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Hippocrates · On Injuries of the Head §15-17

Care of Surrounding Flesh, Bone Exfoliation, and Depressed Fractures

Passage 9 of 11 · Greek

Summary

Discusses the importance of treating surrounding flesh to protect the bone and dura mater, details how to promote the exfoliation of dead bone, and advises against premature intervention in depressed fractures, allowing the bone to rise naturally through flesh regeneration.

§1515.
15.
Φυλάσσεσθαι δὲ χρὴ, ὅκως μή τι κακὸν ἀπολαύσῃ τὸ ὀστέον ἀπὸ τῆς σαρκὸς, ἢν κακῶς ἰητρεύηται.
And one must take care lest the bone should suffer some mischief from the flesh, if it is badly treated.
Ὀστέῳ γὰρ καὶ πεπρισμένῳ, καὶ ἄλλως ἐψιλωμένῳ, ὑγιεῖ δὲ ἐόντι, καὶ ἔχοντί τι σίνος ὑπὸ τοῦ βέλεος, δοκέοντι δὲ ὑγιεῖ εἶναι, κίνδυνός ἐστι μᾶλλον ὑπόπυον γενέσθαι (ἢν καὶ ἄλλως μὴ μέλλῃ), ἢν καὶ ἡ σὰρξ ἡ περιέχουσα τὸ ὀστέον κακῶς θεραπεύηται, καὶ φλεγμαίνηται, καὶ περισφίγγηται·
For in the case of a bone which has been sawed, or otherwise bared, but is sound, and also one which has suffered some injury from the missile but seems to be sound, there is a greater danger of its becoming suppurated (even if it would not otherwise be so), if the flesh surrounding the bone is badly treated, and becomes inflamed, and is constricted.
πυρετῶδες γὰρ γίγνεται, καὶ πολλοῦ φλογμοῦ πλέον.
For it becomes feverish and full of much inflammation.
Καὶ δὴ τὸ ὀστέον ἐκ τῶν περιεχουσῶν σαρκέων ἐς ἑωυτὸ θέρμην τε καὶ φλογμὸν καὶ ἄραδον ἐμποιέει καὶ σφυγμὸν, καὶ ὅσα περ ἡ σὰρξ ἔχει κακὰ ἐν ἑωυτέῃ, καὶ ἐκ τουτέων ὧδε ὑπόπυον γίνεται.
And indeed the bone draws into itself from the surrounding flesh heat, inflammation, disturbance, throbbing, and whatever evils the flesh has in itself, and from these things it thus becomes suppurated.
Κακὸν δὲ καὶ ὑγρήν τε εἶναι τὴν σάρκα ἐν τῷ ἕλκει καὶ μυδῶσαν, καὶ ἐπὶ πολλὸν χρόνον καθαίρεσθαι.
It is also bad for the flesh in the wound to be wet and flabby, and to be cleansed for a long time.
Ἀλλὰ χρὴ διάπυον μὲν ποιῆσαι τὸ ἕλκος ὡς τάχιστα· οὕτω γὰρ ἂν ἥκιστα φλεγμαίνοι τὰ περιέχοντα τὸ ἕλκος, καὶ τάχιστα καθαρὸν εἴη· ἀνάγκη γὰρ ἔχει τὰς σάρκας τὰς κοπείσας καὶ φλασθείσας ὑπὸ τοῦ βέλεος, ὑποπύους γενομένας, ἐκτακῆναι.
But one must make the wound suppurate as quickly as possible; for in this way the parts surrounding the wound would be least inflamed, and it would be cleansed most quickly; for it is necessary that the flesh which has been cut and bruised by the missile, having become suppurated, should melt away.
Ἐπειδὰν δὲ καθαρθῇ, ξηρότερον χρὴ γίγνεσθαι τὸ ἕλκος· οὕτω γὰρ ἂν τάχιστα ὑγιὲς γένοιτο, ξηρῆς σαρκὸς βλαστούσης καὶ μὴ ὑγρῆς, καὶ οὕτως οὐκ ἂν ὑπερσαρκήσειε τὸ ἕλκος.
But when it is cleansed, the wound must become drier; for thus it would most quickly become healthy, dry flesh growing and not wet, and in this way the wound would not produce proud flesh.
Ὁ δ᾿ αὐτὸς λόγος καὶ ὑπὲρ τῆς μήνιγγος τῆς περὶ τὸν ἐγκέφαλον· ἢν γὰρ αὐτίκα ἐκπρίσας τὸ ὀστέον καὶ ἀφελὼν ἀπὸ τῆς μήνιγγος ψιλώσῃς, αὐτὴν καθαρὴν χρὴ ποιῆσαι ὡς τάχιστα καὶ ξηρὴν, ὡς μὴ ἐπὶ πουλὺν χρόνον ὑγρὴ ἐοῦσα μυδήῃ τε καὶ ἐξαίρηται· τούτων γὰρ οὕτω γιγνομένων, σαπῆναι αὐτὴν κίνδυνος.
And the same reasoning holds also for the membrane surrounding the brain; for if you immediately saw the bone and, having removed it from the membrane, bare it, you must make the membrane clean and dry as quickly as possible, so that it may not remain wet for a long time, rot, and swell up; for if these things happen in this way, there is danger of its rotting.
§1616.
16.
Ὀστέον δὲ, ὅ τι δεῖ ἀποστῆναι ἀπὸ τοῦ ἄλλου ὀστέου, ἕλκεος ἐν κεφαλῇ γενομένου, ἕδρης τε ἐούσης τοῦ βέλεος ἐν τῷ ὀστέῳ, ἢ ἄλλως ἐπὶ πουλὺ ψιλωθέντος τοῦ ὀστέου, ἀφίσταται ἐπὶ πουλὺ ἔξαιμον γινόμενον.
