instruments of reduction-第1部分

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　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　400　BC
　　　　　　　　　　　　　　　　　　　　　　　　　　　　INSTRUMENTS　OF　REDUCTION

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　by　Hippocrates

　　　　　　　　　　　　　　　　　　　　　　　　　　translated　by　Francis　Adams


　Part　1

　　With　regard　to　the　construction　of　bones；　the　bones　and　joints　of
the　fingers　are　simple；　the　bones　of　the　hand　and　foot　are　numerous；
and　articulated　in　various　ways；　the　uppermost　are　the　largest；　the
heel　consists　of　one　bone　which　is　seen　to　project　outward；　and　the
back　tendons　are　attached　to　it。　The　leg　consists　of　two　
bones；　united
together　above　and　below；　but　slightly　separated　in　the　middle；　the
external　bone　（fibula）；　where　it　comes　into　proximity　with　the
little　toe；　is　but　slightly　smaller　than　the　other；　more　so　
where　they
are　separated；　and　at　the　knee；　the　outer　hamstring　arises　from　it；
these　bones　have　a　common　epiphysis　below；　with　which　the　foot　is
moved；　and　another　epiphys　is　above；*　in　which　is　moved　the
articular　extremity　of　the　femur；　which　is　simple　and　light　in
proportion　to　its　length；　in　the　form　of　a　condyle；　and　having　the
patella　（connected　with　it？）；　the　femur　itself　bends　outward　and
forward；　its　head　is　a　round　epiphysis　which　gives　origin　to
ligament　inserted　in　the　acetabulum　of　the　hip…joint。　This　bone　is
articulated　somewhat　obliquely；　but　less　so　than　the　humerus。　The
ischium　is　united　to　the　great　vertebra　contiguous　to　the　os　
sacrum　by
a　cartilaginous　ligament。　The　spine；　from　the　os　sacrum　to　the　great
vertebra；　is　curved　backward；　in　this　quarter　are　situated　the
bladder；　the　organs　of　generation；　and　the　inclined　portion　of　the
rectum；　from　this　to　the　diaphragm　it　proceeds　in　a　straight　line
inclining　forward；　and　the　psoae　are　situated　there；　from　this
point；　to　the　great　vertebra　above　the　tops　of　the　
shoulders；　it　rises
in　a　line　that　is　curved　backward；　and　the　curvature　appears　greater
than　it　is　in　reality；　for　the　posterior　processes　of　the　spine　are
there　highest；　the　articulation　of　the　neck　inclines　forward。　The
vertebrae　on　the　inside　are　regularly　placed　upon　one　another；　but
behind　they　are　connected　by　a　cartilaginous　ligament；　they　are
articulated　in　the　form　of　synarthrosis　at　the　back　part　of　
the　spinal
marrow；　behind　they　have　a　sharp　process　having　a　cartilaginous
epiphysis；　whence　proceeds　the　roots　of　nerves　running　downward；　as
also　muscles　extending　from　the　neck　to　the　loins；　and　filling　the
space　between　the　ribs　and　the　spine。　The　ribs　are　connected　to　all
the　intervertebral　spaces　on　the　inside；　from　the　neck　to　the　lumbar
region；　by　a　small　ligament；　and　before　to　the　sternum；　their
extremities　being　spongy　and　soft；　their　form　is　the　most　arched　in
man　of　all　animals；　for　in　this　part；　man　is；　of　all　animals；　the
narrowest　in　proportion　to　his　bulk。　The　ribs　are　united　to　each
vertebra　by　a　small　ligament　at　the　place　from　which　the　short　and
broad　lateral　processes　（transverse　processes？）　arise。　The　sternum
is　one　continuous　bone；　having　lateral　pits　for　the　insertion　of　the
ribs；　it　is　of　a　spongy　and　cartilaginous　structure。　The　
clavicles　are
rounded　in　front；　having　some　slight　movements　at　the　sternum；　but
more　free　at　the　acromion。　The　acromion；　in　man；　arises　from　the
scapula　differently　from　most　other　animals。　The　scapula　is
cartilaginous　toward　the　spine；　and　spongy　elsewhere；　having　an
irregular　figure　externally；　its　neck　and　articular　cavity
cartilaginous；　it　does　not　interfere　with　the　movements　of　the　ribs；
and　is　free　of　all　connection　with　the　other　bones；　except　the
humerus。　The　head　of　the　humerus　is　articulated　with　its　（glenoid？）
cavity；　by　means　of　a　small　ligament；　and　it　consists　of　a　rounded
epiphysis　composed　of　spongy　cartilage；　the　humerus　itself　is　bent
outward　and　forward；　and　it　is　articulated　with　its　（glenoid？）
cavity　by　its　side；　and　not　in　a　straight　line。　At　the　elbow　it　is
broad；　and　has　condyles　and　cavities；　and　is　of　a　solid　consistence；
behind　it　is　a　cavity　in　which　the　coronoid　process　（olecranon？）　of
the　ulna　is　lodged；　when　the　arm　is　extended；　here；　too；　is　inserted
the　benumbling　nerve；　which　arises　from　between　the　two　bones　of　the
forearm　at　their　junction；　and　terminates　there。

