, ὁκόταν μετεωρίσῃ τὸν ἄνθρωπον, ὡς ἀντιρρέποι τὸ ἄλλο σῶμα αὐτῷ, ἀντίον τοῦ βραχίονος τοῦ κατεχομένου ἢν δὲ ἄγαν κοῦφος ἔῃ ὁ ἄνθρωπος, προσεπικρεμασθήτω τούτου ὄπισθέν τις κοῦφος παῖς. Αὗται δὲ αἱ ἐμβολαὶ πᾶσαι κατὰ παλαίστρην εὔχρηστοί εἰσιν, ὅτι οὐδὲν ἀλλοίων ἀρμένων δέονται ἐπεισενεχθῆναι χρήσαιτο δ’ ἄν τις καὶ ἄλλοθι.

4. There is another method of reduction performed by the shoulder of a person standing. The person operating in this way, who should be taller than the patient, is to take hold of his arm and place the sharp point of his own shoulder in the patient’s armpit, and push it in so that it may lodge there, and having for his object that the patient may be suspended at his back by the armpit, he must raise himself higher on this shoulder than the other; and he must bring the arm of the suspended patient as quickly as possible to his own breast. In this position he should shake the patient when he raises him up, in order that the rest of the body may be a counterpoise to the arm which is thus held. But if the patient be very light, a light child should be suspended behind along with him. These methods of reduction are all of easy application in the palestra, as they can all be performed without instruments, but they may also be used elsewhere.

5. Ἀτὰρ καὶ οἱ περὶ τὸ ὕπερον ἀναγκάζοντες, ἐγγύς τι τοῦ κατὰ φύσιν ἐμβάλλουσιν χρὴ δὲ τὸ μὲν ὕπερον κατειλίχθαι ταινίῃ τινὶ μαλθακῇ ἧσσον γὰρ ἂν ὑπολισθάνοἰ, ὑπηναγκάσθαι δὲ μεσηγὺ τῶν πλευρέων καὶ τῆς κεφαλῆς τοῦ βραχίονος καὶ ἢν μὲν βραχὺ ἔῃ τὸ ὕπερον, καθῆσθαι χρὴ τὸν ἄνθρωπον ἐπί τινος, ὡς μόλις

τὸν βραχίονα περιβάλλειν δύνηται περὶ τὸ ὕπερον μάλιστα δὲ ἔστω μακρότερον τὸ ὕπερον, ὡς ἂν ἑστεὼς ὁ ἄνθρωπος κρέμασθαι μικροῦ δέῃ ἀμφὶ τῷ ξύλῳ. Κἄπειτα ὁ μὲν βραχίων καὶ ὁ πῆχυς παρατεταμένος παρὰ τὸ ὕπερον ἔστω, τὸ δὲ ἐπὶ θάτερα τοῦ σώματος καταταγκαζέτω τις, περιβάλλων κατὰ τὸν αὐχένα παρὰ τὴν κληῗδα τὰς χεῖρας. Αὕτη ἡ ἐμβολὴ κατὰ φύσιν ἐπιεικέως ἐστὶ, καὶ ἐμβάλλειν δύναται, ἢν χρηστῶς σκευάσωνται αὐτήν.

5. Those who accomplish the reduction by forcibly bending it round a pestle, operate in a manner which is nearly natural. But the pestle should be wrapped in a soft shawl (for thus it will be less slippery), and it should be forced between the ribs and the head of the humerus. And if the pestle be short, the patient should be seated upon something, that his arm can with difficulty pass above the pestle. But for the most part the pestle should be longer, so that the patient when standing may be almost suspended upon the piece of wood. And then the arm and forearm should be stretched along the pestle, whilst some person secures the opposite side of the body by throwing his arms round the neck, near the clavicle.

6. Ἀτὰρ καὶ ἡ διὰ τοῦ κλιμακίου ἑτέρη τις τοιαύτη, καὶ ἔτι βελτίων, ὅτι ἀσφαλεστέρως ἂν τὸ σῶμα, τὸ μὲν τῇ, τὸ δὲ τῇ, ἀντισηκωθείη μετεωρισθέν περὶ γὰρ τὸ ὑπεροειδὲς ὁ ὦμος ἢν καὶ καταπεπήγῃ, περισφάλλεσθαι τὸ σῶμα κίνδυνος ἢ τῇ, ἢ τῇ χρὴ μέντοι, καὶ ἐπὶ τῷ κλιμακτῆρι ἐπιδεδέσθαι τι ἄνωθεν στρογγύλον ἐναρμόσσον ἐς τὸ κοῖλον τῆς μασχάλης, ὃ προσδιαναγκάσει τὴν κεφαλὴν τοῦ βραχίονος ἐς τὴν φύσιν ἀπιέναι.

6. But the method with a ladder is another of the same kind, and still better, since by it the body can be more safely counterpoised on this side; and that, while in the method which the piece of wood resembling a pestle, there is danger of the body tumbling to either side. But some round thing should be tied upon the step of the ladder which may be fitted to the armpit, whereby the head of the bone may be forced into its natural place.

7. Κρατίστη μέντοι πασέων τῶν ἐμβολέων ἡ τοιήδε ξύλον χρὴ εἶναι, πλάτος μὲν ὡς πενταδάκτυλον, ἢ τετραδάκτυλον τὸ ἐπίπαν, πάχος δὲ ὡς διδάκτυλον, ἢ καὶ λεπτότερον, μῆκος δὲ δίπηχυ, ἢ ὀλίγῳ ἔλασσον ἔστω δὲ ἐπὶ θάτερα τὸ ἄκρον περιφερὲς καὶ στενότατον ταύτῃ καὶ λεπτότατον ἄμβην δὲ ἐχέτω, σμικρὸν

ὑπερέχουσαν, ἐπὶ τῷ ὑστάτῳ τοῦ περιφερέος, ἐν τῷ μέρεϊ, μὴ τῷ πρὸς τὰς πλευρὰς, ἀλλὰ τῷ πρὸς τὴν κεφαλὴν τοῦ βραχίονος ἔχοντι, ὡς ὑφαρμόσειε τῇ μασχάλῃ παρὰ τὰς πλευρὰς ὑπὸ τὴν κεφαλὴν τοῦ βραχίονος ὑποτιθέμενον ὀθονίῳ δὲ ἢ ταινίῃ μαλθακῇ κατακεκολλήσθω ἄκρον τὸ ξύλον, ὅκως προσηνέστερον ἔῃ. Ἔπειτα χρὴ ὑπώσαντα τὴν κεφαλὴν τοῦ ξύλου ὑπὸ τὴν μασχάλην ὡς ἐσωτάτω μεσηγὺ τῶν πλευρέων καὶ τῆς κεφαλῆς τοῦ βραχίονος, τὴν δὲ ὅλην χεῖρα πρὸς τὸ ξύλον κατατείναντα, προσκαταδῆσαι κατά τε τὸν βραχίονα, κατά τε τὸν πῆχυν, κατά τε τὸν καρπὸν τῆς χειρὸς, ὡς ἂν ἀτρεμέῃ ὅτι μάλιστα περὶ παντὸς δὲ χρὴ ποιέεσθαι, ὅκως τὸ ἄκρον τοῦ ξύλου ὡς ἐσωτάτω τῆς μασχάλης ἔσται, ὑπερβεβηκὸς τὴν κεφαλὴν τοῦ βραχίονος. Ἔπειτα χρὴ μεσηγὺ δύο στύλων στρωτῆρα πλάγιον εὖ προσδῆσαι, ἔπειτα ὑπερενεγκεῖν τὴν χεῖρα ξὺν τῷ ξύλῳ ὑπὲρ τοῦ στρωτῆρος, ὅκως ἡ μὲν χεὶρ ἐπὶ θάτερα ἔῃ, ἐπὶ θάτερα δὲ τὸ σῶμα, κατὰ δὲ τὴν μασχάλην ὁ στρωτήρ κἄπειτα ἐπὶ μὲν θάτερα τὴν χεῖρα καταναγκάζειν ξὺν τῷ ξύλῳ περὶ τὸν στρωτῆρα, ἐπὶ θάτερα δὲ τὸ ἄλλο σῶμα. Ὕψος δὲ ἔχων ὁ στρωτὴρ προσδεδέσθω, ὥστε μετέωρον τὸ ἄλλο σῶμα εἶναι ἐπ’ ἄκρων τῶν ποδῶν. Οὗτος ὁ τρόπος παραπολὺ κράτιστος ἐμβολῆς ὤμου δικαιότατα μὲν γὰρ μοχλεύει, ἢν μοῦνον ἐσωτέρω ἔῃ τὸ ξύλον τῆς κεφαλῆς τοῦ βραχίονος δικαιόταται δὲ αἱ ἀντιρροπαὶ,

ἀσφαλέες δὲ τῷ ὀστέῳ τοῦ βραχίονος. Τὰ μὲν οὖν νεαρὰ ἐμπίπτει θᾶσσον, ἢ ὡς ἄν τις οἴοιτο, πρὶν ἢ καὶ κατατετάσθαι δοκέειν ἀτὰρ καὶ τὰ παλαιὰ μούνη αὕτη τῶν ἐμβολέων οἵη τε ἐμβιβάσαι, ἢν μὴ ἤδη ὑπὸ χρόνου σὰρξ μὲν ἐπεληλύθῃ ἐπὶ τὴν κοτύλην, ἡ δὲ κεφαλὴ τοῦ βραχίονος ἤδη τρίβον ἑωυτῇ πεποιημένη ἔῃ ἐν τῷ χωρίῳ, ἵνα ἐξεκλίθη οὐ μὴν ἀλλ’ ἐμβάλλειν γάρ μοι δοκέει καὶ οὕτω πεπαλαιωμένον ἔκπτωμα τοῦ βραχίονος τί γὰρ ἂν δικαίη μόχλευσις οὐχὶ κινήσειε;, μένειν μέντοι οὐκ ἄν μοι δοκέοι κατὰ χώρην, ἀλλ’ ὀλισθάνοι ἂν ὡς τὸ ἔθος. Τὸ αὐτὸ δὲ ποιέει καὶ περὶ κλιμακτῆρα καταναγκάζειν, τοῦτον τὸν τρόπον σκευάσαντα. Πάνυ μὴν ἱκανῶς ἔχει, καὶ περὶ μέγα ἕδος θεσσαλικὸν ἀναγκάζειν, ἢν νεαρὸν ἔῃ τὸ ὀλίσθημα ἐσκευάσθαι μέντοι χρὴ τὸ ξύλον οὕτως, ὥσπερ εἴρηται ἀτὰρ τὸν ἄνθρωπον καθίσαι πλάγιον ἐπὶ τῷ δίφρῳ κἄπειτα τὸν βραχίονα ξὺν τῷ ξύλῳ ὑπερβάλλειν ὑπὲρ τοῦ ἀνακλισμοῦ, καὶ ἐπὶ μὲν θάτερα τὸ σῶμα καταναγκάζειν, ἐπὶ δὲ θάτερα τὸν βραχίονα σὺν τῷ ξύλῳ. Τὸ αὐτὸ δὲ ποιέει καὶ ὑπὲρ δίκλειδος θύρης

ἀναγκάζειν. Χρέεσθαι δὲ χρὴ αἰεὶ τούτοισιν, ἃ ἂν τύχῃ παρεόντα.

7. The following, however, is the strongest of all the methods of reduction. We must get a piece of wood, five, or at least four inches broad, two inches in thickness, or still thinner, and two cubits in length, or a little less; and its extremity at one end should be rounded, and made very narrow and very slender there, and it should have a slightly projecting edge ( ambe ) on its round extremity, not on the part that is to be applied to the side, but to the head of the humerus, so that it may be adjusted in the armpit at the sides under the head of the humerus; and a piece of soft shawl or cloth should be glued to the end of the piece of wood, so as to give the less pain upon pressure. Then having pushed the head of this piece of wood as far inward as possible between the ribs and the head of the humerus, the whole arm is to be stretched along this piece of wood, and is to be bound round at the arm, the fore-arm, and the wrist, so that it may be particularly well secured; but great pains should be taken that the extremity of this piece of wood should be introduced as far as possible into the armpit, and that it is carried past the head of the humerus. Then a cross-beam is to be securely fastened between two pillars, and afterward the arm with the piece of wood attached to it is to be brought over this cross-beam, so that the arm may be on the one side of it and the body on the other, and the cross-beam in the armpit; and then the arm with the piece of wood is to be forced down on the one side of the cross-beam, and the rest of the body on the other. The cross-beam is to be bound so high that the rest of the body may be raised upon tip-toes. This is by far the most powerful method of effecting reduction of the shoulder; for one thus operates with the lever upon the most correct principles, provided only the piece of wood be placed as much as possible within the head of the humerus, and thus also the counter-balancing weights will be most properly adjusted, and safely applied to the bone of the arm. Wherefore recent cases in this way may be reduced more quickly than could be believed, before even extension would appear to be applied; and this is the only mode of reduction capable of replacing old dislocations, and this it will effect, unless flesh has already filled up the (glenoid) cavity, and the head of the humerus has formed a socket for itself in the place to which it has been displaced; and even in such an old case of dislocation, it appears to me that we could effect reduction (for what object would a lever power properly applied not it move?), but it would not remain in its place, but would be again displaced as formerly. The same thing may be effected by means of the ladder, by preparing it in the same manner. If the dislocation be recent, a large Thessalian chair may be sufficient to accomplish this purpose; the wood, however, should be dressed up as described before; but the patient should be seated sideways on the chair, and then the arm, with the piece of wood attached to it, is to be brought over the back of the chair, and force is to be applied to the arm, with the wood on the one side, and the body on the other side. The same means may be applied with a double door. One should always use what happens to be at hand.

8. Εἰδέναι μὲν οὖν χρὴ, ὅτι φύσιες φυσίων μέγα διαφέρουσιν ἐς τὸ ῥηϊδίως ἐμπίπτειν τὰ ἐκπίπτοντα διενέγκοι μὲν γὰρ ἄν τι κα κοτύλη κοτύλης, ἡ μὲν εὐυπέρβατος ἐοῦσα, ἡ δὲ ἧσσον πλεῖστον δὲ διαφέρει καὶ τῶν νεύρων ὁ σύνδεσμος, τοῖσι μὲν ἐπιδόσιας ἔχων, τοῖσι δὲ ξυντεταμένος ἐών. Καὶ γὰρ ἡ ὑγρότης τοῖσιν ἀνθρώποισι γίνεται ἡ ἐκ τῶν ἄρθρων, διὰ τῶν νεύρων τὴν ἀπάρτισιν, ἢν χαλαρά τε ἔῃ φύσει, καὶ τὰς ἐπιτάσιας εὐφόρως φέρῃ συχνοὺς γὰρ ἄν τις ἴδοι, οἳ οὕτως ὑγροί εἰσιν, ὥστε, ὁπόταν ἐθέλωσι, τότε αὐτοῖσι τὰ ἄρθρα ἐξίσταται ἀνωδύνως, καὶ καθίσταται ἀνωδύνως. Διαφέρει μέντοι τι καὶ σχέσις τοῦ σώματος τοῖσι μὲν γὰρ εὖ ἔχουσι τὸ γυῖον καὶ σεσαρκωμένοισιν ἐκπίπτει τε ἧσσον, ἐμπίπτει τε χαλεπώτερον ὅταν δὲ αὐτοὶ σφέων αὐτῶν λεπτότεροι καὶ ἀσαρκότεροι ἔωσι, τότε ἐκπίπτει τε μᾶλλον, ἐμπίπτει τε ῥᾷον. Σημήϊον δὲ, ὅτι ταῦτα οὕτως ἔχει, καὶ τόδε τοῖσι γὰρ βουσὶ τότε ἐκπίπτουσι μᾶλλον οἱ μηροὶ ἐκ τῆς κοτύλης, ἡνίκα ἂν αὐτοὶ σφέων

αὐτῶν λεπτότατοι ἔωσιν γίνονται δὲ βόες λεπτότατοι, τοῦ χειμῶνος τελευτῶντος τότε οὖν καὶ ἐξαρθρέουσι μάλιστα, εἰ δή τι καὶ τοιοῦτο δεῖ ἐν ἰητρικῇ γράψαι δεῖ δέ καλῶς γὰρ Ὅμηρος καταμεμαθήκει, ὅτι πάντων τῶν προβάτων βόες μάλιστα πονέουσι ταύτην τὴν ὥρην, καὶ βοῶν οἱ ἀρόται, ὅτι κατὰ τὸν χειμῶνα ἐργάζονται. Τούτοισι τοίνυν ἐκπίπτει μάλιστα οὗτοι γὰρ μάλιστα λεπτύνονται. Τὰ μὲν γὰρ ἄλλα βοσκήματα δύναται βραχείην τὴν ποίην βόσκεσθαι βοῦς δὲ οὐ μάλα, πρὶν βαθεῖα γένηται τοῖσι μὲν γὰρ ἄλλοισίν ἐστι λεπτὴ ἡ προβολὴ τοῦ χείλεος, λεπτὴ δὲ ἡ ἄνω γνάθος βοϊ δὲ παχείη μὲν ἡ προβολὴ τοῦ χείλεος, παχείη δὲ καὶ ἀμβλεῖα ἡ ἄνω γνάθος διὰ ταῦτα ὑποβάλλειν ὑπὸ τὰς βραχείας ποίας οὐ δύναται. Τά τε αὖ μώνυχα τῶν ζώων, ἅτε ἀμφόδοντα ἐόντα, δύναται μὲν σαρκάζειν, δύναται δὲ ὑπὸ τὴν βραχείην ποίην ὑποβάλλειν τοὺς ὀδόντας, καὶ ἥδεται τῇ οὕτως ἐχούσῃ ποίῃ μᾶλλον, ἢ τῇ βαθείῃ καὶ γὰρ τὸ ἐπίπαν ἀμείνων καὶ στερεωτέρη ἡ βραχείη ποίη τῆς βαθείης, ποτὶ καὶ πρὶν ἐκκαρπεῖν τὴν βαθείην.

Διὰ τοῦτο οὖν ἐποίησεν ὧδε τάδε τὰ ἔπη [Ως δ’ ὁπότ’ ἀσπάσιον ἔαρ ἤλυθε βουσὶν ἕλιξιν], ὅτι ἀσμενωτάτη αὐτοῖσιν ἡ βαθείη ποίη φαίνεται. Ἀτὰρ καὶ ἄλλως ὁ βοὺς χαλαρὸν φύσει τὸ ἄρθρον τοῦτο ἔχει μᾶλλον τῶν ἄλλων ζώων διὰ τοῦτο καὶ εἰλίπουν ἐστὶ μᾶλλον τῶν ἄλλων ζώων, καὶ μάλιστα ὅταν λεπτὸν καὶ γηραλέον ἔῃ. Διὰ ταῦτα πάντα καὶ ἐκπίπτει βοϊ μάλιστα πλείω δὲ γέγραπται περὶ αὐτέου, ὅτι πάντων τῶν προειρημένων ταῦτα μαρτύριά ἐστιν. Περὶ οὗ οὖν ὁ λόγος, τοῖσιν ἀσάρκοισι μᾶλλον ἐκπίπτει, καὶ θᾶσσον ἐμπίπτει, ἢ τοῖσι σεσαρκωμένοισιν καὶ ἧσσον ἐπιφλεγμαίνει τοῖσιν ὑγροῖσιν καὶ τοῖσιν ἀσάρκοισιν, ἢ τοῖσι σκελιφροῖσι καὶ σεσαρκωμένοισιν, καὶ ἧσσόν γε δέδεται ἐς τὸν ἔπειτα χρόνον ἀτὰρ καὶ ἡ μύξα πλείων ὑπείη τοῦ μετρίου μὴ ξὺν φλεγμονῇ, καὶ οὕτως ἂν ὀλισθηρὸν εἴη μυξωδέστερα γὰρ τοὐπίπαν τὰ ἄρθρα τοῖσιν ἀσάρκοισιν, ἢ τοῖσι σεσαρκωμένοισίν ἐστιν καὶ γὰρ αὗται αἱ σάρκες τῶν μὴ ἀπὸ τέχνης ὀρθῶς λελιμαγχημένων, αἱ τῶν λεπτῶν, μυξωδέστεραί εἰσιν, ἢ αἱ τῶν παχέων. Ὅσοισι μέντοι ξὺν φλεγμονῇ μύξα ὑπογίνεται, ἡ φλεγμονὴ δήσασα ἔχει τὸ ἄρθρον διὰ τοῦτο οὐ μάλα ἐκπίπτει τὰ ὑπόμυξα, ἐκπίπτοντα ἂν, εἰ μή τι ἢ πλέον, ἢ ἔλασσον φλεγμονῆς ὑπεγένετο.

8. Wherefore it should be known that one constitution differs much from another as to the facility with which dislocations in them may be reduced, and one articular cavity differs much from another, the one being so constructed that the bone readily leaps out and another less so; but the greatest difference regards the binding together of the parts by the nerves ( ligaments? ) which are slack in some and tight in others. For the humidity in the joints of men is connected with the state of the ligaments, when they are slack and yielding; for you may see many people who are so humid ( flabby? ) that when they choose they can disarticulate their joints without pain, and reduce them in like manner. The habit of the body also occasions a certain difference, for in those who are in a state of embonpoint and fleshy the joint is rarely dislocated, but is more difficult to reduce; but when they are more attenuated and leaner than usual, then they are subject to dislocations which are more easily reduced. And the following observation is a proof that matters are so; for in cattle the thighs are most apt to be dislocated at the hip-joint, when they are most particularly lean, which they are at the end of winter, at which time then they are particularly subject to dislocations (if I may be allowed to make such an observation while treating of a medical subject); and therefore Homer has well remarked, that of all beasts oxen suffer the most at that season, and especially those employed at the plow as being worked in the winter season. In them, therefore, dislocations happen most frequently, as being at that time most particularly reduced in flesh. And other cattle can crop the grass when it is short, but the ox cannot do so until it becomes long; for, in the others, the projection of the lip is slender, and so is the upper lip, but in the ox the projection of the lip is thick, and the upper jaw is thick and obtuse, and therefore they are incapable of seizing short herbs. But the solidungula as having prominent teeth in both their front jaws, can crop the grass and grasp it with their teeth while short, and delight more in short grass than in rank; for, in general, short grass is better and more substantial than rank, as having not yet given out its fructification. Wherefore the poet has the following line: “As when to horned cattle dear the vernal season comes,” because rank grass appears to be most sought after by them. But otherwise in the ox, this joint is slacker than in other animals, and, therefore, this animal drags his foot in walking more than any other, and especially when lank and old. For all these reasons the ox is most particularly subject to dislocations; and I have made the more observations respecting him, as they confirm all that was said before on this subject. With regard, then, to the matter on hand, I say that dislocations occur more readily, and are more speedily reduced in those who are lean than in those who are fleshy; and in those who are humid and lank there is less inflammation than in such as are dry and fleshy, and they are less compactly knit hereafter, and there is more mucosity than usual in cases not attended with inflammation, and hence the joints are more liable to luxations; for, in the main, the articulations are more subject to mucosities in those who are lean than in those who are fleshy; and the flesh of lean persons who have not been reduced by a proper course of discipline abounds more with mucosity than that of fat persons. But in those cases in which the mucosity is accompanied with inflammation, the inflammation binds ( braces? ) the joint, and hence those who have small collections of mucosities are not very subject to dislocations, which they would be if the mucosity had not been accompanied with more or less inflammation.

