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+Project Gutenberg (https://www.gutenberg.org) public repository for
+eBook #69222 (https://www.gutenberg.org/ebooks/69222)
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-The Project Gutenberg eBook of The apparatus used by the Greeks and
-Romans in the setting of fractures and the reduction of dislocations, by
-John S. Milne
-
-This eBook is for the use of anyone anywhere in the United States and
-most other parts of the world at no cost and with almost no restrictions
-whatsoever. You may copy it, give it away or re-use it under the terms
-of the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org. If you are not located in the United States, you
-will have to check the laws of the country where you are located before
-using this eBook.
-
-Title: The apparatus used by the Greeks and Romans in the setting of
-       fractures and the reduction of dislocations
-
-Author: John S. Milne
-
-Release Date: October 24, 2022 [eBook #69222]
-
-Language: English
-
-Produced by: deaurider and the Online Distributed Proofreading Team at
-             https://www.pgdp.net (This file was produced from images
-             generously made available by The Internet Archive)
-
-*** START OF THE PROJECT GUTENBERG EBOOK THE APPARATUS USED BY THE
-GREEKS AND ROMANS IN THE SETTING OF FRACTURES AND THE REDUCTION OF
-DISLOCATIONS ***
-
-Transcriber’s Note: The figures appear to have been mis-numbered: there
-is no Fig. 23, nor any reference to one in the text.
-
-
-
-
-                        THE APPARATUS USED BY THE
-                         GREEKS AND ROMANS IN THE
-                         SETTING OF FRACTURES AND
-                      THE REDUCTION OF DISLOCATIONS.
-
-                                    BY
-                              JOHN S. MILNE,
-             General Practitioner in Hartlepool (a smoky town
-                   on the Northeast Coast of England).
-
-                             REPRINT FROM THE
-                       INTERSTATE MEDICAL JOURNAL,
-                         Vol. XVI., Nos. 2 and 3.
-
-                                ST. LOUIS:
-                      INTERSTATE MEDICAL JOURNAL CO.
-                                  1909.
-
-
-
-
-THE APPARATUS USED BY THE GREEKS AND ROMANS IN THE SETTING OF FRACTURES
-AND THE REDUCTION OF DISLOCATIONS.
-
-By JOHN S. MILNE, General Practitioner in Hartlepool (a smoky town on the
-Northeast Coast of England).
-
-
-Let me point out that the scope of the paper does not cover the whole
-ground of the wide knowledge possessed by the ancients on the subject of
-fractures and dislocations. It is merely an enumeration of the apparatus
-used in the treatment of these, with short extracts indicating the method
-of employing them. The authorities on the subject are Hippocrates,
-in his works on Fractures and Articulations, 460 B. C.; Galen in his
-commentaries on these (130-200 A. D.); Celsus (about 20 A. D.); a chapter
-by Heliodorus preserved in the works of Oribasius (325 A. D.), and the
-little encyclopedia of Paulus Ægineta (6th Century A. D.) I have also
-taken a few illustrations from the Armamentarium of Scultetus.
-
-In the treatment of fractures the ancients employed, as we do to-day,
-splints, pads and bandages.
-
-Hippocrates in his book on _Fractures_ gives a very complete account of
-the method of applying these.
-
-First of all, the limb was smeared with a waxy composition, called
-cerate, in order to prevent the bandages from slipping. The bones having
-been got into position by means of extension and other manipulations, a
-roller bandage soaked in cerate (Fig. 1) was fixed by one or two turns
-round the seat of the fracture, and then carried upward for several
-turns. (Fig. 2.)
-
-Next, a second waxed bandage was applied, beginning as before at the
-fracture, passing downwards for several turns (Fig. 3), and then upwards
-to end at the same spot as the first bandage.
-
-Next, elongated pads, formed of folded linen and stiffened with
-cerate, (Fig. 4) were laid along the limb in such a way as to cover it
-completely, and fixed by the application of roller bandages which had as
-before been dipped in cerate.
-
-No splints were applied at this time, so that so far, the treatment
-corresponds in principle to the immovable bandages of gum and chalk or
-plaster of Paris which we employ to-day. On the third day, the swelling
-of the part having subsided and the bandaging having become somewhat
-loose, the whole was removed and the limb bathed with hot water, and the
-bandages and pads were applied as before.
-
-[Illustration: FIG. 1. Waxing a bandage. After Scultetus. Double spatulæ
-of the form shown are found among ancient Roman instruments from Pompeii.]
-
-[Illustration: FIG. 2. Waxed bandage fixed over site of fracture and
-carried upwards for several turns. After Scultetus.]
-
-[Illustration: FIG. 3. Second waxed bandage fixed over the site of
-fracture and carried downwards for several turns, preparing to return
-upwards and end at the top of the first bandage. After Scultetus.]
-
-Three days afterwards, _i. e._, on the seventh day from the accident, the
-swelling was expected to be quite gone, and the bandages again loosened,
-and now these having been removed and the limb having been bathed, the
-pads and bandages were put on as before, but this time splints were
-applied in addition. (Fig. 5.) These were narrow and rod-like, and were
-arranged all round the limb, the breadth of a finger intervening between
-each, and were kept in place by three or four strings tied just tight
-enough to keep the splints in position without their action contributing
-at all to the compression of the part. The splints were examined every
-third day till bony union had taken place, and the whole dressing was
-reapplied whenever it became loose.
-
-In addition to the fixation by the above methods the part was further put
-at rest by a sling, in the case of the upper limb, and in that of the
-lower, by elevating it in bed on a pillow or a box splint.
-
-Compound fractures were not treated with splints until the wound had
-healed, but were lightly put up in pads and bandages and laid in a box
-splint and dressed frequently. If there was much discharge, a goat’s skin
-was placed beneath, to catch the discharge and embrocations.
-
-We shall now consider a little more fully each of the materials mentioned
-above.
-
-_Roller Bandages._ Hippocrates says that the bandages should be clean,
-light, soft, thin, and without seams, yet strong enough to bear
-stretching. Their breadth should be proportionate to the part under
-treatment. They should be three, four, or five finger breadths broad, and
-as many cubits in length.
-
-Rolling should be practiced with both hands together, and with either
-separately, and it should be done quickly, elegantly and without causing
-discomfort to the patient.
-
-Sometimes the turns were to be made to the right, and sometimes to the
-left, and sometimes a double headed bandage was to be used and applied
-crosswise. After the bandage was on, it was to be finished off by
-stitching with a needle and thread, lest a knot should cause discomfort.
-
-All the methods of applying the roller bandage which we now employ,
-together with many other complicated methods, are described by the
-ancients, and will be found described and figured in the works of
-Oribasius in the edition of Stephanus (_Medicae Artis Principes_) and
-also in Scultetus.
-
-_Pads (or “Compresses”)._ These were made of linen folded three or four
-times. They were three or four fingers in breadth, and their length was
-proportionate to the part.
-
-They were applied longitudinally in such number as to encircle the limb.
-
-In applying splints extra pads were put on parts where the bone
-projected, as at the ankle.
-
-_Splints._ Hippocrates says these should be smooth, even, rounded at the
-ends, and concave. They should be secured with strings. Those at parts
-where bone was prominent should be short so as not to press on the part.
-
-[Illustration: FIG. 4. Applying the waxed compresses over the bandages.
-After Scultetus, but Hippocrates says the compresses ought to completely
-surround the limb and not be separated from each other by a space as this
-figure shows. It makes the pads look like splints.]
-
-[Illustration: FIG. 5. Applying the splints on the seventh day. After
-Scultetus. First the two bandages have been put on, then the waxed pads,
-the bandaging to fix which can be seen under the splints.]
-
-[Illustration: FIG. 6. Splint for leg-fracture described by Hippocrates.
-Made of elastic rods fitting into loops on shackle-like pads above the
-ankle and below the knee. After Littré.]
-
-Palladius says that they should be made of the wood of the lime tree, or,
-where this could not be procured, reeds were to be used. They were to
-be round, and secured with three loose fillets or ribands, one at their
-upper, and one at their lower end, and one at the middle.
-
-Paulus Ægineta says that they should be arranged not more than one
-finger’s breadth from each other.
-
-_Special Splints._ A special form of splints for fractures where the
-deformity could not be kept reduced by ordinary methods is described by
-Hippocrates.
-
-“One should sew two round pads of Egyptian leather, such as are worn by
-persons confined for long in shackles, and the pads should be deeper on
-their aspect facing the wound, and shallower on that facing the joint,
-and they should be well stuffed and soft and easy fitting, the one to the
-part above the ankle, and the other to the part below the knee.
-
-“Each pad should have two loops on its inner aspect and two on its outer.
-(Fig. 6.)
-
-“Then taking four equal rods of the wood of the cornel tree, each of the
-thickness of a finger, and of such a length that they can be fitted into
-the loops by bending, adjust them, two on the inside of the leg and two
-on the outside.
-
-“They should be of such a length that suitable extension may be kept up.
-
-“The two which are uppermost (as the patient lies on his back) may be
-tied together. (Fig. 7.)
-
-“If the apparatus does not fit properly it will do more harm than good,
-as indeed any other contrivance will.”
-
-Galen, commenting on this passage, says that the pads which Hippocrates
-describes as round are really like snakes or like the sausages which
-butchers make, by filling intestines with chopped meat or other such food.
-
-_Minor Splints._ In fracture of the lower jaw Hippocrates bound the teeth
-together with gold wire, and applied a light splint of moulded leather on
-the outside of the jaw.
-
-In fracture of the nose, Paulus Ægineta says that tents of cloth were
-applied to each nostril. Some sewed into these the quills of goose
-feathers, so that the patient could breathe through these.
-
-_Box Splints._ Hippocrates says that he is rather at a loss whether to
-recommend box splints or not. They are of some use, but not of so much
-as many suppose, and a board, unless padded, is rather an uncomfortable
-thing for a limb to lie on. (Fig. 8.) However, the common people have
-more confidence in the treatment where they are used; and they are useful
-in such times as the bed requires rearranging or the patient has the
-bowels moved.
-
-If used at all they should be of sufficient length. Those for fracture of
-the thigh should reach from the hip to the heel, for, if flexion of the
-knee be allowed, distortion of the part is caused.
-
-[Illustration: FIG. 7. Top view of the same to show the tying together of
-the two top rods.]
-
-[Illustration: FIG. 8. Box splint or “canal” after Scultetus.]
-
-[Illustration: FIG. 9. The Glossocomium of Galen, applied for fracture of
-the thigh. After Vidius.]
-
-[Illustration: FIG. 10. Scamnum of Hippocrates after Littré.]
-
-[Illustration: FIG. 11. Scamnum of Hippocrates after Vidius. It differs
-from the description of Hippocrates in having slots instead of grooves,
-but it is the oldest figure of the instrument.]
-
-Nothing, however, is more convenient than a cushion or something similar,
-either of wool or linen and not hard. It is to be made hollowed along its
-middle, and laid below the limb. In any case a shawl should encircle both
-splint and limb, as children are swathed in bed.
-
-Paulus Ægineta describes the box splints as of wood or earthenware.