　　*　Epiphysis　means　a　close　union　of　the　two　bones　by　means　of　a
ligament。

　Part　2
When　the　nose　is　fractured；　the　parts　should　be　modeled
instantly；　if　possible。　If　the　fracture　be　in　its　cartilaginous
part；　introduce　into　the　nostrils　a　tent　formed　of　caddis；　
inclosed　in
the　outer　skin　of　a　Carthaginian　hide；　or　anything　else　
which　does　not
irritate；　the　skin　is　to　be　glued　to　the　parts　displaced；　
which　are　to
be　thus　rectified。　Bandaging　in　this　case　does　mischief。　The　
treatment
is　to　consist　of　flour　with　manna；　or　of　sulphur　with　
cerate。　You　will
immediately　adjust　the　fragments；　and　afterward　retain　them　in　place
with　your　fingers　introduced　into　the　nostrils；　and　turning　the
parts　into　place；　then　the　Carthaginian　skin　is　to　be　used。　Callius
forms　even　when　there　is　a　wound；　and　the　same　things　are　to　be
done；　even　when　there　is　to　be　exfoliation　of　the　bones；　for　this　is
not　of　a　serious　nature。

　Part　3
In　fractures　of　the　ears；　neither　bandages　nor　cataplasms
should　be　used；　or；　if　any　bandage　be　used；　it　should　be　put　on　very
tight；　the　cerate　and　sulphur　should　be　applied　to　agglutinate　the
bandages。　When　matter　forms　in　the　ears；　it　is　found　to　be　
more　deeply
seated　than　might　be　supposed；　for　all　parts　that　are　pulpy；　and
consist　of　juicy　flesh；　prove　deceptious　in　such　a　case。　But　no　harm
will　result　from　making　an　opening；　for　the　parts　are　lean；　watery；
and　full　of　mucus。　No　mention　is　here　made　of　the　places　and
circumstances　which　render　it　fatal　to　make　an　opening。　The　cure　is
soonest　effected　by　transfixing　the　ear　with　a　cautery；　but　
the　ear　is
maimed　and　diminished　in　size；　if　burned　across。　If　opened；　
one　of　the
gentle　medicines　for　flesh　wounds　should　be　used　as　a　dressing。

　Part　4
The　jaw…bone　is　often　slightly　displaced　（subluxated？）；　and　is
restored　again；　it　is　dislocated　but　rarely；　especially　in　gaping；
in　fact；　the　bone　is　never　dislocated　unless　it　slips　while　the
mouth　is　opened　wide。　It　slips；　however；　the　more　readily　from　its
ligaments　being　oblique；　supple；　and　of　a　yielding　nature。　The
symptoms　are：　the　lower　jaw　protrudes；　it　is　distorted　to　the　side
opposite　the　dislocation；　and　the　patient　cannot　shut　his　mouth；
when　both　sides　are　dislocated；　the　jaw　projects　more；　the　mouth　can
be　less　shut；　but　there　is　no　distortion；　this　is　shown　by　
the　rows　of
the　teeth　in　the　upper　and　lower　jaw　corresponding　with　one　another。
If；　then；　both　sides　be　dislocated；　and　not　immediately　reduced；　the
patient　for　the　most　part　dies　on　the　tenth　day；　with　symptoms　of
continued　fever；　stupor；　and　coma；　for　the　muscles　there　induce　such
effects；　there　is　disorder　of　the　bowels　attended　with　scanty　and
unmixed　dejection；　and　the　vomitings；　if　any；　are　of　the　same
character。　The　other　variety　is　less　troublesome。　The　method　of
reduction　is　the　same　in　both：…The　patient　being　laid　down　or
seated；　the　physician　is　to　take　hold　of　his　head；　and　grasping　both
sides　of　the　jaw…bone　with　both　hands；　within　and　without；　he　must
perform　three　manoeuvres　at　once；…rectify　the　position　of　the　jaw；
push　it　backward；　and　shut　the　mouth。　The　treatment　should　consist
of　soothing　applications；　position；　and　applying　a　suitable　
bandage　to
support　the　jaw…bone；　so　as　to　cooperate　with　the　reduction。

　Part　5
The　bone　of　the　shoulder　is　dislocated　downward。　I　have　never
heard　of　any　other　mode。　The　parts　put　on　the　appearance　of
dislocation　forward；　when　the　flesh　about　the　joint　is　wasted　during
consumption；　as　also　seems　to　be　the　case　with　cattle　when　in　a
state　of　leanness　after　winter。　Those　persons　are　most　liable　to
dislocations　who　are　thin；　slender；　and　have　humidities　about　their
joints　without　inflammation；　for　it　knits　the　joints。　Those　who
attempt　to　reduce　and　rectify　dislocations　in　oxen；　commit　a
blunder；　as　forgetting　that　the　symptoms　arise　from　the　manner　in
which　the　ox　uses　the　limb；　and　that　the　appearance　is　the　same　in　a
man　who　is　in　a　similar　condition；　and　forgetting　also　that　Homer
has　said；　that　oxen　are　most　lean　at　that　season。　In　this　
dislocation；
then；　when　not　reduced；　the　patient　cannot　perform　any　of　those　acts
which　others　do；　by　raising　the　arm　from　the　side。　I　have　thus
stated　who　are　the　persons　most　subject　to　this　dislocation；　and　how
they　are　affected。　In　congenital　dislocations　the　nearest　bones　are
most　shortened；　as　is　the　case　with　persons　who　are　weasel…armed；
the　fore…arm　less　so；　and　the　hand　still　less；　the　bones　
above　are　not
affected。　And　the　parts　（near　the　seat　of　the　injury）　are　most
wasted　in　flesh；　and　this　happens　more　especially　on　the　side　of　the
arm　opposite　the　dislocation；　and　that　during　adolescence；　yet　in　a
somewhat　less　degree　than　in　congenital　cases。　The　deep…seated
suppurations　occur　most　frequently　to　new…born　infants　about　
the　joint
of　the　shoulder；　and　these　produce　the　same　consequences　as
dislocations。　In　adults；　the　bones　are　not　so　diminished　in　size；
and　justly