ἴσχει ὀδυνημάτων τὸ χωρίον ἐν τοῖσι τοιούτοισι τρώμασιν, ἢ τοϊσιν ἑτέροισιν. Μάλα μὲν οὖν μετεξέτεροι καταμελέουσι τῶν τοιούτων σινέων, μᾶλλον ἢ ἢν πλευρὴ κατεαγῇ αὐτέοισιν ἀτὰρ καὶ ἰήσιος σκεθροτέρης οἱ τοιοῦτοι δέονται, εἰ σωφρονοῖεν τῇ τε γὰρ διαίτῃ ξυμφέρει ξυνεστάλθαι, ἀτρεμέειν τε τῷ σώματι ὡς μάλιστα, ἀφροδισίων τε ἀπέχεσθαι, βρωμάτων τε λιπαρῶν, καὶ κερχνωδέων, καὶ ἰσχυρῶν πάντων, φλέβα τε κατ’ ἀγκῶνα τέμνεσθαι, σιγᾷν τε ὡς μάλιστα, ἐπιδέεσθαί τε τὸ χωρίον τὸ φλασθὲν σπλήνεσι μὴ πολυπτύχοισι, συχνοῖσι δὲ καὶ πολὺ πλατυτέροισι πάντη τοῦ φλάσματος, κηρωτῇ τε ὑποχρίειν, ὀθονίοισί τε πλατέσι σὺν ταινίῃσι πλατείῃσι καὶ μαλθακῇσιν ἐπιδέειν, ἐρείδειν τε μετρίως, ὥστε μὴ κάρτα πεπιέχθαι φάναι τὸν ἐπιδεδεμένον, μηδ’ αὖ χαλαρόν ἄρχεσθαι δὲ τὸν ἐπιδέοντα κατὰ τὸ φλάσμα, καὶ ἐρηρεῖσθαι ταύτῃ μάλιστα, τὴν δὲ ἐπίδεσιν ποιέεσθαι, ὡς ἀπὸ δύο ἀρχέων ἐπιδέεται, ἵνα μὴ περιρρεπὲς τὸ δέρμα τὸ περὶ τὰς πλευρὰς ἔῃ, ἀλλ’ ἰσόρροπον, ἐπιδέειν δὲ ἢ καθ’ ἑκάστην ἡμέρην, ἢ παρ’ ἑτέρην. Ἄμεινον δὲ καὶ τὴν κοιλίην μαλθάξαι κούφῳ τινὶ, ὅσον κενώσιος εἵνεκεν τοῦ σίτου, καὶ ἐπὶ μὲν δέκα ἡμέρας ἰσχναίνειν, ἔπειτα ἀναθρέψαι τὸ σῶμα, καὶ ἁπαλῦναι τῇ δὲ ἐπιδέσει, ἔστ’ ἂν μὲν ἰσχναίνῃς, ἐρηρεισμένῃ μᾶλλον χρέεσθαι, ὁκόταν δὲ ἐς τὸν ἁπαλυσμὸν ἄγῃς, ἐπιχαλαρωτέρῃ καὶ ἢν μὲν αἷμα ἀποπτύσῃ

καταρχὰς, τεσσαρακονθήμερον τὴν μελέτην καὶ τὴν ἐπίδεσιν ποιέεσθαι χρή ἢν δὲ μὴ πτύσῃ τὸ αἷμα, ἀρκέει ἐν εἴκοσιν ἡμέρῃσιν ἡ μελέτη ὡς ἐπὶ τὸ πολύ τῇ ἰσχύϊ δὲ τοῦ τρώματος τοὺς χρόνους προτεκμαίρεσθαι χρή. Ὅσοι δ’ ἂν ἀμελήσωσι τῶν τοιουτέων ἀμφιφλασμάτων, ἢν καὶ ἄλλο μηδὲν αὐτοῖσι φλαῦρον μέζον γένηται, ὅμως τό γε χωρίον ἀμφιφλασθὲν μυξωδεστέρην τὴν σάρκα ἴσχει, ἢ πρόσθεν εἶχεν. Ὅκου δέ τι τοιοῦτον ἐγκαταλείπεται, καὶ μὴ εὖ ἐξιποῦται τῇ γε ἀλθέξει, φαυλότερον μὲν, ἢν παρ’ αὐτὸ τὸ ὀστέον ἐγκαταλειφθῇ τὸ μυξῶδες οὔτε γὰρ ἔτι ἡ σὰρξ ὁμοίως ἅπτεται τοῦ ὀστέου, τό τε ὀστέον νοσηρότερον γίνεται, σφακελισμοί τε χρόνιοι ὀστέου πολλοῖσιν ἤδη ἀπὸ τοιουτέων προφασίων ἐγένοντο. Ἀτὰρ καὶ ἢν μὴ παρὰ τὸ ὀστέον, ἀλλ’ αὐτὴ ἡ σὰρξ μυξώδης ἔῃ, ὅμως ὑποστροφαὶ γίνονται καὶ ὀδύναι ἄλλοτε καὶ ἄλλοτε, ἤν τι τῷ σώματι τύχῃ πονήσας καὶ διὰ τοῦτο τῇ ἐπιδέσει χρέεσθαι χρὴ, ἅμα μὲν ἀγαθῇ, ἅμα δὲ ἐπὶ πουλὺ προηκούσῃ, ἕως ἂν ξηρανθῇ μὲν καὶ ἀναποθῇ τὸ ἐκχύμωμα τὸ ἐν τῇ φλάσει γενόμενον, αὐξηθῇ δὲ σαρκὶ ὑγιέϊ τὸ χωρίον, ἅψηται δὲ τοῦ ὀστέου ἡ σάρξ. Οἷσι δ’ ἂ̣ ἀμεληθεῖσι χρονιωθῇ, καὶ ὀδυνῶδες τὸ χωρίον γένηται, καὶ ἡ σὰρξ ὑπόμυξος ἔῃ, τούτοισι καῦσις ἴησις ἀρίστη. Καὶ ἢν μὲν αὐτὴ ἡ σὰρξ μυξώδης ἔῃ, ἄχρι τοῦ ὀστέου καίειν χρὴ, μὴ μὴν διαθερμανθῆναι τὸ ὀστέον ἢν δὲ μεσηγὺ τῶν πλευρέων ἔῃ, ἐπιπολῆς μὲν οὐδ’ οὕτω χρὴ καίειν, φυλάσσεσθαι μέντοι, μὴ διακαύσῃς πέρην.

Ἢν δὲ πρὸς τῷ ὀστέῳ δοκέῃ εἶναι τὸ φλάσμα, καὶ ἔτι νεαρὸν ἔῃ, καὶ μήπω σφακελίσῃ τὸ ὀστέον, ἢν μὲν κάρτα ὀλίγον ἔῃ, οὕτω καίειν χρὴ ὥσπερ εἴρηται ἢν μέντοι παραμήκης ἔῃ ὁ μετεωρισμὸς ὁ κατὰ τὸ ὀστέον, πλείονας ἐσχάρας ἐμβάλλειν χρή περὶ δὲ σφακελισμοῦ πλευρῆς ἅμα τῇ τῶν ἐμμότων ἰητρείῃ εἰρήσεται.

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

51. Ἢν δὲ μηροῦ ἄρθρον ἐξ ἰσχίου ἐκπέσῃ, ἐκπίπτει δὲ κατὰ τέσσαρας τρόπους, ἐς μὲν τὸ ἔσω πλειστάκις, ἐς δὲ τὸ ἔξω τῶν ἄλλων πλειστάκις ἐς δὲ τὸ ὄπισθεν καὶ τὸ ἔμπροσθεν ἐκπίπτει μὲν, ὀλιγάκις δέ οἷσι μὲν οὖν ἂν ἐκβῇ ἐς τὸ ἔσω, μακρότερον τὸ σκέλος φαίνεται, παραβαλλόμενον πρὸς τὸ ἕτερον, διὰ δισσὰς προφάσιας εἰκότως ἐπί τε γὰρ τὸ ἀπὸ τοῦ ἰσχίου πεφυκὸς ὀστέον, τὸ ἄνω φερόμενον πρὸς τὸν κτένα, ἐπὶ τοῦτο ἡ ἐπίβασις τῆς κεφαλῆς τοῦ μηροῦ γίνεται, καὶ ὁ αὐχὴν τοῦ ἄρθρου ἐπὶ τῆς κοτύλης ὀχέεται. Ἔξωθέν τε αὖ ὁ γλουτὸς κοῖλος φαίνεται, ἅτε ἔσω ῥεψάσης τῆς κεφαλῆς τοῦ μηροῦ, τό τε αὖ κατὰ τὸ γόνυ τοῦ μηροῦ ἄκρον ἀναγκάζεται ἔξω ῥέπειν, καὶ ἡ κνήμη καὶ δ ποὺς ὡσαύτως. Ἅτε οὖν ἔξω ῥέποντος τοῦ ποδὸς, οἱ ἰητροὶ δι’ ἀπειρίην τὸν ὑγιέα πόδα πρὸς τοῦτον προσίσχουσιν, ἀλλ’ οὐ τοῦτον πρὸς τὸν ὑγιέα διὰ τοῦτο πουλὺ μακρότερον φαίνεται τὸ σιναρὸν τοῦ ὑγιέος πολλαχῆ δὲ

καὶ ἄλλῃ τὰ τοιαῦτα παραξύνεσιν ἔχει. Οὐ μὴν οὐδὲ ξυγκάμπτειν δύνανται κατὰ τὸν βουβῶνα ὁμοίως τῷ ὑγιέϊ ἀτὰρ καὶ ψαυομένη ἡ κεφαλὴ τοῦ μηροῦ κατὰ τὸν περίνεον ὑπερογκέουσα εὔδηλός ἐστιν. Τὰ μὲν οὖν σημήϊα ταῦτά ἐστιν, οἷσιν ἂν ἔσω ἐκπεπτώκῃ ὁ μηρός.

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

52. Οἷσι μὲν ἂν οὖν ἐκπεσὼν μὴ ἐμπέσῃ, ἀλλὰ καταπορηθῇ καὶ ἀμεληθῇ, ἥ τε ὁδοιπορίη περιφοράδην τοῦ σκέλεος ὥσπερ τοῖσι βουσὶ γίνεται, καὶ ἡ ὄχησις πλείστη αὐτέοισιν ἐπὶ τοῦ ὑγιέος σκέλεός ἐστιν. Καὶ ἀναγκάζονται κατὰ τὸν κενεῶνα καὶ κατὰ τὸ ἄρθρον τὸ ἐκπεπτωκὸς κοῖλοι καὶ σκολιοὶ εἶναι κατὰ δὲ τὸ ὑγιὲς ἐς τὸ ἔξω ὁ γλουτὸς ἀναγκάζεται περιφερὴς εἶναι εἰ γάρ τις ἔξω τῷ ποδὶ τοῦ ὑγιέος σκέλεος βαίνοι, ἀπωθοίη ἂν τὸ σῶμα τὸ ἄλλο ἐς τὸ σιναρὸν σκέλος τὴν ὄχησιν ποιέεσθαι τὸ δὲ σιναρὸν οὐκ ἂν δύναιτο ὀχέειν πῶς γάρ; ἀναγκάζεται οὖν οὕτω κατὰ τοῦ ὑγιέος σκέλεος τῷ ποδὶ ἔσω βαίνειν, ἀλλὰ μὴ ἔξω οὕτω γὰρ ὀχέει μάλιστα τὸ σκέλος τὸ ὑγιὲς, καὶ τὸ ἑωυτοῦ μέρος τοῦ σώματος, καὶ τὸ τοῦ σιναροῦ σκέλεος μέρος. Κοιλαινόμενοι δὲ κατὰ τὸν κενεῶνα καὶ κατὰ τὰ ἄρθρα, μικροὶ φαίνονται, καὶ τῷ ξύλῳ ἀναγκάζονται ἀντερείδεσθαι πλάγιοι κατὰ τὸ ὑγιὲς σκέλος δέονται γὰρ ἀντικοντώσιος ταύτῃ

ἐπὶ τοῦτο γὰρ οἱ γλουτοὶ ῥέπουσι, καὶ τὸ ἄχθος τοῦ σώματος ὀχεεται ἐπὶ τοῦτο. Ἀναγκάζονται δὲ καὶ ἐπικύπτειν τὴν γὰρ χεῖρα τὴν κατὰ τὸ σκέλος τὸ σιναρὸν ἀναγκάζονται κατὰ πλάγιον τὸν μηρὸν ἐρείδειν οὐ γὰρ δύναται τὸ σιναρὸν σκέλος ὀχέειν τὸ σῶμα ἐν τῇ μεταλλαγῇ τῶν σκελέων, ἢν μὴ κατέχηται πρὸς τὴν γῆν πιεζόμενον. Ἐν τούτοισιν οὖν τοῖσι σχήμασιν ἀναγκάζονται ἐσχηματίσθαι, οἷσιν ἂν ἔσω ἐκβὰν τὸ ἄρθρον μὴ ἐμπέσῃ, οὐ προβουλεύσαντος τοῦ ἀνθρώπου, ὅκως ἂν ῥήϊστα ἐσχηματισμένον ἔῃ, ἀλλ’ αὐτὴ ἡ ξυμφορὴ διδάσκει ἐκ τῶν παρεόντων τὰ ῥήϊστα αἱρέεσθαι. Ἐπεὶ καὶ ὁκόσοι ἕλκος ἔχοντες ἐν ποδὶ ἢ κνήμῃ οὐ κάρτα δύνανται ἐπιβαίνειν τῷ σκέλεϊ, πάντες, καὶ οἱ νήπιοι, οὕτως ὁδοιπορέουσιν ἔξω γὰρ βαίνουσι τῷ σιναρῷ σκέλεϊ καὶ δισσὰ κερδαίνουσι, δισσῶν γὰρ δέονται τό τε γὰρ σῶμα οὐκ ὀχέεται ὁμοίως ἐπὶ τοῦ ἔξω ἀποβαινομένου, ὥσπερ ἐπὶ τοῦ εἴσω οὐδὲ γὰρ κατ’ ἰθυωρίην αὐτῷ γίνεται τὸ ἄχθος, ἀλλὰ πολλῷ μᾶλλον ἐπὶ τοῦ ὑποβαινομένου κατ’ ἰθυωρίην γὰρ αὐτῷ γίνεται τὸ ἄχθος ἔν τε αὐτῇ τῇ ὁδοιπορίῃ καὶ τῇ μεταλλαγῇ τῶν σκελέων. Ἐν τούτῳ τῷ σχήματι τάχιστα ἂν δύναιτο ὑποτιθέναι τὸ ὑγιὲς σκέλος, εἰ τῷ μὲν σιναρῷ ἐξωτέρω βαίνοι, τῷ δὲ ὑγιέϊ ἐσωτέρω. Περὶ οὗ οὖν ὁ λόγος, ἀγαθὸν εὑρίσκεσθαι αὐτὸ ἑωυτῷ τὸ σῶμα [ἐς] τὰ ῥήϊστα τῶν

σχημάτων. Ὅσοισι μὲν οὖν μήπω τετελειωμένοισιν ἐς αὔξησιν ἐκπεσὼν μὴ ἐμπέσοι, γυιοῦται ὁ μηρὸς καὶ ἡ κνήμη καὶ ὁ πούς οὔτε γὰρ τὰ ὀστέα ἐς τὸ μῆκος ὁμοίως αὔξεται, ἀλλὰ βραχύτερα γίνεται, μάλιστα δὲ τὸ τοῦ μηροῦ, ἄσαρκόν τε ἅπαν τὸ σκέλος καὶ ἄμυον καὶ ἐκτεθηλυσμένον καὶ λεπτότερον γίνεται, ἅμα μὲν, διὰ τὴν στέρησιν τῆς χώρης τοῦ ἄρθρου, ἅμα δὲ, ὅτι ἀδύνατον χρέεσθαί ἐστιν, ὅτι οὐ κατὰ φύσιν κέεται χρῆσις γὰρ μετεξετέρη ῥύεται τῆς ἄγαν ἐκθηλύνσιος ῥύεται δέ τι καὶ τῆς ἐπὶ μῆκος ἀναυξήσιος. Κακοῦται μὲν οὖν μάλιστα, οἷσιν ἂν ἐν γαστρὶ ἐοῦσιν ἐξαρθρήσῃ τοῦτο τὸ ἄρθρον, δεύτερον δὲ, οἷσιν ἂν ὡς νηπιωτάτοισιν ἐοῦσιν, ἥκιστα δὲ τοῖσι τετελειωμένοισιν. Τοῖσι μὲν οὖν τετελειωμένοισιν εἴρηται, οἵη τις ἡ ὁδοιπορίη γίνεται οἷσι δ’ ἂν νηπίοισιν ἐοῦσιν ἡ ξυμφορὴ αὕτη γένηται, οἱ μὲν πλεῖστοι καταβλακεύουσι τὴν διόρθωσιν τοῦ σώματος, ἀλλὰ κακῶς εἰλέονται ἐπὶ τὸ ὑγιὲς σκέλος, τῇ χειρὶ πρὸς τὴν γῆν ἀπερειδόμενοι τῇ κατὰ τὸ ὑγιὲς σκέλος καταβλακεύουσι δὲ ἔνιοι τὴν ἐς τὸ ὀρθὸν ὁδοιπορίην, καὶ οἷσιν ἂν τετελειωμένοισιν αὕτη ἡ ξυμφορὴ γένηται. Ὁκόσοι δ’ ἂν νήπιοι ἐόντες, ταύτῃ τῇ ξυμφορῇ χρησάμενοι, ὀρθῶς παιδαγωγηθῶσι, τῷ μὲν ὑγιέϊ σκέλεϊ χρέονται ἐς ὀρθὸν, ὑπὸ δὲ τὴν μασχάλην τὴν κατὰ τὸ ὑγιὲς σκέλος σκίπωνα περιφέρουσι,

μετεξέτεροι δὲ, καὶ ὑπ’ ἀμφοτέρας τὰς χεῖρας τὸ δὲ σιναρὸν σκέλος μετέωρον ἔχουσι, καὶ τοσούτῳ ῥηΐους εἰσὶν, ὅσῳ ἂν αὐτοῖσιν ἔλασσον τὸ σκέλος τὸ σιναρὸν ἔῃ τὸ δὲ ὑγιὲς ἰσχύει αὐτέοισιν οὐδὲν ἧσσον, ἢ εἰ καὶ ἀμφότερα ὑγιέα ἦν. Θηλύνονται δὲ πᾶσι τοῖσι τοιούτοισιν αἱ σάρκες τοῦ σκέλεος, μᾶλλον δέ τι θηλύνονται αἱ ἐκ τοῦ ἔξω μέρεος, ἢ αἱ ἐκ τοῦ ἔσω ὡς ἐπὶ πολύ.