-Some applied them only in cases of compound fracture. A better means of
-steadying the limb, he thinks, is to make a long pillow of a garment,
-and to fold it up at the sides, round the limb, and to steady the whole
-with pillows. The garment should be lined with a skin, to catch the
-embrocations.
-
-Galen says that they should be rounded externally and hollowed inside.
-They were made of different kinds of wood.
-
-Celsus says that they should have in their lower part a hole for the
-escape of discharge, and they should have a foot plate.
-
-_Glossocomium of Galen._ This ingenious and useful splint, says Galen,
-had been invented by the practitioners of his time.
-
-It took its name, he says, from the Attic name for a box used for storing
-papers of value or which one wished to conceal or to carry on a journey,
-and was variously spelled glossocomum or glossocomium or with two t’s
-instead of two s’s. (Fig. 9.)
-
-It might be applied to the femur or the tibia, and was to be used
-continually till callus had formed.
-
-Galen gives a full description of it, but its principle is best
-understood from a drawing such as that given by Vidius or Scultetus.
-
-On rotating the handle the upper and lower fragments are simultaneously
-pulled apart.
-
-_Dislocations._ The different varieties of dislocations of the joints
-were known to Hippocrates nearly as completely as we know them to-day,
-and the various manipulations necessary for their reduction are fully
-described.
-
-Cases which resisted reduction by means of ordinary measures, such as
-extension over the back of a chair or the lower half of a door in the
-case of the shoulder, were treated by more powerful apparatus, improvised
-or kept for the purpose.
-
-Bands for extension and counterextension were applied. These consisted
-preferably of supple leather, but in the absence of these Hippocrates
-says that iron chains, cords, or the ropes for ships may be used, being
-wrapped round with woolen cloth at the parts where they are to come in
-contact with the skin.
-
-In reducing dislocations of the fingers, Hippocrates says that nooses
-formed from the twisted bast of palm shoots are suitable. Aristotle
-refers to these in his book on the _Parts of Animals_.
-
-The power to be applied was obtained by means of winches or drums on
-axles, levers, wedges, screws and pulleys.
-
-[Illustration: FIG. 12. The scamnum in use for Dislocation at the
-astragalus.]
-
-[Illustration: FIG. 13. Reduction of a Gibbosity of the spine by the
-scamnum.]
-
-Hippocrates only mentions three of these: “Of all the mechanical
-instruments used by men the most powerful are these three, the winch,
-the lever and the wedge.” He does not mention the screw, though it is
-most likely that the Greeks of his time knew of it, but we shall see
-that later the Greeks applied it, as in the machine of Nymphodorus, to
-generate power for reducing dislocations.
-
-Hippocrates does not in this passage refer to the use of the pulley,
-though in another place he mentions it in connection with the treatment
-of fracture of the spine, and we shall see several instances of its use
-for converting the direction of motion in machines for the reduction of
-dislocations.
-
-In one of these, the machine of Fabrus, a system of pulleys is arranged
-to give a considerable increase of power, so that it is not unlikely
-that block and tackle arranged to multiply power would be used as well,
-although we have no direct description of such.
-
-We may note that Scultetus (Tab. xxi) illustrates a block and tackle
-which he says that he has taken from Vitruvius, Lib. 10, ch. x, and which
-he says was in use in his day for the reduction of dislocations.
-
-As many of the surgeons were “_periodeutae_,” traveling about from
-place to place, it was not possible for them to carry about the heavy
-contrivances that the practitioner settled in a large town could have at
-his command, but Hippocrates shows how to improvise imitations of these,
-and small winches which could be attached to such household implements as
-ladders were carried as part of the portable outfit.
-
-_The Scamnum, or Bench, of Hippocrates._ This contrivance, of which the
-first account (Fig. 10) is given by the father of medicine, was used by
-all succeeding ancient surgeons, and Scultetus shows many figures of it
-in actual use in his time. Galen had a very high opinion of it. He says
-that all varieties of dislocation could be reduced by it.
-
-Hippocrates says that “the best thing for any physician who practices in
-a populous city is to have prepared a proper wooden machine with all the
-mechanical powers applicable in cases of fractures and dislocations, both
-for making extension and for levering.
-
-“For this purpose, it will be sufficient to possess a board resembling in
-length, breadth, and thickness, the quadrangular threshing boards made of
-oak.
-
-“It should be six cubits, or a little more, in length, and about two
-cubits in breadth. A foot will be sufficient thickness for it.
-
-“Along it from one end to the other an excavation (in the ground) must be
-made so that the working of the levers may not be higher than necessary.
-
-“Then at both sides we are to raise short, strong, and firmly fixed posts
-carrying axles; and in the middle of the bench five or six long grooves
-are to be scooped out, about four inches distant from each other, three
-inches will be sufficient breadth and also depth for them, and although
-the number of grooves I have mentioned will be sufficient there is
-nothing to prevent their being made all over the bench.
-
-[Illustration: FIG. 14. The scamnum in dislocation of the elbow, after
-Vidius.]
-
-[Illustration: FIG. 15. Reduction of dislocation of the Humerus by the
-scamnum. After Vidius.]
-
-“And the bench should have in its centre a fairly deep hole of a square
-shape, and of about three inches in size, and into this hole, when judged
-necessary, is to be adjusted a corresponding piece of wood, rounded in
-its upper part, which at the proper time is to be adjusted between the
-perineum and the head of the thigh bone. This upright prevents the body
-from yielding to the force dragging downwards by the feet. For sometimes
-this piece of wood serves the same purpose as counterextension (i. e., by
-thongs) in an upward direction, and sometimes, too, when both extension
-and counterextension are made, this piece of wood, if susceptible of
-some motion to this side or that, will serve the purpose of a lever for
-pushing the head of the thigh bone outwards.”
-
-It is on this account that several grooves are scooped out in the bench.
-
-The lever may be round or flat to suit different cases. Another mode of
-using the scamnum was to raise two posts at the middle of the sides, and
-to insert into them a transverse bar like the step of a ladder, to act as
-a horizontal perineal bar.
-
-Figure 10 shows the machine constructed from this description by Littré.
-
-A figure of the machine, by Vidius, is somewhat different, (Fig. 11)
-square holes taking the place of the longitudinal grooves described by
-Hippocrates.
-
-I shall now proceed to give a few descriptions of actual applications of
-the machine to reduction of different dislocations, which, it is hoped,
-will be readily understood by the aid of the accompanying figures, which
-are mainly taken from drawings by Vidius in illustration of a chapter by
-Heliodorus. One cannot help thinking that this machine must originally
-have given the idea for the instrument of torture known as the rack. This
-was well known in the time of Cicero.
-
-Celsus says that the scamnum was quite powerful enough to produce rupture
-of the muscles.
-
-Fig. 12 shows the machine in use for dislocation forwards of the
-astragalus. Extension and counterextension are being made by thongs
-fastened below the knee and above the ankle.
-
-Fig. 13 shows an attempt at reduction of the spine. Extension is being
-made below the seat of the lesion by a thong passed round the abdomen
-above the crest of the pelvis, while counterextension is maintained by a
-thong passed under the armpits.
-
-The operator’s assistant is levering down the gibbosity with a flat board
-used as a lever.
-
-Fig. 14 shows the reduction of a dislocated elbow. The forearm is pulled
-down by a thong passed over its middle, while counterextension is
-maintained by thongs attached to the humerus and the forearm near the
-wrist.
-
-[Illustration: FIG. 16. The Scamnum in dislocation of the jaw. After
-Vidius.]
-
-[Illustration: FIG. 17. Counterextension by an axillary loop on the
-injured side and a perineal band on the other. Extension by a clove hitch
-above the knee. The surgeon’s hands are seen levering the head of the
-bone inwards while the assistant props the left side of the body.]
-
-Fig. 15 shows reduction of the humerus. While the extension and
-counterextension are made, the assistant pulls outwards the head of the
-humerus by a thong passed under the arm in the axilla.
-
-Fig. 16 shows reduction of a dislocated jaw. Heliodorus is the only
-author who describes the use of a machine for this purpose, and it seems
-rather a superfluous display of force but it may occasionally have been
-necessary, as from what Hippocrates says it would seem that owing to the
-dearth of practitioners in some parts it was not uncommon to meet with
-cases which had remained unreduced for some time.
-
-Of dislocation outwards at the hip (Fig. 17) Paulus Ægineta says:
-
-“If the dislocation is outwards, the extension is to be made as above,
-but the thong at the perineum is to be passed by the opposite parts,
-the groin at the one side, the clavicle at the other. The surgeon is to
-propel the limb from without inwards, the lever being fixed in one of the
-furrows formerly prepared, and an assistant fixing the sound nates, that
-the body may not yield.”
-
-Hippocrates says that instead of the perineal extension band the upright
-perineal prop may be used.
-
-Of dislocation inwards, Paulus Ægineta says that if it be not reduced
-after trying with the patient on his back and using the upright perineal
-prop:
-
-“The erect piece of wood (Fig. 18) is to be removed, and two other
-pieces, i. e. the perineal prop of wood fixed on either side, like posts,
-not more than a foot in length, and let another piece of wood be adapted
-to them like the step of a ladder, so that the figure of the three pieces
-of wood may resemble the Greek letter H, the middle piece of wood being
-fixed a little below the tops.
-
-“Then, the man being laid on the sound side, we bring the sound leg
-between the posts, underneath the piece of wood corresponding to the step
-of a ladder, while the injured one is brought above it, so that the head
-of the thigh is upon it; but a folded garment is to be first wrapped
-about it to prevent the thigh from being bruised. Then another board of
-moderate breadth and of such a length as to extend from the head of the
-thigh to the ankle, is to be bound along the inner side of the thigh to
-the ankle.
-
-“Then extension being made, either by the pestles mentioned in treating
-of the dislocation of the vertebra or some such instrument, the leg is
-to be pulled downwards along the board which is fastened to it, so that
-by the force exerted on it the head of the thigh-bone may return to its
-proper place.”
-
-[Illustration: FIG. 18. The scamnum in dislocation inwards of the thigh.
-Counterextension maintained by the horizontal bar.]
-
-[Illustration: FIG. 19. Shows the ambè, fitted into a specially prepared
-upright supported on an ornamented base. After Scultetus.]
-
-[Illustration: FIG. 19A. Anterior and posterior views of the machine of
-Fabrus. (After Vidius.) Between them is an ambè which has at its axillary
-end a bolt to fit into the top cross-bar of the machine.
-
-The power varies only with the ratio of the diameter of the axle to
-length of crank. The pulleys do not multiply power.]
-
-_The Ambè._ We have seen that in using the scamnum (Fig. 19) for the
-reduction of dislocation inwards of the thigh, Paulus Ægineta, (also
-Hippocrates, from whom Paul is copying), recommends us to fix a piece
-of board along the inside of the thigh and leg, to assist in levering
-the head of the bone into position. A board applied in this way was also
-used in reducing the dislocations of the shoulder, either by levering the
-board over the back of a chair or the lower half of a door, or by using
-it in conjunction with some specially constructed machine, such as that
-of Fabrus, with which we shall meet presently.
