on the articulations-第8部分

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arranged；　if　recourse　is　to　be　had　at　all　to　succussion　on　a　ladder；
for　it　is　disgraceful　in　every　art；　and　more　especially　in　medicine；
after　much　trouble；　much　display；　and　much　talk；　to　do　no　good　after
all。

　　45。　In　the　first　place；　the　structure　of　the　spine　known；　for　this
knowledge　is　requisite　in　many　diseases。　Wherefore；　on　the　side　turned
to　the　belly　（the　anterior？）　the　vertebrae　are　in　a　regular　line；
and　are　united　together　by　a　pulpy　and　nervous　band　of　connection；
originating　from　the　cartilages；　and　extending　to　the　spinal　marrow。
There　are　certain　other　nervous　cords　which　decussate；　are　attached
（to　the　vertebrae？）；　and　are　extended　from　both　sides　of　them。　But
we　will　describe　in　another　work　the　connections　of　the　veins　and
arteries；　their　numbers；　their　qualities；　their　origin；　their
functional　offices　in　particular　parts；　in　what　sort　of　sheaths　the
spinal　marrow　is　inclosed；　where　they　arise；　where　they　terminate；　how
they　communicate；　and　what　their　uses。　On　the　opposite　side
（behind？）　the　vertebrae　are　connected　together　by　a　ginglymoid
articulation。　Common　cords　（nerves？）　are　extended　to　all　parts；　both
those　within　and　without。　There　is　an　osseous　process　from　the
posterior　part　of　all　and　each　of　the　vertebra；　whether　greater　or
smaller；　and　upon　these　processes　there　are　cartilaginous　epiphyses；
and　from　them　arise　nervous　productions　（ligaments？）；　akin　to　the
external　nerves　（tonoi）。　The　ribs　are　united　to　them；　having　their
heads　inclined　rather　to　the　inside　than　the　out；　and　every　one　of
them　is　articulated　with　the　vertebrae；　and　the　ribs　in　man　are　very
curved；　and；　as　it　were；　arched。　The　space　between　the　ribs　and　the
processes　of　the　vertebrae　is　filled　on　both　sides　by　muscles；　which
arise　from　the　neck　and　extend　to　the　loins　（？）。　The　spine；
longitudinally；　is　a　straight　line　slightly　curved；　from　the　os　sacrum
to　the　great　vertebra　which　is　connected　with　the　articulation　of
the　femur；　the　spine　inclines　backward；　for　the　bladder；　the　organs　of
generation；　and　the　loose　portion　of　the　rectum；　are　situated　there。
From　this；　to　the　attachment　of　the　diaphragm；　the　spine　inclines
inward；　and　this　portion　alone；　from　the　internal　parts；　gives
origin　to　muscles；　which　are　called　psoae。　From　this　to　the　great
vertebra　（seventh　cervical？）　which　is　above　the　tops　of　the　shoulders；
it　is　convex　behind　lengthways；　but　it　is　more　in　appearance　than　it
really　is；　for　the　spinous　processes　are　highest　in　the　middle；　and
less　so　above　and　below。　The　region　of　the　neck　is　convex　before。

　　46。　In　cases　of　displacement　backward　along　the　vertebrae；　it　does
not　often　happen；　in　fact；　it　is　very　rare；　that　one　or　more　vertebrae
are　torn　from　one　another　and　displaced。　For　such　injuries　do　not
readily　occur；　as　the　spine　could　not　easily　be　displaced　backward　but
by　a　severe　injury　on　the　fore　part　through　the　belly　（which　would
prove　fatal）；　or　if　a　person　falling　from　a　height　should　pitch　on　the
nates；　or　shoulders　（and　even　in　this　case　he　would　die；　but　not
immediately）；　and　it　also　would　not　readily　happen　that　such　a
displacement　could　take　place　forward；　unless　some　very　heavy　weight
should　fall　upon　it　behind；　for　each　of　the　posterior　spinal　processes
is　so　constructed；　that　it　would　sooner　be　broken　than　undergo　any