9. Οἷσι μὲν οὖν, ὅταν ἐμπέσῃ τὸ ἄρθρον, μὴ ἐπιφλεγμαίνει τὰ περιέχοντα, χρῆσθαί τε ἀνωδύνως αὐτίκα τῷ ὤμῳ δύνανται, οὗτοι μὲν οὐδὲν νομίζουσι δεῖν ἑωυτῶν ἐπιμελέεσθαι ἰητροῦ μήν ἐστι καταμαντεύσασθαι τῶν τοιούτων τοῖσι τοιούτοισι γὰρ ἐκπίπτει καὶ αὖθις μᾶλλον, ἢ οἷσιν ἂν ἐπιφλεγμήνῃ τὰ νεῦρα. Τοῦτο κατὰ πάντα τὰ ἄρθρα οὕτως ἔχει, καὶ μάλιστα κατ’ ὦμον καὶ κατὰ γόνυ μάλιστα γὰρ οὖν ὀλισθάνει ταῦτα. Οἷσι δ’ ἂν ἐπιφλεγμήνῃ τὰ νεῦρα, οὐ δύνανται χρέεσθαι τῷ ὤμῳ κωλύει γὰρ ἡ ὀδύνη καὶ ἡ ξύντασις τῆς φλεγμονῆς. Τοὺς οὖν τοιούτους ἰῆσθαι χρὴ κηρωτῇ καὶ σπλήνεσι καὶ ὀθονίοισι πολλοῖσιν ἐπιδέοντα ὑποτιθέναι δὲ ἐς τὴν μασχάλην εἴριον μαλθακὸν, καθαρὸν ξυνειλίσσοντα, ἐκπλήρωμα τοῦ κοίλου ποιέοντα, ἵνα ἀντιστήριγμα μὲν τῇ ἐπιδέσει ἔῃ, ἀνακωχέῃ δὲ τὸ ἄρθρον τὸν δὲ βραχίονα ἐς τὸ ἄνω ῥέποντα ἴσχειν χρὴ τὰ πλεῖστα οὕτω γὰρ ἂν ἑκαστάτω εἴη τοῦ χωρίου, ἐς ὃ ὤλισθεν ἡ κεφαλὴ τοῦ ὤμου. Χρὴ δὲ, ὅταν ἐπιδησῃς τὸν ὦμον, ἔπειτα προσκαταδεῖν τὸν βραχίονα πρὸς τὰς πλευρὰς ταινίῃ τινὶ, κύκλῳ περὶ τὸ σῶμα περιβάλλοντα. Χρὴ δὲ καὶ ἀνατρίβειν τὸν ὦμον ἡσυχαίως καὶ λιπαρῶς. Πολλῶν δὲ ἔμπειρον δεῖ εἶναι τὸν ἰητρὸν, ἀτὰρ δὴ καὶ ἀνατρίψιος ἀπὸ γὰρ τοῦ αὐτέου ὀνόματος οὐ τωὐτὸ

ἀποβαίνει καὶ γὰρ ἂν δήσειεν ἄρθρον ἀνάτριψις, χαλαρώτερον τοῦ καιροῦ ἐὸν, καὶ λύσειεν ἄρθρον, σκληρότερον τοῦ καιροῦ ἐόν ἀλλὰ διοριεῖται ἡμῖν περὶ ἀνατρίψιος ἐν ἄλλῳ λόγῳ. Τὸν γοῦν τοιοῦτον ὦμον μαλθακῇσι ξυμφέρει τῇσι χερσὶν ἀνατρίβειν, καὶ ἄλλως πρηέως τὸ δὲ ἄρθρον διακινέειν μὴ βίῃ, ἀλλὰ τοσοῦτον, ὅσον ἀνωδύνως κινῆσαι. Καθίσταται δὲ πάντα, τὰ μὲν ἐν πλείονι χρόνῳ, τὰ δ’ ἐν ἐλάσσονι.

9. In cases of dislocation those persons who are not attacked with inflammation of the surrounding parts, can use the shoulder immediately without pain, and do not think it necessary to take any precautions with themselves; it is therefore the business of the physician to warn them beforehand that dislocation is more likely to return in such cases than when the tendons have been inflamed. This remark applies to all the articulations, but particularly to those of the shoulder and knee, for these are the joints most subject to luxations. But those who have inflammation of the ligaments cannot use the shoulder, for the pain and the tension induced by the inflammation prevent them. Such cases are to be treated with cerate, compresses, and plenty of bandages; but a ball of soft clean wool is to be introduced into the armpit, to fill up the hollow of it, that it may be a support to the bandaging, and maintain the joint in situ . The arm, in general, should be inclined upward as much as possible, for thus it will be kept at the greatest possible distance from the place at which the head of the humerus escaped. And when you bandage the shoulder you must fasten the arms to the sides with a band, which is to be carried round the body. The shoulder should be rubbed gently and softly. The physician ought to be acquainted with many things, and among others with friction; for from the same name the same results are not always obtained; for friction could brace a joint when unseasonably relaxed, and relax it when unseasonably hard; but we will define what we know respecting friction in another place. The shoulder, then, in such a state, should be rubbed with soft hands; and, moreover, in a gentle manner, and the joint should be moved about, but not roughly, so as to excite pain. Things get restored sometimes in a greater space of time, and sometimes in a smaller.

10. Γινώσκειν δὲ, εἰ ἐκπέπτωκεν ὁ βραχίων, τοισίδε χρὴ τοῖσι σημείοισιν τοῦτο μὲν, ἐπειδὴ δίκαιον ἔχουσι τὸ σῶμα οἱ ἄνθρωποι, καὶ τὰς χεῖρας, καὶ τὰ σκέλεα, παραδείγματι χρέεσθαι δεῖ τῷ ὑγιέϊ πρὸς τὸ μὴ ὑγιὲς, καὶ τῷ μὴ ὑγιεῖ πρὸς τὸ ὑγιὲς, μὴ τὰ ἀλλότρια ἄρθρα καθορῶντα ἄλλοι γὰρ ἄλλων μᾶλλον ἔξαρθροι πεφύκασιν, ἀλλὰ τὰ αὐτοῦ τοῦ κάμνοντος, ἢν ἀνόμοιον ἔῃ τὸ ὑγιὲς τῷ κάμνοντι. Καὶ τοῦτο εἴρηται μὲν ὀρθῶς, παραξύνεσιν δὲ ἔχει πάνυ πολλήν διὰ τὰ τοιαῦτα, καὶ οὐκ ἀρκέει μοῦνον λόγῳ εἰδέναι τὴν τέχνην ταύτην, ἀλλὰ καὶ ὁμιλίῃ ὁμιλέειν πολλοὶ γὰρ ὑπὸ ὀδύνης, ἢ καὶ ὑπ’ ἀλλοίης προφάσιος, οὐκ ἐξεστεώτων αὐτέοισι τῶν ἄρθρων, ὅμως οὐ δύνανται

ἐς τὰ ὅμοια σχήματα καθίστασθαι ἐς οἷά περ τὸ ὑγιαῖνον σῶμα σχηματίζεται προσξυνιέναι μὲν οὖν, καὶ ἐννοεῖν καὶ τὸ τοιόνδε σχῆμα χρή. Ἀτὰρ καὶ ἐν τῇ μασχάλῃ ἡ κεφαλὴ τοῦ βραχίονος φαίνεται ἐγκειμένη πολλῷ μᾶλλον τοῦ ἐκπεπτωκότος ἢ τοῦ ὑγιέος τοῦτο δὲ, ἄνωθεν κατὰ τὴν ἐπωμίδα κοῖλον φαίνεται τὸ χωρίον, καὶ τὸ τοῦ ἀκρωμίου ὀστέον ἐξέχον φαίνεται, ἅτε ὑποδεδυκότος τοῦ ἄρθρου ἐς τὸ κάτω χωρίον παραξύνεσιν μὴν καὶ ἐν τούτῳ ἔχει τινὰ, ἀλλ’ ὕστερον περὶ αὐτοῦ γεγράψεται, ἄξιον γὰρ γραφῆς ἐστιν τοῦτο δὲ, τοῦ ἐκπεπτωκότος ὁ ἀγκὼν φαίνεται ἀφεστεὼς μᾶλλον ἀπὸ τῶν πλευρέων, ἢ τοῦ ἑτέρου εἰ μέντοι τις προσαναγκάζοι, προσάγεται μὲν, ἐπιπόνως δέ τοῦτο δὲ, ἄνω τὴν χεῖρα ἆραι εὐθεῖαν παρὰ τὸ οὖς, ἐκτεταμένου τοῦ ἀγκῶνος, οὐ μάλα δύνανται, ὥσπερ τὴν ὑγιέα, οὐδὲ παράγειν ἔνθα καὶ ἔνθα ὁμοίως. Τά τε οὖν σημήϊα ταῦτά ἐστιν ὤμου ἐκπεπτωκότος αἵ τε ἐμβολαὶ αἱ γεγραμμέναι, αἵ τε ἰητρεῖαι αὗται.

10. A dislocation may be recognized by the following symptoms:-Since the parts of a man’s body are proportionate to one another, as the arms and the legs, the sound should always be compared with the unsound, and the unsound with the sound, not paying regard to the joints of other individuals (for one person’s joints are more prominent than another’s), but looking to those of the patient, to ascertain whether the sound joint be unlike the unsound. This is a proper rule, and yet it may lead to much error; and on this account it is not sufficient to know this art in theory, but also by actual practice; for many persons from pain, or from any other cause, when their joints are not dislocated, cannot put the parts into the same positions as the sound body can be put into; one ought therefore to know and be acquainted beforehand with such an attitude. But in a dislocated joint the head of the humerus appears lying much more in the armpit than it is in the sound joint; and also, above, at the top of the shoulder, the part appears hollow, and the acromion is prominent, owing to the bone of the joint having sunk into the part below; there is a source of error in this case also, as will be described afterward, for it deserves to be described; and also, the elbow of the dislocated arm is farther removed from the ribs than that of the other; but by using force it may be approximated, though with considerable pain; and also they cannot, with the elbow extended, raise the arm to the ear, as they can the sound arm, nor move it about as formerly in this direction and that. These, then, are the symptoms of dislocation at the shoulder. The methods of reduction and the treatment are as described.

11. Ἐπάξιον δὲ τὸ μάθημα, ὡς χρὴ ἰητρεύειν τοὺς πυκνὰ ἐκπίπτοντας ὤμους πολλοὶ μὲν γὰρ ἤδη ἀγωνίης ἐκωλύθησανδιὰ ταύτην τὴν ξυμφορὴν, τἄλλα πάντα ἀξιόχρεοι ἐόντες πολλοὶ δὲ ἐν πολεμικοῖσιν ἀχρήϊοι ἐγένοντο, καὶ διεφθάρησαν διὰ ταύτην τὴν ξυμφορήν ἅμα δὲ ἐπάξιον καὶ διὰ τοῦτο, ὅτι οὐδένα οἶδα ὀρθῶς ἰητρεύοντα, ἀλλὰ τοὺς μὲν μηδὲ ἐγχειρέοντας, τοὺς δὲ τἀναντία τοῦ ξυμφέροντος φρονέοντάς τε καὶ ποιέοντας. Συχνοὶ γὰρ ἤδη ἰητροὶ

ἔκαυσαν ὤμους ἐκπίπτοντας, κατά τε τὴν ἐπωμίδα, κατά τε τὸ ἔμπροσθεν, ᾗ ἡ κεφαλὴ τοῦ βραχίονος ἐξογκέει, κατά τε τοὔπισθεν ὀλίγον τῆς ἐπωμίδος αὗται οὖν αἱ καύσιες, εἰ μὲν ἐς τὸ ἄνω ἐξέπιπτεν ὁ βραχίων, ἢ ἐς τοὔμπροσθεν, ἢ ἐς τοὔπισθεν, ὀρθῶς ἂν ἔκαιον νῦν δὲ δὴ, ὅτε ἐς τὸ κάτω ἐκπίπτει, ἐκβάλλουσιν αὗται αἱ καύσιες μᾶλλον, ἢ κωλύουσιν ἀποκλείουσι γὰρ τῆς ἄνω εὐρυχωρίης τὴν κεφαλὴν τοῦ βραχίονος. Χρὴ δὲ ὧδε καίειν ταῦτα ἀπολαβόντα τοῖσι δακτύλοισι κατὰ τὴν μασχάλην τὸ δέρμα ἀφελκύσαι κατ’ αὐτὴν τὴν ἴξιν μάλιστα, καθ’ ἣν ἡ κεφαλὴ τοῦ βραχίονος ἐκπίπτει ἔπειτα οὕτως ἀφελκυσάμενον τὸ δέρμα διακαῦσαι ἐς τὸ πέρην. Σιδηρίοισι δὲ χρὴ ταῦτα καίειν, μὴ παχέσι, μηδὲ λίην φαλακροῖσιν, ἀλλὰ προμήκεσι ταχυπορώτερα γὰῤ, καὶ τῇ χειρὶ ἐπερείδειν χρὴ δὲ καὶ διαφανέσι καίειν, ὡς ὅτι τάχιστα περαιωθῇ κατὰ δύναμιν τὰ γὰρ παχέα, βραδέως περαιούμενα, πλατυτέρας τὰς ἐκπτώσιας τῶν ἐσχαρῶν ποιέεται, καὶ κίνδυνος ἂν εἴη ξυρραγῆναι τὰς ὠτειλας καὶ κάκιον μὲν οὐδὲν ἂν εἴη, αἴσχιον δὲ καὶ ἀτεχνότερον. Ὅταν δὲ διακαύσῃς ἐς τὸ πέρην, τῶν μὲν πλείστων ἱκανῶς ἂν ἔχοι ἐν τῷ κάτω μέρεϊ τὰς ἐσχάρας ταύτας μόνας θεῖναι ἢν δὲ μὴ κίνδυνος φαίνηται εἶναι ξυρραγῆναι τὰς ὠτειλὰς, ἀλλὰ πολὺ τὸ διὰ μέσου ἔῃ, ὑπάλειπτρον χρὴ λεπτὸν διέρσαι διὰ τῶν καυμάτων,

ἔτι ἀναλελαμμένου τοῦ δέρματος, οὐ γὰρ ἂν ἄλλως δύναιο διέρσαι ἐπὴν δὲ διέρσῃς, ἀφεῖναι τὸ δέρμα, ἔπειτα μεσηγὺ τῶν ἐσχαρέων ἄλλην ἐσχάρην ἐμβάλλειν λεπτῷ σιδηρίῳ, καὶ διακαῦσαι, ἄχρις ἂν τῷ ὑπαλείπτρῳ ἐγκύρσῃ. Ὁκόσον δέ τι χρὴ τὸ δέρμα τὸ ἀπὸ τῆς μασχάλης ἀπολαμβάνειν, τοισίδε χρὴ τεκμαίρεσθαι ἀδένες ὕπεισιν ἢ ἐλάσσους ἢ μείζους πᾶσιν ὑπὸ τῇ μασχάλῃ, πολλαχῆ δὲ καὶ ἄλλῃ τοῦ σώματος. Ἀλλὰ ἐν ἄλλῳ λόγῳ περὶ ἀδένων οὐλομελίης γεγράψεται, ὅ τι τέ εἰσι, καὶ οἷα ἐν οἵοισι σημαίνουσί τε καὶ δύνανται. Τοὺς μὲν οὖν ἀδένας οὐ χρὴ προσαπολαμβάνειν, οὐδ’ ὅσα ἐσωτέρω τῶν ἀδένων μέγας γὰρ ὁ κίνδυνος τοῖσι γὰρ ἐπικαιροτάτοισι τόνοισι γειτονεύονται ὅσον δὲ ἐξωτέρω τῶν ἀδένων, ἐπιπλεῖστον ἀπολαμβάνειν ἀσινέα γάρ. Γινώσκειν δὲ χρὴ. καὶ τάδε, ὅτι, ἢν μὲν ἰσχυρῶς τὸν βραχίονα ἀνατείνῃς, οὐ δυνήσῃ τοῦ δέρματος ἀπολαβεῖν οὐδὲν τοῦ ὑπὸ τῇ μασχάλῃ, ὅ τι καὶ ἄξιον λόγου καταναισιμοῦται γὰρ ἐν τῇ ἀνατάσει οἱ δ’ αὖ τόνοι, οὓς

οὐδεμιῇ μηχανῇ δεῖ τιτρώσκειν, οὗτοι πρόχειροι γίνονται καὶ κατατεταμένοι ἐν τούτῳ τῷ σχήματι ἢν δὲ μικρὸν ἐπάρῃς τὸν βραχίονα, πολὺ μὲν τοῦ δέρματος ἀπολήψῃ, οἱ δὲ τόνοι, ὧν δεῖ προμηθέεσθαι, εἴσω καὶ πρόσω τοῦ χειρίσματος γίνονται. Ἆρ’ οὖν οὐκ ἐν πάσῃ τῇ τέχνῃ περὶ παντὸς χρὴ ποιέεσθαι, τὰ δίκαια σχήματα ἐξευρίσκειν ἐφ’ ἑκάστοισιν; ταῦτα μὲν τὰ κατὰ τὴν μασχάλην, καὶ ἱκαναὶ αὐταὶ αἱ καταλήψιες, ἢν ὀρθῶς τεθῶσιν αἱ ἐσχάραι. Ἔκτοσθεν δὲ τῆς μασχάλης, δισσὰ μόνα ἐστὶ χωρία, ἵνα ἄν τις ἐσχάρας θείη, τιμωρεούσας τῷ παθήματι μίαν μὲν ἐν τῷ ἔμπροσθεν μεσηγὺ τῆς τε κεφαλῆς τοῦ βραχίονος καὶ τοῦ τένοντος τοῦ κατὰ τὴν μασχάλην καὶ ταύτῃ τὸ μὲν δέρμα τελέως διακαίειν χρὴ, βαθύτερον δὲ οὐ χρή φλέψ τε γὰρ παχείη πλησίη, καὶ νεῖρα,

ὧν οὐδέτερα θερμαντέα. Ἔξωθεν δ’ αὖ ἄλλην ἐσχάρην ἐνδέχεται ἐνθεῖναι ἀνωτέρω μὲν συχνῷ τοῦ τένοντος τοῦ κατὰ τὴν μασχάλην, κατωτέρω δὲ ὀλίγῳ τῆς κεφαλῆς τοῦ βραχίονος καὶ τὸ μὲν δέρμα τελέως χρὴ διακαίειν, βαθείην δὲ μηδὲ κάρτα ταύτην ποιέειν πολέμιον γὰρ τὸ πῦρ νεύροισιν. Ἰητρεύειν μὲν οὖν χρὴ διὰ πάσης τῆς ἰητρείης τὰ ἕλκεα, μηδέποτε ἰσχυρῶς ἀνατείνοντα τὸν βραχίονα, ἀλλὰ μετρίως, ὅσον τῶν ἑλκέων ἐπιμελείης εἵνεκα ἧσσον μὲν γὰρ ἂν διαψύχοιτο ξυμφέρει γὰρ πάντα τὰ καύματα σκέπειν, ὡς ἐπιεικέως ἰητρεύεσθαἰ ἧσσον δ’ ἂν ἐκπλίσσοιτο ἧσσον δ’ ἂν αἱμορραγοίη ἧσσον δ’ ἂν σπασμὸς ἐπιγένοιτο. Ὅταν δὲ δὴ καθαρὰ γένηται τὰ ἕλκεα, ἐς ὠτειλάς τε ἴῃ, τότε δὴ καὶ παντάπασι χρὴ αἰεὶ τὸν βραχίονα πρὸς τῇσι πλευρῇσι προσδεδέσθαι, καὶ νύκτα καὶ ἡμέρην ἀτὰρ καὶ ὅταν ὑγιέα γένηται τὰ ἕλκεα, ὁμοίως ἐπὶ πολὺν χρόνον χρὴ προσδεῖν τὸν βραχίονα πρὸς τὰς πλευράς οὕτω γὰρ ἂν μάλιστα ἐπουλωθείη, καὶ ἀποληφθείη ἡ εὐρυχωρίη, καθ’ ἣν μάλιστα ὀλισθάνει ὁ βραχίων.

11. It deserves to be known how a shoulder which is subject to frequent dislocations should be treated. For many persons owing to this accident have been obliged to abandon gymnastic exercises, though otherwise well qualified for them; and from the same misfortune have become inept in warlike practices, and have thus perished. And this subject deserves to be noticed, because I have never known any physician treat the case properly; some abandon the attempt altogether, and others hold opinions and practice the very what is proper. For physicians have burned the shoulders subject to dislocation, at the top of the shoulder, at the anterior part where the head of the humerus protrudes, and a little behind the top of the shoulder; these burnings, if the dislocation of the arm were upward, or forward, or backward, would have been properly performed; but now, when the dislocation is downward, they rather promote than prevent dislocations, for they shut out the head of the humerus from the free space above. The cautery should be applied thus: taking hold with the hands of the skin at the armpit, it is to be drawn into the line, in which the head of the humerus is dislocated; and then the skin thus drawn aside is to be burnt to the opposite side. The burnings should be performed with irons, which are not thick nor much rounded, but of an oblong form (for thus they pass the more readily through), and they are to be pushed forward with the hand; the cauteries should be red-hot, that they may pass through as quickly as possible; for such as are thick pass through slowly, and occasion eschars of a greater breadth than convenient, and there is danger that the cicatrices may break into one another; which, although nothing very bad, is most unseemly, or awkward. When you have burnt through, it will be sufficient, in most cases, to make eschars only in the lower part; but if there is no danger of the ulcers passing into one another, and there is a considerable piece of skin between them, a thin spatula is to be pushed through these holes which have been burned, while, at the same time, the skin is stretched, for otherwise the instrument could not pass through; but when you have passed it through you must let go the skin, and then between the two eschars you should form another eschar with a slender iron, and burn through until you come in contact with the spatula. The following directions enable you to determine how much of the skin of the armpit should be grasped; all men have glands in the armpit greater or smaller, and also in many other parts of the body. But I will treat in another work of the whole constitution of the glands, and explain what they are, what they signify, and what are their offices. The glands, then, are not to be taken hold of, nor the parts internal to the glands; for this would be attended with great danger, as they are adjacent to the most important nerves. But the greater part of the substances external to the glands are to be grasped, for there is no danger from them. And this, also, it is proper to know, that if you raise the arm much, you will not be able to grasp any quantity of skin worth mentioning, for it is all taken up with the stretching; and also the nerves, which by all means you must avoid wounding, become exposed and stretched in this position; but if you only raise the arm a little, you can grasp a large quantity of skin, and the nerves which you ought to guard against are left within, and at a distance from the operation. Should not, then, the utmost pains be taken in the whole practice of the art to find out the proper attitude in every case? So much regarding the armpit, and these contractions will be sufficient, provided the eschars be properly placed. Without the armpit there are only two places where one might place the eschars to obviate this affection; the one before and between the head of the humerus and the tendon at the armpit; and then the skin may be fairly burned through, but not to any great depth, for there is a large vein adjacent, and also nerves, neither of which must be touched with the heat. But externally, one may form another eschar considerably above the tendon at the armpit, but a little below the head of the humerus; and the skin must be burned fairly through, but it must not be made very deep, for fire is inimical to the nerves. Through the whole treatment the sores are to be so treated, as to avoid all strong extension of the arm, and this is to be done moderately, and only as far as the dressing requires; for thus they will be less cooled (for it is of importance to cover up all sorts of burns if one would treat them mildly), and then the lips of them will be less turned aside; there will be less hemorrhage and fear of convulsions. But when the sores have become clean, and are going on to cicatrization, then by all means the arm is to be bound to the side night and day; and even when the ulcers are completely healed, the arm must still be bound to the side for a long time; for thus more especially will cicatrization take place, and the wide space into which the humerus used to escape will become contracted.

