De Medicina (Celsus)

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	De Medicina Author: Celsus	Translator: Walter George Spencer
197	Ac de fractis quidem ossibus hactenus dictum sit . MOVENTVR autem ea sedibus suis duobus modis : nam modo quae iuncta sunt inter se dehiscunt , ut cum latum scapularum os ab umero recedit , et in brachio radius a cubito , et in crure tibia a sura ; interdum calcis os a talo , quod raro tamen fit : modo articuli suis sedibus excidunt . Ante de prioribus dicam . Quorum ubi aliquid incidit , protinus is locus cau us est , depressusque digitus sinum inuenit ; deinde grauis inflammatio oritur , atque in talis praecipu e : siquidem febres quoque et cancros et neruorum uel distentiones uel rigores , qui caput scapulis adnectunt , mouere consueuit . Quorum uitandorum causa facienda ea dem sunt , quae in ossibus omnibus laesis [ aliquid ubi incidit , protinus is locus ] proposita sunt , ut dolor tumorque per ea tollantur . Nam diducta ossa numquam rursus inter se iunguntur , et ut aliquid decoris eo loco , sic nihil usus amittitur . Maxilla uero et uertebra omnesque articuli , cum ualidis neruis conprendantur , excidunt aut ui expulsi , aut aliquo casu neruis uel ruptis uel infirm atis , faciliusque in pueris et adulescentulis quam in robustioribus . Hique elabuntur in priorem * * * in exteriorem partem , quidam omnibus modis , quidam certi s. Sunt que quaedam communia omnium signa , quaedam propria sunt cuiusque : siquidem semper ea parte est tumor , in qua m os prorumpit ; ea sinus , a qua recessit . Et haec quidem in omnibus deprenduntur , alia uero in singulis ; quae , simul atque de quoque dicam , proponenda erunt . Sed ut excidere omnes articuli possunt , sic non omnes reponuntur . Caput enim numquam * * compellitur , neque in spina uertebra , neque ea maxilla , quae , utraque parte prolapsa , antequam reponer etur, inflammationem mouit . Rursus si qui neruorum uitio prolapsi sunt , conpulsi quoque in suas sedes iterum excidunt . A c quibus in pueritia exciderunt neque repositi sunt , minus quam ceteri crescunt . Omniumque , quae loco suo non sunt , caro e macres cit , magi sque in proximo membro quam ulteriore , ut puta , si umerus loco suo non est , maior in eo ipso fit quam in brachio , maior in hoc quam in manu macies . Tum pro sedibus et pro casibus , qui inciderunt , aut maior aut minor usus eius membri relinquitur ; quoque in e o plus usus superest , eo minus id extenuatur . Quicquid autem loco suo motum est , ante inflammationem reponendum est : si illa occupauit , dum conquiescat , n on lacessendum : ubi finitast , temptandum in is membris , quae id patiuntur . Multum autem eo confert et corporis et neruorum habitus . Nam si corpus tenue , si umidum est , si nerui infirmi , expeditius os reponitur : sed ut primo facilius excidit , it a postea minus fideliter continetur . Quae contraria his sunt , melius continent : sed id , quod expulsum est , difficulter admittunt .— Oportet autem ipsam inflammationem leuare super sucida lana ex aceto inposita : a cibo , si ualentioris articuli casus est , triduo , interdum etiam quinque diebus abstinere ; bibere aquam calidam , dum sitim finiat ; curiossiusque haec facere is ossibus motis , quae ualidis plenisque musculis continentur : si uero etiam febris accessit , multo magis ; deinde ex die quinto fouere aqua calida ; remotaque lana ceratum inponere ex cyprino factum , nitro quoque adiecto , donec omnis inflammatio finiatur . Tunc frictionem ei membro adhibere ; cibis uti bonis ; uti uino modice ; iamque ad usus quoque suos id membrum promouere , quia motus ut in dolore pestifer , sic alias saluberrimus corpor i est . Haec communia sunt , nunc de singulis dicam .	11 So much for the discussion of fractured bones. Turning to dislocations, these are of two kinds: for at times bones which are conjoined gape asunder, as when the shoulder-bone recedes from the clavicle, and, in the forearm, the radius from the ulna, or in the leg the tibia from the fibula; sometimes after a jump the heel-bone from the ankle, though this is rare; at times joints slip out of position. I will speak of the former first. Now when anything of this sort happens, there is a depression at once on the spot, and when the finger is put into this a gap is felt; after this severe inflammation arises, particularly at the ankle; indeed this is often a cause of fevers also and gangrene and spasms of the sinews or rigors, which bend back the head to the shoulder-blade. To avoid these things the same is to be done as was laid down for bone injuries in general, so that pain and swelling may be thereby relieved. For bones so separated never again unite, and even if the appearance of the limb is somewhat impaired its usefulness is not. Since all joints, including the jawbone and vertebrae, are held in place by strong sinews, they are displaced either by force or after some accident which has ruptured or weakened the sinews, and this occurs more readily in boys and youths, than in the more robust. And these joints slip out forwards, backwards, inwards, outwards, some in all directions, some in certain only. And there are some signs which are common to all, some special to each; there is always a swelling in the part into which the bone has ruptured, and a hollow whence the bone has receded. These signs are found in all, but others only in some cases; these I will describe when speaking of each separately. But while it is possible for all joints to slip out, yet not all can be