-
-A board especially prepared for this purpose had a rounded enlargement on
-its extremity, to assist in pushing the head of the humerus outwards.
-
-The name of this enlargement (ἄμβη) gradually became transferred to the
-whole instrument. The “ambè” was well known in England till well into the
-last century.
-
-The time of its disappearance in England may be fixed by a passage in
-Adams’ edition of Hippocrates (vol. ii, p. 575) where he says: “Of
-late years the ambè has fallen completely into disuse, and none of the
-various modifications of it are to be seen except in the cabinets of the
-curious.” (This was in 1849.)
-
-Scultetus shows us an ambè mounted in a specially prepared upright for
-use in the surgery (Fig. 19).
-
-The ambè is thus described by Hippocrates:
-
-“We must get a piece of wood five, or at least four, inches broad, two
-inches in thickness, or thinner, and two cubits in length, or a little
-less, and its extremity should be rounded, and made very narrow and very
-slender there, and it should have a slightly projecting edge (ἄμβη) on
-its round extremity—not on the part that is to meet the chest, but the
-head of the humerus.
-
-“A piece of soft shawl should be glued to the end of the piece of wood so
-as to give the least pain on pressure.
-
-“Having pushed the end of this piece of wood as far in as possible,
-between the ribs and the head of the humerus, the whole arm is to be
-stretched along this piece of wood, and is to be bound round at the
-arm, the forearm, and the wrist, so that it may be particularly well
-secured, but great pains should be taken that this piece of wood should
-be introduced as far into the armpit as possible, and that it is carried
-past the head of the humerus.
-
-“Then a crossbeam is to be securely fixed between two pillars, and
-afterwards the arm, with the piece of wood attached to it, is to be
-brought over this crossbeam so that the arm may be on one side of it and
-the body on the other and then the arm with the piece of wood is to be
-forced down. The crossbeam is to be fixed so high that the rest of the
-body is raised on tiptoe.
-
-“This is by far the most powerful method of effecting the reduction of
-the shoulder for thus one operates with the lever on the most approved
-principles.”
-
-Celsus (Bk. VII, ch. xv) describes the ambè thus:
-
-“A wooden spattle is necessary if the body is rather big and the tendons
-are rather strong, and it should be of the thickness of two fingers and
-in length reach from the axilla to the fingers. And at the top of it
-there is a head rounded and gently hollowed out, so as to receive a part
-of the head of the humerus. In it there are two holes at three places
-separated from each other by an interval, and in these soft thongs are
-inserted.
-
-[Illustration: FIG. 20. Patient with arm arranged in the machine of
-Fabrus for reduction of dislocation of shoulder. The thongs from a clove
-hitch applied above the elbow are taken over two pulleys above and two
-pulleys below so that the clove hitch cannot move up nor down, and the
-elbow is thus maintained at the same level. (N. B. These thongs are not
-connected to the axle in any way.) Patient strapped so that he cannot
-resist the treatment.]
-
-[Illustration: FIG. 20A. Setting a fractured humerus in the manner
-described by Hippocrates. After Vidius.]
-
-[Illustration: FIGS. 21 AND 22. Portable winch, known as the plinthium of
-Nileus, for affixing to a ladder.]
-
-“This spattle, wound round with a bandage in order that it may not injure
-by contact, is so applied to the arm at the axilla that its upper end is
-put under the top of the axilla; then by its thongs it is bound to the
-arm, at one place a little below the head of the humerus, at another a
-little above the elbow, at a third above the hand—indeed the spaces and
-holes have been arranged for this purpose.
-
-“The arm, tied in this manner, is passed over the step of a poultry
-ladder at such a height that the man cannot stand and while the body is
-let down on one side, the arm is made tense on the other, and thus it is
-brought about that the head of the humerus—impelled into position by the
-end of the board—is reduced, sometimes audibly, sometimes not so.
-
-“Many other methods can be learnt by reading Hippocrates alone but not
-one has stood the test of experience better.”
-
-_The Machine of Fabrus._ Heliodorus describes the construction of this
-machine, and its application for the reduction of dislocations of the
-humerus. Probably it is a machine used by artisans for some such purpose
-as the elevation of large blocks of stone, as it seems unlikely that such
-a large and cumbrous machine should have been especially invented for the
-single purpose of reducing the dislocation of one joint. Two views of the
-machine are given, (Fig. 19A).
-
-It consists, as will be seen, of two upright posts supported on a heavy
-base, while inside the posts a frame carrying two upright bars is raised
-and depressed by the rotation of an axle acting on a system of pulleys.
-Through the heads of the upright bars there passes another axle carrying
-a padded projection which is placed in the armpit.
-
-The arm is strapped to an ambè in the manner described already and is
-passed over the axle, the patient standing on tiptoe outside the machine.
-(Fig. 20.)
-
-The arm is maintained at one level by thongs affixed by a clove hitch
-above the elbow and passing over pulleys above and below. On rotating the
-lower axle the frame is pushed upwards, forcing the head of the bone into
-position, while at the same time an assistant forces the head of the bone
-outwards by a half turn of the upper axle, causing the padded projection
-to push outwards.
-
-_Extemporized Apparatus and Substitutes._ Having now described the
-apparatus which was used by practitioners settled permanently in populous
-places, we may consider the substitutes for these which were used by
-surgeons on their travels, or under other circumstances where the major
-apparatus was unavailable.
-
-Hippocrates says we must always be ready to make use of whatever happens
-to be at hand.
-
-He says that dislocation inwards at the hip may be reduced in the
-following manner.
-
-[Illustration: FIG. 24. Ladder arranged as a machine for the reduction of
-dislocations. A Plinthium of Nileus has been tied on the lower part of
-it and below this are two pulleys for the converting of the direction of
-extension. A similar pair of pulleys have been tied on the top step of
-the ladder.]
-
-[Illustration: FIG. 25. Reduction of shoulder by ladder with Plinthium of
-Nileus. Extension having been made, the operator is pulling out the head
-of the humerus by a thong. The assistant is bearing down on the patient’s
-neck.]
-
-It is a good, proper and natural mode of procedure, and has something of
-display in it, if anyone take delight in such ostentatious methods.
-
-The patient is to be suspended from a crossbeam by the feet tied together
-by a strong, soft and broad cord.
-
-The feet are to be about four inches or less from each other and a broad
-and soft leather collar also connected with the crossbeam, is to be put
-on above the knees, and the affected leg should be so extended as to be
-two inches higher than the other.
-
-The head should be about two cubits from the ground and the arm should be
-stretched along the sides, and bound with something soft.
-
-All these preparations should be made while he is lying on his back so
-that he may be suspended for as short a time as possible.
-
-When the patient is suspended a person properly instructed and not weak,
-having introduced his arm between his thighs is to place his forearm
-between the perineum and the dislocated head of the femur, and then,
-having joined the other hand to the one thus passed through the thighs,
-he is to stand by the side of the suspended patient and suddenly suspend
-and swing himself in the air as perpendicularly as possible.
-
-In fracture of the humerus, if the bone be set while the elbow is
-extended, the muscles of the arm will assume a different position when
-the elbow is flexed.
-
-To set it in the flexed position, therefore, suspend a piece of wood like
-the handle of a spade from the roof by two chains one at each end.
-
-Place the patient’s arm over this, so that the bar lies in the axilla.
-
-Over the flexed forearm pass a shawl to which attach a great weight, so
-as to produce extension on the lower fragment of the humerus and thus
-reduce the deformity.
-
-Apply the waxed bandages and compresses in this position.
-
-_The Pestle._ Of reduction of the shoulder by means of the pestle,—an
-article for the preparation of food to be found in every Greek
-home,—Hippocrates says:
-
-“Those who accomplish the reduction by forcibly bending it over a pestle
-operate in a manner which is nearly natural. The pestle should be wrapped
-in a soft shawl for thus it will be less slippery.
-
-“It should be forced between the ribs and the head of the humerus. And if
-the pestle be short the patient should be seated on something, so that
-his arm can with difficulty pass over the pestle.
-
-“But, for the most part, the pestle should be longer, so that the
-patient, when standing, may be almost suspended by it. And then the
-arm and forearm should be stretched along the pestle while some person
-secures the opposite side of the body by throwing the arms round the neck
-near the clavicle.”
-
-Hesiod (Works and Days, 1, 421) says that the length of the culinary
-pestle was three cubits.
-
-[Illustration: FIG. 26. Reduction of the ulna.]
-
-[Illustration: FIG. 27. Reduction of both bones at the elbow.]
-
-[Illustration: FIG. 28. Reduction of the shoulder with the ladder in the
-horizontal position. Operator pulling head of humerus outwards with a
-thong.]
-
-From other passages in Hippocrates it would seem that any pestle-like rod
-may be indicated. The word Celsus uses means a staff.
-
-Hippocrates describes several methods of improvising a scamnum.
-
-Any strong couch may be used as the bench, and extension and
-counterextension may be produced by poles levered against boards fixed to
-the feet of the couch, thongs being attached to the middle of the poles.
-
-Or instead of boards attached to the feet of the couch a ladder may be
-placed below the couch and the poles levered against the steps of the
-ladder.
-
-If along with either of these methods it were desired to extemporize a
-lever to press down a hump back, this could be done by driving a post
-into the ground alongside the couch and making a hole in the post for the
-end of the lever to play in.
-
-Or the couch could be drawn alongside a wall and a hole made in the wall
-for the end of the lever.
-
-In fracture-dislocation of the foot the extension might be made as
-follows:
-
-Having fixed in the ground the nave of a wheel or some such object,
-something soft is to be bound round the foot.
-
-Next, some soft thongs are to be attached to the foot and the ends of the
-thongs are to be fixed to a pestle or similar pole. The end of the pole
-is to be fixed in the nave.
-
-On pulling back the pole, the foot is extended, while counterextension is
-made by pulling on the shoulders and the ham of the patient.
-
-Or, counterextension can be made by driving a pole into the ground to act
-as a perineal support.
-
-_Ladder._ A ladder was an object which was always at hand and of service
-in the reduction of dislocations.
-
-In treating of the ambè we showed one use of the ladder, namely to reduce
-the shoulder by levering the arm over a step. For other dislocations
-portable fittings could be applied to generate power for extension and to
-convert the direction of motion.
-
-Thus, two pulleys might be affixed to the top steps and two to the lower,
-and a portable winch fitted to the lower part of the ladder.
-
-One simple form of winch for this purpose was called the _plinthium of
-Nileus_.
-
-It consisted merely of a small frame carrying an axle, with or without a
-ratchet. (Figs. 21, 22.)
-
-Fig. 24 shows a ladder fitted up with pulleys at its top and bottom and a
-plinthium of Nileus below.
-
-Fig. 25 shows the reduction of the humerus by a ladder so fitted. The
-ladder having been fixed in the ground, the arm has been passed over a
-step of the ladder and the plinthium of Nileus has tightened the thongs
-attached to the arm till the patient is almost suspended.
-
-The operator is pulling the head of the humerus outwards by means of a
-fillet, while an assistant is pressing down the shoulders of the patient.
