Hippocratic writings and On the Natural Faculties by Galen [1 ed.] 0852291639

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GREAT BOOKS OF THE WESTERN WORLD ROBERT MAYNARD HUTCHINS, EDITOR IN CHIEF MM

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MMMMM MMM MMMMMMMM MM MMMMM *

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Mortimer J. Adler,

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Associate Editor

Members of the Advisory Board: Stringfellow Barr, Scott Buchanan, John Erskine, Clarence H. Faust, Alexander Meiklejohn, Joseph J. Schwab, Mark Van Doren; Editorial Consultants: A. F. B.

Clark,

F. L.

Wallace Brockway,

Lucas,

Walter Murdoch.

Executive Editor

«>««»»«>«>> tharses. Those in whom the crisis happened on the sixth day, had an intermission of seven days, and from the relapse there was a crisis on the fourth, as happened to the daughter of Agla'idas. The greater part of those who were taken ill under this constitution of things, were affected in this manner, and I did not know a single case of recovery, in which there was not a relapse agreeably to the stated order of relapses; and all those recovered in which the relapses took place teenth day.

according to this form: nor did I know a single instance of those who then passed through the disease in this manner who had another relapse.

49

twentieth, had a crisis on the fortieth. The great-

had a rigor along with the original crisis, and these had also a rigor about the crisis in the relapse. There were fewest cases of rigor in the spring, more in summer, still more in autumn, but by far the most in winter; then hemorrhages

er part

ceased.

Sect. Ill 1.

With regard

to diseases, the circumstances

from which we form

—by attending

a

judgment

to the general

of

them

nature of

the peculiar nature of each individual, disease, the patient,

who

the person

and the

all,

—

to the

—

to

makes

a

applications,

applies them, as that

difference for better or for worse,

—

are,

and

to the

whole

and particularly to and the nature of each country; to the patient's habits, regimen, and pursuits; to his conversation, manners, taciturnity, thoughts, sleep, or absence of sleep, and sometimes his dreams, what and when they occur; to his picking and scratching; to his constitution of the season,

the state of the heavens,

— —

tears;

— —

—

to the alvine discharges, urine, sputa,

13. In these diseases death generally happened on the sixth day, as with Epaminondas,Silenus, and Philiscus the son of Antagoras. Those who had parotid swellings experienced a crisis on

and vomitings; and to the changes of diseases from the one into the other; to the deposits, whether of a deadly or critical character; to the

the twentieth day, but in

respiration,

all

these cases the dis-

went oft without coming to a suppuration, and was turned upon the bladder. But in Craease

tistonax,

and

who

in the

lived by the temple of Hercules,

maid servant

of

Scymnus

the fuller,

turned to a suppuration, and they died. Those who had a crisis on the seventh day, had an intermission of nine days, and a relapse which came to a crisis on the fourth day from the return of the fever, as was the case with Pantacles,who resided close by the temple of Bacchus. Those who had a crisis on the seventh day, after an interval of six days had a relapse, from which they had a crisis on the seventh day, as happened to Phanocritus, who was lodged with Gnathon the fuller. During the winter, about the winter solstices, and until the equinox, the ardent fevers and frenzies prevailed, and many died. The crisis, however, changed, and happened to the greater number on the fifth day from the commencement, left them for four days and relapsed; and after the return, there was a crisis on the fifth day, making in all fourteen days. The crisis took place thus in the case of it

most children, also in elder persons. Some had crisis on the eleventh day, a relapse on the fourteenth, a complete crisis on the twentieth; but certain persons, who had a rigor about the

a

—

eructation,

flatulence,

—

whether

passed silently or with a noise; to hemorrhages and hemorrhoids from these, and their ;

consequences,

—

we must form our judgment.

—

the continual, some of which 2. Fevers are, hold during the day and have a remission at nightj and others hold during the night and have a remission during the day; semi-tertians, tertians, quartans, quintans, septans, nonans. The most acute, strongest, most dangerous, and fatal diseases, occur in the continual fever. The least dangerous of all, and the mildest and most protracted, is the quartan, for it is not only such from itself, but it also carries off other great diseases. In

what

is

called the semi-tertian, other a-

cute diseases are apt to occur, and it is the most faof all others, and moreover phthisical persons, and those laboring under other protracted distal

by it. The nocturnal but protracted; the diur-

eases, are apt to be attacked

fever

nal

is

not very

is still

more

fatal,

and

in

some

septan

is

protracted,

protracted,

passes into phthisis.

The

cases

but not fatal; the nonan more protracted, and not fatal. The true tertian comes quickly to a crisis, and is not fatal; but the quintan is the worst of all, for it proves fatal when it precedes an attack of phthisis, and when it supervenes on persons who are already consumptive. There

ARCHBISHOP MITTY HIGH SCHOOL LIBRARY San Jose,

—

sweat, coldness, rigor, cough, sneezing, hiccup,

California

Hippocrates

5° are peculiar modes,

and constitutions, and par-

every one of these fevers; for examthe continual, in some cases at the very ple, commencement, grows, as it were, and attains

oxysms,

—

in

most dangerous pitch, but is diminished about and at the crisis; in others it begins gentle and suppressed, but gains ground and is exacerbated every day, and bursts forth with all its heat about and at the criits full

strength,

and

rises to its

while in others, again, it commences mildand is exacerbated until it reaches its acme, and then remits until at and about the crisis. These varieties occur in every fever, and in every disease. From these observations one sis;

increases,

ly,

must regulate the regimen accordingly. There many other important symptoms allied to these, part of which have been already noticed, and part will be described afterwards, from a consideration of which one may judge, and decided in each case, whether the disease be acute, and whether it will end in death or recovery; or whether it will be protracted, and will end in death or recovery; and in what cases food is to be given, and in what not; and when and to what amount, and what particular kind of food are

is

to be administered.

Those diseases which have their paroxysms on even dayshavetheircriseson even days; and those which have their paroxysms on uneven days have their crises on uneven days. The first period of those which have the crisis on 3.

even days,

is

the 4th, 6th, 8th, 10th, 14th, 20th,

and the first period on uneven days, is the 1 st, 3d, 5th, 7th, 9th, nth, 17th, 21st, 27th, 31st. It should be known, that if the crisis take place on any other day than on those de30th, 40th, 60th, 80th, 100th; of those

scribed,

which have

it

their crises

indicates that there will be a relapse,

urine; night uncomfortable, no sleep; he delirious

on

subjects.

all

On

the fourth,

symptoms exacerbated, urine

all

black; night

was the

more

comfortable, urine of a better color. On the fifth, about mid-day, had a slight trickling of pure blood from the nose; urine varied in character,

having floating in it round bodies, resembling semen, and scattered, but which did not fall to the bottom; a suppository having been applied, some scanty flatulent matters were passed; night uncomfortable,

little sleep,

talking incoherent-

extremities altogether cold, and could not

ly;

be warmed; urine black; slept a little towards day; lossof speech, cold sweats;extremitieslivid; about the middle of the sixth day he died. The respiration throughout, like that of a person

was rare, and large, and was swelled upon in a round tumor, the sweats cold throughout, the paroxysms on the

recollecting himself,

spleen

even days.

Case

II.

Silenus lived on the Broad-way, near

the house of Evalcidas.From fatigue, drinking,

and unseasonable exercises, he was seized with fever. He began with having pain in the loins; he had heaviness of the head, and there was

On

stiffness of the neck.

the

first

day the alvine

discharges were bilious, unmixed, frothy, high colored, and copious urine black, having a black ;

sediment; he was thirsty, tongue dry; no sleep at night. On the second, acute fever, stools more copious, thinner, frothy; urine black, an uncomfortable night, slight delirium. On the third, all the symptoms exacerbated; an oblong distention, of a softish nature, from both sides of

hypochondrium to the navel; stools thin, and darkish; urine muddy, and darkish no sleep

the

;

at night;

much

talking, laughter, singing, he

could not restrain himself.

On

On

the fourth, in

which may prove fatal. But one ought to pay attention, and know in these seasons what crises will lead to recovery and what to death, or to

mixed, smooth, greasy; urine thin, and trans-

changes for the better or the worse. Irregular fevers, quartans, quintans, septans, and nonans should be studied, in order to find out in what

cold and livid;

periods their crises take place.

On the seventh, loss of speech; extremities could

the

same

state.

the fifth, stools bilious, un-

parent; slight absence of delirium. On the sixth, slight perspiration

about the head; extremities tossing about; no passage

much

from the bowels, urine suppressed, acute

no longer be kept warm; no discharge

Fourteen Cases of Disease Case I.Philiscus,who lived by the Wall, took bed on the first day of acute fever; he sweated; towards night was uneasy. On the second day all the symptoms were exacerbated; late in the evening had a proper stool from a small clyster; to

On

the eighth, a cold sweat

all

fever.

of urine.

over; red rashes

with sweat, of a round figure, small, like vari, by means of a slight

persistent, not subsiding;

morning and until noon, he appeared to be free from fever; towards evening, acute fever, with

from the bowels, and undigested character, with pain; urine acrid, and passed with pain; extremities slightly heated; sleep slight, and comatose; speechless; urine thin, and transparent. On the ninth, in the same state. On the tenth, no drink

tongue parched; passed black

taken; comatose, sleep slight; alvine discharges

the night quiet.

sweating,

thirst,

On

the third day, early in the

stimulus, a copious discharge

of a thin

Of the Epidemics the same; urine abundant, and thickish; when allowed to stand, the sediment farinaceous and

white; extremities again cold.

On

the eleventh,

he died. At the commencement, and throughout, the respiration was slow and large; there was a constant throbbing in the hypochondri-

age was about twenty. Case III.Herophon was seized with an acute

um;

his

fever; alvine discharges at first were scanty, and attended with tenesmus; but afterwards they were passed of a thin, bilious character, and frequent; there was no sleep; urine black, and thin. On the fifth, in the morning, deafness; all the symptoms exacerbated; spleen swollen; disten-

hypochondrium; alvine discharges and black; he became delirious. On the

tion of the scanty,

sixth, delirious; at night, sweating, coldness; the delirium continued. On the seventh, he became cold, thirsty, was disordered in mind; at night

recovered his senses; slept.

On

the eighth,

was

5

passed a large quantity of urine with spasms, (the attendants seldom putting her in mind), it was thick, white, like urine which has been shaken after it has stood for a considerable time until it has subsided, but it had no sediment; in color

and

consistence, the urine resembled that

of cattle, as far as

became swollen; acute

On

fever; deafness a-

the third day after the relapse, the

spleen diminished; deafness less; legs painful;

sweated during the night; crisis took place on the seventeenth day had no disorder of the senses during the relapse. Case IV. In Thasus, the wife of Philinus, having been delivered of a daughter, the lochial discharge being natural, and other matters going on mildly, on the fourteenth day after delivery was seized with fever, attended with rigor; was pained at first in the cardiac region of the stomach and right hypochondrium; pain in the genital organs; lochial discharge ceased. Up;

on the application of a pessary all these symptoms were alleviated; pains of the head, neck, and loins remained; no sleep; extremities cold; thirst;

thin,

bowels in a hot

and

colorless at first.

night, senses restored.

On

tions bilious,

had a

state; stools scanty;

urine

On the sixth, towards

much

disordered, but again were the seventh, thirsty; the evacua-

and high

colored.

On

the eighth,

rigor; acute fever; much spasm, with pain;

much, incoherently; upon the applicaand passed copious dejections, with a bilious flux; no sleep. talked

tion of a suppository, rose to stool,

On the ninth, spasms. On the tenth, slightly reOn the eleventh, slept; had perfect

collected.

recollection, but again

immediately wandered;

four-

slightly collected, but presently became again delirious. About the seventeenth day became speechless, on the twentieth died. Case V. The wife of Epicrates, who was lodged at the house of Archigetes, being near the term of delivery, was seized with a violent rigor, and, as was said, she did not become heated; next day the same. On the third, she was delivered of a daughter, and everything went on properly. On the day following her delivery, she was seized with acute fever, pain in the cardiac region of the stomach, and in the

thin,

gain.

About the

much;

night comfortable; urine better colored, had a scanty sediment. On the ninth, sweated; the crisis took place; fever remitted. On the fifth day afterwards, fever relapsed, spleen immediately

observed.

;

genital parts.

legs;

I

teenth day, startings over the whole body talked

diminished in size; quite collected; had pain at first about the groin, on the same side as the spleen; had pains in both feverish; the spleen

1

Having had

was in and

a suppository,

so far relieved; pain in the head, neck,

no sleep; alvine discharges scanty, bilious, and unmixed; urine thin, and blackish. Towards the night of the sixth day from the time she was seized with the fever, became delirious. On the seventh, all the symptoms exloins;

acerbated; insomnolency, delirium, thirst; stools bilious,

and high colored.

On

the eighth,

had

a

more. On the ninth, the same. On the tenth, her limbs painfully affected; pain again of the cardiac region of the stomach heaviness of the head no delirium slept more bowels rigor; slept

;

;

;

;

On

the eleventh, passed urine of a

better color, and

having an abundant sediment;

constipated.

On the fourteenth had a rigor; acute On the fifteenth, had a copious vomiting

felt lighter.

fever.

and yellow matters; sweated; fever night acute fever; urine thick, sediment white. On the seventeenth, an exacerbation; night uncomfortable; no sleep; delirium. On the eighteenth, thirsty; tongue parched; no sleep; much delirium; legs painfully affected. of bilious

gone;

at

About the twentieth, in the morning, had a slight rigor; was comatose; slept tranquilly; had slight vomiting of bilious and black matters; towards night deafness. About the twenty-first, weight generally in the left side, with pain slight cough urine thick, muddy, and reddish; when allowed to stand, had no sediment; in other respects felt lighter; fever not gone; fauces painful from the commencement, and red; uvula retracted; defluxion remained acrid, pungent, and saltish throughout. About the twenty-seventh, free of ;

fever;

sediment in the urine; pain in the side. thirty-first, was attacked with fever,

About the

Hippocrates

51

vomiting on the complete crisis, and was freed from the fever on the eightieth day. CASEVI.Cleonactides,whowas lodged above the Temple of Hercules, was seized with a fever in an irregular form; was pained in the head and left side from the commencement, and had other pains resembling those produced by fatigue; paroxysms of the fevers inconstant and irregular; occasional sweats; the paroxysms genbilious diarrhea; slight bilious fortieth.

Had

a

erally attacked on the critical days. About the twenty-fourth was cold in the extremities of the hands, vomitings bilious, yellow, and frequent, soon turning to a verdigris-green color; general relief. About the thirtieth, began to have hemorrhage from both nostrils, and this continued in an irregular manner until near the crisis; did not loathe food, and had no thirst throughout, nor was troubled with insomnolency urine thin, and not devoid of color. When about the thirtieth day, passed reddish urine, having a copious red sediment; was relieved, but afterwards the characters of the urine varied, sometimes having sediment, and sometimes not. On the sixtieth, the sediment in the urine copious, white, and smooth; all the symptoms ameliorated; intermission of the fever; urine thin, and well ;

On the seventieth, fever gone for ten On the eightieth had a rigor, was seized

colored.

days.

with acute fever, sweated much; a red, smooth sediment in the urine; and a perfect crisis. Case VII. Meton was seized with fever; there was a painful weight in the loins. Next day, after drinking water pretty copiously, had proper evacuations from the bowels.

On

the third,

heaviness of the head, stools thin, bilious, and reddish.

On

the fourth,

all

the

symptoms

exac-

tion; great incoherence. On the fourth, in a most uncomfortable state; had no sound sleep at night, but dreaming and talking; then all the appearances worse, of a formidable and alarmingchar-

On the morning of the was composed, and quite coherent, but long before noon was furiously mad, so that he

acter; fear, impatience. fifth,

could not constrain himself; extremities cold, and somewhat livid; urine without sediment; died about sunset. The fever in this case was accompanied by sweats throughout; the hypochondria were in a state of meteorism, with distention and pain the urine was black, had round substances floating in it, which did not subside; the alvine evacuations were not stopped; thirst throughout not great; much spasms with sweats about the time of death. Case IX. Criton, in Thasus, while still on foot, and going about, was seized with a violent pain in the great toe; he took to bed the same day, had rigors and nausea, recovered his heat slightly, at night was delirious. On the second, swelling of the whole foot, and about the ankle erythema, with distention, and small bullae (phlyctaenae); acute fever; he became furiously deranged; alvine discharges bilious, unmixed, and rather frequent. He died on the second day ;

from the commencement. Case X. The Clazomenian who was lodged by the Well of Phrynichides was seized with fever. He had pain in the head, neck, and loins from the beginning, and immediately afterwards deafness; no sleep, acute fever, hypochondria elevated with a swelling, but not tention; tongue dry.

night, he

uneasy

On

much

dis-

the fourth, towards

delirious. On the fifth, in an On the sixth, all the symptoms ex-

became

state.

About the eleventh a slight remisfrom the commencement to the fourteenth day the alvine discharges thin, copious, and of the color of water, but were well supported; the bowels then became constipated. Urine throughout thin, and well colored, and had many substances scattered through it, but no sediment. About the sixteenth, urine somewhat thicker, which had a slight sediment; somewhat better, and more collected. On the seventeenth, urine

had twice a scanty trickling of blood from the right nostril; passed an uncomfortable night; alvine discharges like those on the third day; urine darkish, had a darkish cloud floating in it, of a scattered form, which did not subside. On the fifth, a copious hemorrhage of pure blood from the left nostril; he sweated, and had a crisis. After the fever restless, and had some delirium; urine thin, and darkish; had an affusion of warm water on the head; slept and recovered his senses. In this case there was no relapse, but there were frequent hemorrhages

again thin; swellings about both his ears, with pain; no sleep, some incoherence; legs painful-

after the crisis.

ly affected.

Case VIII Erasinus, who lived near the Canal of Bootes, was seized with fever after supper; passed the night in an agitated state. During the first day quiet, but in pain at night. On the second, symptoms all exacerbated; at night delirious. On the third, was in a painful condi-

a crisis,

erbated;

.

acerbated. sion;

On the twentieth,

no sweat,

had About the

free of fever,

perfectly collected.

twenty-seventh, violent pain of the right hip; it speedily went off. The swellings about the ears subsided, and did not suppurate, but were pain-

About the thirty-first, a diarrhoea, attended with a copious discharge of watery matter, and ful.

Of the Epidemics symptoms

of dysentery; passed thick urine;

swellings about the ears gone. About the fortihad pain in the right eye, sight dull. It

eth day,

went away. Case XI. The wife of Dromeades having been delivered of a female child, and all other matters going on properly, on the second day after was seized with rigor and acute fever. Began to have pain about the hypochondrium on the first day; had nausea and incoherence, and for some hours afterwards had no sleep; respiration rare, large, and suddenly interrupted. On the day following that on which she had the rigor, alvine discharges proper; urine thick, white, muddy, like urine which has been shaken after standing for some time, until the sediment had fallen to the

bottom; it had no sediment; she did not sleep during the night. On the third day,about noon, had a rigor, acute fever; urine the same; pain of the hypochondria, nausea, an uncomfortable night, no sleep; a coldish sweat all over, but heat quickly restored. leviation of the

On

the fourth, slight

symptoms about

with pain; sometongue dry,

dria; heaviness of the head,

what comatose;

al-

the hypochon-

slight epistaxis,

urine thin and oily; slept a little, upon awaking was somewhat comatose; slight coldness, slept during the night, was delirious. On the morning of the sixth had a rigor, but soon thirst,

recovered her heat, sweated cold,

was

all

over; extremities

delirious, respiration rare

and

large.

Shortly afterwards spasms from the head be-

gan, and she immediately expired.

Case XII. A man, in a heated state, took supand drank more than enough; he vomited the whole during the night; acute fever, pain of the right hypochondrium, a softish inflammation from the inner part; passed an uncomfortper,

able night; urine at the red, but

when allowed

commencement to stand,

thick,

had no

sedi-

On the On the fifth, urine smooth, oily, and copious; acute fever. On ment, tongue dry, and not very fourth, acute fever, pains

all

thirsty.

over.

the sixth, in the evening, very incoherent, sleep

during the night.

On

the seventh,

all

no the

the

53

symptoms exacerbated; he was

Case XIII. A woman, who lodged on the Quay, being three months gone with child, was seized with fever, and immediately began to have pains in the loins. On the third day, pain of the head and neck, extending to the clavicle, and right hand; she immediately lost the power of speech; was paralyzed in the right hand, with spasms, after the manner of paraplegia; was quite incoherent; passed an uncomfortable night; did not sleep; disorder of the bowels, attended with bilious, unmixed, and scanty stools. On the fourth, recovered the use of her tongue; spasms of the same parts, and general pains remained; swelling in the hypochondrium, accompanied with pain; did not sleep, was quite incoherent; bowels disordered, urine thin, and not of a good color. On the fifth, acute fever; pain of the hypochondrium, quite incoherent; alvine evacuations bilious; towards night had a sweat,

and was freed from the

a rigor; acute fe-

the

some incoand left arm remained; in all other respects was alleviated; quite coherent. For three days remained free from fever. On the eleventh, had a relapse, with rigor and fever. About the fourteenth day, vomited pretty abundantly bilious and yellow matters, had a sweat, the fever went off, by coming herence, pains about the clavicle

to a crisis.