12. Ὅσοισι δ’ ἂν ὦμος καταπορηθῇ ἐμβληθῆναι, ἢν μὲν ἔτι ἐν αὐξήσει ἔωσιν, οὐκ ἐθέλει συναύξεσθαι τὸ ὀστέον τοῦ βραχίονος ὁμοίως τῷ ὑγιέϊ, ἀλλὰ αὔξεται μὲν ἐπί τι, βραχύτερον δὲ τοῦ ἑτέρου

γίνεται καὶ οἱ καλεομενοι δὲ ἐκ γενεῆς γαλιάγκωνες διὰ δισσὰς ξυμφορὰς ταύτας γίνονται, ἤν τέ τι τοιοῦτον αὐτοὺς ἐξάρθρημα καταλάβῃ ἐν τῇ γαστρὶ ἐόντας, διά τε ἄλλην ξυμφορὴν, περὶ ἧς ὕστερόν ποτε γεγράψεται ἀτὰρ καὶ οἷσιν ἔτι νηπίοισιν ἐοῦσι κατὰ τὴν κεφαλὴν τοῦ βραχίονος βαθεῖαι καὶ ὑποβρύχιοι ἐκπυήσιες γίνονται, καὶ οὗτοι πάντες γαλιάγκωνες γίνονται καὶ ἤν τε τμηθῶσιν, ἤν τε καυθῶσιν, ἤν τε αὐτόματόν σφιν ἐκραγῇ, εὖ εἰδέναι χρὴ, ὅτι ταῦτα οὕτως ἔχει. Χρέεσθαι μέντοι τῇ χειρὶ δυνατώτατοί εἰσιν οἱ ἐκ γενεῆς γαλιάγκωνες, οὐ μὴν οὐδὲ ἐκεῖνοί γε ἀνατεῖναι παρὰ τὸ οὖς τὸν βραχίονα, ἐκτανύσαντες τὸν ἀγκῶνα, δύνανται, ἀλλὰ πολὺ ἐνδεεστέρως, ἢ τὴν ὑγιέα χεῖρα. Οἷσι δ’ ἂν ἤδη ἀνδράσιν ἐοῦσιν ἐκπέσῃ ὁ ὦμος, καὶ μὴ ἐμβληθῇ, ἡ ἐπωμὶς ἀσαρκοτέρη γίνεται, καὶ ἡ ἕξις λεπτὴ ἡ κατὰ τοῦτο τὸ μέρος ὅταν μέντοι ὀδυνώμενοι παύσωνται, ὁκόσα μὲν δεῖ ἐργάζεσθαι ἐπάραντας τὸν ἀγκῶνα ἀπὸ τῶν πλευρέων ἐς τὸ πλάγιον, ταῦτα μὲν οὐ δύνανται ἅπαντα ὁμοίως ἐργάζεσθαι ὁκόσα δὲ δεῖ ἐργάζεσθαι, παραφέροντας τὸν βραχίονα παρὰ τὰς πλευρὰς, ἢ ἐς τοὐπίσω, ἢ ἐς τοὔμπροσθεν, ταῦτα δὲ δύνανται ἐργάζεσθαι καὶ γὰρ ἂν ἀρίδα ἑλκύσαιεν, καὶ

πρίονα, καὶ πελεκήσαιεν ἂν, καὶ σκάψαιεν ἂν, μὴ κάρτα ἄνω αἴροντες τὸν ἀγκῶνα, καὶ τἄλλα ὅσα ἐκ τῶν τοιούτων σχημάτων ἐργάζονται.

12. When attempts to reduce a dislocated shoulder have failed, if the patient be still growing, the bone of the affected arm will not increase like the sound one, for although it does increase in so far it becomes shorter than the other; and those persons called weasel-armed , become so from two accidents, either from having met with this dislocation in utero , or from another accident, which will be described afterward. But those who while they were children have had deep-seated suppurations about the head of the bone, all become weasel-armed; and this, it should be well known, will be the issue, whether the abscess be opened by an incision or cautery, or whether it break spontaneously. Those who are thus affected from birth are quite able to use the arm yet neither can they raise the arm to the ear, by extending the elbow, but they do this much less efficiently than with the sound arm. But in those who have had the shoulder dislocated after they were grown up, and when it has not been reduced, the top of the shoulder becomes much less fleshy, and the habit of body at that part is attenuated; but when they cease to have pain, whatever they attempt to perform by raising the elbow from the sides obliquely, they can no longer accomplish as formerly; but whatever acts are performed by carrying the arm around by the sides, either backward or forward, all those they can perform; for they can work with an auger or a saw, or with a hatchet, and can dig, by not raising the elbow too much, and do all other kinds of work which are done in similar attitudes.

13. Ὅσοισι δ’ ἂν τὸ ἀκρώμιον ἀποσπασθῇ, τουτέοισι φαίνεται ἐξέχον τὸ ὀστέον τὸ ἀπεσπασμένον ἔστι δὲ τοῦτο ὁ ξύνδεσμος τῆς κληῗδος καὶ τῆς ὠμοπλάτης ἑτεροίη γὰρ ἡ φύσις ἀνθρώπου ταύτῃ, ἢ τῶν ἄλλων ζώων. Οἱ οὖν ἰητροὶ μάλιστα ἐξαπατέονται ἐν τούτῳ τῷ τρώματι ἅτε γὰρ ἀνασχόντος τοῦ ὀστέου τοῦ ἀποσπασθέντος, ἡ ἐπωμὶς φαίνεται χαμαιζήλη καὶ κοίλἠ, ὥστε καὶ προμηθέεσθαι τῶν ὤμων τῶν ἐκπεπτωκότων πολλοὺς οὖν οἶδα ἰητροὺς, τἄλλα οὐ φλαύρους ἐόντας, οἳ πολλὰ ἤδη ἐλυμήναντο, ἐμβάλλειν πειρώμενοι τοὺς τοιούτους ὤμους, οὕτως οἰόμενοι ἐκπεπτωκέναι, καὶ οὐ πρόσθεν παύονται, πρὶν ἢ ἀπογνῶναι, ἢ ἀπορῆσαι, δοκέοντες αὐτοὶ σφέας αὐτοὺς ἐμβάλλειν τὸν ὦμον. Τούτοισιν ἰητρείη μὲν, ἥπερ καὶ τοῖσιν ἄλλοισιν τοῖσι τοιούτοισι, κηρωτὴ καὶ σπλῆνες καὶ ὀθόνια, καὶ ἐπίδεσις τοιαύτη. Καταναγκάζειν μέντοι τὸ ὑπερέχον χρὴ, καὶ τοὺς σπλῆνας κατὰ τοῦτο τιθέναι πλείστους, καὶ πιέζειν ταύτῃ μάλιστα, καὶ τὸν βραχίονα πρὸς τῇσι πλευρῇσι ποοσηρτημένον ἐς τὸ ἄνω μέρος ἔχειν οὕτω γὰρ ἂν μάλιστα πλησιάζοι τὸ ἀπεσπασμένον. Τάδε μὴν εὖ εἰδέναι χρὴ, καὶ προλέγειν ὡς ἀσφαλέα, εἰ ἄλλως ἐθέλοις, ὅτι βλάβη μὲν οὐδεμίη, οὔτε σμικρὴ, οὔτε μεγάλη, τῷ ὤμῳ γίνεται ἀπὸ τούτου τοῦ τρώματος, αἴσχιον δὲ τὸ χωρίον οὐδὲ γὰρ τοῦτο τὸ ὀστέον ἐς τὴν ἀρχαίην ἕδρην ὁμοίως ἂν

ἱδρυνθείη, ὥσπερ ἐπεφύκεεν, ἀλλ’ ἀνάγκη πλέον ἢ ἔλασσον ὀγκηρότερον εἶναι ἐς τὸ ἄνω. Οὐδὲ γὰρ ἄλλο ὀστέον οὐδὲν ἐς τωὐτὸ καθίσταται, ὅ τι ἂν κοινωνέον ἔῃ ἑτέρῳ ὀστέῳ, καὶ προσπεφυκὸς ἀποσπασθῇ ἀπὸ τῆς ἀρχαίης φύσιος. Ἀνώδυνον δὲ τὸ ἀκρώμιον ἐν ὀλίγῃσιν ἡμέρῃσι γίνεται, ἢν χρηστῶς ἐπιδέηται.

13. In those cases where the acromion has been torn off, the bone which is thus separated appears prominent. The bone is the bond of connection between the clavicle and scapula, for in this respect the constitution of man is different from that of other animals; physicians are particularly liable to be deceived in this accident (for as the separated bone protrudes, the top of the shoulder appears low and hollow), so that they make preparations as if for dislocation of the shoulder; for I have known many physicians, otherwise not inexpert at the art, who have done much mischief by attempting to reduce such shoulders, thus supposing it a case of dislocation; and they did not desist until they gave over mistake of supposing that they had reduced the shoulder. The treatment, in these cases, is similar to that which is applicable in others of a like kind, namely, cerate, compresses, and suitable bandaging with linen cloths. The projecting part must be pushed down, and the greater number of compresses are to be placed on it, and most compression is to be applied at that part, and the arm being fastened to the side is to be kept elevated; for thus the parts which had been torn asunder are brought into closest proximity with one another. All this should be well known, and if you choose you may prognosticate safely that no impediment, small or great, will result from such an injury at the shoulder, only there will be a deformity in the place, for the bone cannot be properly restored to its natural situation, but there must necessarily be more or less tumefaction in the upper part. For neither can any other bone be made exactly as it was, which having become incorporated with another bone, and having grown to it as an apophysis, has been torn from its natural situation. If properly bandaged, the acromion becomes free of pain in a few days.

14. Κληϊς δὲ κατεαγεῖσα, ἢν μὲν ἀτρεκέως ἀποκαυλισθῇ, εὐιητοτέρη ἐστίν ἢν δὲ παραμηκέως, δυσιητοτέρη. Τἀναντία δὲ τούτοισίν ἐστιν, ἢ ὡς ἄν τις οἴοιτο τὴν μὲν γὰρ ἀτρεκέως ἀποκαυλισθεῖσαν προσαναγκάσειεν ἄν τις μᾶλλον ἐς τὴν φύσιν ἐλθεῖν καὶ γὰρ εἰ πάνυ προμηθηθείη, τὸ ἀνωτέρω κατωτέρω ἂν ποιήσειε, σχήμασί τε ἐπιτηδείοισι καὶ ἐπιδέσει ἁρμοζούσῃ εἰ δὲ μὴ τελέως ἱδρυνθείη, ἀλλ’ οὖν τὸ ὑπερέχον γε τοῦ ὀστέου οὐ κάρτα ὀξὺ γίνεται. Ων δὲ ἂν παράμηκες τὸ ὀστέον κατεαγῇ, ἰκέλη ἡ ξυμφορὴ γίνεται τοῖσιν ὀστέοισι τοῖσιν ἀπεσπασμένοισι, περὶ ὧν πρόσθεν γέγραπται οὔτε γὰρ ἱδρυνθῆναι αὐτὸ πρὸς ἑωυτὸ κάρτα ἐθέλει, ἥ τε ὑπερέχουσα ὄκρις τοῦ ὀστέου ὀξείη γίνεται κάρτα. Τὸ μὲν οὖν ξύμπαν, εἰδέναι χρὴ, ὅτι βλάβη οὐδεμίη τῷ ὤμῳ, οὐδὲ τῷ ἄλλῳ σώματι γίνεται διὰ τὴν κάτηξιν τῆς κληῗδος, ἢν μὴ ἐπισφακελίσῃ ὀλιγάκις δὲ τοῦτο γίνεται. Αἶσχός γε μὴν προσγίνεται περὶ τὴν κάτηξιν τῆς κληῗδος, καὶ τούτοισι τὸ πρῶτον αἴσχιστον, ἔπειτα μὴν

ἐπὶ ἧσσον γίνεται. Ξυμφύεται δὲ ταχέως κληϊς, καὶ τἄλλα πάντα ὅσα χαῦνα ὀστέα ταχείην γὰρ τὴν ἐπιπώρωσιν ποιέεται τὰ τοιαῦτα. Ὅταν μὲν οὖν νεωστὶ κατεαγῇ, οἱ τετρωμένοι σπουδάζουσιν, οἰόμενοι μέζον τὸ κακὸν εἶναι, ἢ ὅσον ἐστίν οἵ τε ἰητροὶ προθυμέονται δῆθεν ὀρθῶς ἰῆσθαι προϊόντος δὲ τοῦ χρόνου, οἱ τετρωμένοι, ἅτε οὐκ ὀδυνώμενοι, οὐδὲ κωλυόμενοι οὔτε ὁδοιπορίης, οὔτε ἐδωδῆς, καταμελέουσιν οἵ τε αὖ ἰητροὶ, ἅτε οὐ δυνάμενοι καλὰ τὰ χωρία ἀποδεικνύναι, ἀποδιδράσκουσι, καὶ οὐκ ἄχθονται τῇ ἀμελείῃ τῶν τετρωμένων ἐν τούτῳ δὲ ἡ ἐπιπώρωσις ξυνταχύνεται. Ἐπιδέσιος μὲν οὖν τρόπος καθέστηκε παραπλήσιος τοῖσι πλείστοισι, κηρωτῇ καὶ σπλήνεσι καὶ ὀθονίοισι μαλθακοῖσιν ἰητρεύειν καὶ τάδε δεῖ προσξυνιέναι καὶ μάλιστα ἐν τούτῳ τῷ χειρίσματι, ὅτι τούς τε σπλῆνας πλείστους κατὰ τὸ ἐξέχον χρὴ τιθέναι, καὶ τοῖσιν ἐπιδέσμοισι πλείστοισι καὶ μάλιστα κατὰ τοῦτο πιέζειν. Ἐἰσὶ δὲ δή τινες, οἳ ἐπεσοφίσαντο ἤδη μολύβδιον βαρὺ προσεπικαταδεῖν, ὡς καταναγκάζειν τὸ ὑπερέχον ξυνιᾶσι μὲν οὖν ἴσως οὐδὲ οἱ ἁπλῶς ἐπιδέοντες ἀτὰρ δὴ οὐδ’ οὗτος ὁ τρόπος κληῗδος κατήξιός ἐστιν οὐ γὰρ δυνατὸν τὸ ὑπερέχον καταναγκάζεσθαι οὐδὲν, ὅ τι καὶ ἄξιον λόγου. Ἄλλοι δ’ αὖ τινές εἰσιν, οἵτινες, καταμαθόντες τοῦτο, ὅτι αὗται αἱ ἐπιδέσιες παράφοροί εἰσι καὶ οὐ

κατὰ φύσιν καταναγκάζουσι τὰ ὑπερέχοντα, ἐπιδέουσι μὲν αὐτοὺς, σπλήνεσι καὶ ὀθονίοισι χρώμενοι, ὥσπερ καὶ οἱ ἄλλοι ζώσαντες δὲ τὸν ἄνθρωπον ταινίῃ τινὶ, ᾗ εὐζωστότατος αὐτὸς ἑωυτοῦ ἐστιν, ὅταν ἐπιθῶσι τοὺς σπλῆνας ἐπὶ τὰ ὑπερέχοντα τοῦ κατήγματος, ἐξογκώσαντες ἐπὶ τὰ ἐξέχοντα, τὴν ἀρχὴν τοῦ ὀθονίου προσέδησαν πρὸς τὸ ζῶσμα ἐκ τοῦ ἔμπροσθεν, καὶ οὕτως ἐπιδέουσιν, ἐπὶ τὴν ἴξιν τῆς κληῗδος ἐπιτανύοντες, ἐς τοὔπισθεν ἄγοντες κἄπειτα περιβάλλοντες περὶ τὸ ζῶσμα, ἐς τοὔμπροσθεν ἄγουσι, καὶ αὖθις ἐς τοὔπισθεν. Οἱ δέ τινες οὐχὶ περὶ τὸ ζῶσμα περιβάλλουσι τὸ ὀθόνιον, ἀλλὰ περὶ τὸ περίνεόν τε καὶ παρ’ αὐτὴν τὴν ἕδρην, καὶ παρὰ τὴν ἄκανθαν κυκλεύοντες τὸ ὀθόνιον, οὕτω πιέζουσι τὸ κάτηγμα. Ταῦτα γοῦν ἀπείρῳ μὲν ἀκοῦσαι φαίνεται ἐγγὺς τοῦ κατὰ φύσιν εἶναι, χρεομένῳ δὲ ἄχρηστα οὔτε γὰρ μόνιμα οὐδένα χρόνον, οὐδ’ εἰ κατακέοιτό τις, καίτοι ἐγγυτάτω ἂν οὕτως ἀλλ’ ὅμως εἰ καὶ κατακείμενος ἢ τὸ σκέλος συγκάμψειεν, ἢ αὐτὸς καμφθείη, πάντα ἂν τὰ ἐπιδέσματα κινέοιτο ἄλλως τε ἀσηρὴ ἡ ἐπίδεσις ἥ τε γὰρ ἕδρη ἀπολαμβάνεται, ἀθρόα τε τὰ ὀθόνια ἐν ταύτῃ τῇ στενοχωρίῃ γίνεται τά τε αὖ περὶ τὴν ζώνην περιβαλλόμενα, οὐχ οὕτως

ἰσχυρῶς ἔζωσται, ὡς οὐκ ἀναγκάσαι ἐς τὸ ἄνω τὴν ζώνην ἐπανιέναι, καὶ οὕτως ἀνάγκη ἂν εἴη πάντα χαλᾷν τὰ ἐπιδέσματα. Ἄγχιστα δ’ἄν τις δοκέοι ποιέειν, καίπερ οὐ μεγάλα ποιέων, εἰ τοῖσι μέν τισι τῶν ὀθονίων περὶ τὴν ζώνην περιβάλλοι, τοῖσι δὲ πλείστοισι τῶν ὀθονιων τὴν ἀρχαίην ἐπίδεσιν ἐπιδέοι οὕτω γὰρ ἂν μάλιστο τὰ ἐπιδέσματα μόνιμά τε εἴη, καὶ ἀλλήλοισι τιμωρέοι. Τὰ μὲν οὖν πλεῖσταεἴρηται, ἅσσα καταλαμβάνει τοὺς τὴν κληῗδα καταγνυμένους. Προσξυνιέναι δὲ καὶ τόδε χρὴ, ὅτι κληϊς ὡς ἐπὶ τὸ πολὺ κατάγνυται, ὥστε τὸ μὲν ἀπὸ τοῦ στήθεος πεφυκὸς ὀστέον ἐς τὸ ἄνω μέρος ὑπερέχειν, τὸ δὲ ἀπὸ τῆς ἀκρωμίης πεφυκὸς ὀστέον ἐν τῷ κάτω μέρει εἶναι. Αἴτια δὲ τούτων τάδε, ὅτι τὸ μὲν στῆθος οὔτε κατωτέρω ἂν πολὺ, οὔτε ἀνωτέρω χωρήσειεν σμικρὸς γὰρ ὁ κιγκλισμὸς τοῦ ἄρθρου τοῦ ἐν τῷ στήθεϊ αὐτό τε γὰρ ἑωυτῷ ξυνεχές ἐστι τὸ στήθος, καὶ τῇ ῥάχει ἄγχιστα μὴν ἡ κληϊς πρὸς τὸ τοῦ ὤμου ἄρθρον πλοώδης ἐστίν ἠνάγκασται γὰρ πυκινοκίνητος εἶναι

διὰ τὴν τῆς ἀκρωμίης σύζευξιν. Ἄλλως τε, ὅταν τρωθῇ, φεύγει ἐς τὸ ἄνω μέρος τὸ πρὸς τῷ στήθει προσεχόμενον, καὶ οὐ μάλα ἐς τὸ κάτω μέρος ἀναγκάζεσθαι ἐθέλει καὶ γὰρ πέφυκε κοῦφον, καὶ ἡ εὐρυχωρίη αὐτῷ ἄνω πλείων ἢ κάτω. Ὁ δὲ ὦμος, καὶ ὁ βραχίων, καὶ τὰ προσηρτημένα τούτοισιν εὐαπόλυτά ἐστιν ἀπὸ τῶν πλευρέων καὶ τοῦ στήθεος, καὶ διὰ τοῦτο δύναται καὶ ἀνωτέρω πολὺ ἀνάγεσθαι καὶ κατωτέρω ὅταν οὖν καταγῇ ἡ κληϊς, τὸ πρὸς τῷ ὤμῳ ὀστέον ἐς τὸ κατωτέρω ἐπιρρέπει ἐς τοῦτο γὰρ ἐπιφορώτερον αὐτὸ ἅμα τῷ ὤμῳ καὶ τῷ βραχίονι κάτω ῥέψαι μᾶλλον, ἢ ἐς τὸ ἄνω. Ὁπότε οὖν ταῦτα τοιαῦτά ἐστιν, ἀξυνετέουσιν ὅσοι τὸ ὑπερέχον τοῦ ὀστέου ἐς τὸ κάτω καταναγκάσαι οἴονται. Ἀλλὰ δῆλον, ὅτι τὸ κάτω πρὸς τὸ ἄνω προσακτέον ἐστίν τοῦτο γὰρ ἔχει κίνησιν, τοῦτο γάρ ἐστι καὶ τὸ ἀποστὰν ἀπὸ τῆς φύσιος. Δῆλον οὖν, ὅτι ἄλλως μὲν οὐδαμῶς ἐστιν ἀναγκάσαι τοῦτο αἱ γὰρ ἐπιδέσιες οὐδέν τι μᾶλλον προσαναγκάζουσιν ἢ ἀπαναγκάζουσιν εἰ δέ τις τὸν βραχίονα πρὸς τῇσι πλευρῇσιν ἐόντα ἀναγκάζοι ὡς μάλιστα ἄνω, ὡς ὅτι ὀξύτατος ὁ ὦμος φαίνηται εἶναι, δῆλον ὅτι οὕτως ἂν ἁρμοσθείη πρὸς τὸ ὀστέον τὸ ἀπὸ τοῦ στήθεος πεφυκὸς, ὅθεν ἀπεσπάσθη. Εἰ οὖν τις τῇ μὲν ἐπιδέσει χρῷτο τῇ νομίμῃ τοῦ ταχέως ξυναλθεσθῆναι εἵνεκα, ἡγήσαιτο δὲ τἄλλα πάντα μάτην εἶναι παρὰ τὸ σχῆμα τὸ εἰρημένον, ὀρθῶς τε ἂν ξυνίοι, ἰητρεύοι τε ἂν τάχιστα καὶ κάλλιστα. Κατακέεσθαι μέντοι τὸν ἄνθρωπον μέγα τὸ διάφορόν

ἐστιν καὶ ἡμέραι ἱκαναὶ τεσσαρεσκαίδεκα, εἰ ἀτρεμέοι, εἴκοσι δὲ πάμπολλαι.

14. When a fractured clavicle is fairly broken across it is more easily treated, but when broken obliquely it is more difficult to manage. Matters are different in these cases from what one would have supposed; for a bone fairly broken across can be more easily restored to its natural state, and with proper care the upper part may be brought down by means of suitable position and proper bandaging, and even if not properly set, the projecting part of the bone is not very sharp. But in oblique fractures the case is similar to that of bones which have been torn away, as formerly described; for they do not admit of being restored to their place, and the prominence of the bone is very sharp. For the most part, then, it should be known, no harm results to the shoulder or to the rest of the body from fracture of the clavicle, unless it sphacelate, and this rarely happens. A deformity, however, may arise from fracture of the clavicle, and in these cases it is very great at first, but by and by it becomes less. A fractured clavicle, like all other spongy bones, gets speedily united; for all such bones form callus in a short time. When, then, a fracture has recently taken place, the patients attach much importance to it, as supposing the mischief greater than it really is, and the physicians bestow great pains in order that it may be properly bandaged; but in a little time the patients, having no pain, nor finding any impediment to their walking or eating, become negligent; and the physicians finding they cannot make the parts look well, take themselves off, and are not sorry at the neglect of the patients, and in the meantime the callus is quickly formed. The method of dressing which is most appropriate, is similar to that used in ordinary cases, consisting of cerate, compresses, and bandages; and it should be most especially known in this operation, that most compresses should be placed on the projecting bone, and that the greatest pressure should be made there. There are certain physicians who make a show of superior skill by binding a heavy piece of lead on the part in order to depress the projecting bone; but this mode of treatment does not apply to the clavicle, for it is impossible to depress the projecting part to any extent worth mentioning. There are others who, knowing the fact that the bandages are apt to slip off, and that they do not keep the projecting parts in their place, apply compresses and bandages like the others, and then having girt the patient with a girdle, where it is usually applied with most effect, they make a heap of the compresses upon the projecting bone when they apply them, and having fastened the head of the bandage to the girdle in front, they apply it so as to bring the turns of it into the line of the clavicle, carrying them to the back, and then bringing them around the girdle they carry them to the fore part and again backward. There are others who do not apply the bandage round the girdle, but carry the rounds of it by the perineum and anus, and along the spine, so as to compress the fracture. To an inexperienced person these methods will appear not far from natural, but when tied, they will be found of no service; for they do not remain firm any length of time, even if the patient keep his bed, although in this position they answer best; and yet even when lying in bed, should he bend his leg, or should his trunk be bent, all the will be displaced; and, moreover, the bandaging is inconvenient, in as much as the anus is comprehended by it, and many turns of the bandage are crowded there in a narrow space. And in the method with the girdle, the girdle cannot be so firmly girt around, but that the turns of the bandage force the girdle to ascend, and hence of necessity all the other bandages must be slackened. He would seem to me to come nearest his purpose, although after all he effects but little, who would take a few turns round the girdle, but would use the bandage principally to secure the former bandaging; for in this manner the bandages would be most secure, and would mutually assist one another. Every thing now almost has been said which applies to fracture of the clavicle. But this also should be known, that in fractures of the clavicle, it is the part attached to the breast which is uppermost, and that the piece attached to the acromion is the lowermost. The cause of this is, that for the most part the breast can neither be depressed nor raised, there being but a slight movement of the joint at the breast, for the sternum is connected together on both sides with the spine. The clavicle admits of most motion at the joint of the shoulder, and this arises from its connection with the acromion. And, moreover, when broken, the part which is connected with the sternum flies upward, and is not easily forced downward; for it is naturally light, and there is more room for it above than below. But the shoulder, the arm, and the parts connected with them, are easily moved from the sides and breast, and, on that account, they admit of being considerably elevated and depressed. When, therefore, the clavicle is broken, the fragment attached to the shoulder inclines downward, for it inclines much more readily with the shoulder and arm downward than upward. Matters being as I have stated, they act imprudently who think to depress the projecting end of the bone. But it is clear that the under part ought to be brought to the upper, for the former is the movable part, and that which has been displaced from its natural position. It is obvious, therefore, that there is no other way of applying force to it (for the bandages no more force it to than they force it from); but if one will push the arm when at the sides as much as possible upward, so that the shoulder may appear as sharp as possible, it is clear that in this way it will be adjusted to the fragment of the bone connected with the breast from which it was torn. If one then will apply a bandage, secundum artem , for the purpose of promoting a speedy cure, and will reckon everything else of no value, except the position as described, he will form a correct opinion of the case, and will effect a cure in the speediest and most appropriate manner. It is of great importance, however, that the patient should lie in a recumbent posture. Fourteen days will be sufficient if he keep quiet, and twenty at most.