-
-[Illustration: FIG. 29. Reduction of the wrist. The ladder is probably
-meant to be lying flat, but in the figure it is shown tilted up on its
-side in order to bring the parts into view.]
-
-[Illustration: FIG. 30. Reduction of the dislocated astragalus with the
-ladder in the horizontal position.]
-
-Fig. 26 shows the reduction of the ulna at the elbow, and Fig. 27 the
-reduction of both bones dislocated together. Fig. 28 shows the reduction
-of the shoulder. The ladder is placed horizontally in this case, the ends
-being supported on a pile of wood or stone blocks.
-
-The patient is bound on the ladder, and while extension is made on the
-arm, the head of the humerus is pulled outwards by a thong passed inside
-it.
-
-Fig. 29 shows the reduction of the wrist, extension and counterextension
-are made by thongs affixed below and above the wrist by clove-hitches;
-while Fig. 30 shows the reduction of the ankle on similar principles.
-
-(In the case of the wrist the ladder is shown tilted up on its side, in
-order to bring the parts into view.)
-
-A portable winch of more powerful principle was the Glossocomum of
-Nymphodorus. It is shown in Fig. 31; first, as it appeared when closed
-and ready for use, and next, with one of the shutters removed to show its
-internal construction.
-
-It will be seen to consist of a crank, the rotation of which causes a
-worm on it to turn a cogged wheel.
-
-Round the axle of the cog wheel are ropes passing to another axle, the
-circumference of which is increased by drums so as to multiply the power,
-after the manner shown in the figure. One whole turn of axle moves
-cogged wheel forward one cog. Some of the inner details of the winch are
-shown below. Another portable winch was the Trispastum of Apelles or of
-Archimedes. Its construction is shown in Fig. 32, which shows the sides
-removed to display the working. In actual use, however, it was closed in
-like the last winch.
-
-_Reduction by Means of Inflating a Bladder._ In describing the reduction
-of the dislocation of the spine Hippocrates says that he has tried to
-reduce the deformity by inflating a bladder affixed to a bronze tube and
-placed under the spine. The experiment, however, 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 bladder.
-
-Hippocrates says he has 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.
-
-Again he says that reduction by the bladder was celebrated in the case of
-the hip joint.
-
-It is not a powerful method. It should be placed between the thighs
-uninflated so that it may be carried as far up in the perineum as
-possible, and the thighs, beginning at the patella, are to be bound round
-with a swathe, as far up as the middle of the thigh, and then a bronze
-pipe is to be introduced into one of the loose feet of the bladder and
-air forced into it. The patient is to lie on his side with the injured
-limb uppermost.
-
-From this description it would seem that the bladder had consisted of
-some small skin such as that of a kid.
-
-[Illustration: FIG. 31. Glossocomum of Nymphodorus. Two views, one
-showing it closed and ready for use, the other with the lid removed, to
-show the principle. A crank drives a shaft with a worm thread on it. The
-threads of the worm engage in notches in a drum. Ropes pass from the
-axle on which the cogged wheel drum is carried, to drums carried on a
-second axle. Below are parts of the machine showing its structure and
-also the method of fixing the rope ends. After Vidius. Power, ONE TURN OF
-AXLE only moves the cogged wheel one notch—great power therefore varying
-with length of crank. Power still further increased by lower axle being
-smaller than drums of upper.]
-
-[Illustration: FIG. 32. Trispastum of Apelles or Archimedes with the
-sides removed to show the works. The power depends on ratio of diameter
-of axle to length of crank in this figure. But if the lower drums were
-made smaller than upper as in Fig. 31, power would be further augmented
-accordingly.]
-
-[Illustration: FIG. 33. Succussion on a ladder for dislocation of the
-spine. The patient is bound to the ladder by the lower part of the body,
-the upper hanging free. The ladder is raised by the pulleys and suddenly
-allowed to drop.]
-
-_Succussion, or Suspension on a Ladder._ This was done for dislocation of
-the spine, and usually to astonish the mob, Hippocrates says, although so
-far as he was aware, the method had never straightened anybody yet. To
-the mob, however, things of this sort are wonderful, and they never give
-a thought as to their utility.
-
-A ladder was padded with leather, and on this the patient was laid on his
-back. The ankles were tied to the ladder by soft strong bands.
-
-The arms were bound to the sides of the patient but not to the ladder.
-
-By means of a rope or ropes affixed to the lower end of the ladder (Fig.
-33) it was raised along the gable of a high house or a high tower, or the
-mast of a ship fixed in the ground. The ropes should run over a pulley or
-a winch.
-
-For the sake of completeness we may conclude with a short account of the
-materials used for the treatment of congenital clubfoot by Hippocrates.
-
-Most cases are remediable. After pulling and pushing the parts into
-position they are to be retained with cerate, made with a full proportion
-of rezin, with compresses or pads similar to those described in the
-treatment of fractures, and soft bandages applied in sufficient quantity
-but not too tight. The foot should appear to incline a little outwards.
-
-A sole of leather not very hard, or of lead, is to be bound on as you
-are about to finish the bandaging, not in contact with the skin. The
-bandaging is to be carried up to the top of the calf, and the bandages
-are to be finished by stitching. A small shoe of lead is to be bound on
-externally to the bandaging, having the same shape as the Chian slippers
-had. This, however, should not be necessary. Thus this method requires
-neither cutting (tenotomy) nor burning nor any other complex means, for
-such cases yield sooner to treatment than one would believe. However they
-are to be fairly mastered only by time and not until the body has grown
-up in the natural shape, and then recourse is to be had to a shoe.
-
-The most suitable are the buskins, which derive their name from traveling
-through mud, for this sort of shoe does not yield to the foot but the
-foot yields to it. A shoe shaped like the Cretan is also suitable.
-
-(As Galen, the great admirer and annotator of Hippocrates, confesses that
-he is unable to give an exact account of either the Chian slippers, the
-buskins, or the Cretan shoes, we may leave it to individual imagination
-to conjecture their appearance.)
-
-*** END OF THE PROJECT GUTENBERG EBOOK THE APPARATUS USED BY THE
-GREEKS AND ROMANS IN THE SETTING OF FRACTURES AND THE REDUCTION OF
-DISLOCATIONS ***
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-<p style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of The apparatus used by the Greeks and Romans in the setting of fractures and the reduction of dislocations, by John S. Milne</p>
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-<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: The apparatus used by the Greeks and Romans in the setting of fractures and the reduction of dislocations</p>
-<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: John S. Milne</p>
-<p style='display:block; text-indent:0; margin:1em 0'>Release Date: October 24, 2022 [eBook #69222]</p>
-<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p>
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-<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK THE APPARATUS USED BY THE GREEKS AND ROMANS IN THE SETTING OF FRACTURES AND THE REDUCTION OF DISLOCATIONS ***</div>
-
-<div class="transnote">
-
-<p>Transcriber’s Note: The figures appear to have been mis-numbered: there
-is no Fig. 23, nor any reference to one in the text. Figures can be
-clicked for larger versions.</p>
-
-</div>
-
-<p><span class="pagenum"><a id="Page_1"></a>[1]</span></p>
-
-<div class="box">
-
-<p class="center larger">THE APPARATUS USED BY THE
-GREEKS AND ROMANS IN THE
-SETTING OF FRACTURES AND
-THE REDUCTION OF DISLOCATIONS.</p>
-
-<p class="titlepage"><span class="smaller">BY</span><br />
-<br />
-JOHN S. MILNE,<br />
-General Practitioner in Hartlepool (a smoky town
-on the Northeast Coast of England).</p>
-
-<p class="titlepage"><span class="smaller">REPRINT FROM THE</span><br />
-INTERSTATE MEDICAL JOURNAL,<br />
-Vol. XVI., Nos. 2 and 3.</p>
-
-<p class="titlepage smaller">ST. LOUIS:<br />
-<span class="smcap">Interstate Medical Journal Co.</span><br />
-1909.</p>
-
-</div>
-
-<p><span class="pagenum"><a id="Page_3"></a>[3]</span></p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-
-<p><span class="pagenum"><a id="Page_2"></a>[2]</span></p>
-
-<h1>THE APPARATUS USED BY THE GREEKS AND ROMANS
-IN THE SETTING OF FRACTURES AND THE
-REDUCTION OF DISLOCATIONS.</h1>
-
-<p class="center">By <span class="smcap">John S. Milne</span>, General
-Practitioner in Hartlepool (a smoky town on the Northeast Coast of
-England).</p>
-
-</div>
-
-<p>Let me point out that the scope of the paper does not cover the whole
-ground of the wide knowledge possessed by the ancients on the subject
-of fractures and dislocations. It is merely an enumeration of the apparatus
-used in the treatment of these, with short extracts indicating
-the method of employing them. The authorities on the subject are
-Hippocrates, in his works on Fractures and Articulations, 460 B. C.;
-Galen in his commentaries on these (130-200 A. D.); Celsus (about 20
-A. D.); a chapter by Heliodorus preserved in the works of Oribasius
-(325 A. D.), and the little encyclopedia of Paulus Ægineta (6th Century
-A. D.) I have also taken a few illustrations from the Armamentarium
-of Scultetus.</p>
-
-<p>In the treatment of fractures the ancients employed, as we do to-day,
-splints, pads and bandages.</p>
-
-<p>Hippocrates in his book on <i>Fractures</i> gives a very complete account
-of the method of applying these.</p>
-
-<p>First of all, the limb was smeared with a waxy composition, called
-cerate, in order to prevent the bandages from slipping. The
-bones having been got into position by means of extension and other
-manipulations, a roller bandage soaked in cerate (<a href="#figure1">Fig. 1</a>) was fixed by
-one or two turns round the seat of the fracture, and then carried upward
-for several turns. (<a href="#figure2">Fig. 2.</a>)</p>
-
-<p>Next, a second waxed bandage was applied, beginning as before at
-the fracture, passing downwards for several turns (<a href="#figure3">Fig. 3</a>), and then
-upwards to end at the same spot as the first bandage.</p>
-
-<p>Next, elongated pads, formed of folded linen and stiffened with cerate,
-(<a href="#figure4">Fig. 4</a>) were laid along the limb in such a way as to cover it completely,
-and fixed by the application of roller bandages which had as before
-been dipped in cerate.</p>
-
-<p>No splints were applied at this time, so that so far, the treatment corresponds
-in principle to the immovable bandages of gum and chalk or
-plaster of Paris which we employ to-day. On the third day, the swelling
-of the part having subsided and the bandaging having become somewhat
-loose, the whole was removed and the limb bathed with hot water, and
-the bandages and pads were applied as before.</p>
-
-<p><span class="pagenum"><a id="Page_4"></a>[4]</span></p>
-
-<div class="figcenter illowp100" id="figure1" style="max-width: 31.25em;">
-  <a href="images/illus01.jpg"><img class="w100" src="images/fig01.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 1.</span> Waxing a bandage. After
-Scultetus. Double spatulæ of the form
-shown are found among ancient Roman
-instruments from Pompeii.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure2" style="max-width: 37.5em;">
-  <a href="images/illus01.jpg"><img class="w100" src="images/fig02.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 2.</span> Waxed bandage fixed over site of fracture
-and carried upwards for several turns. After Scultetus.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure3" style="max-width: 37.5em;">
-  <a href="images/illus01.jpg"><img class="w100" src="images/fig03.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 3.</span> Second waxed bandage fixed over the site of fracture
-and carried downwards for several turns, preparing to return upwards
-and end at the top of the first bandage. After Scultetus.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_5"></a>[5]</span></p>
-
-<p>Three days afterwards, <i>i. e.</i>, on the seventh day from the accident,
-the swelling was expected to be quite gone, and the bandages again
-loosened, and now these having been removed and the limb having been
-bathed, the pads and bandages were put on as before, but this time splints
-were applied in addition. (<a href="#figure5">Fig. 5.</a>) These were narrow and rod-like,
-and were arranged all round the limb, the breadth of a finger intervening
-between each, and were kept in place by three or four strings tied
-just tight enough to keep the splints in position without their action contributing
-at all to the compression of the part. The splints were examined
-every third day till bony union had taken place, and the whole
-dressing was reapplied whenever it became loose.</p>
-
-<p>In addition to the fixation by the above methods the part was further
-put at rest by a sling, in the case of the upper limb, and in that of
-the lower, by elevating it in bed on a pillow or a box splint.</p>
-
-<p>Compound fractures were not treated with splints until the wound
-had healed, but were lightly put up in pads and bandages and laid in a
-box splint and dressed frequently. If there was much discharge, a goat’s
-skin was placed beneath, to catch the discharge and embrocations.</p>
-
-<p>We shall now consider a little more fully each of the materials mentioned
-above.</p>
-
-<p><i>Roller Bandages.</i> Hippocrates says that the bandages should be clean,
-light, soft, thin, and without seams, yet strong enough to bear stretching.