Case XIV. Melidia, who lodged near the Tembegan to feel a violent pain of the head, neck, and chest. She was straightway ple of Juno,

seized with acute fever; a slight appearance of

the menses; continued pains of

On and

the sixth,

was

afTected with

all

these parts.

coma, nausea,

rigor; redness about the cheeks; slight de-

lirium.

On

the seventh, had a sweat; the fever

intermitted, the pains remained.

A relapse; little

throughout of a good color, but thin; the alvine evacuations were thin, bilious, sleep; urine

experienced a

morning had

On

the seventh trembling, slight coma,

himself; the bowels being stimulated, passed a watery discharge with lumbrici: night equally

appeared to be free of fever; did

fever.

recovered her reason; was every way relieved; the pain remained about the left clavicle; was thirsty, urine thin, had no sleep. On sixth,

acrid, very scanty, black,

ver, hot sweat,

On

the eleventh, he died.

symptoms exacerbated; urine of the same characters; much talking, and he could not contain

painful. In the

delirious.

and fetid; a white, had a sweat, and perfect crisis on the eleventh day.

smooth sediment

in the urine;

BOOK III. Sect. Case

I.

Pythion,

I

who

lived by the

Temple of commenc-

not sleep long; after the sleep a chill, ptyalism; in the evening, great incoherence; after a little, vomited a small quantity of dark bilious mat-

the Earth, on the

On the ninth, coldness, much delirium, did not sleep. On the tenth, pains in the limbs, all

On the third, the same. On the fourth alvine discharges scanty, unmixed, and bilious. On the

ters.

first

day, trembling

ing from his hands; acute fever, delirium. the second,

all

the

On

symptoms were exacerbated.

Hippocrates

54 fifth, all

symptoms were exacerbated, the

the

tremors remained; stipated.

On

the bowels con-

little sleep,

the sixth sputa mixed, reddish. On

mouth drawn aside. On the eighth, symptoms were exacerbated; the trem-

the seventh, the

all

blings were again constant; urine, from the beginning to the eighth day, thin, and devoid of color; substances floating in

tenth he sweated; sputa

it,

cloudy.

On

the

somewhat digested, had

Garden

of Dealces: had heaviness of the head and pain in the right temple for a considerable time, from some accidental cause, was seized with fever, and took to bed. On the second, there was a trickling of pure blood from the

but the alvinedischargeswere propurine thin, mixed, having small substances

left nostril, er,

floating in

On

it,

like coarse barley meal, or

semen.

the third, acute fever; stools black, thin,

a crisis; urine thinnish about the crisis; but aft-

frothy, a livid sediment in the dejections; slight

on the fortieth day, an abscess about the anus, which passed off by a strangury.

coma; uneasiness at the times he had to get up; sediment in the urine livid, and somewhat viscid. On the fourth, slight vomiting of bilious,

er the crisis,

Explanation of the characters. It is probably that the great discharge of urine brought about the resolution of the disease,

and the cure

of

the patient on the fortieth day.

Case II. Hermocrates, who lived by the New Wall, was seized with fever. He began to have pain in the head and loins; an empty distention of the hypochondrium; the tongue at first was parched; deafness at the commencement; there was no sleep; not very thirsty; urine thick and red, when allowed to stand it did not subside; alvine discharge very dry, and not scanty. On the fifth, urine thin, had substances floating in it which did not fall to the bottom; at night he

was

delirious. On the sixth, had jaundice; all symptoms were exacerbated; had no recol-

yellow matters, and, after a short interval, of the color of verdigris; a few drops of pure blood ran from the left nostril; stools the same; urine the same; sweated about the head and clavicles; spleen enlarged, pain of the thigh on the same side loose swelling of the right hypochondrium at night had no sleep, slight delirium. On the ;

sixth, stools black, fatty, viscid, fetid; slept,

collected.

On

more

the seventh, tongue dry, thirsty,

did not sleep; was somewhat delirious; urine good color. On the eighth, stools

thin, not of a

black, scanty,

and compact;

lected; not very thirsty.

slept,

became

col-

On the ninth had a rig-

lection.

acute fever, sweated, a chill, was delirious, strabismus of the right eye, tongue dry, thirsty, without sleep. On the tenth, much the same.

state;

On

the

On the seventh, in an uncomfortable urine thin, as formerly; on the following days the same. About the eleventh day, all the symptoms appeared to be lightened. Coma set in; urine thicker, reddish, thin substances below, had no sediment; by degrees he became collected. On the fourteenth, fever gone; had

no sweat; slept, quite collected; urine of the same characters. About the seventeenth, had a relapse, became hot. On the following days, acute fever, urine thin, was delirious. Again, on the twentieth, had a crisis; free of fever; had no sweat; no appetite through the whole time; was perfectly collected; could not speak, tongue dry,

without thirst; deep sleep. About the twentyfourth day he became heated; bowels loose, with a thin, watery discharge; on the following days acute fever, tongue parched. On the twentyseventh he died. In this patient deafness continued throughout; the urine either thick and red, without sediment, or thin, devoid of color, and, having substances floating in it: he could taste nothing.

Explanation of the characters.

It is

probably

was the suppression of the discharges from the bowels which occasioned death on the

that

it

twenty-seventh day.

Case

III.

The man who was lodged

in the

or,

the eleventh,

from

became quite

collected; free

about the crisis. The two following days without fever; it returned on the fourteenth, then immediately insomnolency and complete delirium. On the fifteenth, urine muddy, like that which has been shaken after the sediment has fallen to the bottom; acute fever, quite delirious, did not sleep; knees and legs painful; after a suppository, had fever, slept, urine thin

alvine dejections of a black color.

On

the six-

eneorema, was delirious. On the seventeenth, in the morning, extremities cold, was covered up with the bedteenth, urine thin,

had

a cloudy

clothes, acute fever, general sweat, felt relieved,

more collected; not free of fever, thirsty, vomited yellow bile, in small quantities; formed faeces passed from the bowels, but soon afterwards black, scanty, and thin; urine thin, not well colored. On the eighteenth, not collected, coma-

On the nineteenth, in the same state. On the twentieth, slept; quite collected, sweated, free from fever, not thirsty, but the urine thin. tose.

On the twenty-first,

slight delirium;

somewhat

pain of the hypochondrium, and throbbing about the navel throughout. On the twentyfourth, sediment in the urine, quite collected. Twenty-seventh, pain of the right hip joint; thirsty,

Of the Epidemics urine thin and bad, a sediment; all the other symptoms milder. About the twenty-ninth, pain of the right eye; urine thin. Fortieth, dejections pituitous, white, rather frequent;

dantly

over;

all

had

a

complete

sweated abun-

was cured

in forty days.

Sect. II

Case

In Thasus, Philistes had headache and sometimes was con-

I.

had

a crisis; urine, after the re-

lapse and the crisis, well colored, having a sediment; neither was he delirious in the relapse.

On the eighteenth, became a little heated; some urine thin, with cloudy substances floating in it; slight wandering in his mind. About the nineteenth, free of fever, had a pain in his neck; a sediment in the urine. Had a complete crisis on the twentieth. Explanation of the characters. It is probable thirst,

crisis.

Explanation of the characters. It is probable that, by means of the stools, the urine, and the sweat, this patient

55

ed, free of fever;

that the patient

was cured

in

twenty days, by

of long continuance,

the abundance of bilious stools and urine.

fined to bed, with a tendency to deep sleep; having been seized with continual fevers from

Case III. The daughter of Euryanax, a maid, was taken ill of fever. She was free of thirst throughout, but had no relish for food. Alvine

drinking, the pain was exacerbated; during the night he, at first, became hot. On the first day,

discharges small, urine thin, scanty, not well

the third, in an uncomfortable state. On the fourth, convulsions; all the symptoms exacerbated. On the fifth, early in the

had a pain about the nates. On the sixth day, was free of fever, did not sweat, had a crisis; the complaint about the nates came to a small suppuration, and burst at the crisis. After the crisis, on the seventh day, had a rigor, became slightly heated, sweated. On the eighth day after the rigor, had an inconsiderable rigor; the extremities cold ever after. About the tenth day, after a sweat which came on, she became delirious, and again immediately afterwards was collected;

morning, died. Explanation of the characters.

these symptoms were said to have been brought on by eating grapes. After an intermission of

he vomited some bilious matters, at first yellow, but afterwards of a verdigris-green color, and in greater quantity; formed faeces passed from the bowels; passed the night uncomfort-

On

ably.

the second, deafness, acute fever; rehypochondrium; urine

traction of the right thin, transparent, like

semen

mid-day.

had some small substances

floating in

it;

delirium ferox about

On

that the death of the patient

It is

on the

to be attributed to a phrenitis,with

probable

fifth

day

is

unfavorable

colored. In the beginning of the fever,

the twelfth day, she again talked ;

evacuations.

unmixed,

Charion, who was lodged at the house of Demaenetus, contracted a fever from drinking. Immediately he had a painful heaviness of the head; did not sleep; bowels disordered, with thin and somewhat bilious discharges. On the third day, acute fever; trembling of the head, but especially of the lower lip; after a little time a rigor, convulsions; he was quite delirious; passed the night uncomfortably. On the fourth, quiet, slept little, talked incoherently. On the

to get frequently up.

Case

fifth, in

II.

pain;

all

the

symptoms exacerbated; de-

lirium; passed the night uncomfortably; did not sleep.

On

the sixth, in the

same

state.

seventh had a rigor, acute fever, sweated his

body; had a

crisis.

On all

Throughout the

the

over

alvine

discharges were bilious, scanty, and unmixed;

urine thin, well colored, having cloudy substances floating ink. About the eighth day, pass-

ed urine of a better color, having a white scanty sediment; was collected, free from fever for a season. On the ninth it relapsed. About the fourteenth, acute fever.

On

much incoher-

ently her bowels disordered with bilious, scanty, thin, acrid discharges; she required

She died on the seventh day after the return of the delirium. At the com-

mencement throat, and

had pain in the was red throughout, uvula retract-

of the disease she

it

ed, defluxions abundant, thin, acrid; coughed,

but had no concocted sputa; during the whole time loathed all kinds of food, nor had the least desire of anything; had no thirst, nor drank anything worth mentioning; was silent, and never spoke a word; despondency; had no hopes of herself. She had a congenital tendency to phthisis.

woman affected with quinsy, lodged in the house of Aristion: her complaint began in the tongue; speech inarticulate; tongue red and parched. On the first day, felt chilly, and afterwards became heated. On the Case IV. The

who

third day, a rigor, acute fever; a reddish

and

hard swelling on both sides of the neck and chest, extremities cold

and

livid; respiration ele-

vated; the drink returned by the nose; she could

the sixteenth, vomited

not swallow; alvine and urinary discharges sup-

On

pressed. On the fourth, all of the symptoms were

pretty frequently yellow, bilious matters.

the seventeenth had a rigor, acute fever, sweat-

exacerbated.

On

the fifth she died of the quinsy.

Hippocrates

56 Explanation of the characters. that the cause of death

on the

It is

sixth

probable

day was the

suppression of the discharges.

Case V. The young man who was lodged by Market was seized with fever from fatigue, labor, and running out of season. On

the Liars'

the

first

day, the bowels disordered, with

bil-

and copious dejections; urine thin and blackish; had no sleep; was thirsty. On the second all the symptoms were exacerbated; dejections morecopious and unseasonable; he had no sleep; disorder of the intellect; slight sweat. ious, thin,

On

the third day, restless, thirst, nausea,

much

tossing about, bewilderment, delirium; extremities livid and cold; softish distention of the hypochondrium on both sides. On the fourth, did

not sleep;

still

On

worse.

the seventh he died.

He was

about twenty years of age. Explanation of the characters. It is probable that the cause of his death on the seventh day was the unseasonable practices mentioned

An

above.

acute affection.

came

collected; had no thirst; labored under insomnolency; alvine dejections copious, and unseasonable throughout; urine scanty, thin, darkish; extremities cold,

sixth day, in the

somewhat state.

On

livid.

On

the

the seventh she

died. Phrenitis.

A woman who lodged near the Market, having then brought forth a son in a first and difficult labor, was seized with fever. Immediately on the commencement had thirst, nausea, and cardialgia; tongue dry; bowels disordered, with thin and scanty dejections; Case IX.

Liars'

had no

sleep.

On

the second, had slight rigor,

acute fever; a faint cold sweat about the head. On the third, painfully affected; evacuations

from the bowels undigested, On the fourth, had a rigor;

thin,

exacerbated; insomnolency.

On

painful state.

On

all

and copious. symptoms

the

the fifth, in a

the sixth, in the

same

state;

discharges from the bowels liquid and copious. On the seventh, had a rigor, fever acute; much thirst;

Case VI. The woman who lodged at the house of Tisamenas had a troublesome attack

same

much

tossing about; towards evening a

cold sweat over

all;

extremities cold, could no

warm; and again at night had a extremities could not be warmed; she did

longer be kept

of iliac passion, much vomiting; could not keep

rigor;

her drink; pains about the hypochondria, and pains also in the lower part of the belly; constant tormina; not thirsty; became hot; extrem-

not sleep; was slightly delirious, and again speed-

ities

cold throughout, with nausea and insom-

nolency; urine scanty and thin; dejections undigested, thin, scanty.

Nothing could do her

any good. She died. Case VII A woman of those who lodged with Pantimides,from a miscarriage, was taken ill of fever. On the first day, tongue dry, thirst, nausea, insomnolency, belly disordered, with thin, .

copious, undigested dejections.

On

the second

day, had a rigor, acute fever; alvine discharges

copious; had no sleep. er.

On

the third, pains great-

On the fourth, delirious. On the seventh

she

died. Belly throughout loose, with copious, thin,

undigested evacuations; urine scanty, thin. ardent fever.

An

Case VIII. Another woman, after a miscarriage about the fifth month, the wife of Ocetes, was seized with fever. At first had sometimes coma and sometimes insomnolency; pain of the loins; heaviness of the head.

On the second, the

ily collected.

On the eighth, about mid-day, she

became warm, was sea;

thirsty, comatose, had nauvomited small quantities of yellowish bile;

did not sleep; passed frequenturine without consciousness. On the ninth, all the symptoms gave way; comatose, towards evening slight rigors; small vomitings of bile. On the tenth, rigor; exacerbation of the fever, did not sleep at all in the morning passed much urine having a sediment; extremities recovered their heat. On the eleventh, restless at night,

ly large quantities of

;

vomited bile of a verdigris-green color; not long had a rigor, and again the extremities cold; towards evening a rigor, a cold sweat, much

after

vomiting; passed a painful night. On the had copious black and fetid vomitings;

twelfth,

much

hiccup, painful thirst.

On

the thirteenth,

vomitings black, fetid, and copious; rigor about mid-day, loss of speech. On the fourteenth, some blood ran from her nose, she died. In this case the bowels were loose throughout; with rigors: her age about seventeen. An ardent fever.

bowels were disordered, with scanty, thin, and

unmixed dejections. On the third, more and worse; at night did not sleep. On fourth was delirious; frights, despondency;

at first

copious, the

strabismus of the right eye; a faint cold sweat about the head; extremities cold. On the fifth day,

all

much

the

symptoms were exacerbated; talked and again immediately be-

incoherently,

Sect. Ill i.

The

year was southerly, rainy; no winds

throughout. Droughts having prevailed during the previous seasons of the year, the south winds towards the rising of Arcturus were attended with much rain. Autumn gloomy and cloudy, with copious rains. Winter southerly, damp,

Of the Epidemics

57

and near the

But long after the much wintery weather out of season;

the inflammation and erysipelas disappeared, and when no abscess was formed, a great num-

and when now close to the equinox, northerly, and winterly weather for no long time.

ber of these died. In like manner, the same things happened to whatever part of the body the dis-

and

soft.

equinox,

The

solstice,

much rain Summer fine and hot; great

spring again southerly, calm,

until the dog-days.

suffocating heats. The Etesian winds blew small and irregular; again, about the season of Arcturus, much rains with north winds. 2. The year being southerly, damp, and soft towards winter, all were healthy, except those affected with phthisis, of whom we shall write

afterwards. 3.

Early in spring, along with the prevailing

were many cases of erysipelas, some from a manifest cause, and some not. They were of a malignant nature, and proved fatal to many; many had sore-throat and loss of speech. There were many cases of ardent fever, phrensy, aphthous affections of the mouth, tumors on the cold, there

genital organs; of ophthalmia, anthrax, disor-

der of the bowels, anorexia, with thirst and without it; of disordered urine, large in quantity, and bad in quality of persons affected with coma ;

and then falling into a state of insomnolency. There were many cases of failure of crisis, and many of unfavorable crisis; for a long time,

Such were the There were patients affected with every one of the species which have been mentioned, and many died. The symptoms in each of these cases were as follows: 4. In many cases erysipelas, from some obvious cause, such as an accident, and sometimes from even a very small wound, broke out all

many

of dropsy

and of

phthisis.

diseases then epidemic.

over the body, especially, in persons about sixty years of age, about the head, if such an accident was neglected in the slightest degree; and

happened in some who were under treatment; great inflammation took place, and the

this

most them the abscesses ended in suppurations, and

erysipelas quickly spread all over. In the

of

there were great fallings off (sloughing) of the flesh,

tendons, and bones; and the defluxion

was not like pus, but a and the running was large and of various characters. Those cases in which any of these things happened about the head were accompanied with falling off of the hairs of the head and chin, the bones were laid bare and separated, and there were excessive runnings; and these symptoms happened in fevers and without fevers. But these things were more forwhich seated

in the part

sort of putrefaction,

midable

when

in

appearance than dangerous; for

the concoction in these cases turned to a suppuration, most of them recovered; but when

ease wandered, for in

many

cases both forearm

and arm dropped off; and in those cases in which it fell upon the sides, the parts there, either before or behind, got into a bad state; and in some cases the whole femur and bones of the leg and whole foot were laid bare. But of all such cases, the most formidable were those which took place about the pubes and genital 1 organs. Such was the nature of these cases when attended with sores, and proceeding from an external cause; but the same things occurred in fevers, before fevers, and after fevers. But those cases in which an abscess was formed, and turned to a suppuration, or a seasonable diarrhea or discharge of good urine took place, were relieved thereby: but those cases in which none of these symptoms occurred, but they disappeared without a crisis, proved fatal. The greater

number

of these erysipelatous

cases

took place in the spring, but were prolonged through the summer and during autumn. 5. In certain cases there was much disorder, and tumors about the fauces, and inflammations of the tongue, and abscesses about the teeth. And many were attacked with impairment or loss of speech; at first, those in the commencement of phthisis, but also persons in ardent fe-

and

ver

in phrenitis.

The

cases of ardent fever and phrenitis occurred early in spring after the cold set in, and great numbers were taken ill at that time, and these cases were attended with acute and fatal symptoms. The constitution of the ardent fevers which then occurred was as follows: at the commencement they were affected with coma, nausea, and rigors; fever not acute, not much thirst, nor delirium, slight epistaxis, the paroxysms for the most part on even days; and, about the time of the paroxysms, forgetfulness, loss of strength and of speech, the extremities, that is to say, the hands and feet, at all times, but more especially about the time of the paroxysms, were colder than natural; they slowly and imperfectly became warmed, and again recovered their 6.

recollection

and speech. They were constantly coma, in which they got

affected either with

no

with insomnolency, attended with most had disorders of the bowels, attended with undigested, thin, and copious evacuations; urine copious, thin, having nothsleep, or

pains;

1

Compare Thucydides'

of Athens.

description of the plague

Hippocrates

58 ing critical

nor favorable about it; neither critical appearance in per-

was there any other

sons affected thus; tor neither was there any proper hemorrhage, nor any other of the ac-

customed evacuations, to prove a crisis. They it happened, in an irregular manner,

died, as

but in some instances after having lost their speech for a long time, and having had copious sweats. These were mostly about the

the

crisis,

symptoms which marked the

fatal cases of

ardent fever; similar symptoms occurred in the phrenitic cases; but these were particularly free from thirst, and none of these had wild

delirium as in other cases, but they died oppressed by a bad tendency to sleep, and stupor. 7. But there were also other fevers, as will be

Many had their mouths affected with aphthous ulcerations. There were also many de-

described.

fluxions about the genital parts, and ulcerations,

(phymata), externally and internally, about the groins. Watery ophthalmies of a chronic character, with pains; fungous excrescences of boils

the eyelids, externally

and

internally, called

fici,

which destroyed the sight of many persons. There were fungous growths, in many other instances, on ulcers, especially on those seated on the genital organs. There were many attacks of carbuncle (anthrax) through the summer, and other affections, which are called "the putrefaction" (seps); also large ecthymata, and large {her petes) in many instances. And many and serious complaints attacked many persons in the region of the belly. In the tetters 8.

first

place, tenesmus,

attacked many, but

and

all

who had

accompanied with pain,

more

especially children,

not attained to puberty; and

There were many cases and of dysentery; but these were not attended with much pain. The evacuations were bilious, and fatty, and thin, and watery; in many instances the disease terminated in this way, with and without fever; there were painful tormina and volvuli of a malignant kind; copious evacuations of the contents of the guts, and yet much remained behind; and the passages did the most of these died. of lientery

not

carry off the pains, but yielded with dif-

ficulty to the

means administered;

cases purgings this

were hurtful

manner; many died

most

for in

to those affected in

speedily, but in

others they held out longer. In a word,

many

all

died,

both those who had acute attacks and those who

had chronic, most especially from affections of it was the belly which carried them

the belly, for all off.

