best when the sk he middle, or if the one, in such case. ecomes a little to ng need not require 11: for it is enori apply the doublebest application vashed, and mixe wheat, and if it he t if it be not very pulverized, is to le with it, or a very re depressed and ething may be inall such deformie nostrils, if this roduced with the ssed portion, and mended as an inthe mode of preses, it is sufficient ade of flour, wita were of all shapes ark that a female this purpose. As r the purpose of ARTICULATIONS. 1 111 the physician is to take hold of the nose externally on both sides, and at the same time raise it up. And if the fracture be much in the fore part one may introduce into the nostrils as already stated, either caddis scraped from a linen towel, or something such wrapped up in a piece of cloth, or rather stitched in Carthaginian leather, and moulded into a shape suitable to the place into which it is to be introduced. But if the fracture be at a greater distance, it is not possible to introduce anything within, for if it was irksome to bear anything of the kind in the fore part, how is it not to be so when introduced farther in? At first, then, by rectifying the parts from within, and sparing no pains upon them from without, they are to be brought to their natural position, and set. A fractured nose may be readily restored to shape, especially on the day of the accident, or even a little later, but the physicians act irresolutely, and touch it more delicately at first than they should; for the fingers should be applied on both sides along the natural line of the nose, and it is to be pushed downward, and thus, with pressure from within, the displacement is to be rectified. But for these purposes no physician is equal to the index-fingers of the patient himself, if he will pay attention and has resolution, for they are the most natural means. Either of the fingers is to be placed firmly along the whole nose, and thus it is to be gently held, and steadily, if possible until it become firm, but if not, he himself is to hold it for as long a time as possible, in the manner described; or if he cannot, a child or woman should do it, for the hands ought to be soft. Thus may a fracture of the nose, attended with depression, and not with displacement to the side, but in a straight line, be most properly treated. I have never seen a case of fractured nose which could not be rectified when attempted, before callus is formed, provided the treatment be properly applied. But although men would give a great price to escape being deformed, yet at the same time they do not know how to take care, nor have resolution, if they do not experience pain, nor fear death, although the formation of callus in the nose speedily takes place, for the most part is consolidated in ten days, provided sphacelus do not take place. 38. When the fractured bone is displaced laterally, the treatment is the same, but it is obvious that the reduction is to be made, not by applying equal force on both sides, but by pushing the displaced portion into its natural position, and pressing on it from without, and introducing something into the nostrils, and boldly rectifying the fragments which incline inward, until the whole be properly adjusted, well knowing that if I may mention that most modern authorities disapprove of introducing any substances into the nostrils to support the broken bone, as fancying that they are a source of irritation, and that they are not required. See Bell's Operative Surgery, vol. ii., p. 222. Chelius admits them only in cases in which the broken ends (Surgery, vol. i., p. 527,) Like our author, he disapproves caddis, see the note on the Mochlicus. are again displaced, must be distorted. But when you restore the parts to their natural position, either the patient himself, or some other person, is to apply one finger or more to the part which protrudes, and keep it in position until the fracture be consolidated; but the little finger is, from time to time, to be pushed into the nostril, to rectify the parts which incline inward. When any inflammation supervenes, dough must be used, but attention must still be equally paid to the application of the fingers, although the dough be on the part. But if the fracture be in the cartilage, with lateral displacement, the end of the nose must necessarily be distorted. In such cases some of the aforementioned means of reduction, or whatever suits, is to be introduced into the nostril; but there are many convenient things to be found which have no smell, and are appropriate in other respects; thus, on one occasion, I introduced a slice of sheep's lung, as it happened to be at hand; for sponges, if introduced, imbibe humidities. Then the outer skin of Carthaginian leather is to be taken, and a piece of the size of the thumb, or what will answer, is to be cut off and glued to the outside of the nostril which is turned aside, and then this piece of thong is to be stretched to the proper degree, or rather a little more than what will be sufficient to make the nose straight and regular.' Then (for the thong must be long) it is to be brought below the ear and round the head, and the end of the thong may either be glued to the forehead, or a still longer one may be carried all round the head, and secured. This is a natural mode of setting the nose, is of easy application, and is calculated to enable the counter-extension on the nose to be made greater or less, as you may incline. In a case where the fractured nose is turned to the side, the treatment is to be conducted otherwise, as already described; and in most of them the thong ought to be glued to the end of the nose, in order to make extension in the opposite direction. 