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

53. Μυθολογοῦσι δέ τινες, ὅτι αἱ Ἀμαζονίδες τὸ ἄρσεν γένος τὸ ἑωυτῶν αὐτίκα νήπιον ἐὸν ἐξαρθρέουσιν, αἱ μὲν, κατὰ [τὰ] γούνατα, αἱ δὲ, κατὰ τὰ ἰσχία, ὡς δῆθεν χωλὰ γίνοιτο, καὶ μὴ ἐπιβουλεύοι τὸ ἄρσεν γένος τῷ θήλεϊ χειρώναξιν ἄρα τουτέοισι χρέονται, ὁκόσα ἢ σκυτείης ἔργα, ἢ χαλκείης, ἢ ἄλλο ὅ τι ἑδραῖον ἔργον. Εἰ μὲν οὖν ἀληθέα ταῦτά ἐστιν, ἐγὼ μὲν οὐκ οἶδα ὅτι δὲ γίνοιτο ἂν τοιαῦτα, οἶδα, εἴ τις ἐξαρθρέοι αὐτίκα νήπια ἐόντα. Κατὰ μὲν οὖν τὰ ἰσχία μέζον τὸ διάφορόν ἐστιν ἐς τὸ ἔσω, ἢ ἐς τὸ ἔξω ἐξαρθρῆσαι κατὰ δὲ τὰ γούνατα διαφέρει μέν τι, ἔλασσον δέ τι διαφέρει τρόπος δὲ ἑκατέρου τοῦ χωλώματος ἴδιός ἐστιν κυλλοῦται

γὰρ μᾶλλον, οἷσιν ἂν ἐς τὸ ἔξω ἐξαρθρήσῃ ὀρθοὶ δὲ ἧσσον ἵστανται, οἷσιν ἂν ἐς τὸ ἔσω ἐξαρθρήσῃ. Ωσαύτως δὲ καὶ ἢν παρὰ τὸ σφυρὸν ἐξαρθρήσῃ, ἢν μὲν ἐς τὸ ἔξω μέρος, κυλλοὶ μὲν γίνονται, ἑστάναι δὲ δύνανται ἢν δὲ ἐς τὸ ἔσω μέρος, βλαισοὶ μὲν γίνονται, ἧσσον δὲ ἑστάναι δύνανται. Ἥ γε μὴν ξυναύξησις τῶν ὀστέων τοιήδε γίνεται οἷσι μὲν ἂν τὸ κατὰ τὸ σφυρὸν ὀστέον τὸ τῆς κνήμης ἐκστῇ, τούτοισι μὲν τὰ τοῦ ποδὸς ὀστέα ἥκιστα ξυναύξεται, ταῦτα γὰρ ἐγγυτάτω τοῦ τρώματός ἐστι, τὰ δὲ τῆς κνήμης ὀστέα αὔξεται μὲν, οὐ πολὺ δὲ ἐνδεεστέρως, αἱ μέντοι σάρκες μινύθουσιν. Οἷσι δ’ ἂν κατὰ μὲν τὸ σφυρὸν μένῃ τὸ ἄρθρον κατὰ φύσιν, κατὰ δὲ τὸ γόνυ ἐξεστήκῃ, τούτοισι τὸ τῆς κνήμης ὀστέον οὐκ ἐθέλει ξυναύξεσθαι ὁμοίως, ἀλλὰ βραχύτατον γίνεται, τοῦτο γὰρ ἐγγυτάτω τοῦ τρώματός ἐστιν τοῦ μέντοι ποδὸς τὰ ὀστέα μινύθει μὲν, ἀτὰρ οὐχ ὁμοίως, ὥσπερ ὀλίγον τι πρόσθεν εἴρηται, ὅτι τὸ ἄρθρον τὸ παρὰ τὸν πόδα σῶόν ἐστιν εἰ δέ οἱ χρέεσθαι ἠδύναντο, ὥσπερ καὶ τῷ κυλλῷ, ἔτι ἂν ἧσσον ἐμινύθει τὰ τοῦ ποδὸς ὀστέα τούτοισιν. Οἷσι δ’ ἂν κατὰ τὸ ἰσχίον ἡ ἐξάρθρησις γένηται, τούτοισι τοῦ μηροῦ τὸ ὀστέον οὐκ ἐθέλει ξυναύξεσθαι ὁμοίως, τοῦτο γὰρ ἐγγυτάτω τοῦ τρώματός ἐστιν, ἀλλὰ βραχύτερον τοῦ ὑγιέος γίνεται τὰ μέντοι τῆς κνήμης ὀστέα οὐχ ὁμοίως τούτοισιν ἀναυξέα γίνεται, οὐδὲ τὰ τοῦ ποδὸς, διὰ τοῦτο δὲ, ὅτι τὸ τοῦ μηροῦ ἄρθρον τὸ παρὰ τὴν κνήμην ἐν τῇ ἑωυτοῦ φύσει μένει, καὶ τὸ τῆς κνήμης τὸ παρὰ τὸν

πόδα σάρκες μέντοι μινύθουσι παντὸς τοῦ σκέλεος τούτοισιν εἰ μέντοι χρέεσθαι τῷ σκέλεϊ ἠδύναντο, ἔτι ἂν μᾶλλον τὰ ὀστέα ξυνηυξάνετο, ὡς καὶ πρόσθεν εἴρηται, πλὴν τοῦ μηροῦ, κἂν ἧσσον ἄσαρκα εἴη, ἀσαρκότερα δὲ πολλῷ ἢ εἰ ὑγιέα ἦν. Σημήϊον δὲ, ὅτι ταῦτα τοιαῦτά ἐστιν ὁκόσοι γὰρ, τοῦ βραχίονος ἐκπεσόντος, γαλιάγκωνες ἐγένοντο ἐκ γενεῆς, ἢ καὶ ἐν αὐξήσει πρὶν τελειωθῆναι, οὗτοι τὸ μὲν ὀστέον τοῦ βραχίονος βραχὺ ἴσχουσι, τὸν δὲ πῆχυν καὶ ἄκρην τὴν χεῖρα ὀλίγῳ ἐνδεεστέρην τοῦ ὑγιέος, διὰ ταύτας τὰς προφάσιας τὰς εἰρημένας, ὅτι ὁ μὲν βραχίων ἐγγυτάτω τοῦ ἄρθρου τοῦ τρώματός ἐστιν, ὥστε διὰ τοῦτο βραχύτερος γέγονεν ὁ δ’ αὖ πῆχυς διὰ τοῦτο οὐχ ὁμοίως ἐνακούει τῆς ξυμφορῆς, ὅτι τὸ τοῦ βραχίονος ἄρθρον τὸ πρὸς τοῦ πήχεος ἐν τῇ ἀρχαίῃ φύσει μένει, ἥ τε αὖ χεὶρ ἄκρη ἔτι τηλοτέρω ἄπεστιν, ἢ ὁ πῆχυς, ἀπὸ τῆς ξυμφορῆς. Διὰ ταύτας οὖν τὰς εἰρημένας προφάσιας, τῶν ὀστέων τά τε μὴ ξυναυξανόμενα οὐ ξυναυξάνεται, τά τε ξυναυξανόμενα ξυναυξάνεται. Ἐς δὲ τὸ εὔσαρκον τῇ χειρὶ καὶ τῷ βραχίονι ἡ ταλαιπωρίη τῆς χειρὸς μέγα προσωφελέει ὅσα γὰρ χειρῶν ἔργα ἐστὶ, τὰ πλεῖστα προθυμέονται οἱ γαλιάγκωνες ἐργάζεσθαι τῇ χειρὶ ταύτῃ, ὅσα περ καὶ τῇ ἑτέρῃ δύνανται, οὐδὲν ἐνδεεστέρως τῆς ἀσινέος οὐ γὰρ δεῖ ὀχέεσθαι τὸ σῶμα ἐπὶ τῶν χειρῶν, ὡς ἐπὶ τῶν σκελέων, ἀλλὰ κοῦφα αὐτέῃσι τὰ ἔργα ἐστίν. Διὰ δὲ τὴν χρῆσιν οὐ μινύθουσιν αἱ σάρκες αἱ κατὰ τὴν χεῖρα καὶ τὸν πῆχυν τοῖσι γαλιάγκωσιν,

ἀλλὰ καὶ ὁ βραχίων τι προσωφελέεται ἐς εὐσαρκίην διὰ ταῦτα ὅταν δὲ ἰσχίον ἐκπαλὲς γένηται ἐς τὸ ἔσω μέρος ἐκ γενεῆς, ἢ καὶ ἔτι νηπίῳ ἐόντι, μινύθουσιν αἱ σάρκες διὰ τοῦτο μᾶλλον ἢ τῆς χειρὸς, ὅτι οὐ δύνανται χρέεσθαι τῷ σκέλεϊ. Μαρτύριον δέ τι ἓν ἔσται καὶ ἐν τοῖσιν ὀλίγον ὕστερον εἰρησομένοισιν, ὅτι ταῦτα τοιαῦτά ἐστιν.

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

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

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

55. Οἷσι μὲν οὖν ἂν τετελειωμένοισιν ἤδη ἐκπεσὸν τὸ ἄρθρον

μὴ ἐμπέσῃ, τούτοισι βραχύτερον μὲν φαίνεται τὸ ξύμπαν σκέλος, ἐν δὲ τῇ ὁδοιπορίῃ τῇ μὲν πτέρνῃ οὐ δύνανται καθικνέεσθαι ἐπὶ τῆς γῆς, τῷ δὲ στήθεϊ τοῦ ποδὸς βαίνουσιν ἐπὶ τὴν γῆν ὀλίγον δὲ ἐς τὸ ἔσω μέρος ῥέπουσι τοῖσι δακτύλοισιν ἄκροισιν. Ὀχέειν δὲ δύναται τὸ σῶμα τὸ σιναρὸν σκέλος τούτοισι πολλῷ μᾶλλον, ἢ οἷσιν ἂν ἐς τὸ ἔσω μέρος ἐκπεπτώκῃ, ἅμα μὲν, ὅτι ἡ κεφαλὴ τοῦ μηροῦ, καὶ ὁ αὐχὴν τοῦ ἄρθρου πλάγιος φύσει πεφυκὼς, ὑπὸ συχνῷ μέρεϊ τοῦ ἰσχίου τὴν ὑπόστασιν πεποίηται, ἅμα δὲ, ὅτι ἄκρος ὁ ποὺς οὐκ ἐς τὸ ἔξω μέρος ἀναγκάζεται ἐκκεκλίσθαι, ἀλλ’ ἐγγύς ἐστι τῆς ἰθυωρίης τῆς κατὰ τὸ σῶμα, καὶ τείνει καὶ ἐσωτέρω. Ὅταν οὖν τρίβον μὲν λάβῃ τὸ ἄρθρον ἐν τῇ σαρκὶ, εἰς ἣν ἐξεκλίθη, ἡ δὲ σὰρξ γλισχρανθῇ, ἀνώδυνον τῷ χρόνῳ γίνεται ὅταν δὲ ἀνώδυνον γένηται, δύνανται μὲν ὁδοιπορέειν ἄνευ ξύλου, ἢν ἄλλως βούλωνται δύνανται δὲ ὀχέειν τὸ σῶμα ἐπὶ τὸ σιναρὸν σκέλος. Δι’ οὖν τὴν χρῆσιν ἧσσον τοῖσι τοιούτοισιν ἐκθηλύνονται αἱ σάρκες, ἢ οἷσιν ὀλίγον πρόσθεν εἴρηται ἐκθηλύνονται δὲ ἢ πλεῖον, ἢ ἔλασσον μᾶλλον δέ τι ἐκθηλύνονται κατὰ τὸ ἔσω μέρος, ἢ κατὰ τὸ ἔξω, ὡς ἐπὶ τὸ πολύ. Τὸ μέντοι ὑπόδημα μετεξέτεροι τούτων ὑποδέεσθαι οὐ δύνανται διὰ τὴν ἀκαμπίην τοῦ σκέλεος, οἱ δέ τινες καὶ δύνανται. Οἷσι δὲ ἂν ἐν γαστρὶ ἐοῦσιν ἐξαρθρήσῃ τοῦτο τὸ ἄρθρον, ἢ ἔτι ἐν αὐξήσει ἐοῦσι βίῃ ἐκπεσὸν ἤδη μὴ ἐμπέσῃ, ἢ καὶ ὑπὸ νούσου ἐξαρθρήσῃ τοῦτο τὸ ἄρθρον καὶ ἐκπαλήσῃ πολλὰ γὰρ τοιαῦτα γίνεται, καὶ ἐνίων μὲν τῶν τοιούτων ἢν ἐπισφακελίσῃ ὁ μηρὸς, ἐμπυήματα χρόνια καὶ ἔμμοτα γίνεται, καὶ ὀστέων ψιλώσιες ἐνίοισιν, ὁμοίως δὲ καὶ οἷσιν ἐπισφακελίζει,

καὶ οἷσι μὴ ἐπισφακελίζει, τοῦ μηροῦ τὸ ὀστέον πολλῷ βραχύτερον γίνεται, καὶ οὐκ ἐθέλει ξυναύξεσθαι, ὥσπερ τοῦ ὑγιέος τὰ μέντοι τῆς κνήμης βραχύτερα μὲν γίνεται, ἢ τὰ τῆς ἑτέρης, ὀλίγῳ δὲ, διὰ τὰς αὐτὰς προφάσιας, αἳ καὶ πρόσθεν εἴρηνται ὁδοιπορέειν τε δύνανται οἱ τοιοῦτοι, οἱ μέν τινες αὐτῶν τοῦτον τὸν τρόπον, ὥσπερ οἷσι τετελειωμένοισιν ἐξέπεσε καὶ μὴ ἐνέπεσεν, οἱ δὲ καὶ βαίνουσι μὲν παντὶ τῷ ποδὶ, διαρρέπουσι δὲ ἐν τῇσιν ὁδοιπορίῃσιν, ἀναγκαζόμενοι διὰ τὴν βραχύτητα τοῦ σκέλεος. Ταῦτα δὲ τοιαῦτα γίνεται, ἢν ἐπιμελέως μὲν παιδαγωγηθῶσιν ἐν τοῖσι σχήμασι καὶ ὀρθῶς, ἐν οἷσι δεῖ, πρὶν κρατυνθῆναι ἐς τὴν ὁδοιπορίην, ἐπιμελέως δὲ καὶ ὀρθῶς, ἐπὴν κρατυνθῶσιν πλείστης δὲ ἐπιμελείης δέονται, οἷσιν ἂν νηπιωτάτοισιν ἐοῦσιν αὕτη ἡ ξυμφορὴ γένηται ἢν γὰρ ἀμεληθῶσι νήπιοι ἐόντες, ἀχρήϊον παντάπασι καὶ ἀναυξὲς ὅλον τὸ σκέλος γίνεται. Αἱ δὲ σάρκες τοῦ ξύμπαντος σκέλεος μινύθουσι μᾶλλον, ἢ τοῦ ὑγιέος πάνυ μὴν πολλῷ ἧσσον τούτοισι μινύθουσιν, ἢ οἷσιν ἂν ἔσω ἐκπεπτώκῃ, διὰ τὴν χρῆσιν καὶ τὴν ταλαιπωρίην, οἷον εὐθέως δύνασθαι χρέεσθαι τῷ σκέλεϊ, ὡς καὶ πρόσθεν ὀλίγῳ περὶ τῶν γαλιαγκώνων εἴρηται.

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

56. Εἰσὶ δέ τινες, ὧν τοῖσι μὲν ἐκ γενεῆς αὐτίκα, τοῖσι δὲ καὶ ὑπὸ νούσου ἀμφοτέρων τῶν σκελέων ἐξέστη τὰ ἄρθρα ἐς τὸ ἔξω μέρος τούτοισιν οὖν τὰ μὲν ὀστέα ταὐτὰ παθήματα πάσχει αἱ μέντοι

σάρκες ἥκιστα ἐκθηλύνονται τοῖσι τοιούτοισιν εὔσαρκα δὲ καὶ τὰ σκέλεα γίνεται, πλὴν εἴ τι ἄρα κατὰ τὸ εἴσω μέρος ἐλλείποι ὀλίγον διὰ τοῦτο δὲ εὔσαρκά ἐστιν, ὅτι ἀμφοτέροισι τοῖσι σκέλεσιν ὁμοίως ἡ χρῆσις γίνεται ὁμοίως γὰρ σαλεύουσιν ἐν τῇ ὁδοιπορίῃ ἔνθα καὶ ἔνθα ἐξεχέγλουτοι δὲ οὗτοι ἰσχυρῶς φαίνονται διὰ τὴν ἔκστασιν τῶν ἄρθρων. Ἢν δὲ μὴ ἐπισφακελίσῃ αὐτοῖσι τὰ ὀστέα, μηδὲ κυφοὶ ἀνωτέρω τῶν ἰσχίων γένωνται ἐνίους γὰρ καὶ τὰ τοιαῦτα καταλαμβάνεἰ, ἢν οὖν μὴ τοιοῦτόν τι γένηται, ἱκανῶς ὑγιηροὶ τἄλλα διαφέρονται ἀναυξέστεροι μέντοι τὸ πᾶν σῶμα οὗτοι γίνονται, πλὴν τῆς κεφαλῆς.

