On the Doctor's Workshop — First Draft Translation

ON THE DOCTOR'S WORKSHOP. Either like or unlike from the beginning; from the greatest, from the easiest, from what is known everywhere and in every way. 1. What can be seen, touched, and heard; what can be perceived by sight, touch, hearing, smell, taste, and mind; what it is possible to know by all the means by which we know. The things pertaining to hand-work in the workshop: the patient; the one doing; the assistants; the instruments; the light; where; how; how many; how; where the body is, the equipment; the time; the manner; the place. 3. The one doing, whether seated or standing, positioned proportionately in relation to himself, in relation to what is being worked on, in relation to the light. Now light has two kinds: common light and artificial light. The common light is not in our control; the artificial is in our control. Of each of these two there are two uses: facing the light or with the light behind. Working with the light behind is of little use, and the measure of it is obvious. For work facing the light, one should turn what is being worked on toward the brightest of the available and serviceable lights — except for those parts that need to remain unobserved, or that it is unseemly to expose. So: the part being worked on should face the light, and the one doing the work should face the part being worked on, except so as not to cast shadow; for in this way the one doing will see, while the part being worked on will not be seen. For his own position, when seated: feet set straight in a line with the knees toward the upper level; separation of the feet, slightly together; knees slightly above the groin, and their separation determined by placement and positioning of the elbows. The garment: worn neatly, distinctly, evenly, and uniformly at elbows and shoulders. In relation to what is being worked on: the forward and near, the upper, the lower, and to one side or the other, or the middle. The limit of forward and near: the elbows should not pass the knees toward the front, nor the sides toward the back; the limit of above: the fingertips should not be held higher than the breast; the limit of below: not lower than when, with the chest resting on the knees, the fingertips are held at right angles to the upper arm; for what is at the middle, thus; for what is to one side or the other, not outside the seat, but with the body applied proportionately to the inclination, and the working part of the body in relation to it. For the one standing: to be seen planted on both feet equally, a sufficient width apart; but to do the work with the weight on one foot, not the one on the same side as the working hand; the height of the knee relative to the groin, as when seated; and the other limits the same. The one being worked on should assist the one working with the other parts of the body, whether standing, sitting, or lying down, so that as easily as possible he maintains throughout the required position, guarding against sliding down, settling, twisting, or sagging, so that the required shape and form of the part being worked on is preserved during presentation, during the working, and in the subsequent state of rest. Nails: neither projecting beyond nor falling short; use the fingertip surfaces; practise — with the fingers most often the index against the thumb; with the whole hand, palm downward; with both hands, working in opposite directions; the natural quality of the fingers matters greatly: the space between the fingers, and the thumb opposed to the index finger. 4. The affliction through which they are also harmed — in those in whom from birth or upbringing the thumb has been accustomed to be held under the other fingers — is clear. Practise all procedures working with either hand separately and with both together (for both are alike), aiming well at doing good, beautifully, swiftly, without effort, rhythmically, and with ready facility. Instruments — when, and in what condition, will be said; where needed; not in the way of the work, nor in the way of taking up; alongside the part of the body being worked on; and if another person is handing them, let him be ready a little before, and let him act when you tell him. 6. Those attending the patient: let them present the part being worked on as seems fit; and let them hold the rest of the body steady so that it does not move, keeping silent and attending to the one in charge. There are two kinds of bandaging: the completed and the in-progress. 7. In-progress: swiftly, without effort, with ready facility, rhythmically; swiftly — to accomplish the work; without effort — to act easily; with ready facility — to be prepared for every contingency; rhythmically — to be pleasant to observe; and the practices from which these arise have been described. Completed: done well and beautifully; beautifully — simply and distinctly; either like parts equally and in like manner, or unlike and unequal parts, unequally and in unlike manner; the forms are: simple, adze-form, concave-form, eye-form, rhomb, and half-section; the form fitted to the form and the condition of the part to be bandaged. Two kinds of benefit in bandaging: either strength through compression or through number of bandage-layers. 