-Their breadth should be proportionate to the part under treatment. They
-should be three, four, or five finger breadths broad, and as many cubits
-in length.</p>
-
-<p>Rolling should be practiced with both hands together, and with either
-separately, and it should be done quickly, elegantly and without causing
-discomfort to the patient.</p>
-
-<p>Sometimes the turns were to be made to the right, and sometimes
-to the left, and sometimes a double headed bandage was to be used and
-applied crosswise. After the bandage was on, it was to be finished off
-by stitching with a needle and thread, lest a knot should cause discomfort.</p>
-
-<p>All the methods of applying the roller bandage which we now employ,
-together with many other complicated methods, are described by the
-ancients, and will be found described and figured in the works of
-Oribasius in the edition of Stephanus (<i>Medicae Artis Principes</i>) and
-also in Scultetus.</p>
-
-<p><i>Pads (or “Compresses”).</i> These were made of linen folded three or
-four times. They were three or four fingers in breadth, and their
-length was proportionate to the part.</p>
-
-<p>They were applied longitudinally in such number as to encircle the
-limb.</p>
-
-<p>In applying splints extra pads were put on parts where the bone projected,
-as at the ankle.</p>
-
-<p><i>Splints.</i> Hippocrates says these should be smooth, even, rounded at
-the ends, and concave. They should be secured with strings. Those
-at parts where bone was prominent should be short so as not to press
-on the part.</p>
-
-<p><span class="pagenum"><a id="Page_6"></a>[6]</span></p>
-
-<div class="figcenter illowp90" id="figure4" style="max-width: 37.5em;">
-  <a href="images/illus02.jpg"><img class="w100" src="images/fig04.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 4.</span> Applying the waxed compresses over the bandages.
-After Scultetus, but Hippocrates says the compresses
-ought to completely surround the limb and not be separated
-from each other by a space as this figure shows. It makes
-the pads look like splints.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure5" style="max-width: 37.5em;">
-  <a href="images/illus02.jpg"><img class="w100" src="images/fig05.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 5.</span> Applying the splints on the seventh day. After
-Scultetus. First the two bandages have been put on, then
-the waxed pads, the bandaging to fix which can be seen under
-the splints.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure6" style="max-width: 31.25em;">
-  <a href="images/illus02.jpg"><img class="w100" src="images/fig06.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 6.</span> Splint for leg-fracture described by
-Hippocrates. Made of elastic rods fitting into loops
-on shackle-like pads above the ankle and below the
-knee. After Littré.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_7"></a>[7]</span></p>
-
-<p>Palladius says that they should be made of the wood of the lime
-tree, or, where this could not be procured, reeds were to be used. They
-were to be round, and secured with three loose fillets or ribands, one at
-their upper, and one at their lower end, and one at the middle.</p>
-
-<p>Paulus Ægineta says that they should be arranged not more than one
-finger’s breadth from each other.</p>
-
-<p><i>Special Splints.</i> A special form of splints for fractures where the
-deformity could not be kept reduced by ordinary methods is described
-by Hippocrates.</p>
-
-<p>“One should sew two round pads of Egyptian leather, such as are
-worn by persons confined for long in shackles, and the pads should be
-deeper on their aspect facing the wound, and shallower on that facing
-the joint, and they should be well stuffed and soft and easy fitting, the
-one to the part above the ankle, and the other to the part below the
-knee.</p>
-
-<p>“Each pad should have two loops on its inner aspect and two on its
-outer. (<a href="#figure6">Fig. 6.</a>)</p>
-
-<p>“Then taking four equal rods of the wood of the cornel tree, each of
-the thickness of a finger, and of such a length that they can be fitted
-into the loops by bending, adjust them, two on the inside of the leg and
-two on the outside.</p>
-
-<p>“They should be of such a length that suitable extension may be
-kept up.</p>
-
-<p>“The two which are uppermost (as the patient lies on his back) may
-be tied together. (<a href="#figure7">Fig. 7.</a>)</p>
-
-<p>“If the apparatus does not fit properly it will do more harm than
-good, as indeed any other contrivance will.”</p>
-
-<p>Galen, commenting on this passage, says that the pads which Hippocrates
-describes as round are really like snakes or like the sausages which
-butchers make, by filling intestines with chopped meat or other such food.</p>
-
-<p><i>Minor Splints.</i> In fracture of the lower jaw Hippocrates bound the
-teeth together with gold wire, and applied a light splint of moulded
-leather on the outside of the jaw.</p>
-
-<p>In fracture of the nose, Paulus Ægineta says that tents of cloth were
-applied to each nostril. Some sewed into these the quills of goose
-feathers, so that the patient could breathe through these.</p>
-
-<p><i>Box Splints.</i> Hippocrates says that he is rather at a loss whether to
-recommend box splints or not. They are of some use, but not of so
-much as many suppose, and a board, unless padded, is rather an uncomfortable
-thing for a limb to lie on. (<a href="#figure8">Fig. 8.</a>) However, the common
-people have more confidence in the treatment where they are used;
-and they are useful in such times as the bed requires rearranging or the
-patient has the bowels moved.</p>
-
-<p>If used at all they should be of sufficient length. Those for fracture
-of the thigh should reach from the hip to the heel, for, if flexion of the
-knee be allowed, distortion of the part is caused.</p>
-
-<p><span class="pagenum"><a id="Page_8"></a>[8]</span></p>
-
-<div class="figcenter illowp100" id="figure7" style="max-width: 31.25em;">
-  <a href="images/illus03.jpg"><img class="w100" src="images/fig07.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 7.</span> Top view of the same to show the tying together
-of the two top rods.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure8" style="max-width: 18.75em;">
-  <a href="images/illus03.jpg"><img class="w100" src="images/fig08.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 8.</span> Box splint or “canal”
-after Scultetus.</p>
-</div>
-
-<div class="figcenter illowp30" id="figure9" style="max-width: 12.5em;">
-  <a href="images/illus03.jpg"><img class="w100" src="images/fig09.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 9.</span> The Glossocomium
-of Galen, applied for fracture
-of the thigh. After Vidius.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure10" style="max-width: 25em;">
-  <a href="images/illus03.jpg"><img class="w100" src="images/fig10.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 10.</span> Scamnum of Hippocrates after Littré.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure11" style="max-width: 25em;">
-  <a href="images/illus03.jpg"><img class="w100" src="images/fig11.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 11.</span> Scamnum of Hippocrates
-after Vidius. It differs from the description
-of Hippocrates in having slots instead
-of grooves, but it is the oldest figure of
-the instrument.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_9"></a>[9]</span></p>
-
-<p>Nothing, however, is more convenient than a cushion or something
-similar, either of wool or linen and not hard. It is to be made hollowed
-along its middle, and laid below the limb. In any case a shawl should
-encircle both splint and limb, as children are swathed in bed.</p>
-
-<p>Paulus Ægineta describes the box splints as of wood or earthenware.
-Some applied them only in cases of compound fracture. A better means
-of steadying the limb, he thinks, is to make a long pillow of a garment,
-and to fold it up at the sides, round the limb, and to steady the whole
-with pillows. The garment should be lined with a skin, to catch the
-embrocations.</p>
-
-<p>Galen says that they should be rounded externally and hollowed inside.