great　inclination　forward　from　a　force　which　would　have　to　overcome
the　ligaments　and　the　articulations　mutually　connecting　them。　And
the　spinal　marrow　would　suffer；　if　from　the　displacement　of　a　vertebra
it　were　to　be　bent　even　to　a　small　extent；　for　the　displaced
vertebra　would　compress　the　spinal　marrow；　if　it　did　not　break　it；　and
if　compressed　and　strangled；　it　would　induce　insensibility　of　many
great　and　important　parts；　so　that　the　physician　need　not　give　himself
any　concern　about　rectifying　the　displacement　of　the　vertebra；
accompanied；　as　it　is；　by　many　other　ill　consequences　of　a　serious
nature。　It　is　evident；　then；　that　such　a　case　could　not　be　reduced
either　by　succussion　or　by　any　other　method；　unless　one　were　to　cut
open　the　patient；　and　then；　having　introduced　the　hand　into　one　of　the
great　cavities；　were　to　push　outward　from　within；　which　one　might　do
on　the　dead　body；　but　not　at　all　on　the　living。　Wherefore；　then；　do
I　write　all　this？　Because　certain　persons　fancy　that　they　have　cured
patients　in　whom　the　vertebra　had　undergone　complete　dislocation
forward。　Some；　indeed；　suppose　that　this　is　the　easiest　of　all　these
dislocations　to　be　recovered　from；　and　that　such　cases　do　not　stand　in
need　of　reduction；　but　get　well　spontaneously。　Many　are　ignorant；
and　profit　by　their　ignorance；　for　they　obtain　credit　from　those　about
them。　These　are　deceived　in　this　way；　for　they　suppose　the　spinous
processes　to　be　the　vertebrae　themselves；　because　every　one　of　them
appears　round　to　the　touch；　not　knowing　that　these　bones　are　processes
from　the　vertebrae；　as　formerly　stated；　but　the　vertebrae　are　at　a
considerable　distance　before　them；　for　of　all　animals；　man；　in
proportion　to　his　bulk；　has　the　belly　（internal　cavity？）　the　narrowest
from　behind　to　before；　especially　at　the　breast。　When；　therefore；
any　of　these　processes　are　severely　fractured；　whether　one　or　more；
the　part　there　appears　lower　than　on　either　side；　and　for　that
reason　they　are　deceived；　supposing　that　the　vertebrae　are　displaced
inward。　And　the　patient　contribute　also　to　deceive　them；　for　if　they
attempt　to　put　themselves　into　a　bent　position；　they　are　pained；
from　the　skin　being　stretched　at　the　seat　of　the　injury；　and　at　the
same　time　the　fragments　of　the　bones　wound　the　skin　still　more；　but　if
they　bend　forward；　they　feel　easier；　for　the　skin　at　the　wound　is　thus
relaxed；　and　the　bones　are　less　disposed　to　hurt　them；　and　if　touched；
they　shrink　and　bend　forward；　and　the　part　which　is　touched　appears
empty　and　soft。　All　the　circumstances　now　mentioned　contribute　to
deceive　the　physician。　Such　patients　speedily　get　well　without　any　bad
effects；　for　callus　readily　forms　in　all　such　bones　as　are　porous。

　　47。　There　are　many　varieties　of　curvature　of　the　spine　even　in
persons　who　are　in　good　health；　for　it　takes　place　from　natural
conformation　and　from　habit；　and　the　spine　is　liable　to　be　bent　from
old　age；　and　from　pains。　Gibbosities　（or　projections　backward）　from
falls　generally　take　place　when　one　pitches　on　the　nates；　or　falls
on　the　shoulders。　In　this　case　some　one　of　the　vertebrae　must
necessarily　appear　higher　than　natural；　and　those　on　either　side　to
a　less　degree；　but　yet　no　one　generally　has　started　out　of　the　line　of
the　others；　but　every　one　has　yielded　a　little；　so　that　a　considerable
extent　of　them　is　curved。　On　this　account　the　spinal　marrow　easily
bears　such　distortions；　because　they　are　of　a　circular　shape；　and
