Part 5

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.