replaced. For the head is never forced back into position, nor is a spinal vertebra, nor a jawbone which has been dislocated forwards on both sides, and has become inflamed before it has been replaced. Again, any joints which have slipped owing to a lesion of their sinews, even when forced back into position slip out again. Also when joints have been dislocated in childhood, and have not been replaced, there is less growth than elsewhere. The flesh of all which are out of place wastes, and in the near more than in the distant part of the limb; for instance, if the upper arm-bone is not in its place, the wasting is more here than in the forearm, more in the forearm than in the hand. Again, according to the site and character of the accidents, more or less use of the limb is retained; and the more use is retained, the less does it waste. Now every dislocation ought to be replaced before there is inflammation; but if this has set in already, the limb is not to be disturbed until after it subsides; only when it has ended should replacement be attempted in the limbs which allow of it. But for this much depends upon the general constitution of the patient and his sinews. For if his body is slender, and humid, if sinews are weak, the bone is readily replaced; but just as the bones slips out more easily in the first instance, so the replacement is less secure. With an opposite type of constitution the replacement is more lasting but there is more difficulty in restoring that which has been put out of position. The inflammation should be relieved by applying greasy wool saturated with vinegar: there should be abstinence from food, in the case of the stronger joints, for three days, some he said for five; warm water is drunk, enough to relieve thirst; this regimen must be followed more strictly after dislocation of bones which are held in place by strong and large muscles; far more strictly indeed if fever supervenes; then after the fifth day there should be hot-water fomentation; when the wool is removed, a cerate must be applied made with cyprus oil with the addition of soda, until all inflammation has ended. Then the limb is to be rubbed, good food given and wine in moderation; and now also the natural use of the limb is to be encouraged; because though movement when it gives pain is harmful, it is otherwise most beneficial to the body. After these generalities, I will now speak of particular cases.
198	Maxilla in priorem partem propellitur , sed modo altera parte , modo utraque . Si alter a , in contrariam partem ipsa mentum que inclinatur ; dentes paribus non respondent , sed sub is , qui secant , canini sunt . A t si utraque , totum mentum in exteriorem partem promouetur ; inferioresque dentes longius quam superiores excedunt ; intentique super musculi apparent . — Primo quoque tempore autem homo in sedili conlocandus est sic , ut minister a posteriore parte caput eius contineat , uel sic , ut iuxta parietem is sedeat , subiecto inter parietem et caput eius scorteo puluino duro , eoque caput e ius per ministrum urgeatur , quo sit immobili us. Tum medici digiti pollices linteolis uel fasceis , ne delabantur , inuoluti in os eius coiciendi , ceteri extrinsecus admouendi sunt . Vbi uehementer maxilla adprehensa est , si una parte procidit , concutiendum mentum et ad guttur adducendum est . Tum simul et caput adprehendendum , et excitato mento maxilla in suam sedem conpellenda , et os eius conprimendum est sic , ut omnia paene uno momento fiant . Si n utraque parte prolapsa est , eadem omnia eadem facienda , sed aequaliter retro maxilla agenda est . Reposito osse , si cum dolore oculorum et ceruic is ist e casus incidit , ex brachio sanguis mittendus est . Cum omnibus uero , quo rum ossa mota sunt , primo liquidior cibus conueniat , tum his praecipue , adeo ut sermo quoque frequenti motu oris per neruos laedat .	12 The lower jaw is displaced forwards, sometimes on one side, sometimes on both. If on one side, it inclines with the chin to the opposite side, the teeth do not correspond with their fellows, but the canine are under the incisors. But if on both sides, the whole chin is moved forwards, and the lower teeth stick out beyond the upper ones; and the muscles above appear tense. As soon as possible the patient is to be seated on a stool, with an assistant behind holding his head, or with his back against a wall and a hard leather cushion between the wall and the back of his head, against which his head is firmly pushed by the assistant, to keep it from moving. Then the surgeon's thumbs, which have been wrapped round with strips of linen or bandages so that they may not slip, are inserted into the mouth whilst the fingers are applied outside. When the jaw has been grasped firmly, if it has slipped forwards to one side, the chin is to be pressed down towards the throat with a jerk. Then simultaneously the head is firmly held, and the chin being raised the jaw is forced back to its place, and the mouth is closed so that all this is done almost with one movement. If it has been dislocated on both sides all the same movements are to be done except that the jaw is forced straight backwards. When the bone is in its place, if the accident has been attended with pain in the eyes and neck, blood is to be let from the arm. For all patients with dislocated bones, a more liquid diet is proper at first, but especially in this case, since even talking, as it causes constant movement of the mouth by means of the sinews, is harmful.