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

57. Ὅσοισι δ’ ἂν ἐς τοὔπισθεν ἡ κεφαλὴ τοῦ μηροῦ ἐκπέσῃ, ὀλίγοισι δὲ ἐκπίπτει, οὗτοι ἐκτανύειν οὐ δύνανται τὸ σκέλος, οὔτε κατὰ τὸ ἄρθρον τὸ ἐκπεσὸν, οὔτε τι κάρτα κατὰ τὴν ἰγνύην ἀλλ’ ἥκιστα τῶν ἐκπαλέων οὗτοι ἐκτανύουσι καὶ τὸ κατὰ τὸν βουβῶνα, καὶ τὸ κατὰ τὴν ἰγνύην ἄρθρον. Προσξυνιέναι μὲν οὖν καὶ τόδε χρὴ εὔχρηστον γὰρ καὶ πολλοῦ ἄξιόν ἐστι, καὶ τοὺς πλείστους λήθεἰ, ὅτι οὐδ’ ὑγιαίνοντες δύνανται κατὰ τὴν ἰγνύην ἐκτανύειν

τὸ ἄρθρον, ἢν μὴ ξυνεκτανύωσι καὶ τὸ κατὰ τὸν βουβῶνα ἄρθρον, πλὴν ἢν μὴ πάνυ ἄνω ἀείρωσι τὸν πόδα, οὕτω δ’ ἂν δύναιντο οὐ τοίνυν οὐδὲ ξυγκάμπτειν δύνανται τὸ κατὰ τὴν ἰγνύην ἄρθρον ὁμοίως, ἀλλὰ πολὺ χαλεπώτερον, ἢν μὴ ξυγκάμψωσι καὶ τὸ κατὰ τὸν βουβῶνα ἄρθρον. Πολλὰ δὲ καὶ ἄλλα κατὰ τὸ σῶμα τοιαύτας ἀδελφίξιας ἔχει, καὶ κατὰ νεύρων ξυντάσιας, καὶ κατὰ μυῶν σχήματα, καὶ πλεῖστά τε καὶ πλείστου ἄξια γινώσκεσθαι, ἢ ὥς τις οἴεται, καὶ κατὰ τὴν τοῦ ἐντέρου φύσιν, καὶ τὴν τῆς ξυμπάσης κοιλίης, καὶ κατὰ τὰς τῶν ὑστερέων πλάνας καὶ ξυντάσιας ἀλλὰ περὶ μὲν τούτων ἑτέρωθι λόγος ἔσται, ἠδελφισμένος τοῖσι νῦν λεγομένοισιν. Περὶ οὗ δὲ ὁ λόγος ἐστὶν, οὔτε ἐκτανύειν δύνανται, ὥσπερ ἤδη εἴρηται βραχύτερόν τε τὸ σκέλος φαίνεται διὰ δισσὰς προφάσιας, ὅτι τε οὐκ ἐκτανύεται, ὅτι τε πρὸς τὴν σάρκα ὠλίσθηκε τὴν τοῦ πυγαίου ἡ γὰρ φύσις τοῦ ἰσχίου τοῦ ὀστέου ταύτῃ, ᾗ καὶ ἡ κεφαλὴ καὶ ὁ αὐχὴν τοῦ μηροῦ γίνεται, ὅταν δὲ ἐξαρθρήσῃ, καταφερὴς πέφυκεν ἐπὶ τοῦ πυγαίου τὸ ἔξω μέρος. Ξυγκάμπτειν μέντοι δύνανται, ὅταν μὴ ἡ ὀδύνη κωλύῃ καὶ ἡ κνήμη τε καὶ ὁ ποὺς ὀρθὰ ἐπιεικέως φαίνεται, καὶ οὔτε τῇ, οὔτε τῇ πολὺ ἐκκεκλιμένα κατὰ δὲ τὸν βουβῶνα δοκέει τι ἡ σὰρξ λαπαρωτέρη εἶναι, ποτὶ καὶ ψαυομένη, ἅτε τοῦ ἄρθρου ἐς τὰ ἐπὶ θάτερα μέρη

ὠλισθηκότος κατὰ δὲ αὐτὸ τὸ πυγαῖον διαψαυομένη ἡ κεφαλὴ τοῦ μηροῦ δοκέει ἐξογκέειν μᾶλλον. Τὰ μὲν οὖν σημήϊα ταῦτα, ᾧ ἂν ἐς τὸ ὄπισθεν ἐκπεπτώκῃ ὁ μηρός.

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

58. Ὅτεῳ μὲν οὖν ἂν τετελειωμένῳ ἤδη ἐκπεσὼν μὴ ἐμπέσῃ, ὁδοιπορέειν μὲν δύναται, ὅταν ὁ χρόνος ἐγγένηται, καὶ ἡ ὀδύνη παύσηται, καὶ ἐθισθῇ τὸ ἄρθρον ἐν τῇ σαρκὶ ἐνστροφᾶσθαι ἀναγκάζεται μέντοι ἰσχυρῶς ξυγκάμπτειν κατὰ τοὺς βουβῶνας ὁδοιπορέων, διὰ δισσὰς προφάσιας, ἅμα μὲν ὅτι πολλῷ βραχύτερον τὸ σκέλος γίνεται διὰ τὰ προειρημένα, καὶ τῇ μὲν πτέρνῃ καὶ πάνυ πολλοῦ δέεται ψαύειν τῆς γῆς μόλις δὲ τῷ στήθεϊ τοῦ ποδὸς καθικνέεται, καὶ οὐδὲ οὕτως, ἢν μὴ κάμψῃ αὐτὸς ἑωυτὸν κατὰ τοὺς βουβῶνας, καὶ τῷ ἑτέρῳ σκέλεϊ κατὰ τὴν ἰγνύην ἐπιξυγκάμψῃ. Ἐπὶ δὲ τούτοισιν ἀναγκάζεται, ὥστε τῇ χειρὶ τῇ κατὰ τὸ σιναρὸν σκέλος ἐρείδεσθαι ἐς τὸ ἄνω τοῦ μηροῦ ἐφ’ ἑκάστῃ ξυμβάσει ἀναγκάζει οὖν τι καὶ τοῦτο αὐτὸ, ὥστε κάμπτεσθαι κατὰ τοὺς βουβῶνας ἐν γὰρ τῇ μεταλλαγῇ τῶν σκελέων ἐν τῇ ὁδοιπορίῃ οὐ δύναται τὸ σῶμα ὀχέεσθαι ἐπὶ τοῦ σιναροῦ σκέλεος, εἰ μὴ προσκατερείδεται

τὸ σιναρὸν πρὸς τὴν γῆν ὑπὸ τῆς χειρὸς, ἅτε οὐχ ὑφεστεῶτος τοῦ ἄρθρου ὑπὸ τῷ σῶματι, ἀλλ’ ἐς τὸ ὄπισθεν ἐξεστεῶτος κατὰ τὸ ἰσχίον εἰ γὰρ πειρήσαιτο καὶ ἐπ’ ὀλίγον τοῦ ποδὸς ὀχηθῆναι μηδενὶ ἄλλῳ ἀντιστηριζόμενος, ἐς τὸ ὀπίσω ἂν πέσοι ἡ γὰρ ῥοπὴ πολλὴ ἂν εἴη, τῶν ἰσχίων ἐπὶ πουλὺ ἐς τοὐπίσω ὑπερεχόντων ὑπὲρ τοῦ ποδὸς τῆς βάσιος, καὶ τῆς ῥάχιος ἐς τὰ ἰσχία ῥεπούσης. Ἄνευ μὲν οὖν ξύλου δύνανται ὁδοιπορέειν οἱ τοιοῦτοι, ἢν ἄλλως ἐθισθέωσιν διὰ τοῦτο, ὅτι ἡ βάσις τοῦ ποδὸς κατὰ τὴν ἀρχαίην ἰθυωρίην ἐστὶν, ἀλλ’ οὐκ ἐς τὸ ἔξω ἐκκεκλιμένη, διὰ τοῦτο οὐδὲ δέονται τῆς ἀντικοντώσιος. Ὅσοι μέντοι βούλονται ἀντὶ τῆς τοῦ μηροῦ ἐπιλαβῆς ὑπὸ τὴν μασχάλην τὴν κατὰ τὸ σιναρὸν σκέλος ὑποτιθέμενοι σκίπωνα ἀντερείδειν, κεῖνοι, ἢν μὲν μακρότερον τὸν σκίπωνα ὑποτιθέοιντο, ὀρθότεροι μὲν ὁδοιπορήσουσι, τῷ δὲ ποδὶ πρὸς τὴν γῆν οὐκ ἐρείδονται εἰ δ’ αὖ βούλονται ἐρείδεσθαι τῷ ποδὶ, βραχύτερον μὲν τὸ ξύλον φορητέον, κατὰ δὲ τοὺς βουβῶνας ἐπιξυγκάμπτεσθαι ἂν δέοι αὐτούς. Τῶν δὲ σαρκῶν αἱ μινυθήσιες κατὰ λόγον. γίνονται καὶ τούτοισιν, ὥσπερ πρόσθεν εἴρηται τοῖσι μὲν γὰρ μετέωρον ἔχουσι τὸ σκέλος καὶ μηδὲν ταλαιπωρέουσιν, τούτοισι καὶ μάλιστα μινύθουσιν οἳ δ’ ἂν πλεῖστα χρέωνται τῇ ἐπιβάσει, τούτοισιν

ἥκιστα μινύθουσιν. Τὸ μέντοι ὑγιὲς σκέλος οὐκ ὠφελέεται, ἀλλὰ μᾶλλον ̣αὶ ἀσχημονέστερον γίνεται, ἢν χρέωνται τῷ σιναρῷ σκέλεϊ ἐπὶ τὴν γῆν ξυνυπουργέον γὰρ ἐκείνῳ ἐξίσχιόν τε ἀπαναγκάζεται εἶναι, καὶ κατὰ τὴν ἰγνύην ξυγκάμπτειν ἢν δὲ μὴ προσχρέηται τῷ σιναρῷ ἐπὶ τὴν γῆν, ἀλλὰ, μετέωρον ἔχων, σκίπωνι ἀντερείδηται, οὕτω δὲ καρτερὸν γίνεται τὸ ὑγιὲς σκέλος ἔν τε γὰρ τῇ φύσει διαιτᾶται, καὶ τὰ γυμνάσια προσκρατύνει αὐτό. Φαίη μὲν οὖν ἄν τις, ἔξω ἰητρικῆς τὰ τοιαῦτα εἶναι τί γὰρ δῆθεν δεῖ περὶ τῶν ἤδη ἀνηκέστων γεγονότων ἔτι προσξυνιέναι; πολλοῦ δὲ δεῖ οὕτως ἔχειν τῆς γὰρ αὐτῆς γνώμης καὶ ταῦτα ξυνιέναι οὐ γὰρ οἷόν τε ἀπαλλοτριωθῆναι ἀπ’ ἀλλήλων. Δεῖ μὲν γὰρ ἐς τὰ ἀκεστὰ μηχανάασθαι, ὅκως μὴ ἀνήκεστα ἔσται, ξυνιέντα ὅκη ἂν μάλιστα κωλυτέα ἐς τὸ ἀνήκεστον ἐλθεῖν δεῖ δὲ τὰ ἀνήκεστα ξυνιέναι, ὡς μὴ μάτην λυμαίνηται τὰ δὲ προρρήματα λαμπρὰ καὶ ἀγωνιστικὰ, ἀπὸ τοῦ διαγινώσκειν, ὅπη ἕκαστον, καὶ οἵως, καὶ ὁκότε τελευτήσει, ἤν τε ἐς τὸ ἀκεστὸν τράπηται, ἤν τε ἐς τὸ ἀνήκεστον. Ὁκόσοισι δ’ ἂν ἐκ γενεῆς, ἢ καὶ ἄλλως πως ἐν αὐξήσει ἐοῦσιν, οὕτως ὀλίσθῃ τὸ ἄρθρον ὀπίσω, καὶ μὴ ἐμπέσῃ, ἤν τε βίῃ ὀλίσθῃ, ἤν τε καὶ ὑπὸ νούσου πολλὰ γὰρ τοιαῦτα ἐξαρθρήματα γίνετα ἐν νούσοισιν οἷαι δέ τινές εἰσιν αἱ νοῦσοι, ἐν ᾗσιν ἐξ̣θρέεται τὰ τοιαῦτα, ὕστερον γεγράψεταἰ, ἢν οὖν ἐκστὰν μὴ ἐμπέσῃ, τοῦ μὲν μηροῦ τὸ ὀστέον βραχὺ γίνεται, κακοῦται δὲ καὶ

πᾶν τὸ σκέλος, καὶ ἀναυξέστερον γίνεται καὶ ἀσαρκότερον πολλῷ διὰ τὸ μηδὲν προσχρέεσθαι αὐτῷ κακοῦται γὰρ τούτοισι καὶ τὸ κατὰ τὴν ἰγνύην ἄρθρον τὰ γὰρ νεῦρα ἐντεταμένα γίνεται διὰ τὰ πρόσθεν εἰρημένα διὸ οὐ δύνανται τὸ κατὰ τὴν ἰγνύην ἄρθρον ἐκτανύειν, οἷσιν ἂν οὕτως ἰσχίον ἐκπέσῃ. Ως γὰρ ἐν κεφαλαίῳ εἰπεῖν, πάντα τὰ ἐν τῷ σώματι ὁκόσα ἐπὶ χρήσει γέγονε, χρεομένοισι μὲν μέτρια καὶ γυμναζομένοισιν ἐν τῇσι ταλαιπωρίῃσιν, ἐν ᾗσιν ἕκαστα εἴθισται, οὕτω μὲν ὑγιεινὰ καὶ αὔξιμα καὶ εὔγηρα γίνεται μὴ χρεομένοισι δὲ, ἀλλ’ ἐλινύουσι νοσηρότερα γίνεται καὶ ἀναυξέα καὶ ταχύγηρα. Ἐν δὲ τούτοισιν οὐχ ἥκιστα τὰ ἄρθρα τοῦτο πέπονθε καὶ τὰ νεῦρα, ἢν μή τις αὐτοῖσι χρέηται κακοῦνται μὲν οὖν διὰ ταύτας τὰς προφάσιας μᾶλλόν τι ἐν τούτῳ τῷ τρόπῳ τοῦ ὀλισθήματος, ἢ ἐν τοῖσιν ἄλλοισιν ὅλον γὰρ τὸ σκέλος ἀναυξὲς γίνεται, καὶ τῇ ἀπὸ τῶν ὀστέων φύσει, καὶ τῇ ἀπὸ τῶν σαρκῶν οἱ οὖν τοιοῦτοι ὁκόταν ἀνδρωθῶσι, μετέωρον καὶ ξυγκεκαμμένον τὸ σκέλος ἴσχουσιν, ἐπὶ δὲ τοῦ ἑτέρου ὀχέονται, καὶ τῷ ξύλῳ ἀντιστηριζόμενοι, οἱ μὲν, ἑνὶ, οἱ δὲ, δυσίν.

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

59. Οἷσι δ’ ἂν ἐς τοὔμπροσθεν ἡ κεφαλὴ τοῦ μηροῦ ἐκπέσῃ, ὀλίγοισι δὲ τοῦτο γίνεται, οὗτοι ἐκτανύειν μὲν τὸ σκέλος δύνανται τελείως, ξυγκάμπτειν δὲ ἥκιστα οὗτοι δύνανται τὰ κατὰ τὸν βουβῶνα πονέουσι δὲ, καὶ ἢν κατὰ τὴν ἰγνύην ἀναγκάζωνται ξυγκάμπτειν. Μῆκος δὲ τοῦ σκέλεος παραπλήσιον φαίνεται, κατὰ

μὲν τὴν πτέρνην καὶ πάνυ ἄκρος δὲ ὁ ποὺς ἧσσόν τι προκύπτειν ἐθέλει ἐς τοὔμπροσθεν ὅλον δὲ τὸ σκέλος ἔχει τὴν ἰθυωρίην τὴν κατὰ φύσιν, καὶ οὔτε τῇ, οὔτε τῇ ῥέπει. Ὀδυνῶνται δὲ αὐτίκα οὗτοι μάλιστα, καὶ οὖρον ἴσχεται τὸ πρῶτον τούτοισι μᾶλλόν τι, ἢ τοῖσιν ἄλλοισιν ἐξαρθρήμασιν ἐγκέεται γὰρ ἡ κεφαλὴ τοῦ μηροῦ ἐγγυτάτω τούτοισι τῶν τόνων τῶν ἐπικαίρων. Καὶ κατὰ μὲν τὸν βουβῶνα ἐξογκέον τε καὶ κατατεταμένον τὸ χωρίον φαίνεται, κατὰ δὲ τὸ πυγαῖον, στολιδωδέστερον καὶ ἀσαρκότερον. Ταῦτα μὲν οὖν σημήϊά ἐστι τὰ εἰρημένα, ὧν ἂν οὕτως ἐκπεπτώκῃ ὁ μηρός.

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

60. Ὁκόσοισι μὲν οὖν ἂν ἤδη ἠνδρωμένοισι τοῦτο τὸ ἄρθρον ἐκπεσὸν μὴ ἐμπέσῃ, οὗτοι, ὁκόταν αὐτοῖσιν ἡ ὀδύνη παύσηται καὶ τὸ ἄρθρον ἐθισθῇ ἐν τῷ χωρίῳ τούτῳ στροφᾶσθαι, ἵνα ἐξέπεσεν, οὗτοι δύνανται σχεδὸν εὐθὺς ὀρθοὶ ὁδοιπορέειν ἄνευ ξύλου, καὶ πάνυ μέντοι εὐθέες, ἐπὶ δὲ τὸ σιναρὸν, ἅτε οὔτε κατὰ τὸν βουβῶνα εὔκαμπτοι ἐόντες, οὔτε κατὰ τὴν ἰγνύην διὰ οὖν τοῦ βουβῶνος τὴν ἀκαμπίην εὐθυτέρῳ ὅλῳ τῷ σκέλεϊ ἐν τῇ ὁδοιπορίῃ χρέονται, ᾒ ὅτε ὑγίαινον. Καὶ σύρουσι δὲ ἐνίοτε πρὸς τὴν γῆν τὸν πόδα, ἅτε οὐ ῥηϊδίως ξυγκάμπτοντες τὰ ἄνω ἄρθρα, καὶ ἅτε παντὶ βαίνοντες τῷ ποδί οὐδὲν γὰρ ἧσσον τῇ πτέρνῃ οὗτοι βαίνουσιν, ἢ τῷ ἔμπροσθεν εἰ δέ γε ἠδύναντο μέγα προβαίνειν, κἂν πάνυ πτερνοβάται ἦσαν καὶ

γὰρ οἱ ὑγιαίνοντες ὅσῳ ἂν μέζον προβαίνοντες ὁδοιπορέωσι, τοσούτῳ μᾶλλον πτερνοβάται εἰσὶ, τιθέντες τὸν πόδα, αἴροντες δὲ τὸν ἐναντίον. Ὁκόσοισι δὲ δὴ οὕτως ἐκπέπτωκε, καὶ ἔτι μᾶλλον τῇ πτέρνῃ προσεγχρίπτουσιν, ἢ τῷ ἔμπροσθεν τὸ γὰρ ἔμπροσθεν τοῦ ποδὸς, ὅταν ἐκτεταμένον ἔῃ τὸ ἄλλο σκέλος, οὐχ ὁμοίως δύναται ἐς τὸ πρόσω καμπύλλεσθαι, ὥσπερ ὅταν ξυγκεκαμμένον ἔῃ τὸ σκέλος οὔτ’ αὖ σιμοῦσθαι δύναται ὁ ποὺς, ξυγκεκαμμένου τοῦ σκέλεος, ὡς ὅταν ἐκτεταμένον ἔῃ τὸ σκέλος. Ὑγιαίνουσά τε οὖν ἡ φύσις οὕτω πέφυκεν, ὥσπερ εἴρηται ὅταν δὲ ἐκπεσὸν μὴ ἐμπέσῃ τὸ ἄρθρον, οὕτως ὁδοιπορέουσιν, ὡς εἴρηται, διὰ τὰς προφάσιας ταύτας τὰς εἰρημένας ἀσαρκότερον μέντοι τὸ σκέλος τοῦ ἑτέρου γίνεται, κατά τε τὸ πυγαῖον, κατά τε τὴν γαστροκνημίην, καὶ κατὰ τὴν ὄπισθεν ἴξιν. Οἷσι δ’ ἂν νηπίοισιν ἔτι ἐοῦσι τὸ ἄρθρον οὕτως ὀλισθάνον μὴ ἐμπέσῃ, ἢ καὶ ἐκ γενεῆς οὕτω γένηται, καὶ τούτοισι τὸ τοῦ μηροῦ ὀστέον μᾶλλόν τι μινύθει, ἢ τὰ τῆς κνήμης καὶ τὰ τοῦ ποδός ἥκιστα μὴν ἐν τούτῳ τῷ τρόπῳ τοῦ ὀλισθήματος ὁ μηρὸς μειοῦται. Μινύθουσι μέντοι αἱ σάρκες πάντη, μάλιστα δὲ κατὰ τὴν ὄπισθεν ἴξιν, ὥσπερ ἤδη καὶ πρόσθεν εἴρηται. Ὅσοι μὲν οὖν ἂν τιθηνηθῶσιν ὀρθῶς, οὗτοι μὲν δύνανται προσχρέεσθαι τῷ σκέλεϊ αὐξανόμενοι, βραχυτέρῳ μέν τινι τοῦ ἑτέρου ἐόντι, ὅμως δὲ ἐρειδόμενοι ξύλῳ ἐπὶ ταῦτα, ᾗ τὸ σιναρὸν σκέλος οὐ γὰρ κάρτα δύνανται ἄνευ τῆς πτέρνης τῷ στήθεϊ τοῦ ποδὸς χρέεσθαι, ἐπικαθιέντες ὥσπερ

ἐν ἑτέροισι χωλεύμασιν ἔνιοι δύνανται αἴτιον δὲ τοῦ μὴ δύνασθαι τὸ ὀλίγῳ πρόσθεν εἰρημένον διὰ οὖν τοῦτο προσδέονται ξύλου. Ὅσοι δ’ ἂν καταμεληθέωσι καὶ μηδὲν χρέωνται ἐπὶ τὴν γῆν τῷ σκέλεϊ, ἀλλὰ μετέωρον ἔχωσι, τούτοισι μινύθει μὲν τὰ ὀστέα ἐς αὔξησιν μᾶλλον, ἢ τοῖσι χρεομένοισιν μινύθουσι δὲ καὶ αἱ σάρκες πολὺ μᾶλλον, ἢ τοῖσι χρεομένοισιν κατὰ δὲ τὰ ἄρθρα ἐς τὸ εὐθὺ πηροῦται τούτοισι τὸ σκέλος μᾶλλόν τι, ἢ οἷσιν ἂν ἄλλως ἐκπεπτώκῃ.