15. Εἰ μέντοι τινὶ ἐπὶ τἀναντία ἡ κληϊς κατεαγείη, ὃ οὐ μάλα γίνεται, ὥστε τὸ μὲν ἀπὸ τοῦ στήθεος ὀστέον ὑποδεδυκέναι, τὸ δὲ ἀπὸ τῆς ἀκρωμίης ὀστέον ὑπερέχειν καὶ ἐποχέεσθαι ἐπὶ τοῦ ἑτέρου, οὐδεμιῆς μεγάλης ἰητρείης ταῦτά γ’ ἂν δέοιτο αὐτὸς γὰρ ὁ ὦμος ἀφιέμενος καὶ ὁ βραχίων ἱδρύοι ἂν τὰ ὀστέα πρὸς ἄλληλα, καὶ φαύλη ἄν τις ἐπίδεσις ἀρκέοι, καὶ ὀλίγαι ἡμέραι τῆς πωρώσιος γένοιντ’ ἄν.

15. But if the clavicle be fractured in the opposite manner (which does not readily happen), so that the fragment of bone connected with the breast is depressed, while the piece connected with the acromion is raised up and rides over other, this case does not require much management, for if the shoulder and arm be let go, the fragments of the bone will be adjusted to one another, and an ordinary bandage will suffice, and the callus will be formed in the course of a few days.

16. Εἰ δὲ μὴ κατεαγείη μὲν οὕτως, παρολισθάνοι δὲ ἐς τὸ πλάγιον ἢ τῇ ἢ τῇ, ἐς τὴν φύσιν μὲν ἀπαγαγεῖν ἂν δέοι, ἀναγαγόντα τὸν ὦμον σὺν τῷ βραχίονι, ὥσπερ καὶ πρόσθεν εἴρηται ὅταν δὲ ἵζηται ἐς τὴν ἀρχαίην φύσιν, ταχείη ἂν ἡ ἄλλη ἰητρείη εἴη. Τὰ μὲν οὖν πλεῖστα τῶν παραλλαγμάτων κατορθοῖ αὐτὸς ὁ βραχίων ἀναγκαζόμενος πρὸς τὰ ἄνω. Ὅσα δὲ τῶν ἄνωθεν παρολισθάνοντα ἐς τὸ πλάγιον ἦλθεν, ἢ ἐς τὸ κατωτέρω, συμπορσύνοι ἂν τὴν κατόρθωσιν, εἰ ὁ μὲν ἄνθρωπος ὕπτιος κέοιτο, κατὰ δὲ τὸ μεσηγὺ τῶν ὠμοπλατέων ὑψηλότερόν τι ὀλίγῳ ὑποκέοιτο, ὡς περιρρηδὲς ἔῃ τὸ στῆθος ὡς μάλιστα καὶ τὸν βραχίονα εἰ ἀνάγοι τις παρὰ τὰς πλευρὰς παρατεταμένον, ὁ δὲ ἰητρὸς τῇ μὲν ἑτέρῃ χειρὶ ἐς τὴν

κεφαλὴν τοῦ βραχίονος ἐμβαλὼν τὸ θέναρ τῆς χειρὸς ἀπωθέοι, τῇ δὲ ἑτέρῃ τὰ ὀστέα τὰ κατεηγότα εὐτεθίζοι, οὕτως ἂν μάλιστα ἐς τὴν φύσιν ἄγοι ἀτὰρ, ὥσπερ ἤδη εἴρηται, οὐ μάλα τὸ ἄνωθεν ὀστέον ἐς τὸ κάτω φιλέει ὑποδύνειν. Τοῖσι μὲν οὖν πλείστοισιν, ὅταν ἐπιδεθῶσι, τὸ σχῆμα ἀρήγει, παρ’ αὐτὰς τὰς πλευρὰς τὸν ἀγκῶνα ἔχοντα, οὕτως ἐς τὸ ἄνω τὸν ὦμον ἀναγκάζεσθαι ἔστι δ’ οἷσι μὲν τὸν ὦμον ἀναγκάζειν δεῖ ἐς τὸ ἄνω, ὡς εἴρηται, τὸν δὲ ἀγκῶνα πρὸς τὸ στῆθος παράγειν, ἄκρην δὲ τὴν χεῖρα παρὰ τὸ ἀκρώμιον τοῦ ὑγιέος ὤμου ἴσχειν. Ἢν μὲν οὖν κατακέεσθαι τολμᾷ, ἀντιστήριγμά τι προστιθέναι χρὴ, ὡς ἂν ὁ ὦμος ἀνωτάτω ἔῃ ἢν δὲ περιίῃ, σφενδόνην χρὴ, ἐκ ταινίης περὶ τὸ ὀξὺ τοῦ ἀγκῶνος ποιήσαντα, ἀναλαμβάνειν περὶ τὸν αὐχένα.

16. If the fracture be not thus, but if it incline either forward or backward, it may be restored to its natural position, by raising the shoulder with the arm as formerly described, and brought back to its natural place, when the cure will be speedily accomplished. Most of the varieties of displacement may be rectified by raising the arm upward. When the upper bone is displaced laterally or downward, it would favor the adaptation of the parts if the patient would lie on his back, and if some elevated substance were placed between the shoulder-blades, so that the breast may be depressed as much as possible upon the two sides; and if, while another person raised the arm extended along the sides, the physician, applying the palm of the one hand to the head of the bone, would push it away, and with the other would adjust the broken bones, he would thus reduce the parts most readily to their natural position. But, as formerly stated, the upper bone ( sternal fragment? ) is rarely depressed downward. In most cases, after the bandages have been applied, that position is beneficial in which the elbow is fixed to the same side, and the shoulder is kept elevated; but in certain cases, the shoulder is to be raised, as has been directed, and the elbow is to be brought forward to the breast, and the hand laid on the acromion of the sound side. If the patient has the resolution to lie in bed, something should be placed so as to support the shoulder, and keep it as much elevated as possible. But if he walk about, the arm should be slung in a shawl, which embraces the point of the elbow, and is passed round the neck.

17. Ἀγκῶνος δὲ ἄρθρον παραλλάξαν μὲν ἢ παραρθρῆσαν πρὸς πλευρὴν ἢ ἔξω, μένοντος τοῦ ὀξέος τοῦ ἐν τῷ κοίλῳ τοῦ βραχίονος, ἐς εὐθὺ κατατείναντα, τὸ ἐξέχον ἀπωθεῖν ὀπίσω καὶ ἐς τὸ πλάγιον.

17. When the elbow-joint is displaced or dislocated to the side or outward, while its sharp point ( olecranon? ) remains in the cavity of the humerus, extension is to be made in a straight line, and the projecting part is to be pushed backward and to the side.

18. Τὰ δὲ τελείως ἐκβάντα ἢ ἔνθα, ἢ ἔνθα, κατάτασις μὲν, ἐν

ᾗ ὁ βραχίων κατεαγεὶς ἐπιδέεται οὕτω γὰρ ἂν τὸ καμπύλον τοῦ ἀγκῶνος οὐ κωλύσει. Ἐκπίπτει δὲ μάλιστα ἐς τὸ πρὸς πλευρὰς μέρος. Τὰς δὲ κατορθώσιας, ἀπάγοντα ὅτι πλεῖστον, ὡς μὴ ψαύῃ τῆς κορώνης ἡ κεφαλὴ, μετέωρον περιάγειν, καὶ περικάμπτειν, καὶ μὴ ἐς εὐθὺ βιάζεσθαι, ἅμα δὲ ὠθέειν τἀναντία ἐφ’ ἑκάτερα, καὶ παρωθέειν ἐς χώρην ξυνωφελοίη δ’ ἂν καὶ ἐπίστρεψις ἀγκῶνος ἐν τουτέοισιν, ἐν τῷ μὲν ἐς τὸ ὕπτιον, ἐν τῷ δὲ ἐς τὸ πρηνές. Ἴησις δὲ, σχήματος μὲν, ὀλίγῳ ἀνωτέρω ἄκρην τὴν χεῖρα τοῦ ἀγκῶνος ἔχειν, βραχίονα δὲ κατὰ πλευράς οὕτω δὲ καὶ ἀνάληψις, καὶ θέσις, καὶ εὔφορον καὶ φύσις, καὶ χρῆσις ἐν κοινῷ, ἢν ἄρα μὴ κακῶς πωρωθῇ πωροῦται δὲ ταχέως. Ἴησις δὲ, ὀθονίοισι κατὰ τὸν νόμον τὸν ἀρθριτικὸν, καὶ τὸ ὀξὺ προσεπιδέειν.

18. In complete dislocations toward either side, extension is to be made as in bandaging fracture of the arm; for thus the rounded part of the elbow will not form an obstacle to it. Dislocation, for the most part, takes place toward the sides ( inwardly? ). Reduction is to be effected by separating (the bones) as much as possible, so that the end (of the humerus) may not come in contact with the olecranon, and it is to be carried up, and turned round, and not forced in a straight line, and, at the same time, the opposite sides are to be pushed together, and propelled into their proper place. It will further assist if rotation of the fore-arm be made at the elbow, sometimes turning it into a supine position, and sometimes into a prone. The position for the treatment consists in keeping the hand a little higher than the elbow, and the arm at the sides; then it may either be suspended or laid at rest, for either position will answer; and nature and the usage of common means will accomplish the cure, if the callus does not form improperly: it is formed quickly. The treatment is to be conducted with bandages according to the rule for bandaging articulations, and the point of the elbow is to be included in the bandage.

19. Παλιγκοτώτατον δὲ ὁ ἀγκὼν πυρετοῖσιν, ὀδύνῃ ἀσώδεϊ, ἀκρητοχόλῳ, ἀγκῶνος δὲ μάλιστα τοὐπίσω διὰ τὸ ναρκῶδες, δεύτερον δὲ τοὔμπροσθεν ἴησις δὲ ἡ αὐτή ἐμβολαὶ δὲ, τοῦ μὲν ὀπίσω, ἐκτείναντα κατατεῖναι σημεῖον δέ οὐ γὰρ δύνανται ἐκτείνειν τοῦ δὲ ἔμπροσθεν, οὐ δύνανται ξυγκάμπτειν τουτέῳ δὲ ἐνθέντα

τι ξυνειλιγμένον σκληρὸν, περὶ τοῦτο ξυγκάμψαι ἐξ ἐκτάσιος ἐξαίφνης.

19. Dislocations at the elbow give rise to the most serious consequences, such as fevers, pain, nausea, vomitings of pure bile, and more especially when the humerus is displaced backward from pressure on the nerve, which occasions numbness; next to it is the dislocation forward; the treatment is the same; reduction in dislocation backward is by extension and adaptation; the symptom of this variety-loss of the power of extension; of dislocation forward-loss of the power of flexion, and in this case reduction is to be accomplished by placing a hard ball (in the bend of the elbow), and bending the fore-arm about it, along with sudden extension.

20. Διαστάσιος δὲ ὀστέων σημήϊον, κατὰ τὴν φλέβα τὴν κατὰ τὸν βραχίονα σχιζομένην διαψαύοντι.

20. Diastasis of the bones may be recognized by examining the part where the vein that runs along the arm divides.

The Genuine Works of Hippocrates. Hippocrates. Charles Darwin Adams. New York. Dover. 1868.

21. Ταῦτα δὲ ταχέως διαπωροῦται ἐκ γενεῆς δὲ, βραχύτερα τὰ κάτω τοῦ σίνεος ὀστέα, πλεῖστον τὰ ἐγγύτατα τοῦ πήχεος, δεύτερον, χειρὸς, τρίτον, δακτύλων βραχίων δὲ καὶ ὦμος, ἐγκρατέστερα διὰ τὴν τροφήν ἡ δὲ ἑτέρη χεὶρ διὰ τὰ ἔργα ἔτι πλείω ἐγκρατεστέρη. Μινύθησις δὲ σαρκῶν, εἰ μὲν ἔξω ἐξέπεσεν, ἔσωθεν εἰ δὲ μὴ, ἐς τοὐναντίον, ᾗ ἐξέπεσεν.

21. In those cases callus is quickly formed. In congenital dislocations the bones below the seat of the injury are shorter than natural, and, mostly, those nearest to the place; namely, the bones of the fore-arm, next those of the hand; and, third, those of the fingers. The arm and shoulder are stronger, owing to the nourishment which they receive, and the other arm, from the additional work which it has to perform, is still more strong. Wasting of the flesh takes place on the inside if the dislocation be on the outside; or otherwise, on the side opposite the dislocation.

22. Ἀγκὼν δὲ ἢν ἔσω ἢ ἔξω ἐκβῇ, κατάτασις μὲν ἐν σχήματι ἐγγωνίῳ τῷ πήχεϊ πρὸς βραχίονα τὴν μὲν μασχάλην ἀναλαμβάνοντα ταινίῃ ἀνακρεμάσαι, ἀγκῶνι δὲ ἄκρῳ ὑποτιθέντα τι παρὰ τὸ ἄρθρον βάρος, ἐκκρεμάσαι, ἢ χερσὶ καταναγκάζειν ὑπεραιωρηθέντος δὲ τοῦ ἄρθρου, αἱ παραγωγαὶ τοῖσι θέναρσιν, ὡς τὰ ἐν χερσίν ἐπίδεσις ἐν τουτέῳ τῷ σχήματι, καὶ ἀνάληψις, καὶ θέσις.

22. When the elbow is dislocated either inward or outward, extension is to be made with the fore-arm at a right angle to the arm; the arm, suspended by means of a shawl passed through the armpit, and a weight attached to the extremity of the elbow; or force may be applied with the hands; when the articular extremity has been cleared, the displaced parts are to be rectified with the palms of the hand, as in dislocations of the hands. It is to be bandaged, suspended in a sling, and placed while in this attitude.

23. Τὰ δὲ ὄπισθεν, ἐξαίφνης ἐκτείνοντα, διορθοῦν τοῖσι θέναρσιν ἅμα δὲ δεῖ ἐν τῇ διορθώσει καὶ ἐν τοῖσιν ἑτέροισιν. Ἢν δὲ

ἔμπροσθεν, ἀμφὶ ὀθόνιον ξυνειλιγμένον, εὔογκον, ξυγκάμπτοντα ἅμα διορθοῦν.

23. Dislocations backward are to be rectified by the palms of the hands, along with sudden extension; the two acts are to be performed together, as in other cases of the kind. But in dislocation forward the arm is to be bent around a ball of cloth of proper size, and at the same time replaced.

24. Ἢν δὲ ἑτεροκλινὲς ἔῃ, ἐν τῇ διορθώσει ἀμφότερα ἅμα χρὴ ποιέειν. Τῆς δὲ μελέτης τῆς θεραπείης, κοινὸν τὸ σχῆμα καὶ ἡ ἐπίδεσις. Δύναται δὲ καὶ ἐκ τῆς διατάσιος κοινῇ ξυμπίπτειν ἅπαντα.

24. But if the displacement be on the other side, both these operations are to be performed in effecting the adjustment. For conducting the treatment, the position and bandaging are the same as in the other cases. But all these cases may be reduced by ordinary distention.

25. Τῶν δὲ ἐμβολέων, αἱ μὲν ἐξ ὑπεραιωρήσιος ἐμβάλλονται, αἱ δὲ ἐκ κατατάσιος, αἱ δὲ ἐκ περισφάλσιος αὗται δὲ ἐκ τῶν ὑπερβολέων τῶν σχημάτων, ἢ τῇ, ἢ τῇ, ξὺν τῷ τάχει.

25. Of the methods of reduction, some operate by raising up the part, some by extension, and some by rotation: the last consists in rapidly turning the fore-arm to this side and that.

26. Χειρὸς δὲ ἄρθρον ὀλισθάνει ἢ ἔσω, ἢ ἔξω, ἔσω δὲ τὰ πλεῖστα. Σημήϊα δὲ εὔσημα ἢν μὲν εἴσω, ξυγκάμπτειν τοὺς δακτύλους οὐ δύνανται ἢν δὲ ἔξω, ἐκτείνειν. Ἐμβολὴ δὲ, ὑπὲρ τραπέζης τοὺς δακτύλους ἔχων, τοὺς μὲν τείνειν, τοὺς δὲ ἀντιτείνειν, τὸ δὲ ἐξέχον ἢ θέναρι, ἢ πτέρνῃ ἅμα ἀπωθέειν, πρόσω καὶ κάτωθεν

κατὰ τὸ ἕτερον ὀστέον, ὄγκον μαλθακὸν ὑποθεὶς, ἢν μὲν ἄνω, καταστρέψας τὴν χεῖρα, ἢν δὲ κάτω, ὑπτίην. Ἴησις δὲ, ὀθονίοισιν.

26. The joint of the hand is dislocated either inward or outward, most frequently inward. The symptoms are easily recognized: if inward, the patient cannot at all bend his fingers; and if outward, he cannot extend them. With regard to the reduction,-by placing the fingers above a table, extension and counter-extension are to be made by other persons, while with the palm or heel of the hand on the projecting bone one pushes forward, and another from behind on the other bone; some soft substance is to be applied to it, and the arm is to be turned to the prone position if the dislocation was forward, but to the supine, if backward. The treatment is to be conducted with bandages.

27. Ὅλη δὲ ἡ χεὶρ ὀλισθάνει, ἢ ἔσω, ἢ ἔξω, ἢ ἔνθα, ἢ ἔνθα, μάλιστα δὲ εἴσω ἔστι δ’ ὅτε καὶ ἡ ἐπίφυσις ἐκινήθη ἔστι δ’ ὅτε τὸ ἕτερον τῶν ὀστέων διέστη. Τουτέοισι κατάτασις ἰσχυρὴ ποιητέη καὶ τὸ μὲν ἐξέχον ἀπωθέειν, τὸ δὲ ἕτερον ἀντωθέειν, δύο εἴδεα ἅμα, ἐς τοὐπίσω καὶ ἐς τὸ πλάγιον, ἢ χερσὶν ἐπὶ τραπέζης, ἢ πτέρνῃ. Παλίγκοτα δὲ καὶ ἀσχήμονα τῷ δὲ χρόνῳ κρατύνεται ἐς χρῆσιν. Ἴησις, ὀθονίοισι ξὺν τῇ χειρὶ καὶ τῷ πήχεϊ καὶ νάρθηκας μέχρι δακτύλων τιθέναι ἐν νάρθηξι δὲ τεθέντα ταῦτα πυκνότερον λύειν, ἢ τὰ κατήγματα, καὶ καταχύσει πλείονι χρέεσθαι.

27. The whole hand is dislocated either inward or outward, or to this side or that, but more especially inward; and sometimes the epiphysis is displaced, and sometimes the other of these bones is separated. In these cases strong extension is to be applied, and pressure is to be made on the projecting bone, and counter-pressure on the opposite side, both at the same time, behind and at the side, with the hands upon a table, or with the heel. These accidents give rise to serious consequences and deformities; but in the course of time the part gets strong, and admits of being used. The cure is with bandages, which ought to embrace both the hand and fore-arm; and splints are to be applied as far as the fingers; and when they are used they should be more frequently unloosed than infractures, and more copious affusions of water should be used.

28. Ἐκ γενεῆς δὲ, βραχυτέρη ἡ χεὶρ γίνεται, καὶ μινύθησις σαρκῶν μάλιστα τἀναντία, ἢ ᾗ τὸ ἔκπτωμα ηὐξημένῳ δὲ τὰ ὀστέα μένει.

28. In congenital dislocations (at the wrist) the hand becomes shortened, and the atrophy of the flesh occurs, for the most part, on the side opposite to the dislocation. In an adult the bones remain of their natural size.

29. Δακτύλου δὲ ἄρθρον, ὀλισθὸν μὲν, εὔσημον. Ἐμβολὴ δὲ, κατατείναντα ἐς ἰθὺ, τὸ μὲν ἐξέχον ἀπωθέειν, τὸ δὲ ἐναντίον ἀντωθέειν

ἴησις δὲ, ὀθονίοισιν. Μὴ ἐμπεσὸν δὲ, ἐπιπωροῦται ἔξωθεν Ἐκ γενεῆς δὲ ἢ ἐν αὐξήσει ἐξαρθρήσαντα, τὰ ὀστέα βραχύνεται τὰ κάτω τοῦ ὀλισθήματος, καὶ σάρκες μινύθουσι τἀναντία μάλιστα, ἢ ὡς τὸ ἔκπτωμα ηὐξημένῳ δὲ τὰ ὀστέα μένει.

29. Dislocation at the joint of a finger is easily recognized. Reduction is to be effected by making extension in a straight line, and applying pressure on the projecting bone, and counter-pressure on the opposite side of the other. The treatment is with bandages. When not reduced, callus is formed outside of the joint. When the dislocation takes place at birth, during adolescence the bones below the dislocation are shortened, and the flesh is wasted rather on the opposite than on the same side with the dislocation. When it occurs in an adult the bones remain of their proper size.

