Fig. 29.Reduction of the wrist. The ladder is probably meant to be lying flat, but in the figure it is shown tilted up on its side in order to bring the parts into view.
Fig. 29.Reduction of the wrist. The ladder is probably meant to be lying flat, but in the figure it is shown tilted up on its side in order to bring the parts into view.
Fig. 30.Reduction of the dislocated astragalus with the ladder in the horizontal position.
Fig. 30.Reduction of the dislocated astragalus with the ladder in the horizontal position.
Fig. 26shows the reduction of the ulna at the elbow, andFig. 27the reduction of both bones dislocated together.Fig. 28shows the reduction of the shoulder. The ladder is placed horizontally in this case, the ends being supported on a pile of wood or stone blocks.
The patient is bound on the ladder, and while extension is made on the arm, the head of the humerus is pulled outwards by a thong passed inside it.
Fig. 29shows the reduction of the wrist, extension and counterextension are made by thongs affixed below and above the wrist by clove-hitches; whileFig. 30shows the reduction of the ankle on similar principles.
(In the case of the wrist the ladder is shown tilted up on its side, in order to bring the parts into view.)
A portable winch of more powerful principle was the Glossocomum of Nymphodorus. It is shown inFig. 31; first, as it appeared when closed and ready for use, and next, with one of the shutters removed to show its internal construction.
It will be seen to consist of a crank, the rotation of which causes a worm on it to turn a cogged wheel.
Round the axle of the cog wheel are ropes passing to another axle, the circumference of which is increased by drums so as to multiply the power, after the manner shown in the figure. 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 inFig. 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. The experiment, however, did not succeed for when the man was fairly extended the bladder yielded, and the air could not be forced into it, and besides, the hump of the patient was apt to slip off the bladder.
Hippocrates says he has written this expressly, for it is a valuable piece of knowledge to learn what things have been tried and have proved ineffectual, and wherefore they did not succeed.
Again he says that reduction by the bladder was celebrated in the case of the hip joint.
It is not a powerful method. It should be placed between the thighs uninflated so that it may be carried as far up in the perineum as possible, and the thighs, beginning at the patella, are to be bound round with a swathe, as far up as the middle of the thigh, and then a bronze pipe is to be introduced into one of the loose feet of the bladder and air forced into it. The patient is to lie on his side with the injured limb uppermost.
From this description it would seem that the bladder had consisted of some small skin such as that of a kid.
Fig. 31.Glossocomum of Nymphodorus. Two views, one showing it closed and ready for use, the other with the lid removed, to show the principle. 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 axleonly 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.
Fig. 31.Glossocomum of Nymphodorus. Two views, one showing it closed and ready for use, the other with the lid removed, to show the principle. 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 axleonly 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.
Fig. 32.Trispastum of Apelles or Archimedes with the sides removed to show the works. The power depends on ratio of diameter of axle to length of crank in this figure. But if the lower drums were made smaller than upper as in Fig. 31, power would be further augmented accordingly.
Fig. 32.Trispastum of Apelles or Archimedes with the sides removed to show the works. The power depends on ratio of diameter of axle to length of crank in this figure. But if the lower drums were made smaller than upper as in Fig. 31, power would be further augmented accordingly.
Fig. 33.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.
Fig. 33.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.
Succussion, or Suspension on a Ladder.This was done for dislocation of the spine, and usually to astonish the mob, Hippocrates says, although so far as he was aware, the method had never straightened anybody yet. To the mob, however, things of this sort are wonderful, and they never give a thought as to their utility.
A ladder was padded with leather, and on this the patient was laid on his back. The ankles were tied to the ladder by soft strong bands.
The arms were bound to the sides of the patient but not to the ladder.
By means of a rope or ropes affixed to the lower end of the ladder (Fig. 33) it was raised along the gable of a high house or a high tower, or the mast of a ship fixed in the ground. 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.
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 small shoe of lead is to be bound on externally to the bandaging, having the same shape as the Chian slippers had. This, however, should not be necessary. Thus this method requires neither cutting (tenotomy) nor burning nor any other complex means, for such cases yield sooner to treatment than one would believe. However they are to be fairly mastered only by time and not until the body has grown up in the natural shape, and then recourse is to be had to a shoe.
The most suitable are the buskins, which derive their name from traveling through mud, for this sort of shoe does not yield to the foot but the foot yields to it. A shoe shaped like the Cretan is also suitable.
(As Galen, the great admirer and annotator of Hippocrates, confesses that he is unable to give an exact account of either the Chian slippers, the buskins, or the Cretan shoes, we may leave it to individual imagination to conjecture their appearance.)