on fractures-第1节

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　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　400　BC
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　ON　FRACTURES

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　by　Hippocrates

　　　　　　　　　　　　　　　　　　　　　　　　　　Translated　by　Francis　Adams

　　　　　　　　　　　　　　　

　　IN　TREATING　fractures　and　dislocations；　the　physician　must　make
the　extension　as　straight　as　possible；　for　this　is　the　most　natural
direction。　But　if　it　incline　to　either　side；　it　should　rather　turn
to　that　of　pronation；　for　there　is　thus　less　harm　than　if　it　be　toward
supination。　Those；　then；　who　act　in　such　cases　without　deliberation；
for　the　most　part　do　not　fall　into　any　great　mistake；　for　the　person
who　is　to　have　his　arm　bound；　presents　it　in　the　proper　position
from　necessity；　but　physicians　who　fancy　themselves　learned　in　these
matters；　are　they　who　commit　blunders。　There　is　no　necessity　for
much　study；　then；　in　order　to　set　a　broken　arm；　and　in　a　word；　any
ordinary　physician　can　perform　it；　but　I　am　under　the　necessity　of
giving　the　longer　directions　on　this　subject；　because　I　know
physicians　who　have　the　reputation　of　being　skilled　in　giving　the
proper　positions　to　the　arm　in　binding　it　up；　while　in　reality　they
are　only　showing　their　own　ignorance。　But　many　other　things　in　our　art
are　judged　of　in　this　manner；　for　people　rather　admire　what　is　new；
although　they　do　not　know　whether　it　be　proper　or　not；　than　what
they　are　accustomed　to；　and　know　already　to　be　proper；　and　what　is
strange；　they　prefer　to　what　is　obvious。　I　must　now　state　what　the
mistakes　of　medical　men　are；　which　I　wish　to　unteach；　and　what
instructions　I　have　to　give　as　to　the　management　of　the　arm；　for
what　I　have　to　say　regarding　it；　will　apply　to　the　other　bones　in
the　body。
　　2。　The　arm；　then；　for　that　is　the　subject　we　were　treating　of；　was
presented　in　the　prone　position　to　be　bound；　but　the　physician
forced　his　patient　to　hold　it　as　the　archers　do　when　they　project
the　shoulder；　and　in　this　position　he　bound　it　up；　thinking　within
himself　that　he　was　acting　according　to　Nature；　and　in　proof　of　this
he　pointed　out　that　all　the　bones　in　the　fore…arm　were　thus　in　a
straight　line；　and　that　the　integuments　both　inside　and　outside；
were　also　in　a　straight　line；　and　that　the　flesh　and　nerves　（tendons？）
were　thus　put　in　their　natural　position；　and　he　appealed　to　what
happens　in　archery；　as　a　proof　of　this。　And　so　saying；　and　so　doing；
he　is　looked　up　to　as　a　sage；　and　yet　he　forgets　that　in　all　the　other
arts　and　performances；　whether　executed　whether　executed　by　strength
or　dexterity；　what　is　reckoned　the　natural　position　is　not　the　same；
and　that　in　the　same　piece　of　work　it　may　happen　that　the　natural
position　of　the　right　arm　is　not　the　same　as　that　of　the　left。　For
there　is　one　attitude　in　throwing　the　javelin；　and　another　in
slinging；　another　in　casting　stones；　another　in　boxing；　and　another　in
a　state　of　repose。　And　whatever　arts　one　examines；　it　will　be　found
that　the　natural　position　of　the　arms　is　not　the　same　in　each；　but
that　in　every　case　the　arms　are　put　into　the　attitude　which　suits　best
with　the　instrument　that　is　used；　and　the　work　to　be　performed。　In
practicing　archery；　no　doubt　this　is　the　best　attitude　of　the　left
arm；　for　gingly…moid　extremity　of　the　humerus　being　fixed　in　the
cavity　of　the　ulna；　in　this　position；　throws　the　bones　of　the
forearm　and　arm　into　a　line；　as　if　they　constituted　a　single　bone；　and
all　flexion　at　the　joint　is　prevented　in　this　position。　It　is　no　doubt
certain　that　the　member　is　thus　put　into　the　most　unbending　and
extended　position　possible；　so　as　not　to　be　overcome　or　yield　when　the
string　is　drawn　by　the　right　arm；　and　thus　will　the　archer　be
enabled　to　draw　the　string　farthest；　and　discharge　his　arrow　with
the　greatest　force　and　rapidity；　for　arrows　thus　discharged　have　the
greatest　swiftness　and　force；　and　are　carried　to　the　greatest
distances。　But　there　is　nothing　in　common　between　the　binding　up　of　an
arm　and　archery。　Moreover；　if　having　thus　bound　up　the　arm；　the
physician　direct　the　patient　to　keep　it　thus；　he　will　occasion　him
greater　pain　than　he　had　from　the　wound　itself；　and　thus　also；　if
the　physician　order　him　to　bend　the　arm；　neither　the　bones；　the
nerves；　nor　the　flesh　will　any　longer　be　in　the　same　condition；　but
will　be　arranged　differently；　having　overcome　the　bandaging。　What　use；
then；　is　there　of　the　archer's　attitude？　And　these　mistakes；　the
physician；　conceited　in　his　knowledge；　would　probably　not　have
committed　if　he　had　allowed　the　patient　himself　to　present　his　arm。