39. When the fracture is complicated with a wound, one need not be troubled on that account, but pitch-cerate or any of the applications for fresh wounds is to be applied to the sores; for, in general, they admit of easy cure, even when there is reason to apprehend that pieces of bone will come out. The parts, at first, are to be adjusted fearlessly, taking care that nothing is omitted, and, subsequently, they are also to be adjusted with the fingers; more softly, indeed, but still it must be done; and of 1 The use of the piece of skin in bandaging a fractured nose is adverted to by Paulus Ægineta; but, he says, it was not much approved of by recent authorities in his time. (B. VI., 92, Syd. Soc. edit.) See the authorities there quoted. Celsus describes the mode of treatment recommended by Hippocrates in the following terms:-" Extrinsecus autem circumdanda habena est mollis, medio illita mistis inter se simila et thuris fuligine, eaque ultra aures ducenda, et fronti duobus capitibus agglutinanda est. Id enim corpori quasi gluten inhærescit, et cum induruit, nares commode continet." viii., 5. In fractures think of a is the more becomes p staplasms, are bad, d troubleso h applica Taste of meal as possible: both to the e patient's pos especially if t In oren the this may be suppurati Tare stated un simon in anc The formidable is, with whic h the cestus escribed by th Dis Rhodius ut to have been the ears was who represents Servos Apollonius Rh the same reg To makes ailusi rt of the palæs By syrmaism ch with heav Mes and the bulb Le subject is fully may further co Frantzius, under So more than w e but that the o their natural p is to apply on in position unti time to time, ine inward. out attention mɛɛ Ithough the dog e, with lateral d Historted. In a or whatever convenient this in other respec ng, as it happe dities. Then the a piece of the glued to the onpiece of thong e more than whe 1 1 Then (for the round the head. rehead, or a sti -ured. This is s. and is calculated greater or les is turned to the ready described; ! nd of the nose, ne need not be applications fcr they admit d ces of bone wil ly, taking care to be adjusted done; and of adverted to by cent authorities e quoted. Cels in the follows, medio illita t fronti duobus scit, et cum in ARTICULATIONS. all parts of the body the nose is modeled with the greatest ease. 113 And there is nothing to prevent us from having recourse to the practice of gluing on the thongs, and drawing the nose to the opposite side, even if there be a wound or the parts be inflamed, for these thongs give no pain. 40. În fractures of the ear all sorts of bandages do harm.' For one would not think of applying it quite loose, and if applied more tightly, it only does the more harm, for even the sound ear, when confined with a bandage, becomes painful, throbs, and gets into a febrile state. With regard to cataplasms, the heaviest, on the whole, are the worst; but almost all kinds are bad, form abscesses, occasion an increase of humors, and afterward troublesome suppurations; and a fractured ear stands in less need of such applications than any other part; the most ready, if required, is the paste of meal, but neither should it have weight. It should touch as little as possible; for it is a good remedy sometimes to apply nothing at all, both to the ear and to many other cases. Attention must be paid to the patient's position during sleep. And the body must be reduced, more especially if there be danger lest the ear suppurate; it will also be better to open the bowels, and if the patient can be readily made to vomit, this may be accomplished by means of the syrmaïsm. If the part come to suppuration, it should not be hastily opened; for often when 1I have stated under a former head, that fractures of the nose and ears were very common in ancient times, as the necessary results of the boxing-matches with the formidable cestus. It consisted of thongs of leather studded with large iron nails, with which the hands of the boxers were firmly bound. That the combat with the cestus was a favorite amusement of the ancients, is obvious from its being described by their greatest and most popular poets; for example, by Homer, Apollonius Rhodius, Theocritus, Virgil, and Valerius Flaccus. Indeed this may be said to have been one of the loci communes of the ancient poets. That a blow about the ears was reckoned a master-stroke is evident from Theocritus's description, who represents Amycus, when he appears in the ring with Pollux, as being Δεινὸς ἰδεῖν, σκληραῖσι τεθλασμένος δνατα πυγμαῖς. (Idyll. 22.) And Apollonius Rhodius describes Amycus as having received the fatal stroke at last in the same region: Κόψε μεταίγδην ὑπὲρ ὄνατος ὀστέα δ' ἔίσω Ῥῆξεν ὁ δ ̓ ἅμ' ὀδύνῃ γνύξ ήριπεν· οἱ δ' ιάχησαν Ηρωες Μινύοι· τού δ' ἀθρόος ἔκχυτο θυμός. (Argonaut. ii., 95.) Plato makes allusion in his Gorgias to persons with fractured ears, from the sports of the palæstra. By syrmaïsm was meant the process of producing vomiting by loading the stomach with heavy things, such as honey and strong hydromel, along with radishes and the bulbous roots of the narcissus, when these were found necessary. The subject is fully discussed in the Commentary on PAULUS ÆGINETA, B. I., 42. One may further consult the editors of Erotian, as given in the edition of his works by Frantzius, under åñò ovpμaiopov. All their learned discussions, however, amount to no more than what we have given above in few words. VOL. II.