Part 4

“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 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.

“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.