8. One kind of bandage itself cures; the other serves those things that cure. For these purposes there is a rule; and in these, the most important things in bandaging are: compression such that what is applied does not stand away, nor press forcefully, but is fitted — not forced; less tightly toward the extremities, least of all in the middle. The knot and the suture should run upward, not downward, during presentation, holding in position, bandaging, and compression. The starting-points should not be placed over the wound, but where the knot is. The knot should not be at a point of friction, nor where work is done, nor where it is already present. The knot and suture should be soft, not large. One should clearly understand that every bandage slips toward the downward and tapering parts — for instance, toward the top on the head, toward the bottom on the lower leg. 9. Bandage the right side to the left, the left side to the right, except the head; the head according to its axis. Counter-directional parts: from two starting-points; or if from one, toward what is alike, toward what is stable — for instance, the middle of the head, or anything else of that kind. Moving parts, such as joints: where they bend, wrap as little and as compactly as possible, as at the hollow of the knee; where they are stretched out, use simple and broad turns, as at the kneecap; wrap additionally for securing the parts around those points, and for taking up the whole bandage, at the still and flatter parts of the body — for instance, above and below the knee; what agrees for the shoulder is the circuit around the opposite armpit; for the groin, the circuit around the other flank; and for the lower leg, the area above the calf. Where the slipping is upward, the counter-hold comes from below; where downward, the opposite; where neither is possible, as on the head, make the holdings at the most level part, using the least oblique bandage, so that what is wrapped on last, being the most stable, holds what is most prone to wander. Where the linen bandages do not hold well or take up well, make the holdings with sutures from a base or from sewing-together. Bandages should be clean, light, soft, fine. 10. Practise rolling with both hands together and with each hand separately. Use the hand appropriate to the widths and thicknesses of the parts, judging accordingly. The heads of rolls: firm, even, distinct. Those about to slip off are worse than those that quickly fall away; and some should be such as neither to compress nor to fall away. Whether it is binding, underlying bandage, or both that is needed: the underlying bandage is the cause, so as either to draw back what stands away, or to gather in what is spread out, or to stretch apart what has contracted, or to straighten what is twisted — or the opposite. 11. Prepare bandage-strips: light, fine, soft, clean, broad, without seams or protrusions, and sound so as to bear stretching — and a little more — not dry but well-moistened with the fluid with which each is naturally nurtured. For parts standing away: so that the raised surfaces touch the base without pressing; begin from the healthy part, end toward the wound, so that what has collected beneath is drawn out and no further material gathers; bandage straight parts straight, oblique parts obliquely, in an easy position in which there will be neither constriction nor separation; from this, when changing to a resting position or placement, they will not change but will keep the same condition — muscles, vessels, sinews, bones — most favorably arranged and maintained; and one should rest or lie in an easy, natural position; for the parts where there is deviation, the opposite. For those in which spread-out parts need to be gathered in, the rest is the same, but the gathering must be from a great distance and the compression by degrees — least at first, then more, the limit of greatest being when they barely touch. For those in which contracted parts need to be separated, when there is inflammation, the opposite; without inflammation, the same preparation but the opposite bandaging. For twisting that requires straightening: the rest is the same; but what has gone away must be brought back by underlying bandage, adherence, and taking-up; and the opposite parts, the opposite. For fractures, the lengths, widths, thicknesses, and numbers of splint-pads: length — the extent of the bandage; width — three or four fingers; thickness — three or four folds; number — going round without going over or falling short; for those needing straightening, the length should go round; width and thickness should be judged by the deficiency, filling not all at once. 12. Of the linen strips there are two sub-bandages: the first ending from the wound upward, the second ending from the wound downward and then from below upward; compress most at the wound, least at the extremities, the rest proportionately. The bandage should take in much of the healthy part. Of bandages: number, length, width; number — not to be overcome by the wound, nor to cause indentation by the splints, nor to be a burden, nor to roll round, nor to cause weakness; length and width — three, four, five, or six cubits in length, and fingers in width. And the circuits of the padding: enough not to compress; soft, not thick; all this proportioned to the length, width, and thickness of the affected part. Splints: smooth, even, concave at the tips, slightly shorter on both sides than the bandaging, thickest where the fracture broke. Where parts are naturally convex and without flesh, guard the protruding points — as at the fingers or ankles — either by position or by shortness. With the padding, fit without compressing at first. Let it be wrapped in soft, smooth, clean wax-salve. The warmth and quantity of water: warmth — pour it over your own hand; quantity — for relaxation and slimming, the most is best; for building up flesh and softening, the moderate amount; the measure of the pouring — one should stop while the limb is still elevated, before it subsides; for it rises first, then slims down. 14. The positioning should be soft, even, and elevated for the projecting parts of the body — such as the heel and the hip — so that there is neither bending back, nor bending aside, nor turning away. A channel for the whole limb or the half; keep in view the condition and everything else that is clearly harmful. Presentation, extension, molding, and the rest according to nature. 