John Stewart Milne

“ 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. ”

“ 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. ”

“ The ropes should run over a pulley or a winch.
For the sake of completeness we may conclude with a short account of the materials used for the treatment of congenital clubfoot by Hippocrates.
Most cases are remediable. After pulling and pushing the parts into position they are to be retained with cerate, made with a full proportion of rezin, with compresses or pads similar to those described in the treatment of fractures, and soft bandages applied in sufficient quantity but not too tight. The foot should appear to incline a little outwards. ”

“ In applying splints extra pads were put on parts where the bone projected, as at the ankle.
Splints. Hippocrates says these should be smooth, even, rounded at the ends, and concave. They should be secured with strings. Those at parts where bone was prominent should be short so as not to press on the part.
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Fig. 4. Applying the waxed compresses over the bandages. After Scultetus, but Hippocrates says the compresses ought to completely surround the limb and not be separated from each other by a space as this figure shows. It makes the pads look like splints. ”

“ 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. ”

“ 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 ”

“ Succussion on a ladder for dislocation of the spine. The patient is bound to the ladder by the lower part of the body, the upper hanging free. The ladder is raised by the pulleys and suddenly allowed to drop. ”

“ 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. ”

“ 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. ”

“ Patient with arm arranged in the machine of Fabrus for reduction of dislocation of shoulder. The thongs from a clove hitch applied above the elbow are taken over two pulleys above and two pulleys below so that the clove hitch cannot move up nor down, and the elbow is thus maintained at the same level. (N. B. These thongs are not connected to the axle in any way.) Patient strapped so that he cannot resist the treatment.
Fig. 20A. Setting a fractured humerus in the manner described by Hippocrates. ”

“ A sole of leather not very hard, or of lead, is to be bound on as you are about to finish the bandaging, not in contact with the skin. The bandaging is to be carried up to the top of the calf, and the bandages are to be finished by stitching. ”

“ A crank drives a shaft with a worm thread on it. The threads of the worm engage in notches in a drum. Ropes pass from the axle on which the cogged wheel drum is carried, to drums carried on a second axle. Below are parts of the machine showing its structure and also the method of fixing the rope ends. After Vidius. Power, one turn of axle only moves the cogged wheel one notch—great power therefore varying with length of crank. Power still further increased by lower axle being smaller than drums of upper. ”

“ 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. ”

“ One whole turn of axle moves cogged wheel forward one cog. Some of the inner details of the winch are shown below. Another portable winch was the Trispastum of Apelles or of Archimedes. Its construction is shown in Fig. 32, which shows the sides removed to display the working. In actual use, however, it was closed in like the last winch.
Reduction by Means of Inflating a Bladder. In describing the reduction of the dislocation of the spine Hippocrates says that he has tried to reduce the deformity by inflating a bladder affixed to a bronze tube and placed under the spine. ”