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

61. Ως μὲν οὖν ἐν κεφαλαίῳ εἰρῆσθαι, τὰ ἄρθρα τὰ ἐκπίπτοντα καὶ τὰ ὀλισθάνοντα ἀνίσως αὐτὰ ἑωυτοῖσιν ἐκπίπτει καὶ ὀλισθάνει, ἄλλοτε μὲν πουλὺ πλεῖον, ἄλλοτε δὲ πολὺ ἔλασσον καὶ οἷσι μὲν ἂν πολὺ πλεῖον ὀλίσθῃ ἢ ἐκπέσῃ, χαλεπώτερα ἐμβάλλειν τὸ ἐπίπαν ἐστὶ, καὶ ἢν μὴ ἐμβιβασθῇ, μέζους καὶ ἐπιδηλοτέρας τὰς πηρώσιας καὶ κακώσιας ἴσχει τὰ τοιαῦτα, καὶ ὀστέων, καὶ σαρκῶν, καὶ σχημάτων ὅταν δὲ μεῖον ἐκπέσῃ καὶ ὀλίσθῃ, ῥηΐδιον μὲν ἐμβάλλειν τὰ τοιαῦτα τῶν ἑτέρων γίνεται, ἢν δὲ καταπορηθῇ ἢ ἀμεληθῇ ἐμπεσεῖν, μείους καὶ ἀσινέστεραι αἱ πηρώσιες γίνονται τούτοισιν, ἢ οἷσιν ὀλίγῳ πρόσθεν εἴρηται. Τὰ μὲν οὖν ἄλλα ἄρθρα καὶ πάνυ πολὺ διαφέρει ἐς τὸ ὁτὲ μὲν μεῖον, ὁτὲ δὲ μεῖζον τὸ ὀλίσθημα ποιέεσθαι μηροῦ δὲ καὶ βραχίονος κεφαλαὶ

παραπλησιώτατα ὀλισθάνουσιν αὐτὴ ἑωυτῇ ἑκατέρη ἅτε γὰρ στρογγύλαι μὲν αἱ κεφαλαὶ ἐοῦσαι, ἁπλῆν τῆν στρογγύλωσιν καὶ φαλακρὴν ἔχουσι, κυκλοτερέες δὲ αἱ κοιλίαι ἐοῦσαι, αἱ δεχόμεναι τὰς κεφαλὰς, ἁρμόζουσι δὲ τῇσι κεφαλῇσιν διὰ τοῦτο οὐκ ἔστιν αὐτῇσι τὸ ἥμισυ ἐκστῆναι τοῦ ἄρθρου ὀλισθάνοι γὰρ ἂν διὰ τὴν περιφερείην, ἢ ἐς τὸ ἔξω, ἢ ἐς τὸ ἔσω. Περὶ οὗ οὖν ὁ λόγος, ἐκπίπτουσι τελέως ἤδη, ἐπεὶ ἄλλως γε οὐκ ἐκπίπτουσιν ὅμως δὲ καὶ ταῦτα ὁτὲ μὲν πλεῖον ἀποπηδᾷ ἀπὸ τῆς φύσιος, ὁτὲ δὲ ἔλασσον μᾶλλον δέ τι μηρὸς τοῦτο βραχίονος πέπονθεν.

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

62. Ἐπεὶ ἔνια καὶ τῶν ἐκ γενεῆς γενομένων ὀλισθημάτων, ἢν

μικρὸν ὀλίσθῃ, οἷά τε ἐς τὴν φύσιν ἄγεσθαι, καὶ μάλιστα τὰ παρὰ τοῦ ποδὸς ἄρθρα. Ὁκόσοι ἐκ γενεῆς κυλλοὶ γίνονται, τὰ πλεῖστα τούτων ἰήσιμά ἐστιν, ἢν μὴ πάνυ μεγάλη ἡ ἔκκλισις ἔῃ, ἢ καὶ προαυξέων γεγονότων ἤδη τῶν παιδίων ξυμβῇ. Ἄριστον μὲν οὖν ὡς τάχιστα ἰητρεύειν τὰ τοιαῦτα, πρὶν πάνυ μεγάλην τὴν ἔνδειαν τῶν ὀστέων τῶν ἐν τῷ ποδὶ γενέσθαι, πρίν τε πάνυ μεγάλην τὴν ἔνδειαν τῶν σαρκῶν τῶν κατὰ τὴν κνήμην εἶναι. Τρόπος μὲν οὖν κυλλώσιος οὐχ εἷς, ἀλλὰ πλείονες, τὰ πλεῖστα μὴν οὐκ ἐξηρθρηκότα παντάπασιν, ἀλλὰ δι’ ἔθος σχήματος ἔν τινι ἀπολήψει τοῦ ποδὸς κεκυλλωμένα. Προσέχειν δὲ καὶ ἐν τῇ ἰητρείῃ τοισίδε χρή ἀπωθέειν μὲν καὶ κατορθοῦν τῆς κνήμης τὸ κατὰ τὸ σφυρὸν ὀστέον, τὸ ἔξωθεν, ἐς τὸ ἔσω μέρος, ἀντωθέειν δὲ ἐς τὸ ἔξω μέρος τὸ τῆς πτέρνης τὸ κατὰ τὴν ἴξιν, ὅκως ἀλλήλοις ἀπαντήσῃ τὰ ὀστέα τὰ ἐξίσχοντα κατὰ μέσον τε καὶ πλάγιον τὸν πόδα τοὺς δ’ αὖ δακτύλους ἀθρόους ξὺν τῷ μεγάλῳ δακτύλῳ ἐς

τὸ εἴσω μέρος ἐγκλίνειν καὶ περιαναγκάζειν οὕτως ἐπιδεῖν δὲ κηρωτῇ ἐρρητινωμένῃ εὖ, καὶ σπλήνεσι, καὶ ὀθονίοισι μαλθακοῖσι, μὴ ὀλίγοισι, μηδὲ ἄγαν πιέζοντα οὕτω δὲ τὰς περιαγωγὰς ποιέεσθαι τῆς ἐπιδέσιος, ὥσπερ καὶ τῇσι χερσὶν ἡ κατόρθωσις ἦν τοῦ ποδὸς, ὅκως ὁ ποὺς ὀλίγῳ μᾶλλον ἐς τὸ βλαισὸν ῥέπων φαίνηται. Ἴχνος δέ τι χρὴ ποιέεσθαι, ἢ δέρματος μὴ ἄγαν σκληροῦ, ἢ μολύβδινον, προσεπιδεῖν δὲ, μὴ πρὸς τὸν χρῶτα τιθέντα, ἀλλ’ ὅταν ἤδη τοῖσιν ὑστάτοισιν ὀθονίοισι μέλλῃς ἐπιδέειν ὅταν δὲ ἤδη ἐπιδεδεμένος ἔῃ, ἑνός τινος τῶν ὀθονίων χρὴ, οἷσιν ἐπιδέεται, τὴν ἀρχὴν προσράψαι πρὸς τὰ κάτω τοῦ ποδὸς ἐπιδέσματα κατὰ τὴν ἴξιν τοῦ μικροῦ δακτύλου ἔπειτα ἐς τὸ ἄνω τείνοντα, ὅκως ἂν δοκέῃ μετρίως ἔχειν, περιβάλλειν ἄνωθεν τῆς γαστροκνημίης, ὡς μόνιμον ἔῃ, κατατεταγμένον οὕτως. Ἁπλῷ δὲ λόγῳ, ὥσπερ κηροπλαστέοντα, χρὴ ἐς τὴν φύσιν τὴν δικαίην ἄγειν καὶ τὰ ἐκκεκλιμένα καὶ τὰ συντεταμένα παρὰ τὴν φύσιν, καὶ τῇσι χερσὶν οὕτω διορθοῦντα, καὶ τῇ ἐπιδέσει ὡσαύτως, προσάγειν δὲ οὐ βιαίως, ἀλλὰ παρηγορικῶς προσράπτειν δὲ τὰ ὀθόνια, ὅκως ἂν ξυμφέρῃ τὰς ἀναλήψιας ποιέεσθαι, ἄλλα γὰρ ἄλλης τῶν χωλωμάτων δέεται ἀναλήψιος. Ὑποδημάτιον δὲ ποιέεσθαι μολύβδινον, ἔξωθεν τῆς ἐπιδέσιος

ἐπιδεδεμένον, οἷον αἱ χῖαι κρηπῖδες ῥυθμὸν εἶχον ἀλλ’ οὐδὲν αὐτοῦ δεῖ, ἤν τις ὀρθῶς μὲν τῇσι χερσὶ διορθώσῃ, ὀρθῶς δὲ τοῖσιν ὀθονίοισιν ἐπιδέῃ, ὀρθῶς δὲ καὶ τὰς ἀναλήψιας ποιοῖτο. Ἡ μὲν οὖν ἴησις αὕτη, καὶ οὔτε τομῆς, οὔτε καύσιος οὐδὲν δεῖ, οὔτ’ ἄλλης ποικιλίης θᾶσσον γὰρ ἐνακούει τὰ τοιαῦτα τῆς ἰητρείης, ἢ ὡς ἄν τις οἴοιτο. Προσνικᾷν μέντοι χρὴ τῷ χρόνῳ, ἕως ἂν αὐξηθῇ τὸ σῶμα ἐν τοῖσι δικαίοισι σχήμασιν. Ὅταν δὲ ἐς ὑποδήματος λόγον ἴῃ, ἀρβύλαι ἐπιτηδειόταται αἱ πηλοπάτιδες καλεόμεναι τοῦτο γὰρ ὑποδημάτων ἥκιστα κρατέεται ὑπὸ τοῦ ποδὸς, ἀλλὰ κρατέει μᾶλλον ἐπιτήδειος δὲ καὶ ὁ κρητικὸς τρόπος τῶν ὑποδημάτων.

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

63. Ὅσοισι δ’ ἂν κνήμης ὀστέα ἐξαρθρήσαντα καὶ ἕλκος

ποιήσαντα τελείως ἐξίσχῃ κατὰ τὰ παρὰ τὸν πόδα ἄρθρα, εἴτε ἔσω ῥέψαντα, εἴτε μέντοι καὶ ἔξω, τὰ τοιαῦτα μὴ ἐμβάλλειν, ἀλλ’ ἐᾷν τὸν βουλόμενον τῶν ἰητρῶν ἐμβάλλειν. Σαφέως γὰρ εἰδέναι χρὴ, ὅτι ἀποθανεῖται, ᾧ ἂν ἐμβληθέντα ἐμμείνῃ, καὶ ἡ ζωὴ δὲ ὀλιγήμερος τουτέοισι γενήσεται ὀλίγοι γὰρ ἂν αὐτέων τὰς ἑπτὰ ἡμέρας ὑπερβάλλοιεν σπασμὸς γὰρ ὁ κτείνων ἐστίν ἀτὰρ καὶ γαγγραινοῦσθαι ἱκνέεται τὴν κνήμην καὶ τὸν πόδα. Ταῦτα βεβαίως εἰδέναι χρὴ οὕτως ἐσόμενα καὶ οὐκ ἄν μοι δοκέει οὐδὲ ἐλλέβορος ὠφελήσειν, αὐθημερόν τε δοθεὶς, καὶ αὖθις πινόμενος, ἄγχιστα δὲ, εἴπερ τι τοιοῦτον οὐ μέντοι γε οὐδὲ τοῦτο δοκέω. Ἢν δὲ μὴ ἐμβληθῇ, μηδ’ ἀπ’ ἀρχῆς μηδεὶς πειρηθῇ ἐμβάλλειν, περιγίνονται οἱ πλεῖστοι αὐτέων. Χρὴ δὲ ἡρμόσθαι μὲν τὴν κνήμην καὶ τὸν πόδα οὕτως, ὡς αὐτὸς ἐθέλει, μοῦνον δὲ, μὴ ἀπῃωρημένα, μηδὲ κινεύμενα ἔστω ἰητρεύειν δὲ πισσηρῇ καὶ σπλήνεσιν οἰνηροῖσιν, ὀλίγοισι, μὴ ἄγαν ψυχροῖσι, ψῦχος γὰρ ἐν τοῖσι

τοιούτοισι σπασμὸν ἐπικαλέεται ἐπιτήδεια δὲ καὶ φύλλα σεύτλων, ἢ βηχίου, ἢ ἄλλου τινὸς τῶν τοιουτέων, ἐν οἴνῳ μέλανι αὐστηρῷ ἡμίεφθα ἐπιτιθέντα ἰητρεύειν ἐπί τε τὸ ἕλκος, ἐπί τε τὰ περιέχοντα, κηρωτῇ δὲ χλιερῇ ἐπιχρίειν αὐτὸ τὸ ἕλκος ἢν δὲ ἡ ὥρη χειμερινὴ ἔῃ, καὶ ἔρια ῥυπαρὰ οἴνῳ καὶ ἐλαίῳ καταρραίνοντα χλιεροῖσιν ἄνωθεν ἐπιτέγγειν καταδεῖν δὲ μηδὲν μηδενὶ, μηδε περιπλάσσειν εὖ γὰρ εἰδέναι χρὴ, ὅτι πίεξις καὶ ἀχθοφορίη πᾶν κακὸν τοῖσι τοιούτοισίν ἐστιν. Ἐπιτήδεια δὲ πρὸς τὰ τοιαῦτα καὶ τῶν ἐναίμων μετεξέτερα, ὅσοισιν αὐτῶν ξυμφέρει ἔρια δὲ ἐπιτιθέντα, οἴνῳ ἐπιτέγγοντα, πουλὺν χρόνον ἐᾷν τὰ δὲ ὀλιγημερώτατα τῶν ἐναίμων, καὶ ὅσα ῥητίνῃ προσκαταλαμβάνεται, οὐχ ὁμοίως ἐπιτήδεια ἐκείνοισίν ἐστιν χρονίη γὰρ ἡ κάθαρσις τῶν ἑλκέων γίνεται τούτων πουλὺν γὰρ χρόνον πλαδαρὴ γίνεται τινὰς δὲ τούτων ἀγαθὸν ἐπιδέειν. Εἰδέναι μὲν δή που σάφα χρὴ, ὅτι ἀνάγκη τὸν ἄνθρωπον χωλὸν αἰσχρῶς γενέσθαι καὶ γὰρ ὁ ποὺς ἐς τὸ ἄνω ἀνέσπασται τῶν τοιούτων, καὶ τὰ ὀστέα

τὰ διολισθήσαντα ἔξω ἐξέχοντα φαίνεται οὔτε γὰρ ψιλοῦται τῶν τοιούτων ὀστέων οὐδὲν ὡς ἐπὶ τὸ πουλὺ, εἰ μὴ κατὰ βραχύ τι, οὔτε ἀφίσταται, ἀλλὰ περιωτειλοῦται λεπτῇσιν ὠτειλῇσι καὶ ἀσθενέσι, καὶ ταῦτα, ἢν ἀτρεμίζωσι πουλὺν χρόνον ἢν δὲ μὴ, ἑλκύδριον ἐγκαταλειφθῆναι κίνδυνος ἀναλθές. Ὅμως δὲ, περὶ οὗ ὁ λόγος, οὕτω μὲν ἰητρευόμενοι σώζονται, ἐμβληθέντος δὲ τοῦ ἄρθρου καὶ ἐμμείναντος, ἀποθνήσκουσιν.

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

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

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

65. Ὅσοισι δ’ ἂν κνήμης ὀστέον, ἕλκος ποιησάμενον παρὰ τὸ

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

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

66. Ωὑτὸς δὲ λόγος καὶ περὶ τῶν κατὰ τὸν ἀγκῶνα ἄρθρων, καὶ περὶ τῶν τοῦ πήχεος καὶ βραχίονος ἃ γὰρ ἂν τούτων ἐξαρθρήσαντα ἐξίσχῃ ἕλκος ποιησάμενα, πάντα, ἢν ἐμβληθῇ, θάνατον φέρει, μὴ ἐμβληθέντα δὲ, ἐλπίδα σωτηρίης χώλωσις δὲ ἑτοίμη τοῖσι περιγενομένοισιν. Θανατωδέστερα δὲ τοῖσιν ἐμβαλλομένοισίν. ἐστι τὰ ἀνωτέρω τῶν ἄρθρων, ἀτὰρ καὶ τοῖσι μὴ ἐμβαλλομένοισι κινδυνωδέστερα αὐτὰ ταῦτα. Εἰ δέ τινι τὰ ἀνώτατα ἄρθρα ἐξαρθρήσαντα,

ἕλκος ποιήσαντα, ἐξίσχοι, ταῦτα ἂν ἔτι καὶ ἐμβαλλόμενα ταχυθανατώτατα εἴη, καὶ μὴ ἐμβαλλόμενα κινδυνωδέστατα ἰητρείη δὲ ἤδη εἴρηται, οἵη τις ἐμοὶ δοκέει ἐπιτηδειοτάτη εἶναι τῶν τοιουτέων.

