on the articulations-第6部分

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and　the　part　that　inclines　inward　is　to　forced　outward　by　pushing　with
the　fingers　from　within。　It　is　after　having　applied　extension　to
separate　the　fragments　that　this　is　to　be　done；　for　they　will　thus
be　more　easily　restored　to　their　natural　position；　than　if　one
should　bring　them　together　by　using　force。　This　is　proper　to　be
known　as　applying　to　all　such　cases。　When　you　have　set　the　parts；
you　must　fasten　the　teeth　on　both　sides　to　one　another；　as　formerly
directed。　The　treatment　is　to　be　accomplished　with　cerate；　a　few
compresses；　and　bandages。　This　part；　in　particular；　requires　a　short
but　complex　（？）　bandaging；　for　it　is　nearly　cylindrical；　though　not
exactly　so；　but　the　turn　of　the　bandage　is　to　be　made；　if　the　right
jaw　was　dislocated；　to　the　right　hand　（that　is　said　to　be　to　the　right
hand　when　the　right　hand　conducts　the　bandaging）；　but　if　the　other　jaw
be　the　seat　of　the　dislocation；　the　bandaging　is　to　be　made　in　the
other　direction。　And　if　matters　be　properly　adjusted；　and　the
patient　keep　quiet；　there　will　be　a　speedy　recovery；　and　the　teeth
will　be　uninjured；　but　if　not；　the　recovery　will　be　more　protracted；
the　teeth　will　be　distorted；　will　give　trouble；　and　become　useless。

　　35。　Of　fractures　of　the　nose　there　are　more　than　one　variety；　but
those　who；　without　judgment；　delight　in　fine　bandagings；　do　much
mischief；　most　especially　in　injuries　about　the　nose。　For　this　is
the　most　complex　of　all　the　forms　of　bandaging；　having　most　of　the
turns　of　the　bandage　called　〃ascia；〃　and　rhomboidal　intervals　and
uncovered　spaces　of　the　skin。　As　has　been　said；　those　who　practice
manipulation　without　judgment　are　fond　of　meeting　with　a　case　of
fractured　nose；　that　they　may　apply　the　bandage。　For　a　day　or　two；
then；　the　physician　glories　in　his　performance；　and　the　patient　who
has　been　bandaged　is　well　pleased；　but　speedily　the　patient
complains　of　the　incumbrance　of　the　bandage；　and　the　physician　is
satisfied；　because　he　has　had　an　opportunity　of　showing　his　skill　in
applying　a　complex　bandage　to　the　nose。　Such　a　bandaging　does
everything　the　very　reverse　of　what　is　proper；　for；　in　the　first
place；　those　who　have　their　nose　flattened　by　the　fracture；　will
clearly　have　the　part　rendered　still　more　flat；　if　pressure　above　be
applied　to　it；　and　further；　those　cases　in　which　the　nose　is　distorted
to　either　side；　whether　at　the　cartilage　or　higher　up；　will
evidently　derive　no　benefit　from　bandaging　above　it；　but　will　rather
be　injured；　for　it　will　not　admit　of　having　compresses　properly
arranged　on　either　side　of　the　nose；　and　indeed；　persons　applying　this
bandage　do　not　seek　to　do　this。

　　36。　This　bandaging　would　appear　to　me　to　answer　best　when　the　skin
surrounding　the　bone　is　contused　on　its　ridge　near　the　middle；　or　if
the　bone　itself　have　sustained　some　injury；　but　not　a　great　one；　in
such　cases；　redundant　callus　forms　in　the　nose；　and　the　part　becomes　a
little　too　prominent；　and　yet；　even　in　these　cases；　the　bandaging　need
not　require　much　trouble；　if；　indeed；　any　bandage　be　applied　at　all；
for　it　is　enough　if　one　lay　a　waxed　compress　on　the　contusion；　and
then　apply　the　double…headed　bandage；　thus　taking　one　turn　with　it。
The　best　application　to　such　accidents　is　a　small　cataplasm　of　wheaten
flour；　washed；　and　mixed　up　into　a　viscid　mass。　If　the　flour　be　made
from　good　wheat；　and　if　it　be　glutinous；　it　should　be　used　alone　for
all　such　cases；　but　if　it　be　not　very　glutinous；　a　little　of　the　manna
of　frankincense；　well　pulverized；　is　to　be　moistened　with　water；　and
the　flour　is　to　be　mixed　up　with　it；　or　a　very　little　gum　may　be　mixed
in　like　manner。

　　37。　In　those　cases　in　which　the　fractured　portions　are　depressed　and
flattened；　if　it　is　depressed　in　front　at　the　cartilage；　something　may
be　introduced　into　the　nostrils　to　rectify　the　parts。　If　not；　all　such
deformities　may　be　restored　by　introducing　the　fingers　into　the
nostrils；　if　this　can　be　managed；　but　if　not；　a　thick　spatula　is　to　be
introduced　with　the　fingers；　not　to　the　fore　part　of　the　nose；　but
to　the　depressed　portion；　and　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；　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　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