-They were made of different kinds of wood.</p>
-
-<p>Celsus says that they should have in their lower part a hole for the
-escape of discharge, and they should have a foot plate.</p>
-
-<p><i>Glossocomium of Galen.</i> This ingenious and useful splint, says
-Galen, had been invented by the practitioners of his time.</p>
-
-<p>It took its name, he says, from the Attic name for a box used for
-storing papers of value or which one wished to conceal or to carry on
-a journey, and was variously spelled glossocomum or glossocomium or
-with two t’s instead of two s’s. (<a href="#figure9">Fig. 9.</a>)</p>
-
-<p>It might be applied to the femur or the tibia, and was to be used
-continually till callus had formed.</p>
-
-<p>Galen gives a full description of it, but its principle is best understood
-from a drawing such as that given by Vidius or Scultetus.</p>
-
-<p>On rotating the handle the upper and lower fragments are simultaneously
-pulled apart.</p>
-
-<p><i>Dislocations.</i> The different varieties of dislocations of the joints were
-known to Hippocrates nearly as completely as we know them to-day,
-and the various manipulations necessary for their reduction are fully
-described.</p>
-
-<p>Cases which resisted reduction by means of ordinary measures, such
-as extension over the back of a chair or the lower half of a door in the
-case of the shoulder, were treated by more powerful apparatus, improvised
-or kept for the purpose.</p>
-
-<p>Bands for extension and counterextension were applied. These consisted
-preferably of supple leather, but in the absence of these Hippocrates
-says that iron chains, cords, or the ropes for ships may be used,
-being wrapped round with woolen cloth at the parts where they are
-to come in contact with the skin.</p>
-
-<p>In reducing dislocations of the fingers, Hippocrates says that nooses
-formed from the twisted bast of palm shoots are suitable. Aristotle
-refers to these in his book on the <i>Parts of Animals</i>.</p>
-
-<p>The power to be applied was obtained by means of winches or drums
-on axles, levers, wedges, screws and pulleys.</p>
-
-<p><span class="pagenum"><a id="Page_10"></a>[10]</span></p>
-
-<div class="figcenter illowp41" id="figure12" style="max-width: 17.1875em;">
-  <a href="images/illus04.jpg"><img class="w100" src="images/fig12.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 12.</span> The scamnum in use for
-Dislocation at the astragalus.</p>
-</div>
-
-<div class="figcenter illowp56" id="figure13" style="max-width: 23.4375em;">
-  <a href="images/illus04.jpg"><img class="w100" src="images/fig13.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 13.</span> Reduction of a Gibbosity of the
-spine by the scamnum.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_11"></a>[11]</span></p>
-
-<p>Hippocrates only mentions three of these: “Of all the mechanical
-instruments used by men the most powerful are these three, the winch,
-the lever and the wedge.” He does not mention the screw, though it is
-most likely that the Greeks of his time knew of it, but we shall see that
-later the Greeks applied it, as in the machine of Nymphodorus, to
-generate power for reducing dislocations.</p>
-
-<p>Hippocrates does not in this passage refer to the use of the pulley,
-though in another place he mentions it in connection with the treatment
-of fracture of the spine, and we shall see several instances of its
-use for converting the direction of motion in machines for the reduction
-of dislocations.</p>
-
-<p>In one of these, the machine of Fabrus, a system of pulleys is arranged
-to give a considerable increase of power, so that it is not unlikely
-that block and tackle arranged to multiply power would be used as well,
-although we have no direct description of such.</p>
-
-<p>We may note that Scultetus (Tab. xxi) illustrates a block and tackle
-which he says that he has taken from Vitruvius, Lib. 10, ch. x, and
-which he says was in use in his day for the reduction of dislocations.</p>
-
-<p>As many of the surgeons were “<i>periodeutae</i>,” traveling about from
-place to place, it was not possible for them to carry about the heavy
-contrivances that the practitioner settled in a large town could have at
-his command, but Hippocrates shows how to improvise imitations of
-these, and small winches which could be attached to such household implements
-as ladders were carried as part of the portable outfit.</p>
-
-<p><i>The Scamnum, or Bench, of Hippocrates.</i> This contrivance, of
-which the first account (<a href="#figure10">Fig. 10</a>) is given by the father of medicine, was
-used by all succeeding ancient surgeons, and Scultetus shows many
-figures of it in actual use in his time. Galen had a very high opinion
-of it. He says that all varieties of dislocation could be reduced by it.</p>
-
-<p>Hippocrates says that “the best thing for any physician who practices
-in a populous city is to have prepared a proper wooden machine
-with all the mechanical powers applicable in cases of fractures and dislocations,
-both for making extension and for levering.</p>
-
-<p>“For this purpose, it will be sufficient to possess a board resembling
-in length, breadth, and thickness, the quadrangular threshing boards
-made of oak.</p>
-
-<p>“It should be six cubits, or a little more, in length, and about two
-cubits in breadth. A foot will be sufficient thickness for it.</p>
-
-<p>“Along it from one end to the other an excavation (in the ground)
-must be made so that the working of the levers may not be higher than
-necessary.</p>
-
-<p>“Then at both sides we are to raise short, strong, and firmly fixed
-posts carrying axles; and in the middle of the bench five or six long
-grooves are to be scooped out, about four inches distant from each
-other, three inches will be sufficient breadth and also depth for them, and
-although the number of grooves I have mentioned will be sufficient there
-is nothing to prevent their being made all over the bench.</p>
-
-<p><span class="pagenum"><a id="Page_12"></a>[12]</span></p>
-
-<div class="figcenter illowp37" id="figure14" style="max-width: 15.625em;">
-  <a href="images/illus05.jpg"><img class="w100" src="images/fig14.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 14.</span> The scamnum in dislocation
-of the elbow, after Vidius.</p>
-</div>
-
-<div class="figcenter illowp52" id="figure15" style="max-width: 21.875em;">
-  <a href="images/illus05.jpg"><img class="w100" src="images/fig15.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 15.</span> Reduction of dislocation of the Humerus
-by the scamnum. After Vidius.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_13"></a>[13]</span></p>
-
-<p>“And the bench should have in its centre a fairly deep hole of a
-square shape, and of about three inches in size, and into this hole,
-when judged necessary, is to be adjusted a corresponding piece of wood,
-rounded in its upper part, which at the proper time is to be adjusted
-between the perineum and the head of the thigh bone. This upright
-prevents the body from yielding to the force dragging downwards by
-the feet. For sometimes this piece of wood serves the same purpose
-as counterextension (i. e., by thongs) in an upward direction, and
-sometimes, too, when both extension and counterextension are made, this
-piece of wood, if susceptible of some motion to this side or that, will
-serve the purpose of a lever for pushing the head of the thigh bone outwards.”</p>
-
-<p>It is on this account that several grooves are scooped out in the
-bench.</p>
-
-<p>The lever may be round or flat to suit different cases. Another mode
-of using the scamnum was to raise two posts at the middle of the sides,
-and to insert into them a transverse bar like the step of a ladder, to act
-as a horizontal perineal bar.</p>
-
-<p><a href="#figure10">Figure 10</a> shows the machine constructed from this description by
-Littré.</p>
-
-<p>A figure of the machine, by Vidius, is somewhat different,
-(<a href="#figure11">Fig. 11</a>) square holes taking the place of the longitudinal grooves described
-by Hippocrates.</p>
-
-<p>I shall now proceed to give a few descriptions of actual applications
-of the machine to reduction of different dislocations, which, it is hoped,
-will be readily understood by the aid of the accompanying figures, which
-are mainly taken from drawings by Vidius in illustration of a chapter
-by Heliodorus. One cannot help thinking that this machine must
-originally have given the idea for the instrument of torture known as
-the rack. This was well known in the time of Cicero.</p>
-
-<p>Celsus says that the scamnum was quite powerful enough to produce
-rupture of the muscles.</p>
-
-<p><a href="#figure12">Fig. 12</a> shows the machine in use for dislocation forwards of the
-astragalus. Extension and counterextension are being made by thongs
-fastened below the knee and above the ankle.</p>
-
-<p><a href="#figure13">Fig. 13</a> shows an attempt at reduction of the spine. Extension is being
-made below the seat of the lesion by a thong passed round the abdomen
-above the crest of the pelvis, while counterextension is maintained by a
-thong passed under the armpits.</p>
-
-<p>The operator’s assistant is levering down the gibbosity with a flat board
-used as a lever.</p>
-
-<p><a href="#figure14">Fig. 14</a> shows the reduction of a dislocated elbow. The forearm is
-pulled down by a thong passed over its middle, while counterextension
-is maintained by thongs attached to the humerus and the forearm near
-the wrist.</p>
-
-<p><span class="pagenum"><a id="Page_14"></a>[14]</span></p>
-
-<div class="figcenter illowp41" id="figure16" style="max-width: 17.1875em;">
-  <a href="images/illus06.jpg"><img class="w100" src="images/fig16.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 16.</span> The Scamnum in dislocation
-of the jaw. After Vidius.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure17" style="max-width: 37.5em;">
-  <a href="images/illus06.jpg"><img class="w100" src="images/fig17.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 17.</span> Counterextension by an axillary loop on the injured
-side and a perineal band on the other. Extension by a clove hitch
-above the knee. The surgeon’s hands are seen levering the head of
-the bone inwards while the assistant props the left side of the body.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_15"></a>[15]</span></p>
-
-<p><a href="#figure15">Fig. 15</a> shows reduction of the humerus. While the extension and
-counterextension are made, the assistant pulls outwards the head of
-the humerus by a thong passed under the arm in the axilla.</p>
-
-<p><a href="#figure16">Fig. 16</a> shows reduction of a dislocated jaw. Heliodorus is the only
-author who describes the use of a machine for this purpose, and it seems
-rather a superfluous display of force but it may occasionally have been
-necessary, as from what Hippocrates says it would seem that owing to
-the dearth of practitioners in some parts it was not uncommon to meet
-with cases which had remained unreduced for some time.</p>
-
-<p>Of dislocation outwards at the hip (<a href="#figure17">Fig. 17</a>) Paulus Ægineta says:</p>
-
-<p>“If the dislocation is outwards, the extension is to be made as above,
-but the thong at the perineum is to be passed by the opposite parts, the
-groin at the one side, the clavicle at the other. The surgeon is to propel
-the limb from without inwards, the lever being fixed in one of the furrows
-formerly prepared, and an assistant fixing the sound nates, that
-the body may not yield.”</p>
-
-<p>Hippocrates says that instead of the perineal extension band the upright
-perineal prop may be used.</p>
-
-<p>Of dislocation inwards, Paulus Ægineta says that if it be not reduced
-after trying with the patient on his back and using the upright
-perineal prop:</p>
-
-<p>“The erect piece of wood (<a href="#figure18">Fig. 18</a>) is to be removed, and two other
-pieces, i. e. the perineal prop of wood fixed on either side, like posts,
-not more than a foot in length, and let another piece of wood be
-adapted to them like the step of a ladder, so that the figure of the
-three pieces of wood may resemble the Greek letter H, the middle piece
-of wood being fixed a little below the tops.</p>
-
-<p>“Then, the man being laid on the sound side, we bring the sound leg
-between the posts, underneath the piece of wood corresponding to the
-step of a ladder, while the injured one is brought above it, so that the
-head of the thigh is upon it; but a folded garment is to be first wrapped
-about it to prevent the thigh from being bruised. Then another board
-of moderate breadth and of such a length as to extend from the head of
-the thigh to the ankle, is to be bound along the inner side of the thigh
-to the ankle.</p>
-
-<p>“Then extension being made, either by the pestles mentioned in treating
