De Medicina (Celsus)

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	De Medicina Author: Celsus	Translator: Walter George Spencer
201	Vmerus autem modo in alam excidit , modo in partem priorem . Si in alam delapsus e st , cubitus recedit a latere ; rursum iuxta eiusdem partis aurem cum umero porrigi non potest , longius que altero id brachium est . At si in priorem partem , summ um quidem brachium extenditur , minus tamen quam naturaliter ; difficiliusque in priorem partem quam in posteriorem cubitus porrigitur . Igitur si in alam umerus excidit , et uel puerile adhuc est corpus uel molle , certe inbecillius neruis intentum est , satis est conlocare id in sedili ; et ex duobus ministris alteri imperare , ut caput lati scapularum oss is leniter redducat , alteri ut brachium extendat : ipsum posteriore parte residentem † renum sub ala eius † coire ; simulque et ill a os * et altera manu brachium eius ad latus impellere . At si uastius corpus neruiue robustiores sunt , necessaria est spatula lignea , et quae crassitudinem duorum digitorum habet , longitudin e ab ala usque ad digitos peruenit ; in qua summa capitulum est rotundum , leniter cauum , ut recipere particulam aliquam ex capite umeri possit . In ea bina foramina tribus locis sunt inter se spatio distantibus , in quae lora mollia coiciuntur . Eaque spata fascia inuoluta , quo minus tactu laedat , ad alam brachio derigitur sic , ut caput eius summae alae subiciatur ; deinde loris suis ad brachium deligatur , uno loco paulum infra umeri caput , altero paulum supra cubitum , tertio citra manu m ; cu i rei protinus interualla II VI quoque foraminum aptata sunt . Sic brachium deligatum super scalae gallinariae gradum traicitur , ita altae , ut consistere homo ipse non possit ; simulque in alteram partem corpus demittitur , in alteram brachium intenditur ; eoque fit , ut capite ligni caput umeri inpulsum in suam sedem modo cum sono , modo sine hoc compellatur . Multas alias esse rationes scire facile est uno Hippocrate lecto , sed non alia magis usu conprobata est . At si in partem priorem umerus excidit , supinus homo collocandus est ; fasciaque aut habena media ala circumdanda est , capitaque eius post caput hominis ministro tradenda , brachium alteri ; praecipiendumque , ut il le habenam , hic brachium extendat . Deinde medicus caput quidem hominis sinistr a debet repellere ; dextra uero cubitum cum umero attollere et os in suam sedem compellere ; faciliusque id in hoc casu quam in priore reuertitur . Reposito umero lana alae subicienda est ; si interiore parte os fuit , ut ei opponatur ; si in priore , ut tamen commodius deligetur . Tum fascia primum sub ala obuoluta caput eius debet conprehendere ; deinde per pectus ad alteram alam , ab eaque ad scapulas , russusque ad eiusdem umeri caput tendere ; saepiusque eadem ratione circumagi , donec bene id teneat . Vinctus hac ratione umerus commodius continetur , si adductus ad latus si c quoque fascia deligatur .	15 Passing to the humerus, it is sometimes put out into the armpit, sometimes forwards. If it is dislocated into the armpit, the elbow stands out from the side; again, this elbow, together with the upper arm, cannot be raised to the level of the ear on the same side, and that forearm is longer than the other. But if forwards, the upper forearm can be stretched out, but not to its full extent; and it is more difficult to stretch out the elbow forwards than backwards. So if the upper bone has slipped out into the armpit and the patient is still young or supple, at any rate if the sinews are not very powerful, it is sufficient to have him held on a stool; one of the two assistants is directed to press gently upon the head of the blade-bone, while the other stretches the forearm; then the surgeon seated behind thrusts one hand into the point's armpit, presses the bone up with this hand, and with the other presses the elbow to the side. But for a more powerful patient, with stronger sinews, a wooden board is required, two fingers thick, and lon enough to reach from the armpit to the fingers; the upper end is rounded and slightly hollowed to admit a small part of the head of the humerus. In three places in this, with a space between, are two slots through which soft straps are passed. And this board, covered with bandage to avoid injury by contact, is so applied from the forearm to the armpit, that its upper end is put under the armpit: it is then tied to the limb by its straps, one just below the head of the humerus, the second a little above the elbow, the third short of the wrist, to which purpose the two spaces between the six holes are adapted. The limb so fixed is passed over a rung of a poultry ladder at such a height that the patient himself cannot stand firmly; and whilst his body is allowed to sink down to one side, the limb is stretched on the other side; and thus it comes about that the top of the humerus is forced upwards into place by the top of the board, sometimes with, sometimes without a sound. It is easy to learn that there are many other methods by reading Hippocrates alone, but no other has met with more approval in practice. But if the humerus is put out forwards, the man is laid on his back and a bandage or a leather strap passed under his armpit, the ends of which are handed to one assistant behind the man's head and his forearm to another assistant; and it must be arranged that the former pulls the strap, the latter the forearm. Then the surgeon should thrust back the man's head with his left hand, whilst with his right he raises the elbow together with the upper arm and forces the bone back into place; and reduction is easier in this case than in the previous one. When the bone has been replaced, the armpit is filled with wool; if the bone had moved backwards, to prevent it from slipping back; if forwards, to make the bandaging more effective. Then the bandage must first pass under the armpit and control the head of the bone, then stretch across the chest under the opposite armpit, next over the shoulder-blades and again back to the head of the same arm-bone, and it is to be carried round several times in the same way until bone is well held. The bone when bandaged in this way is held in place more comfortably if it is also bandaged close to the side.
