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Part 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 [p. 244]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 into it may [p. 245]make pressure more especially at that spot. When matters are thus adjusted, one person, or two if necessary, must press down the end of the board, whilst others at the same time make extension and counter-extension as along the body, as formerly described. Extension may also be made with axles, which may either be fastened in the ground beside the bench, or the post of the axles may be attached to the bench itself, if you will make them perpendicular and overtopping (the bench?) a little at both ends, or at either end of the bench. These powers are easily regulated, so as to be made stronger or weaker, and they are of such force, that if one were to have recourse to them for a mischievous purpose, and not as a remedy, they would operate strongly in this way also; for by making merely extension and counter-extension longitudinally, without any additional force, one might make sufficient extension; and if, without making extension at all, one were only to press down properly with the board, sufficient force might be applied in this way. Such powers, then, are excellent which admit of being so regulated, that they can be made weaker and stronger as required. And the forces are applied in the natural way; for the pressure above forces the displaced parts into their place. Natural extension restores parts which have come too near one another to their natural position. I, then, am acquainted with no powers which are better or more appropriate than these; for extension along the spine downward has no proper hold at the bone called the os sacrum; and extension upward, along the neck and head, has indeed a hold; but extension thus made is unseemly to behold, and, besides, if increased, may occasion much mischief otherwise. I once made trial of the following plan. Having placed the patient on his back, I put below the hump a bladder, not inflated, and afterward introduced air into the bladder by means of a brass pipe connected with it. But the experiment did not succeed; for, when the man was fairly extended, the bladder yielded, and the air could not be forced into it; and, besides, the hump of the patient was apt to slip off the distended bladder when they were pressed together. But when I did not extend the man strongly, the bladder was swelled up by the air, and the man became more bent forward [p. 246] than proper. I have written this expressly; for it is a valuable piece of knowledge to learn what things have been tried and have proved ineffectual, and wherefore they did not succeed.

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