30. Γνάθος δὲ ὀλίγοισι τελέως ἐξήρθρησεν ὀστέον τε γὰρ τὸ ἀπὸ τῆς ἄνω γνάθου πεφυκὸς ὑπεζύγωται πρὸς τῷ ὑπὸ τὸ οὖς ὀστέῳ προσπεφυκότι, ὅπερ ἀποκλείει τὰς κεφαλὰς τῆς κάτω γνάθου, τῆς μὲν ἀνωτέρω ἐὸν, τῆς δὲ κατωτέρω τῶν κεφαλέων. Τὰ δὲ ἄκρεα τῆς κάτω γνάθου, τὸ μὲν διὰ τὸ μῆκος οὐκ εὐπαρείσδυτον, τὸ δ’ αὖ κορωνόν τε καὶ ὑπερέχον ὑπὲρ τοῦ ζυγώματος ἅμα τε ἀπ’ ἀμφοτέρων τῶν ἀκρέων τούτων νευρώδεες τένοντες πεφύκασιν, ἐξ ὧν ἐξήρτηνται οἱ μύες οἱ κροταφῖται καὶ μασσητῆρες καλεόμενοι διὰ τοῦτο δὲ καλέονται, καὶ διὰ τοῦτο κινέονται, ὅτι ἐντεῦθεν

ἐξήρτηνται ἐν γὰρ τῇ ἐδωδ̣, καὶ ἐν τῇ διαλέκτῳ, καὶ ἐν τῇ ἄλλῃ χρήσει τοῦ στόματος, ἡ μὲν ἄνω γνάθος ἀτρεμέει ξυνήρτηται γὰρ τῇ κεφαλῇ. καὶ οὐ διήρθρωται ἡ δὲ κά̣ω γνάθος κινέεται ἀπήρθρωται γὰρ ἀπὸ τῆς ἄνω γνάθου, καὶ ἀπὸ τῆς κεφαλῆς. Διότι μὲν οὖν ἐν σπασμοῖσι καὶ τετάνοισι πρῶτον τοῦτο τὸ ἄρθρον ἐπισημαίνει συντεταμένον, καὶ διότι πληγαὶ καίριοι καὶ καροῦσαι αἱ κροταφίτιδες γίνονται, ἐν ἄλλῳ λόγῳ εἰρήσεται. Περὶ δὲ τοῦ μὴ κάρτα ἐξαρθρέειν τάδε τὰ αἴτια αἴτιον δὲ καὶ τόδε, ὅτι οὐ μάλα καταλαμβάνουσι τοιαῦται ἀνάγκαι βρωμάτων, ὥστε τὸν ἄνθρωπον χανέειν μέζον ἢ ὅσον δύναται ἐκπέσοι δ’ ἂν ἀπ’ οὐδενὸς ἄλλου σχήματος, ἢ ἀπὸ τοῦ μέγα χανόντα παραγαγεῖν τὴν γένυν ἐπὶ θάτερα. Προσξυμβάλλεται μέντοι καὶ τόδε πρὸς τὸ ἐκπίπτειν ὁκόσα γὰρ νεῦρα καὶ ὁκόσοι μύες παρὰ τὰ ἄρθρα εἰσὶν, ἢ ἀπὸ ἄρθρων ἀφ’ ὧν ξυνδέδενται, τούτων ὅσα ἐν τῇ χρήσει πλειστάκις διακινέεται, ταῦτα καὶ ἐς τὰς κατατάσιας δυνατώτατα ἐπιδιδόναι, ὥσπερ καὶ τὰ δέρματα τὰ εὐδεψητότατα πλείστην ἐπίδοσιν ἔχει. Περὶ οὗ οὖν ὁ λόγος, ἐκπίπτει μὲν γνάθος ὀλιγάκις σχᾶται μέντοι πολλάκις ἐν

χάσμῃσιν, ὥσπερ καὶ ἄλλαι πολλαὶ μυῶν παραλλαγαὶ και νεύρων τούτο ποιέουσιν. Δῆλον μὲν οὖν ἐκ τῶνδε μάλιστά ἐστιν, ὅταν ἐκπεπτώκῃ προΐσχει γὰρ ἡ κάτω γνάθος ἐς τοὔμπροσθεν, καὶ παρῆκται τἀναντία τοῦ ὀλισθήματος, καὶ τοῦ ὀστέου τὸ κορωνὸν ὀγκηρότερον φαίνεται παρὰ τὴν ἄνω γνάθον, καὶ χαλεπῶς ξυμβάλλουσι τὰς κάτω γνάθους. Τούτοισι δὲ ἐμβολὴ πρόδηλος, ἥτις γίνοιτ’ ἂν ἁρμόζουσα χρὴ γὰρ τὸν μέν τινα κατέχειν τὴν κεφαλὴν τοῦ τετρωμένου, τὸν δὲ περιλαβόντα τὴν κάτω γνάθον καὶ ἔσωθεν καὶ ἔξωθεν τοῖσι δακτύλοισι κατὰ τὸ γένειον, χάσκοντος τοῦ ἀνθρώπου ὅσον μετρίως δύναται, πρῶτον μὲν διακινέειν τὴν κάτω γνάθον χρόνον τινὰ, τῇ καὶ τῇ παράγοντα τῇ χειρὶ, καὶ αὐτὸν τὸν ἄνθρωπον κελεύειν χαλαρὴν τὴν γνάθον ἔχειν, καὶ ξυμπαράγειν, καὶ ξυνδιδόναι ὡς μάλιστα ἔπειτα ἐξαπίνης σχάσαι, τρισὶ σχήμασιν ὁμοῦ προσέχοντα τὸν νόον δεῖ μὲν γὰρ παράγεσθαι ἐκ τῆς διαστροφῆς ἐς τὴν φύσιν, δεῖ δὲ ἐς τοὐπίσω ἀπωσθῆναι τὴν γνάθον τὴν κάτω, δεῖ δὲ ἑπόμενον τούτοισι ξυμβάλλειν τὰς γνάθους, καὶ μὴ χάσκειν. Ἐμβολὴ μὲν οὖν αὕτη, καὶ οὐκ ἂν γένοιτο ἀπ’ ἄλλων σχημάτων. Ἰητρείη δὲ βραχείη ἀρκέει σπλῆνα προστιθέντα κεκηρωμένον χαλαρῷ ἐπιδέσμῳ ἐπιδεῖν. Ἀσφαλέστερον δὲ χειρίζειν ἐστὶν ὕπτιον κατακλίναντα τὸν ἄνθρωπον, ἐρείσαντα τὴν κεφαλὴν αὐτοῦ ἐπὶ σκυτίνου ὑποκεφαλαίου ὡς πληρεστάτου, ἵνα ὡς ἥκιστα ὑπείκῃ προσκατέχειν δέ τινα χρὴ τὴν κεφαλὴν τοῦ τετρωμένου.

30. The jaw-bone, in few cases, is completely dislocated, for the zygomatic process formed from the upper jaw-bone ( malar? ) and the bone behind the ear ( temporal? ) shuts up the heads of the under jaw, being above the one ( condyloid process? ), and below the other ( coronoid process? ). Of these extremities of the lower jaw, the one, from its length, is not much exposed to accidents, while the other, the coronoid, is more prominent than the zygoma, and from both these heads nervous tendons arise, with which the muscles called temporal and masseter are connected; they have got these names from their actions and connections; for in eating, speaking, and the other functional uses of the mouth, the upper jaw is at rest, as being connected with the head by synarthrosis, and not by diarthrosis ( enarthrosis? ): but the lower jaw has motion, for it is connected with the upper jaw and the head by enarthrosis. Wherefore, in convulsions and tetanus, the first symptom manifested is rigidity of the lower jaw; and the reason why wounds in the temporal region are fatal and induce coma, will be stated in another place. These are the reasons why complete dislocation does not readily take place, and this is another reason, because there is seldom a necessity for swallowing so large pieces of food as would make a man gape more than he easily can, and dislocation could not take place in any other position than in great gaping, by which the jaw is displaced to either side. This circumstance, however, contributes to dislocation there; of nerves ( ligaments? ) and muscles around joints, or connected with joints, such as are frequently moved in using the member are the most yielding to extension, in the same manner as well-dressed hides yield the most. With regard, then, to the matter on hand, the jaw-bone is rarely dislocated, but is frequently slackened ( partially displaced? ） in gaping, in the same manner as many other derangements of muscles and tendons arise. Dislocation is particularly recognized by these symptoms: the lower jaw protrudes forward, there is displacement to the opposite side, the coronoid process appears more prominent than natural on the upper jaw, and the patient cannot shut his lower jaw but with difficulty. The mode of reduction which will apply in such cases is obvious: one person must secure the patient’s head, and another, taking hold of the lower jaw with his fingers within and without at the chin, while the patient gapes as much as he can, first moves the lower jaw about for a time, pushing it to this side and that with the hand, and directing the patient himself to relax the jaw, to move it about, and yield as much as possible; then all of a sudden the operator must open the mouth, while he attends at the same time to three positions: for the lower jaw is to be moved from the place to which it is dislocated to its natural position; it is to be pushed backward, and along with these the jaws are to be brought together and kept shut. This is the method of reduction, and it cannot be performed in any other way. A short treatment suffices, a waxed compress is to be laid on, and bound with a loose bandage. It is safer to operate with the patient laid on his back, and his head supported on a leather cushion well filled, so that it may yield as little as possible, but some person must hold the patient’s head.

31. Ἢν δ’ ἀμφότεραι αἱ γνάθοι ἐξαρθρήσωσιν, ἡ μὲν ἴησις ἡ αὐτή. Ξυμβάλλειν δέ τι ἧσσον οὗτοι τὸ στόμα δύνανται καὶ γὰρ προπετέστεραι αἱ γένυες τούτοισιν, ἀστραβέες δέ τὸ δὲ ἀστραβὲς μάλιστ’ ἂν γνοίης τοῖσιν ὁρίοισι τῶν ὀδόντων, τῶν τε ἄνω καὶ τῶν κάτω κατ’ ἴξιν. Τούτοισι ξυμφέρει ἐμβάλλειν ὡς τάχιστα ἐμβολῆς δὲ τρόπος πρόσθεν εἴρηται. Ἢν δὲ μὴ ἐμπέσῃ, κίνδυνος περὶ τῆς ψυχῆς ὑπὸ πυρετῶν ξυνεχέων καὶ νωθρῆς καρώσιος καρώδεες γὰρ οἱ μύες οὗτοι, καὶ ἀλλοιούμενοι, καὶ ἐντεινόμενοι παρὰ φύσιν φιλέει δὲ καὶ ἡ γαστὴρ ὑποχωρέειν τούτοισι χολώδεα, ἄκρητα, ὀλίγα καὶ ἢν ἐμέωσιν, ἄκρητα ἐμέουσιν οὗτοι οὖν καὶ θνήσκουσι δεκαταῖοι μάλιστα.

31. When the jaw is dislocated on both sides, the treatment is the same. The patients are less able to shut the mouth than in the former variety; and the jaw protrudes farther in this case, but is not distorted; the absence of distortion may be recognized by comparing the corresponding rows of the teeth in the upper and lower jaws. In such cases reduction should be performed as quickly as possible; the method of reduction has been described above. If not reduced, the patient’s life will be in danger from continual fevers, coma attended with stupor (for these muscles, when disordered and stretched preternaturally, induce coma); and there is usually diarrhea attended with billous, unmixed, and scanty dejections; and the vomitings, if any, consist of pure bile, and the patients commonly die on the tenth day.

32. Ἢν δὲ κατεαγῇ ἡ κάτω γνάθος, ἢν μὲν μὴ ἀποκαυλισθῇ παντάπασιν, ἀλλὰ ξυνέχηται τὸ ὀστέον, ἐκκεκλιμένον δὲ ἔῃ, κατορθῶσαι μὲν χρὴ τὸ ὀστέον, παρά γε τὴν γλῶσσαν πλαγίην ὑπείραντα τοὺς δακτύλους, τὸ δὲ ἔξωθεν ἀντερείδοντα, ὡς ἂν ξυμφέρῃ καὶ ἢν διεστραμμένοι ἔωσιν οἱ ὀδόντες οἱ κατὰ τὸ τρῶμα καὶ κεκινημένοι, ὁκόταν τὸ ὀστέον κατορθωθῇ, ζεῦξαι τοὺς ὀδόντας χρὴ πρὸς ἀλλήλους, μὴ μόνον τοὺς δύο, ἀλλὰ καὶ πλέονας, μάλιστα μὲν χρυσίῳ, ἔστ’ ἂν κρατυνθῇ τὸ ὀστέον, εἰ δὲ μὴ, λίνῳ ἔπειτα

ἐπιδεῖν κηρωτῇ καὶ σπλήνεσιν ὀλίγοισι καὶ ὀθονίοισιν ὀλίγοισι, μὴ ἄγαν ἐρείδοντα, ἀλλὰ χαλαροῖσιν. Εὖ γὰρ εἰδέναι χρὴ, ὅτι ἐπίδεσις ὀθονίων, γνάθου καταγείσης, μικρὰ μὲν ἂν ὠφελέοι, εἰ χρηστῶς ἐπιδέοιτο, μεγάλα δ’ ἂν βλάπτοι, εἰ κακῶς ἐπιδέοιτο. Πυκνὰ δὲ παρὰ τὴν γλῶσσαν ἐσματέεσθαι χρὴ, καὶ πουλὺν χρόνον ἀντέχειν τοῖσι δακτύλοισι κατορθοῦντα τοῦ ὀστέου τὸ ἐκκλιθέν ἄριστον δὲ, εἰ αἰεὶ δύναιτο, ἀλλ’ οὐχ οἶόν τε.

32. In fracture of the lower jaw, when the bone is not fairly broken across, and is still partially retained, but displaced, it should be adjusted by introducing the fingers at the side of the tongue, and making suitable counter-pressure on the outside; and if the teeth at the wound be distorted and loosened, when the bone is adjusted, they should be connected together, not only two, but more of them, with a gold thread, if possible, but otherwise, with a linen thread, until the bone be consolidated, and then the part is to be dressed with cerate, a few compresses, and a few bandages, which should not be very tight, but rather loose. For it should be well known that in fracture of the jaw, dressing with bandages, if properly performed, is of little advantage, but occasions great mischief if improperly done. Frequent examinations should be made about the tongue, and prolonged pressure should be applied with the fingers, in order to rectify the displaced bone. It would be best if one could do so constantly, but that is impossible.

33. Ἢν δὲ ἀποκαυλισθῇ παντάπασι τὸ ὀστέον ὀλιγάκις δὲ τοῦτο γίνεταἰ, κατορθοῦν μὲν χρὴ τὸ ὀστέον οὕτω, καθάπερ εἴρηται. Ὅταν δὲ κατορθώσῃς, τοὺς ὀδόντας χρὴ ζευγνῦναι, ὡς πρόσθεν εἴρηται μέγα γὰρ ἂν ξυλλαμβάνοι ἐς τὴν ἀτρεμίην, προσέτι καὶ ἤν τις ὀρθῶς ζεύξῃ, ὥσπερ χρὴ, τὰς ἀρχὰς ῥάψας. Ἀλλὰ γὰρ οὐ ῥηΐδιον ἐν γραφῇ χειρουργίην πᾶσαν ἀτρεκέως διηγέεσθαι, ἀλλὰ καὶ αὐτὸν ὑποτοπέεσθαι χρὴ ἐκ

τῶν γεγραμμένων. Ἔπειτα χρὴ δέρματος καρχηδονίου, ἢν μὲν νηπιώτερος ἔῃ ὁ τρωθεὶς, ἀρκέει τῷ λοπῷ χρέεσθαι, ἢν δὲ τελειότερος ἔῃ, αὐτῷ τῷ δέρματι ταμόντα δὲ χρὴ εὖρος ὡς τριδάκτυλον, ἢ ὅκως ἂν ἁρμόζῃ, ὑπαλείψαντα κόμμι τὴν γνάθον εὐμενέστερον γὰῤ, κόλλῃ προσκολλῆσαι τὸ δέρμα ἄκρον πρὸς τὸ ἀποκεκαυλισμένον τῆς γνάθου, ἀπολείποντα ὡς δάκτυλον ἀπὸ τοῦ τρώματος ἢ ὀλίγῳ πλέον τοῦτο μὲν ἐς τὸ κάτω μέρος ἐχέτω δὲ ἐντομὴν κατὰ τὴν ἴξιν τοῦ γενείου ὁ ἱμὰς, ὡς ἀμφιβεβήκῃ ἀμφὶ τὸ ὀξὺ τοῦ γενείου. Ἕτερον δὲ ἱμάντα τοιοῦτον, ἢ ὀλίγῳ πλατύτερον προσκολλῆσαι χρὴ πρὸς τὸ ἄνω μέρος τῆς γνάθου, ἀπολείποντα καὶ τοῦτον ἀπὸ τοῦ τρώματος, ὅσονπερ ὁ ἕτερος ἀπέλιπεν ἐσχίσθω δὲ καὶ οὗτος ὁ ἱμὰς τὴν ἀμφὶ τὸ οὖς περίβασιν. Ἀποξέες δὲ ἔστωσαν οἱ ἱμάντες ἀμφὶ τὴν ξυναφήν ἐν δὲ τῇ κολλήσει ἡ σὰρξ τοῦ σκύτεος πρὸς τοῦ χρωτὸς ἔστω, ἐχεκολλότερον γὰρ οὕτως. Ἔπειτα κακατείναντα χρὴ καὶ τοῦτον τὸν ἱμάντα μᾶλλον δέ

τι τὸν περὶ τὸ γένειον, ὡς ὅτι μάλιστα μὴ ἀπομυλλήνῃ ἡ γνάθος, ξυνάψαι τοὺς ἱμάντας κατὰ τὴν κορυφὴν, κἄπειτα περὶ τὸ μέτωπον ὀθονίῳ καταδῆσαι, καὶ κατάβλημα χρὴ εἶναι, ὥσπερ νομίζεται, ὡς ἀτρεμέῃ τὰ δεσμά. Τὴν δὲ κατάκλισιν ποιεέσθω ἐπὶ τὴν ὑγιέα γνάθον, μὴ τῇ γνάθῳ ἐρηρεισμένος, ἀλλὰ τῇ κεφαλῇ. Ἰσχναίνειν δὲ χρὴ τὸ σῶμα ἄχρι ἡμερέων δέκα, ἔπειτα ἀνατρέφειν

μὴ βραδέως ἢν γὰρ ἐν τῇσι πρώτῃσιν ἡμέρῃσι μὴ φλεγμήνῃ, ἐν εἴκοσιν ἡμέρῃσιν ἡ γνάθος κρατύνεται ταχέως γὰρ ἐπιπωροῦται, ὥσπερ καὶ τὰ ἄλλα τὰ ἀραιὰ ὀστέα, ἢν μὴ ἐπισφακελίσῃ. Ἀλλὰ γὰρ περὶ σφακελισμῶν τῶν ξυμπάντων ὀστέων ἄλλος μακρὸς λόγος λείπεται. Αὕτη ἡ διάτασις ἡ ἀπὸ τῶν κολλημάτων εὐμενὴς, καὶ εὐταμίευτος, καὶ ἐς πολλὰ καὶ πολλαχοῦ διορθώματα εὔχρηστος. Τῶν δὲ ἰητρῶν οἱ μὴ ξὺν νόῳ εὔχειρες, καὶ ἐν ἄλλοισι τρώμασι τοιοῦτοί εἰσι καὶ ἐν γνάθων κατήξεσιν ἐπιδέουσι γὰρ γνάθον κατεαγεῖσαν ποικίλως καὶ καλῶς καὶ κακῶς. Πᾶσα γὰρ ἐπίδεσις γνάθου οὕτω καταγείσης ἐκκλίνει τὰ ὀστέα τὰ ἐς τὸ κάτηγμα ῥέποντα μᾶλλον, ἢ ἐς τὴν φύσιν ἄγει.

33. But if the bone be fairly broken across (this, however, rarely happens), it is to be set in the manner now described. When adjusted, the teeth are to be fastened together as formerly described, for this will contribute much toward keeping the parts at rest, especially if properly fastened, and the ends of the thread secured with knots. But it is not easy to describe exactly in writing the whole manipulation of the case; but the reader must figure the thing to himself from the description given. Then one must take a piece of Carthaginian leather; if the patient be a younger person, it will be sufficient to use the outer skin, but if an adult the whole thickness of the hide will be required; it is to be cut to the breadth of about three inches, or as much as will be required, and having smeared the jaw with a little gum (for thus it sticks more pleasantly), the end of the skin is to be fastened with the glue near the fractured part of the jaw, at the distance of an inch or a little more, from the wound. This piece is to be applied below the jaw; but the thong should have a cut in it, in the direction of the chin, so that it may go over the sharp point of the chin. Another piece of thong like this, or somewhat broader, is to be glued to the upper part of the jaw, at about the same distance from the wound as the other thong; this thong should be so cut as to encircle the ear. The thongs should be sharp-pointed at the part where they unite, and in gluing them, the flesh of the thong should be turned to the patient’s skin, for in this way it will be more tenacious; then we must stretch this thong, but still more so the one at the chin, in order to prevent the fragments of the jaw from riding over each other, and the thongs are to be fastened at the vertex, and then a bandage is to be bound round the forehead, and a proper apparatus is to be put over all, to prevent the bandages from being displaced. The patient should lie upon the sound side of the jaw, not resting upon the jaw, but upon the head. He is to be kept on a spare diet for ten days, and then nourished without delay. If there be no inflammation during the first days, the jaw is consolidated in twenty days; for callus quickly forms in this, as in all the other porous bones, provided there be no sphacelus ( exfoliation? ). But much remains to be said on the sphacelus of bones in another place. This method of distention with glued substances is mild, of easy application, and is useful for many dislocations in many parts of the body. Those physicians who have not judgment combined with their dexterity, expose themselves in fractures of the jaws, as in other cases, for they apply a variety of bandages to a fractured jaw-bone, sometimes properly, and sometimes improperly. For all such bandaging of a fractured jawbone has a tendency rather to derange the bones connected with the fracture, than to bring them into their natural position.

34. Ἢν δὲ ἡ κάτω γνάθος κατὰ τὴν ξύμφυσιν τὴν κατὰ τὸ γένειον διασπασθῇ μούνη δὲ αὕτη ξύμφυσις ἐν τῇ κάτω γνάθῳ ἐστὶν, ἐν δὲ τῇ ἄνω πολλαί ἀλλ’ οὐ βούλομαι ἀποπλανᾷν τὸν λόγον, ἐν ἄλλοισι γὰρ εἴδεσι νουσημάτων περὶ τούτων λεκτέον, ἢν οὖν διαστῇ ἡ κατὰ τὸ γένειον ξύμφυσις, κατορθῶσαι μὲν παντὸς ἀνδρός ἐστιν τὸ μὲν γὰρ ἐξεστεὸς ἐσωθέειν χρὴ ἐς τὸ ἔσω μέρος, προσβάλλοντα τοὺς δακτύλους τὸ δὲ εἴσω ῥέπον ἀνάγειν ἐς τὸ ἔξω μέρος, ἐνερείσαντα τοὺς δακτύλους. Ἐς διάστασιν μέντοι διατεινάμενον, ταῦτα χρὴ ποιέειν ῥᾷον γὰρ οὕτως ἐς τὴν φύσιν ἥξει, ἢ εἰ ἐγχρίπτων τις ἐς ἄλληλα

τὰ ὀστέα, καταναγκάζειν πειρᾶται τοῦτο παρὰ πάντα τὰ τοιαῦτα ὑπομνήματα χάριεν εἰδέναι. Ὁκόταν δὲ κατορθώσῃς, ζεῦξαι μὲν χρὴ τοὺς ὀδόντας τοὺς ἔνθεν καὶ ἔνθεν πρὸς ἀλλήλους, ὥσπερ καὶ πρόσθεν εἴρηται. Ἰῆσθαι δὲ χρὴ κηρωτῇ καὶ σπλήνεσιν ὀλίγοισι καὶ ὀθονίοισιν. Ἐπίδεσιν δὲ βραχείην ποικίλην μάλιστα τοῦτο τὸ χωρίον ἐπιδέχεται, ἐγγὺς γάρ τι τοῦ ἰσορρόπου ἐστὶν, ὡς δὴ μὴ ἰσόρροπον ἐόν τοῦ δὲ ὀθονίου τὴν περιβολὴν ποιέεσθαι χρὴ, ἢν μὲν ἡ δεξιὴ γνάθος ἐξεστήκῃ, ἐπὶ δεξιὰ ἐπὶ δεξιὰ γὰρ νομίζεται εἶναι, ἢν ἡ δεξιὴ χεὶρ προηγῆται τῆς ἐπιδέσιος ἢν δὲ ἡ ἑτέρη γνάθος ἐξεστήκῃ, ὡς ἑτέρως χρὴ τὴν ἐπίδεσιν ἄγειν. Κἢν μὲν ὀρθῶς τις κατορθώσηται καὶ ἐπατρεμήσῃ ὡς χρὴ, ταχείη

μὲν ἡ ἄλθεξις, οἱ δὲ ὀδόντες ἀσινέες γίνονται ἢν δὲ μὴ, χρονιωτέρη μὲν ἡ ἄλθεξις, διαστροφὴν δὲ ἴσχουσιν οἱ ὀδόντες, καὶ σιναροὶ καὶ ἀχρήϊοι γίνονται.