A bone which must exfoliate from the rest of the bone, when a wound occurs in the head, and there is a mark of the missile on the bone, or if the bone is otherwise bared to a great extent, exfoliates to a great extent, becoming bloodless.
Ἀναξηραίνεται γὰρ τὸ αἷμα ἐκ τοῦ ὀστέου ὑπό τε τοῦ χρόνου καὶ ὑπὸ φαρμάκων τῶν πλείστων· τάχιστα δ᾿ ἆν ἀποσταίη, εἴ τις τὸ ἕλκος ὡς τάχιστα καθήρας ξηραίνοι τὸ λοιπὸν τό τε ἕλκος καὶ τὸ ὀστέον, καὶ τὸ μεῖζον καὶ τὸ ἧσσον.
For the blood is dried up from the bone both by time and by most medicines; and it would exfoliate most quickly if one, having cleansed the wound as quickly as possible, should for the future dry both the wound and the bone, both the larger and the smaller.
Τὸ γὰρ τάχιστα ἀποξηρανθὲν καὶ ἀποστρακωθὲν τούτῳ μάλιστα ἀφίεται ἀπὸ τοῦ ἄλλου ὀστέου τοῦ ἐναίμου τε καὶ ζῶντος αὐτέου, ἔξαιμόν τε γενόμενον καὶ ξηρὸν τῷ ἐναίμῳ καὶ ζῶντι μάλα ἐφίσταται.
For that which is most quickly dried up and shriveled is by this means most easily separated from the rest of the bone which is bloody and living, and having become bloodless and dry, it stands off markedly from that which is bloody and living.
§1717.
17.
Ὅσα δὲ τῶν ὀστέων ἐσφλᾶται ἔσω ἐκ τῆς φύσιος τῆς ἑωυτῶν, καταῤῥαγέντα ἢ καὶ διακοπέντα πάνυ εὐρέα, ἀκινδυνότερα τὰ τοιαῦτα γίνεται, ἐπὴν ἡ μῆνιγξ ὑγιὴς ᾖ· καὶ τὰ πλέοσι ῥωγμῇσιν ἐσκαταῤῥαγέντα καὶ εὐρυτέρῃσιν, ἔτι ἀκινδυνότερα καὶ εὐμαρέστερα ἐς τὴν ἀφαίρεσιν γίνεται.
But such of the bones as are depressed inward from their natural position, being fractured or even cut very widely, become less dangerous if the membrane is sound; and those which are fractured inward with more and wider cracks become still less dangerous and easier to remove.
Καὶ οὐ χρὴ πρίειν τῶν τοιούτων οὐδὲν, οὐδὲ κινδυνεύειν τὰ ὀστέα πειρώμενον ἀφαιρέειν, πρὶν ἢ αὐτόματα ἐπανίῃ, οἴδεος πρῶτον χαλάσαντος.
And one must not saw any of such bones, nor run risks in trying to remove the bones, before they rise up of their own accord, after the swelling has first subsided.
Ἐπανέρχεται δὲ τῆς σαρκὸς ὑποφυομένης· ὑποφύεται δὲ ἐκ τῆς διπλόης τοῦ ὀστέου καὶ ἐκ τοῦ ὑγιέος, ἢν ἡ ἄνωθεν μοῖρα μούνη σφακελίσῃ.
But they rise up as the flesh grows underneath; and it grows underneath from the diploe of the bone and from the sound part, if the upper part alone mortifies.
Οὕτω δ᾿ ἂν τάχιστα ἥ τε σὰρξ ὑποφύοιτο καὶ βλαστάνοι, καὶ τὰ ὀστέα ἐπανίοι, εἴ τις τὸ ἕλκος ὡς τάχιστα διάπυον ποιήσας καθαρὸν ποιήσηται.
And in this way the flesh would most quickly grow underneath and sprout, and the bones would rise up, if one, having made the wound suppurate as quickly as possible, should make it clean.
Καὶ ἢν διὰ παντὸς τοῦ ὀστέου ἄμφω αἱ μοῖραι ἐσφλασθῶσιν ἔσω ἐς τὴν μήνιγγα, ἥ τε ἄνω μοίρη τοῦ ὀστέου καὶ ἡ κάτω, ἰητρεύοντι ὡσαύτως τὸ ἕλκος ὑγιὲς τάχιστα ἔσται, καὶ τὰ ὀστέα τάχιστα ἐπάνεισι, τὰ ἐσφλασθέντα ἔσω.
And if both parts of the bone, both the upper part of the bone and the lower, are depressed inward toward the membrane through the whole bone, the wound will most quickly become healthy for one who treats it in the same manner, and the bones which are depressed inward will most quickly rise up.

Notes

  1. p.244ἀνάγκη γὰρ ἔχει — Similar to the impersonal construction `ἀνάγκη ἐστί` ("it is necessary"), here `ἀνάγκη` serves as the subject with the verb `ἔχει` ("necessity holds/constrains"), indicating a strong physical inevitability. The accusative `τὰς σάρκας` acts as the subject of the infinitive `ἐκτακῆναι` ("to melt away").
  2. §17Ὅσα δὲ τῶν ὀστέων ... τὰ τοιαῦτα — The demonstrative pronoun `τὰ τοιαῦτα` ("such things") in the main clause summarizes and refers back to the entire preceding relative clause `Ὅσα δὲ τῶν ὀστέων ἐσφλᾶται...` ("as many of the bones as are depressed..."), functioning as a resumptive subject.

Cite this passage

Hippocrates, On Injuries of the Head §15-17. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg007.humanitext-grc1:15-17

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