9.

All persons had an aversion to food in

all

the afore-mentioned complaints toa degree such

as I never met with before, and persons in these complaints most especially, and those recovering from them, and in all other diseases of a mortal nature. Some were troubled with thirst, and some not; and both in febrile complaints

and in others no one drank unseasonably or disobeyed injunctions. 10. The urine in many cases was not in proportion to the drink administered, but greatly in excess; and the badness of the urine voided

was great, for it had not the proper thickness, nor concoction, nor purged properly; for in many cases purgings by the bladder indicate favorably, but in the greatest number they indicated a melting of the body, disorder of the bowels, pains, and a want of crisis. 1 1 Persons laboring under phrenitis and causus were particularly disposed to coma; but also in all other great diseases which occurred along with fever. In the main, most cases were attended either by heavy coma, or by short and

light sleep. 12. And many other forms of fevers were then epidemic, of tertian, of quartan, of nocturnal,

of continual, of chronic, of erratic, of fevers at-

tended with nausea, and of irregular fevers. All were attended with much disorder, for the bowels in most cases were disordered, accompanied with rigors, sweats not of a critical character, and with the state of the urine as dethese

scribed. In

most instances the disease was prowhich took

tracted, for neither did the deposits

place prove critical as in other cases; for in

complaints and in

all

cases there

was

all

difficulty

want of crisis, and protraction of the most especially in these. A few had the crisis about the eightieth day, but in most instances it (the disease? ) left them irregularly. A few of them died of dropsy without being of crisis,

disease, but

confined to bed. And in many other diseases people were troubled with swelling, but more especially in phthisical cases. 13. The greatest and most dangerous disease, and the one that proved fatal to the greatest number, was the consumption. With many persons it commenced during the winter, and of these some were confined to bed, and others bore up on foot; the most of those died early in spring who were confined to bed; of the others, the cough left not a single person, but it became milder through the summer; during the autumn, all these were confined to bed, and many of them died, but in the greater number of cases the disease was long protracted. Most of these were suddenly attacked with these diseases, having frequent rigors, often continual and acute

Of the Epidemics and cold sweats throughout; great coldness, from which they had great difficulty in being restored to heat; the bowels variously constipated, and again imfevers; unseasonable, copious,

mediately in a loose state, but towards the termination in all cases with violent looseness of the bowels; a determination downwards of all matters collected about the lungs; urine excessive, and not good; troublesome melting. The coughs throughout were frequent, and sputa copious, digested, and liquid, but not brought up

and even when they had some purging of the matters about the lungs went on mildly. The fauces were not very irritable, nor were they troubled with any saltish humors; but there were viscid, white, liquid, frothy, and copious defluxions from the head. But by far the greatest mischief attending these and the other complaints, was the aversion to food, as has been described. For neither had they any relish for drink along with their food, but continued without thirst. There was heaviness of the body, disposition to coma, in most cases swelling, which ended in dropsy; they had rigors, and were delirious towards with

much

pain;

slight pain, in all cases the

14.

The form

body peculiarly subject to was the smooth, the whit-

of

phthisical complaints ish,

that resembling the lentil; the reddish, the

blue-eyed, the leucophlegmatic,

and that with

the scapulae having the appearance of wings:

and

women

in like

manner, with regard

to the

whatever that

diseases;

is

common

From

these

it is

critical days,

easy to

know

the order of the ac-

cordingly. And to a person things,

how

it is

easy to

who is skilled in these know to whom, when, and

aliment ought to be administered.

Sixteen Cases of Disease

Case I. In Thasus, the Parian who lodged above the Temple of Diana was seized with an acute fever, at first of a continual and ardent type; thirsty, inclined to be comatose at first, and afterwards troubled with insomnolency; bowels disordered at the beginning, urine thin.

On

was delirisymptoms were ex-

the sixth day, passed oily urine,

On

the seventh,

all

the

acerbated; had no sleep, but the urine of the

same

characters,

and the understanding

disor-

dered; alvine dejections bilious and fatty.

On

the eighth, a slight epistaxis; small vomiting of

verdigris-green matters; slept a ninth, in the

same

state.

On

little.

the tenth,

On

the

all

the

symptoms gave way. On the eleventh, he sweated, but not over the whole body; he became

eth,

mer was

ious; aversion to food, comatose.

and the

each con-

and prognosticate from them

melancholic and subsanguineous,phrenitic and dysenteric affections principally attacked them. Tenesmus troubled young persons of a phlegmatic temperament. Chronic diarrhoea, acrid and viscid discharges from the bowels, attacked those who were troubled with bitter bile. 15. To all those which have been described, the season of spring was most inimical, and proved fatal to the greatest numbers: the sumthe most favorable to them,

in

and disease is good, and whatever is bad; whatever disease will be protracted and end in death, and whatever will be protracted and end in recovery; which disease of an acute nature will end in death, and which in recovery. stitution

ous.

death.

59

has been written. For he that knows and makes a proper use of these things, would appear to me not likely to commit any great mistake in the art. He ought to learn accurately the constitution of every one of the seasons, and of the

cold, but

On

immediately recovered his heat again.

the fourteenth, acute fever; discharges

bili-

and copious; substances floating in the urine; he became incoherent. On the seventeenth, in a painful state, for he had no sleep, and the fever was more intense. On the twentious, thin,

sweated

all

over; apyrexia, dejections bil-

On the twentyOn the thirty-fourth, apy-

fewest died then; in autumn, and under the Plei-

fourth,

ades, again there died great numbers.lt appears

bowels not confined; and he again recovered his heat. Fortieth, apyrexia, bowels confined for no long time, aversion to food; had again slight symptoms of fever, and throughout in an irregular form; apyrexia at times, and

me, according to the reason of things, that the coming on of summer should have done good in these cases; for winter coming on cures to

the diseases of

summer, and summer coming

on removes the

diseases of winter.

summer

was not of became suddenly

in question

stituted, for

it

And

itself

yet the

well con-

hot, southerly,

and calm; but, notwithstanding, it proved beneficial by producing a change on the other constitution. 16. 1

look upon

art to be able to

it as being a great part of the judge properly of that which

had

a relapse.

rexia;

at others not; for if the fever intermitted,

was

and

immediately relapsed again; he used much and improper food; sleep bad; about the time of the relapse he was delirious; passed thick urine at that time, but troubled, and of bad characters; bowels at first confined, and again loose; slight fevers of a continual type; discharges copious and thin. On the alleviated for a

little,

it

Hippocrates

60

hundred and twentieth day he died. In this patient the bowels were constantly from the first either loose, with bilious, liquid, and copious dejections, or constipated with hot and undigested faxes; the urine throughout bad; for the most part coma, or insomnolency with pain; con-

tinued aversion to food. Ardent fever. Explanation of the characters. It is probable that the weakness produced by the fever, the

Case III. InThasus,Pythion,whowas lodged above the Temple of Hercules, from labor, fatigue, and neglected diet, was seized with strong rigor and acute fever; tongue dry, thirsty, and bilious; had no sleep; urine darkish, eneorema floating on the top of the urine, did not subside. On the second day, about noon, coldness of the extremities, especially about the hands and head; loss of speech and of articulation; breathing short for a considerable time; recovered his

and affection of the hypochondrium caused death on the hundred and twentieth day. Case II. In Thasus, the woman who lodged near the Cold Water, on the third day after de-

day

livery of a daughter, the lochial discharge not

sunset, slight chills; nausea, agitation; passed

taking place, was seized with acute fever, accompanied with rigors. But a considerable time before delivery she was feverish, confined to bed, and loathed her food. After the rigor which took place, continual and acute fevers, with rigors. On the eighth and following days, was very incoherent, and immediately afterwards became

the night in a painful state; had no sleep; small

phrenitis,

collected;

bowels disordered, with copious, thin,

watery, and bilious stools; no thirst.

On

the

heat; thirst; passed the night quietly; slight

sweats about the head. in a

stools of

On

composed

compact

On

the third, passed the

state; in

faeces

the evening, about

passed from the bowels.

the fourth, in the morning, composed; a-

bout noon

all

the

symptoms became exacerbatand of articulation;

ed; coldness, loss of speech,

became worse; recovered

his heat after a time; passed black urine, having substances floating in it; the night quiet; slept. On the fifth, seemed to be lightened, but a painful weight about the

eleventh was collected, but disposed to coma; urine copious, thin, and black; no sleep. On the

belly; thirsty, passed the night in a painful state.

and immediately afterwards was warm; slight incoherence; no sleep; with regard to the bowels, in the same condition; urine watery, and copious. On the twentyseventh, free from fever; bowels constipated;

evening the pains greater; had a paroxysm; in the evening the bowels properly opened by a small clyster; slept at night. On the seventh, during the day, in a state of nausea, somewhat disturbed; passed urine of the appearance of oil; at night, much agitation, was incoherent, did not sleep. On the eighth, in the morning, slept a little; but immediately coldness, loss of speech, respiration small and weak; but in the evening recovered his heat again; was delirious, but towards day was somewhat lightened stools small, bilious, and unmixed. On the ninth, affected with coma, and with nausea when roused; not very thirsty; about sunset he became restless and incoherent; passed a bad night. On the tenth, in the morning, had become speechless; great coldness; acute fever; much perspiration; he died. His sufferings were on the even days.

twentieth, slight chills,

not long afterwards violent pain of the right hip-joint for a considerable time; fevers afterwards supervened; urine watery. On the fortieth, complaints about the hip-joint better; continued coughs, with copious, watery sputa bowels constipated aversion to food urine the same fever not leaving her entirely, but having par;

;

;

oxysms in an irregular form, sometimes present, sometimes not. On the sixtieth, the coughs left her without a crisis, for no concoction of the sputa took place, nor any of the usual abscesses; jaw on the right side convulsively retracted; comatose, was again incoherent, and immediately became collected; utter aversion to food; the aw became relaxed alvine discharges small, and bilious; fever more acute, affected with rigors; on the following days lost her speech, and again became collected, and talked. On the j

;

On

the sixth, in the morning, in a quiet state;

in the

;

Explanation of the characters. It is probable that the excessive sweats caused death on the tenth day.

Case IV. The patient affected with phrenitis, having taken to bed on the first day, vomited

and thin matters; feand conover; heaviness of the head

eightieth she died. In this case the urine through-

largely of verdigris-green

out was black, thin, and watery; coma supervened; there was aversion to food, despondency, and insomnolency; irritability, restlessness; she was of a melancholic turn of mind. Explanation of the characters. It is probable that the suppression of the lochial discharge caused death on the eightieth day.

ver,

accompanied with

rigors, copious

tinued sweats all and neck, with pain; urine thin, substances floating in the urine small, scattered, did not subside; had copious dejections from the bowels; very delirious; no sleep. On the second, in the morning, loss of speech; acute fever; he sweated,

Of the Epidemics fever did not leave

whole body,

him; palpitations over the

at night, convulsions.

On the third,

the symptoms exacerbated; he died. Explanation of the characters. It is probable that the sweats and convulsions caused death. Case V. In Larissa,a man, who was bald, suddenly was seized with pain in the right thigh; none of the things which were administered all

did

him any good. On

the

first

day, fever acute,

of the ardent type, not agitated, but the pains the second, the pains in the thigh persisted.

On

abated, but the fever increased; somewhat tossed about; did not sleep; extremities cold; passed a large quantity of urine, not of a good On the third, the pain of the thigh

character.

ceased;

derangement of the

and much tossing about.

intellect,

On

confusion,

the fourth, about

noon, he died. An acute disease. Case VI. In Abdera, Pericles was seized with a fever of the acute, continual type, with pain; much thirst, nausea, could not retain his drink; somewhat swelled about the spleen, with heaviness of the head.

rhage from the

On

the

first

left nostril,

but

day,

had hemor-

still

the fever be-

came more violent; passed much muddy, white urine, which when allowed to stand did not subside. On the second day, all the symptoms were exacerbated, yet the urine was thick, and more inclined to have a sediment; the nausea less; he slept. On the third, fever was milder; abundance of urine, which was concocted, and had a copious sediment; passed a quiet night. On the fourth, had a copious and warm sweat all over about noon; was free of fever, had a crisis, no relapse. An acute affection. Case VII. In Abdera, the young woman who was lodged in the Sacred Walk was seized with an ardent fever. She was thirsty, and could not sleep; had menstruation for the first time. On the sixth,

much

and tossed about.

nausea, flushing, was chilly,

On

the seventh, in the same

state; urine thin, but of a good color; no disturbance about the bowels. On the eighth, deafness, acute fever, insomnolency, nausea, rigors, became collected; urine the same. On the ninth, in the same state, and also on the following days;

thus the deafness persisted.

On

the fourteenth,

disorder of the intellect; the fever abated.

On

hemorrhage from the and on the following days, nausea, deafness, and incoher-

the seventeenth, a copious

nose; the deafness slightly better; ence.

On

the twentieth, pain of the feet; deaf-

and delirium left her; a small hemorrhage from the nose; sweat, apyrexia. On the twentyness

61

ty-seventh,

deafness

had

left

a copious sweat, apyrexia; the

her; the pain of her feet partly re-

mained; in other respects had a complete crisis. Explanation of the characters. It is probable that the restoration of health on the twentieth day was the result of the evacuation of urine. Case VIII. In Abdera, Anaxion, who was lodged near the Thracian Gates, was seized with an acute fever; continued pain of the right side; dry cough, without expectoration during the first days, thirst, insomnolency; urine well colored, copious, and thin. On the sixth, delirious; no relief from the warm applications. On the seventh, in a painful state, for the fever increased,

while the pains did not abate, and the cough was troublesome, and attended with dyspnoea. On the eighth, I opened a vein at the elbow, and much blood, of a proper character, flowed; the pains were abated, but the dry coughs continued. On the eleventh, the fever diminished; slight sweats about the head; coughs, with more liquid sputa; he was relieved. On the twentieth, sweat, apyrexia; but after the crisis he was thirsty, and the expectorations were not good. On the twenty-seventh the fever relapsed; he coughed, and brought up much concocted sputa: sediment in the urine copious and white; he became free of thirst, and the respiration was good. On the thirty-fourth, sweated all over, apyrexia, general

crisis.

Explanation of the characters. It is probable that the evacuation of the sputa brought about the recovery on the thirty-fourth day.

on

Case IX. In Abdera, Heropythus, while still foot, had pain in the head, and not long

afterwards he took to bed; he lived near the High Street. Was seized with acute fever of the ardent type; vomitings at first of much bilious matter; thirst; great restlessness; urine thin, black, substances sometimes floating high in

it,

and sometimes not; passed the night in a painful state; paroxysms of the fever diversified, and for the most part irregular. About the fourteenth day, deafness; the fever increased; urine the same.

much

On the twentieth and following days, On the thirtieth, copious hem-

delirium.

orrhage from the nose, and became more collected; deafness continued, but less; the fever diminished; on the following days, frequent hemorrhages, at short intervals. About the sixtieth, the hemorrhages ceased, but violent pain of the hip-joint, and increase of fever. Not long afterwards, pains of all the inferior parts; it then

became

a rule, that either the fever

and deaf-

fourth, the fever returned, deafness again; pain

ness increased, or, if these abated and were light-

On the twen-

ened, the pains of the inferior parts were in-

of the feet remained; incoherence.

Hippocrates

6i creased.

About the

eightieth day,

all

the

com-

way, without leaving any behind; tor the urine was of a good color, and had a copious sediment, while the delirium became less. About the hundredth day, disorder of the bowels, with copious and bilious evacuations, and these continued for a considerable time, and again assumed the dysenteric form with pain; plaints gave

but relief of all the other complaints. On the whole, the fevers went off, and the deafness ceased. On the hundred and twentieth day, had a complete crisis.

Ardent

incoherent and talked obscurely; pains frequent,

andcontinued. On the second,

in t^esame had no sleep; fever more acute. On the third, the spasms left her: but coma, and disposition to sleep, and again awaked, started up, and could not contain herself; much incoherence: acute fever; on that night a copious sweat all over: apyrexia, slept, quite collected: had a crisis. About the third dav,theunne b'ack.thin,

great, state;

substances floating

not

fall

to the

in

generally round, did

it

bottom; about the

crisis a

copious

menstruation.

fever.

Explanation of the characters. It is probable brought about the recovery on the hundred and twentieth day. Case X. In Abdera, Nicodemus was seized with fever from venery and drinking. At the commencement he was troubled with nausea and cardialgia; thirsty, tongue was parched; urine thin and dark. On the second day, the fever exacerbated; he was troubled with rigors and nausea; had no sleep; vomited yellow bile; urine the same; passed a quiet night, and slept.

Case XII. In Larissa, a young unmarried seized with a fever of the acute and ardent type; insomnolency, thirst: tongue sooty and dry; urine of a good color, but thin. On the second, in an uneasy state, did not sleep. On the third, alvine discharges copious, watery, and greenish, and on the following days passed such with relief. On the fourth, passed a small quantity of thin urine, having substances floating towards its surface, which did not subside; was

On

hemorrhage from the nose; a chill, with a copious and hot sweat all over; apyrexia, had a crisis. In the fever, and when it had passed the crisis, the menses took place for the first time, for she was a young woman. Throughout she was oppressed with nausea, and rigors; redness of

that the bilious discharge

the third, a general remission; amelioration;

but about sunset felt again somewhat uncomfortable; passed an uneasy night. On the fourth, rigor, much fever, general pains; urine thin, with substances floating in it; again a quiet night. On the fifth, all the symptoms remained, but there

was an amelioration.

On

the sixth,

some

general pains; substances floating in the urine; very incoherent. eighth,

all

On

the other

the seventh, better.

symptoms

abated.

On the On the

and following days, there were pains, but all less; in this case throughout, the paroxysms and pains were greater on the even days. On the twentieth, the urine white and thick, but when allowed to stand had no sediment; much sweat; seemed to be free from fever; but again in the evening he became hot, with the same tenth,

pains, rigor, thirst, slightly incoherent. On the twenty-fourth, urine copious, white, with an abundant sediment; a copious and warm sweat all

over; apyrexia; the fever

came

Explanation of the characters. that the cure

was owing

to

its crisis.

It is

probable

to the bilious evacua-

and the sweats. Case XI. In Thasus, a woman, of a melancholic turn of mind, from some accidental cause of sorrow, while still going about, became affected with loss of sleep, aversion to food, and had thirst and nausea. She lived near the Pylates, upon the Plain. On the first, at the comtions

mencement

of night, frights,

much

talking, de-

spondency, slight fever; in the morning, frequent spasms, and when they ceased, she was

woman was

On

delirious towards night.

the sixth, a great

the face; pain of the eyes; heaviness of the head;

she had no relapse, but the fever sis.

The

came

to a cri-

pains were on the even days.

Case XIII. Apollonius, in Abdera, bore up (under the fever?) for some time, without betaking himself to bed. His viscera were enlarged,

was a conand then he became affected with jaundice; he was flatulent, and of a whitish complexion. Having eaten beef, and drunk unseasonably, he became a little heated at first, and betook himself to bed, and having used large quantities of milk, that of goats and sheep, and both boiled and raw, with a bad diet otherwise, great mischief was occasioned by all these things; for the fever was exacerbated, and of the food taken scarcely any portion worth mentioning was passed from the bowels; the urine was thin and scanty nosleep; troublesome meteorism; much thirst; disposition to coma; painful swelling of the right hypochondrium; and

for a considerable time there

stant pain about the liver,

;

extremities altogether coldish; slight incoherence, forgetfulness of everything he said; he was

About the fourteenth day after he betook himself to bed, had a rigor, became heated, and was seized with furious delirium; loud cries, much talking, again composed, and beside himself.

On

Injuries of the

then coma came on; afterwards the bowels ordered, with copious, bilious, unmixed, and undigested stools; urine black, scanty, and thin; much restlessness; alvine evacuations of varied dis-

characters, either black, scanty,

green, or fatty, undigested,

and

and

verdigris-

acrid;

and

at

times the dejections resembled milk. About the twenty-fourth, enjoyed a calm; other matters in

became somewhat collected; remembered nothing that had happened since he was confined to bed; immediately afterwards became delirious; every symptom rapidly getting worse. About the thirtieth, acute fever; stools copious and thin; was delirious; extremithe

ties

same

state;

cold; loss of speech.

On the thirty-fourth he

died. In this case, as far as

I

saw, the bowels

Head

63

seized with an acute fever, attended with chills. From first to last she wrapped herself up in

her bedclothes;

still silent,

she fumbled, picked,

bored, and gathered hairs (from them); tears, and again laughter; no sleep; bowels irritable,

but passed nothing; when directed, drank a little; urine thin and scanty; to the touch of the

hand the

fever

tremities.