-of the dislocation of the vertebra or some such instrument, the leg
-is to be pulled downwards along the board which is fastened to it, so
-that by the force exerted on it the head of the thigh-bone may return
-to its proper place.”</p>
-
-<p><span class="pagenum"><a id="Page_16"></a>[16]</span></p>
-
-<div class="figcenter illowp48" id="figure18" style="max-width: 20.3125em;">
-  <a href="images/illus07.jpg"><img class="w100" src="images/fig18.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 18.</span> The scamnum in dislocation inwards
-of the thigh. Counterextension maintained
-by the horizontal bar.</p>
-</div>
-
-<div class="figcenter illowp37" id="figure19" style="max-width: 9.375em;">
-  <a href="images/illus07.jpg"><img class="w100" src="images/fig19.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 19.</span> Shows the ambè,
-fitted into a specially prepared
-upright supported on
-an ornamented base. After
-Scultetus.</p>
-</div>
-
-<div class="figcenter illowp90" id="figure19a" style="max-width: 37.5em;">
-  <a href="images/illus07.jpg"><img class="w100" src="images/fig19a.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 19A.</span> Anterior and posterior views of the machine
-of Fabrus. (After Vidius.) Between them is an ambè
-which has at its axillary end a bolt to fit into the top cross-bar
-of the machine.</p>
-  <p class="caption">The power varies only with the ratio of the diameter of
-the axle to length of crank. The pulleys do not multiply
-power.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_17"></a>[17]</span></p>
-
-<p><i>The Ambè.</i> We have seen that in using the scamnum (<a href="#figure19">Fig. 19</a>) for
-the reduction of dislocation inwards of the thigh, Paulus Ægineta,
-(also Hippocrates, from whom Paul is copying), recommends us to fix
-a piece of board along the inside of the thigh and leg, to assist in levering
-the head of the bone into position. A board applied in this way was
-also used in reducing the dislocations of the shoulder, either by levering
-the board over the back of a chair or the lower half of a door, or
-by using it in conjunction with some specially constructed machine, such
-as that of Fabrus, with which we shall meet presently.</p>
-
-<p>A board especially prepared for this purpose had a rounded enlargement
-on its extremity, to assist in pushing the head of the humerus outwards.</p>
-
-<p>The name of this enlargement (ἄμβη) gradually became transferred to
-the whole instrument. The “ambè” was well known in England till well
-into the last century.</p>
-
-<p>The time of its disappearance in England may be fixed by a passage
-in Adams’ edition of Hippocrates (vol. ii, p. 575) where he says: “Of
-late years the ambè has fallen completely into disuse, and none of the
-various modifications of it are to be seen except in the cabinets of the
-curious.” (This was in 1849.)</p>
-
-<p>Scultetus shows us an ambè mounted in a specially prepared upright
-for use in the surgery (<a href="#figure19">Fig. 19</a>).</p>
-
-<p>The ambè is thus described by Hippocrates:</p>
-
-<p>“We must get a piece of wood five, or at least four, inches broad, two
-inches in thickness, or thinner, and two cubits in length, or a little less,
-and its extremity should be rounded, and made very narrow and very
-slender there, and it should have a slightly projecting edge (ἄμβη) on
-its round extremity—not on the part that is to meet the chest, but the
-head of the humerus.</p>
-
-<p>“A piece of soft shawl should be glued to the end of the piece of wood
-so as to give the least pain on pressure.</p>
-
-<p>“Having pushed the end of this piece of wood as far in as possible,
-between the ribs and the head of the humerus, the whole arm is to be
-stretched along this piece of wood, and is to be bound round at the arm,
-the forearm, and the wrist, so that it may be particularly well secured,
-but great pains should be taken that this piece of wood should be introduced
-as far into the armpit as possible, and that it is carried past the
-head of the humerus.</p>
-
-<p>“Then a crossbeam is to be securely fixed between two pillars, and
-afterwards the arm, with the piece of wood attached to it, is to be
-brought over this crossbeam so that the arm may be on one side of it
-and the body on the other and then the arm with the piece of wood is
-to be forced down. The crossbeam is to be fixed so high that the rest
-of the body is raised on tiptoe.</p>
-
-<p>“This is by far the most powerful method of effecting the reduction
-of the shoulder for thus one operates with the lever on the most approved
-principles.”</p>
-
-<p>Celsus (Bk. VII, ch. xv) describes the ambè thus:</p>
-
-<p>“A wooden spattle is necessary if the body is rather big and the
-tendons are rather strong, and it should be of the thickness of two
-fingers and in length reach from the axilla to the fingers. And at the
-top of it there is a head rounded and gently hollowed out, so as to receive
-a part of the head of the humerus. In it there are two holes at
-three places separated from each other by an interval, and in these soft
-thongs are inserted.</p>
-
-<p><span class="pagenum"><a id="Page_18"></a>[18]</span></p>
-
-<div class="figcenter illowp48" id="figure20" style="max-width: 20.3125em;">
-  <a href="images/illus08.jpg"><img class="w100" src="images/fig20.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 20.</span> Patient with arm arranged in
-the machine of Fabrus for reduction of dislocation
-of shoulder. The thongs from a
-clove hitch applied above the elbow are taken
-over two pulleys above and two pulleys below
-so that the clove hitch cannot move up nor
-down, and the elbow is thus maintained at the
-same level. (N. B. These thongs are not
-connected to the axle in any way.) Patient
-strapped so that he cannot resist the treatment.</p>
-</div>
-
-<div class="figcenter illowp43" id="figure20a" style="max-width: 10.9375em;">
-  <a href="images/illus08.jpg"><img class="w100" src="images/fig20a.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 20A.</span> Setting a fractured
-humerus in the manner
-described by Hippocrates.
-After Vidius.</p>
-</div>
-
-<div class="figcenter illowp52" id="figure21-22" style="max-width: 21.875em;">
-  <a href="images/illus08.jpg"><img class="w100" src="images/fig21-22.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Figs. 21 and 22.</span> Portable winch, known as the
-plinthium of Nileus, for affixing to a ladder.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_19"></a>[19]</span></p>
-
-<p>“This spattle, wound round with a bandage in order that it may not
-injure by contact, is so applied to the arm at the axilla that its upper
-end is put under the top of the axilla; then by its thongs it is bound
-to the arm, at one place a little below the head of the humerus, at another
-a little above the elbow, at a third above the hand—indeed the
-spaces and holes have been arranged for this purpose.</p>
-
-<p>“The arm, tied in this manner, is passed over the step of a poultry
-ladder at such a height that the man cannot stand and while the body
-is let down on one side, the arm is made tense on the other, and thus it
-is brought about that the head of the humerus—impelled into position
-by the end of the board—is reduced, sometimes audibly, sometimes not so.</p>
-
-<p>“Many other methods can be learnt by reading Hippocrates alone but
-not one has stood the test of experience better.”</p>
-
-<p><i>The Machine of Fabrus.</i> Heliodorus describes the construction of
-this machine, and its application for the reduction of dislocations of the
-humerus. Probably it is a machine used by artisans for some such purpose
-as the elevation of large blocks of stone, as it seems unlikely that
-such a large and cumbrous machine should have been especially invented
-for the single purpose of reducing the dislocation of one joint.
-Two views of the machine are given, (<a href="#figure19a">Fig. 19A</a>).</p>
-
-<p>It consists, as will be seen, of two upright posts supported on a heavy
-base, while inside the posts a frame carrying two upright bars is raised
-and depressed by the rotation of an axle acting on a system of pulleys.
-Through the heads of the upright bars there passes another axle carrying
-a padded projection which is placed in the armpit.</p>
-
-<p>The arm is strapped to an ambè in the manner described already and
-is passed over the axle, the patient standing on tiptoe outside the machine.
-(<a href="#figure20">Fig. 20.</a>)</p>
-
-<p>The arm is maintained at one level by thongs affixed by a clove hitch
-above the elbow and passing over pulleys above and below. On rotating
-the lower axle the frame is pushed upwards, forcing the head of
-the bone into position, while at the same time an assistant forces the
-head of the bone outwards by a half turn of the upper axle, causing the
-padded projection to push outwards.</p>
-
-<p><i>Extemporized Apparatus and Substitutes.</i> Having now described the
-apparatus which was used by practitioners settled permanently in
-populous places, we may consider the substitutes for these which were
-used by surgeons on their travels, or under other circumstances where
-the major apparatus was unavailable.</p>
-
-<p>Hippocrates says we must always be ready to make use of whatever
-happens to be at hand.</p>
-
-<p>He says that dislocation inwards at the hip may be reduced in the
-following manner.</p>
-
-<p><span class="pagenum"><a id="Page_20"></a>[20]</span></p>
-
-<div class="figcenter illowp48" id="figure24" style="max-width: 20.3125em;">
-  <a href="images/illus09.jpg"><img class="w100" src="images/fig24.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 24.</span> Ladder arranged as a machine
-for the reduction of dislocations. A Plinthium
-of Nileus has been tied on the lower part
-of it and below this are two pulleys for the
-converting of the direction of extension. A
-similar pair of pulleys have been tied on the
-top step of the ladder.</p>
-</div>
-
-<div class="figcenter illowp48" id="figure25" style="max-width: 20.3125em;">
-  <a href="images/illus09.jpg"><img class="w100" src="images/fig25.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 25.</span> Reduction of shoulder by ladder
-with Plinthium of Nileus. Extension having
-been made, the operator is pulling out the
-head of the humerus by a thong. The assistant
-is bearing down on the patient’s neck.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_21"></a>[21]</span></p>
-
-<p>It is a good, proper and natural mode of procedure, and has something
-of display in it, if anyone take delight in such ostentatious
-methods.</p>
-
-<p>The patient is to be suspended from a crossbeam by the feet tied together
-by a strong, soft and broad cord.</p>
-
-<p>The feet are to be about four inches or less from each other and a
-broad and soft leather collar also connected with the crossbeam, is to
-be put on above the knees, and the affected leg should be so extended
-as to be two inches higher than the other.</p>
-
-<p>The head should be about two cubits from the ground and the arm
-should be stretched along the sides, and bound with something soft.</p>
-
-<p>All these preparations should be made while he is lying on his back
-so that he may be suspended for as short a time as possible.</p>
-
-<p>When the patient is suspended a person properly instructed and not
-weak, having introduced his arm between his thighs is to place
-his forearm between the perineum and the dislocated head of the femur,
-and then, having joined the other hand to the one thus passed through
-the thighs, he is to stand by the side of the suspended patient and suddenly
-suspend and swing himself in the air as perpendicularly as
-possible.</p>
-
-<p>In fracture of the humerus, if the bone be set while the elbow is
-extended, the muscles of the arm will assume a different position when
-the elbow is flexed.</p>
-
-<p>To set it in the flexed position, therefore, suspend a piece of wood
-like the handle of a spade from the roof by two chains one at each end.</p>
-
-<p>Place the patient’s arm over this, so that the bar lies in the axilla.</p>
-
-<p>Over the flexed forearm pass a shawl to which attach a great weight,
-so as to produce extension on the lower fragment of the humerus and
-thus reduce the deformity.</p>
-
-<p>Apply the waxed bandages and compresses in this position.</p>
-
-<p><i>The Pestle.</i> Of reduction of the shoulder by means of the pestle,—an
-article for the preparation of food to be found in every Greek home,—Hippocrates
-says:</p>
-
-<p>“Those who accomplish the reduction by forcibly bending it over a
-pestle operate in a manner which is nearly natural. The pestle should
-be wrapped in a soft shawl for thus it will be less slippery.</p>
-
-<p>“It should be forced between the ribs and the head of the humerus.