34. But if the lower jaw be disjointed at its symphysis in the chin (there is but one symphysis in the lower jaw, but there are several in the upper; but I am unwilling to digress from the subject, as these matters will have to be touched upon in other kinds of disease)-if, then, the symphysis be separated at the chin, it is the work which anybody can perform, to rectify it; for the part which protrudes is to be pushed inward by pressure with the fingers, and the part that inclines inward is to forced outward by pushing with the fingers from within. It is after having applied extension to separate the fragments that this is to be done, for they will thus be more easily restored to their natural position, than if one should bring them together by using force. This is proper to be known as applying to all such cases. When you have set the parts, you must fasten the teeth on both sides to one another, as formerly directed. The treatment is to be accomplished with cerate, a few compresses, and bandages. This part, in particular, requires a short but complex (?) bandaging, for it is nearly cylindrical, though not exactly so; but the turn of the bandage is to be made, if the right jaw was dislocated, to the right hand (that is said to be to the right hand when the right hand conducts the bandaging); but if the other jaw be the seat of the dislocation, the bandaging is to be made in the other direction. And if matters be properly adjusted, and the patient keep quiet, there will be a speedy recovery, and the teeth will be uninjured; but if not, the recovery will be more protracted, the teeth will be distorted, will give trouble, and become useless.

35. Ἢν δὲ ἡ ῥὶς καταγῇ, τρόπος μὲν οὐχ εἷς ἐστι κατήξιος ἀτὰρ πολλὰ μὲν δὴ καὶ ἄλλα λωβέονται οἱ χαίροντες τῇσι καλῇσιν ἐπιδέσεσιν ἄνευ νόου, ἐν δὲ τοῖσι περὶ τὴν ῥῖνα μάλιστα ἐπιδεσίων γάρ ἐστιν αὕτη ποικιλωτάτη, καὶ πλείστους μὲν σκεπάρνους ἔχουσα, διαρρωγὰς δὲ καὶ διαλείψιας ποικιλωτάτας τοῦ χρωτὸς ῥομβοειδέας. Ως οὖν εἴρηται, οἱ τὴν ἀνόητον εὐχειρίην ἐπιτηδεύοντες ἄσμενοι ῥινὸς κατεαγυίης ἐπιτυγχάνουσιν, ὡς ἐπιδήσωσιν. Μίαν μὲν οὖν ἡμέρην, ἢ δύο, ἀγάλλεται μὲν ὁ ἰητρὸς, χαίρει δὲ ὁ ἐπιδεδεμένος ἔπειτα ταχέως μὲν ὁ ἐπιδεδεμένος κορίσκεται, ἀσηρὸν γὰρ τὸ φόρημα ἀρκέει δὲ τῷ ἰητρῷ, ἐπειδὴ ἐπέδειξεν,

ὅτι ἐπίσταται ποικίλως ῥῖνα ἐπιδέειν. Ποιέει δὲ ἡ ἐπίδεσις ἡ τοιαύτη πάντα τἀναντία τοῦ δέοντος τοῦτο μὲν γὰρ, ὁκόσοι σιμοῦνται διὰ τὴν κάτηξιν, δηλονότι, εἰ ἄνωθέν τις μᾶλλον πιέζοι, σιμώτεροι ἂν ἔτι εἶεν τοῦτο δὲ, ὅσοισι παραστρέφεται ἢ ἔνθα ἢ ἔνθα ἡ ῥὶς, ἢ κατὰ τὸν χόνδρον, ἢ ἀνωτέρω, δηλονότι οὐδὲν αὐτοὺς ἡ ἄνωθεν ἐπίδεσις ὠφελήσει, ἀλλὰ καὶ βλάψει μᾶλλον οὐχ οὕτω γὰρ εὖ ξυναρμόσει σπλήνεσι τὸ ἐπὶ θάτερον τῆς ῥινὸς, καίτοι οὐδὲ τοῦτο ποιέουσιν οἱ ἐπιδέοντες.

35. Of fractures of the nose there are more than one variety, but those who, without judgment, delight in fine bandagings, do much mischief, most especially in injuries about the nose. For this is the most complex of all the forms of bandaging, having most of the turns of the bandage called “ascia,” and rhomboidal intervals and uncovered spaces of the skin. As has been said, those who practice manipulation without judgment are fond of meeting with a case of fractured nose, that they may apply the bandage. For a day or two, then, the physician glories in his performance, and the patient who has been bandaged is well pleased, but speedily the patient complains of the incumbrance of the bandage, and the physician is satisfied, because he has had an opportunity of showing his skill in applying a complex bandage to the nose. Such a bandaging does everything the very reverse of what is proper; for, in the first place, those who have their nose flattened by the fracture, will clearly have the part rendered still more flat, if pressure above be applied to it; and further, those cases in which the nose is distorted to either side, whether at the cartilage or higher up, will evidently derive no benefit from bandaging above it, but will rather be injured; for it will not admit of having compresses properly arranged on either side of the nose, and indeed, persons applying this bandage do not seek to do this.

36. Ἄγχιστα δὲ ἡ ἐπίδεσίς μοι δοκέῃ ἄν τι ποιέειν, εἰ κατὰ μέσην τὴν ῥῖνα, κατὰ τὸ ὀξὺ, ἀμφιφλασθείη ἡ σὰρξ κατὰ τὸ ὀστέον, ἢ εἰ κατὰ τὸ ὀστέον μικρόν τι σίνος εἴη, καὶ μὴ μέγα τοῖσι γὰρ τοιούτοισιν ἐπιπώρωμα ἴσχει ἡ ῥὶς, καὶ ὀκριοειδεστέρη τινὶ γίνεται ἀλλ’ ὅμως οὐδὲ τούτοισι δή που πολλοῦ ὄχλου δέεται ἡ ἐπίδεσις, εἰ δή τι καὶ δεῖ ἐπιδέειν ἀρκέει δὲ ἐπὶ μὲν τὸ φλάσμα σπληνίον ἐπιτείναντα κεκηρωμένον, ἔπειτα ὡς ἀπὸ δύο ἀρχέων ἐπιδέεται, οὕτως ὀθονίῳ ἐς ἅπαξ περιβάλλειν. Ἀρίστη μέντοι ἰητρείη, τῷ ἀλήτῳ, τῷ σιτανίῳ, τῷ πλυτῷ, γλίσχρῳ, πεφυρημένῳ, ὀλίγῳ,

καταπλάσσειν τὰ τοιαῦτα χρὴ δὲ, ἢν μὲν ἐξ ἀγαθῶν ἔῃ τῶν πυρῶν τὸ ἄλητον καὶ εὐόλκιμον, τούτῳ χρέεσθαι ἐς πάντα τὰ τοιαῦτα ἢν δὲ μὴ πάνυ ὅλκιμον ἔῃ, ὀλίγην μάννην ὕδατι ὡς λειοτάτην διέντα, τούτῳ φυρᾷν τὸ ἄλητον, ἢ κόμμι πάνυ ὀλίγον ὡσαύτως μίσγειν.

36. This bandaging would appear to me to answer best when the skin surrounding the bone is contused on its ridge near the middle, or if the bone itself have sustained some injury, but not a great one, in such cases, redundant callus forms in the nose, and the part becomes a little too prominent; and yet, even in these cases, the bandaging need not require much trouble, if, indeed, any bandage be applied at all; for it is enough if one lay a waxed compress on the contusion, and then apply the double-headed bandage, thus taking one turn with it. The best application to such accidents is a small cataplasm of wheaten flour, washed, and mixed up into a viscid mass. If the flour be made from good wheat, and if it be glutinous, it should be used alone for all such cases, but if it be not very glutinous, a little of the manna of frankincense, well pulverized, is to be moistened with water, and the flour is to be mixed up with it, or a very little gum may be mixed in like manner.

37. Ὁκόσοισι μὲν οὖν ῥὶς ἐς τὸ κάτω καὶ ἐς τὸ σιμὸν ῥέπουσα κατεαγῇ, ἢν μὲν ἐκ τοῦ ἔμπροσθεν μέρεος κατὰ τὸν χόνδρον ἵζηται, οἷόν τέ ἐστι καὶ ἐντιθέναι τι διόρθωμα ἐς τοὺς μυκτῆρας ἢν δὲ μὴ, ἀνορθοῦν μὲν χρὴ πάντα τὰ τοιαῦτα, τοὺς δακτύλους ἐς τοὺς μυκτῆρας ἐντιθέντα, ἢν ἐνδέχηται ἢν δὲ μὴ, παχὺ ὑπάλειπτρον

μὴ ἐς τὸ ἔμπροσθεν τῆς ῥινὸς ἀνάγοντα τοῖσι δακτύλοισιν, ἀλλ’ ᾗ ἵδρυται ἔξωθεν δὲ τῆς ῥινὸς ἔνθεν καὶ ἔνθεν ἀμφιλαμβάνοντα τοῖσι δακτύλοισι, ξυναναγκάζειν τε ἅμα καὶ ἀναφέρειν ἐς τὸ ἄνω. Καὶ ἢν μὲν πάνυ ἐν τῷ ἔμπροσθεν τὸ κάτηγμα ἔῃ, οἷόν τέ τι καὶ ἔσω τῶν μυκτήρων ἐντιθέναι, ὥσπερ ἤδη εἴρηται, ἢ ἄχνην τὴν ἀφ’ ἡμιτυβίου, ἢ ἄλλο τι τοιοῦτον ἐν ὀθονίῳ εἱλίσσοντα, μᾶλλον δὲ ἐν καρχηδονίῳ δέρματι ἐρράψαντα, σχηματίσαντα τὸ ἁρμόσσον σχῆμα τῷ χωρίῳ, ἵνα ἐγκείσεται. Ἢν μέντοι πρωσωτέρω ἔῃ τὸ κάτηγμα, οὐδὲν οἷόν τε ἔσω ἐντιθέναι καὶ γὰρ εἰ ἐν τῷ ἔμπροσθεν ἀσηρὸν τὸ φόρημα, πῶς γε δὴ οὐκ ἐν τῷ ἐσωτέρω; Τὸ μὲν οὖν πρῶτον, καὶ ἔσωθεν ἀναπλάσσεσθαι καὶ ἔξωθεν ἀφειδήσαντα, χρὴ ἀναγαγεῖν ἐς τὴν ἀρχαίην φύσιν, καὶ διορθώσασθαι. Κάρτα γὰρ οἵη τε ῥὶς καταγεῖσα ἀναπλάσσεσθαι, μάλιστα μὲν αὐθήμερος, ἢν δὲ μὴ, ὀλίγῳ ὕστερον ἀλλὰ καταβλακεύουσιν οἱ ἰητροὶ, καὶ ἁπαλωτέρως τὸ πρῶτον ἅπτονται, ἢ ὡς χρὴ παραβάλλοντα γὰρ τοὺς δακτύλους χρὴ ἔνθεν καὶ ἔνθεν κατὰ τὴν φύσιν τῆς ῥινὸς ὡς κατωτάτω, κάτωθεν ξυναναγκάζειν, καὶ οὕτω μάλιστα ἀνορθοῦται

σὺν τῇ ἔσωθεν διορθώσει. Ἔπειτα δὲ ἐς ταῦτα ἰητρὸς οὐδεὶς ἄλλος ἐστὶ τοιοῦτος, εἰ ἐθέλοι καὶ μελετᾷν καὶ τολμᾷν, ὡς οἱ δάκτυλοι αὐτοῦ οἱ λιχανοί οὗτοι γὰρ κατὰ φύσιν μάλιστά εἰσιν. Παραβάλλοντα γὰρ χρὴ τῶν δακτύλων ἑκάτερον, παρὰ πᾶσαν τὴν ῥῖνα ἐρείδοντα, ἡσύχως οὗτως ἔχειν, μάλιστα μὲν, εἰοἷόν τε εἴη, αἰεὶ, ἐστ’ ἂν κρατυνθῇ, εἰ δὲ μὴ, ὡς πλεῖστον χρόνον, αὐτὸν, ὡς εἴρηται εἰ δὲ μὴ, ἢ παῖδα ἢ γυναῖκά τινα μαλθακὰς γὰρ τὰς χεῖρας δεῖ εἶναι. Οὕτω γὰρ ἂν κάλλιστα ἰητρευθείη, ὁτέῳ ἡ ῥὶς μὴ ἐς τὸ σκολιὸν, ἀλλ’ ἐς τὸ κάτω ἱδρυμένη, ἰσόρροπος εἴη. Ἐγὼ μὲν οὖν οὐδεμίην που ῥῖνα εἶδον, ἥτις οὕτω κατεαγεῖσα οὐχ οἵη τε διορθωθῆναι, αὐτίκα πρὶν πωρωθῆναι ξυναναγκαζομένη, ἐγένετο, εἴ τις ὀρθῶς ἐθέλοι ἰητρέυειν. Ἀλλὰ γὰρ οἱ ἄνθρωποι αἰσχροὶ μὲν εἶναι πολλοῦ ἀποτιμῶνται, μελετᾷν δὲ ἅμα μὲν οὐκ ἐπίστανται, ἅμα δὲ οὐ τολμέουσιν, ἢν μὴ ὀδυνέωνται, ἢ θάνατον δεδοίκωσιν καίτοι ὀλιγοχρόνιος ἡ πώρωσις τῆς ῥινός ἐν γὰρ δέκα ἡμέρῃσι κρατύνεται, ἢν μὴ ἐπισφακελίσῃ.

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

38. Ὁκόσοισι δὲ τὸ ὀστέον ἐς τὸ πλάγιον κατάγνυται, ἡ μὲν ἴησις ἡ αὐτή τὴν δὲ διόρθωσιν δηλονότι χρὴ ποιέεσθαι, οὐκ ἰσόρροπον ἀμφοτέρωθεν, ἀλλὰ τό τε ἐκκεκλιμένον ὠθέειν ἐς τὴν φύσιν, ἔκτοσθεν ἀναγκάζοντα, καὶ ἐσματτευόμενον ἐς τοὺς μυκτῆρας, καὶ τὰ εἴσω ῥέψαντα διορθοῦν ἀόκνως, ἔστ’ ἂν κατορθώσῃς,

εὖ εἰδότα, ὅτι, ἢν μὴ αὐτίκα κατορθώσῃς, οὐχ οἷόν τε μὴ οὐχὶ διεστράφθαι τὴν ῥῖνα. Ὅταν δὲ ἀγάγῃς ἐς τὴν φύσιν, προσβάλλοντα χρὴ ἐς τὸ χωρίον, ἢ τοὺς δακτύλους, ἢ τὸν ἕνα δάκτυλον, ᾗ ἐξέσχεν, ἀνακωχέειν, ἢ αὐτὸν, ἢ ἄλλον τινὰ, ἔστ’ ἂν κρατυνθῇ τὸ τρῶμα ἀτὰρ καὶ ἐς τὸν μυκτῆρα τὸν σμικρὸν δάκτυλον ἀπωθέοντα, ἄλλοτε καὶ ἄλλοτε διορθοῦν χρὴ τὰ ἐγκλιθέντα. Ὅ τι δ’ ἂν φλεγμονῆς ὑπογίνηται τουτέοισι, χρὴ τῷ σταιτὶ χρέεσθαι τοῖσι μέντοι δακτύλοισι προσέχειν χρὴ ὁμοίως, καὶ τοῦ σταιτὸς ἐπικειμένου. Ἢν δέ που κατὰ τὸν χόνδρον ἐς τὰ πλάγια καταγῇ, ἀνάγκη τὴν ῥῖνα ἄκρην παρεστράφθαι. Χρὴ οὖν τοῖσι τοιούτοισιν ἐς τὸν μυκτῆρα ἄκρον διόρθωμά τι τῶν εἰρημένων, ἢ ὅ τι τούτοισιν ἔοικεν, ἐντιθέναι πολλὰ δ’ ἄν τις εὕροι τὰ ἐπιτήδεια, ὅσα μήτε ὀδμὴν ἴσχει, ἄλλως τε καὶ προσηνέα ἐστίν ἐγὼ δέ ποτε πλεύμονος προβάτου ἀπότμημα ἐνέθηκα, τοῦτο γάρ πως παρέτυχεν οἱ γὰρ σπόγγοι ἐντιθεμένοι ὑγράσματα δέχονται. Ἔπειτα χρὴ καρχηδονίου δέρματος λοπὸν, πλάτος ὡς τοῦ μεγάλου δακτύλου τετμημένον, ἢ ὅκως ἂν ξυμφέρῃ, προσκολλῆσαι ἐς τὸ ἔκτοσθεν πρὸς τὸν μυκτῆρα τὸν ἐκκεκλιμένον κἄπειτα κατατεῖναι τὸν ἱμάντα, ὅκως ἂν ξυμφέρῃ

μᾶλλον δὲ ὀλίγῳ τείνειν χρὴ, [ἢ] ὥστε ὀρθὴν καὶ ἀπαρτῆ τὴν ῥῖνα εἶναι. Ἔπειτα μακρὸς γὰρ ἔστω ὁ ἱμὰς, κάτωθεν τοῦ ὠτὸς ἀγαγόντα αὐτὸν, ἀναγαγεῖν περὶ τὴν κεφαλήν καὶ ἔξεστι μὲν κατὰ τὸ μέτωπον προσκολλῆσαι τὴν τελευτὴν τοῦ ἱμάντος, ἔξεστι δὲ καὶ μακρότερον ἐπιπεριελίσσοντα περὶ τὴν κεφαλὴν καταδέειν. Τοῦτο ἅμα μὲν δικαίην τὴν διόρθωσιν ἔχει, ἅμα δὲ εὐταμίευτον, καὶ μᾶλλον, ἢν ἐθέλῃ, καὶ ἧσσον τὴν ἀντιρροπίην ποιῆσαι τῆς ῥινός. Ἀτὰρ καὶ ὁκόσοισιν ἐς τὸ πλάγιον ἡ ῥὶς κατάγνυται, τὰ μὲν ἄλλα ἰητρεύειν χρὴ, ὡς προείρηται προσδέεται δὲ τοῖσι πλείστοισι καὶ τοῦ ἱμάντος πρὸς ἄκρην τὴν ῥῖνα προσκολληθῆναι τῆς ἀντιρροπίης εἵνεκα.

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

39. Ὅσοισι δὲ σὺν τῇ κ̣τήξει καὶ ἕλκεα προσγίνεται, οὐδὲν δεῖ ταράσσεσθαι διὰ τοῦτο ἀλλ’ ἐπὶ μὲν τὰ ἕλκεα ἐπιτιθέναι ἢ πισσηρὴν, ἢ τῶν ἐναίμων τι εὐαλθέα γὰρ τῶν τοιούτων τὰ πλεῖστά ἐστιν ὁμοίως, κἢν ὀστέα μέλλῃ ἀπιέναι. Τὴν δὲ διόρθωσιν τὴν πρώτην ἀόκνως χρὴ ποιέεσθαι, μηδὲν ἐπιλείποντα, καὶ τὰς διορθώσιας τοῖσι δακτύλοισιν ἐν τῷ ἔπειτα χρόνῳ, χαλαρωτέροισι μὲν

χρεόμενον, χρεόμενον δέ εὐπλαστότατον γάρ τι παντὸς τοῦ σώματος ἡ ῥίς ἐστιν. Τῶν δὲ ἱμάντων τῇ κολλήσει καὶ τῇ ἀντιρροπίῃ παντάπασιν οὐδὲν κωλύει χρέεσθαι, οὔτ’ ἢν ἕλκος ᾖ, οὔτ’ ἢν ἐπιφλεγμήνῃ ἀλυπόταται γάρ εἰσιν.

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

40. Ἢν δὲ οὖς κατεαγῇ, ἐπιδέσιες μὲν πᾶσαι πολέμιαι οὐ γὰρ οὕτω τις καλαρὸν περιβάλλοι ἢν δὲ μᾶλλον πιέζῃ, πλέον κακὸν ἐργάζεται ἐπεὶ καὶ ὑγιὲς οὖς, ἐπιδέσει πιεχθὲν, ὀδυνηρὸν καὶ σφυγματῶδες καὶ πυρετῶδες γίνεται. Ἀτὰρ καὶ τὰ ἐπιπλάσματα, κάκιστα μὲν τὰ βαρύτατα τὸ ἐπίπαν ἀτὰρ καὶ τὰ πλεῖστα φλαῦρα καὶ ἀποστατικὰ, καὶ μύξαν τε ὑποποιέει πλείω, κἄπειτα ἐκπυήσιας ἀσηράς τούτων δὲ ἥκιστα οὖς κατ̣γὲν προσδέεται ἄγχιστα μὴν, εἴπερ χρὴ, τὸ γλίσχρον ἄλητον χρὴ δὲ μηδὲ τοῦτο βάρος ἔχειν. Ψαύειν δὲ ὡς ἥκιστα ξυμφέρει ἀγαθὸν γὰρ φάρμακόν ἐστιν ἐνίοτε καὶ τὸ μηδὲν προσφέρειν καὶ πρὸς οὖς καὶ πρὸς ἄλλα πολλά. Χρὴ δὲ καὶ τὴν ἐπικοίμησιν φυλάσσεσθαι τὸ δὲ σῶμα ἰσχναίνειν, καὶ μᾶλλον, ᾧ ἂν κίνδυνος ἔῃ ἔμπυον τὸ οὖς γενέσθαι ἄμεινον δὲ καὶ μαλθάξαι τὴν κοιλίην ἢν δὲ καὶ εὐήμετος

ἔῃ, ἐμέειν ἀπὸ συρμαϊσμοῦ. Ἢν δὲ ἐς ἐμπύησιν ἔλθῃ, ταχέως μὲν οὐ χρὴ στομοῦν πολλὰ γὰρ καὶ τῶν δοκεόντων ἐκπυέεσθαι ἀναπίνεταί ποτε, κἢν μηδέν τις καταπλάσῃ. Ἢν δὲ ἀναγκασθῇ στομῶσαι, τάχιστα μὲν ὑγιὲς γίνεται, ἤν τις πέρην διακαύσῃ εἰδέναι μέντοι χρὴ σαφῶς, ὅτι κυλλὸν ἔσται τὸ οὖς καὶ μεῖον τοῦ ἑτέρου, ἢν πέρην διακαυθῇ. Ἢν δὲ μὴ πέρην καίηται, τάμνειν χρὴ τὸ μετέωρον, μὴ πάνυ σμικρὴν τομήν διὰ παχυτέρου μὴν καὶ τὸ πῦον εὑρίσκεται, ἢ ὡς ἄν τις δοκέοι ὡς δ’ ἐν κεφαλαίῳ εἰπεῖν, καὶ πάντα τἄλλα τὰ μυξώδεα καὶ μυξοποιὰ, ἅτε γλίσχρα ἐόντα, ὑποθιγγανόμενα διολισθάνει ταχέως ὑπὸ τοὺς δακτύλους καὶ ἔνθα καὶ ἔνθα διὰ τοῦτο διὰ παχυτέρου εὑρίσκουσι τὰ τοιαῦτα οἱ ἰητροὶ, ἢ ὡς οἴονται ἐπεὶ καὶ τῶν γαγγλιωδέων ἔνια, ὅσα ἂν πλαδαρὰ ἔῃ, καὶ μυξώδεα σάρκα ἔχῃ, πολλοὶ στομοῦσιν, οἰόμενοι ῥεῦμα ἀνευρήσειν ἐς τὰ τοιαῦτα ἡ μὲν οὖν γνώμη τοῦ ἰητροῦ ἐξαπατᾶται τῷ δὲ πρήγματι τῷ τοιούτῳ οὐδεμία βλάβη στομωθέντι. Ὅσα δὲ ὑδατώδεα χωρία ἐστὶν, ἢ μύξης πεπληρωμένα, καὶ ἐν οἵοισι χωρίοισιν ἕκαστα θάνατον φέρει στομούμενα, ἢ καὶ ἀλλοίας βλάβας, περὶ τούτων ἐν ἄλλῳ λόγῳ γεγράψεται. Ὅταν οὖν τάμῃ τις τὸ οὖς, πάντων μὲν καταπλασμάτων, πάσης τε μοτώσιος ἀπέχεσθαι χρή ἰητρεύειν

δὲ ἢ ἐναίμῳ, ἢ ἄλλῳ τῳ, ὅ τι μήτε βάρος, μήτε πόνον παρασχήσει ἢν γὰρ ὁ χόνδρος ἄρξηται ψιλοῦσθαι, καὶ ὑποστάσιας ἴσχῃ, ὀχλῶδες γιγνεται δὲ τοῦτο δι’ ἐκείνας τὰς ἰήσιας. Πάντων δὲ τῶν παλιγκοτησάντων ἡ πέρην διάκαυσις αὐταρκέστατον.