On

ently,

On

was

slight; coldness of the ex-

the ninth, talked

much

incoher-

and again became composed and

silent.

the fourteenth, breathing rare, large, at in-

tervals;

and again hurried

respiration.

sixteenth, looseness of the bowels

On

the

from a stimu-

lant clyster; afterwards she passed her drink,

nor could retain anything, for she was completely insensible; skin parched and tense. On the twentieth, much talk, and again became

tion to

were disordered; urine thin and black; disposicoma; insomnolency; extremities cold;

composed;

delirious throughout. Phrenitis.

On

Case XIV. In Cyzicus, a woman who had brought forth twin daughters, after a difficult labor, and in whom the lochial discharge was insufficient, at first was seized with an acute fever, attended with chills; heaviness of the head and neck, with pain; insomnolency from the commencement; she was silent, sullen, and disobedient; urine thin, and devoid of color; thirst, nausea for the most part; bowels irregularly disordered, and again constipated. On the sixth, towards night, talked much incoherently; had no sleep. About the eleventh day was seized with wild delirium, and again became collected; urine black, thin, and again deficient, and of an oily appearance; copious, thin, and disordered evacuations from the bowels. On the fourteenth,

throughout was rare and large; she was totally insensible; always wrapped up in her bedclothes; either much talk or completely silent throughout. Phrenitis. Case XVI. In Melibcea, a young man having become heated by drinking and much venery, was confined to bed; he was affected with rigors and nausea; insomnolency and absence of thirst. On the first day much faeces passed from the bowels along with a copious flux; and on the following days he passed many watery stools of a green color; urine thin, scanty, and deficient in color; respiration rare, large, at long inter-

frequent convulsions; extremities cold; not in anywise collected; suppression of urine. On the sixteenth loss of speech. On the seventeenth, she

passed urine of an oily appearance. On the tenth, he had calm delirium, for he was naturally of

died. Phrenitis.

Explanation of the characters. It is probable was caused, on the seventeenth day, by the affection of the brain consequent upon her accouchement. Case XV.InThasus, the wife of Dealces,who was lodged upon the Plain, from sorrow was that death

On

vals; softish distention of the

of

an oblong form, on both

MEN'S heads are by no means all like to one

ever has a prominence in the anterior part of the head (by prominence is meant the round

protuberant part of the bone which projects be-

Her

respiration

hypochondrium,

sides;

continued pal-

pitation in the epigastric region throughout;

an orderly and quiet disposition; skin parched and tense; dejections either copious and thin,

and fatty. On the fourteenth, all the symptoms were exacerbated; he became delirious, and talked much incoherently On the twentieth, wild delirium, jactitation, passed no urine; or bilious

.

small drinks were retained.

On

the twenty-

fourth he died. Phrenitis.

Injuries of the

another, nor are the sutures of the head of all men constructed in the same form. Thus, who-

loss of speech; respiration hurried.

the twenty-first she died.

Head

yond the rest of it), in him the sutures of the head take the form of the Greek letter tau, T; for the head has the shorter line running transverse before the prominence, while the other line runs through the middle of the head, all the way to the neck. But whoever has the prom-

^4 inence in the back part of the head, in

Hippocrates him

the

sutures are constructed in quite the opposite

the temples; for it is the conjunction of the lower jaw with the cranium, and there is mo-

up and down

form

tion there

line

organ of hearing is near it; and further, a hollow and important vein runs along the temple. But the whole bone of the head behind the vertex and the ear is stronger than the whole anterior part, and the bone itself has a larger and deeper covering of flesh upon it. And hence it follows, that when exposed to the same or even greater injuries from instruments of the same or greater size, the bone is less liable to be fractured and depressed than elsewhere; and that

to the former; for in this case the shorter runs in front of the prominence, while the longer runs through the middle all along to the forehead. But whoever has a prominence of the head both before and behind, in him the sutures resemble the Greek letter eta H; for the long lines of the letter run transverse before each prominence while the short one runs through the middle and terminates in the long lines.

But whoever has no prominence on either part he has the sutures of the head resembling the Greek letter \; for the one line comes transverse to the temple while the other passes along the middle of the head. The bone at the middle of the head is double, the hardest and most compact part being the upper portion, where it is connected with the skin, and the lowest, where it is connected with the meninx (dura mater);

and the

in a fatal accident the patient will live longer

when

the

wound

is

in the posterior part of the

head than when elsewhere; and that pus takes longer time to form and penetrate through the bone to the brain, owing to the thickness of the bone; and moreover, as there is less brain in that part of the head,

and from the uppermost and lowermost parts the bone gradually becomes softer and less compact, till you come to the diploe. The diploe is the most porous, the softest, and most cavernous part. But the whole bone of the head, with

wounded

the exception of a small portion of the upper-

situated.

most and lowermost portions of it, is like a sponge; and the bone has in it many juicy substances, like caruncles; and if one will rub them with the fingers, some blood will issue from them. There are also in the bone certain very slender and hollow vessels full of blood. So it is with regard to hardness, softness, and porosity. 2. In respect to thickness and thinness; the thinnest and weakest part of the whole head is the part about the bregma; and the bone there has the smallest and thinnest covering of flesh upon it, and the largest proportion of brain is

as at a joint;

than of those

And

more persons who

in the back part of the

who

are

wounded

are

head escape

in the anterior

man

will survive longer in winter than in summer, whatever be the part of the head in which the wound is part.

3.

As

in fatal cases, a

to the hcedrce (dints or

sharp and light weapons, in the

bone without

when

marks?) of

they take place

fissure, contusion, or de-

pression inwards (and these take place equally

and posterior part of the head), does occur, does not properly resuture appearing in a wound, sult from them. in the anterior

death,

when

it

A

when

the bone

the head the

is

laid bare,

on whatever part of

wound may have been

inflicted, is

the weakest point of the head to resist a blow or

situated in that region of the head.

weapon, when the weapon happens to be impinged into the suture itself; but more especially when this occurs in the bregma at the weak-

it

est part of the

And hence happens that from similar or even smaller wounds and instruments, when a person is wounded to the same or a less degree, the bone of the head there is more contused, fractured, and depressed; and that injuries there are more deadly and more difficult to cure; and it is more difficult to save one's life in injuries there than in any other part of the head; that from having sustained a similar or even a less wound a man will die, and that, too, in a shorter space of time than from a wound in any other part of the head. For the brain about the bregma feels more quickly and strongly any mischief that may occur to

the flesh or the bone; for the brain about the bregma is in largest quantity, and is covered by the thinnest bone and the least flesh. Of the other portions, the weakest is that about

a

head, and the sutures happen to be situated near the wound, and the weapon has hit the sutures themselves. 4. The bone in the head is liable to be wound-

ed in the following modes, and there are varieties in each of these

modes

many

of fracture:

When

a wounded bone breaks, in the bone comprehending the fissure, contusion necessarily takes place where the bone is broken; for an instrument that breaks the bone occasions a contusion thereof more or less, both at the fracture and in the parts of the bone surrounding the fracture. This is the first mode. But there are all possible varieties of fissures; for some of them are fine, and so very fine that they can-

not be discovered, either immediately after the injury, or during the period in which it would

On be of use to the patient tained.

And some

if

Injuries of the

could be ascer-

this

of these fissures are thicker

and wider, certain of them being very wide. And some of them extend to a greater, and some to a smaller, distance. And some are more straight, nay, completely straight; and some are more curved, and that in a remarkable degree. And some are deep, so as to extend downwards and through the whole bone; and some are less so, and do not penetrate through the whole bone. 5. But a bone may be contused, and yet remain in its natural condition without any fracture in it; this is the second mode. And there are many varieties of contusion; for they

occur to a great-

and to a greater depth, so as sometimes to extend through the whole bone; or to a less depth, so as not to extend through the whole bone; and to a greater and smaller length and breadth. But it is not possible to recognize any of these varieties by the sight, so as to determine their form and extent; neither, indeed, is it visible to the eyes when any mischief of this kind takes place, and immediately after the injury, whether or not the bone has been acer or less degree,

tually bruised, as

is

likewise the case with cer-

from the

seat of in-

And the bone being fractured, is

sometimes

tain fractures at a distance jury. 6.

depressed inwards from its natural level along with the fractures, otherwise there would be no depression; for the depressed portion being frac-

tured and broken

pushed inwards, while the rest of the bone remains in its natural position; and in this manner a fracture is combined with the depression. This is the third mode. There are many varieties of depression, for it may comprehend a greater and a small extent of bone, and may either be to a greater depth, or less so, and more superficial. 7. When a hedra, or dint of a weapon, takes place in a bone, there may be a fracture combined with it; and provided there be a fracture, contusion must necessarily be joined, to a greater or less extent, in the seat of the dint and fracture, and in the bone which comprehends them. This is the fourth mode. And there may be a hedra, or indentation of the bone, along with contusion of the surrounding bone, but without any fracture either in the hedra or in the contusion inflicted by the weapon. But the indentation of a weapon takes place in a bone, and is called hedra, when the bone remaining in its natural state, the weapon which struck against the bone leaves its impression on the part which it

off, is

struck. In each of these

modes

there are

many

Head

65

with regard to the contusion and fracture, if both these be combined with the hedra, or if contusion alone, as it has been already stated that there are many varieties of contusion and varieties,

And the hedra, or dint, of itself may be longer and shorter, crooked, straight, and fracture.

and there are many varieties of this mode, according to the shape of the weapon; and they may be more or less deep, and narrower or broader, and extremely broad. When a part is cleft, the cleft or notch which occurs in the bone, to whatever length or breadth, is a hedra, if the other bones comprehending the cleft remain in their natural position, and be not driven inwards; for in this case it would be a depression, and no longer a hedra. 8. A bone may be injured in a different part of the head from that on which the person has received the wound, and the bone has been laid bare. This is the fifth mode. And for this misfortune, when it occurs, there is no remedy; for when this mischief takes place, there is no means of ascertaining by any examination whether or not it has occurred, or on what part of the head. 9. Of these modes of fracture, the following require trepanning: the contusion, whether the bone be laid bare or not; and the fissure, whether apparent or not. And if, when an indentation {hedra) by a weapon takes place in a bone it be attended with fracture and contusion, and even if contusion alone, without fracture, be comcircular;

bined with the indentation, it requires trepanA bone depressed from its natural position rarely requires trepanning; and those which are most pressed and broken require trepanning the least; neither does an indentation {hedra) without fracture and contusion require trepanning; nor does a notch, provided it is large and wide; for a notch and a hedra are the same. 10. In the first place, one must examine the ning.

wounded wound is weaker

person, in situated,

parts;

what part

whether

of the head the

in the stronger or

and ascertain respecting the

hairs

about the wound, whether they have been cut off by the instrument, and have gone into the wound; and if so, one should declare that the bone runs the risk of being denuded of flesh, and of having sustained some injury from the weapon. These things one should say from a distant inspection,

man; but on

and before laying a hand on the

a close examination one should en-

deavor to ascertain clearly whether the bone be of flesh ornot;andif the denuded bone be visible to the eyes, this will be enough; but otherwise an examination must be made with the sound. And if you find the bone denuded of the

denuded

Hippocrates

66

from the wound, you must and the exof the mischief, and of what assistance it

flesh, first

tent

and not

safe

ascertain the state of the bone,

stands in need. One should also inquire of the wounded person how and in what way he sus-

and

be not apparent whether the bone has sustained an injury or not, it will be still more necessary, provided the bone be denuded, to make inquiry how the tained the injury;

if

it

wound occurred, and in what manner; for when contusions and fractures exist in the bone, but are not apparent, we must ascertain, in the first

place

from the

patient's answers,

whether

or not the bone has sustained any such injuries,

and then find out the nature of the case by word and deed, with the exception of sounding. For sounding does not discover to us whether the bone has sustained any of these injuries or not; but sounding discovers to us an indentation inflicted by a weapon, and whether a bone be depressed from its natural position, and whether the bone be strongly fractured; all which may also be ascertained visibly with the eyes. ii. And a bone sustains fractures, either so fine as to escape the sight, or such as are apparent,

and contusions which are not apparent, and

depression from

its

when one person

natural position, especially

is

intentionally

wounded by

another, or when, whether intentionally or not,

blow or stroke is received from an elevated and if the instrument in the hand, whether used in throwing or striking, be of a powerful nature, and if a stronger person wound a a

place,

weaker. Of those who are wounded in the parts about the bone, or in the bone itself, by a fall, he who falls from a very high place upon a very hard and blunt object is in most danger of sustaining a fracture and contusion of the bone, and of having it depressed from its natural position; whereas he that falls upon more level ground, and upon a softer object, is likely to suffer less injury in the bone, or

be injured at falling

all.

Of

it

may

not

those instruments which,

upon the head, wound the

parts about

which falls from a very high place, and the least on a level with the person struck, and which is at the same time very hard, very blunt, and very heavy, and which is the least light, sharp, and soft, such an instrument would occasion a fracture and contusion of the bone. And there is most danger that the bone may sustain these injuries, under the bone, or the bone

itself,

that

such circumstances, when the wound is direct and perpendicular to the bone, whether struck from the hand or from a throw, or when any object falls upon the person, or when he is

wounded by falling, or in whatever way the bone sustains a direct wound from this instrument. Those weapons which graze the bone obliquely are

less

apt to fracture, contuse, or de-

when

press the bone, even of flesh; for in flicted the

some

bone

is

the bone

of those

is

denuded

wounds thus

not laid bare of the

in-

flesh.

Those instruments more especially produce fractures in the bone, whether apparent or not, and contusions, and inward depression of the bone, which are rounded, globular, smooth on all sides, blunt, heavy, and hard; and such weapons bruise, compress, and pound the flesh; and the wounds inflicted by such instruments, whether obliquely or circularly, are round, and are more disposed to suppurate, and to have a discharge, and take longer time to become clean; for the flesh which has been bruised and pounded must necessarily suppurate and slough away. But weapons of an oblong form, being, for the most part, slender, sharp, and light, penetrate the flesh rather than bruise it, and the bone in like manner; and such an instrument may occasion a hedra and a cut (for a hedra and a cut are same thing); but weapons of this description do not produce contusions, nor fractures, nor depressions inwardly. And in addition to the ap-

pearances in the bone, which you can detect by make inquiry as to all these particulars (for they are symptoms of a the sight, you should

greater or less injury), whether the

wounded

person was stunned, and whether darkness was diffused over his eyes, and whether he had vertigo, and fell to the ground. 12. When the bone happens to be denuded of flesh by the weapon, and when the wound occurs upon the sutures, it is difficult to distinguish the indentation (hedra) of a weapon which is clearly recognized in other parts of the

bone, whether it exist or not, and especially if the hedra be seated in the sutures themselves. For the suture being rougher than the rest of the bone occasions confusion, and it is not clear which is the suture, and which the mark inflicted by the instrument, unless the latter (hedra)

be large. Fracture also for the most part is combined with the indentation when it occurs in the sutures;

and

discern

when

count, that

if

this fracture

the bone

is

is

more

difficult to

broken, on this ac-

there be a fracture,

it is

situated

most part in the suture. For the bone is liable to be broken and slackened there, owing to the natural weakness of the bone there, and to its porosity, and from the suture being readily ruptured and slackened: but the other bones which surround the suture remain unbroken, for the

On

Injuries of the

because they are stronger than the suture. For the fracture which occurs at the suture is also a slackening of the suture, and it is not easy to detect whether the bone be broken and slackened by the indentation of a weapon occurring in the suture, or from a contusion of the bone at

the sutures; but

it is still

more

difficult to detect

connected with contusion. For the sutures, having the appearance of fissures, elude the discernment and sight of the physician, as being rougher than the rest of the bone, unless the bone be strongly cut and slackened (for a a fracture

hedra are the same thing). But it is if the wound has occurred at the sutures, and the weapon has impinged on the bone or the parts about it, to pay attention and find out what injury the bone has sustained. For a person wounded to the same, or a much smaller, extent, and by weapons of the same size and quality, and even much less, will sustain a much greater injury, provided he has received the blow at the sutures, than if it was elsewhere. And many of these require trepanning, but you must not apply the trepan to the sutures themselves, but on the adjoining bone. 13. And with regard to the cure of wounds cut

and

a

necessary,

in the

head, and the mode of detecting injuries bone which are not apparent, the follow-

ing

my

in the

is

opinion:

—In a wound of the head,

you must not apply anything liquid, not even wine, but as little as possible, nor a cataplasm, nor conduct the treatment with tents, nor apply a bandage to an ulcer on the head, unless it be situated

on the forehead,

in the part

which

is

bare of hairs, or about the eyebrow and eye, for

wounds occurring

there require

cataplasms

and bandages more than upon any other part of the head. For the rest of the head surrounds the whole forehead, and the wounds wherever situated become inflamed and swelled, owing to an influx of blood from the surrounding parts. And neither must you apply cataplasms and bandages to the forehead at all times; but when the inflammation is stopped and the swelling has subsided, you must give up the cataplasms and bandages. A wound in any other part of the head must not be treated with tents, bandages, or cataplasms, unless

You must perform

it

also requires in-

on wounds on the head and forehead, whenever the bone is denuded of flesh, and appears to have sustained some injury from the blow, but the wound has not sufficient length and breadth cision.

incision

situated

for the inspection of the bone, so that

seen whether the blow,

and

it

it

may

be

has received any mischief from

of

what nature the injury

is,

and

Head

67

to what extent the flesh has been contused, and whether the bone has sustained any injury, or whether it be uninjured by the blow, and has suffered no mischief; and with regard to the treatment, what the wound, and the flesh, and the injury of the bone stand in need of. Ulcers of this description stand in need of incision; and, if the bone be denuded of the flesh, and if it be hollow, and extend far obliquely, we cut up the cavity wherever the medicine cannot penetrate readily, whatever medicine it may be; and wounds which are more inclined to be circular and hollow, and for the most part others of the like shape, are cut up by making a double in-

cision in the circle lengthways, according to the

figure of the

man,

make the wound of may be practiced with

so as to

a long form. Incisions

impunity on other parts of the head, with the exception of the temple and the parts above it, where there is a vein that runs across the temple, in which region an incision is not to be made. For convulsions seize on a person who has been thus treated; and if the incision be on the left temple, the convulsions seize on the right side; and if the incision be on the right side, the convulsions take place on the left side. 14. When, then, you lay open a wound in the head on account of the bones having been denuded of the flesh, as wishing to ascertain whether or not the bone has received an injury from the blow, you must make an incision proportionate to the size of the wound, and as much as shall be judged necessary. And in making the incision you must separate the flesh from the bone where it is united to the membrane (pericranium?) and to the bone, and then fill the whole wound with a tent, which will expand the wound very wide next day with as little pain as possible; and along with the tents apply a cataplasm, consisting of a mass (maza)

of fine flour as to render

next day,

pounded it

when you remove

amined the bone tained,

if

in vinegar, or boiled so

as glutinous as possible.

to see

On

the

the tent, having ex-

what injury

it

has sus-

the wound in the bone be not right seen

by you, nor can you discover what mischief the bone itself has sustained, but the instrument seems to have penetrated to the bone so as to have injured it, you must scrape the bone with a raspatory to a depth and length proportionate to the suture of the patient, and again in a transverse direction, for the sake of the fractures

and of the contusions which accompanied with depression of the bone from its natural position. For the scraping discovers the mis-

which

are not seen,

are not discovered, as not being

Hippocrates

68

if the injuries in the bone be not otherwise manifest. And if you perceive an indentation (hedru) left in the bone by the blow, you

chief,

actually sound, or only appears to be so, but

must scrape the dint

has sustained some injury from the blow, there may be danger of its suppurating (although it would not otherwise have done so), if the flesh

bones,

lest,

itself

and the surrounding

as often happens, there should be a

and contusion, or a contusion alone, combined with the dint, and escape observation. And when you scrape the bone with the raspatory, and it appears that the wound in the bone requires the operation, you must not postpone it for three days, but do it during this period, more especially if the weather be hot, and you have had the management of the treatment from thecommencement.If you suspect that the bone is broken or contused, or has sustained both these injuries, having formed your judgement from the severity of the wound, and from the fracture

information of the patient, as that the person who inflicted the wound, provided it was done by another person, was remarkably strong, and that the weapon by which he was wounded was of a dangerous description, and then that the man had been seized with vertigo, dimness of vision, and stupor, and fell to the ground, under these circumstances, if you cannot discover whether the bone be broken, contused, or both the one and the other, nor can see the truth of the matter, you

must

dissolve the

jet-

wound with

black ointment, and

fill

when

and apply a linen rag

this dissolved,

the

it

smeared with oil, and then a cataplasm of the maza with a bandage; and on the next day, having cleaned out the wound, scrape the bone with the raspatory. And if the bone is not sound, but fractured and contused, the rest of it which is scraped will be white; but the fracture and contusion, having imbibed the preparation, will appear black, while the rest of the bone is white. And you must again scrape more deeply the fracture where it appears black; and, if you thus remove the fissure, and cause it to disappear, you may conclude that there has been a contusion of the bone to a greater or less extent, which has occasioned the fracture that has disappeared under the raspatory; but it is less dangerous, and a matter of less consequence, when the fissure has been effaced. But if the fracture extend deep, and do not seem likely to disappear when scraped, such an accident requires trepanning. But having performed this operation, you must apply the other treatment to the

wound.