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

67. Ὅσοισι δὲ ἄρθρα δακτύλων, ἢ ποδὸς ἢ χειρὸς, ἐξαρθρήσαντα, ἕλκος ποιήσαντα, ἐξέσχε, μὴ κατεηγότος τοῦ ὀστέου, ἀλλὰ κατ’ αὐτὴν τὴν ξύμφυσιν ἀποσπασθέντος, τούτοισιν ἢν ἐμβληθέντα ἐμμείνῃ, ἔνι μέν τις κίνδυνος σπασμοῦ, ἢν μὴ χρηστῶς ἰητρεύωνται ὅμως δέ τι ἄξιον ἐμβάλλειν, προειπόντα ὅτι φυλακῆς πολλῆς καὶ μελέτης δέεται. Ἐμβάλλειν μέντοι ῥήιστον καὶ δυνατώτατον καὶ τεχνικώτατόν ἐστι τῷ μοχλίσκῳ, ὥσπερ καὶ πρόσθεν εἴρηται ἐν τοῖσι καταγνυμένοισι καὶ ἐξίσχουσιν ὀστέοισιν ἔπειτα ἀτρεμέειν ὡς μάλιστα χρὴ, καὶ κατακεῖσθαι, καὶ ὀλιγοσιτέειν ἄμεινον δὲ καὶ φαρμακεῦσαι ἄνω κούφῳ τινὶ φαρμάκῳ τὸ δὲ ἕλκος, ἰητρεύειν μὲν ἢ ἐναίμοισι τοῖσιν ἐπιτέγκτοισιν, ἢ πολυοφθάλμοισιν, ἢ οἷσι κεφαλῆς ὀστέα κατεηγότα ἰητρεύεται, κατάψυχρον δὲ κάρτα μηδὲν προσφέρειν. Ἥκιστα μὲν οὖν τὰ πρῶτα ἄρθρα κινδυνώδεά ἐστι, τὰ δὲ ἔτι ἀνωτέρω κινδυνωδέστερα. Ἐμβάλλειν δὲ χρὴ αὐθημερὸν, ἢ τῇ ὑστεραίῃ,

τριταίῳ δὲ ἢ τεταρταίῳ ἥκιστα τεταρταῖα γὰρ ἐόντα, ἐπισημαίνει τῇσι παλιγκοτίῃσι μάλιστα. Οἷσιν ἂν οὖν μὴ αὐτίκα ἐγγένηται ἐμβάλλειν, ὑπερβαίνειν χρὴ ταύτας τὰς εἰρημένας ἡμέρας ὅ τι γὰρ ἂν ἔσω δέκα ἡμερέων ἐμβάλλῃς, σπᾷν καταληπτέον. Ἢν δὲ ἄρα ἐμβεβλημένῳ σπασμὸς ἐπιγένηται, ἐκβάλλειν τὸ ἄρθρον δεῖ ταχὺ, καὶ θερμῷ τέγγειν ὡς πλειστάκις, καὶ τὸ ὅλον σῶμα θερμῶς καὶ λιπαρῶς καὶ μαλθακῶς ἔχειν, καὶ μάλιστα κατὰ τὰ ἄρθρα κεκάμφθαι δὲ μᾶλλον ἢ ἐκτετάσθαι πᾶν τὸ σῶμα χρή. Προσδέχεσθαι μέντοι χρὴ κατὰ τοὺς δακτύλους τὰ ἄρθρα τὰ ἐμβαλλόμενα ἀποστατικὰ ἔσεσθαι τὰ γὰρ πλεῖστα οὕτω γίνεται, ἢν καὶ ὁτιοῦν φλεγμονῆς ὑπογένηται, ὡς, εἰ μὴ δι’ ἀμαθίην τῶν δημοτέων ἐν αἰτίῃ ἔμελλεν ὁ ἰητρὸς ἔσεσθαι, οὐδὲν ἂν πάντως οὐδ’ ἐμβάλλειν ἔδει. Τὰ μὲν οὖν κατὰ τὰ ἄρθρα ὀστέα ἐξίσχοντα ἐμβαλλόμενα οὕτω κινδυνώδεά ἐστιν, ὡς εἴρηται.

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

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

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

69. Ἀποσφακελίσιες μέντοι σαρκῶν, καὶ ἐν τρώμασιν αἱμορρόοισι γενομένοισιν ἀποσφιγχθεῖσιν ἰσχυρῶς, καὶ ἐν ὀστέων κατήγμασι πιεχθεῖσι μᾶλλον τοῦ καιροῦ, καὶ ἐν ἄλλοισι δεσμοῖσι βιαίοισιν ἀποληφθέντα ἀποπίπτει πολλοῖσι, καὶ οἱ πολλοὶ περιγίνονται τῶν τοιούτων, καὶ οἷσι μηροῦ μέρος τι ἀποπίπτει, καὶ τῶν σαρκῶν καὶ τοῦ ὀστέου, καὶ οἷσι βραχίονος, ἧσσον δέ πήχεός τε καὶ κνήμης ἀποπεσούσης, καὶ ἔτι εὐφόρως περιγίνονται. Οἷσι μὲν οὖν, κατεαγέντων τῶν ὀστέων, ἀποσφίγξιες αὐτίκα ἐγένοντο καὶ μελασμοὶ, τούτοισι μὲν ταχεῖαι αἱ περιρρήξιες γίνονται τοῦ

σώματος, καὶ τὰ ἀποπίπτοντα ταχέως ἀποπίπτει, ἥδη τῶν ὀστέων προενδεδωκότων οἷσι δὲ, ὑγιέων ἐόντων τῶν ὀστέων, οἱ μελασμοὶ γίνονται, αἱ μὲν σάρκες ταχέως θνήσκουσι καὶ τούτοισι, τὰ δὲ ὀστέα βραδέως ἀφίσταται, ᾗ ἂν τὰ ὅρια τοῦ μελασμοῦ γένηται καὶ ἡ ψίλωσις τοῦ ὀστέου. Χρὴ δὲ, ὅσα ἂν κατωτέρω τοῦ σώματος τῶν ὁρίων τοῦ μελασμοῦ ἔῃ, ταῦτα, ὅταν ἤδη πάμπαν τεθνήκῃ καὶ ἀναλγέα ἔῃ, ἀφαιρέειν κατὰ τὸ ἄρθρον, προμηθεόμενον ὅκως μὴ τιτρώσκῃ ἢν γὰρ ὀδυνηθῇ ἀποταμνόμενος, καὶ μήπω κυρήσῃ τὸ σῶμα τεθνεὸς ταύτῃ, ἧ ἀποτέμνεται, κάρτα κίνδυνος ὑπὸ τῆς ὀδύνης λειποθυμῆσαι αἱ δὲ τοιαῦται λειποθυμίαι πολλοὺς παραχρῆμα ἤδη ἀπώλεσαν. Μηροῦ μὲν οὖν ὀστέον, ψιλωθὲν ἐκ τοιούτου τρόπου, ὀγδοηκοσταῖον εἶδον ἐγὼ ἀποστάν ἡ μέντοι κνήμη τούτῳ τῷ ἀνθρώπῳ κατὰ τὸ γόνυ ἀφῃρέθη εἰκοσταίη, ἐδόκεε δέ μοι καὶ ἐγγυτέρω οὐ γὰρ ἅμα, ἀλλ’ ἐπὶ τὸ προμηθέστερον ἔδοξέ μοί τι ποιέειν. Κνήμης δὲ ὀστέα ἐκ τοιούτου μελασμοῦ, μάλα κατὰ μέσην τὴν κνήμην ἐόντα, ἑξηκοσταῖά μοι ἀπέπεσεν, ὅσα ἐψιλώθη αὐτέων. Διενέγκοι μὲν γὰρ ἄν τι καὶ ἰητρείη ἰητρείης ἐς τὸ θᾶσσόν τε καὶ βραδύτερον τὰ ὀστέα ψιλούμενα ἀποπίπτειν

διενέγκοι δ’ ἄν τι καὶ πίεξις πιέξιος, καὶ ἐπὶ τὸ ἰσχυρότερόν τε καὶ ἀσθενέστερον, καὶ ἐς τὸ θᾶσσόν τε καὶ βραδύτερον ἀπομελανθέντα ἀποθανεῖν τὰ νεῦρα καὶ τὰς σάρκας καὶ τὰς ἀρτηρίας καὶ τὰς φλέβας ἐπεὶ ὅσα μὴ ἰσχυρῶς ἀποληφθέντων θνήσκει, ἔνια τῶν τοιουτέων οὐκ ἀφικνέεται ἐς ὀστέων ψιλώματα, ἀλλ’ ἐπιπολαιότερα ἐκπίπτει ἔνια δὲ οὐδὲ ἐς νεύρων ψιλώματα ἀφικνεῖται, ἀλλὰ ἐπιπολαιότερα ἐκπίπτει. Διὰ οὖν ταύτας τὰς εἰρημένας προφάσιας οὐκ ἐστὶν ἓν οὔνομα ἀριθμοῦ τῷ χρόνῳ θέσθαι, ἐν ὁκόσῳ ἕκαστα τούτων κρίνεται. Προσδέχεσθαι δὲ μάλα χρὴ τὰ τοιαῦτα ἰήματα ἐσιδέειν γὰρ φοβερώτερά ἐστιν, ἢ ἰητρεύειν καὶ ἰητρείη πραείη ἀρκέει πᾶσι τοιούτοισιν αὐτὰ γὰρ ἑωυτὰ κρίνει μοῦνον τῆς δὲ διαίτης ἐπιμελέεσθαι χρὴ, ὡς κατὰ δύναμιν ἀπύρετος ἔῃ, καὶ ἐν σχήμασι δικαίοισιν εὐθετίζειν τὸ σῶμα δίκαια δὲ ταῦτα, μηδὲ μετέωρον ποιέειν, μηδὲ ἐς τὸ κάτω ῥέπον, ἀλλὰ μᾶλλον ἐς τὸ ἄνω, ποτὶ καὶ ἔστ’ ἂν τελείως περιρραγῇ αἱμορραγιέων γὰρ ἐν τούτῳ τῷ χρόνῳ κίνδυνος διὰ τοῦτο οὖν οὐ χρὴ κατάρροπα τὰ τρώματα ποιέειν, ἀλλὰ τἀναντία. Ἐπεὶ ὅταν γε χρόνος ἐγγένηται πλείων, καὶ καθαρὰ τὰ ἕλκεα γένηται, οὐκ ἔτι τὰ αὐτὰ σχήματα ἐπιτήδειά ἐστιν,

ἀλλ’ ἡ εὐθεῖα θέσις, καὶ ἐνίοτε ἐπὶ τὸ κατάρροπον ῥέποντα ἀνὰ χρόνον γὰρ ἐνίοισι τουτέων ἀποστάσιες πύου γίνονται, καὶ ὑποδεσμίδων δέονται. Προσδέχεσθαι δὲ χρὴ τοὺς τοιούτους ἀνὰ χρόνον ὑπὸ δυσεντερίης πιέζεσθαι καὶ γὰρ ἐπὶ τοῖσι μελαινομένοισι τοῖσι πλείστοισιν ἐπιγίνεται δυσεντερίη, καὶ ἐπὶ τῇσιν αἱμορραγίῃσιν ἐξ ἑλκέων ἐπιγίνεται δὲ ὡς ἐπὶ τὸ πολὺ, κεκριμένων ἤδη τῶν μελασμῶν καὶ τῆς αἱμορραγίης, καὶ ὁρμᾶται μὲν λαύρως καὶ ἰσχυρῶς ἀτὰρ οὔτε πολυήμερος γίνεται, οὔτε θανατώδης οὔτε γὰρ μάλα ἀπόσιτοι γίνονται οἱ τοιοῦτοι, οὔτε ἄλλως ξυμφέρει κενεαγγέειν.

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

70. Μηροῦ δὲ ὀλίσθημα κατ’ ἰσχίον ὧδε χρὴ ἐμβάλλειν, ἢν ἐς τὸ ἔσω μέρος ὠλισθήκῃ ἀγαθὴ μὲν ἥδε καὶ δικαίη καὶ κατὰ φύσιν ἡ ἐμβολὴ, καὶ δή τι καὶ ἀγωνιστικὸν ἔχουσα, ὅστις γε τοῖσι τοιούτοισιν ἥδεται κομψευόμενος. Κρεμάσαι χρὴ τὸν ἄνθρωπον τῶν ποδῶν πρὸς μεσόδμην δεσμῷ δυνατῷ μὲν, μαλθακῷ δὲ καὶ πλάτος ἔχοντι τοὺς δὲ πόδας διέχειν χρὴ, ὅσον τέσσαρας δακτύλους ἀπ’ ἀλλήλων, ἢ καὶ ἔλασσον χρὴ δὲ καὶ ἐπάνωθεν τῶν ἐπιγουνίδων προσπεριβεβλῆσθαι πλα̣ῖ ἱμάντι καὶ μαλθακῷ,

ἀνατείνοντι ἐς τὴν μεσόδμην τὸ δὲ σκέλος τὸ σιναρὸν ἐντετάσθαι χρὴ ὡς δύο δακτύλους μᾶλλον τοῦ ἑτέρου ἀπὸ δὲ τῆς γῆς τὴν κεφαλὴν ἀπεχέτω ὡς δύο πήχεας, ἢ ὀλίγῳ πλέον, ἢ ἔλασσον τὰς δὲ χεῖρας παρατεταμένας παρὰ τὰς πλευρὰς προσδεδεμένος ἔστω μαλθακῷ τινι πάντα δὲ ταῦτα ὑπτίῳ κατακειμένῳ κατασκευασθήτω, ὡς ὅτι ἐλάχιστον χρόνον κρέμηται. Ὅταν δὲ κρεμασθῇ, ἄνδρα χρὴ εὐπαίδευτον καὶ μὴ ἀσθενέα, ἐνείραντα τὸν πῆχυν μεσηγὺ τῶν μηρῶν, εἶτα θέσθαι τὸν πῆχυν μεσηγὺ τοῦ περινέου καὶ τῆς κεφαλῆς τοῦ μηροῦ τῆς ἐξεστηκυίης, ἔπειτα ξυνάψαντα τὴν ἑτέρην χεῖρα πρὸς τὴν διῃρμένην, παραστάντα ὀρθὸν παρὰ τὸ σῶμα τοῦ κρεμαμένου, ἐξαπίνης ἐκκρεμασθέντα, μετέωρον αἰωρηθῆναι ὡς ἰσορροπώτατον. Αὕτη δὲ ἡ ἐμβολὴ παρέχεται πάντα, ὅσα χρὴ κατὰ φύσιν αὐτό τε γὰρ τὸ σῶμα, κρεμάμενον, τῷ ἑωυτοῦ βάρεϊ κατάτασιν ποιέεται, ὅ τε ἐκκρεμασθεὶς ἅμα μὲν τῇ κατατάσει ἀναγκάζει ὑπεραιωρέεσθαι

τὴν κεφαλὴν τοῦ μηροῦ ὑπὲρ τῆς κοτύλης, ἅμα δὲ τῷ ὀστέῳ τοῦ πήχεος ἀπομοχλεύει καὶ ἀναγκάζει ἐς τὴν ἀρχαίην φύσιν ὀλισθάνειν. Χρὴ δὲ παγκάλως μὲν τοῖσι δεσμοῖσιν ἐσκευάσθαι, φρονέοντα δὲ καὶ ὡς ἐχυρώτατον τὸν ἐξαιωρούμενον εἶναι.

70. Dislocation inward at the hip-joint is to be reduced in the following manner: (it is a good, proper, and natural mode of reduction, and has something of display in it, if any one takes delight in such ostentatious modes of procedure). The patient is to be suspended by the feet from a cross-beam with a strong, soft, and broad cord; the feet are to be about four inches or less from one another; and a broad and soft leather collar connected with the cross-beam is to be put on above the knees; and the affected leg should be so extended as to moved be two inches longer than the other; the head should be about two cubits from the ground, or a little more or less; and the arms should be stretched along the sides, and bound with something soft; all these preparations should be made while he is lying on his back, so that he may be suspended for as short a time as possible. But when the patient is suspended, a person properly instructed and not weak, having introduced his arm between his thighs, is to place his fore-arm between the perineum and the dislocated head of the os femoris; and then, having joined the other hand to the one thus passed through the thighs, he is to stand by the side of the suspended patient, and suddenly suspend and swing himself in the air as perpendicularly as possible. This method comprises all the conditions which are natural; for the body being suspended by its weight, produces extension, and the person suspended from him, along with the extension, forces the head of the thigh-bone to rise up above the acetabulum; and at the same time he uses the bone of the fore-arm as a lever, and forces the os femoris to slip into its old seat. The cords should be properly prepared, and care should be taken that the person suspended along with the patient have a sufficiently strong hold.