not　angular。　The　apparatus　for　the　reduction　in　this　case　must　be
managed　in　the　following　manner：　a　strong　and　broad　board；　having　an
oblong　furrow　in　it；　is　to　be　fastened　in　the　ground；　or；　in　place
of　the　board；　we　may　scoop　out　an　oblong　furrow　in　the　wall；　about　a
cubit　above　the　floor；　or　at　any　suitable　height；　and　then　something
like　an　oaken　bench；　of　a　quadrangular　shape；　is　to　be　laid　along　（the
wall？）　at　a　distance　from　the　wall；　which　will　admit　of　persons　to
pass　round　if　necessary；　and　the　bench　is　to　be　covered　with　robes；　or
anything　else　which　is　soft；　but　does　not　yield　much；　and　the
patient　is　to　be　stoved　with　vapor；　if　necessary；　or　bathed　with
much　hot　water；　and　then　he　is　to　be　stretched　along　the　board　on
his　face；　with　his　arms　laid　along　and　bound　to　his　body；　the
middle；　then；　of　a　thong　which　is　soft；　sufficiently　broad　and　long；
and　composed　of　two　cross　straps　of　leather；　is　to　be　twice　carried
along　the　middle　of　the　patient's　breast；　as　near　the　armpits　as
possible；　then　what　is　over　of　the　thongs　at　the　armpits　is　to　be
carried　round　the　shoulders；　and　afterward　the　ends　of　the　thong　are
to　be　fastened　to　a　piece　of　wood　resembling　a　pestle；　they　are　to
be　adapted　to　the　length　of　the　bench　laid　below　the　patient；　and　so
that　the　pestle…like　piece　of　wood　resting　against　this　bench　may　make
extension。　Another　such　band　is　to　be　applied　above　the　knees　and
the　ankles；　and　the　ends　of　the　thongs　fastened　to　a　similar　piece
of　wood；　and　another　thong；　broad；　soft；　and　strong；　in　the　form　of
a　swathe；　having　breadth　and　length　sufficient；　is　to　be　bound　tightly
round　the　loins；　as　near　the　hips　as　possible；　and　then　what　remains
of　this　swathelike　thong；　with　the　ends　of　the　thongs；　must　be
fastened　to　the　piece　of　wood　placed　at　the　patient's　feet；　and
extension　in　this　fashion　is　to　be　made　upward　and　downward；　equally
and　at　the　same　time；　in　a　straight　line。　For　extension　thus　made
could　do　no　harm；　if　properly　performed；　unless　one　sought　to　do
mischief　purposely。　But　the　physicians；　or　some　person　who　is
strong；　and　not　uninstructed；　should　apply　the　palm　of　one　hand　to　the
hump；　and　then；　having　laid　the　other　hand　upon　the　former；　he
should　make　pressure；　attending　whether　this　force　should　be　applied
directly　downward；　or　toward　the　head；　or　toward　the　hips。　This　method
of　applying　force　is　particularly　safe；　and　it　is　also　safe　for　a
person　to　sit　upon　the　hump　while　extension　is　made；　and　raising
himself　up；　to　let　himself　fall　again　upon　the　patient。　And　there　is
nothing　to　prevent　a　person　from　placing　a　foot　on　the　hump；　and
supporting　his　weight　on　it；　and　making　gentle　pressure；　one　of　the
men　who　is　practiced　in　the　palestra　would　be　a　proper　person　for
doing　this　in　a　suitable　manner。　But　the　most　powerful　of　the
mechanical　means　is　this：　if　the　hole　in　the　wall；　or　in　the　piece
of　wood　fastened　into　the　ground；　be　made　as　much　below　the　man's　back
as　may　be　judged　proper；　and　if　a　board；　made　of　limetree；　or　any
other　wood；　and　not　too　narrow；　be　put　into　the　hole；　then　a　rag；
folded　several　times　or　a　small　leather　cushion；　should　be　laid　on　the
hump；　nothing　large；　however；　should　be　laid　on　the　back；　but　just
as　much　as　may　prevent　the　board　from　giving　unnecessary　pain　by　its
hardness；　but　the　hump　should　be　as　much　as　possible　on　a　line　with
the　hole　made　in　the　wall；　so　that　the　board　introduced　int