You must

be upon your guard lest the bone sustain any injury from the fleshy parts if not properly treated. When the bone has been sawed and otherwise denuded, whether it be 15.

which surrounds the bone be

come inflamed and

ill

cured, and be-

strangled; for

it

gets into a

and becomes much inflamed. For the bone acquires heat and inflammation from the surrounding flesh, along with irritation and throbbing, and the other mischiefs which are in the flesh itself, and from these it gets into a state of suppuration. It is a bad thing for the flesh {granulations?) in an ulcer to be moist and mouldy, and to require a long time to become clean. But the wound should be made to febrile state,

suppurate as quickly as possible; parts surrounding the

for,

thus the

wound would

be the disposed to inflammation, and would become the soonest clean; for the flesh which has been chopped and bruised by the blow, must necessarily suppurate and slough away. But when cleaned the wound must be dried, for thus least

wound will most speedily become whole, when flesh devoid of humors grows up, and the

thus there will be no fungous flesh in the sore.

The same thing applies

to the

membrane which

surrounds the brain: for when, by sawing the bone, and removing it from the meninx, you lay the latter bare,

you must make

dry as quickly as possible,

it

clean and

being in a moist state for a considerable time, it become soaked therewith and swelled; for when these things occur, there 16.

A

is

danger of

lest

its

piece of bone that

mortifying.

must separate from

the rest of the bone, in consequence of a

wound

in the head, either from the indentation {hedra)

blow in the bone, or from the bone being otherwise denuded for a long time, separates mostly by becoming exsanguous. For the bone becomes dried up and loses its blood by time and a multiplicity of medicines which are used; and the separation will take place most quickly, if one having cleaned the wound as quickly as of a

possible will next dry it, and the piece of bone, whether larger or smaller. For a piece of bone which is quickly dried and converted, as it were, into a shell, is most readily separated from the rest of the bone which retains its blood and vitality; for, the part having become exsanguous and dry, more readily drops ofif from that which retains its blood and is alive. 17. Such pieces of bone as are depressed from their natural position, either being broken off or chopped of? to a considerable extent, are attended with less danger, provided the membrane be safe; and bones which are broken bv

On

numerous and broader fractures are still less dangerous and more easily extracted. And you must not trepan any of them, nor run any risks in

attempting to extract the pieces of bone, unthey rise

til

up

of their

own

accord,

Head

Injuries of the

upon the

subsidence of the swelling. They rise up when the flesh {granulations) grows below, and it

69

and it becomes glutinous, and appears being of a tawny and somewhat livid color; and the bone then begins to sphacelate, and turns black where it was white before, and at last becomes pale and blanched. But

dies in

it;

like a pickle,

when suppuration

is

fairly established in

And,

grows from the diploe of the bone, and from

delirious.

the sound portion, provided the upper table alone be in a state of necrosis. And the flesh will

seize the other side of the body; for,

shoot

up and grow below the more quickly, and bone ascend, if one will get the suppurate and make it clean as quick-

the pieces of

wound

to

And when

ly as possible.

both the tables of the

bone are driven in upon the membrane, the upper the

and lower, the wound,

same way,

if

I

mean

treated in

will very soon get well,

and the

depressed bones will quickly rise up. 1 8. The bones of children are thinner and softer, for this reason, that they contain more blood [than those of adults] and they are porous and spongy, and neither dense nor hard. ;

And when wounded

to a similar or inferior de-

weapons of the same or even of an inpower, the bone of a young person more

gree by ferior

and quickly suppurates, and that in less time than the bone of an older person; and in accidents, which are to prove fatal, the younger person will die sooner than the elder. But if the bone is laid bare of flesh, one must attend and readily

what even is not obvious to the and discover whether the bone be broken and contused, or only contused; and if, when there is an indentation in the bone, whether try to find out, sight,

contusion, or fracture, or both be joined to

and

if

juries,

it;

the bone has sustained any of these in-

we must

give issue to the blood by per-

forating the bone with a small trepan, observing

bone of young more superficial than that

the greatest precautions, for the

persons is thinner and of elder persons. 19.

When

wound on

a person has sustained a mortal

you may form an opinion of his approaching dissolution, and foretell what is to happen from the following symptoms which such a person experiences. When a bone is

broken, or

cleft,

or contused, or otherwise in-

and when by mistake it has not been discovered, and neither the raspatory nor trepan jured,

has been applied as required, but the case has been neglected as if the bone were sound, fever will generally come on before the fourteenth day if

in winter,

and

in

summer the fever usually And when this happens,

seizes after seven days.

the

wound

loses its color,

and the inflammation

for the

be situated on the

most

left side,

part, convulsions if

the wound

the convulsions will

seize the right side of the body; or if the wound be on the right side of the head, the convulsion

attacks the left side of the body.

come

apoplectic.

And

end of seven days, fourteen,

if

if

in winter.

And some

be-

thus they die before the in

summer; and before these symptoms in-

And

same manner, whether the wound if you perceive that fever is coming on, and that any of these symptoms accompany it, you must not put off, but having sawed the bone to the membrane (mendicate, in the

be older or more recent. But

it with a raspatory (and it is then easily sawed or scraped), you must apply the other treatment as may seem proper, attention being paid to circumstances. 20. When in any wound of the head, whether the man has been trepanned or not, but the bone has been laid bare, a red and erysipelatous swelling supervenes in the face, and in both eyes, or in either of them, and if the swelling be painful to the touch, and if fever and rigor come on, and if the wound look well, whether as regards the flesh or the bone, and if the parts surrounding the wound be well, except the swelling in the face, and if the swelling be not connected with any error in the regimen, you must purge the bowels in such a case with a medicine which will evacuate bile; and when thus purged the fever goes off, the swelling subsides, and the patient gets well. In giving the medicine you must pay attention to the strength

inx), or scraped

of the patient.

the head, which cannot be cured, nor

his life preserved,

it,

small blisters form on the tongue and he dies

21. is

With regard

a necessity for

to trepanning,

it,

when

there

the following particulars

should be known.

If you have had the managefrom the first, you must not at once saw the bone down to the meninx; for it

ment

of the case

is not proper that the membrane should be laid bare and exposed to injuries for a length of time,

as in the

end

it

may become

fungous.

And there

you saw the bone down to the meninx and remove it at once, lest in the act of sawing you should wound the meninx. But is

another danger

in trepanning,

if

when

only a very

little

of the

bone remains to be sawed through, and the bone can be moved, you must desist from saw-

Hippocrates

jo

and leave the bone to fall out of itself. For bone not sawed through, and where a portion is left of the sawing, no mischief can haping,

vided there be matter below

to a

often happens that the bone

pen; for the portion now left is sufficiently thin. In other respects you must conduct the treat-

may appear suitable to the wound. trepanning you must frequently remove the trepan, on account of the heat in the bone, and plunge it in cold water. For the trepan being heated by running round, and heating and drying the bone, burns it and makes a larger piece of bone around the sawing to drop off, than would otherwise do. And if you wish to saw at once down to the membrane, and then ment

And

as

in

remove the bone, you must

manner,

also, in like

frequently take out the trepan and dip

it

in cold

you have not charge of the treatment from the first, but undertake it from another after a time, you must saw the bone at once down to the meninx with a serrated trepan, and in doing so must frequently take out the trepan and examine with a sound (specillum), and water. But

if

otherwise along the tract of the instrument. is much sooner sawn through, pro-

For the bone

On IT

know, and things dissimilar; those connected with things most important, most easily known, and in anywise 1 known; which are to be seen, touched, and heard; which are to be perceived in the sight, and the touch, and the hearing, and the nose, and the tongue, and the understanding; which are to be known by all the means we know other IS the business of the physician to

things.

The

if

the

wound

and in it, and it more superficial,

situated in that part

is

where the bone is rather thinner than in other parts. But you must take care where you apply the trepan, and see that you do so only where it appears to be particularly thick, and having fixed the instrument there, that you frequently make examinations and endeavor by moving the bone to bring it up. Having removed it, you must apply the other suitable remedies to the wound. And if, when you have the management of the treatment from the first, you wish to saw through the bone at once, and remove it from the membrane, you must, in like manner, examine the tract of the instrument frequently with the sound, and see that it is fixed on the thickest part of the bone, and endeavor to remove the bone by moving it about. But if you use a perforator (trepan?), you must not penetrate to the membrane, if you operate on a case which you have had the charge of from the first, but must leave a thin scale of of the head

bone, as described in the process of sawing.

the Surgery

in the first place, things similar

2.

especially

it

is

things relating to surgery, are

—the

each, either to the light, or

the side?). There

from (or oblique of

it

is

obvious.

from the

to the light),

As

light (to

use of that which

is little

is

and the degree

to opposite the light,

we

must turn the part to be operated upon to that which is most brilliant of present and convenient lights, unless those parts which should be concealed, and which it is a shame to look upon; thus the part that is operated upon should be opposite the light, and the operator opposite the part operated upon, except in so far as he

own

patient; the operator; the assistants; the in-

does not stand in his

struments; the light, where and how; how many things, and how; where the body, and the in-

the operator will indeed see, but the thing oper-

struments; the time; the manner; the place. 3. The operator is either sitting or standing,

conveniently for himself, for the person operated upon, for the light. There are two kinds of

common and the artificial; the comnot at our disposal, the artificial is at our disposal. There are two modes of using

light, the

mon 1

is

The meaning

of the

first

tence, according to Galen,

which the medical

is,

practitioner

clause of this senthat the

must do

first

thing

to

make

is

himself well acquainted with semeiology, by comparing carefully the condition of disease with that of health.

ated self:

upon

light; for in this case

will not be seen.

when

sitting, his feet

With regard

to

him-

should be raised to

with his knees, and nearly in conwith one another; the knees a little higher than the groins, and at some distance from one another, for the elbows to rest upon them. The robe, in a neat and orderly manner, is to be thrown over the elbows and shoulders equally a direct line tact

and proportionally. With regard to the part operated upon; we have to consider how far distant, and how near, above, below, on this side, on that side, or in the middle. The measure as to distance and proximity is, that the elbows do not press the knees before, nor the sides be-

On

the Surgery

hind; that the hands be not raised higher than the breasts, nor lower than so as that when the

on the knees he may have the with the arm: thus it is

breast reposes

hands

at right angles

as regards the

medium; but

side or that, the operator

as concerns this

must not be beyond

71

it when done. It should be done quickwithout pain, with ease, and with elegance; quickly, by despatching the work; without pain, by being readily done; with ease, by being prepared for everything; and with elegance, so that

regards

ly,

may

it

be agreeable to the sight.

By what mode

but in proportion as he may require turning he must shift the body, or part of the body, that is operated upon. When standing, he

of training these accomplishments are to be ac-

and

judgment, and when it is equal and unequal, according as the parts are equal or unequal. The forms of it (the bandage? ) are the simple,

his seat,

must make

his inspection, resting firmly

equally on both feet; but he must operate while supporting himself upon either leg, and not the

one on the same side with the hand which he makes use of; the knee being raised to the height of the groins as while sitting; and the other measures in like manner. The person operated upon should accommodate the operator with regard to the other parts of his body, either standing, sitting, or lying; so as that he may continue to preserve his figure, avoid sinking down,

may mainand position of the part operated

shrinking from, turning away; and tain the figure

upon, during the act of presentation, during the operation, and in the subsequent position. 4. The nails should be neither longer nor shorter than the points of the fingers; and the surgeon should practice with the extremities of the fingers, the index-finger being usually turned to the thumb; when using the entire hand, it should be prone; when both hands, they should be opposed to one another. It greatly promotes a dexterous use of the fingers when

and when the But it is clearly a disease when the thumb is impaired from birth, or when, from a habit contracted during the time of nursing, it is impeded in its motions the space between

them

thumb

to the index.

is

opposed

is

large,

One

should practice all sorts of and with both together (for they are both alike), endeavouring to do them well, elegantly, quickly, without trouble, neatly, and promptly. by the fingers.

work with

either of them,

5. The instruments, and when and how they should be prepared, will be treated of afterwards; so that they may not impede the work,

and that there may be no difficulty in taking hold of them, with the part of the body which operates. But if another gives them, he must be ready a little beforehand, and do as you direct. 6. Those about the patient must present the part to be operated upon as may seem proper, and they must hold the rest of the body steady, in silence, and listening to the commands of the operator.

There are two views of bandaging: that which regards it while doing, and that which 7.

quired has been stated. fit

well and neatly;

it is

When

done,

neatly done

it

should

when with

winding (called ascia), the sloping (sima), the monoculus, the rhombus, and the

the slightly

semi-rhombus. The form of bandage should be

form and the affection of the part which it is applied. 8. There are two useful purposes to be fulfilled by bandaging: {first,) strength, which is imparted by the compression and the number of folds. In one case the bandage effects the cure, and in another it contributes to the cure. For these purposes this is the rule that the

suitable to the to

—

force of the constriction be such as to prevent

the adjoining parts from separating, without compressing them much, and so that the parts

may

be adjusted but not forced together; and

that the constriction be small at the extremities,

and a

middle. The knot and the passed through should not be in but in an upward direction, regard

least of all in the

thread that

is

downward

being had to the circumstances under which the case is presented; to position, to the bandaging, and to the compression. The commencement of the ligatures is not to be placed at the wound, but where the knot is situated. The knot should not be placed where it will be exposed to friction, nor where it will be in the way, nor where it will be useless. The knot and the thread should be soft, and not large. 9. {Second.) One ought to be well aware that every bandage has a tendency to fall off towards the part that declines or becomes smaller; as, for example,

upwards, in the case of the head,

and downwards, in the case of the leg. The turns of the bandage should be made from right to left, and from left to right, except on the head, where it should be in a straight direction. When opposite parts are to be bandaged together, we must use a bandage with two heads; or if we make use of a bandage with one

head,

we must

attach

it

in like

manner

at

some

fixed point: such, for example, as the middle of

the head; and so in other cases. Those parts which are much exposed to motion, such as the joints, where there is a flexion, should have few

Hippocrates

72-

and slight bandages applied to them, as at the ham; but where there is much extension, the bandage should be single and broad, as at the kneepan; and for the maintenance of the bandage in its proper place, some turns should be carried to those parts which are not much moved, and are lank, such as the parts above and below the knee. In the case of the shoulder, a fold should be carried round by the other armpit; in that of the groin, by the flanks of the opposite

and of the leg, to above the calf of the leg. the bandage has a tendency to escape above, it should be secured below, and vice versa; and where there is no means of doing side;

When

the case of the head, the turns are to

such a position as to create no pain; and so that may be no constriction nor falling of! on a

there

change of position, either

for the purpose of taking hold of anything, or laying the limb; and that muscles, veins, nerves, and bones may be properly placed and adjusted to one another. It should be raised or laid in a natural position, so as not to occasion pain. In those cases in

formed, we must act in a our object is to bring together parts which have become expanded, in other respects we must proceed on the same plain; and we must commence the bringing to-

which an abscess

contrary way.

is

When

gether from some considerable distance; and

approach,

af-

we must

last applied may secure the portions which more movable. When we cannot secure the bandaging by means of folds of the cloth, nor by suspending them from the opposite side, we must have recourse to stitching it with ligatures, either passed circularly or in the form of

apply compression, at first slight, and afterwards stronger, the limit of it being the actual contact of the parts. In order to separate parts which are drawn together, when attended with inflammation, we must proceed on the opposite plan; but when without inflammation, we must use the same preparations, but bandage in the opposite direction. In order to rectify distorted parts, we must proceed otherwise on the same principles; but the

a seam.

parts

The bandages should be clean, light, soft, and thin. One should practice rolling with both hands together, and with either separately. One

position.

should also choose a suitable one, according to

trary, this

this, as in

be made mostly on the most level part of the head, and the folds are to be done with as little obliquity as possible, so that the firmest part

being are

10.

the breadth

and thickness

of the parts.

The

ter their

which are separated must be brought together by an underbandage, by agglutinants, and by suspending

12.

it

(the limb?) in

natural

its

And when the deformities are the condone on the contrary plan.

to be

is

In fractures

we must attend

to the length,

number

heads of the bandages should be hard, smooth, and neatly put on. That sort of bandaging is the worst which quickly falls off; but those are bad bandages which neither compress nor yet

of the comlength should be that of the bandaging; the breadth, three or four fingers; thick-

come off. n. The following

the limb, neither

breadth, thickness, and presses.

The

number so as to encircle more nor less; those applied

ness, three or fourfold;

which the

for the purpose of rectifying a deformity, should

upper bandage, the under bandage, or both aim at: The object of the under bandage is either to bring together parts that are separated, or to compress such as are expanded, or to separate what are contracted, or to restore to shape what are

be of such a length as to encircle it; the breadth and thickness being determined by the vacuity,

are the object

which

is

not to be

filled

bandages are two, the

up

at once.

first

of

The upper

which

is

to be

on them, but sound, and able

from the seat of the injury upwards, and the second from the seat of the inj ury downwards, and from below upwards; the parts about the seat of the injury being most compressed, the extremities least, and the rest in

stretching, or even a

proportion.

distorted, or the contrary. It is necessary to prepare pieces of linen cloth, which are light, thin, soft, clean, having no seams nor protuberances

little

to bear some more than required;

not dry, but wetted with a juice suitable to the purpose required. must deal with parts separated (in a sinus?) in such wise, that the parts which are raised may touch the bottom without producing pressure; we must begin on the sound part, and terminate at the wound; so that whatever humor is in it may be expelled, and that it may be prevented from collecting more. And straight parts are to be bandaged in a straight direction, and oblique obliquely, in

We

carried

The upper bandages should

take in

a considerable portion of the sound parts.

We

number, length, and breadth of the bandages; the number must be such as not to be inferior to what the injury requires,

must attend

to the

nor occasion compression with the splints, nor prove cumbersome, nor occasion any slipping As to of them, nor render them inefficient. length and breadth, they should be three, four, five,

or six cubits in length,

broad.

The

and

as

folds of the strings

many

fingers

(selvages?)

On

the Surgery

should be such as not to occasion pressure; they are to be soft and not thick; and all these things are to be proportionate to the length, breadth,

and thickness of the part affected. The splints are to be smooth, even, and rounded at the ex-

somewhat less all along than the upper bandaging, and thickest at the part to which the fracture inclines. Those parts where there are tuberosities, and which are devoid of flesh, such as the ankles or fingers, we must guard from the splints which are placed over them, either by position, or by their shortness. They are to be secured by the strings in such a mantremities;

A

soft, ner as not to occasion pressure at first. consistent, and clean cerate should be rubbed

into the folds of the bandage. 13. As to the temperature and quantity of the water used, its heat should be just such as the hand can bear, and it ought to be known that a large quantity is best for producing relaxation and attenuation, whereas a moderate quantity is best for incarnating and softening. The limit

to the affusion

is,

to stop

when

the parts be-

come swelled up, and before the swelling subsides; for the parts swell up at first, and fall

The

should be

on which it (the limb?) is laid smooth, and sloping upwards to-

object soft,

ward the protuberant

parts of the body, such as

the heel or hips, so that there

may

be no projec-

nor bending inwards, nor turning aside. The canal (spout or gutter?) should rather comprehend the whole limb than the half of it, attention being paid to the injury and to whatever else appears to create inconvenience. tion,

The

15.

presentation of the injured part to

the physician, the extension, the arrangement,

and

so forth, are to be regulated according to

nature.

What

is

nature in these operations

is

to

be determined by the accomplishment of the

pose

which we have in we must look to the

in

middle

object

its

state of rest

state,

and

and

view, and for this purpart in the state of rest,

to habit; in

regard to the

relaxation, as in the arm, that

be in a line with the hand; and with regard to and extension, that the forearm be at right angles to the arm; and it

the medium between flexion

with regard to habit, it should be considered that some limbs bear certain positions preferably, as, for example, the thighs extension; for in such attitudes the parts can best bear to be placed for a considerable time without a change of posture. And in the change from the state of distention, the muscles, veins, nerves,

when

is

16.

when

73

raised or placed.

The

extension should be most powerful

the largest and thickest bones, or

both are broken; next

and

least of all,

moderate,

it is

when

when

when

the under-bone,

the upper.

When

im-

injurious, except in the case of

The limb should be a little elevated. The model by which we judge if the part be

children.

properly

set is

or the part

the sound part of the

which

17. Friction

is its

can relax, brace, incarnate,

tenuate: hard braces, soft relaxes, ates,

same name,

pair.

much

at-

attenu-

and moderate thickens.

The

following should be the state of matfirst application of the bandage. The person to whom it has been applied should say 18.

ters

on the

that he feels the compression particularly at

the seat of the injury, but very

little at

the ex-

tremities; the parts should be adjusted but not

pressed together, and that rather by the

number

of the bandages than by the force of the con-

and the tightness should rather be on first day and night; but on the next it should be less, and on the third the bandages should be loose. On the next day striction;

the increase during the

a soft swelling should be observed in the ex-

afterward. 14.

limb

and bones,

properly arranged and secured, will pre-

serve their relations to

one another while the

and on the third day, when the bandaging is loosed, the swelling should be found diminished in size, and this should be the case every time the bandages are removed. At the second application of the bandage, it should be ascertained whether the dressing has been properly done, and then greater compression should be made, and with more bandages; and on the third, still greater, and still more. On the seventh day from the first dressing, when the bandages are loosed, the limb should be found slender and the bones mobile. We must then have recourse to the splints, provided the limb be free of swelling, pruritus, and ulceration, and allow them to remain until twenty days after the accident; but if any suspicions arise, the bandages must be loosed in the interval. The splints should be tightened every third day. 19. The suspending of a fractured limb in a sling, the disposition of it, and the bandaging, all have for their object to preserve it in position. The principal considerations with regard to the position are the habits and the peculiar nature of each of the limbs: the varieties are shown in running, walking, standing, lying, action, retremities;

pose. 20. It should be kept in

mind

that exercise

and inactivity wastes. Compression should be produced by the

strengthens, 21.

number

of bandages, rather than by the force

Hippocrates

74 of the constriction.