71. Ως μὲν οὖν καὶ πρόσθεν εἴρηται, μέγα τὸ διαφέρον ἐστὶ τῶν φυσίων τοῖσιν ἀνθρώποισιν ἐς τὸ εὐέμβλητα εἶναι, καὶ δυσέμβλητα καὶ διότι μέγα διαφέρει, εἴρηται πρόσθεν ἐν τοῖσι περὶ ὤμου. Ἐνίοισι γὰρ ὁ μηρὸς ἐμπίπτει ἀπ’ οὐδεμιῆς παρασκευῆς, ἀλλ’ ὀλίγης μὲν κατατάσιος, ὅσον τῇσι χερσὶ κατιθῦναι, βραχείης δὲ κιγκλίσιος πολλοῖσι δὲ ξυγκάμψασι τὸ σκέλος κατὰ τὸ ἄρθρον, ἐνέπεσεν, ἤδη ἀμφίσφαλσιν ποιησάμενον. Ἀλλὰ γὰρ τὰ πουλὺ πλείω οὐκ ἐνακούει τῆς τυχούσης παρασκευῆς διὰ τοῦτο ἐπίστασθαι μὲν χρὴ τὰ κράτιστα περὶ ἑκάστου ἐν πάσῃ τῇ τέχνῃ χρέεσθαι δὲ, οἷσιν ἂν δόξῃ ἑκάστοτε. Εἴρηνται μὲν οὖν τρόποι κατατασίων καὶ ἐν τοῖσιν ἔμπροσθεν γεγραμμένοισιν, ὥστε χρέεσθαι τούτων, ὅστις ἂν παρατύχῃ. Δεῖ γὰρ ἀντικατατετάσθαι ἰσχυρῶς, ἐπὶ θάτερα μὲν τοῦ σκέλεος, ἐπὶ θάτερα δὲ τοῦ

σώματος ἢν γὰρ εὖ καταταθῇ, ὑπεραιωρηθήσεται ἡ κεφαλὴ τοῦ μηροῦ ὑπὲρ τῆς ἀρχαίης ἕδρης καὶ ἢν μὲν ὑπεραιωρηθῇ οὕτως, οὐδὲ κωλύσαι ἔτι ῥηΐδιον ἵζεσθαι αὐτὴν ἐς τὴν ἑωυτῆς ἕδρην, ὥστε ἤδη πᾶσα ἀρκέει μόχλευσίς τε καὶ κατόρθωσις ἀλλὰ γὰρ ἐλλείπουσιν ἐν τῇ κατατάσει διὰ τοῦτο ὄχλον πλείω παρέχει ἡ ἐμβολή. Χρὴ οὖν οὐ μόνον παρὰ τὸν πόδα τὰ δεσμὰ ἐξηρτῆσθαι, ἀλλὰ καὶ ἄνωθεν τοῦ γούνατος, ὅκως μὴ κατὰ τὸ τοῦ γούνατος ἄρθρον ἐν τῇ τανύσει ἡ ἐπίδεσις ἔῃ μᾶλλον, ἢ κατὰ τὸ τοῦ ἰσχίου ἄρθρον. Οὕτω μὲν οὖν χρὴ τὴν κατάτασιν, τὴν πρὸς τὸ τοῦ ποδὸς μέρος, ἐσκευάσθαι ἀτὰρ καὶ τὴν ἐπὶ θάτερα κατάτασιν, μὴ μοῦνον ἐκ τῆς περὶ τὸ στῆθος καὶ τὰς μασχάλας περιβολῆς ἀντιτείνεσθαι, ἀλλὰ καὶ ἱμάντι μακρῷ, διπτύχῳ, ἰσχυρῷ, προσηνεῖ, παρὰ τὸν περίνεον βεβλημένῳ, παρατεταμένῳ ἐπὶ μὲν τὰ ὄπισθεν παρὰ τὴν ῥάχιν, ἐπὶ δὲ τὰ ἔμπροσθεν παρὰ τὴν κληῗδα, προσηρτημένῳ πρὸς τὴν ἀρχὴν τὴν ἀκτικατατείνουσαν, οὕτω διαναγκάζεσθαι, τοῖσι μὲν ἔνθα διατεινομένοισι, τοῖσι δὲ ἔνθα, ὅκως δὲ ὁ ἱμὰς ὁ παρὰ τὸν περίνεον μὴ περὶ τὴν κεφαλὴν τοῦ μηροῦ παρατεταμένος ἔσται, ἀλλὰ μεσηγὺ τῆς κεφαλῆς καὶ τοῦ περινέου ἐν δὲ τῇ κατάτασει, κατὰ μὲν τὴν κεφαλὴν τοῦ μηροῦ ἐρείσας

τὴν πυγμὴν, ἐς τὸ ἔξω ὠθεέτω ἢν δὲ μετεωρίζηται ἑλκόμενος, διέρσας τὴν χεῖρα καὶ ἐπιξυνάψας τῇ ἑτέρῃ χειρὶ, ἅμα μὲν συγκατατεινέτω, ἅμα δὲ ἐς τὸ ἔξω ξυναναγκαζέτω ἄλλος δέ τις τὸ παρὰ τὸ γόνυ τοῦ μηροῦ ἡσύχως ἐς τὸ ἔσω μέρος κατορθούτω.

71. Wherefore, as formerly stated, men’s constitutions differ much from one another as to the facility or difficulty with which dislocations are reduced; and the cause of this was also stated formerly in treating of the shoulder. In some the thigh is reduced with no preparation, with slight extension, directed by the hands, and with slight movement; and in some the reduction is effected by bending the limb at the joint, and making rotation. But much more frequently it does not yield to any ordinary apparatus, and therefore one should be acquainted with the most powerful means which can be applied in each case, and use whatever maybe judged most proper under all circumstances. The modes of extension have been described in the former parts of the work, so that one may make use of whatever may happen to be at hand. For, extension and counter-extension are to be made in the direction of the limb and the body; and if this be properly effected, the head of the thigh-bone will be raised above its ancient seat; and if thus raised, it will not be easy to prevent it from settling in its place, so that any ordinary impulse with the lever and adjustment will be quite sufficient; but some apply insufficient extension, and hence the reduction gives much trouble. The bands then should be fastened, not only at the foot, but also above the knee, so that the force of the extension may not be expended on the knee-joint more than upon the hip-joint. The extension in the direction of the foot is to be thus contrived. But the counter-extension is not only to be managed by means of something carried round the chest and armpits, but also by a long, double, strong, and supple thong applied to the perineum, and carried behind along the spine, and in front along the collar-bone and fixed to the point from which counter-extension is made; and then force is to be so applied, by means of this extension and counter-extension, that the thong at the perineum may not pass over the head of the thigh-bone, but between it and the perineum; and during the extension one should strike the head of the femur with the fist, so as to drive it outward. And when the patient is raised up by the stretching, you should pass a hand through ( between the legs? ) and grasp it with the other hand, so as at the same time to make extension, and force the dislocated limb outward; while some other person sitting by the knee quietly directs it inward.

72. Εἴρηται δὲ καὶ πρόσθεν ἤδη, ὅτι ἐπάξιον, ὅστις ἐν πόλει πολυανθρώπῳ ἰητρεύει, ξύλον κεκτῆσθαι τετράγωνον, ὡς ἑξάπηχυ ἢ ὀλίγῳ μέζον, εὖρος δὲ, ὡς δίπηχυ, πάχος δὲ, ἀρκέει σπιθαμιαῖον ἔπειτα κατὰ μῆκος μὲν, ἔνθεν καὶ ἔνθεν ἐντομὴν ἔχειν χρὴ, ὡς μὴ ὑψηλοτέρη τοῦ καιροῦ ἡ μηχάνησις ἔῃ ἔπειτα φλιὰς βραχείας, ἰσχυρὰς, καὶ ἰσχυρῶς ἐνηρμοσμένας, ὀνίσκον ἔχειν ἑκατέρωθεν ἔπειτα ἀρκέει μὲν ἐν τῷ ἡμίσεϊ τοῦ ξύλου

οὐδὲν δὲ κωλύει καὶ διὰ παντὸς ἐντετμῆσθαι ὡς καπέτους μακρὰς πέντε ἢ ἓξ, διαλείπουσας ἀπ’ ἀλλήλων ὡς τέσσαρας δακτύλους, αὐτὰς δὲ ἀρκέει εὖρος τριδακτύλους εἶναι, καὶ βάθος οὕτως. Ἔχειν δὲ κατὰ μέσον τὸ ξύλον καὶ καταγλυφὴν χρὴ βαθυτέρην, ἐπὶ τετράγωνον, ὡς τριῶν δακτύλων, καὶ ἐς μὲν τὴν καταγλυφὴν ταύτην, ὅταν δοκέῃ προσδεῖν, ξύλον ἐμπηγνύναι ἐναρμόζον τῇ καταγλυφῇ, τὸ δὲ ἄνω στρογγύλον, ἐμπηγνύναι δὲ, ἐπήν ποτε δοκέῃ ξυμφέρειν, μεσηγὺ τοῦ περινέου καὶ τῆς κεφαλῆς τοῦ μηροῦ. Τοῦτο τὸ ξύλον ἑστεὸς κωλύει τὴν ἐπίδοσιν ἐπιδιδόναι τὸ σῶμα τοῖσι πρὸς ποδῶν ἕλκουσιν ἐνίοτε γὰρ ἀρκέει αὐτὸ τὸ ξύλον τοῦτο ἀντὶ τῆς ἄνωθεν ἀντικατατάσιος ἐνίοτε δὲ καὶ, κατατεινομένου τοῦ σκέλεος ἔνθεν καὶ ἔνθεν, αὐτὸ τὸ ξύλον τοῦτο, χαλαρὸν ἐγκείμενον ἢ τῇ ἢ τῇ, ἐκμοχλεύειν ἐπιτήδειον ἂν εἴη τὴν κεφαλὴν τοῦ μηροῦ ἐς τὸ ἔξω μέρος. Διὰ τοῦτο γὰρ καὶ αἱ κάπετοι ἐντετμέαται, ὡς, καθ’ ὁκοίην ἂν αὐτέων ἁρμόσῃ, ἐμβαλλόμενος ξύλινος μοχλὸς μοχλεύοι, ἢ παρὰ τὰς κεφαλὰς τῶν ἄρθρων, ἢ κατὰ τὰς κεφαλὰς τελέως ἐρειδόμενος ἅμα τῇ κατατάσει, ἤν τε ἐς τὸ ἔξω μέρος ξυμφέρῃ ἐκμοχλεύεσθαι, ἤν τε ἐς τὸ ἔσω, καὶ ἤν τε στρογγύλον τὸν μοχλὸν ξυμφέρῃ εἶναι, ἤν τε πλάτος ἔχοντα ἄλλος γὰρ ἄλλῳ τῶν ἄρθρων ἁρμόζει. Εὔχρηστος δέ ἐστιν ἐπὶ πάντων τῶν ἄρθρων ἐμβολῆς, τῶν κατὰ τὰ σκέλεα, αὕτη ἡ

μόχλευσις ξὺν τῇ κατατάσει. Περὶ οὖ οὖν ὁ λόγος ἐστὶ, στρογγύλος ἁρμόζει ὁ μοχλὸς εἶναι τῷ μέντοι ἔξω ἐκπεπτωκότι ἄρθρῳ πλατὺς ἁρμόσει εἶναι. Ἀπὸ τουτέων τῶν μηχανέων καὶ ἀναγκέων οὐδὲν ἄρθρον μοι δοκέει οἷόν τε εἶναι ἀπορηθῆναι ἐμπεσεῖν.

72. It has been formerly stated by us that it will be of importance for any person who practices medicine in a populous city to get prepared a quadrangular board, about six cubits or a little more in length, and about two cubits in breadth; a fathom will be sufficient thickness for it; and then along it from the one end to the other, an excavation must be made, so that the working of the levers may not be higher than is proper; then at both sides we are to raise short, strong, and strongly-fixed posts, having axles; and in the middle of the bench five or six long grooves are to be scooped out about four inches distant from one another, three inches will be a sufficient breadth for them, and the depth in like manner; and although the number of grooves I have mentioned will be sufficient, there is nothing to prevent their being made all over the bench. And the bench should have in its middle a pretty deep hole, of a square shape, and of about three inches in size; and into this hole, when judged necessary, is to be adjusted a corresponding piece of wood, rounded above, which, at the proper time, is to be adjusted between the perineum and the head of the thigh-bone. This upright piece of wood prevents the body from yielding to the force dragging downward by the feet; for sometimes this piece of wood serves the purpose of counter-extension upward; and sometimes, too, when extension and counter-extension are made, this piece of wood, if susceptible of some motion to this side or that, will serve the purpose of a lever for pushing the head of the thigh-bone outward. It is on this account that several grooves are scooped out on the bench, so that this piece of wood, being erected at the one which answers, may act as a lever, either on the sides of the articular heads of bones, or may make pressure direct on the heads along with the extension, according as it may suit to push inward or outward with the lever; and the lever may be either of a round or broad form, as may be judged proper; for sometimes the one form and sometimes the other suits with the articulation. This mode of applying the lever along with extension is applicable in the reduction of all dislocations of the thigh. In the case now on hand, a round lever is proper; but in dislocations outward a flat lever will be the suitable one. By means of such machines and of such powers, it appears to me that we need never fail in reducing any dislocation at a joint.

73. Εὕροι δ’ ἄν τις καὶ ἄλλους τρόπους τούτου τοῦ ἄρθρου ἐμβολῆς εἰ γὰρ τὸ ξύλον τὸ μέγα τοῦτο ἔχοι κατὰ μέσον καὶ ἐκ πλαγίων φλιὰς δύο, ὡς ποδιαίας, ὕψος δὲ ὅκως ἂν δοκέοι ξυμφέρειν, τὴν μὲν ἔνθεν, τὴν δὲ ἔνθεν, ἔπειτα ξύλον πλάγιον ἐνείη ἐν τῇσι φλιῇσιν ὡς κλιμακτὴρ, ἔπειτα διέρσαι τὸ ὑγιὲς σκέλος μεσηγὺ τῶν φλιέων, τὸ δὲ σιναρὸν ἄνωθεν τοῦ κλιμακτῆρος ἔχειν ἁρμόζον ἀπαρτὶ πρὸς τὸ ὕψος καὶ πρὸς τὸ ἄρθρον, ᾗ ἐκπέπτωκεν ῥηΐδιον δὲ ἁρμόζειν τὸν γὰρ κλιμακτῆρα ὑψηλότερόν τινι χρὴ ποιέειν τοῦ μετρίου, καὶ ἱμάτιον πολύπτυχον, ὡς ἂν ἁρμόσῃ, ὑποτείνειν ὑπὸ τὸ σῶμα. Ἔπειτα χρὴ ξύλον, ἔχον

πλάτος μέτριον καὶ μῆκος, ἄχρι τοῦ σφυροῦ ὑποτεταμένον ὑπὸ τὸ σκέλος εἶναι, ἱκνεόμενον ἐπέκεινα τῆς κεφαλῆς τοῦ μηροῦ ὡς οἷόν τε προσκαταδεδέσθαι δὲ χρὴ πρὸς τὸ σκέλος, ὅκως ἂν μετρίως ἔχῃ. Κἄπειτα κατατεινομένου τοῦ σκέλεος, εἴτε ξύλῳ. ὑπεροειδέϊ, εἴτε τουτέων τινὶ τῶν κατατασίων, ὁμοῦ χρὴ καταναγκάζεσθαι τὸ σκέλος περὶ τὸν κλιμακτῆρα ἐς τὸ κάτω μέρος ξὺν τῷ ξύλῳ τῷ προσδεδεμένῳ τὸν δέ τινα κατέχειν τὸν ἄνθρωπον ἀνωτέρω τοῦ ἄρθρου κατὰ τὸ ἰσχίον. Καὶ γὰρ οὕτως ἅμα μὲν ἡ κατάτασις ὑπεραιωρέοι ἂν τὴν κεφαλὴν τοῦ μηροῦ ὑπὲρ τῆς κοτύλης, ἅμα δὲ ἡ μόχλευσις ἀπωθέοι τὴν κεφαλὴν τοῦ μηροῦ ἐς τὴν ἀρχαίην φύσιν. Αὗται πᾶσαι αἱ εἰρημέναι ἀνάγκαι ἰσχυραὶ, καὶ πᾶσαι κρέσσους τῆς ξυμφορῆς, ἤν τις ὀρθῶς καὶ καλῶς σκευάζῃ. Ὥσπερ δὲ καὶ πρόσθεν ἤδη εἴρηται, πουλύ τι ἀπὸ ἀσθενεστέρων κατατασίων καὶ φαυλοτέρης κατασκευῆς τοῖσι πλείοσιν ἐμπίπτει.

73. And one might find out other modes of reduction for this joint. If the large bench were to have raised on it two posts about a foot ( in diameter? ), and of a suitable height, on each side near its middle, and if a transverse piece of wood like the step of a ladder, were inserted in the posts, then if the sound leg were carried through between the posts, and the injured limb were brought over the transverse piece of wood, which should be exactly adapted in height to the joint which is dislocated (and it is an easy matter so to adjust it, for the step of the ladder should be made a little higher than required, and a convenient robe, folded several times, is to be laid below the patient’s body), then a piece of wood, of suitable breadth and length, is to be laid below the limb, and it should reach from the ankle to beyond the head of the thigh-bone, and should be bound moderately tight to the limb. Then the limb being extended, either by means of the pestle-like piece of wood (formerly described), or by any of the other methods of extension, the limb which is carried over the step with the piece of wood attached to it, is to be forced downward, while somebody grasps the patient above the hip-joint. In this manner the extension will carry the head of the thighbone above the acetabulum, while the lever power that is exercised will push the head of the thigh-bone into its natural seat. All the above-mentioned powers are strong, and more than sufficient to rectify the accident, if properly and skill-fully applied. For, as formerly stated, in most cases reduction may be effected by much weaker extension, and an inferior apparatus.

74. Ἢν δὲ ἐς τὸ ἔξω κεφαλὴ μηροῦ ὀλίσθῃ, τὰς μὲν κατατάσιας

ἔνθα καὶ ἔνθα χρὴ ποιέεσθαι, ὥσπερ εἴρηται, ἢ τοιουτοτρόπως τὴν δὲ μόχλευσιν πλάτος ἔχοντι μοχλῷ μοχλεύειν χρὴ ἅμα τῇ κατατάσει, ἐκ τοῦ ἔξω μέρεος ἐς τὸ ἔσω ἀναγκάζοντα, κατά γε αὐτὸν τὸν γλουτὸν τιθέμενον τὸν μοχλὸν καὶ ὀλίγῳ ἀνωτέρω ἐπὶ δὲ τὸ ὑγιὲς ἰσχίον κατὰ τὸν γλουτὸν ἀντιστηριζέτω τις τῇσι χερσὶν, ὡς μὴ ὑπείκῃ τὸ σῶμα, ἢ ἑτέρῳ τινὶ τοιούτῳ μοχλῷ, ὑποβάλλων καὶ ἐρείσας, ἐκ τῶν καπέτων τὴν ἁρμόζουσαν ἀντικατεχέτω τοῦ δὲ μηροῦ τοῦ ἐξηρθρηκότος τὸ παρὰ τὸ γόνυ ἔσωθεν ἔξω παραγέτω ἡσύχως. Ἡ δὲ κρέμασις οὐχ ἁρμόσει τούτῳ τῷ τρόπῳ τῆς ὀλισθήσιος τοῦ ἄρθρου ὁ γὰρ πῆχυς τοῦ ἐκκρεμαμένου ἀπωθέοι ἂν τὴν κεφαλὴν τοῦ μηροῦ ἀπὸ τῆς κοτύλης. Τὴν μέντοι ξὺν τῷ ξύλῳ τῷ ὑποτεινομένῳ μόχλευσιν μηχανήσαιτ’ ἄν τις, ὥστε ἁρμόζειν καὶ τούτῳ τῷ τρόπῳ τοῦ ὀλισθήματος, ἔξωθεν προσαρτέων. Ἀλλὰ τί καὶ δεῖ πλείω λέγειν; ἢν γὰρ ὀρθῶς μὲν καὶ εὖ κατατείνηται, ὀρθῶς δὲ μοχλεύηται, τί οὐκ ἂν ἐμπέσοι ἄρθρον, οὕτως ἐκπεπτωκός;

74. If the head of the bone slip outward, extension and counter-extension must be made as described, or in a similar manner. But along with the extension a broad lever is to be used to force the bone from without inward, the lever being placed at the nates or a little farther up, and some person is to steady the patient’s body, so that it may not yield, either by grasping him at the buttocks with his hands, or this may be effected by means of another similar lever, adjusted to one of the grooves, while the patient has something laid below him, and he is secured, and the dislocated thigh is to be turned gently from within outward at the knee. Suspension will not answer in this form of dislocation, for, in this instance, the arm of the person suspended from him, would push the head of the thigh-bone from the acetabulum. But one might use the piece of wood placed below him as a lever, in such a manner as might suit with this mode of dislocation; it must work from without. But what use is there for more words? For if the extension be well and properly done, and if the lever be properly used, what dislocation of the joint could occur, that might not be thus reduced?

