on the articulations-第8章

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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　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　you　do　not　restore　the　parts　at　once；
it　is　impossible　but　that　the　nose　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　it　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　all　parts　of　the
body　the　nose　is　modeled　with　the　greatest　ease。　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。　In　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　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
syrmaism。　If　the　part　come　to　suppuration；　it　should　not　be　hastily
opened；　for　often　when　matter　appears　to　be　formed　it　is　absorbed
again；　even　when　no　cataplasm　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　vertebrae　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　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　sharp…pointed
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　appear
to　have　more　prominent　necks　than　persons　in　good　health；