22. Incases of ecchymosis, contusions, sprains,

quire a supply greater than its loss, and may be thus disposed to growth and restoration of its

or swellings not attended with inflammations, blood is to be expelled from the wound, in greatest quantity to the upper part, and in smallest

fleshy parts.

to the inferior; neither the arm nor the leg should be placed in a declining position: the head of the bandage should be placed on the

that they

It is better also to bandage the parts above, as the thigh in the case of the leg, and also the thigh and leg of the opposite side, so

may

be placed in similar circum-

greatest pressure should

and may both equally be deprived of motion; and that the supply of nourishment may be alike curtailed and open to both. The

be made; the least at the extremities, and intermediately in the middle; the last fold of the

compression should be the effect rather of the number of the bandages than of their tight-

bandage should be at the upper part of the body. As to binding and compression, these objects are to be attained rather by the number of the bandages than the force of the constriction; and moreover, in these cases the bandages should be thin, light, soft, clean, broad, sound, so that they may effect their purpose, even without splints. And we must use affusions. 23. Dislocations, sprains, diastases of bones, violent separation, abruption of the extremities of bones, and distrainings, so as to induce varus or valgus, in these cases we must apply the band-

ness. We relax first the part most requiring it, and have recourse to that kind of friction which will promote the growth of flesh, and to affu-

wound, and there the

ages so as not to compress the part whence the displacement took place, and that we may render them tight at the side to which the displacement was, and give the limb an inclination in the opposite direction,

degree.

and that

in

an excessive

We employ bandages, compresses,

sus-

pension of the limb in a sling, attitude, extention, friction, rectification; and along with these the affusion of

much water.

24. In treating parts which are atrophied, we must comprehend a considerable part of the sound limb with the bandage, so that by the influx thereby

produced, the wasted part

may

On IN TREATING the

make

straight as possible, for this direction.

But

if

it

and

fractures

physician must

ac-

sion.

splints.

Those things which are for the purpose of giving support and strength to the part, as to the breast, side, head, and so forth, are used in such cases as the following: for pulsations, that may be no motion in the part; and in separation at the sutures of the skull, in order to give support; and in order to strengthen the chest and head, in coughs, sneezings, and other movements. In all these cases the same measure of bandaging is to be observed, for where the injury is, there the bandage should compress most, and something soft is to be placed below that suits with the complaint; and we must not apply the bandages tighter than just to stop the there

pulsations

from creating disturbance, and

the separated parts at the sutures

that

may

be

brought into contact, they must not be such as absolutely to stop the coughs and sneezings, but so as to give support, and, without occasioning uneasiness, prevent the parts from be-

ing shaken.

dislocations,

the most natural

incline to either side,

it

form

but

I

am

under the necessity of giving

being skilled in giving the proper positions to arm in binding it up, while in reality they are only showing their own ignorance. But many other things in our art are judged of in this manner, for people rather admire what is new, although they do not know whether it be proper or not, than what they are accustomed the

who commit blunders. There is no necessity for much study, then, in order to set a broken arm,

now

and

tions

word, any ordinary physician can per-

it;

the longer directions on this subject, because I know physicians who have the reputation of

should rather turn to that of pronation, for there is thus less harm than if it be toward supination. Those, then, who act in such cases without deliberation, for the most part do not fall into any great mistake, for the person who is to have his arm bound, presents it in the proper position from necessity, but physicians who fancy themselves learned in these matters, are they

in a

No

25.

Fractures

the extension as is

stances,

to,

and know already

to be proper;

strange, they prefer to

are,

is

and what is I must

obvious.

what the mistakes of medical men I wish to unteach, and what instruchave to give as to the management of the

state

which I

what

On arm; for what

Fractures

have to say regarding it, will apply to the other bones in the body. 2. The arm, then, for that is the subject we were treating of, was presented in the prone position to be bound, but the physician forced his patient to hold it as the archers do when I

75

arranged differently, having overcome the bandaging.

What use, then, is there And these mistakes,

of the archer's

attitude?

the physician,

conceited in his knowledge, would probably not

have committed

if

he had allowed the patient

himself to present his arm.

But another physician putting the arm

they project the shoulder, and in this position he bound it up, thinking within himself that

to the state of supination, gives orders to extend

3.

arm

in-

he was acting according to Nature, and in proof

the

of this he pointed out that all the bones in the

reckoning

fore-arm were thus in a straight line, and that the integuments both inside and outside, were also in a straight line, and that the flesh and

ing thus from the skin, and also fancying the bones to be thus in their natural position, because the bone which protrudes at the wrist, where the little finger is, appears to be in a line with the bone from which people measure the bone of the fore-arm. These things he brings forward as proofs that the parts are in their natural state, and he is supposed to speak correctly. But, indeed, if the arm be kept stretched in a supine position, it will become very painful, and this fact any one may ascertain by extending his own arm in this attitude. And also a weaker man grasping with his hands a stronger man whose arm is turned in a supine position, could lead him wherever he chose, and neither, if a man held a sword thus in his hand, could he make any proper use of it, so constrained is this position. And, moreover, if, when a physician has thus bound up the arm, he allow it to remain in the same position, the patient will endure greater pain if he walk about, but considerable, even if he remain at rest. And thus, too, if he shall bend the arm, the muscles and the bones must necessarily assume a different position. But, in addition to other mischief, he is ignorant of these facts regarding the position, that the bone which protrudes at the wrist, close to the little finger, belongs to

nerves (tendons?) were thus put in their natural position, and he appealed to what hap-

pens in archery, as a proof of this. And so saying, and so doing, he is looked up to as a sage; and yet he forgets that in all the other arts and performances, whether executed by strength or dexterity, is

what

is

reckoned the natural position

not the same, and that in the same piece of

work

it

may happen

the right

arm

is

that the natural position of

not the same as that of the

left.

For there is one attitude in throwing the javelin, and another in slinging, another in casting stones, another in boxing, and another in a state of repose. And whatever arts one examines, it will be found that the natural position of the arms is not the same in each, but that in every case the arms are put into the attitude which suits best with the instrument that is used, and the work to be performed. In practicing archery, no doubt this is the best attitude of the left arm, for the gingly-moid extremity of the humerus being fixed in the cavity of the ulna, in this position, throws the bones of the fore-

arm and arm

into a line, as

a single bone,

and

all

if

they constituted

flexion at the joint

is

pre-

vented in this position. It is no doubt certain that the member is thus put into the most unbending and extended position possible, so as not to be overcome or yield when the string is drawn by the right arm, and thus will the archer be enabled to draw the string farthest, and discharge his arrow with the greatest force and rapidity, for arrows thus discharged have the greatest swiftness

and

force,

and are carried

the greatest distances. But there

common between

the binding

is

up

to

nothing in of an arm

and archery. Moreover, if having thus bound up the arm, the physician direct the patient to keep it thus, he will occasion him greater pain than he had from the wound itself; and thus also, if the physician order him to bend the arm, neither the bones, the nerves, nor the flesh will

any longer be

in the

same condition, but

will be

thus, it

and bandages

it

in this position,

the one according to nature, judg-

the fore-arm, whereas the one at the joint, from

which people measure the fore-arm, is the head humerus. He fancies that both these belong to the same bone, and many others are of this opinion. The latter, in fact, is the same part as that which is called the elbow, upon which we sometimes rest, and when he holds the arm of the

thus in a supine position, in the

first

place the

bone appears distorted, and in the next place the tendons which extend from the carpus along the inner side and from the fingers become distorted while the

arm

has a supine position; for

these tendons proceed to the bone of the hu-

merus, from which the fore-arm is measured. Such, and so many mistakes and marks of ignorance are committed, regarding the natural construction of the arm. But if one will extend a broken arm as I direct, he will turn the bone,

Hippocrates

76 situated at the extremity of the

little

finger, in-

and also the one at the elbow, and the tendons which stretch from the to the straight line,

carpus to the extremity of the humerus will be placed in the straight line; and when the arm is suspended in a sling, it will be in the same attitude as that in

which

it

was bound up, and

when he walks when he lies reclined, and will not become fatigued. The man should be so seated that the prominent part of the bone may be will give

no pain

to the patient

about, nor

turned to the brightest light which is at hand, so that the operator in making the extension, may be at no loss to discover if it be sufficiently straight.

The prominence

of a

broken bone

could not escape being detected by the hand of an experienced person, when applied for this purpose, and, moreover, the projecting part is particularly painful to the touch. 4. In cases of fracture in either of the bones of the forearm, it is easier to effect a cure if the upper bone be broken, although it be the thicker one, both because the sound bone is situated below, and forms a support to it, and because the deformity is more easily concealed, there

being a thick mass of flesh on the upper side, except near to the wrist. But the lower bone is without a covering of flesh, is not easily con-

and requires stronger extension. If it is not this bone, but the other which is broken, a more feeble extension proves sufficient, but if both be broken, a more powerful extension is cealed,

required. In the case of a

known

the extension

young person

made more

I

have

strong than

was necessary, but in general the extension made than what is required. And when they are extended, the physician should apply the palms of the hands, and adjust the fractured parts and then having rubbed the parts with cerate, but

is less

not in large quantity, so that the bandages may not come off, it is to be bound up in this state, care being taken that the hand be not lower than the elbow, but a little higher, so that the blood do not flow toward the extremity, but

may

be determined to the upper part; and to be secured with the bandage, the head of which is to be placed at the fracture, and the bandage should impart firmness to the parts without occasioning strong compression. When you have carried the bandage twice or

then

it is

round at the seat of the fracture, it is to be carried upward, so that the afflux of blood into it may be stopped, and the bandage should

thrice

terminate there, and the first bandages ought not to be long. The head of the second bandage is also to be placed upon the seat of the frac-

and a single round of it being made there, then to be carried downward, and is not to be applied so tight as theother,and there should be greater distances between the turns, so that the bandage may prove sufficient to revert to the spot where the other terminated. The bandages may be rolled to the left hand or to the right, or to whatever side suits best with the position of the fractured arm, or according to ture, it is

the inclination

we must

which

smeared with a

it

may

have. Afterward

along the arm, compresses,

place

little

sion less uneasiness,

cerate, for thus they occa-

and are more

easily ar-

ranged. And then we must apply the bandages crossways, sometimes to the right hand, and

sometimes to the left, for the most part beginning below and terminating above, but sometimes commencing above and ending below. The parts which are thinly covered with flesh should be wrapped round with compresses, and inequalities should be made up, not by a number of folds at once, but by degrees. Some slack turns are also to be made around the wrist, to this side and to that. These two bandages are sufficient at first. 5.

And

these are the signs that the patient has

been well treated and properly bandaged: if you ask him if the arm feels tight, and he says it does, but moderately so, and especially about the fracture; and this reply he should make all along, if the bandage be properly applied. And these are symptoms of the bandaging being moderately tight; if for the first day and night he fancies that the tightness does not diminish, but rather increases; and if on the next day there be a soft swelling in the hand, for this is a sign of moderate compression, but at the end of the second day the compression should feel less, and on the third day the bandaging should appear loose. And if any of these symptoms be wanting, you may conclude that the bandaging is slacker than it should be; or if any of these symptoms be in excess, you may infer that the compression is more than moderate; and judging from these, you will apply the next bandages either slacker or tighter. Having removed the bandages on the third day, you must make

extension and adjust the fracture, and bind it up again; and if the first bandaging was moderately applied, the second bandaging should be made somewhat tighter. The heads of the bandages should be placed on the fractures as in the former case; for, by so doing, the humors will be driven to the extremities, whereas if you bandage any other part beforehand, the humors will be forced from it to the seat of the fracture: it

On is

of

Fractures

much importance

that this should be prop-

Thus

the bandaging and com-

erly understood.

pression should always

commence

at the seat of

and everything else should be conducted on the same principle, so that the farther you proceed from the fracture, the comthe fracture,

pression should always be the

less.

The band-

ages should never be actually loose, but should be smoothly put on. At each dressing the number of bandages should be increased; and the patient, if asked, should answer, that he feels the

bandages somewhat tighter than on the former occasion, especially about the fracture,

and

ev-

erything else in proportion; and with respect to the swelling, the pain, and recovery, everything should proceed as after the former dress-

But on the third day the outer bandaging should appear looser. Then having removed the bandages, you should bind it up again, somewhat tighter than before, and with all the bandages which will be required on the occasion, and afterwards one ought to experience the same train of symptoms as at the former periods of bandaging. 6. When the third day arrives, that is to say, the seventh from the first dressing, if properly ing.

done, the swelling in the hand should be not very great; and the part which has been bandaged should be found more slender and less

77

And

be found necessary that splints should be applied in these directions at the seat of the fracture, they should be made shorter than the others, so as that they may not reach the bones which are prominent at the wrist, for otherwise there is danger of ulceration, and of the tendons being laid bare. The splints should be adjusted anew every third day, in a very gentle manner, always keeping in mind that the object of the splints is to maintain the lower bandages in their place, and that they are not needed in order to contribute to the compresside of

it.

if

it

sion. 7. If,

you

see that the bones are propby the first dressings, and that no troublesome pruritus in the part, nor

then,

erly adjusted

there

is

any reason to suspect ulceration, you may allow the arm to remain bandaged in the splints until after the lapse of more than twenty days. The bones of the fore-arm generally get consolidated in thirty days altogether; but there

nothing precise in

is

one constitution differs from another, and one period of life from another. When you remove the bandages, you must pour hot water on the arm and bind it up again, but somewhat slacker, and with fewer bandages than formerly: and again on the third day you undo the bandages, and bind it still more loosely, and with still fewer

And

this matter, for

arm

bound up

swelled at each time, and on the seventh day

bandages.

the swelling should be quite gone, and the brok-

you should at any time suspect that the bones do not lie properly, or if anything about the bandages annoys the patient, you should loose them at the middle of the time, or a little earlier, and apply them again. A diet

en bones should be more readily moved, and admit of being easily adjusted. And if these things be so, you should, after setting the fracture, apply the bandages so as to suit the splints, and a little more tight than formerly, unless there be more pain from the swelling in the hand. When you have applied the bandages, you must adjust the splints all around the limb, and secure them with strings so loose as just to keep them in their place, without the application of the splints contributing at all to the

compression of the arm. After this the pain and recovery should proceed as in the preceding periods of the bandaging. But if, on the third day, the patient say that the bandaging

you must then fasten the

is

loose,

splints, especially at

the fracture, but also elsewhere, wherever the is rather loose than tight. The splint should be thickest where the fracture protrudes, but it should not be much more so than elsewhere. Particular attention should be paid to

bandaging

the line of the so that

of

it,

no

arm corresponding to the thumb,

splint be laid

on

it,

nor in the line of the

the bone

is

prominent

but upon each side

little

ringer

at the wrist,

where

but on each

if,

while the

is

in the splints,

slightly restricted will be sufficient in those cases

in

or

which there was no external wound at first, when the bone does not protrude; but one

should live rather sparingly until the tenth day, as being now deprived of exercise; and tender articles of food should be used, such as moderately loosen the bowels; but one should abstain altogether from flesh and wine, and then by degrees resume a more nourishing diet. This doctrine may be laid down as a just rule in the treatment of fractures, both as to how they should be treated, and what will be the results of a proper plan of treatment; so that one may know, that if things do not turn out thus, there has been some defect or excess in the treatment. And in this simple plan of treatment it is necessary to attend also to the following directions, which some physicians pay little attention to, although, when improperly executed, they are capable of marring the whole process of bandaging: for if both the bones be broken, or the

Hippocrates

78

lower one only, and the patient who has got his it slung in a shawl, and that the shawl is particularly loose at the tracture, so that the arm is not properly suspended

arm bandaged keep

end or

bone must necessarily be found distorted upwards; whereat this

as,

that, in this case the

when both bones

are thus broken,

if

the

arm

at the wrist and elbow, but be not kept up, the bone in this case will be distorted to the lower side. The

recline in the

the rest of

shawl

it

greater part of the

hand should

arm and

the wrist of the

therefore be equally suspended in

a broad soft shawl.

When the arm

is

the arm: having got a piece of

somewhat

wood

less in length, like

a cubit or

the handles of

by means of a chain fastened to its extremities at both ends; and having seated the man on some high object, the arm is to be brought over, so that the armpit may rest on the piece of wood, and the man can scarcely touch the seat, being almost suspended; then having brought another seat, and placed one or more leather pillows under the arm, so as to keep it a moderate height while it is bent at a right angle, the best plan is to put round the arm a broad and soft skin, or broad shawl, and to hang some great weight to it, so as to produce moderate extension; or otherwise, while the arm is in the position I have described, a strong man is to take hold of it at the elbow and pull it downward. But the physician standing erect, must perform the proper manipulation, having the one foot on some pretty high object, and adjusting the bone with the palms of his hands; and it will readily be adjusted, for the spades, suspend

extension

him bind

is

it

good

the arm,

if

properly applied.

commencing

Then

let

at the fracture,

and do otherwise as directed above; let him put the same questions and avail himself of the same signs to ascertain whether the arm be moderately tight or not; and every third day let him bind it anew and make it tighter; and on the seventh or ninth day let him bind it up with splints, and leave it so until after the lapse of more than thirty days. And if he suspect that the bone is not lying properly, let him remove the bandages in the interval, and having adjusted the arm, let him bind it up again. The bone of the arm is generally consolidated in

When

these are past, the dressing

applied instead of

on

is

removed, and fewer and slacker bandages

a stricter diet,

it.

and

The

patient

is

to be kept

for a longer space of

than in the former case; and

time

we must form our

judgment

of it from the swelling in the hand, looking also to the strength of the patient. This also should be known, that the arm is naturally inclined outward; to this side, therefore, the distortion usually takes place,

ed; but indeed,

if

not properly treat-

the other bones are usually

all

distorted during treatment for fracture to that

which they naturally

side to

broken, if one stretch the fore-arm and adjust it while in this position, the muscle of the arm will be bound while extended; but when the dressing is over, and the patient bends his arm at the elbow, the muscle of the arm will assume a different shape. The following, then, is the most natural plan of setting 8.

forty days. to be

incline.

therefore, anything of this kind

the

arm

which

to be encircled in a

is

is

When,

suspected,

broad shawl,

round the breast, and when the patient goes to rest, a compress of many folds, or some such thing, is to be folded and placed between the elbow and the side, for thus the bending of the bone will be rectified, but care must be taken lest it be inclined too much is

to be carried

inwards. 9.

The human

foot

is

composed of

several

small bones like the hand. These bones therefore are scarcely ever broken, unless the skin at

same time be wounded by some sharp and heavy body. The treatment of such injuries, therefore, will be delivered under the head of wounds. But if any bone be moved from its place, or a joint of the toes be luxated, or any of the bones of the part called the tarsus be displaced, it must be forced back again to its place as described with regard to the hand; and is to be treated with cerate, compresses, and bandages, like the fractures, with the exception of the splints; and is to be secured tightly in the same way, and the bandages renewed on the third day; and the patient thus bandaged should return the same answers as in fractures, as to the bandages feeling tight or slack. All these bones recover perfectly in twenty days, except those that are connected with the bones of the leg, and are in a line with them. It is advantageous to lie in bed during the whole of this time; but the patients, thinking light of the complaint, have not perseverance to do this, and they walk about before they get well; wherethe

fore

many

covery.

of these

And

do not make a perfect rethem in mind

often the pain puts

of the injury;

and deservedly,

for the feet sus-

weight of the whole body. When, therefore, they walk about before they are whole, the joints which have been luxated are cured incompletely; and, on that account, while walking about, they have pains in the leg from time tain the

to time.

On Fractures

79

of the

occurred in the leg and it is long of healing, and is connected with the heel, or when the same thing happens in the thigh, or when in any disease a protracted decubitus takes place on the back, in all such cases the sores are inveterate, troublesome, and frequently break out again, unless particular attention be paid to the cure, along with much rest, as in all the cases attended with sphacelus. And cases of sphacelus con-

bandages are to be made there. And at each time the bandages are taken of?, much hot wa-

conveniences, are attended with great danger

io. But those bones which are connected with the bones of the leg are larger than the others, and the cure of them when luxuated is more protracted. The mode of treatment then is the same; but we must use more bandages and

more

splints,

round be

and the bandage is to be carried and to that, and pressure is to

to this side

made

as in the other cases, particularly at the

seat of the luxation,

ter

is

and the

first circles

to be used, for in all injuries at joints the

affusion of hot water in large quantity

had recourse

to.

And

is

to be

same symptoms of

the

compression and relaxation should manifest themselves in the same times, as in the cases formerly treated of, and the subsequent bandagings should be conducted in like manner. These cases get completely well for the most part in forty days, if the patients have resolution to keep their bed; but if not, they are subjected to the complaints formerly described, or still

worse.

ii.