　　3。　But　another　physician　putting　the　arm　into　the　state　of
supination；　gives　orders　to　extend　the　arm　thus；　and　bandages　it　in
this　position；　reckoning　it　the　one　according　to　nature；　judging
thus　from　the　skin；　and　also　fancying　the　bones　to　be　thus　in　their
natural　position；　because　the　bone　which　protrudes　at　the　wrist；　where
the　little　finger　is；　appears　to　be　in　a　line　with　the　bone　from　which
people　measure　the　bone　of　the　fore…arm。　These　things　he　brings
forward　as　proofs　that　the　parts　are　in　their　natural　state；　and　he　is
supposed　to　speak　correctly。　But；　indeed；　if　the　arm　be　kept　stretched
in　a　supine　position；　it　will　become　very　painful；　and　this　fact　any
one　may　ascertain　by　extending　his　own　arm　in　this　attitude。　And
also　a　weaker　man　grasping　with　his　hands　a　stronger　man　whose　arm
is　turned　in　a　supine　position；　could　lead　him　wherever　he　chose；
and　neither；　if　a　man　held　a　sword　thus　in　his　hand；　could　he　make　any
proper　use　of　it；　so　constrained　is　this　position。　And；　moreover；
if；　when　a　physician　has　thus　bound　up　the　arm；　he　allow　it　to
remain　in　the　same　position；　the　patient　will　endure　greater　pain　if
he　walk　about；　but　considerable；　even　if　he　remain　at　rest。　And
thus；　too；　if　he　shall　bend　the　arm；　the　muscles　and　the　bones　must
necessarily　assume　a　different　position。　But；　in　addition　to　other
mischief；　he　is　ignorant　of　these　facts　regarding　the　position；　that
the　bone　which　protrudes　at　the　wrist；　close　to　the　little　finger；
belongs　to　the　fore…arm；　whereas　the　one　at　the　joint；　from　which
people　measure　the　fore…arm；　is　the　head　of　the　humerus。　He　fancies
that　both　these　belong　to　the　same　bone；　and　many　others　are　of　this
opinion。　The　latter；　in　fact；　is　the　same　part　as　that　which　is　called
the　elbow；　upon　which　we　sometimes　rest；　and　when　he　holds　the　arm
thus　in　a　supine　position；　in　the　first　place　the　bone　appears
distorted；　and　in　the　next　place　the　tendons　which　extend　from　the
carpus　along　the　inner　side　and　from　the　fingers　become　distorted
while　the　arm　has　a　supine　position；　for　these　tendons　proceed　to
the　bone　of　the　humerus；　from　which　the　fore…arm　is　measured。　Such；
and　so　many　mistakes　and　marks　of　ignorance　are　committed；　regarding
the　natural　construction　of　the　arm。　But　if　one　will　extend　a　broken
arm　as　I　direct；　he　will　turn　the　bone；　situated　at　the　extremity　of
the　little　finger；　into　the　straight　line；　and　also　the　one　at　the
elbow；　and　the　tendons　which　stretch　from　the　carpus　to　the
extremity　of　the　humerus　will　be　placed　in　the　straight　line；　and　when
the　arm　is　suspended　in　a　sling；　it　will　be　in　the　same　attitude　as
that　in　which　it　was　bound　up；　and　will　give　no　pain　to　the　patient
when　he　walks　about；　nor　when　he　lies　reclined；　and　will　not　become
fatigued。　The　man　should　be　so　seated　that　the　prominent　part　of　the
bone　may　be　turned　to　the　brightest　light　which　is　at　hand；　so　that
the　operator　in　making　the　extension；　may　be　at　no　loss　to　discover　if
it　be　sufficiently　straight。　The　prominence　of　a　broken　bone　could　not
escape　being　detected　by　the　hand　of　an　experienced　person；　when
applied　for　this　purpose；　and；　moreover；　the　projecting　part　is
particularly　painful　to　the　touch。
　　4。　In　cases　of　fracture　in　either　of　the　bones　of　the　forearm；　it　is
easier　to　effect　a　cure　if　the　upper　bone　be　broken；　although　it　be
the　thicker　one；　both　because　the　sound　bone　is　situated　below；　and
forms　a　support　to　it；　and　because　the　deformity　is　more　easily
concealed；　there　being　a　thick　mass　of　flesh　on　the　upper　side；　except
near　to　the　wrist。　But　the　lower　bone　is　without　a　covering　of
flesh；　is　not　easily　concealed；　and　requires　stronger　extension。　If　it
is　not　this　bone；　but　the　other　which　is　broken；　a　more　feeble
extension　proves　sufficient；　but　if　both　be　broken；　a　more　powerful
extension　is　required。　In　the　case　of　a　young　person　I　have　known
the　extension　made　more　strong　than　was　necessary；　but　in　general
the　extension　made　is　less　than　what　is　required。　And　when　they　are
extended；　the　physician　should　apply　the　palms　of　the　hands；　and
adjust　the　fractured　parts　and　then　having　rubbed　the　parts　with
cerate；　but　not　in　large　quantity　so　that　the　bandages　may　not　come
off；　it　is　to　be　bound　up　in　this　state；　care　being　taken　that　the
hand　be　not　lower　than　the　elbow；　but　a　little　higher；　so　that　the
blood　do　not　flow　toward　the　extremity；　but　may　be　determined　to　the
upper　part；　and　then　it　is　to　be　secured　with　the　bandage；　the　head　of
which　is　to　be　placed　at　the　fracture；　and　the　bandage　should　impart
firmness　to　the　parts　without　occasioning　strong　compression。　When　you
have　carried　the　b