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

41. Σπόνδυλοι δὲ οἱ κατὰ ῥάχιν, ὅσοισι μὲν ὑπὸ νοσημάτων ἕλκονται ἐς τὸ κυφὸν, τὰ μὲν πλεῖστα ἀδύνατα λύεσθαι, ποτὶ καὶ ὅσα ἀνωτέρω τῶν φρενῶν τῆς προσφύσιος κυφοῦται. Τῶν δὲ κατωτέρω μετεξέτερα λύουσι κιρσοὶ γενόμενοι ἐν τοῖσι σκέλεσι, μᾶλλον δέ τι ἐγγινόμενοι κιρσοὶ ἐν τῇ κατ’ ἰγνύην φλεβί οἷσι δ’ ἂν τὰ

κυφώματα λύηται, ἐγγίνονται δὲ καὶ ἐν τῇ κατὰ βουβῶνα ἤδη δέ τισιν ἔλυσε καὶ δυσεντερίη πολυχρόνιος γενομένη. Καὶ οἷσι μὲν κυφοῦται ῥάχις παισὶν ἐοῦσι, πρὶν ἢ τὸ σῶμα τελειωθῆναι ἐς αὔξησιν, τουτέοισι μὲν οὐδὲ ξυναύξεσθαι ἐθέλει κατὰ τὴν ῥάχιν τὸ σῶμα, ἀλλὰ σκέλεα μὲν καὶ χεῖρες τελειοῦνται ταῦτα δὲ ἐνδεέστερα γίνεται. Καὶ ὅσοισιν ἂν ᾖ ἀνωτέρω τῶν φρενῶν τὸ κῦφος, τούτοισι μὲν αἵ τε πλευραὶ οὐκ ἐθέλουσιν ἐς τὸ εὐρὺ αὔξεσθαι, ἀλλ’ ἐς τοὔμπροσθεν, τό τε στῆθος ὀξὺ γίνεται, ἀλλ’ οὐ πλατὺ, αὐτοί τε δύσπνοοι γίνονται, καὶ κερχώδεες ἧσσον γὰρ εὐρυχωρίην ἔχουσιν αἱ κοιλίαι αἱ τὸ πνεῦμα δεχόμεναι καὶ προπέμπουσαι. Καὶ μέντοι καὶ ἀναγκάζονται κατὰ τὸν μέγαν σπόνδυλον λορδὸν τὸν αὐχένα ἔχειν, ὡς μὴ προπετὴς ἔῃ αὐτέοισιν ἡ κεφαλή στενοχωρίην μὲν οὖν πολλην τῇ φάρυγγι παρέχει καὶ τοῦτο, ἐς τὸ ἔσω ῥέπον καὶ γὰρ τοῖσιν ὀρθοῖσι φύσει δύσπνοιαν παρέχει

τοῦτο τὸ ὀστέον, ἢν ἔσω ῥέψῃ, ἔστ’ ἂν ἀναπιεχθῇ. Δι’ οὖν τὸ τοιοῦτον σχῆμα ἐξεχέβρογχοι οἱ τοιοῦτοι τῶν ἀνθρώπων μᾶλλον φαίνονται, ἢ οἱ ὑγιέες φυματίαι τε ὡς ἐπὶ τὸ πολὺ κατὰ τὸν πλεύμονά εἰσιν οἱ τοιοῦτοι σκληρῶν φυμάτων καὶ ἀπέπτων καὶ γὰρ ἡ πρόφασις τοῦ κυφώματος καὶ ἡ ξύντασις τοῖσι πλείστοισι διὰ τοιαύτας ξυστροφὰς γίνεται, ᾗσιν ἂν κοινωνήσωσιν οἱ τόνοι οἱ ξύνεγγυς. Ὅσοισι δὲ κατωτέρω τῶν φρενῶν τὸ κύφωμά ἐστι, τούτοισι νοσήματα μὲν ἐνίοισι προσγίνεται νεφριτικὰ, καὶ κατὰ κύστιν ἀτὰρ καὶ ἀποστάσιες ἐμπυήματι καὶ κατὰ κενεῶνας, καὶ κατὰ βουβῶνας, χρόνιαι καὶ δυσαλθέες, καὶ τουτέων οὐδετέρη λύει τὰ κυφώματα ἰσχία δὲ τοῖσι τοιουτέοισιν ἔτι ἀσαρκότερα γίνεται, ἢ τοῖσιν ἄνωθεν κυφοῖσιν ἡ μέντοι ξύμπασα ῥάχις μακροτέρη τουτέοισιν, ἢ τοῖσιν ἄνωθεν κυφοῖσιν ἥβη δὲ καὶ γένειον βραδύτερα καὶ ἀτελέστερα, καὶ ἀγονώτεροι οὗτοι τῶν ἄνωθεν κυφῶν. Οἷσι δ’ ἂν ηὐξημένοισιν ἤδη τὸ σῶμα ἡ κύφωσις γένηται, τούτοισιν ἀπαντικρὺ μὲν τῆς νούσου τῆς τότε παρεούσης κρίσιν ποιέει ἡ κύφωσις ἀνὰ χρόνον μέντοι ἐπισημαίνει τι τῶν αὐτέων, ὥσπερ καὶ τοῖσι νεωτέροισιν, ἢ πλέον, ἢ ἔλασσον ἧσσον

δὲ κακοήθως ὡς τὸ ἐπίπαν μὴν τοιαῦτα πάντα ἐστίν. Πολλοὶ μέντοι ἤδη καὶ εὐφόρως ἤνεγκαν καὶ ὑγιεινῶς τὴν κύφωσιν ἄχρι γήρως, μάλιστα δὲ οὗτοι, οἷσιν ἂν ἐς τὸ εὔσαρκον καὶ πιμελῶδες προτράπηται τὸ σῶμα ὀλίγοι μὴν ἤδη καὶ τῶν τοιούτων ὑπὲρ ἑξήκοντα ἔτη ἐβίωσαν οἱ δὲ πλεῖστοι βραχυβιώτεροί εἰσιν. Ἔστι δ’ οἷσι καὶ ἐς τὸ πλάγιον σκολιοῦνται σπόνδυλοι ἢ τῇ, ἢ τῇ πάντα μὴν ἢ τὰ πλεῖστα τὰ τοιαῦτα γίνεται διὰ ξυστροφὰς τὰς ἔσωθεν τῆς ῥάχιος προσξυμβάλλεται δὲ ἐνίοισι ξὺν τῇ νούσῳ καὶ τὰ σχήματα, ἐφ’ ὁκοῖα ἂν. ἐθισθέωσι κεκλίσθαι. Ἀλλὰ περὶ μὲν τούτων ἐν τοῖσι χρονίοισι κατὰ πλεύμονα νοσήμασιν εἰρήσεται ἐκεῖ γάρ εἰσιν αὐτῶν χαριέσταται προγνώσιες περὶ τῶν μελλόντων ἔσεσθαι.

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

42. Ὅσοισι δὲ ἐκ καταπτώσιος ῥάχις κυφοῦται, ὀλίγα δὴ τούτων ἐκρατήθη, ὥστε ἐξιθυνθῆναι. Τοῦτο μὲν γὰρ, αἱ ἐν τῇ κλίμακι κατασείσιες οὐδένα πω ἐξίθυναν, ὧν γε ἐγὼ οἶδα χρέονται δὲ οἱ ἰητροὶ μάλιστα αὐτῇ οὗτοι οἱ ἐπιθυμέοντες ἐκχαυνοῦν τὸν πολὺν ὄχλον τοῖσι γὰρ τοιούτοισι ταῦτα θαυμάσιά ἐστιν, ἢν ἢ κρεμάμενον ἴδωσιν, ἢ ῥιπτεόμενον, ἢ ὅσα τοῖσι τοιούτοισιν ἔοικε, καὶ ταῦτα κληΐζουσιν αἰεὶ, καὶ οὐκέτι αὐτοῖσι μέλει, ὁκοῖόν τι ἀπέβη ἀπὸ τοῦ χειρίσματος, εἴτε κακὸν, εἴτε ἀγαθόν. Οἱ μέντοι ἰητροὶ οἱ τὰ τοιαῦτα ἐπιτηδεύοντες, σκαιοί εἰσιν, οὓς ἔγωγε ἔγνων τὸ μὲν γὰρ ἐπινόημα ἀρχαῖον, καὶ ἐπαινέω ἔγωγε σφόδρα τὸν πρῶτον ἐπινοήσαντα καὶ τοῦτο καὶ ἄλλο πᾶν, ὅ τι μηχάνημα κατὰ φύσιν

ἐπενοήθη οὐδὲν γάρ μοι ἄελπτον, εἴ τις καλῶς σκευάσας καλῶς κατασείσειε, κἂν ἐξιθυνθῆναι ἔνια. Αὐτὸς μέντοι κατῃσχύνθην πάντα τὰ τοιουτότροπα ἰητρεύειν οὕτω, διὰ τοῦτο ὅτι πρὸς ἀπατεώνων μᾶλλον οἱ τοιοῦτοι τρόποι.

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

43. Ὅσοισι μὲν οὖν ἐγγὺς τοῦ αὐχένος ἡ κύφωσις γίνεται, ἧσσον εἰκὸς ὠφελέειν τὰς κατασείσιας ταύτας τὰς ἐπὶ κεφαλὴν σμικρὸν γὰρ τὸ βάρος ἡ κεφαλὴ καὶ τὰ ἀκρώμια καταρρέποντα ἀλλὰ τούς γε τοιούτους εἰκὸς ἐπὶ τοὺς πόδας κατασεισθέντας μᾶλλον ἐξιθυνθῆναι μέζων γὰρ οὕτως ἡ καταρροπίη ἡ ἐπὶ ταῦτα. Ὅσοισι δὲ κατωτέρω τὸ ὕβωμα, τουτέοισιν εἰκὸς μᾶλλον ἐπὶ κεφαλὴν κατασείεσθαι. Εἰ οὖν τις ἐθέλοι κατασείειν, ὀρθῶς ἂν ὧδε σκευάζοι τὴν μὲν κλίμακα χρὴ σκυτίνοισιν ὑποκεφαλαίοισι πλαγίοισιν, ἢ ἐρινέοισι, καταστρῶσαι εὖ προς δεδεμένοισιν, ὀλίγῳ πλέον καὶ ἐπὶ μῆκος καὶ ἔνθεν καὶ ἔνθεν, ἢ ὅσον ἂν τὸ σῶμα τοῦ ἀνθρώπου κατάσχοι ἔπειτα τὸν ἄνθρωπον ὕπτιον κατακλῖναι ἐπὶ τὴν κλίμακα χρή κἄπειτα προσδῆσαι μὲν τοὺς πόδας παρὰ τὰ σφυρὰ πρὸς τὴν κλίμακα μὴ διαβεβῶτας, δεσμῷ εὐόχῳ μὲν, μαλθακῷ δέ προσδῆσαι δὲ κατωτέρω ἑκάτερον τῶν γουνάτων, καὶ ἀνωτέρω προσδῆσαι δὲ καὶ κατὰ τὰ ἰσχία κατὰ δὲ τοὺς κενεῶνας καὶ κατὰ τὸ στῆθος χαλαρῇσι ταινίῃσι περιβαλέειν οὕτως, ὅκως μὴ κωλύωσι

τὴν κατάσεισιν τὰς δὲ χεῖρας παρὰ τὰς πλευρὰς παρατείναντα προσκαταλαβεῖν πρὸς αὐτὸ τὸ σῶμα, καὶ μὴ πρὸς τὴν κλίμακα. Ὅταν δὲ ταῦτα κατασκευάσῃς οὕτως, ἀνέλκειν τὴν κλίμακα ἢ πρὸς τύρσιν τινὰ ὓψηλὴν, ἢ πρὸς ἀέτωμα οἴκου τὸ δὲ χωρίον, ἵνα κατασείεις, ἀντίτυπον ἔστω τοὺς δὲ ἀνατείνοντας εὐπαιδεύτους χρὴ εἶναι, ὅκως ὁμαλῶς καὶ ἰσορρόπως καὶ ἐξαπιναίως ἀφήσουσι, καὶ μήτε ἡ κλίμαξ ἑτερόρροπος ἐπὶ τὴν γῆν ἀφίξεται, μήτε αὐτοὶ προπετέες ἔσονται. Ἀπὸ μέντοι τύρσιος ἀφιεὶς ἢ ἀπὸ ἱστοῦ καταπεπηγότος καρχήσιον ἔχοντος, ἔτι κάλλιον ἄν τις σκευάσαιτο, ὥστε ἀπὸ τροχιλίης τὰ χαλώμενα εἶναι ὅπλα, ἢ ἀπὸ ὄνου. Ἀηδὲς μὴν καὶ μακρολογέειν περὶ τούτων ὅμως δὲ ἐκ τουτέων ἂν τῶν κατασκευῶν κάλλιστ’ ἄν τις κατασεισθείη.

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

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

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

45. Χρὴ δὲ πρῶτον μὲν γινώσκειν τὴν φύσιν τῆς ῥάχιος, οἵη τίς ἐστιν ἐς πολλὰ γὰρ νουσήματα προσδέοι ἂν αὐτῆς. Τοῦτο μὲν γὰρ, τὸ πρὸς τὴν κοιλίην ῥέπον, οἱ σπόνδυλοι ἐντὸ ἄρτιοί εἰσιν ἀλλήλοισι, καὶ δέδενται πρὸς ἀλλήλους δεσμῷ μυξώδεϊ καὶ νευρώδεϊ, ἀπὸ χόνδρων ἀποπεφυκότι ἄχρι πρὸς τὸν νωτιαῖον. Ἄλλοι δέ τινες τόνοι νευρώδεες διανταῖοι, πρόσφυτοι, παρατέτανται ἔνθεν καὶ ἔνθεν αὐτῶν. Αἱ δὲ φλεβῶν καὶ ἀρτηριῶν κοινωνίαι ἐν ἐτέρῳ λόγῳ δεδηλώσονται, ὅσαι τε καὶ οἷαι, καὶ ὅθεν ὡρμημέναι, καὶ ἐν οἵοισιν οἷα δύνανται, αὐτὸς δὲ ὁ νωτιαῖος οἷσιν ἐλύτρωται ἐλύτροισι, καὶ ὅθεν ὡρμημένοισι, καὶ ὅπη κραίνουσιν, καὶ οἷσι κοινωνέουσι, καὶ οἷα δυναμένοισιν. Ἐν δὲ τῷ ἐπέκεινα, ἐν ἄρθροισι γεγιγγλύμωνται πρὸς ἀλλήλους οἱ σπόνδυλοι. Τόνοι δε κοινοὶ παρὰ πάντας, καὶ ἐν τοῖσιν ἔξω μέρεσι, καὶ ἐν τοῖσιν ἔσω παρατέτανται. Ἀπόφυσις δέ ἐστιν ὀστέου ἐς τὸ ἔξω μέρος ἀπὸ πάντων τῶν σπονδύλων, μία ἀπὸ ἑνὸς ἑκάστου, ἀπό τε τῶν μειζόνων, ἀπό τε τῶν ἐλασσόνων ἐπὶ δὲ τῇσιν ἀποφύσεσι ταύτῃσι χονδρίων ἐπιφύσιες, καὶ

ἀπ’ ἐκείνων νεύρων ἀποβλάστησις ἠδελφισμένη τοῖσιν ἐξωτάτω τόνοισιν. Πλευραὶ δὲ προσπεφύκασιν, ἐς τὸ εἴως μέρος τὰς κεφαλὰς ῥέπουσαι μᾶλλον, ἢ ἐς τὸ ἔξω καθ’ ἕνα δὲ ἕκαστον τῶν σπονδύλων προσήρθρωνται καμπυλώταται δὲ πλευραὶ ἀνθρώπου εἰσὶ ῥαιβοειδέα τρόπον. Τὸ δὲ μεσηγὺ τῶν πλευρέων καὶ τῶν ὀστέων τῶν ἀποπεφυκότων ἀπὸ τῶν σπονδύλων, ἀποπληρέουσιν ἑκατέρωθεν

οἱ μύες ἀπὸ τοῦ αὐχένος ἀρξάμενοι, ἄχρι τῆς προσφύσιος. Αὐτὴ δὲ ἡ ῥάχις κατὰ μῆκος ἰθυσκόλιός ἐστιν ἀπὸ μὲν τοῦ ἱεροῦ ὀστέου ἄχρι τοῦ μεγάλου σπονδύλου, παρ’ ὃν προσήρτηται τῶν σκελέων ἡ πρόσφυσις, ἄχρι μὲν τούτου κυφή κύστις τε γὰρ, καὶ γοναὶ, καὶ ἀρχοῦ τὸ χαλαρὸν ἐν τουτέῳ ἔκτισται. Ἀπὸ δὲ τούτου ἄχρι φρενῶν προσαρτήσιος, ἰθυλόρδη καὶ παραφύσιας ἔχει μυῶν τοῦτο μοῦνον τὸ χωρίον ἐκ τῶν εἴσωθεν μερῶν, ἃς δὴ καλέουσι ψόας. Ἀπὸ δὲ τούτου ἄχρι τοῦ μεγάλου σπονδύλου τοῦ ὑπὲρ τῶν ἐπωμίδων, ἰθυκύφη ἔτι δὲ μᾶλλον δοκέει ἢ ἐστίν ἡ γὰρ ἄκανθα κατὰ μέσον ὑψηλοτάτας τὰς ἐκφύσιας τῶν ὀστέων ἔχει, ἔνθεν δὲ καὶ ἔνθεν ἐλάσσους. Αὐτὸ δὲ τὸ ἄρθρον τοῦ αὐχένος λορδόν ἐστιν.

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

46. Ὁκόσοισι μὲν οὖν κυφώματα γίνεται κατὰ τοὺς σπονδύλους, ἔξωσις μὲν μεγάλη ἀπορραγεῖσα ἀπὸ τῆς ξυμφύσιος ἢ ἑνὸς σπονδύλου, ἢ καὶ πλειόνων, οὐ μάλα πολλοῖσι γίνεται, ἀλλ’ ὀλίγοισιν. Οὐδὲ γὰρ τὰ τρώματα τὰ τοιαῦτα ῥηΐδιον γίνεσθαι οὔτε γὰρ ἐς τὸ ἔξω ἐξωσθῆναι ῥηΐδίον ἐστιν, εἰ μὴ ἐκ τοῦ ἔμπροσθεν ἰσχυρῷ τινι τρωθείη διὰ τῆς κοιλίης οὕτω δ’ ἂν ἀπόλοιτὀ, ἢ εἴ τις ἀφ’ ὑψηλοῦ τοῦ χωρίου πεσὼν ἐρείσειε τοῖσιν ἰσχίοισιν ἢ τοῖσιν ὤμοισιν ἀλλὰ καὶ οὕτως ἂν ἀποθάνοι, παραχρῆμα δὲ οὐκ ἂν ἀποθάνοἰ ἐκ δὲ τοῦ ὄπισθεν οὐ ῥηΐδιον τοιαύτην ἔξαλσιν γενέσθαι ἐς τὸ ἔσω, εἰ μὴ ὑπέρβαρύ τι ἄχθος ἐμπέσοι τῶν τε γὰρ ὀστέων τῶν ἐκπεφυκότων ἔξω ἓν ἕκαστον τοιοῦτόν ἐστιν, ὥστε πρόσθεν ἂν αὐτὸ καταγῆναι, πρὶν ἢ μεγάλην ῥοπὴν εἴσω ποιῆσαι, τούς τε ξυνδέσμους βιησάμενον, καὶ τὰ ἄρθρα τὰ ἐνηλλαγμένα. Ὅ τε αὖ νωτιαῖος πονοίη ἂν, εἰ ἐξ ὀλίγου χωρίου τὴν περικαμπὴν ἔχοι, τοιαύτην ἔξαλσιν ἐξαλλομένου σπονδύλου ὅ τ’ ἐκπηδήσας σπόνδυλος πιέζοι ἂν τὸν νωτιαῖον, εἰ μὴ καὶ ἀπορρήξειεν πιεχθεὶς δ’ ἂν καὶ ἀπολελαμμένος, πολλῶν ἂν καὶ μεγάλων καὶ ἐπικαίρων ἀπονάρκωσιν ποιήσειεν ὥστε οὐκ ἂν μέλοι τῷ ἰητρῷ, ὅκως χρὴ τὸν σπόνδυλον κατορθῶσαι, πολλῶν καὶ βιαίων ἄλλων κακῶν παρεόντων. Ὥστε

δὴ οὐδ’ ἐμβαλεῖν οἷόν τε πρόδηλον τὸν τοιοῦτον οὔτε κατασείσει, οὔτε ἄλλῳ τρόπῳ οὐδενὶ, εἰ μή τις διαταμὼν τὸν ἄνθρωπον, ἔπειτα ἐσμασάμενος ἐς τὴν κοιλίην, ἐκ τοῦ εἴσωθεν τῇ χειρὶ ἐς τὸ ἔξω ἀντωθέοι καὶ ταῦτα νεκρῷ μὲν οἷόν τε ποιέειν, ζῶντι δὲ οὐ πάνυ. Διὰ τί οὖν ταῦτα γράφω; Ὅτι οἴονταί τινες ἰητρευκέναι ἀνθρώπους, οἷσιν ἔσωθεν ἔπεσον σπόνδυλοι, τελέως ὑπερβάντες τὰ ἄρθρα καίτοι γε ῥηΐστην ἐς τὸ περιγενέσθαι τῶν διαστροφέων ταύτην ἔνιοι νομίζουσι, καὶ οὐδὲν δέεσθαι ἐμβολῆς, ἀλλ’ αὐτόματα ὑγιέα γίνεσθαι τὰ τοιαῦτα. Ἀγνοέουσι δὲ πολλοὶ, καὶ κερδαίνουσιν, ὅτι ἀγνοέουσιν πείθουσι γὰρ τοὺς πέλας. Ἐξαπατῶνται δὲ διὰ τόδε οἴονται γὰρ τὴν ἄκανθαν τὴν ἐξέχουσαν κατὰ τὴν ῥάχιν ταύτην τοὺς σπονδύλους αὐτοὺς εἶναι, ὅτι στρογγύλον αὐτῶν ἕκαστον φαίνεται ψαυόμενον, ἀγνοεῦντες ὅτι τὰ ὀστέα ταῦτά ἐστι τὰ ἀπὸ τῶν σπονδύλων πεφυκότα, περὶ ὧν ὁ λόγος ὀλίγῳ πρόσθεν εἴρηται οἱ δὲ σπόνδυλοι πολὺ προσωτέρω ἄπεισιν στενοτάτην γὰρ πάντων τῶν ζώων ὥνθρωπος κοιλίην ἔχει, ὡς ἐπὶ τῷ μεγέθει, ἀπὸ τοῦ ὄπισθεν ἐς τὸ ἔμπροσθεν, ποτὶ καὶ κατὰ τὸ στῆθος. Ὅταν οὖν τι τούτων τῶν ὀστέων τῶν ὑπερεχόντων ἰσχυρῶς καταγῇ, ἤν τε ἓν, ἤν τε πλείω, ταύτῃ ταπεινότερον τὸ χωρίον γίνεται, ἢ τὸ ἔνθεν καὶ ἔνθεν, καὶ διὰ τοῦτο ἐξαπατῶνται, οἰόμενοι τοὺς σπονδύλους ἔσω οἴχεσθαι. Προσεξαπατᾷ δὲ ἔτι αὐτοὺς καὶ

τὰ σχήματα τῶν τετρωμένων ἢν μὲν γὰρ πειρῶνται καμπύλλεσθαι, ὀδυνῶνται, περιτενέος γινομένου ταύτῃ τοῦ δέρματος, ᾗ τέτρωνται καὶ ἅμα τὰ ὀστέα τὰ κατεηγότα ἐνθράσσει οὕτω μᾶλλον τὸν χρῶτα ἢν δὲ λορδαίνωσι, ῥᾴους εἰσίν χαλαρώτερον γὰρ τὸ δέρμα κατὰ τὸ τρῶμα ταύτῃ γίνεται, καὶ τὰ ὀστέα ἧσσον ἐνθράσσει ἀτὰρ καὶ ἤν τις ψαύῃ αὐτῶν, κατὰ τοῦτο ὑπείκουσι λορδοῦντες, καὶ τὸ χωρίον κενεὸν καὶ μαλθακὸν ψαυόμενον ταύτῃ φαίνεται. Ταῦτα πάντα τὰ εἰρημένα προσεξαπατᾷ τοὺς ἰητρούς Ὑγιέες δὲ ταχέως καὶ ἀσινέες αὐτόματοι οἱ τοιοῦτοι γίνονται ταχέως γὰρ πάντα τὰ τοιαῦτα ὀστέα ἐπιπωροῦται, ὅσα χαῦνά ἐστιν.