In persons

object pitch

who jumping from any

upon

with great

their heel

high force,

and the veins pour forth their contents, owing to the contusion of the flesh surrounding the bone, and hence a swelling and much pain supervene. For this the bones are separated,

bone (os calcis) is not a small one, protrudes beyond the line of the leg, and is connected with important veins and tendons; for the back tendon of the leg is inserted into this bone. Such cases are to be treated with cerate, and with compresses and bandages; and hot water is to be used in large quantity; and they require many bandages, which ought to be particularly good and appropriate. And if the patient happen to have a tender skin about the heel, nothing is to be done to it; but if, as some have it, the skin be thick and hardened, it is to be pared down smoothly and thinned, but without wounding it. It is not everybody who can apply the bandage properly in such cases; for if one shall bind the parts, as in other accidents about the ankle, sometimes bringing a fold round the foot and sometimes round the tendon, these turns leave out the heel,

which

contusion, and thus there calcis

may

place, the

sphacelate;

is

and

is

the seat of the

danger that the os if

this

impediment may endure

should take for life

and

also in all the other cases of sphacelus, not pro-

ceeding from such a cause as this; as when, from being carelessly allowed to lie in a certain position during confinement to bed, the heel

becomes black, or when a serious wound has

nected with this cause, in addition to other in-

whole body. For they are apt to be attended with very acute fevers, of the continual type, accompanied with tremblings, hiccup, aberration of intellect, and which prove fatal within a few days: and there may be lividities of 1 bloody veins, with nausea, and gangrene from to the

pressure; these diseases

may

occur, besides the

Those which have been described are the most violent contusion; but in general the contusions are mild, and no great care is required with regard to the treatment, and yet it must be conducted properly. But when the contusion appears to be severe, we must do as sphacelus.

making many

described above,

bandage around the

turns of the

sometimes carrying it to the extremity of the foot, sometimes to the middle, and sometimes around the leg; and, in addition, all the surrounding parts are to be bandaged in this direction and that, as formerly described; and the compression should not be heel,

made strong, but we should make use of many bandages, and it is better also to administer hellebore the same day or on the morrow; and the bandages should be removed on the third day and reapplied. And these are the symptoms by which we discover whether the case will get worse or not: when the extravasated blood, the lividities, and the surrounding parts become red and hard, there is danger of an exacerbation. But if there be no fever, we must give emetics, as has been said, and administer the other remedies which are applicable

when

the

not of a continual type; but if continual fever be present, we must not give strong medicines, but enjoin abstinence from solid food and soups, and give water for drink, and not allow wine but oxygly\y (a composition from vinefever

is

gar and honey?). But if the case be not going to get worse, the ecchymosed and livid parts, and those surrounding them become greenish and not hard; for this is a satisfactory proof in all cases of ecchymosis, that they are not to get worse; but when lividity is complicated 1

as

By bloody

veins

Galen explains.

is

meant veins

of a large size,

Hippocrates

8o

danger that the part may become blackened. And we must so manage the foot as that it may be generally raised a little higher than the rest of the body. Such a patient will get well in sixty days if he keep with hardness, there

is

quiet.

The

12.

the one

one

is

leg consists of

two bones, of which

much more slender than the other at much more slender at an-

part, but not

These are connected together at the foot, and form a common epiphysis, but they are not united together along the line of the leg; and at the thigh they are united together and form an epiphysis, and this epiphysis has a diaphysis; but the other bone in a line with the little toe is a little longer. Such is the nature of the bones of other.

Sometimes the bones connected with the sometimes both bones with their epiphysis; sometimes the whole epiphysis is slightly moved, and sometimes the other bone. These cases are less troublesome than the same 13.

foot are displaced,

accidents at the wrist,

if

the patients will have

them rest. The mode of treatsame as that of the other, for the reto be made, as of the other, by means

resolution to give is

duction

knee, and aids in thus

making

at the

counter-exten-

sion. Or thus, if you prefer it: having bound other thongs of leather about the limb, either at the knee, or around the thigh, and having fas-

tened another nave of a wheel in the ground above the head, and adjusted the thongs to some piece of wood adapted to the nave, extension

may the

thus be

feet.

Or

made

if

in the opposite direction to

you choose,

it

may

be done thus:

instead of the naves, lay a moderate-sized

beam

under the couch, and then having fastened pieces of wood in this beam, both before and behind the head, make counter-extension by

means

of thongs, or place windlasses at this ex-

make extension by means There are many other methods of making extension. But the best thing is, for any tremity and that, and

of them.

the leg.

ment

another person takes hold of the limb

the is

of extension, but greater force

most

part,

fractures

two men

will

and

dislocation, either for

making

ex-

For this purpose it will be sufficient to possess a board in length, breadth, and thickness, resembling the quadtension, or acting as a lever.

rangular threshing-boards

required, as

is

the parts of the body concerned are stronger in this case. But, for the

who practices in a large city, to have prepared a proper wooden machine, with all the mechanical powers applicable in cases of physician

14. is

is

made

of oak.

When you have made proper extension, it

easy to reduce the joint, for the displaced bone

thus raised into a line with the other.

And

be sufficient, by

making extension

in opposite

the bones are to be adjusted with the palms of

directions, but,

they are not sufficiently strong,

upon the projecting bone with the one, and making counter-pressure below the ankle with the other. When you have replaced the bones, you must apply the bandages while the parts are upon the stretch, if you possibly can; but if prevented by the thongs, you must loose them, and make counter-extension until you get the bandages applied. The bandage is* to be applied in the manner formerly described, the heads of the bandages being

it is

easy to

if

make more powerful

extension in

the following way: having fixed in the

ground any such object, something soft is to be bound round the foot, and then some broad thongs of ox-skin being brought round it, the heads of the thongs are to be fastened to a pestle or any other piece of wood, the end of which is to be inserted into the nave, and it, the pestle, is to be pulled away, while other persons make counter-extension by grasping the shoulders and the ham. It is also sometimes necessary to secure the upper extremity otherwise; this if you desire to effect, fasten deeply in the ground a round, smooth piece of wood, and place the upper extremity of the piece of wood at the perineum, so that it may prevent the body from yielding to the pulling at the foot, and, moreover, to prevent the leg while stretched, from inclining downward; some person seated at his side should push back the hip, so that the body may not turn round with the pulling, and for this purpose, if you either the nave of a wheel, or

think fit, pieces of wood may be fastened about the armpits on each side, and they are to be stretched by the hands, and thus secured, while

the hands, pressing

placed on the projecting part, and the first turns made in like manner, and so also with regard

number of compresses and the compresand turns of the bandages are to be brought frequently round on this and on that side of the ankle. But this joint must be bound more tight at the first dressing than in the case of the hand. But when you have applied the bandage, you must place the bandaged part somewhat higher than the rest of the body, and in such a position that the foot may hang as little as possible. The attenuation of the body is to be made proportionate to the magnitude to the

sion;

of the luxation, for one luxation

is

to be a small,

and another to a great extent. But in general we must reduce more, and for a longer time,

On Fractures about the legs, than in those about the hands; for the former parts are larger and thicker than the latter, and it is necessary that the body should be kept in a state of rest, and in a recumbent position. There is nothing to in injuries

prevent or require the limb to be bandaged anew on the third day. And all the treatment otherwise is to be conducted in like manner, as in the preceding cases. And if the patient have resolution to lie quiet, forty days will be sufficient for this purpose, if only the bones be prop-

but if he will not lie quiet, he will not be able to use the limb with ease, and he will find it necessary to wear a bandage for a long time. When the bones are not properly replaced, but there has been some defect in this erly reduced,

respect, the hip, the thigh, and the leg become wasted, and if the dislocation be inward, the external part of the thigh is wasted, and vice versa. But for the most part the dislocation is

inward.

And when both bones of the leg are broken without a wound of the skin, stronger extension is required. We may make extension 15.

by some of the methods formerly described, provided the bones ride over one another to a considerable degree. But extension by men is also sufficient, and for the most part two strong men will suffice, by making extension and counterextension. Extension must naturally be made straight in a line with the leg and thigh, whether on account of a fracture of the bones of the leg or of the thigh. And in both cases they are to be bandaged while in a state of extension, for the same position does not suit with the leg and the arm. For when the fractured bones of the arm or fore-arm are bandaged, the fore-arm is suspended in a sling, and if you bind them up while extended, the figures of the fleshy parts will be changed in bending the arm at the elbow, for the elbow cannot be kept long extende 1. since persons are not in the custom of keeping the joint long in this form, but in a bent position, and persons who have been wounded

arm, and are still able to walk about, require to have the arm bent at the elbow-joint. But the leg, both in walking and standing, is habitually extended, either completely or nearly so, and is usually in a depending position in the

from

its

construction,

and

in order that

it

may

bear the weight of the rest of the body. Wherefore sary,

it

readily bears to be extended

and even when

this position.

in

when

bed the limb

is

neces-

often in

And when wounded, necessity sub-

dues the understanding, since the patients become incapable of raising themselves up, so that

81

they neither think of bending the limb nor of getting up erect, but remain lying in the same position. For these reasons, neither the same

same mode of bandaging aparm and to the leg. If, then, extenby means of men be sufficient, we should

position nor the plies to the

sion

not have recourse to any useless contrivances, for it is absurd to employ mechanical means when not required; but if extension by men be not sufficient, you may use any of the mechanical

powers which

is

suitable.

When

sufficiently

extended, it will be easy to adjust the bones and bring them into their natural position, by straightening and arranging them with the palms of the hand. 16. When the parts are adjusted, you should apply the bandages while the limb is in a stretched position, making the first turns to the right or to the left, as may be most suitable; and the end of the bandage should be placed

over the fracture, and the first turns made at that place; and then the bandage should be carried up the leg, as described with regard to the other fractures. But the bandages should be broader and longer, and more numerous, in the case of the leg than in that of the arm. And when it is bandaged it should be laid upon some smooth and soft object, so that it may not be distorted to the one side or the other, and that there may be no protrusion of the bones either forward or backward; for this purpose nothing is more convenient than a cushion, or something similar, either of linen or wool, and not hard; it is to be made hollow along its middle, and placed below the limb. With regard to the canals {gutters?) usually placed below frac-

tured legs, I am at a loss whether to advise that they should be used or not. For they certainly are beneficial, but not to the extent which those who use them suppose. For the canals do not preserve the leg at rest as they suppose; nor,

when

the rest of the body

is

turned to the one

side or the other, does the canal prevent the leg

from following, unless the patient himself pay attention; neither does the canal prevent the

limb from being moved without the body to the one side or the other. And a board is an uncomfortable thing to have the limb laid upon, unless something soft be placed above it. But it is a very useful thing in making any subsequent arrangements of the bed and in going to stool. A limb then may be well or ill arranged with or without the canal. But the common people have more confidence, and the surgeon is more likely to escape blame, when the canal is placed under the limb, although it is not secundum at-

Hippocrates

82.

For the limb should by all means lie straight upon some level and soft object, since the bandaging must necessarily be overcome by any distortion in the placing of the leg, whenever or to whatever extent it may be inclined. The patient, when bandaged, should return the same answers as formerly stated, for the bandaging should be the same, and the same swellings should arise in the extremities, and the slackening of the bandages in like manner, and the new bandaging on the third day; and the bandaged part should be found reduced in swelling; and the new bandagings should be more tightly put on, and more pieces of cloth should be used; and the bandages should be tern.

carried loosely about the foot, unless the

wound

be near the knee. Extension should be made and the bones adjusted at every new bandaging; for, if properly treated, and if the swelling progress in a suitable manner, the bandaged limb will have become more slender and attenuated, and the bones will be more mobile, and

and the patients speedily get on foot, for it is the inner bone of the leg which supports the most of the weight of the body. For along with the thigh, as being in a line with weightthrown upon the thigh, the inner bone has more work to sustain; inasmuch as it is the head of the thigh-bone which sustains the upper part of the body, and it is on the inner and not on the outer side of the thigh, being in a line with the tibia; and the other half of the body approxi-

mates more to

and

this line

than to the external one;

same time the inner bone

at the

is

larger

than the outer, as in the fore-arm the bone in the line of the

little

finger

is

the slenderer and

longer. But in the joint of the inferior extremity,

the disposition of the longer bone

alike, for the

ferently.

elbow and the

ham

is

not

are bent dif-

For these reasons when the external

the ninth, or the eleventh day, the splints should

broken, the patients can soon walk about; but in fractures of the inner, it is a long time before they can walk. 19. When the thigh-bone is broken, particular pains should be taken with regard to the extension that it may not be insufficient, for when

be applied as described in treating of the other

excessive,

fractures. Attention should be paid to the posi-

one should bandage a limb while the extremities of the bone are separated to a distance from one another by the force of the extension, the bandaging will not keep them separate, and so the bones will come together again as soon as

more

yield

readily to extension.

On the seventh,

and along which runs up the leg.

tion of the splints about the ankles

the tendon of the foot

The bones

of the leg get consolidated in forty

properly treated. But

you suspect that arrangement of the limb, or dread any ulceration, you should loose the bandages in the interval, and having put everything right, apply them again. 17. But if the other bone (fibula?) of the leg be broken, less powerful extension is required, and yet it must not be neglected, nor be performed slovenly, more especially at the first bandaging. For in all cases of fracture this obdays,

if

anything

is

wanting

if

to the proper

bone

is

no great harm

the persons stretching

results

it let

go

from

it.

For, if

their hold; for

the fleshy parts (muscles?) being thick strong, are

more powerful than

instead of being less so. In the case then

we

are

ted in

and

the bandaging,

which

now treating of, nothing should be omitorder that the parts may be properly

distended and put in a straight line; for it is a and an injury to exhibit a shortened thigh. For the arm, when shortened, might great disgrace

would not be

ject

be concealed, and the mistake

sible.

great; but a shortened thigh-bone would exhibit

should be attained then as quickly as posFor when the bandage is applied tight while the bones are not properly arranged, the part becomes more painful. The treatment otherwise is the same. 18. Of the bones of the leg, the inner one, called the tibia, is the more troublesome to man-

and requires the greater extension; and

if

the broken bones are not properly arranged,

it

the

man maimed. For when

placed beside

it,

the sound limb is being longer than the other,

it exposes the mistake, and therefore it would be to the advantage of a person who would be improperly treated that both his legs should be

impossible to conceal the distortion, for the

broken, rather than either of them; for in this would be of the same length as the other. When, then, proper extension has been

is exposed and wholly uncovered with and it is much longer before patients can walk on the leg when this bone is broken. But if the outer bone be broken, it causes much less trouble, and the deformity, when the bones are not properly set, is much more easily concealed, the bone being well covered with flesh;

made, you must adjust the parts with the palms of the hands, and bandage the limb in the manner formerly described, placing the hands of the bandages as was directed, and making the turns upward. And the patient should return the same answers to the same questions as formerly, should be pained and recover in like

age,

is

bone

flesh;

case the one

I

On

Fractures

manner, and should have the bandaging renewed in the same way; and the application of the splints should be the same. is

The

thigh-bone

consolidated in forty days.

should be known, that the curved rather to the outside than to the inside, and rather forward than backward; when not properly treated, then, the distortions are in these directions; and the bone is least covered with flesh at the same parts, so that the distortion cannot be concealed. If, therefore, you suspect anything of this kind, you should have recourse to the mechanical contrivances recommended in distortion of the arm. And a few turns of the bandage should be brought round by the hip and the loins, so that the groin and the articulation near the perineum may be included in the bandage; and moreover, it is expedient that the extremitiesof thesplints should not do mischief by being placed on parts not covered with the bandages. The splints, in fact, should be carefully kept off the naked parts at both ends; and the arrangement of them should 20.

But

this also

thigh-bone

is

may

be so managed, as that they

not be placed

on the natural protuberances of the bone at the knee-joint, nor on the tendon which is situated there. 21.

The

swellings which arise in the ham, at

the foot, or in any other part

from the pressure,

should be well wrapped in unscoured and carded wool, washed with wine and oil, and anointed with cerate, before bandaging; and if the splints give pain they should be slackened. You may sooner reduce the swellings, by laying aside the splints, and applying plenty of bandages to them, beginning from below and rolling upward; for thus the swellings will be most speedily reduced, and the humors be propelled to the parts above the former bandages. But this form of bandaging must not be used unless there be danger of vesications or blackening in the swelling, and nothing of the kind occurs unless the fracture be bound too tight, or unless the limb be allowed to hang, or it be rubbed with the hand, or some other thing of an irritant nature be applied to the skin. 22. More injury than good results from placing below the thigh a canal which does not pass

farther

down

than the ham, for

vents the body nor the leg

it

neither pre-

from being moved

without the thigh. And it creates uneasiness by being brought down to the ham, and has a tendency to produce what of all things should be avoided, namely, flexion at the knee, for this completely disturbs the bandages; and when the thigh and leg are bandaged, if one bend the

83

limb at the knee, the muscles necessarily assume another shape, and the broken bones are also necessarily moved. Every endeavor then should be made to keep the ham extended. But it appears to me, that a canal which embraces the limb from the nates to the foot is of use. And moreover, a shawl should be put loosely round at the ham, along with the canal, as children are swathed in bed; and then, if the thigh-bone gets displaced either

upward

or to the side,

it

can be more easily kept in position by this means along with the canal. The canal then should be made so as to extend all along the limb or not used at all. 23. The extremity of the heel should be particularly attended to, so that it may be properly laid, both in fractures of the legand of the thigh. For if the foot be placed in a dependent position, while the rest of the body is supported, the limb must present a curved appearance at the forepart of the leg; and if the heel be placed higher than is proper, and if the rest of the leg be rather too low, the bone at the forepart of the

must present a hollow, more especially if the But all the bones get consolidated more slowly, if not laid properly, and if not kept steady in the same position, and in this case the callus is more leg

heel of the patient be naturally large.

feeble.

24. is

These things relate to

cases in

which there

fracture of the bones without protrusion of

same or wound of any other kind. In those which the bones are simply broken across, and are not comminuted, but protrude, if reduced the same day or next, and secured in their place, and if there be no reason to anticipate that any splintered bones will come away; and in those in which the broken bones do not the

cases in

is the mode of fracture such that reason to expect the splinters will come out, some physicians heal the sores in a way which neither does much good nor harm, by means of a cleansing application, applying pitch ointment, or some of the dressings for fresh

protrude, nor

there

is

wounds, or anything else which they are accustomed to do, and binding above them compresses wetted with wine, or greasy wool, or something else of the like nature. And when the wounds become clean and are new healed, they endeavor to bind up the limb with plenty of bandages, and keep it straight with splints. This treatment does some good, and never much harm. The bones, however, can never be equally well restored to their place, but the part is a little more swelled than it should be; and the limb will be somewhat shortened, provided

Hippocrates

84

both bones either of the leg or fore-arm have been fractured. 25. There are others who treat such cases at first with bandages, applying them on both sides of the seat of the injury, but omit them there, and leave the wound uncovered, and afterward they apply to the wound some cleansing medicine, and complete the dressing with compresses dipped in wine and greasy wool. This plan of treatment is bad, and it is clear that those who adopt this mode of practice are guilty of great mistakes in other cases of fracture as well as these. For it is a most important consideration to know in what manner the head of the bandage should be placed and at what part the greatest pressure should be, and what benefits would result from applying the end of the bandage and the pressure at the proper place, and what mischiefs would result from applying the head of the bandage and the pressure otherwise than at the proper place. Wherefore it has been stated in the preceding part of the work what are the results of either;

and the

practice of

medicine bears witness to the truth of it, for in a person thus bandaged, a swelling must necessarily arise on the wound. For, if even a sound

were bandaged on either side, and were left in the middle, the part thus left unbandaged would become most swelled, and would assume a bad color; how then could it piece of skin a part

be that a wound would not suffer in like manner? The wound then must necessarily become discolored and its lips everted, the discharge

and without pus, and the bones, which should not have got into a state of necrosis, exfoliate; and the wound gets into a throbbing and inflamed condition. And they are obliged to apply a cataplasm on account of the swelling, but this is an unsuitable application to parts which are bandaged on both sides, for a useless load is added to the throbbing which formerly existed in it. At last they loose the bandages when matters get very serious, and conduct the rest of the treatment without bandaging; and notwithstanding, if they meet with another case of the same description, they treat it in the same manner, for they do not think that the application of the bandages on both sides, and the exposure of the wound are the cause of what happened, but some other untoward circumstance. Wherefore I would not have written so much on this subject, if I had not well known that this mode of bandaging is unsuitable, and yet that many conduct the treatment in this way, whose will be ichorous

mistake it is of vital importance to correct, while what is here said is a proof, that what

was formerly written as to the circumstances under which bandages should be tightly applied to fractures or otherwise has been correctly written.

26.

