Of Medicine, in Eight Books

by Aulus Cornelius Celsus

In the nose, both the bone and the cartilage are liable to be fractured; and that sometimes happens in the fore part, sometimes on one side. If either both, or one of them be fractured in the fore part, the nostrils fall in, and the breath is drawn with difficulty. If the bone is fractured on one side, that part is hollow; if the cartilage, the nostrils are turned to the opposite side.

Any part of the cartilage, that has given way, must be gently raised, either by a probe put under it, or two fingers compressing it on both sides; then lint platted of a due length, sewed up in soft leather, must be put within; or some part of a dry penecillum composed in the same manner; or a large quill dipped in gum or joiner’s glue, and covered with soft leather, which prevent the cartilage from sinking in. But if the fracture be in the fore part, both nostrils are to be equally filled. If on one side, what is put in ought to be thicker in that part where the nose falls in, and smaller on the other; and externally, a soft strap must be carried round, the middle of which is spread with fine flour and soot of frankincense mixed together; and this must be drawn beyond the ears, and the two ends being crossed there and returned, are to be glued to the forehead: for it sticks to the skin like glue, and when it has grown hard, it keeps the nostrils firm. But if what is put within gives pain, which happens chiefly where the interior part of the cartilage is broke through, the nostrils being raised in the same[(14)] manner, must be only held firm by the strap abovementioned; then, after fourteen days, that must be removed; it is to be separated by hot water, with which also the swelled part[(15)] must be fomented every day.

But if the bone be fractured, that must also be reduced into its place by the fingers; and when the fracture is in the fore part, both nostrils must be filled; when on the side, that to which the bone has been forced; cerate also must be applied, and it is to be bound down a little more tightly; because in that part, there not only grows callus enough to make it sound, but even to form an eminence. From the third day, it must be fomented with hot water, and the more so, the nearer it may be expected to approach a sound state. And if there be several small pieces in the fracture, nevertheless each of them that are beat in, must be forced into its place by the fingers: also the strap must be applied externally, as before directed; and over that a cerate, without any other bandage.

But if any fragment be separated all round, and will not be united with the rest, as may be known from the humour, which will be discharged in great quantity from the wound, it must be extracted by a vulsella; and when the inflammation is gone, some one of those medicines that are gently repellent, must be applied. The case is worse, when besides a fracture of the bone, or cartilage, there is also a wound in the skin. This very seldom occurs. When it does happen, they must nevertheless be raised to their place in the same manner; and upon the skin must be laid some one of these plaisters, that are adapted to recent wounds: but no bandage must be applied over it.

CHAP. VI. OF FRACTURES OF THE EARS.

Sometimes the cartilage of the ear is broke. When this happens, an agglutinating medicine must be applied, before a suppuration begins; for that often prevents it, and heals the ear. Both here and in the nose, it should be understood, that the cartilage itself is not re-united, but that the flesh growing round it consolidates the part; and therefore, if, together with the skin the cartilage is broke, the skin is sewed on both sides; but I now speak of the cartilage fractured, when the skin is entire. If pus then is already formed, the skin must be opened on one side, and over against the incision, the cartilage itself must be cut in a lunated form; then a gentle styptic must be used; such as lycium diluted with water, till the bleeding be stopped; after that a plaister that is not greasy, spread upon linen, must be laid on, and soft wool put behind the ear, to fill up the space between that and the head; then it must be fastened by a gentle bandage; and from the third day fomented with warm water, as I directed for the nostrils; and in these kinds of accidents, at first abstinence is necessary, till the inflammation be gone.

CHAP. VII. OF A FRACTURED MAXILLA, TOGETHER WITH SOME GENERAL OBSERVATIONS RELATING TO FRACTURES.

As I am to proceed from these parts to the lower jaw, I think it proper to insert some observations relating to all the bones in general, to prevent a frequent repetition of them. Every bone then is sometimes split longitudinally, like wood, sometimes is fractured transversely, sometimes obliquely; and in this last species the ends are sometimes blunt, sometimes acute, which last is of the worst kind; because they are not easily united, where they do not rest upon something obtuse, then they also wound the flesh, and sometimes a nerve or a muscle: moreover, one fragment sometimes happens to be divided into several. In fractures of the other bones, one end often recedes entirely from the other; but the broken ends of a jaw-bone remain always in contact in some one part.

Therefore, first the bones are to be forced into their place, by two fingers pressing on each side, both within the mouth and upon the chin; then if the fracture of the jaw-bone be transverse, (in which case one tooth generally stands out beyond that next to it) when it is reduced, the two contiguous teeth, or if they are loose, those next to them, must be tied together by a horse-hair. In a different kind of fracture this is needless. All the other steps are the same as in the above-described fractures; for a double linen cloth dipped in wine and oil must be laid upon it, and with that fine flour, and the soot of frankincense; then a roller or soft strap, with a longitudinal opening in the middle, that it may take in the chin both above and below; and lastly, the ends of it must be brought over the head and tied there.

With regard to the bones in general, it may further be remarked once for all, that fasting at first is necessary; then from the third day moist food; when the inflammation is removed a little fuller diet and such as promotes the growth of flesh; wine is hurtful through the whole time. On the third day, they ought to be opened, and fomented with the vapour of hot water by a spunge, and the same dressings, as at first, are to be put on; this to be repeated on the fifth day, and so on, till the inflammation is gone, which ceases, either on the ninth day, or generally on the seventh: when that is removed, the bones must be examined again, that if any fragment is not in its place, it may be reduced, and the bandage must not be taken away, till two thirds of the time have elapsed, in which the several bones unite.