on the articulations-第7章

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it　seldom　happens　that　one　succeeds　in　straightening　it。　Wherefore
succussion　on　a　ladder　has　never　straightened　anybody；　as　far　as　I
know；　but　it　is　principally　practiced　by　those　physicians　who　seek
to　astonish　the　mob…for　to　such　persons　these　things　appear　wonderful；
for　example；　if　they　see　a　man　suspended　or　thrown　down；　or　the
like；　and　they　always　extol　such　practices；　and　never　give
themselves　any　concern　whatever　may　result　from　the　experiment；
whether　bad　or　good。　But　the　physicians　who　follow　such　practices；
as　far　as　I　have　known　them；　are　all　stupid。　The　device；　however；　is
an　old　one；　and　I　give　great　praise　to　him　who　first　invented　this；
and　any　other　mechanical　contrivance　which　is　according　to　nature。　For
neither　would　I　despair；　but　that　if　succussion　were　properly　gone
about；　the　spine；　in　certain　cases；　might　be　thereby　rectified。　But；
indeed；　for　my　own　part；　I　have　been　ashamed　to　treat　all　such　cases
in　this　way；　because　such　modes　of　procedure　are　generally　practiced
by　charlatans。

　　43　Those　cases　in　which　the　gibbosity　is　near　the　neck；　are　less
likely　to　be　benefited　by　these　succussions　with　the　head　downward；
for　the　weight　of　the　head；　and　tops　of　the　shoulders；　when　allowed　to
hang　down；　is　but　small；　and　such　cases　are　more　likely　to　be　made
straight　by　succussion　applied　with　the　feet　hanging　down；　since　the
inclination　downward　is　greater　in　this　way。　When　the　hump　is　lower
down；　it　is　more　likely　in　this　case　that　succussion　with　the　head
downward　should　do　good。　If　one；　then；　should　think　of　trying
succussion；　it　may　be　applied　in　the　following　manner：…The　ladder　is
to　be　padded　with　leather　lined　cushions；　laid　across；　and　well
secured　to　one　another；　to　a　somewhat　greater　extent；　both　in　length
and　breadth；　than　the　space　which　the　man's　body　will　occupy；　he　is
then　to　be　laid　on　the　ladder　upon　his　back；　and　the　feet；　at　the
ankles；　are　to　be　fastened；　at　no　great　distance　from　one　another；
to　the　ladder；　with　some　firm　but　soft　band；　and　he　is　further　to　be
secured；　in　like　manner；　both　above　and　below　the　knee；　and　also　at
the　nates；　and　at　the　groins　and　chest　loose　shawls　are　to　be　put
round　in　such　a　fashion　as　not　to　interfere　with　the　effect　of　the
succussion；　and　his　arms　are　to　be　fastened　along　his　sides　to　his　own
body；　and　not　to　the　ladder。　When　you　have　arranged　these　matters
thus；　you　must　hoist　up　the　ladder；　either　to　a　high　tower　or　to　the
gable…end　of　a　house；　but　the　place　where　you　make　the　succussion
should　be　firm；　and　those　who　perform　the　extension　should　be　well
instructed；　so　that　they　may　let　go　their　hold　equally　to　the　same
extent；　and　suddenly；　and　that　the　ladder　may　neither　tumble　to　the
ground　on　either　side；　nor　they　themselves　fall　forward。　But；　if　the
ladder　be　let　go　from　a　tower；　or　the　mast　of　a　ship；　fastened　into
the　ground　with　its　cordage；　it　will　be　better；　so　that　the　ropes
run　upon　a　pulley　or　axle…tree。　But　it　is　disagreeable　even　to　enlarge
upon　these　matters；　and　yet；　by　the　contrivances　now　described；　the
proper　succussion　may　be　made。

　　44。　But　if　the　hump　be　situated　very　high　up；　and　if　succussion　be
by　all　means　to　be　used；　it　will　be　better　to　do　it　with　the　feet
downward；　as　has　been　said；　for　the　force　downward　will　be　the　greater
in　this　case。　The　patient　is　to　be　well　fastened　to　the　ladder　by
cords　at　the　breast；　at　the　neck　by　means　of　a　very　loose　shawl　so
as　merely　to　keep　the　part　properly　on　the　ladder；　and　the　head　is
to　be　fastened　to　the　ladder　at　the　forehead；　the　arms　are　to　be
stretched　along　and　attached　to　the　patient's　body；　and　not　to　the
ladder；　and　the　rest　of　the　body　is　not　to　be　bound；　except　so　as　to
keep　it　in　place　by　means　of　a　loose　shawl　wrapped　round　it　and　the
ladder；　attention；　moreover；　should　be　paid　that　these　ligatures　do
not　interfere　with　the　force　of　the　succussion；　and　the　legs　are　not
to　be　fastened　to　the　ladder；　but　should　be　placed　near　one　another；
so　as　to　be　in　line　with　the　spine。　These　matters　should　be　thus
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　b