INSTRUMENTS OF REDUCTION.docx

INSTRUMENTS OF REDUCTION.docx

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INSTRUMENTSOFREDUCTION

400BC

INSTRUMENTSOFREDUCTION

byHippocratestranslatedbyFrancisAdamsPart1Withregardtotheconstructionofbones,thebonesandjointsofthefingersaresimple,thebonesofthehandandfootarenumerous,andarticulatedinvariousways;theuppermostarethelargest;theheelconsistsofonebonewhichisseentoprojectoutward,andthebacktendonsareattachedtoit.Thelegconsistsoftwobones,unitedtogetheraboveandbelow,butslightlyseparatedinthemiddle;theexternalbone（fibula）,whereitcomesintoproximitywiththelittletoe,isbutslightlysmallerthantheother,moresowheretheyareseparated,andattheknee,theouterhamstringarisesfromit;theseboneshaveacommonepiphysisbelow,withwhichthefootismoved,andanotherepiphysisabove,*inwhichismovedthearticularextremityofthefemur,whichissimpleandlightinproportiontoitslength,intheformofacondyle,andhavingthepatella（connectedwithit?

）,thefemuritselfbendsoutwardandforward;itsheadisaroundepiphysiswhichgivesorigintoligamentinsertedintheacetabulumofthehip-joint.Thisboneisarticulatedsomewhatobliquely,butlesssothanthehumerus.Theischiumisunitedtothegreatvertebracontiguoustotheossacrumbyacartilaginousligament.Thespine,fromtheossacrumtothegreatvertebra,iscurvedbackward;inthisquarteraresituatedthebladder,theorgansofgeneration,andtheinclinedportionoftherectum;fromthistothediaphragmitproceedsinastraightlineincliningforward,andthepsoaearesituatedthere;fromthispoint,tothegreatvertebraabovethetopsoftheshoulders,itrisesinalinethatiscurvedbackward,andthecurvatureappearsgreaterthanitisinreality,fortheposteriorprocessesofthespinearetherehighest;thearticulationoftheneckinclinesforward.Thevertebraeontheinsideareregularlyplacedupononeanother,butbehindtheyareconnectedbyacartilaginousligament;theyarearticulatedintheformofsynarthrosisatthebackpartofthespinalmarrow;behindtheyhaveasharpprocesshavingacartilaginousepiphysis,whenceproceedstherootsofnervesrunningdownward,asalsomusclesextendingfromthenecktotheloins,andfillingthespacebetweentheribsandthespine.Theribsareconnectedtoalltheintervertebralspacesontheinside,fromthenecktothelumbarregion,byasmallligament,andbeforetothesternum,theirextremitiesbeingspongyandsoft;theirformisthemostarchedinmanofallanimals;forinthispart,manis,ofallanimals,thenarrowestinproportiontohisbulk.Theribsareunitedtoeachvertebrabyasmallligamentattheplacefromwhichtheshortandbroadlateralprocesses（transverseprocesses?

）arise.Thesternumisonecontinuousbone,havinglateralpitsfortheinsertionoftheribs;itisofaspongyandcartilaginousstructure.Theclaviclesareroundedinfront,havingsomeslightmovementsatthesternum,butmorefreeattheacromion.Theacromion,inman,arisesfromthescapuladifferentlyfrommostotheranimals.Thescapulaiscartilaginoustowardthespine,andspongyelsewhere,havinganirregularfigureexternally;itsneckandarticularcavitycartilaginous;itdoesnotinterferewiththemovementsoftheribs,andisfreeofallconnectionwiththeotherbones,exceptthehumerus.Theheadofthehumerusisarticulatedwithits（glenoid?

）cavity,bymeansofasmallligament,anditconsistsofaroundedepiphysiscomposedofspongycartilage,thehumerusitselfisbentoutwardandforward,anditisarticulatedwithits（glenoid?

）cavitybyitsside,andnotinastraightline.Attheelbowitisbroad,andhascondylesandcavities,andisofasolidconsistence;behinditisacavityinwhichthecoronoidprocess（olecranon?

）oftheulnaislodged,whenthearmisextended;here,too,isinsertedthebenumblingnerve,whicharisesfrombetweenthetwobonesoftheforearmattheirjunction,andterminatesthere.

*Epiphysismeansacloseunionofthetwobonesbymeansofaligament.

Part2

Whenthenoseisfractured,thepartsshouldbemodeledinstantly,ifpossible.Ifthefracturebeinitscartilaginouspart,introduceintothenostrilsatentformedofcaddis,inclosedintheouterskinofaCarthaginianhide,oranythingelsewhichdoesnotirritate;theskinistobegluedtothepartsdisplaced,whicharetobethusrectified.Bandaginginthiscasedoesmischief.Thetreatmentistoconsistofflourwithmanna,orofsulphurwithcerate.Youwillimmediatelyadjustthefragments,andafterwardretaintheminplacewithyourfingersintroducedintothenostrils,andturningthepartsintoplace;thentheCarthaginianskinistobeused.Calliusformsevenwhenthereisawound;andthesamethingsaretobedone,evenwhenthereistobeexfoliationofthebones,forthisisnotofaseriousnature.