-8. is applied. But if forced to open it, the part will get soonest well if transfixed with a cautery, and yet it should be well understood that the ear gets maimed, and is less than the other if burned through. If not burned through, an incision, and not a very small one, should be made on the upper side; for the pus is found to be surrounded with a thicker covering than one would have supposed; and it may be said, in general, that all parts of a mucous nature and which form mucus, as being all viscid, when touched, slip from below the fingers to either side; and on that account the physician, in such cases, finds that he has to pass his instrument through a thicker substance than he supposed; and in certain ganglionic cases, when the skin is flabby and mucous, many physicians open them, expecting to find a collection in them; here the physician forms a wrong judgment, but by such a procedure no great harm results to the patient from having had the part opened. But with regard to watery parts, and such as are filled with mucus, and which are situated in regions where every one of the parts, if opened, will occasion death or some other injury, these will be treated of in another work. When, therefore, incision is made in the ear, all sorts of cataplasms and pledges should be avoided, and it is to be treated either with applications for recent wounds, or anything else which is neither heavy nor will occasion pain, for if the cartilage be laid bare and abscesses form, the case will be troublesome;' this happens from such modes of treatment. In all aggravated cases, the most effectual remedy is the transfixing of the part with a hot iron. 41. The vertebræ of the spine when contracted into a hump behind from disease, for the most part cannot be remedied, more especially when the gibbosity is above the attachment of the diaphragm to the spine. Certain of those below the diaphragm are carried off by varices in the legs, more especially by such as occur in the vein at the ham; and in those cases where the gibbosities are removed, the varices take place also in the groin; and some have been carried off by a dysentery when it becomes chronic. And when the gibbosity occurs in youth before the body has 3 'M. Littré certainly improves the text in this place. See the Lectiones variantes. In addition to his Commentary, Galen gives many importment remarks on the paragraph relating to curvatures of the spine in his work, De Locis Affectis (iv., 6). As he remarks, Hippocrates divides curvatures of the spine into gibbosity or the posterior projection, the anterior projection, and the lateral curvature. His terms cyphosis, lordosis, and scoliosis, are adopted by modern authorities, as, for example, Chelius. It is proper to remark that our author, however, does not restrict scoliosis to lateral curvature, but sometimes applies it indiscriminately to the others. It does not appear clear what has lead our author to consider varices in the lower extremities as being a natural cure of curvature of the spine. Perhaps his opinion had originated in observing that the compression of the veins at the top when no cataplasm onest well if trace Eood that the e h. If not burne be made on the thicker covering general, that al gall viscid, whe on that acccILE. his instrument ertain ganglion Hans open ther forms a wroZ ts to the patien atery parts, and n regions where some other inerefore, incision uld be avoidei, wounds, or any Or if the cartiblesome; this cases, the most ARTICULATIONS. 2 115 attained its full growth, in these cases the body does not usually grow along the spine, but the legs and the arms are fully developed, whilst the parts (about the back) are arrested in their development. And in those cases where the gibbosity is above the diaphragm, the ribs do not usually expand properly in width, but forward, and the chest becomes sharppointed and not broad, and they become affected with difficulty of breathing and hoarseness; for the cavities which inspire and expire the breath do not attain their proper capacity. And they are under the necessity of keeping the neck bent forward at the great vertebra,' in order that their head may not hang downward; this, therefore, occasions great contraction of the pharynx by its inclination inward; for, even in those who are erect in stature, dyspnoea is induced by this bone inclining inward, until it be restored to its place. From this frame of body, such persons appear to have more prominent necks than persons in good health, and they generally have hard and unconcocted tubercles in the lungs, for the gibbosity and the distension are produced mostly by such tubercles, with which the neighboring nerves communicate. When the gibbosity is below the diaphragm, in some of these cases nephritic diseases and affections of the bladder supervene, but abscesses of a chronic nature, and difficult to cure, occur in the loins and groins, and neither of these carries off the gibbosity; and in these cases the hips are more emaciated than when the gibbosity is seated higher up; but the whole spine is more elongated in them than in those who have the gibbosity seated higher up, the hair of the pubes and chin is of slower growth and less developed, and they are less capable of generation than those who have the gibbosity higher up.* When the gibbosity seizes persons who have already attained their full growth, it usually occasions a crisis of the then existing disease, but in the course of time some of them attack, as in the case of younger persons, to a greater or less degree; but, for the most part, all these diseases are less malignant. And yet many have borne the affection well, and Those cases in of the thigh had given rise to enlargement of the veins below. 1 1 By the great vertebra, in this place, our author appears to mean the second, or vertebra dentata. See Galen's Commentary. * Galen shrewdly remarks, that when the curvature is high up in the spine, the evacuation of matter usually takes place in the lungs. 3 The reader will readily remark that psoas and lumbar abscesses are here described. It is well known that, as represented by our author, these cases are of a very intractable nature. Galen ascribes these symptoms to sympathy with the spine. This may naturally be supposed to vary according to the seat of the disease in the vertebral column. |