15. Nature in active procedures is to be judged by what it intends in the actual doing of the work; and for these matters, from the state of rest, from the common condition, from habit: from the state of rest and release, examine the natural alignments — as in the hand; from the common condition, extension and bending, as in the forearm near its angle against the upper arm; from habit, the fact that certain other positions cannot be maintained more easily, as in the extension of the legs — for from these, the limbs could most easily be kept for the longest time without change. In the change from extension, muscles, vessels, sinews, bones will keep the same condition as they go into a state or position, most favorably arranged and maintained. Extension especially of the largest and thickest parts, and where both apply; second, of those whose underlying part is stretched; least, of those whose upper part is stretched; more than the moderate causes harm, except in children; hold them slightly elevated. 16. The model for straightening: the corresponding part, the paired part, the like part, the healthy part. Rubbing has the power to loosen, to bind, to build up flesh, to reduce: vigorous rubbing binds; gentle rubbing loosens; much rubbing reduces; moderate rubbing thickens. 18. Bandage for the first time; the one bandaged should say that he feels most compressed at the wound, least at the extremities; that it fits him, not compresses him; in number of layers, not in force; and a little more so during that day and night, less the following day, on the third day loose. Let there be found the next day at the extremities a soft swelling; on the third day, what was bandaged, when loosened, thinner — and this at every bandaging. At the next day's bandaging, if it appears that the first bandaging was done correctly, one must learn from this; and from then on, let it be compressed more and with more layers; on the third bandaging, still more and with still more layers. On the seventh day from the first bandaging, when loosened, let the bones be found thin and slack. When set in splints, if they are thin and without itching and without ulceration, leave them up to twenty days from the injury; if anything is suspected, loosen in the middle; press the splints every other day. The taking-up, the positioning, the bandaging: so as to preserve the same shape throughout. 19. The chief points of positions: the habitual states and natures of each of the limbs; the forms derived from running, walking, standing, lying down, from active use, from rest. Because use strengthens and inactivity wastes. 21. Compression by number of layers, not by force. For ecchymoses, or contusions, or sprains, or non-inflammatory swellings, blood is drawn out from the wound — most to the upper part of the body, a little also toward the lower — without letting the hand or leg hang downward; placing the start at the wound and pressing hardest there, least at the extremities, moderately through the middle; directing the end toward the upper parts of the body; by bandaging, by compression — and here too by number of layers rather than force; for these especially, bandage-strips fine, light, soft, clean, broad, sound, so as to be without splints; and use pouring. 23. For displacements, sprains, separations, avulsions, fractures, or twistings — such as club-deformities, lateral deviations — yielding from the side where it has displaced, drawing together toward the side where it tightens, so that it tends toward the opposite, when bandaged or before bandaging, slightly more than to make it level; and with bandages, splint-pads, supports, and positions, by extension, rubbing, straightening, and these together with more pouring. For wasting parts, taking in much of the healthy, bandage so as to bring — by an onrush — what has wasted, more than the wasting itself, by shifting to a different kind of bandaging, drawing it toward the increase and rebuilding of the flesh. 24. It is better also to bandage up from above — as with the lower leg — and the other thigh and the healthy leg together, so that they are more alike, and rest alike, and are alike excluded from nourishment and receive it; by number of bandage-strips, not by compression; relaxing first what is most in need, using rubbing that builds up flesh, and pouring; without splints. For supports and braces — as for the chest, the ribs, the head, and all such — some for the sake of pulsations, so that there is no jarring; others also for the separations along the sutures in the bones of the head, for the sake of buttressing; also against coughing, sneezing, or other movement, such as the supports that are used for the chest and the head. 25. For all these, the same measures of bandaging apply: where the injuries are, press most; place something soft appropriate to the condition underneath; bandage no more tightly than is needed to prevent the pulsations from jarring, and no more than so that the edges of the separated sutures barely touch each other, and not so as to prevent coughing and sneezing, but to serve as a brace — so that there is neither forced displacement nor jarring.