The Apparatus Used by the Greeks and Romans in the Setting of Fractures and the Reduction of Dislocations

Part 1

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.

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.

Part 2

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.

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