199	Caput duobus processibus in duos sinus summae uertebrae demissis super ceruicem contineri in prima parte proposui . Hi processus interdum in posteriorem partem excidunt ; quo fit , ut , qui nerui s unt sub occipitio , extendantur , mentum pectori adglutinetur , neque bibere is , neque lo qui possit , interdum sine uoluntate semen emittat ; quibus celerrime mors superuenit . Ponendum autem hoc esse credi di , non quo curatio eius rei ulla sit , sed ut res indiciis cognosc eretur et non putarent sibi medicum defuisse , si qui sic aliquem perdidisse nt.	13 As I stated in the first part, the head is held by two processes, inserted into two cups in the highest vertebra. These processes sometimes slip out backwards; with the result that the sinews under the occiput are stretched, and the chin fixed to the chest; the man cannot drink or speak, and sometimes has involuntary emission of semen; upon these symptoms death very quickly supervenes. Now I thought this condition should be described, not that there is any treatment for it, but that it may be recognized by these indications, and that those who have lost someone in this way may not deem the medical man to have been at fault.
200	Idem casus manet eos , quorum in spina uertebrae excide runt: id enim non potest fieri , nisi et medulla , quae per medium , et duabus membranulis , quae per duos a lateribus processus feruntur , et neruis , qui contine nt, ruptis . Excidunt autem et in posteriorem partem et in priorem et supra saeptum transuersum et infra . In utram partem excideri nt, a posteriore parte uel tumor uel sinus † donec . Si super saeptum id incidit , manus resoluuntur , uomitus aut neruorum distentio insequitur , spiritus difficulter mouetur , dolor urguet et aures obtusae sunt . Si sub sae pto, femina resoluuntur , urina subprimitur , interdum etiam sine uoluntate prorumpit . Ex eiusmodi casibus , ut tardius qua m ex capitis , sic tamen intra triduum homo moritur . Nam quod Hippocrates dixit , uertebra in exteriorem partem prolapsa pronum hominem collocandum esse et extendendum , tum calce aliquem super ipsum os debere consistere , et id intus inpellere , in is accipiendum , quae paulum excesserunt , non is , quae toto loco mota sunt . Nonnumquam enim neruorum inbecillitas efficit , ut , quamuis non exciderit uertebra , tantum paruum tamen aut * * * in priorem partem promineat . Id non iugulat : sed ab interiore parte ne contingit quidem † posse : ab exteriore si propulsum est , plerumque iterum redit , nisi , quod admodum rarum est , uis neruis restituta est .	14 The same fate awaits those whose spinal vertebrae have been dislocated; for this cannot happen without rupture of the marrow in the middle of them, and of the two little membranes which pass oust between the two processes at the side, and of the sinews which hold them together. But the vertebrae may slip pout both backwards and forwards, above the diaphragm or below it. The direction of the displacement is indicated either by a swelling or by a hollow at the back. If it happens above the diaphragm, there is paralysis of the arms, and vomiting or spasm follow, breathing is difficult, pain is severe, and hearing blunted. If below the diaphragm, the lower limbs are paralysed, the urine is suppressed, or sometimes is passed involuntarily. From such accidents the man dies more slowly than when the head is displaced, yet within three days. As for what Hippocrates said, that when a vertebra has been displaced backwards, the man is to be laid out on his face, and stretched out, while an assistant presses his heel upon the displaced bone and pushes it inwards, that procedure is only to be adopted when the bone has slipped out a little, not if there is a total displacement. For occasionally weakness of the sinews causes a vertebra, although not displaced, to project a little, either backwards or forwards. This is not a fatal accident, but we cannot press upon a vertebra from within; it cannot even be touched; and if it is pressed upon from outside, it generally slips back again, unless, as very rarely happens, the strength of the sinews is renewed.