75. Ἢν δὲ ἐς τοὔπισθεν μέρος ἐκπεπτώκῃ ὁ μηρὸς, τὰς

μὲν κατατάσιας καὶ ἀντιτάσιας οὕτω δεῖ ποιέεσθαι, καθάπερ εἴρηται ἐπιστορέσαντα δὲ ἐπὶ τὸ ξύλον ἱμάτιον πολύπτυχον, ὡς μαλακώτατον ἔῃ, πρηνέα κατακλίναντα τὸν ἄνθρωπον, οὕτω κατανείνειν άμα δὲ τῇ κατατάσει χρὴ τῇ σανίδι καταναγκάζειν τὸν αὐτὸν τρόπον ὡς τὰ ὑβώματα, κατ’ ἴξιν τοῦ πυγαίου ποιησάμενον τὴν σανίδα, καὶ μᾶλλον ἐς τὸ κάτω μέρος, ἢ ἐς τὸ ἄνω τῶν ἰσχίων καὶ ἡ ἐντομὴ, ἡ ἐν τῷ τοίχῳ τῇ σανίδι, μὴ εὐθεῖα ἔστω, ἀλλ’ ὀλίγον καταφερὴς πρὸς τὸ τῶν ποδῶν μέρος. Αὕτη ἡ ἐμβολὴ κατὰ φύσιν τε μάλιστα τῷ τρόπῳ τούτῳ τοῦ ὀλισθήματός ἐστι, καὶ ἅμα ἰσχυροτάτη. Ἀρκέσειε δ’ ἂν ἴσως ἀντὶ τῆς σανίδος καὶ ἐφεζόμενόν τινα, ἢ τῇσι χερσὶν ἐρεισάμενον, ἢ ἐπιβάντα, ἐξαπίνης ἐπαιωρηθῆναι ἅμα τῇ κατατάσει. Ἄλλη δὲ οὐδεμίη ἐμβολὴ τῶν προειρημένων κατὰ φύσιν ἐστὶ τῷ τρόπῳ τούτῳ τοῦ ὀλισθήματος.

75. In dislocation of the thigh, backward, extension and counter-extension should be made as has been described; and having laid on the bench a cloth which has been folded several times, so that the patient may lie soft, he is to be laid on his face, and extension thus made, and, along with the extension, pressure is to be made with a board, as in the case of humpback, the board being placed on the region of the nates, and rather below than above the hip-joint; and the hole made in the wall for the board should not be direct over, but should be inclined a little downward, toward the feet. This mode of reduction is particularly appropriate to this variety of dislocation, and at the same time is very strong. But perhaps, instead of the board, it might be sufficient to have a person sitting ( on the seat of luxation? ), or pressing with his hands, or with his foot, and suddenly raising himself up, along with the extension. None of the other afore-mentioned modes of reduction are natural in this form of dislocation.

76. Ἢν δὲ ἐς τὸ ἔμπροσθεν ὀλίσθῃ, τῶν μὲν κατατασίων ὁ αὐτὸς τρόπος ποιητέος, ἄνδρα δὲ χρὴ ὡς ἰσχυρότατον ἀπὸ χειρῶν καὶ ὡς εὐπαιδευτότατον, ἐνερείσαντα τὸ θέναρ τῆς χειρὸς τῆς ἑτέρης παρὰ τὸν βουβῶνα, καὶ τῇ ἑτέρῃ χειρὶ τὴν ἑωυτοῦ χεῖρα προσκαταλαβόντα, ἅμα μὲν ἐς τὸ κάτω ὠθέειν τὸ

ὀλίσθημα, ἅμα δὲ ἐς τὸ ἔμπροσθεν τοῦ γούνατος μέρος. Οὗτος γὰρ ὁ τρόπος τῆς ἐμβολῆς μάλιστα κατὰ φύσιν τούτῳ τῷ ὀλισθήματί ἐστιν. Ἀτὰρ καὶ ὁ κρεμασμὸς ἐγγύς τι τοῦ κατὰ φύσιν δεῖ μέντοι τὸν ἐκκρεμάμενον ἔμπειρον εἶναι, ὡς μὴ ἐκμοχλεύῃ τῷ πήχεϊ τὸ ἄρθρον, ἀλλὰ περὶ μέσον τὸν περίνεον καὶ κατὰ τὸ ἱερὸν ὀστέον τὴν ἐκκρέμασιν ποιέηται.

76. In dislocation forward, the same mode of extension should be made; but a person who has very strong hands, and is well trained, should place the palm of the one hand on the groin, and taking hold of this hand with the other, is at the same time to push the dislocated part downward, and at the same time to the fore part of the knee. This method of reduction is most especially conformable to this mode of dislocation. And the mode of suspension is also not far removed from being natural, but the person suspended should be well trained, so that his arm may not act as a lever upon the joint, but that the force of the suspension may act about the middle of the perineum, and at the os sacrum.

77. Εὐδοκιμέει δὲ δὴ καὶ ἀσκῷ τοῦτο τὸ ἄρθρον ἐμβάλλεσθαι καὶ ἤδη μέν τινας εἶδον, οἵτινες ὑπὸ φαυλότητος καὶ τὰ ἔξω ἐκκεκλιμένα καὶ τὰ ὄπισθεν ἀσκῷ ἐπειρῶντο ἐμβάλλειν, οὐ γινώσκοντες, ὅτι ἐξέβαλλον αὐτὸ μᾶλλον, ἢ ἐνέβαλλον ὁ μέντοι πρῶτος ἐπινοήσας δῆλον ὅτι πρὸς τὰ ἔσω ὠλισθηκότα, ἀσκῷ ἐμβάλλειν ἐπειρήσατο. Ἐπίστασθαι μὲν οὖν χρὴ, ὡς χρηστέον ἀσκῷ, εἰ δέοι χρέεσθαι, διαγινώσκειν δὲ χρὴ, ὅτι ἕτερα πολλὰ ἀσκοῦ κρέσσω ἐστίν χρὴ δὲ τὸν μὲν ἀσκὸν κατατιθέναι ἐς τοὺς μηροὺς ἀφύσητον ἐόντα, ὡς ἂν δύναιτο, ἀνωτάτω πρὸς τὸν περίνεον ἀνάγοντα ἀπὸ δὲ τῶν ἐπιγουνίδων ἀρξάμενον, ταινίῃ πρὸς ἀλλήλους τοὺς μηροὺς καταδῆσαι ἄχρι τοῦ ἡμίσεος τῶν μηρῶν ἔπειτα ἐς ἕνα τῶν ποδῶν, τὸν λελυμένον, ἐνθέντα αὐλὸν ἐκ χαλκείου, φῦσαν ἐσαναγκάζειν ἐς τὸν ἀσκόν τὸν δὲ ἄνθρωπον

πλάγιον κατακέεσθαι. τὸ σιναρὸν σκέλος ἐπιπολῆς ἔχοντα. Ἡ μὲν οὖν παρασκευὴ αὕτη ἐστίν σκευάζονται δὲ κάκιον οἱ πλεῖστοι, ἢ ὡς ἐγὼ εἴρηκα οὐ γὰρ καταδέουσι τοὺς μηροὺς ἐπὶ συχνὸν, ἀλλὰ μοῦνον τὰ γούνατα. οὐδὲ κατατείνουσι, χρὴ δὲ καὶ προσκατατείνειν ὅμως δὲ ἤδη τινὲς ἐνέβαλον, ῥηϊδίου πρήγματος ἐπιτυχόντες. Εὐφόρως δὲ οὐ πάνυ ἔχει διαναγκάζεσθαι οὕτως ὅ τε γὰρ ἀσκὸς, ἐμφυσώμενος, οὐ τὰ ὀγκηρότατα αὐτοῦ ἔχει πρὸς τῷ ἄρθρῳ τῆς κεφαλῆς, ἣν δεῖ μάλιστα ἐκμοχλεύσασθαι, ἀλλὰ κατὰ ἑωυτὸν αὐτὸς μέσος, καὶ τῶν μηρῶν ἴσως ἢ κατὰ τὸ μέσον ἢ ἔτι κατωτέρω οἵ τε αὖ μηροὶ φύσει γαυσοὶ πεφύκασιν, ἄνωθεν γὰρ σαρκώδεές τε καὶ ξύμμηροι, ἐς δὲ τὸ κάτω ὑπόξηροι, ὥστε καὶ ἡ τῶν μηρῶν φύσις ἀπαναγκάζει τὸν ἀσκὸν ἀπὸ τοῦ ἐπικαιροτάτου χωρίου. Εἴ τε οὖν τις μικρὸν ἐνθήσει τὸν ἀσκὸν, μικρὴ ἡ ἰσχὺς ἐοῦσα ἀδύνατος ἔσται ἀναγκάζειν τὸ ἄρθρον. Εἰ δὲ δεῖ ἀσκῷ χρέεσθαι, ἐπὶ πουλὺ οἱ μηροὶ ξυνδετέοι πρὸς ἀλλήλους, καὶ ἅμα τῇ κατατάσει τοῦ σώματος ὁ ἀσκὸς φυσητέος τὰ δὲ σκέλεα ἀμφότερα ὁμοῦ καὶ καταδέειν ἐν τούτῳ τῷ τρόπῳ τῆς ἐμβολῆς ἐπὶ τὴν τελευτήν.

77. Reduction by the bladder is also celebrated in dislocations at this joint, and I have seen certain persons who, from ignorance, attempted to reduce both dislocations outward and backward therewith, not knowing that they were rather displacing than replacing the parts; it is clear, however, that he who first invented this method intended it for dislocation inward. It is proper, then, to know how the bladder should be used, if it is to be used, and it should be understood that many other methods are more powerful than it. The bladder should be placed between the thighs uninflated, so that it may be carried as far up the perineum as possible, and the thighs beginning at the patella are to be bound together with a swathe, as far up as the middle of the thigh, and then a brass pipe is to be introduced into one of the loose feet of the bladder, and air forced into it, the patient is to lie on his side with the injured limb uppermost. This, then, is the preparation; some, however, do the thing worse than as I have described, for they do not bind the thighs together to any extent, but only at the knees, neither do they make extension, whereas extension should be made, and yet some people by having the good fortune to meet with a favorable case, have succeeded in making reduction. But it is not a convenient method of applying force, for the bladder, when inflated, does not present its most prominent part to the articular extremity of the femur, which is the place that ought to be more especially pressed outward, but its middle, which probably corresponds with the middle of the thigh, or still lower down, for the thighs are naturally curved, being fleshy, and in contact above, and becoming smaller downward, so that the natural configuration of the parts forces the bladder from the most proper place. And if a small bladder be introduced, its power will be small, and unable to overcome the resistance of the articular bone. But if the bladder must be used, the thighs are to be bound together to a considerable extent, and the bladder is to be inflated along with the extension of the body, and in this method of reduction both legs are to be bound together at their extremity.

78. Χρὴ δὲ περὶ πλείστου μὲν ποιέεσθαι ἐν πάσῃ τῇ τέχνῃ, ὅκως ὑγιὲς μὲν ποιήσεις τὸ νοσέον εἰ δὲ πολλοῖσι τρόποισιν οἷόν τε εἴη ὑγιέας ποιέειν, τὸν ἀοχλότατον χρὴ αἱρέεσθαι καὶ γὰρ ἀνδραγαθικώτερον τοῦτο καὶ τεχνικώτερον, ὅστις μὴ ἐπιθυμέει δημοειδέος κιβδηλίης. Περὶ οὗ οὖν ὁ λόγος ἐστὶ, τοιαίδε ἄν τινες κατοικίδιοι κατατάσιες εἶεν τοῦ σώματος, ὥστε ἐκ τῶν παρεόντων τὸ εὔπορον εὑρίσκειν τοῦτο μὲν, εἰ τὰ δεσμὰ τὰ ἱμάντινα μὴ παρείη τὰ μαλθακὰ καὶ προσηνέα, ἀλλ’ ἢ σιδήρεα, ἢ ὅπλα, ἢ σχοινία, ταινίῃσι χρὴ ἢ ἐκρήγμασι τρυχίων ἐρινεῶν περιελίσσειν ταύτῃ μάλιστα, ᾗ μέλλει τὰ δεσμὰ καθέξειν, καὶ ἔτι ἐπὶ πλέον ἔπειτα οὕτω δεῖν τοῖσι δεσμοῖσιν τοῦτο δὲ, ἐπὶ κλίνης χρὴ, ἥτις ἰσχυροτάτη καὶ μεγίστη τῶν παρεουσέων, κατατ ετάσθαι καλῶς τὸν ἄνθρωπον τῆς δὲ κλίνης τοὺς πόδας, ἢ τοὺς πρὸς κεφαλῆς, ἢ τοὺς πρὸς ποδῶν, ἐρηρεῖσθαι πρὸς τὸν οὐδὸν, εἴ τε ἔξωθεν ξυμφέρει, εἴτε ἔσωθεν παρὰ δὲ τοὺς ἑτέρους πόδας παρεμβεβλῆσθαι ξύλον τετράγωνον, πλάγιον, διῆκον ἀπὸ τοῦ ποδὸς πρὸς τὸν πόδα, καὶ, ἢν μὲν λεπτὸν ἔῃ τὸ ξύλον, προσδεδέσθω πρὸς τοὺς πόδας τῆς κλίνης, ἢν δὲ παχὺ ἔῃ, μηδέν ἔπειτα τὰς ἀρχὰς χρὴ τῶν δεσμῶν, καὶ τῶν πρὸς τῆς κεφαλῆς, καὶ τῶν πρὸς

τῶν ποδῶν, προσδῆσαι ἑκατέρας πρὸς ὕπερον, ἢ πρὸς ἄλλο τι τοιοῦτον ξύλον ὁ δὲ δεσμὸς ἐχέτω ἰθυωρίην κατὰ τὸ σῶμα, ἢ καὶ ὀλίγον ἀνωτέρω, ξυμμέτρως δὲ ἐκτετάσθω πρὸς τὰ ὕπερα, ὡς, ὀρθὰ ἑστεῶτα, τὸ μὲν παρὰ τὸν οὐδὸν ἐρείδηται, τὸ δὲ παρὰ τὸ ξύλον τὸ παραβεβλημένον κἄπειτα οὕτω τὰ ὕπερα ἀνακλῶντα χρὴ τὴν κατάτασιν ποιέειν. Ἀρκέει δὲ καὶ κλίμαξ ἰσχυροὺς ἔχουσα τοὺς κλιμακτῆρας, ὑποτεταμένη ὑπὸ τὴν κλίνην, ἀντὶ τοῦ οὐδοῦ τε καὶ τοῦ ξύλου τοῦ παρατεταμένου, ὡς τὰ ὕπερα, πρὸς τῶν κλιμακτήρων τοὺς ἁρμόζοντας ἔνθεν καὶ ἔνθεν προσερηρεισμένα, ἀνακλώμενα, οὕτω τὴν κατάτασιν ποιέηται τῶν δεσμῶν. Ἐμβάλλεται δὲ μηροῦ ἄρθρον καὶ τόνδε τὸν τρόπον, ἢν ἐς τὸ ἔσω ὠλισθήκῃ καὶ ἐς τὸ ἔμπροσθεν κλίμακα χρὴ κατορύξαντα, ἐπικαθίσαι τὸν ἄνθρωπον, ἔπειτα τὸ μὲν ὑγιὲς σκέλος ἡσύχως κατατείναντα προσδῆσαι, ὅκου ἂν ἁρμόσῃ, ἐκ δὲ τοῦ σιναροῦ ἐς κεράμιον ὕδωρ ἐγχέαντα ἐκκρεμάσαι ἢ ἐς σφυρίδα λίθους ἐμβαλόντα. Ἕτερος τρόπος ἐμβολῆς ἢν ἐς τὸ ἔσω

ὠλισθήκῃ, στρωτῆρα χρὴ διαδῆσαι μεταξὺ δύο στύλων, ὕψος ἔχοντα σύμμετρον προεχέτω δὲ τοῦ στρωτῆρος κατὰ τὸ ἓν μέρος δκόσον τὸ πυγαῖον περιδήσας δὲ περὶ τὸ στῆθος τοῦ ἀνθρώπου ἱμάτιον, ἐπικαθίσαι τὸν ἄνθρωπον ἐπὶ τὸ προέχον τοῦ στρωτῆρος εἶτα προσλαβεῖν τὸ στῆθος πρὸς τὸν στύλον πλατέϊ τινί ἔπειτα τὸ μὲν ὑγιὲς σκέλος κατεχέτω τις, ὡς μὴ περισφάλληται ἐκ δὲ τοῦ σιναροῦ ἐκκρεμάσαι βάρος, ὅσον ἂν ἁρμόζῃ, ὡς καὶ πρόσθεν ἤδη εἴρηται.

78. The prime object of the physician in the whole art of medicine should be to cure that which is diseased; and if this can be accomplished in various ways, the least troublesome should be selected; for this is more becoming a good man, and one well skilled in the art, who does not covet popular coin of base alloy. With regard to the subject now on hand, the following are domestic means of making extension of the body, so that it is easy to choose from among the things at hand:-In the first place, when soft and supple thongs are not at hand for ligatures, either iron chains, or cords, or cables of ships, are to be wrapped round with scarfs or pieces of woolen rags, especially at the parts of them which are to be applied, and in this state they are to be used as bands. In the second place, the patient is to be comfortably laid on the strongest and largest couch that is at hand, and the feet of the couch, either those at the ( patient’s? ) head, or those at the feet, are to be fastened to the threshold, either within or without, as is most suitable; and a square piece of wood is to be laid across, and extending from the one foot to the other; and if this piece of wood be slender, it should be bound to the feet of the couch, but, not withstanding, if it be thick, there will be no necessity for this; then the heads of the ligatures, both of those at the head and those at the feet, are to be fastened to a pestle, or some such piece of wood, difficult to reduce at either end; the ligatures should run along the line of the body, or be a little elevated above it, and it should be stretched proportionally to the pestles, so that, standing erect, the one may be fastened to the threshold, and the other to the transverse piece of wood. Extension is then to be made by bending back the ends of the pestles. A ladder, having strong steps, if laid below the bed, will serve the purpose of the threshold and the piece of wood laid along ( the foot of the couch? ), as the pestles can be fastened to the steps at either end, and when drawn back they thus make extension of the ligatures. Dislocation, inward or forward, may be reduced in the following manner: a ladder is to be fastened in the ground, and the man is to be seated upon it, and then the sound leg is to be gently stretched along and bound to it, wherever it is found convenient; and water is to be poured into an earthen vessel, or stones put into a hamper and slung from the injured leg, so as to effect the reduction. Another mode of reduction: a cross-beam is to be fastened between two pillars of moderate height; and at one part of the cross-beam there should be a protuberance proportionate to the size of the nates; and having bound a coverlet round the patient’s breast, he is to be seated on the protuberant part of the cross-beam, and afterward the breast is to be fastened to the pillar by some broad ligature; then some one is to hold the sound leg so that he may not fall off, and from the injured limb is to be suspended some convenient weight, as formerly described.

