§4040.
40.
Σημεῖα παραλλαγμάτων καὶ ἐκπτωμάτων, καὶ ᾗ, καὶ ὅκως, καὶ ὅσον διαφέρει ταῦτα πρὸς ἄλληλα.
Signs of displacements and dislocations, and where, and how, and how much these differ from one another.
Καὶ οἷσιν ἡ κοτύλη παρέαγε, καὶ οἷσι νευρίον ἀπεσπάσθη, καὶ οἷσιν ἐπίφυσις ἀπέαγε, καὶ οἷσι, καὶ ὡς, καὶ ἓν ἢ δύο, ὧν δύο ἐστίν·
Also, in those in whom the cavity has been partially fractured, and in those in whom a ligament has been torn away, and in those in whom an epiphysis has been broken off, in which bones, and how, and whether one or both of them, where there are two.
ἐπὶ τουτέοισι κίνδυνοι, ἐλπίδες, οἷσι κακαὶ, καὶ ὅτε κακώσιες θανάτου, ὑγιείης ἀσφαλείης.
On these depend the dangers, the prognoses, in which cases they are bad, and when the injuries lead to death, or to recovery and safety.
Καὶ ἂ ἐυβλητέα, ἢ χειριστέα, καὶ ὅτε, καὶ οὒ, ἢ ὅτε οὔ· ἐπὶ τουτέοισιν ἐλπίδες, κίνδυνοι.
Also, which cases are to be reduced, or which are to be operated upon, and when, and when not, or when not to do so; on these depend the hopes and the dangers.
Οἷα καὶ ὅτε χειριστέα καὶ τὰ ἐκ γενεῆς ἔξα ρθρα, τὰ αὐξανόμενα, τὰ ηὐξημένα, καὶ ὅ τι θᾶσσον, καὶ ὅ τι βραδύτερον, καὶ ὅ τι χωλὸν, καὶ ὡς, καὶ οὔ· καὶ διότι καὶ ὅ τι μινυθήσει, καὶ ᾗ, καὶ ὡς, καὶ οἷσιν ἧσσον.
Which congenital dislocations are to be treated, and when, both in those still growing and in those fully grown, and which of them heal faster and which slower, and which are lame, and how, and which are not; and why and which part will waste away, and where, and how, and in which cases it is less so.
Καὶ ὅτι τὰ καταγέντα θᾶσσον καὶ βραδύτερον φυόμενα, ᾗ αἱ διαστροφαὶ καὶ ἐπιπωρώσιες γίνονται, καὶ ἄκη τουτέων.
And that fractured bones unite faster or slower, how distortions and excessive callus formations occur, and the remedies for these.
Οἷσιν ἕλκεα αὐτίκα ἢ ὕστερον γίνονται· οἷσι καὶ ὀστέα καταγεῖσι, μείω, οἷσιν οὔ· οἷσι καταγέντα ἐξέσχεν, καὶ ᾗ ἐξίσχει μᾶλλον· οἷσιν ἐκβάντα [ἢ] ἄρθρα ἐξίσχει.
In whom wounds occur immediately or later; in whom, with fractured bones, there is shortening, and in whom not; in whom fractured bones protrude, and where they protrude more; in whom dislocated joints protrude.
Ἀπατῶνται, καὶ δι᾿ ἃ, ἐν οἷσιν ὁρῶσιν, ἐν οἷσι διανοεῦνται ἀμφὶ τὰ παθήματα, ἀμφὶ τὰ θεραπεύματα.
How men are deceived, and for what reasons, in what they see and in what they think concerning the affections and the treatments.
Νόμοισι τοῖσ νομίμοισι, περὶ ἐπιδέσιος· παρασκευὴ, πάρεξις, κατάτασις, διόρθωσις, ἀνάτριψις, ἐπίδεσις, ἀνάληψις, θέσις, σχῆμα, χρόνοι, δίαιται.
According to the established rules concerning bandaging: preparation, presentation, traction, correction, friction, bandaging, suspension, positioning, attitude, periods, and diets.
Τὰ χαυνότατα τάχιστα φύεται, τά δ᾿ ἐναντία ἐναντίως.
The most porous parts unite most quickly, and the opposite parts conversely.
Διαστροφαὶ, ᾗ κυρτοί· ἄσαρκοι, ἄνευροι, ᾗ τὸ ἐκπεσόν.
Distortions, in what direction they are curved; they become fleshless and tendonless where the part has dislocated.
Τὸ ἐμπεσὸν ὡς προσωτάτω ἔσται τοῦ χωρίου, οὗ ἐξέπεσεν.
The reduced bone will be as far as possible from the place from which it was dislocated.
