6 In the ear also the cartilage is sometimes ruptured. If this happens, before suppuration has supervened, an agglutinating medicament should be put on; for this often prevents suppuration, and cures the ear. As in the case of the nose, it must not be overlooked that the cartilage itself does not agglutinate, but flesh grows round it and so the place becomes consolidated. Hence, if the skin is torn along with rupture of the cartilage, the skin on both sides is to be stitched. But I speak now of a case where the cartilage is broken, but the skin intact. Now in that case if suppuration supervenes, the skin on the other side is to be laid open and a crescent-shaped piece of cartilage cut out beneath; then a mild styptic such as lycium dissolved in water is put on until bleeding ceases; next lint smeared with a plaster without any grease is applied and soft wool to fill the space between the ear and the head; then the ear is lightly bandaged, and from the third day the ear is steamed as in the case of the nose (5.4). In these kinds of injuries also fasting is necessary at first until inflammation has ceased.
7 As I am going to pass on from the above to the lower jaw I think I ought to point out certain matters pertaining to fractures so as not to have to say the same things too often. Any bone, then, may be split, either in a straight line as a log of wood is cleft lengthwise, or across, sometimes obliquely; and in the latter case, the fractured ends are sometimes blunted, sometimes pointed. The last is the
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worst because two ends are not brought together easily when they have nothing blunt to rest against, and they lacerate the flesh, sometimes also sinews and muscles; indeed sometimes there are several fragments. Now in other bones one fragment often separates from another completely; but in the case of the jaw the pieces of bone even when injured are always in contact with one another at some point. Begin then by applying pressure with the two thumbs in the mouth and two fingers on the skin outside, and force all the fragments into position; next, if the lower jaw has been broken across, in which case generally one tooth stands higher than its neighbour, when it has been put back into position tie together with horsehair the two adjacent teeth, or if these are loose, teeth further away. In other varieties of this fracture, the binding is superfluous, but what follows is the same for all: a double fold of linen soaked in wine and oil is to be put on, smeared with fine flour and incense as before; then over this a bandage or strip of soft leather has a slit made in the middle to enclose the chin on each side and thence the ends are carried to the top of the head and tied there. What follows applies to fractures in general: fasting is a necessity at first; then from the third day a fluid diet, and when the inflammation has subsided a somewhat fuller diet to build up the strength; wine is wrong throughout; then on the third day the bandage is removed, and the part fomented with steam by means of a sponge, and the bandage reapplied as before; the same thing is to be done again on the fifth day and so on until the inflammation has ceased, which is generally by the ninth or the seventh day. The inflammation gone,
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the bones must be examined again, and if the fractured ends are not in place, they are reset; after which the bandaging should not be dispensed with until two-thirds of the time has elapsed which such bones take to unite. Bones generally reunite as follows: between the fourteenth and twenty-first days the lower jaw, cheek-bones, clavicle, sternum, blade-bones, ribs, spine, hip-bone, astragalus, heel-bone, and the bones of the hands and feet; between the twentieth and thirtieth days the bones of the leg and forearm; between the twenty-seventh and fortieth days the upper arm and thigh. But in the case of the lower jaw, there is this addition, that fluid food has to be taken for a longer period. And even after time has elapsed the patient must continue to eat pancakes and such-like, and must not eat anything hard until the formation of callus has rendered the lower jaw quite firm; also, at any rate for the first days, the patient should not speak.