Hippocrates

“ But many other things in our art are judged of in this manner, for people rather admire what is new, although they do not know whether it be proper or not, than what they are accustomed to, and know already to be proper; and what is strange, they prefer to what is obvious. I must now state what the mistakes of medical men are, which I wish to unteach, and what instructions I have to give as to the management of the arm; for what I have to say regarding it, will apply to the other bones in the body. ”

“ When the thigh-bone is broken, particular pains should be taken with regard to the extension that it may not be insufficient, for when excessive, no great harm results from it. For, if one should bandage a limb while the extremities of the bone are separated to a distance from one another by the force of the extension, the bandaging will not keep them separate, and so the bones will come together again as soon as the persons stretching it let go their hold; for the fleshy parts (muscles?) being thick and strong, are more powerful than the bandaging, instead of being less so. ”

“ Of the bones of the leg, the inner one, called the tibia, is the more troublesome to manage, and requires the greater extension; and if the broken bones are not properly arranged, it is impossible to conceal the distortion, for the bone is exposed and wholly uncovered with flesh; and it is much longer before patients can walk on the leg when this bone is broken. But if the outer bone be broken, it causes much less trouble, and the deformity, when the bones are not properly set, is much more easily concealed, the bone being well covered with flesh ”

“ The attenuation of the body is to be made proportionate to the magnitude of the luxation, for one luxation is to be a small, and another to a great extent. But in general we must reduce more, and for a longer time, in injuries about the legs, than in those about the hands; for the former parts are larger and thicker than the latter, and it is necessary that the body should be kept in a state of rest, and in a recumbent position. There is nothing to prevent or require the limb to be bandaged anew on the third day. ”

“ If you are deceived with regard to a recent wound, supposing there will be no exfoliation of the bones, while they are on the eve of coming out of the sore, you must not hesitate to adopt this mode of treatment; for no great mischief will result, provided you have the necessary dexterity to apply the bandages well and without doing any harm. And this is a symptom of an exfoliation of bone being about to take place under this mode of treatment; pus runs copiously from the sore, and appears striving to make its escape. ”

“ But the best thing is, for any physician who practices in a large city, to have prepared a proper wooden machine, with all the mechanical powers applicable in cases of fractures and dislocation, either for making extension, or acting as a lever. ”

“ To the wound itself a cerate mixed with pitch is to be applied, a thin folded compress is to be bound upon it, and the parts around are to be anointed with white cerate. The cloths for bandages and the other things should be torn broader than in cases in which there is no wound, and the first turn of the bandage should be a good deal broader than the wound. For a narrower bandage than the wound binds the wound like a girdle, which is not proper, or the first turn should comprehend the whole wound, and the bandaging should extend beyond it on both sides. ”

“ For when the fractured bones of the arm or fore-arm are bandaged, the fore-arm is suspended in a sling, and if you bind them up while extended, the figures of the fleshy parts will be changed in bending the arm at the elbow, for the elbow cannot be kept long extended, since persons are not in the custom of keeping the joint long in this form, but in a bent position, and persons who have been wounded in the arm, and are still able to walk about, require to have the arm bent at the elbow-joint. ”

“ The prominence of a broken bone could not escape being detected by the hand of an experienced person, when applied for this purpose, and, moreover, the projecting part is particularly painful to the touch. ”

“ The man should be so seated that the prominent part of the bone may be turned to the brightest light which is at hand, so that the operator in making the extension, may be at no loss to discover if it be sufficiently straight. ”

“ The bandages are to be renewed every third day, and no splints are to be applied, but rest is to be more rigidly maintained than in the former cases, along with a restricted diet. It should be known, that if any piece of flesh or tendon be to come away, the mischief will spread much less, and the parts will much more speedily drop off, and the swelling in the surrounding parts will much more completely subside, under this treatment, than if any of the cleansing applications be put upon the sore. ”

“ For the most part, the bones separate most quickly in those cases in which suppuration takes place most quickly, and when new flesh is most quickly formed, and is particularly sound, for the flesh which grows up below in the wound generally elevates the pieces of bone. ”

“ For the arm, when shortened, might be concealed, and the mistake would not be great; but a shortened thigh-bone would exhibit the man maimed. For when the sound limb is placed beside it, being longer than the other, it exposes the mistake, and therefore it would be to the advantage of a person who would be improperly treated that both his legs should be broken, rather than either of them ”

“ The pieces of iron should be as strong as possible, so that they may not bend. This is a powerful assistance, provided the pieces of iron be suitable, and one use them properly as levers. Of all the mechanical instruments used by men, the most powerful are these three, the axis in peritrochio, the lever, and the wedge. Without these, one or all, men could not perform any of their works which require great force. Wherefore, reduction with the lever is not to be despised, for the bones will be reduced in this way, or not at all. ”

“ The following is the symptom of such a displacement: the arm cannot be bent in the least degree at the elbow, and upon feeling the joint the nature of the accident becomes obvious. If, then, it is not speedily reduced, strong and violent inflammation, attended with fever, will come on, but if one happen to be on the spot at the time it is easily reduced. ”

“ But another physician putting the arm into the state of supination, gives orders to extend the arm thus, and bandages it in this position, reckoning it the one according to nature, judging thus from the skin, and also fancying the bones to be thus in their natural position, because the bone which protrudes at the wrist, where the little finger is, appears to be in a line with the bone from which people measure the bone of the fore-arm. ”

“ But in the joint of the inferior extremity, the disposition of the longer bone is not alike, for the elbow and the ham are bent differently. For these reasons when the external bone is broken, the patients can soon walk about; but in fractures of the inner, it is a long time before they can walk. ”

“ But those who approve of binding up the limb with wool for a day or two, and on the third and fourth apply bandages, and make the greatest compression and extension at that period, such persons show themselves to be ignorant of the most important principles of medicine ”

“ It is also sometimes necessary to secure the upper extremity otherwise; this if you desire to effect, fasten deeply in the ground a round, smooth piece of wood, and place the upper extremity of the piece of wood at the perineum, so that it may prevent the body from yielding to the pulling at the foot, and, moreover, to prevent the leg while stretched, from inclining downward ”

“ There are certain physicians who, in all fractures of the leg, whether bandages be applied or not, fasten the sole of the foot to the couch, or to some other piece of wood which they have fixed in the ground near the couch. ”