Νεύρων, τὰ μὲν ἐν κινήσει καὶ ἐν πλάδῳ, ἐπιδοτικά· τὰ δὲ μὴ, ἧσσον.
Of ligaments, those in motion and in a moist state are yielding; those not so, less so.
Ἄριστον, ᾗ ἂν ἐκπέσῃ, εἰ ἐμπέσοι τάχιστα.
It is best, wherever a dislocation occurs, if it can be reduced as quickly as possible.
Πυρεταίνοντι μὴ ἐμβάλλειν, μηδὲ τεταρταῖα, πεμπταῖα, ἥκιστα ἀγκῶνα, καὶ τὰ ναρκώδεα πάντα· ὡς τάχιστα ἄριστα, τὴν φλεγμονὴν παρέντα.
Do not reduce a dislocation in a patient with fever, nor on the fourth or fifth day, least of all the elbow, and all those accompanied by numbness; the quicker the better, but leaving aside the inflammation.
Τὰ ἀποσπώμενα, ἢ νεῦρα, ἢ χόνδρια, ἢ ἐπιφύσιες, ἢ διιστάμενα κατὰ συμφύσεις, ἀδύνατα ὁμοιωθῆναι· διαπωροῦται ταχέως τοῖσι πλείστοισιν· ἡ δὲ χρῆσις σώζεται.
Parts torn away, whether ligaments, cartilages, epiphyses, or those separated at their sutures, cannot be restored to their original state; in most cases they quickly become callus, but the use of the limb is preserved.
Ἐκβάντων, τὰ ἔσχατα, ῥᾷον.
Of dislocations, the outermost parts are easier.
Τὰ ῥᾷστα ἐκπεσόντα ἥκιστα φλεγμαίνει· τὰ δὲ ἥκιστα θερμαίνοντα, καὶ μὴ ἐπιθεραπευθέντα, μάλιστα αὖθις ἐκπίπτει.
Those most easily dislocated inflame the least; but those which heat up the least, if not treated additionally, are most liable to dislocate again.
Κατατείνειν ἐν σχήματι τοιουτέῳ, ἐν ᾧ μάλιστα ὑπεραιωρηθήσεται, σκεπτόμενον ἐς τὴν φύσιν καὶ τὸν τόπον.
Perform traction in such a posture in which the bone will most easily clear the obstacle, having regard to its nature and position.
ᾟ ἐξέβη, διόρθωσις· ὀπίσω ἐς ὀρθὸν καὶ ἐς πλάγιον παρωθεῖν·
Correction on the side where it slipped out; push it back into its straight line and to the side.
τὰ δὲ ταχέως ἀντισπάσαντα ἀντισπάσαι ταχέως ἤδη ἐκ περιαγωγῆς.
What has been quickly pulled back in the opposite direction must be quickly pulled back at once by a circular movement.
Τὰ πλειστάκις ἐκπίπτοντα ῥᾷον ἐμπίπτει· αἴτιον φύσις, ἢ νεύρων, ἢ ὀστέων, νεύρων μὲν, μῆκος ἢ ἐπίδοσις, ὀστέων δὲ, κοτύλης ὁμαλότης, κεφαλῆς φαλακρότης·
Those parts which dislocate most frequently are most easily reduced; the cause is the nature, either of the ligaments or of the bones: of the ligaments, their length or elasticity; of the bones, the flatness of the socket or the smoothness of the head.
τὸ ἔθος τρίβον ποιέει· αἰτίη, καὶ σχέσις, καὶ ἕξις, καὶ ἡλικίη.
Habit creates a track; the cause is also attitude, habit of body, and age.
Τὸ ὑπόμυξον, ἀφλέγμαντον.
A somewhat mucous state is free from inflammation.
§4141.
41.
Οἷσον ἕλκεα ἐγένετο, ἢ αὐτίκα, ἢ ὀστέων ἐξισχόντων, ἢ ἔπειτα, ἢ κνησμῶν, ἢ τρηχυσμῶν, ταῦτα μὲν ἢν αἰσθῇ, εὐθέως οὔσας, πισσηρὴν ἐπὶ τὸ ἕλκος ἐπιθεὶς, ἐπιδεῖν ὡς ἐπὶ τὸ ἕλκος πρῶτον τὴν ἀρχὴν βαλλόμενος, καὶ τἄλλα ὡς οὐ ταύτῃ τοῦ σίνεος ἐόντος·
In those cases where wounds have occurred, either immediately, or from the protruding of bones, or afterwards from itching or chafing: if you perceive these, you must immediately apply pitch-cerate upon the wound where it is, and bandage it, making the first turn of the bandage directly over the wound, and doing the rest as if the injury were not at this place.
