Part 3

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.