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

47. Σκολιαίνεται μὲν οὖν ῥάχις, καὶ ὑγιαίνουσι, κατὰ πολλοὺς τρόπους καὶ γὰρ ἐν τῇ φύσει καὶ ἐν τῇ χρήσει οὕτως ἔχει ἀτὰρ καὶ ὑπὸ γήραος καὶ ὑπὸ ὀδυνημάτων ξυνδοτική ἐστιν. Αἱ δὲ δὴ κυφώσιες, αἱ ἐν τοῖσι πτώμασιν, ὡς ἐπὶ τὸ πολὺ γίνονται, ἢν ἢ τοῖσιν ἰσχίοισιν ἐρείσῃ, ἢ ἐπὶ τοὺς ὤμους πέσῃ. Ἀνάγκη γὰρ ἔξω φαίνεσθαι ἐν τῷ κυφώματι ἕνα μέν τινα ὑψηλότερον τῶν σπονδύλων,

τοὺς δὲ ἔνθεν καὶ ἔνθεν, ἐπὶ ἧσσον οὔκουν εἷς ἐπὶ πουλὺ ἀποπεπηδηκὼς ἀπὸ τῶν ἄλλων ἐστὶν, ἀλλὰ μικρὸν ἕκαστος ξυνδιδοῖ, ἀθρόον δὲ πολὺ γίνεται. Διὰ οὖν τοῦτο καὶ ὁ νωτιαῖος μυελὸς εὐφόρως φέρει τὰς τοιαύτας διαστροφὰς, ὅτι κυκλώδης αὐτῷ ἡ διαστροφὴ γίνεται, ἀλλ’ οὐ γωνιώδης. Χρὴ δὲ τὴν κατασκευὴν τοῦ διαναγκασμοῦ τοιήνδε κατασκευάσαι ἔξεστι μὲν ξύλον ἰσχυρὸν καὶ πλατὺ, ἐντομὴν παραμήκεα ἔχον, κατορύξαι ἔξεστι δὲ καὶ ἀντὶ τοῦ ξύλου ἐν τοίχῳ ἐντομὴν παραμήκεα ἐνταμεῖν, ἢ πήχεϊ ἀνωτέρω τοῦ ἐδάφεος, ἢ ὅκως ἂν μετρίως ἔχῃ ἔπειτα οἷον στύλον δρύϊνον, τετράγωνον, πλάγιον παραβάλλειν, ἀπολείποντα ἀπὸ

τοῦ τοίχου, ὅσον παρελθεῖν τινα, ἢν δέῃ καὶ ἐπὶ μὲν τὸν στύλον ἐπιστορέσαι ἢ χλαίνας, ἢ ἄλλο τι, ὃ μαλθακὸν μὲν ἔσται, ὑπείξει δὲ μὴ μέγα τὸν δὲ ἄνθρωπον πυριῆσαι, ἢν ἐνδέχηται, ἢ πολλῷ θερμῷ λοῦσαι κἄπειτα πρηνέα κατακλῖναι κατατεταμένον, καὶ τὰς μὲν χεῖρας αὐτοῦ παρατείναντα κατὰ φύσιν προσδῆσαι πρὸς τὸ σῶμα ἱμάντι δὲ μαλθακῷ, ἱκανῶς πλατέϊ τε καὶ μακρῷ, ἐκ δύο διανταίων ξυμβεβλημένῳ, μέσῳ, κατὰ μέσον τὸ στῆθος δὶς περιβεβλῆσθαι χρὴ ὡς ἐγγυτάτω τῶν μασχαλέων ἔπειτα τὸ περισσεῦον τῶν ἱμάντων κατὰ τὴν μασχάλην, ἑκάτερον περὶ τοὺς ὤμους περιβεβλήσθω ἔπειτα αἱ ἀρχαὶ πρὸς ξύλον ὑπεροειδές τι προσδεδέσθωσαν, ἁρμόζουσαι τὸ μῆκος τῷ ξύλῳ τῷ ὑποτεταμένῳ, πρὸς ὅ τι προσβάλλον τὸ ὑπεροειδὲς ἀντιστηρίζοντα κατατείνειν. Τοιούτῳ δέ τινι ἑτέρῳ δεσμῷ χρὴ ἄνωθεν τῶν γουνάτων δήσαντα καὶ ἄνωθεν τῶν πτερνέων, τὰς ἀρχὰς τῶν ἱμάντων πρὸς τοιοῦτό τι ξύλον προσδῆσαι ἄλλῳ δὲ ἱμάντι πλατέϊ, καὶ μαλθακῷ, καὶ δυνατῷ, ταινιοειδέϊ, πλάτος ἔχοντι καὶ μῆκος ἱκανὸν, ἰσχυρῶς περὶ τὰς ἰξύας κύκλῳ περιδεδέσθαι ὡς ἐγγύτατα τῶν ἰσχίων ἔπειτα τὸ

περισσεῦον τοῦ ταινιοειδέος, ἅμα ἀμφοτέρας τὰς ἀρχὰς τῶν ἱμάντων, πρὸς τὸ ξύλον προσδῆσαι τὸ πρὸς τῶν ποδῶν κἄπειτα κατατείνειν ἐν τούτῳ τῷ σχήματι ἔνθα καὶ ἔνθα, ἅμα μὲν ἰσορρόπως, ἅμα δὲ ἐς ἰθύ. Οὐδὲν γὰρ ἂν μέγα κακὸν ἡ τοιαύτη κατάτασις ποιήσειεν, εἰ χρηστῶς σκευασθείη, εἰ μὴ ἄρα ἐξεπίτηδές τις βούλοιτο σίνεσθαι. Τὸν δὲ ἰητρὸν χρὴ ἢ ἄλλον, ὅστις ἰσχυρὸς καὶ μὴ ἀμαθὴς, ἐπιθέντα τὸ θέναρ τῆς χειρὸς ἐπὶ τὸ ὕβωμα, καὶ τὴν ἑτέρην χεῖρα προσεπιθέντα ἐπὶ τὴν ἑτέρην, καταναγκάζειν, προσξυνιέντα, ἤν τε ἐς ἰθὺ ἐς τὸ κάτω πεφύκῃ καταναγκάζεσθαι, ἤν τε πρὸς τῆς κεφαλῆς, ἤν τε πρὸς τῶν ἰσχίων. Καὶ ἀσινεστάτη μὲν αὕτη ἡ ἀνάγκη ἀσινὲς δὲ καὶ ἐπικαθίζεσθαί τινα ἐπὶ τὸ κύφωμα, αὐτοῦ ἅμα κατατεινομένου, καὶ ἐνσεῖσαι μετεωρισθέντα. Ἀτὰρ καὶ ἐπιβῆναι τῷ ποδὶ, καὶ ὀχηθῆναι ἐπὶ τὸ κύφωμα, ἡσύχως τε ἐπενσεῖσαι οὐδὲν κωλύει τὸ τοιοῦτο δὲ ποιῆσαι μετρίως ἐπιτήδειος ἄν τις εἴη τῶν ἀμφὶ παλαίστρῃ εἰθισμένων. Δυνατωτάτη μέντοι τῶν ἀναγκέων ἐστὶν, εἰ ὁ μὲν τοῖχος, ᾗ ἐντέτμηται, ἢ τὸ ξύλον τὸ κα. τορωρυγμένον, ᾗ ἐντέτμηται, κατωτέρω εἴη τῆς ῥάχιος τοῦ ἀνθρώπου, ὁκόσῳ ἂν δοκέῃ μετρίως ἔχειν, σανὶς δὲ φιλυρίνη, μὴ λεπτὴ, ἐνείη, ἢ καὶ ἄλλου τινὸς ξύλου ἔπειτα ἐπὶ τὸ ὕβωμα ἐπιτεθείη ἢ τρύχιόν τι πολύπτυχον, ἢ σμικρόν τι σκύτινον ὑποκεφάλαιον ὡς ἐλάχιστα μὴν ἐπικεῖσθαι ξυμφέρει, μόνον προμηθεόμενον, ὡς

μὴ ἡ σανὶς ὑπὸ σκληρότητος ὀδύνην παρὰ καιρὸν προσπαρέχῃ κατ’ ἴξιν δὲ ἔστω ὡς μάλιστα τῇ ἐντομῇ τῇ ἐς τὸν τοῖχον, τὸ ὕβωμα, ὡς ἂν ἡ σανὶς, ᾗ μάλιστα ἐξέστηκε, ταύτῃ μάλιστα πιέζῃ ἐπιτεθεῖσα. Ὅταν δὲ ἐπιτεθῇ, τὸν μέν τινα καταναγκάζειν χρὴ τὸ ἄκρον τῆς σανίδος, ἤν τε ἕνα δέῃ, ἤν τε δύο, τοὺς δὲ κατατείνειν τὸ σῶμα κατὰ μῆκος, ὡς πρόσθεν εἴρηται, τοὺς μὲν τῇ, τοὺς δὴ τῇ. Ἔξεστι δὲ καὶ ὀνίσκοισι τὴν κατάτασιν ποιέεσθαι, ἢ παρακατορύξαντα παρὰ τὸ ξύλον, ἢ ἐν αὐτῷ τῷ ξύλῳ τὰς φλιὰς τῶν ὀνίσκων ἐντεκτηνάμενον, ἤν τε ὀρθὰς ἐθέλῃς ἑκατέρωθεν σμικρὸν ὑπερεχούσας, ἤν τε κατὰ κορυφὴν τοῦ ξύλου ἔνθεν καὶ ἔνθεν. Αὗται αἱ ἀνάγκαι εὐταμίευτοί εἰσι καὶ ἐς τὸ ἰσχυρότερον καὶ ἐς τὸ ἧσσον, καὶ ἰσχὺν ἔχουσι τοιαύτην, ὥστε, καὶ εἴ τις ἐπὶ λύμῃ βούλοιτο, ἀλλὰ μὴ ἐπὶ ἰητρείῃ, ἐς τοιαύτας ἀνάγκας ἀγαγεῖν, κἂν τούτῳ ἰσχυρῶς δύνασθαι καὶ γὰρ ἂν κατατείνων κατὰ μῆκος μοῦνον ἔνθεν καὶ ἔνθεν οὕτω, καὶ ἄλλην ἀνάγκην οὐδεμίην προστιθεὶς, ὅμως κατατείνειεν ἄν τις ἱκανῶς καὶ εἰ μὴ κατατείνων, αὐτῇ δὲ μοῦνον τῇ σανίδι οὕτως ἰποίη τις, καὶ οὕτως ἂν ἱκανῶς καταναγκάσειεν. Καλαὶ οὖν αἱ τοιαῦται ἰσχύες εἰσὶν, ᾗσιν ἔξεστι καὶ ἀσθενεστέρῃσι καὶ ἰσχυροτέρῃσι χρέεσθαι αὐτὸν ταμιεύοντα. Καὶ μὲν δὴ καὶ κατὰ φύσιν γε ἀναγκάζουσιν

τὰ μὲν γὰρ ἐξεστεῶτα ἐς τὴν χώρην ἀναγκάζει ἡ ἴπωσις ἰέναι, τὰ δὲ ξυνεληλυθότα κατὰ φύσιν κατατείνουσιν αἱ κατὰ φύσιν κατατάσιες. Οὔκουν ἐγὼ ἔχω τουτέων ἀνάγκας καλλίους, οὐδὲ δικαιοτέρας ἡ γὰρ κατ’ αὐτὴν τὴν ἄκανθαν ἰθυωρίη τῆς κατατάσιος κάτωθέν τε καὶ κατὰ τὸ ἱερὸν ὀστέον καλεόμενον οὐκ ἔχει ἐπιλαβὴν οὐδεμίην ἄνωθεν δὲ κατὰ τὸν αὐχένα καὶ κατὰ τὴν κεφαλὴν, ἐπιλαβὴν μὲν ἔχει, ἀλλ’ ἐσιδέειν γε ἀπρεπὴς ταύτῃ τοι γινομένη ἡ κατάτασις, καὶ ἄλλας βλάβας ἂν προσπαρέχοι πλεονασθεῖσα. Ἐπειρήθην δὲ δή ποτε, ὕπτιον τὸν ἄνθρωπον κατατείνας, ἀσκὸν ἀφύσητον ὑποθεῖναι ὑπὸ τὸ ὕβωμα, κἄπειτα αὐλῷ ἐκ χαλκείου ἐς τὸν ἀσκὸν τὸν ὑποκείμενον ἐνιέναι φῦσαν. Ἀλλά μοι οὐκ. εὐπορεῖτο ὅτε μὲν γὰρ εὖ κατατείνοιμι τὸν ἄνθρωπον, ἡσσᾶτο ὁ ἀσκὸς, καὶ οὐκ ἠδύνατο ἡ φῦσα ἐσαναγκάζεσθαι καὶ ἄλλως ἕτοιμον περιολισθάνειν ἦν, ἅτε ἐς τὸ αὐτὸ ἀναγκαζόμενον, τό τε τοῦ ἀνθρώπου

ὕβωμα, καὶ τὸ τοῦ ἀσκοῦ πληρουμένου κύρτωμα. Ὅτε δ’ αὖ μὴ κάρτα κατατείνοιμι τὸν ἄνθρωπον, ὁ μὲν ἀσκὸς ὑπὸ τῆς φύσης ἐκυρτοῦτο, ὁ δὲ ἄνθρωπος πάντη μᾶλλον ἐλορδαίνετο ἢ ᾗ ξυνέφερεν. Ἔγραψα δὲ ἐπίτηδες τοῦτο καλὰ γὰρ καὶ ταῦτα τὰ μαθήματά ἐστιν, ἃ, πειρηθέντα, ἀπορηθέντα ἐφάνη, καὶ δι’ ἅσσα ἠπορήθη.

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

48. Ὅσοισι δὲ ἐς τὸ εἴσω σκολιαίνονται οἱ σπόνδυλοι ὑπὸ πτώματος, ἢ καὶ ἐμπεσόντος τινὸς βαρέος, εἷς μὲν οὐδεὶς τῶν σπονδύλων μέγα ἐξίσταται κάρτα ὡς ἐπὶ τὸ πολὺ ἐκ τῶν ἄλλων, ἢν δὲ ἐκστῇ μέγα ἢ εἷς, ἢ πλείονες, θάνατον φέρουσιν ὥσπερ δὲ καὶ πρόσθεν εἴρηται, κυκλώδης καὶ αὕτη, καὶ οὐ γωνιώδης γίνεται ἡ παραλλαγή. Οὖρα μὲν οὖν τούτοισι καὶ ἀπόπατος μᾶλλον ἴσχεται, ἢ τοῖσιν ἔξω κυφοῖσι, καὶ πόδες καὶ ὅλα τὰ σκέλεα ψύχεται μᾶλλον, καὶ θανατηφόρα ταῦτα μᾶλλον ἐκείνων καὶ ἢν περιγένωνται δὲ, ῥυώδεες τὰ οὖρα μᾶλλον οὗτοι, καὶ τῶν σκελέων ἀκρατέστεροι καὶ ναρκωδέστεροι ἢν δὲ καὶ ἐν τῷ ἄνω μέρεϊ μᾶλλον τὸ λόρδωμα γένηται, παντὸς τοῦ σώματος ἀκρατέες καὶ κατανεναρκωμένοι γίνονται. Μηχανὴν δὲ οὐκ ἔχω οὐδεμίην ἔγωγε, ὅκως χρὴ τὸν

τοιοῦτον ἐς τὸ αὐτὸ καταστῆσαι, εἰ μή τινα ἡ κατὰ τῆς κλίμακος κατάσεισις ὠφελέειν οἵη τε εἴη, ἢ καὶ ἄλλη τις τοιαύτη ἴησις, ἢ κατάτασις, οἵηπερ ὀλίγῳ πρόσθεν εἴρηται. Κατανάγκασιν δὲ σὺν τῇ κατατάσει οὐδεμίην ἔχω, ἥτις ἂν γίνοιτο, ὥσπερ τῷ κυφώματι τὴν κατανάγκασιν ἡ σανὶς ἐποιέετο. Πῶς γὰρ ἄν τις ἐκ τοῦ ἔμπροσθεν διὰ τῆς κοιλίης ἀναγκάσαι δύναιτο; οὐ γὰρ οἷόν τε. Ἀλλὰ μὴν οὔτε βῆχες, οὔτε πταρμοὶ οὐδεμίην δύναμιν ἔχουσιν, ὥστε τῇ κατατάσει ξυντιμωρέειν οὐ μὴν οὐδ’ ἔνεσις φύσης ἐνιεμένη ἐς τὴν κοιλίην οὐδὲν ἂν δυνασθείη. Καὶ μὴν αἱ μεγάλαι σικύαι προσβαλλόμεναι ἀνασπάσιος εἵνεκα δῆθεν τῶν ἔσω ῥεπόντων, σπονδύλων, μεγάλη ἁμαρτὰς γνώμης ἐστίν ἀπωθέουσι γὰρ μᾶλλον, ἢ ἀνασπῶσιν καὶ οὐδ’ αὐτὸ τοῦτο γινώσκουσιν οἱ προσβάλλοντες ὅσῳ γὰρ ἄν τις μέζω προσβάλλῃ, τοσούτῳ μᾶλλον λορδοῦνται οἱ προσβληθέντες, ξυναναγκαζομένου ἄνω τοῦ δέρματος. Τρόπους δὲ ἄλλους κατασεισίων, ἢ οἷοι πρόσθεν εἴρηνται, ἔχοιμι ἂν εἰπεῖν, ἁρμόσαι οὓς ἄν τις δοκέοι τῷ παθήματι μᾶλλον ἀλλ’ οὐ κάρτα πιστεύω αὐτοῖσιν διὰ τοῦτο οὐ γράφω. Ἀθρόον δὲ ξυνιέναι χρὴ περὶ

τούτων, ὧν ἐν κεφαλαίῳ εἴρηται, ὅτι τὰ μὲν ἐς τὸ λορδὸν ῥέψαντα ὀλέθριά ἐστι καὶ σινάμωρα, τὰ δὲ ἐς τὸ κυφὸν ἀσινέα θανάτου, καὶ οὔρων σχεσίων, καὶ ἀποναρκωσίων τὸ ἔπίπαν οὐ γὰρ ἐντείνει τοὺς ὀχετοὺς τοὺς κατὰ τὴν κοιλίην, οὐδὲ κωλύει εὐρόους εἶναι ἡ ἐς τὸ ἔξω κύφωσις ἡ δὲ λόρδωσις ταῦτά τε ἀμφότερα ποιέει, καὶ ἐς τὰ ἄλλα πολλὰ προσγίνεται. Ἐπείτοι πολὺ πλείονες σκελέων τε καὶ χειρῶν ἀκρατέες γίνονται, καὶ καταναρκοῦνται τὸ σῶμα, καὶ οὖρα ἴσχεται αὐτέοισιν, οἷσιν ἂν μὴ ἐκστῇ μὲν τὸ ὕβωμα μήτε ἔξω, μήτε ἔσω, σεισθέωσι δὲ ἰσχυρῶς ἐς τὴν ἰθυωρίην τῆς ῥάχιος οἷσι δὲ ἂν ἐκστῇ τὸ ὕβωμα, ἧσσον τοιαῦτα πάσχουσιν.

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

49. Πολλὰ δὲ καὶ ἄλλα ἐν ἰητρικῇ ἄν τις θεάσοιτο, ὧν τὰ μὲν ἰσχυρὰ ἀσινέα ἐστὶ, καὶ καθ’ ἑωυτὰ τὴν κρίσιν ὅλην λαμβάνοντα τοῦ νουσήματος, τὰ δὲ ἀσθενέστερα σινάμωρα, καὶ ἀποτόκους νοσημάτων χρονίους ποιέοντα, καὶ κοινωνέοντα τῷ ἄλλῳ σώματι ἐπὶ πλέον. Ἐπεὶ καὶ πλευρέων κάτηξις τοιοῦτόν τι πέπονθεν οἷσι μὲν γὰρ ἂν καταγῇ πλευρὴ, μία ἢ πλέονες, ὡς τοῖσι πλείστοισι

κατάγνυται, μὴ διασχόντα τὰ ὀστέα ἐς τὸ ἔσω μέρος, μηδὲ ψιλωθέντα, ὀλίγοι μὲν ἤδη ἐπυρέτηναν ἀτὰρ οὐδὲ αἷμα πολλοὶ ἤδη ἔπτυσαν, οὐδὲ ἔμπυοι πολλοὶ γίνονται, οὐδὲ ἔμμοτοι, οὐδὲ ἐπισφακελίσιες τῶν ὀστέων δίαιτά τε φαύλη ἀρκέει ἢν γὰρ μὴ πυρετὸς ξυνεχὴς ἐπιλαμβάνῃ αὐτοὺς, κενεαγγέειν κάκιον τοῖσι τοιούτοισιν, ἢ μὴ κενεαγγέειν, καὶ ἐπωδυνέστερον, καὶ πυρετωδέστερον, καὶ βηχωδέστερον τὸ γὰρ πλήρωμα τὸ μέτριον τῆς κοιλίης, διόρθωμα τῶν πλευρέων γίνεται ἡ δὲ κένωσις κρεμασμὸν τῇσι πλευρῇσι ποιέει ὁ δὲ κρεμασμὸς, ὀδύνην. Ἔξωθέν τε αὖ φαύλη ἐπίδεσις τοῖσι τοιούτοισιν ἀρκέει κηρωτῇ καὶ σπλήνεσι καὶ ὀθονίοισιν ἡσύχως ἐρείδοντα, ὁμαλὴν τὴν ἐπίδεσιν ποιέεσθαι, ἢ καὶ ἐριῶδές τι προσεπιθέντα. Κρατύνεται δὲ πλευρὴ ἐν εἴκοσιν ἡμέρῃσιν ταχεῖαι γὰρ αἱ ἐπιπωρώσιες τῶν τοιουτέων ὀστέων.

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

50. Ἀμφιφλασθείσης μέντοι τῆς σαρκὸς ἀμφὶ τῇσι πλευρῇσιν, ἢ ὑπὸ πληγῆς, ἢ ὑπὸ πτώματος, ἢ ὑπὸ ἀντερείσιος, ἢ ἄλλου τινὸς τοιουτοτρόπου, πολλοὶ ἤδη πουλὺ αἷμα ἔπτυσαν οἱ γὰρ ὀχετοὶ οἱ κατὰ τὸ λαπαρὸν τῆς πλευρῆς ἑκάστης παρατεταμένοι, καὶ οἱ τόνοι ἀπὸ τῶν ἐπικαιροτάτων τῶν ἐν τῷ σώματι τὰς ἀφορμὰς ἔχουσιν πολλοὶ οὖν ἤδη βηχώδεες, καὶ φυματίαι, καὶ ἔμπυοι ἐγένοντο, καὶ ἔμμοτοι, καὶ ἡ πλευρὴ ἐπεσφακέλισεν αὐτοῖσιν. Ἀτὰρ καὶ οἷσι μηδὲν τοιοῦτον προσεγένετο, ἀμφιφλασθείσης τῆς σαρκὸς ἀμφὶ τῇσι πλευρῇσιν, ὅμως δὲ βραδύτερον ὀδυνώμενοι παύονται οὗτοι, ἢ οἷσιν ἂν πλευρὴ καταγῇ, καὶ ὑποστροφὰς μᾶλλον