202	In cubito autem tria co ire ossa umeri et radii et cubiti ipsius , ex is , quae prima parte huius uoluminis posita sunt , intellegi potuit . S i cubitus , qui adnexus umero est , ab hoc excidit , radius , qui adiunctus est , interdum trahitur , interdum subsistit . In omnes uero quattuor partes excidere cubitus potest : sed si in priorem prolapsus est , extentum brachium est neque recur uatur; si in posteriorem , brachium curuum est neque extenditur , breuiusque altero est ; interdum febrem uomitum que bilis mouet ; si in exteriorem interioremue , brachium porrectum est , sed paulum in ea m parte m , a qua os recessit , recuruatum .— Quicquid incidit , reponendi ratio una est ; neque in cubito tantum sed in omnibus quoque membris longis , quae per articulum * longa testa iunguntur : utrumque membrum in diuersas partes extendere , donec spatium inter ossa liberum sit ; tum id os , quod excidit , ab ea parte , in quam prolapsum est , in contrariam impellere . Extendendi tamen alia atque alia genera sunt , prout aut nerui ualent , aut ossa huc illucue se dederunt . Ac modo manibus solis utendum est , modo quaedam alia adhibenda . Ergo si in priorem partem cubitus prolapsus est , extendi per duos manibus , interdum etiam habenis adiectis , satis est ; deinde rotundum aliquid a lacerti parte ponendum est , et super id repente cubitus ad umerum inpellendus est . At in aliis casibus commodissimum est eadem ratione brachium extendere , quae fracto cubito supra posita est , et tum ossa reponere . Reliqua eadem curatio est , quae in omnibus : celerius tantum et saepius id resoluendum est , multa magis aqua calida fouendum , diutius ex oleo et nitro ac sale perfricandum . In cubito enim celerius quam in ullo alio articulo , siue extra remansit siue intus reuertit , callus circumdatur ; isque si per quietem increuit , flexus illius postea prohibet .	16 From what was said at the beginning of this book, it can be understood how the three bones, humerus, radius and ulna, meet together at the elbow. If the ulna which is connected to the upper arm slips away from it, the radius which is joined to the ulna is sometimes dragged with it, sometimes remains in position. The ulna can slip out in all four directions: but if it is dislocated forwards, the forearm is extended and cannot be flexed; if backwards, the forearm is flexed and cannot be extended, and it is shorter than on the opposite side; sometimes this causes fever and bilious vomiting. If the ulna has been dislocated outwards or inwards, the forearm is stretched but a little bent towards the part from which the bone has receded. Whatever has happened, there is one method of treatment which holds good not only for the ulna but also for all long bones which are connected at their articulation by a long head. Each limb is to be pulled in opposite directions until there is a gap between the bones. Then the bone which has fallen out of place is forced into the opposite direction from the position into which it has slipped. The methods of extension, however, are various according to the strength of the sinews, and the direction in which the bones have given way. And sometimes only the hands are used, sometimes other means have to be applied. Thus if the ulna has slipped for- wards, extension by two hands, at times aided by straps, is sufficient; then some round object is to be put in front of the biceps and the ulna suddenly flexed over it towards the upper arm. But in other forms of displacement, it is best to stretch the forearm as described above for fracture of the elbow and then to replace the bones. The rest of the treatment is the same as in all other cases; only the dressing must be taken off more quickly and more often and there must be more plentiful fomentations with hot water, and more prolonged rubbing with oil, nitre and salt. For whether the elbow remains out of place or is put back again, callus forms more quickly round it than round any other joint, and if this callus has grown through resting the joint it prevents flexion afterwards.
203	Manus quoque in omnes quattuor partes prolabitur . Si in posteriorem partem excidit , porrigi digiti non possunt ; si in priorem , non inclinantur ; si in alterutrum latus , manus in contrarium conuertitur . Reponi non difficillime potest . Super durum locum et renitentem ex altera parte intendi manus , altera brachium debet sic , ut prona sit , si in posteriorem partem os excidit ; supina , si in priorem ; si in interiorem exterioremue , in latus . Vbi satis nerui diducti sunt , os , qu od in alterutrum latus procidit , manibus in contrarium repellendum est . At is , quae in priorem posterioremue partem lapsa sunt , super inponendum durum aliquid , idque supra prominens os manu urguendum est , per quod uis adiecta facilius id in suam sedem compellit .	17 The hand also may be dislocated in all four directions. If it has slipped out backwards, the fingers cannot be stretched out; if forwards, they do not bend; if to either side, the hand is turned in the opposite direction either towards the thumb or towards the little finger. It can be replaced without difficulty. The hand, supported on a hard and resistant object, must be stretched one way, the forearm the other, in such a way that the hand is palm downwards if the bone has slipped out backwards, palm upwards if forwards; if the displacement is inwards or outwards, upon the side. When the sinews are sufficiently stretched, the surgeon's hands push back the bone, in the opposite direction to the side to which it has slipped. Where the dislocation is forwards or backwards, some hard object is placed upon the hand, and pressed on the projecting bone, and by this additional force the bone is more readily pushed back into place.
204	In palma qu oque ossa interdum suis sedibus pro mouentur , modo in priorem partem , modo in posteriorem : in latus enim moueri paribus ossibus oppositis non possunt . Signum id solum est omniumque commune : tumo r ea parte , in quam os uenit ; ab ea sinu s, a qua recessit . Sed sine intentione digito tantummodo bene pressum os in suam sedem reuertitur .	18 In the palm also bones are sometimes moved from their places, either forwards or backwards; for they cannot move sideways because of the bones on either side. There is but one sign, and that common to all, a swelling over the displacement, a hollow at the spot from which the bone has receded. But without extension the bone is returned into its place imply by firm pressure with a finger.