οὕτω γὰρ αὐτό τε ἰσχνότατον, καὶ ἐκπυήσει τάχιστα, καὶ περιῤῥήξεται, καὶ καθαρθέντα τάχιστα φύσεται·
For in this way the wound itself will become most thin, suppurate most quickly, the slough will separate, and, when cleansed, it will heal most quickly.
νάρθηκας δὲ μήτε κατ᾿ αὐτὸ τοῦτο προσάγειν, μήτε πιέζειν·
One must neither apply splints directly to this part, nor apply pressure.
καὶ ὧν ὀστέα μὴ μεγάλα ἄπεισιν, οὕτω ποιέειν· ὧν δὲ μεγάλα, οὔ· πολλὴ γὰρ ἐμπύησις, καὶ ταῦτ᾿ οὐκ ἔτι οὕτως, ἀλλ᾿ ἀνέψυκται τῶν ὑποστασίων εἵνεκα.
In those from whom the bones which come away are not large, one should do thus; but where they are large, not so, for there is much suppuration, and these cases can no longer be treated in this way, but are kept cool for the sake of the discharges.
Τὰ δὲ τοιαῦτα ὁπόσα ἐξέσχε, καὶ εἴ τε ἐμβληθῇ, εἴ τε μὴ, ἐπίδεσις μὲν οὐκ ἐπιτήδειον, διάτασις δὲ, σφαῖραι ποιηθεῖσαι, οἷαι πέδαις, ἡ μὲν παρὰ σφυρὸν, ἡ δὲ παρὰ γόνυ, ἐς κνήμην πλατεῖαι, προσηνέες, ἰσχυραὶ, κρίκους ἔχουσαι· ῥάβδοι τε σύμμετροι κρανίης καὶ μῆκος καὶ πάχος, ὥστε διατείνειν· ἱμάντια δὲ ἐξ ἄκρων ἀμφοτέρωθεν ἔχοντα εἰς τοὺς κρίκους ἐνδεδέσθαι, ὡς τὰ ἄκρα ἐς τὰς σφαίρας ἐνστηριζόμενα διαναγκάζῃ.
In all such cases where there is protrusion, whether they are reduced or not, bandaging is not suitable, but traction is; pads being made, like those on fetters, one near the ankle, the other near the knee, broad, soft, and strong for the leg, and having rings; and rods of cornel wood, suitable in length and thickness to keep up the tension; and leather straps starting from both ends are to be bound to the rings, so that the ends, bracing against the pads, force the parts asunder.
Ἴησις δὲ, πισσηρὴ θερμή· σχήματα, καὶ ποδὸς θέσις καὶ ἰσχίου· δίαιτα ἀτρεκής.
The treatment consists of warm pitch-cerate, the positions and placement of the foot and hip, and a strict diet.
Ἐμβάλλειν τὰ ὀστέα τὰ ὑπερίσχοντα αὐθήμερα, ἢ δευτεραῖα, τεταρταῖα δὲ ἢ πεμπταῖα, μὴ, ἀλλ᾿ ἐπὴν ἰσχνὰ ᾖ.
Reduce the protruding bones on the first or second day; but on the fourth or fifth day do not, but wait until they are free from swelling.
Ἡ δ᾿ ἐμβολὴ τοῖσι μοχλικοῖσιν· ἢ τὸ ἐμβαλλόμενον τοῦ ὀστέου, ἢν μὴ ἔχῃ ἀποστήριξιν, ἀποπρῖσαι τῶν κωλυόντων.
The reduction is to be made with levering instruments; or, if the bone to be reduced has no point of support, saw off the obstructing parts.
Ἀτὰρ καὶ ὡς τὰ ψιλωθέντα ἀποπεσπεῖται, καὶ βραχύτερα τὰ μέλεα.
But even so, the denuded parts will fall off, and the limbs will be shorter.
§4242 Τὰ δὲ ἄρθρα, τὰ μὲν πλέον, τὰ δὲ μεῖον ὀλισθάνει·
42.
καὶ τὰ μὲν μεῖον, ἐμβαλεῖν ῥᾴδιον· τὰ δὲ πλέον μέζους ποιεῖ τὰς κακώσιας καὶ ὀστέων, καὶ νεύρων, καὶ ἄρθρων, καὶ σαρκῶν, καὶ σχημάτων.
As for joints, some slip more and some less; and those which slip less are easy to reduce; but those which slip more cause greater damage to bones, ligaments, joints, flesh, and postures.
Μηρὸς δὲ καὶ βραχίων ὁμοιότατα ἐκπίπτουσιν.
The thigh and the arm dislocate in a very similar manner.