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.
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.
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.
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.
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.
“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.
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.”
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.
“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.
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.
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.
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.
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.)