79. Πρῶτον μὲν οὖν δεῖ εἰδέναι, ὅτι πάντων τῶν ὀστέων αἱ ξυμβολαί εἰσιν ὡς ἐπὶ πουλὺ ἡ κεφαλὴ καὶ ἡ κοτύλη ἐφ’ ὧν δὲ καὶ ἡ χώρα κοτυλοειδὴς καὶ ἐπίμακρος ἔνιαι δὲ τῶν χωρέων γληνοειδέες εἰσίν. Ἀεὶ δὲ ἐμβάλλειν δεῖ πάντα τὰ ἐκπίπτοντα ἄρθρα, μάλιστα μὲν εὐθὺς παραχρῆμα ἔτι θερμῶν ἐόντων εἰ δὲ μὴ, ὡς τάχιστα καὶ γὰρ τῷ ἐμβάλλοντι ῥηΐτερον καὶ θᾶσσόν ἐστιν ἐμβαλεῖν, καὶ τῷ ἀσθενέοντι πουλὺ ἀπονωτέρη ἡ ἐμβολὴ, ἡ πρὶν διοιδεῖν, ἐστιν. Δεῖ δὲ ἀεὶ πάντα τὰ ἄρθρα, ὁκόταν μέλλῃς ἐμβάλλειν, προαναμαλάξαι καὶ διακιγκλίσαι ῥᾷον γὰρ ἐθέλει

ἐμβάλλεσθαι. Παρὰ πάσας δὲ τὰς τῶν ἄρθρων ἐμβολὰς ἰσχναίνειν δεῖ τὸν ἄνθρωπον, μάλιστα μὲν περὶ τὰ μέγιστα ἄρθρα καὶ χαλεπώτατα ἐμβάλλεσθαι, ἥκιστα δὲ περὶ τὰ ἐλάχιστα καὶ ῥηΐδια.

79. It should be particularly known that the union of all bones is, for the most part, by a head and socket ( cotyle ); in some of these the place ( socket? ) is cotyloid and oblong, and in some the socket is glenoid ( shallow? ). In all dislocations reduction is to be effected, if possible, immediately, while still warm, but otherwise, as quickly as it can be done; for reduction will be a much easier and quicker process to the operator, and a much less painful one to the patient, if effected before swelling comes on. But all the joints when about to be reduced should be first softened, and gently moved about; for, thus they are more easily reduced. And, in all cases of reduction at joints, the patient must be put on a spare diet, but more especially in the case of the greatest joints, and those most difficult to reduce, and less so in those which are very small and easily reduced.

80. Δακτύλων δὲ ἢν ἐκπέσῃ ἄρθρον τι τῶν τῆς χειρὸς, ἤν τε τὸ πρῶτον, ἤν τε τὸ δεύτερον, ἤν τε τὸ τρίτον, ωὑτὸς καὶ ἴσος τρόπος τῆς ἐμβολῆς χαλεπώτερα μέντοι ἀεὶ τὰ μέγιστα τῶν ἄρθρων ἐμβάλλειν. Ἐκπίπτει δὲ κατὰ τέσσαρας τρόπους, ἢ ἄνω, ἢ κάτω, ἢ ἐς τὸ πλάγιον ἑκατέρωθεν, μάλιστα μὲν ἐς τὸ ἄνω, ἥκιστα δὲ ἐς τὰ πλάγια, ἐν τῷ σφόδρα κινέεσθαι. Ἑκατέρωθεν δὲ τῆς χώρης, οὗ ἐκβέβηκεν, ὥσπερ ἄμβη ἐστίν. Ἢν μὲν οὖν ἐς τὸ ἄνω ἐκπέσῃ ἢ ἐς τὸ κάτω διὰ τὸ λειοτέρην εἶναι ταύτην τὴν χώρην, ἢ ἐκ τῶν πλαγίων, καὶ ἅμα μικρῆς ἐούσης τῆς ὑπερβάσιος, ἢν μεταστῇ τὸ ἄρθρον, ῥηΐδιόν ἐστιν ἐμβάλλειν. Τρόπος δὲ τῆς ἐμβολῆς ὅδε περιελίξαι τὸν δάκτυλον ἄκρον ἢ ἐπιδέσματί τινι ἢ ἄλλῳ τρόπῳ τοιούτῳ τινὶ, ὅκως, ὁκόταν κατατείνῃς ἄκρου λαβόμενος, μὴ. ἀπολισθάνῃ ὅταν δὲ περιελίξῃς, τὸν μέν τινα διαλαβέσθαι ἄνωθεν τοῦ καρποῦ τῆς χειρὸς, τὸν δὲ τοῦ κατειλημμένου ἔπειτα κατατείνειν πρὸς ἑωυτὸν ἀμφοτέρους εὖ μάλα, καὶ ἅμα ἀπῶσαι τὸ ἐξεστηκὸς ἄρθρον ἐς τὴν χώρην. Ἢν δὲ ἐς τὰ πλάγια ἐκπέσῃ, τῆς μὲν κατατάσιος ωὑτὸς τρόπος ὅταν δὲ δὴ δοκέῃ σοι ὑπερβεβηκέναι τὴν γραμμὴν, ἅμα χρὴ κατατείναντας ἀπῶσαι ἐς τὴν χώρην εὐθὺς, ἕτερον δέ τινα ἐκ τοῦ ἑτέρου μέρεος τοῦ δακτύλου φυλάσσειν καὶ ἀνωθέειν, ὅκως μὴ πάλιν ἐκεῖθεν ἀπολίσθῃ. Ἐμβάλλουσι δὲ ἐπιεικέως

καὶ αἱ σαῦραι αἱ ἐκ τῶν φοινίκων πλεκόμεναι, ἢν κατατείνῃς ἔνθεν καὶ ἔνθεν τὸν δάκτυλον, λαβόμενος τῇ μὲν ἑτέρῃ τῆς σαύρης, τῇ δὲ ἑτέρῃ τοῦ καρποῦ τῆς χειρός. Ὁκόταν δὲ ἐμβάλῃς, ἐπιδεῖν δεῖ ὀθονίοισιν ὡς τάχιστα, λεπτοτάτοισι, κεκηρωμένοισι κηρωτῇ μήτε λίην μαλακῇ μήτε λίην σκληρῇ, ἀλλὰ μετρίως ἐχούσῃ ἡ μὲν γὰρ σκληρὴ ἀφέστηκεν ἀπὸ τοῦ δακτύλου, ἡ δὲ ἁπαλὴ καὶ ὑγρὴ διατήκεται καὶ ἀπόλλυται, θερμαινομένου τοῦ δακτύλου λύειν δὲ ἄρθρον δακτύλου τριταῖον ἢ τεταρταῖον τὸ δὲ ὅλον, ἢν μὲν φλεγμήνῃ, πυκνότερον λύειν, ἢν δὲ μὴ, ἀραιότερον κατὰ πάντων δὲ τῶν ἄρθρων ταῦτα λέγω. Καθίσταται δὲ τοῦ δακτύλου τὸ ἄρθρον τεσσαρεσκαιδεκαταῖον. Ὁ αὐτὸς δέ ἐστι θεραπείης τρόπος δακτύλων χειρός τε καὶ ποδός.

80. If any joint of the fingers is dislocated, whether the first, second, or the third, the same method of reduction is to be applied, but the largest joints are the most difficult to reduce. There are four modes of displacement-either upward, downward, or to either side; most commonly upward, and most rarely laterally, and in consequence of violent motion. On both sides of its articular cavity there is a sort of raised border. When the dislocation is upward or downward, owing to the articular cavity having smoother edges there than at the sides, if the joint of it be dislocated, it is more easily reduced. This is the mode of reduction:-The end of the finger is to be wrapped round with a fillet, or something such, that, when you lay hold of it and make extension, it will not slip; and when this is done, some person is to grasp the arm at the wrist, and another is to take hold of the finger which is wrapped in the fillet, and then each is to make considerable extension toward himself, and at the same time the projecting bone is to be pushed into its place. But, if the dislocation be lateral, the same mode of reduction is to be used; but when you think that the extremity of the bone has cleared the rim, at the same time that extension is made, the bone is to be pushed direct into its place, while another person on the other side of the finger is to take care and make counter-pressure, so that it may not again slip out there. The twisted nooses formed from palm-shoots are convenient for effecting reduction, if you will make extension and counter-extension by holding the twisted string in the one hand and the wrist in the other. When reduced, you must bind the part as quickly as possible with bandages; these are to be very slender and waxed with cerate, neither very soft nor very hard, but of middle consistence; for that which is hard drops off from the finger, while that which is soft and liquid is melted and lost by the increased heat of the finger. The bandage is to be loosed on the third or fourth day; but on the whole, if inflamed, it is to be the more frequently loosed, and if otherwise, more rarely; this I say respecting all the joints. The articulation of a finger is restored in fourteen days. The treatment of the fingers and of the toes is the same.

81. Παρὰ πάσας δὲ τὰς τῶν ἄρθρων ἐμβολὰς δεῖ ἰσχναίνειν καὶ λιμαγχονέειν ἄχρι ἑβδόμης καὶ εἰ μὲν φλεγμαίνοι, πυκνότερον λύειν, εἰ δὲ μὴ, ἀραιότερον ἡσυχίην δὲ δεῖ ἔχειν ἀεὶ τὸ πονέον ἄρθρον, καὶ ὡς κάλλιστα ἐσχηματισμένον κέεσθαι.

81. After all reductions of joints the patient should be confined to a restricted diet and abstinence until the seventh day; and if there be inflammation, the bandages are to be the more frequently loosed, but otherwise, less frequently, and the pained joint is to be kept constantly in a state of rest, and is to be laid in the most convenient position possible.

82. Γόνυ δὲ εὐηθέστερον ἀγκῶνος διὰ τὴν εὐσταλίην καὶ τὴν εὐφυΐην, διὸ καὶ ἐκπίπτει καὶ ἐμπίπτει ῥᾷον ἐκπίπτει δὲ πλειστάκις ἔσω, ἀτὰρ καὶ ἔξω καὶ ὄπισθεν. Ἐμβολαὶ δὲ, ἐκ

τοῦ ξυγκεκάμφθαι ἢ ἐκλακτίσαι ὀξέως, ἢ ξυνελίξας ταινίης ὄγκον, ἐν τῇ ἰγνύϊ θεὶς, ἀμφὶ τοῦτον ἐξαίφνης ἐς ὄκλασιν ἀφιέναι τὸ σῶμα. Δύναται δὲ καὶ κατατεινόμενον μετρίως, ὥσπερ ἀγκὼν, ἐμπίπτειν, τὰ ὄπισθεν τὰ δὲ ἔνθα ἢ ἔνθα, ἐκ τοῦ ξυγκεκάμφθαι, ἢ ἐκλακτίσαι, ἀτὰρ καὶ ἐκ κατατάσιος μετρίης. Ἡ διόρθωσις ἅπασι κοινή. Ἢν δὲ μὴ ἐμπέσῃ, τοῖσι μὲν ὄπισθεν, ξυγκάμπτειν οὐ δύνανται, ἀτὰρ οὐδὲ τοῖσιν ἄλλοισι πάνυ μινύθει δὲ μηροῦ καὶ κνήμης τοὔμπροσθεν ἢν δὲ ἐς τὸ ἔσω, βλαισότεροι, μινύθει δὲ τὰ ἔξω ἢν δὲ ἐς τὸ ἔξω, γαυσότεροι, χωλοὶ δὲ ἧσσον, κατὰ γὰρ τὸ παχύτερον ὀστέον ὀχέει, μινύθει δὲ τὰ ἔσω, Ἐκ γενεῆς δὲ καὶ ἐν αὐξήσει κατὰ λόγον τὸν πρόσθεν.

82. Accidents at the knee are more mild than at the elbow, from its being compact, regular, and elegant in its construction; and, therefore, it is more readily dislocated and reduced. It is most frequently dislocated inward, but also outward and backward. The modes of reduction are these: by flexion at the knee, or by sudden calcitration, or having rolled a swathe into a ball, and fixed it in the ham, the patient’s body is to be suddenly dropped on its bended knees. Dislocation backward, also, as in the case of the elbow, may be reduced by moderate extension, and to either side, either by flexion or calcitration, but also by moderate extension. The adjustment is the same in all cases. In dislocations backward which are not reduced, the patient cannot bend the joint, but neither can he, to any great extent, in the other varieties; the thigh and leg are wasted in front; but if inward the patients become bow-legged, and the external parts are wasted; but if outward they become more bandy-legged, but the impediment is less, for the body is supported on the larger of the bones, and the inner parts are wasted. When these accidents happen at birth or during adolescence, they follow the rule formerly stated.

83. Τὰ δὲ κατὰ τὰ σφυρὰ, κατατάσιος ἰσχυρῆς δέεται, ἢ τῇσι χερσὶν, ἢ ἄλλοισι τοιούτοισι, κατορθώσιος δὲ ἅμα ἀμφότερα ποιεούσης κοινὸν δὲ τοῦτο ἅπασιν.

83. Dislocations at the ankle-joints require strong extension, either with the hands or some such means; and adjustment, which at the same time effects both purposes, as is common in all cases.

84. Τὰ δὲ ἐν ποδὶ, ὡς καὶ τὰ ἐν χειρὶ, ὑγιέες.

84. Injuries of the foot are to be remedied like those of the hand.

85. Τὰ δὲ τῆς κνήμης ξυγκοινωνέοντα, καὶ ἐκπεσόντα ἐκ γενεῆς, ἢ καὶ ἐν αὐξήσει ἐξαρθρήσαντα, ταὐτὰ ἃ καὶ ἐν χειρί.

85. The bones connected with the leg, and which are dislocated, either at birth or during adolescence, follow the same course as those in the hand.

86. Ὁκόσοι δὲ πηδήσαντες ἄνωθεν ἐστηρίξαντο τῇ πτέρνῃ, ὥστε διαστῆναι τὰ ὀστέα, καὶ φλέβας ἐκχυμωθῆναι, καὶ νεῦρα ἀμφιφλασθῆναι, ὁκόταν γένηται οἷα τὰ δεινὰ, κίνδυνος μὲν σφακελίσαντα τὸν αἰῶνα πρήγματα παρασχεῖν ῥοιώδη μὲν γὰρ τὰ ὀστέα, τὰ δὲ νεῦρα ἀλλήλοισι κοινωνέοντα. Ἐπεὶ καὶ οἷσιν ἂν μάλιστα κατεηγεῖσιν, ἢ ὑπὸ τρώματος ἢ ἐν κνήμῃ, ἢ ἐν μηρῷ, ἢ νεύρων ἀπολυθέντων, ἃ κοινωνέει τούτων, ἢ ἐκ κατακλίσιος ἀμελέος ἐμελάνθη πτέρνη, καὶ τούτοισι τὰ παλιγκοτέοντα ἐκ τῶν τοιούτων. Ἔστιν ὅτε καὶ πρὸς τῷ σφακελισμῷ γίνονται πυρετοὶ ὀξέες, λυγμώδεες, γνώμης ἁπτόμενοι, ταχυθάνατοι, καὶ ἔτι φλεβῶν αἱμορροιέων πελιώσιες. Σημήϊα δὲ τῶν παλιγκοτησάντων, ἢν τὰ ἐκχυμώματα καὶ τὰ μελάσματα καὶ τὰ περὶ ταῦτα ὑπόσκληρα καὶ ὑπέρυθρα ἤν τε ξὺν σκληρύσματι πελιδνωθῇ, κίνδυνος μελανθῆναι

ἢν δὲ ὑποπέλια ᾖ, ἢ καὶ πέλια μάλα καὶ ἐκκεχυμωμένα, ἢ ὑπόχλωρα καὶ μαλακὰ, ταῦτα ἐπὶ πᾶσι τοῖσι τοιούτοισιν ἀγαθά. Ἴησις, ἢν μὲν ἀπύρετος ἔῃ, ἐλλέβορον ἢν δὲ μὴ, μή ἀλλὰ ποτὸν ὀξύγλυκυ, εἰ δέοι. Ἐπίδεσις δὲ, ἄρθρων ἐπὶ δὲ πάντα, μᾶλλον τοῖσι φλάσμασιν, ὀθονίοισι πλείοσι καὶ μαλθακωτέροισιν πίεξις ἧσσον προσπεριβάλλειν δὲ τὰ πλεῖστα τῇ πτέρνῃ. Τὸ σχῆμα, ὅπερ ἡ ἐπίδεσις, ὡς μὴ ἐς τὴν πτέρνην ἀποπιέζηται. Νάρθηξι δὲ μὴ χρέεσθαι.

86. When persons jumping from a height pitch on the heel, so as to occasion separation ( diastasis ) of the bones, ecchymosis of the veins, and contusion of the nerves; when these symptoms are very violent there is danger of sphacelus, and that the case may give trouble during life, for the bones are so constructed as to slip from one another, and the nerves communicate together. And, indeed, in cases of fracture, either from an injury in the leg or thigh, or in paralysis of the nerves ( tendons? ) connected with these parts, or from neglect during confinement to bed, when the heel gets blackened the most serious consequences result therefrom. Sometimes, in addition to the sphacelus, there come on acute fevers accompanied with hiccup, aberration of intellect, and speedy death, with lividities of the large blood-vessels. With regard to the symptoms attending exacerbations, if the ecchymosed and blackened parts and those around be somewhat hard and red, and if along with the hardness there be lividity, mortification is to be apprehended; but if the parts be slightly livid, or even very livid, and the swelling diffused, or if greenish and soft, these appearances, in such cases, are all favorable. The treatment, if no fever be present, consists in the administration of hellebore, but otherwise (it is not to be given, but oxyglyky ( decoction of honeycombs and vinegar ) is to be given for drink, if required. Bandaging as in the other articulations: above all, more especially in contusions, the bandages should be numerous and softer than usual, but the compression should be less; most turns should be made around the heel. Position, like the bandaging, should be so regulated as not to determine to the heel. Splints are not to be used.

87. Οἷσι δ’ ἂν ἐκβῇ ὁ ποὺς ἢ αὐτὸς, ἢ ξὺν τῇ ἐπιφύσει, ἐκπίπτει μὲν μᾶλλον ἐς τὸ ἔσω. Ἢν δὲ μὴ ἐμπέσῃ, λεπτύνεται ἀνὰ χρόνον τό τε ἰσχίον καὶ ὁ μηρὸς καὶ κνήμης τὸ ἀντίον τοῦ ὀλισθήματος. Ἐμβολὴ δὲ ἄλλη, ὥσπερ καρποῦ, κατάτασις δὲ ἰσχυρή. Ἴησις δὲ, νόμος ἄρθρων. Παλιγκοτέει, ἧσσον δὲ καρποῦ, ἢν ἡσυχάσωσιν. Δίαιτα μείων, ἐλινύουσιν. Τὰ δὲ ἐκ γενεῆς ἢ ἐν αὐξήσει, κατὰ λόγον τὸν πρότερον.

87. When the foot is dislocated, either alone or along with its epiphysis, the displacement is, for the most part, to the inside. If not reduced, in the course of time, the hip, the thigh, and the side of the leg opposite the dislocation, become atrophied. Reduction is the same as in the wrist, but the extension requires to be very powerful. Treatment, agreeably to the general rule for joints. Exacerbations do occur, but less frequently than in dislocations at the wrist, provided the parts get rest. While they remain at rest the diet should be restricted. Those which occur at birth, or during adolescence, follow the rule formerly stated.