As

a general rule

it

may

be said, that in

those cases in which a separation of bone is not expected, the same treatment should be applied

when the fractures are not complicated with an external wound; for the extension, adjustment of the bones, and the bandaging, are to be conducted in the same manner. To the wound itself a cerate mixed with pitch is to be applied, a thin folded compress is to be bound upon it, and the parts around are to be anointed with white cerate. The cloths for bandages and the other things should be torn broader than in cases in which there is no wound, and the first turn of the bandage should be a good deal broader than the wound. For a narrower bandage than the wound binds the wound like a as

which is not proper, or the first turn should comprehend the whole wound, and the bandaging should extend beyond it on both sides. The bandage then should be put on in the direction of the wound, and should be not quite so tight as when there is no wound, but the bandage should be otherwise applied in the manner described above. The bandages should be of a soft consistence, and more especially so in such cases than in those not complicated with a wound. The number of bandages should not be smaller, but rather greater than those formerly described. When applied, the patient should have the feeling of the parts being properly secured, but not too tight, and in particular he should be able to say that they are firm about the wound. And the intervals of time during which the parts seem to be properly adjusted, and those in which they get loose, should be the same as those formerly described. The bandages should girdle,

be renewed on the third day, and the after treatment conducted in the same manner as formerly described,

except that in the latter case the

compression should be somewhat less than in the former. And if matters go on properly, the parts about the wound should be found at every dressing always more and more free of swelling, and the swelling should have subsided on the whole part comprehended by the bandages. And the suppurations will take place more speedily than in the case of wounds treated otherwise; and the pieces of flesh in the wound which have become black and dead, will sooner separate and fall off under this plan of treatment than any other, and the sore will come more

quickly to cicatrization

when

thus treated than

On The reason which the wound

otherwise. in

rounding

of all this is

is,

situated,

Fractures

that the parts

and the

sur-

parts, are kept free of swelling. In all

is to be conducted without a wound of the integuments. Splints should not be applied. On this account the bandages should be more numerous than in the former case, both because they must be put on less tight, and because the splints are later of being applied. But if you do apply the splints, they should not be applied along the wound, and they are to be put on in a loose manner, especial care being taken that there may be no great compression from the splints. This direction has been formerly given. And the diet should be more restricted, and for

other respects the treatment

as in cases of fracture

which there is commencement, and when the

a longer period, in those cases in

a

wound

at the

bones protrude through the skin; and, in a word, the greater the wound, the more severe and protracted should the regimen be. 27. The treatment of the sores is the same in

which there was no but one has formed treatment, owing to the pres-

those cases of fracture in

wound

of the skin at

in the course of

first,

sure of the splints occasioned by the bandages, from any other cause. In such cases it is as-

or

is an ulcer, by the pain and and the swelling in the extremibecomes harder than usual, and if you ap-

certained that there the throbbing; ties

ply your finger the redness disappears, but speedily returns. If you suspect anything of the kind you must loose the dressing, if there be any itching below the under-bandages, or in any other part that is bandaged, and used a pitched cerate instead of the other. If there be nothing of that, but if the ulcer be found in an irritable state, being very black and foul, and the fleshy parts about to suppurate, and the tendons to slough away, in these cases no part is to be exposed to the air, nor is anything to be apprehended from these suppurations, but the treatment is to be conducted in the same manner as in those cases in which there was an external wound at first. You must begin to apply the bandages loosely at the swelling in the extremities, and then gradually proceed upward with the bandaging, so that it may be tight at no place, but particularly firm at the sore, and less so elsewhere. The first bandages should be clean and not narrow, and the number of bandages should be as great as in those cases in which

the splints were used, or somewhat fewer. To the sore itself a compress, anointed with white cerate, will be sufficient, for if a piece of flesh or nerve (tendon?) become black, it will fall

85

such sores are not to be treated with acrid, but with emollient applications, like burns. The bandages are to be renewed every third day, and no splints are to be applied, but rest is to be more rigidly maintained than in the former cases, along with a restricted diet. It should be known, that if any piece of flesh or tendon be to come away, the mischief will spread much of?; for

and the parts will much more speedily drop and the swelling in the surrounding parts will much more completely subside, under this treatment, than if any of the cleansing applications be put upon the sore. And if any part that

less,

oft,

is

to

come away

carnate sooner

shall fall oft, the part will in-

when

thus treated than other-

and will more speedily cicatrize. Such are the good effects of knowing how a bandage can be well and moderately applied. But a proper position, the other parts of the regimen, and suitable bandages co-operate. 28. If you are deceived with regard to a recent wound, supposing there will be no exfoliation of the bones, while they are on the eve of coming out of the sore, you must not hesitate to adopt this mode of treatment; for no great mischief will result, provided you have the necessary dexterity to apply the bandages well and without doing any harm. And this is a symptom of an exfoliation of bone being about to take place under this mode of treatment; pus runs copiously from the sore, and appears striving to make its escape. The bandage must be renewed more frequently on account of the diswise,

charge, since otherwise fevers

come on;

if

the

and surrounding parts be compressed by the bandages they become wasted. Cases comsore

plicated with the exfoliation of very small bones,

do not require any change of treatment, only the bandages should be put on more loosely, so that the discharge of pus

may

not be inter-

and the dressings are to be frequently renewed until the bone exfoliate, and cepted, but left free,

the splints should not be applied until then. 29. Those cases in which the exfoliation of a larger piece of bone

discover this at the

is

expected, whether you

commencement,

or perceive

subsequently that it is to happen, no longer require the same mode of treatment, only that the extension and arrangement of the parts are to be performed in a manner that has been described; but having formed double compresses, not less than half a fathom in breadth (being guided in this by the nature of the wound), and considerably shorter than what would be required to go twice round the part that is wounded, but considerably longer than to go

Hippocrates

86 once round, and

in

number what

cient, these are to be

dipped

in a

will be suffi-

black austere

wine; and beginning at the middle, as is done in applying the double-headed bandage, you are to wrap the part around and proceed crossing the heads in the form of the bandage called These things are to be done at the wound, and on both sides of it; and there must

"ascia."

be no compression, but they are to be laid on wound. And on the

so as to give support to the

wound itself is to be applied the pitched cerate, or one of the applications to recent wounds, or any other medicine which will suit with the embrocation. And if it be the summer season, the compresses are to be frequently damped with wine; but if the winter season, plenty of greasy wool, moistened with wine and oil, should be applied. And a goat's skin should be spread below, so as to carry off the fluids which run from the wound; these must be guarded against, and it should be kept in mind, that parts which remain long in the same position are subject to excoriations

which are

difficult to

cure. 30. In such cases as do not admit of bandaging according to any of the methods which have been described, or which will be described, great pains should be taken that the fractured part of the body be laid in a right position, and attention should be paid that it may incline upward rather than downward. But if one would wish to do the thing well and dexterously, it is proper to have recourse to some mechanical contrivance, in order that the fractured part of the body may undergo proper and not violent

extension; and this

means

is

particularly appli-

cable in fractures of the leg.

There are

certain

physicians who, in all fractures of the leg, whether

bandages be applied or not, fasten the

sole of

some other piece of wood which they have fixed in the ground near the couch. These persons thus do all sorts of mischief but no good; for it contributes nothing the foot to the couch, or to

thus bound, as the rest of the body will no less sink down to the foot, and thus the limb will no longer be stretched, neither will it do any good toward keeping to the extension that the foot

is

such as are worn by persons confined for a length of time in large shackles, and the balls should havecoats on each side, deeper toward the

wound, but

shorter toward the joints;

and the

should be well stuffed and soft, and fit well, the one above the ankles, and the other below the knee. Sideways it should have below two appendages, either of a single or double thong, and short, like loops, the one set being placed on either side of the ankle, and the other on the knee. And the other upper ball should have others of the same kind in the same line. Then taking four rods, made of the cornel tree, of equal balls

length,

and of the thickness

of a finger,

and of

such length that when bent they will admit of being adjusted to the appendages, care should be taken that the extremities of the rods bear not upon the skin, but on the extremities of the balls. There should be three sets of rods, or more, one set a little longer than another, and another a little shorter and smaller, so that they may produce greater or less distention, if required. Either of these sets of rods should be placed on this side and that of the ankles. If these things be properly contrived, they should occasion a proper and equable extension in a straight line, without giving any pain to the wound; for the pressure, if there is any, should be thrown at the foot and the thigh. And the rods are commodiously arranged on either side of the ankles, so as not to interfere with the

and the wound is easily And, if thought proper, there is nothing to prevent the two upper rods from being fastened to one another; and if any light covering be thrown over the limb, it will thus be kept off from the wound. If, then, the balls be well made, handsome, soft, and newly stitched, and if the extension by the rods be properly managed, as has been already described, this is an excellent contrivance; but if any of them do not fit properly, it does more position of the limb;

examined and

easily arranged.

harm than good. And

all

other mechanical con-

trivances should either be properly done, or not

be had recourse to at all, for it is a disgraceful and thing to use mechancial means in an

awkward

from followhad not been

unmechanical way. 31. Moreover, the greater part of physicians treat fractures, both with and without an external wound, during the first days, by means of unwashed wool, and there does not appear to be anything improper in this. It is very ex-

bound it would have been less distorted, as it would have been the less prevented from fol-

cusable for those who are called upon to treat newly-received accidents of this kind, and who

lowing the motion of the rest of the body. But one should sew two balls of Egyptian leather,

up with wool;

the limb in a proper position, but will do harm, for

when

the rest of the body

side or that, the

foot

bandaging

turned to

is

this

will not prevent the

and the bones belonging

ing the rest of the body. For

to

it

if it

at hand, to do them except cloth for bandages,

have no cloth for bandages for,

On Fractures one could not have anything better than wool in such cases; but a good deal should be used for this purpose, and it should be well carded and not rough, for in small quantity and of a bad quality it has little power. But those who approve of binding up the limb with wool for a day or two, and on the third and fourth apply bandages, and make the greatest compression and extension at that period, such persons show themselves to be ignorant of the most important principles of medicine; for, in a word, at no time is it so little proper to disturb all kinds of

wounds

as

on the third and fourth day; and

all

probing should be avoided on these days in whatever other injuries are attended with sort of

irritation. For, generally, the third

and fourth

day in most cases of wounds, are those which give rise to exacerbations, whether the tendency be to inflammation, to a foul condition of the sore, or to fevers. And if any piece of informais; to which most important cases in medicine does it not apply? and that not only in wounds but in many other diseases, unless one should call all other diseases wounds. And this doctrine is not

tion be particularly valuable this

of the

devoid of a certain degree of plausibility, for they are allied to one another in many respects. But those who maintain that wool should be used until after the first seven days, and then that the parts should be extended and adjusted, and secured with bandages, would appear not to be equally devoid of proper judgment, for the most dangerous season for inflammation is then past, and the bones being loose can be easily set after the lapse of these days.

of treatment

is

But

far inferior to that

still

this

mode

with bandages

from the commencement; for, the latter method on the seventh day free from inflammation, and ready for complete bandaging with splints; while the former method is far behind in this respect, and is attended with many other bad effects which it would be tedi-

exhibits the patient

ous to describe. 31. In those cases of fracture in which the bones protrude and cannot be restored to their place, the following

practiced:

—Some

mode

of reduction

may

be small pieces of iron are to be

prepared like the levers which the cutters of stone make use of, one being rather broader and another narrower; and there should be three of them at least, and still more, so that you may use those that suit best; and then, along with extension, we must use these as levers, applying the under surface of the piece of iron to the under fragment of the bone, and the upper surface to the upper bone; and, in a word, we

87

must operate powerfully with the lever as we would do upon a stone or a piece of wood. The pieces of iron should be as strong as possible, so

may

not bend. This is a powerful provided the pieces of iron be suitable, and one use them properly as levers. Of all the mechanical instruments used by men, the most powerful are these three, the axis in that they

assistance,

peritrochio, the lever,

and the wedge. Without

men

could not perform any of their works which require great force. Wherefore, reduction with the lever is not to be despised, for the bones will be reduced in this way, or not at all. But if the upper fragment which rides over the other does not furnish a suitable point of support for the lever, but the protruding part is sharp, you must scoop out of the bone what will furnish a proper place for the lever to rest on. The lever, along with extension, may be had recourse to on the day of the accident,or next day, but by no means on the third, the fourth, and the fifth. For if the limb is disturbed on these days, and yet the fractured bones not reduced, inflammation will be excited, and this no less if they are reduced; for convulsions are more apt to occur if reduction take place, than if the attempt should fail. These tacts should be well known, for if convulsions should come on when reduction is effected, there is little hope of recovery; but it is of use to displace the bones again if this can be done with out trouble. For it is not at the time when the parts are in a particularly relaxed condition that convulsions and tetanus are apt to supervene, but when they are more than usually tense. In the case we are now treating of, we should not disturb the limb on the aforesaid days, but strive to keep the wound as free from inflammation as possible, and especially encourage suppuration in it. But when seven days have elapsed, or rather more, if there be no fever, and if the wound be not inflamed, then there will be less to prevent an attempt at reduction, if you hope to succeed; but otherwise you' need not take and these,

one or

all,

give trouble in vain. 32.

When you have reduced the bones to their

place, the

modes

of treatment, whether you ex-

pect the bones to exfoliate or not, have been

al-

ready described. All those cases in which an exfoliation of bone is expected, should be treated by the method of bandaging with cloths, beginning for the most part at the middle of the bandage, as is done with the double-headed bandage; but particular attention should be paid to the shape of the wound, so that its lips may gape or be distorted as little as possible under the band-

Hippocrates

88 age.

Sometimes the turns of the bandage have made to the right, and sometimes to the and sometimes a double-headed bandage

ors,

and

also of convulsions; for convulsions

to be

are induced by cold things,

left,

33. It should be known that bones, which it has been found impossible to reduce, as well as

proper to know that the members are necessarily shortened in those cases in which the bones have been broken, and have healed the one across the other, and in those

denuded of flesh, will become detached. In some cases the upper part of the bone is laid bare, and in others the flesh dies all around; and, from a sore of long standing, certain of the bones become carious, and some not, some more, and some less; and in some the small, and in others the large bones. From what has been said it will be seen, that it

which the whole circle of the bone has become detached. 35. Those cases in which the bone of the thigh, or of the arm, protrudes, do not easily recover. For the bones are large, and contain much marrow; and many important nerves, muscles, and veins are wounded at the same time. .And if you reduce them, convulsions usually super-

is

to be used.

those which are wholly

is

tell in one word when the bones Some come away more quickly,

impossible to

will separate.

owing

and some from being merely fixed at the point; and some, from pieces not separating, but merely exfoliating, become dried up and putrid; and besides, different modes of treatment have different effects. For the most part, the bones separate most quickly in those cases in which suppuration takes place most quickly, and when new flesh is most quickly formed, and is particularly sound, for the flesh which grows up below in the wound gento their smallness,

erally elevates the pieces of bone. It will be well if

the whole circle of the bone separate in forty

days; for in days,

and

pieces of

more

in

some some

cases to

it is

protracted to sixty

more; for the more porous

bone separate more quickly, but the

solid

come away more

other smaller splinters in others otherwise.

slowly; but the

much

less

time,

and

A portion of bone which pro-

sawn off for the following reacannot be reduced, and if it appears that only a small piece is required in order that it may get back into its place; and if it be such that it can be taken out, and if it occasions inconvenience and irritates any part of the flesh, and prevents the limb from being properly laid, and if, moreover, it be denuded of flesh, such a piece of bone should be taken off. With regard to the others, it is not of much consequence whether they be sawed off or not. For it should be known for certain, that such bones as are completely deprived of flesh, and have become

by wounds.

and

also

sometimes

It is

cases in

vene; and,

come

not reduced, acute bilious fevers

if

on, with singultus

and mortification. The

chances of recovery are not fewer in those cases in which the parts have not been reduced, nor any attempts made at reduction. Still more recover in those cases in which the lower, than

which the upper part of the bone proand some will recover when reduction has been made, but very rarely indeed. For modes of treatment and peculiarity of consti-

those in trudes;

tution

make

a great difference as to the capa-

enduring such an injury. And it makes a great difference if the bones of the arm and of

bility of

the thigh protrude to the inside; for there are

many and important vessels situated of which,

if

wounded, will prove

such also on the outside, but of In

wounds

there,

less

importance.

of this sort, then, one ought not to

be ignorant of the dangers, and should prognosticate them in due time. But if you are com-

and hope and if the bones do not cross one another much, and if the muscles are not con-

trudes should be

pelled to have recourse to reduction,

sons:

to succeed,

if it

dried, all separate completely.

Those which

are

about to exfoliate should not be sawn off. Those that will separate completely must be judged of from the symptoms that have been laid down. 34. Such cases are to be treated with compresses and vinous applications, as formerly laid down regarding bones which will separate. We must avoid wetting it at the beginning with anything cold; for there is danger of febrile rig-

some

fatal; there are

tracted (for they usually are contracted), the lever in such cases

may

be advantageously em-

ployed. 36.

Having

effected the reduction,

you must

give an emollient draught of hellebore the same day, provided it has been reduced on the day of the accident, but otherwise

it

should not be

at-

The wound should

be treated with the same things as are used in fractures of the bones of the head, and nothingcold should be applied;

tempted.

the patient should be restricted from food together,

and

if

al-

naturally of a bilious constitu-

he should have for a diet a little fragrant oxyglyky sprinkled on water; but if he is not bilious, he should have water for drink; and if fever of the continual type come on, he is to be confined to this regimen for fourteen days at least, but if he be free of fever, for only seven days, and then you must bring him back by detion,

On grees to a

common

diet.

To those cases

Fractures

in which

the bones have not been reduced, a similar

course of medicine should be administered, along with the same treatment of the sores and regimen; and in like manner the suspended part of the body should not be stretched, but should rather be contracted, so as to relax the parts about the wound. The separation of the bones is

89

figuration of the joint, are

more

difficult to re-

duce if the bones are not immediately replaced. For the bones at the elbow are less subject to dislocation than those of the knee, but are more difficult to reduce and keep in their position, and are more apt to become inflamed and ankylosed. 39.

For the most part the displacements of

protracted, as also

these bones are small, sometimes toward the

should try to

ribs, and sometimes to the outside; and the whole articulation is not displaced, but that part of the humerus remains in place which is articulated with the cavity of the bone of the forearm that has a protuberance {ulna?). Such dislocations, to whatever side, are easily reduced, and the extension is to be made in the line of the arm, one person making extension at the wrist, and another grasping the armpit, while a third, applying the palm of his hand to the part of the joint which is displaced, pushes it inward, and at the same time makes counterpressure on the opposite side near the joint with

was formerly stated. But one escape from such cases, provided

one can do so honourably, for the hopes of recovery are small, and the dangers many; and if the physician do not reduce the fractured bones he will be looked upon as unskillful, while by reducing them he will bring the patient nearer to death than to recovery. 37. Luxations and subluxations at the knee are much milder accidents than subluxations and luxations at the elbow. For the knee-joint, in proportion to its size, is more compact than that of the arm, and has a more even conformation, and is rounded, while the joint of the arm is

large,

and has many

cavities.

And

in addition,

the bones of the leg are nearly of the

length, for the external one overtops the other to so small an extent as hardly to deserve being mentioned, and therefore affords no great resistance, although the external nerve {ligament?) at the ham arises from it; but the bones of the fore-arm are unequal, and the shorter is considerably thicker than the other, and the more slender {ulna?) protrudes, and passes up above the joint, and to it (the olecranon?) are attached the nerves {ligaments?) which go downward

bone {ulna?) has more {radius?).

to

of the articu-

and of the bones of the elbow, is such have described. Owing to their configuration, the bones at the knee are indeed frequently I

dislocated, but they are easily reduced, for

no

great inflammation follows, nor any constric-

They

are displaced for the

most and

part to the inside, sometimes to the outside, occasionally into the

not

ham. The reduction

in all

but in the dislocations inward and outward, the patient should be placed on a low seat, and the thigh should be elevated, but not much. Moderate exten-

these cases

is

difficult,

most part sufficeth, extension being the leg, and counter-extension at the

sion for the

made

at

thigh. 38. Dislocations at the elbow are more troublesome than those at the knee, and, owing to the inflammation which comes on, and the con-

of the

humerus

at the

Such luxations readily

The displacement

elbow gets yield to re-

for the

most part

is

to the in-

but sometimes to the outside, and they are readily recognized by the shape of the limb. And often such luxations are reduced without any powerful extension. In dislocations inward, the joint is to be pushed into its place, while the side,

is brought round to a state of pronaSuch are most of the dislocations at the el-

fore-arm

bow.

The configuration then

tion of the joint.

of the ulna.

do with the insertion the thick bone

arm than

The end

duction, if applied before the parts get inflamed.

tion.

lations,

as

40.

displaced {subluxated?) by leaving the cavity

and the slender

to the junction of the bones;

of the ligaments in the

the other hand.

same

41. But if the articular extremity of the humerus be carried to either side above the bone of the fore-arm, which is prominent, into the hollow of the arm ( ?), this rarely happens; but if

does happen, extension in the straight line is not so proper under such circumstances; for in such a mode of extension, the process of the ulna {olecranon?) prevents the bone of the arm it

{humerus?) from passing over

it.

In disloca-

tions of this kind, extension should be

the

manner described when

made

bandaging of fractured bones of the arm, tension being

made upward

in

treating of the at the

ex-

armpit,

while the parts at the elbow are pushed downward, for in this manner can the humerus be most readily raised above its cavity; and when so raised, the reduction is easy with the palms of the hand, the one being applied so as to make pressure on the protuberant part of the arm,

and the other making counter-pressure,

so as to

Hippocrates

9