400 BC
INSTRUMENTS OF REDUCTION
by Hippocrates
translated by Francis Adams
Part 1
With regard to the construction of bones； the bones and joints of
the fingers are simple； the bones of the hand and foot are numerous；
and articulated in various ways； the uppermost are the largest； the
heel consists of one bone which is seen to project outward； and the
back tendons are attached to it。 The leg consists of two
bones； united
together above and below； but slightly separated in the middle； the
external bone （fibula）； where it comes into proximity with the
little toe； is but slightly smaller than the other； more so
where they
are separated； and at the knee； the outer hamstring arises from it；
these bones have a common epiphysis below； with which the foot is
moved； and another epiphys is above；* in which is moved the
articular extremity of the femur； which is simple and light in
proportion to its length； in the form of a condyle； and having the
patella （connected with it？）； the femur itself bends outward and
forward； its head is a round epiphysis which gives origin to
ligament inserted in the acetabulum of the hip…joint。 This bone is
articulated somewhat obliquely； but less so than the humerus。 The
ischium is united to the great vertebra contiguous to the os
sacrum by
a cartilaginous ligament。 The spine； from the os sacrum to the great
vertebra； is curved backward； in this quarter are situated the
bladder； the organs of generation； and the inclined portion of the
rectum； from this to the diaphragm it proceeds in a straight line
inclining forward； and the psoae are situated there； from this
point； to the great vertebra above the tops of the
shoulders； it rises
in a line that is curved backward； and the curvature appears greater
than it is in reality； for the posterior processes of the spine are
there highest； the articulation of the neck inclines forward。 The
vertebrae on the inside are regularly placed upon one another； but
behind they are connected by a cartilaginous ligament； they are
articulated in the form of synarthrosis at the back part of
the spinal
marrow； behind they have a sharp process having a cartilaginous
epiphysis； whence proceeds the roots of nerves running downward； as
also muscles extending from the neck to the loins； and filling the
space between the ribs and the spine。 The ribs are connected to all
the intervertebral spaces on the inside； from the neck to the lumbar
region； by a small ligament； and before to the sternum； their
extremities being spongy and soft； their form is the most arched in
man of all animals； for in this part； man is； of all animals； the
narrowest in proportion to his bulk。 The ribs are united to each
vertebra by a small ligament at the place from which the short and
broad lateral processes （transverse processes？） arise。 The sternum
is one continuous bone； having lateral pits for the insertion of the
ribs； it is of a spongy and cartilaginous structure。 The
clavicles are
rounded in front； having some slight movements at the sternum； but
more free at the acromion。 The acromion； in man； arises from the
scapula differently from most other animals。 The scapula is
cartilaginous toward the spine； and spongy elsewhere； having an
irregular figure externally； its neck and articular cavity
cartilaginous； it does not interfere with the movements of the ribs；
and is free of all connection with the other bones； except the
humerus。 The head of the humerus is articulated with its （glenoid？）
cavity； by means of a small ligament； and it consists of a rounded
epiphysis composed of spongy cartilage； the humerus itself is bent
outward and forward； and it is articulated with its （glenoid？）
cavity by its side； and not in a straight line。 At the elbow it is
broad； and has condyles and cavities； and is of a solid consistence；
behind it is a cavity in which the coronoid process （olecranon？） of
the ulna is lodged； when the arm is extended； here； too； is inserted
the benumbling nerve； which arises from between the two bones of the
forearm at their junction； and terminates there。
* Epiphysis means a close union of the two bones by means of a
ligament。
Part 2
When the nose is fractured； the parts should be modeled
instantly； if possible。 If the fracture be in its cartilaginous
part； introduce into the nostrils a tent formed of caddis；
inclosed in
the outer skin of a Carthaginian hide； or anything else
which does not
irritate； the skin is to be glued to the parts displaced；
which are to
be thus rectified。 Bandaging in this case does mischief。 The
treatment
is to consist of flour with manna； or of sulphur with
cerate。 You will
immediately adjust the fragments； and afterward retain them in place
with your fingers introduced into the nostrils； and turning the
parts into place； then the Carthaginian skin is to be used。 Callius
forms even when there is a wound； and the same things are to be
done； even when there is to be exfoliation of the bones； for this is
not of a serious nature。
Part 3
In fractures of the ears； neither bandages nor cataplasms
should be used； or； if any bandage be used； it should be put on very
tight； the cerate and sulphur should be applied to agglutinate the
bandages。 When matter forms in the ears； it is found to be
more deeply
seated than might be supposed； for all parts that are pulpy； and
consist of juicy flesh； prove deceptious in such a case。 But no harm
will result from making an opening； for the parts are lean； watery；
and full of mucus。 No mention is here made of the places and
circumstances which render it fatal to make an opening。 The cure is
soonest effected by transfixing the ear with a cautery； but
the ear is
maimed and diminished in size； if burned across。 If opened；
one of the
gentle medicines for flesh wounds should be used as a dressing。
Part 4
The jaw…bone is often slightly displaced （subluxated？）； and is
restored again； it is dislocated but rarely； especially in gaping；
in fact； the bone is never dislocated unless it slips while the
mouth is opened wide。 It slips； however； the more readily from its
ligaments being oblique； supple； and of a yielding nature。 The
symptoms are： the lower jaw protrudes； it is distorted to the side
opposite the dislocation； and the patient cannot shut his mouth；
when both sides are dislocated； the jaw projects more； the mouth can
be less shut； but there is no distortion； this is shown by
the rows of
the teeth in the upper and lower jaw corresponding with one another。
If； then； both sides be dislocated； and not immediately reduced； the
patient for the most part dies on the tenth day； with symptoms of
continued fever； stupor； and coma； for the muscles there induce such
effects； there is disorder of the bowels attended with scanty and
unmixed dejection； and the vomitings； if any； are of the same
character。 The other variety is less troublesome。 The method of
reduction is the same in both：…The patient being laid down or
seated； the physician is to take hold of his head； and grasping both
sides of the jaw…bone with both hands； within and without； he must
perform three manoeuvres at once；…rectify the position of the jaw；
push it backward； and shut the mouth。 The treatment should consist
of soothing applications； position； and applying a suitable
bandage to
support the jaw…bone； so as to cooperate with the reduction。
Part 5
The bone of the shoulder is dislocated downward。 I have never
heard of any other mode。 The parts put on the appearance of
dislocation forward； when the flesh about the joint is wasted during
consumption； as also seems to be the case with cattle when in a
state of leanness after winter。 Those persons are most liable to
dislocations who are thin； slender； and have humidities about their
joints without inflammation； for it knits the joints。 Those who
attempt to reduce and rectify dislocations in oxen； commit a
blunder； as forgetting that the symptoms arise from the manner in
which the ox uses the limb； and that the appearance is the same in a
man who is in a similar condition； and forgetting also that Homer
has said； that oxen are most lean at that season。 In this
dislocation；
then； when not reduced； the patient cannot perform any of those acts
which others do； by raising the arm from the side。 I have thus
stated who are the persons most subject to this dislocation； and how
they are affected。 In congenital dislocations the nearest bones are
most shortened； as is the case with persons who are weasel…armed；
the fore…arm less so； and the hand still less； the bones
above are not
affected。 And the parts （near the seat of the injury） are most
wasted in flesh； and this happens more especially on the side of the
arm opposite the dislocation； and that during adolescence； yet in a
somewhat less degree than in congenital cases。 The deep…seated
suppurations occur most frequently to new…born infants about
the joint
of the shoulder； and these produce the same consequences as
dislocations。 In adults； the bones are not so diminished in size；
and justly