-And if the pestle be short the patient should be seated on something,
-so that his arm can with difficulty pass over the pestle.</p>
-
-<p>“But, for the most part, the pestle should be longer, so that the patient,
-when standing, may be almost suspended by it. And then the
-arm and forearm should be stretched along the pestle while some person
-secures the opposite side of the body by throwing the arms round the
-neck near the clavicle.”</p>
-
-<p>Hesiod (Works and Days, 1, 421) says that the length of the culinary
-pestle was three cubits.</p>
-
-<p><span class="pagenum"><a id="Page_22"></a>[22]</span></p>
-
-<div class="figcenter illowp41" id="figure26" style="max-width: 17.1875em;">
-  <a href="images/illus10.jpg"><img class="w100" src="images/fig26.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 26.</span> Reduction of the ulna.</p>
-</div>
-
-<div class="figcenter illowp45" id="figure27" style="max-width: 18.75em;">
-  <a href="images/illus10.jpg"><img class="w100" src="images/fig27.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 27.</span> Reduction of both bones at the elbow.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure28" style="max-width: 31.25em;">
-  <a href="images/illus10.jpg"><img class="w100" src="images/fig28.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 28.</span> Reduction of the shoulder with the ladder in the horizontal
-position. Operator pulling head of humerus outwards with a thong.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_23"></a>[23]</span></p>
-
-<p>From other passages in Hippocrates it would seem that any pestle-like
-rod may be indicated. The word Celsus uses means a staff.</p>
-
-<p>Hippocrates describes several methods of improvising a scamnum.</p>
-
-<p>Any strong couch may be used as the bench, and extension and counterextension
-may be produced by poles levered against boards fixed to the
-feet of the couch, thongs being attached to the middle of the poles.</p>
-
-<p>Or instead of boards attached to the feet of the couch a ladder may be
-placed below the couch and the poles levered against the steps of the
-ladder.</p>
-
-<p>If along with either of these methods it were desired to extemporize
-a lever to press down a hump back, this could be done by driving a post
-into the ground alongside the couch and making a hole in the post for
-the end of the lever to play in.</p>
-
-<p>Or the couch could be drawn alongside a wall and a hole made in the
-wall for the end of the lever.</p>
-
-<p>In fracture-dislocation of the foot the extension might be made as
-follows:</p>
-
-<p>Having fixed in the ground the nave of a wheel or some such object,
-something soft is to be bound round the foot.</p>
-
-<p>Next, some soft thongs are to be attached to the foot and the ends of
-the thongs are to be fixed to a pestle or similar pole. The end of the
-pole is to be fixed in the nave.</p>
-
-<p>On pulling back the pole, the foot is extended, while counterextension
-is made by pulling on the shoulders and the ham of the patient.</p>
-
-<p>Or, counterextension can be made by driving a pole into the ground
-to act as a perineal support.</p>
-
-<p><i>Ladder.</i> A ladder was an object which was always at hand and of
-service in the reduction of dislocations.</p>
-
-<p>In treating of the ambè we showed one use of the ladder, namely to
-reduce the shoulder by levering the arm over a step. For other dislocations
-portable fittings could be applied to generate power for extension
-and to convert the direction of motion.</p>
-
-<p>Thus, two pulleys might be affixed to the top steps and two to the
-lower, and a portable winch fitted to the lower part of the ladder.</p>
-
-<p>One simple form of winch for this purpose was called the <i>plinthium
-of Nileus</i>.</p>
-
-<p>It consisted merely of a small frame carrying an axle, with or without
-a ratchet. (<a href="#figure21-22">Figs. 21, 22.</a>)</p>
-
-<p><a href="#figure24">Fig. 24</a> shows a ladder fitted up with pulleys at its top and bottom and
-a plinthium of Nileus below.</p>
-
-<p><a href="#figure25">Fig. 25</a> shows the reduction of the humerus by a ladder so fitted.
-The ladder having been fixed in the ground, the arm has been passed
-over a step of the ladder and the plinthium of Nileus has tightened the
-thongs attached to the arm till the patient is almost suspended.</p>
-
-<p>The operator is pulling the head of the humerus outwards by means
-of a fillet, while an assistant is pressing down the shoulders of the
-patient.</p>
-
-<p><span class="pagenum"><a id="Page_24"></a>[24]</span></p>
-
-<div class="figcenter illowp100" id="figure29" style="max-width: 31.25em;">
-  <a href="images/illus11.jpg"><img class="w100" src="images/fig29.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 29.</span> Reduction of the wrist. The ladder is probably meant to
-be lying flat, but in the figure it is shown tilted up on its side in order to
-bring the parts into view.</p>
-</div>
-
-<div class="figcenter illowp100" id="figure30" style="max-width: 31.25em;">
-  <a href="images/illus11.jpg"><img class="w100" src="images/fig30.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 30.</span> Reduction of the dislocated astragalus with the ladder in the
-horizontal position.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_25"></a>[25]</span></p>
-
-<p><a href="#figure26">Fig. 26</a> shows the reduction of the ulna at the elbow, and <a href="#figure27">Fig. 27</a> the
-reduction of both bones dislocated together. <a href="#figure28">Fig. 28</a> shows the reduction
-of the shoulder. The ladder is placed horizontally in this case, the
-ends being supported on a pile of wood or stone blocks.</p>
-
-<p>The patient is bound on the ladder, and while extension is made on the
-arm, the head of the humerus is pulled outwards by a thong passed inside
-it.</p>
-
-<p><a href="#figure29">Fig. 29</a> shows the reduction of the wrist, extension and counterextension
-are made by thongs affixed below and above the wrist by clove-hitches;
-while <a href="#figure30">Fig. 30</a> shows the reduction of the ankle on similar principles.</p>
-
-<p>(In the case of the wrist the ladder is shown tilted up on its side, in
-order to bring the parts into view.)</p>
-
-<p>A portable winch of more powerful principle was the Glossocomum
-of Nymphodorus. It is shown in <a href="#figure31">Fig. 31</a>; first, as it appeared when
-closed and ready for use, and next, with one of the shutters removed to
-show its internal construction.</p>
-
-<p>It will be seen to consist of a crank, the rotation of which causes a
-worm on it to turn a cogged wheel.</p>
-
-<p>Round the axle of the cog wheel are ropes passing to another axle,
-the circumference of which is increased by drums so as to multiply the
-power, after the manner shown in the figure. One whole turn of axle
-moves cogged wheel forward one cog. Some of the inner details of
-the winch are shown below. Another portable winch was the Trispastum
-of Apelles or of Archimedes. Its construction is shown in <a href="#figure32">Fig. 32</a>,
-which shows the sides removed to display the working. In actual use,
-however, it was closed in like the last winch.</p>
-
-<p><i>Reduction by Means of Inflating a Bladder.</i> In describing the reduction
-of the dislocation of the spine Hippocrates says that he has tried
-to reduce the deformity by inflating a bladder affixed to a bronze tube
-and placed under the spine. The experiment, however, 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 bladder.</p>
-
-<p>Hippocrates says he has 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.</p>
-
-<p>Again he says that reduction by the bladder was celebrated in the
-case of the hip joint.</p>
-
-<p>It is not a powerful method. It should be placed between the thighs
-uninflated so that it may be carried as far up in the perineum as possible,
-and the thighs, beginning at the patella, are to be bound round with a
-swathe, as far up as the middle of the thigh, and then a bronze pipe is
-to be introduced into one of the loose feet of the bladder and air forced
-into it. The patient is to lie on his side with the injured limb uppermost.</p>
-
-<p>From this description it would seem that the bladder had consisted of
-some small skin such as that of a kid.</p>
-
-<p><span class="pagenum"><a id="Page_26"></a>[26]</span></p>
-
-<div class="figcenter illowp93" id="figure31" style="max-width: 31.25em;">
-  <a href="images/illus12.jpg"><img class="w100" src="images/fig31.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 31.</span> Glossocomum of Nymphodorus. Two views, one showing it closed
-and ready for use, the other with the lid removed, to show the principle. A
-crank drives a shaft with a worm thread on it. The threads of the worm engage
-in notches in a drum. Ropes pass from the axle on which the cogged wheel drum
-is carried, to drums carried on a second axle. Below are parts of the machine
-showing its structure and also the method of fixing the rope ends. After Vidius.
-Power, <span class="smcap">one turn of axle</span> only moves the cogged wheel one notch—great power
-therefore varying with length of crank. Power still further increased by lower
-axle being smaller than drums of upper.</p>
-</div>
-
-<div class="figcenter illowp45" id="figure32" style="max-width: 18.75em;">
-  <a href="images/illus12.jpg"><img class="w100" src="images/fig32.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 32.</span> Trispastum of Apelles or
-Archimedes with the sides removed to
-show the works. The power depends on
-ratio of diameter of axle to length of crank
-in this figure. But if the lower drums
-were made smaller than upper as in Fig.
-31, power would be further augmented
-accordingly.</p>
-</div>
-
-<div class="figcenter illowp56" id="figure33" style="max-width: 23.4375em;">
-  <a href="images/illus12.jpg"><img class="w100" src="images/fig33.jpg" alt="" /></a>
-  <p class="caption"><span class="smcap">Fig. 33.</span> Succussion on a ladder for dislocation
-of the spine. The patient is bound to the
-ladder by the lower part of the body, the upper
-hanging free. The ladder is raised by the pulleys
-and suddenly allowed to drop.</p>
-</div>
-
-<p><span class="pagenum"><a id="Page_27"></a>[27]</span></p>
-
-<p><i>Succussion, or Suspension on a Ladder.</i> This was done for dislocation
-of the spine, and usually to astonish the mob, Hippocrates says, although
-so far as he was aware, the method had never straightened anybody
-yet. To the mob, however, things of this sort are wonderful, and
-they never give a thought as to their utility.</p>
-
-<p>A ladder was padded with leather, and on this the patient was laid on
-his back. The ankles were tied to the ladder by soft strong bands.</p>
-
-<p>The arms were bound to the sides of the patient but not to the ladder.</p>
-
-<p>By means of a rope or ropes affixed to the lower end of the ladder
-(<a href="#figure33">Fig. 33</a>) it was raised along the gable of a high house or a high
-tower, or the mast of a ship fixed in the ground. The ropes should run
-over a pulley or a winch.</p>
-
-<p>For the sake of completeness we may conclude with a short account
-of the materials used for the treatment of congenital clubfoot by
-Hippocrates.</p>
-
-<p>Most cases are remediable. After pulling and pushing the parts into
-position they are to be retained with cerate, made with a full proportion
-of rezin, with compresses or pads similar to those described in the
-treatment of fractures, and soft bandages applied in sufficient quantity
-but not too tight. The foot should appear to incline a little outwards.</p>
-
-<p>A sole of leather not very hard, or of lead, is to be bound on as you
-are about to finish the bandaging, not in contact with the skin. The
-bandaging is to be carried up to the top of the calf, and the bandages
-are to be finished by stitching. A small shoe of lead is to be bound on
-externally to the bandaging, having the same shape as the Chian slippers
-had. This, however, should not be necessary. Thus this method requires
-neither cutting (tenotomy) nor burning nor any other complex
-means, for such cases yield sooner to treatment than one would
-believe. However they are to be fairly mastered only by time and not
-until the body has grown up in the natural shape, and then recourse is
-to be had to a shoe.</p>
-
-<p>The most suitable are the buskins, which derive their name from
-traveling through mud, for this sort of shoe does not yield to the foot
-but the foot yields to it. A shoe shaped like the Cretan is also suitable.</p>
-
-<p>(As Galen, the great admirer and annotator of Hippocrates, confesses
-that he is unable to give an exact account of either the Chian
-slippers, the buskins, or the Cretan shoes, we may leave it to individual
-imagination to conjecture their appearance.)</p>
-
-<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK THE APPARATUS USED BY THE GREEKS AND ROMANS IN THE SETTING OF FRACTURES AND THE REDUCTION OF DISLOCATIONS ***</div>
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