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.

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.