Part3

Infracturesoftheears,neitherbandagesnorcataplasmsshouldbeused;or,ifanybandagebeused,itshouldbeputonverytight;thecerateandsulphurshouldbeappliedtoagglutinatethebandages.Whenmatterformsintheears,itisfoundtobemoredeeplyseatedthanmightbesupposed,forallpartsthatarepulpy,andconsistofjuicyflesh,provedeceptiousinsuchacase.Butnoharmwillresultfrommakinganopening,forthepartsarelean,watery,andfullofmucus.Nomentionisheremadeoftheplacesandcircumstanceswhichrenderitfataltomakeanopening.Thecureissoonesteffectedbytransfixingtheearwithacautery;buttheearismaimedanddiminishedinsize,ifburnedacross.Ifopened,oneofthegentlemedicinesforfleshwoundsshouldbeusedasadressing.

Part4

Thejaw-boneisoftenslightlydisplaced（subluxated?

）,andisrestoredagain;itisdislocatedbutrarely,especiallyingaping;infact,theboneisneverdislocatedunlessitslipswhilethemouthisopenedwide.Itslips,however,themorereadilyfromitsligamentsbeingoblique,supple,andofayieldingnature.Thesymptomsare:

thelowerjawprotrudes,itisdistortedtothesideoppositethedislocation,andthepatientcannotshuthismouth;whenbothsidesaredislocated,thejawprojectsmore,themouthcanbelessshut,butthereisnodistortion;thisisshownbytherowsoftheteethintheupperandlowerjawcorrespondingwithoneanother.

If,then,bothsidesbedislocated,andnotimmediatelyreduced,thepatientforthemostpartdiesonthetenthday,withsymptomsofcontinuedfever,stupor,andcoma,forthemusclesthereinducesucheffects;thereisdisorderofthebowelsattendedwithscantyandunmixeddejection;andthevomitings,ifany,areofthesamecharacter.Theothervarietyislesstroublesome.Themethodofreductionisthesameinboth:

-Thepatientbeinglaiddownorseated,thephysicianistotakeholdofhishead,andgraspingbothsidesofthejaw-bonewithbothhands,withinandwithout,hemustperformthreemanoeuvresatonce,-rectifythepositionofthejaw,pushitbackward,andshutthemouth.Thetreatmentshouldconsistofsoothingapplications,position,andapplyingasuitablebandagetosupportthejaw-bone,soastocooperatewiththereduction.

Part5

Theboneoftheshoulderisdislocateddownward.Ihaveneverheardofanyothermode.Thepartsputontheappearanceofdislocationforward,whenthefleshaboutthejointiswastedduringconsumption,asalsoseemstobethecasewithcattlewheninastateofleannessafterwinter.Thosepersonsaremostliabletodislocationswhoarethin,slender,andhavehumiditiesabouttheirjointswithoutinflammation,foritknitsthejoints.Thosewhoattempttoreduceandrectifydislocationsinoxen,commitablunder,asforgettingthatthesymptomsarisefromthemannerinwhichtheoxusesthelimb,andthattheappearanceisthesameinamanwhoisinasimilarcondition,andforgettingalsothatHomerhassaid,thatoxenaremostleanatthatseason.Inthisdislocation,then,whennotreduced,thepatientcannotperformanyofthoseactswhichothersdo,byraisingthearmfromtheside.Ihavethusstatedwhoarethepersonsmostsubjecttothisdislocation,andhowtheyareaffected.Incongenitaldislocationsthenearestbonesaremostshortened,asisthecasewithpersonswhoareweasel-armed;thefore-armlessso,andthehandstillless;thebonesabovearenotaffected.Andtheparts（neartheseatoftheinjury）aremostwastedinflesh;andthishappensmoreespeciallyonthesideofthearmoppositethedislocation,andthatduringadolescence,yetinasomewhatlessdegreethanincongenitalcases.Thedeep-seatedsuppurationsoccurmostfrequentlytonew-borninfantsaboutthejointoftheshoulder,andtheseproducethesameconsequencesasdislocations.Inadults,thebonesarenotsodiminishedinsize,andjustly,seeingthattheotherswillnotincreaseasintheformercase;butwastingofthefleshtakesplace,foritisincreased,andisdiminishedeveryday,andatallages.Andattentionshouldbepaidtotheforceofhabit,andtothesymptomproducedbythetearingawayoftheacromion,wherebyavoidisleft,whichmakespeoplesupposethatthehumerusisdislocated.Theheadofthehumerusisfeltinthearmpit,andthepatientcannotraisehisarm,norswingittothissideandthat,asformerly.Theothershouldershowsthedifference.Modesofreduction:

-Thepatienthimselfhavingplacedhisfistinthearmpit,pushesuptheheadofthehumeruswithit,andbringsthehandforwardtothebreast.Another:

-Forceitbackward,sothatyoumayturnitround.Another:

-Applyyourheadtotheacromion,andyourhandstothearmpit,separatetheheadofthehumerus（fromtheside?

）,andpushtheelbowintheoppositedirection;or,insteadofyourknees,anotherpersonmayturn