SECT. CVI.—ON THE ARRANGEMENT OF THE LIMB.
When the thigh or leg is fractured, the manner of arranging the limb will be as important a consideration to you as the other treatment. For the evenness of the fractured parts is especially preserved by this means when properly performed. Some, therefore, lay the fractured part upon a canal, either of wood or of earthenware, or else they lay the whole limb upon it; others apply it only in cases of fracture with a wound, because, say they, these cannot be bound with splints. But the moderns altogether reject the use of these canals for many reasons, but more especially on account of the pressure occasioned by their hardness. Nor is it improper to apply splints to fractured limbs with a wound, as we shall show afterwards. Let the patient, then, lie upon his back, and let a thick garment, equal to the limb in length, be laid under it, more especially where the fracture is, and let both its ends be convoluted and wrapped round so as to resemble the canal in its middle longitudinal cavity, and let it be covered with a soft skin for receiving the embrocations; and then let the limb be fitted to this canal-like cavity, and let other garments or wool be applied on both sides to prevent the limb from being moved to the sides. And let a small board, covered with rags for sake of softness, be fastened to the sole of the foot; and, for the sake of greater security, let the middle of two or three ligatures be applied under this canal-like garment, and let the broken limb be lightly bound along with it. But if the patient be unable to restrain himself from drawing in his leg, his foot should be fastened to the board by means of ligatures around the ankle, so that he may be prevented even from drawing in his leg involuntarily in his sleep. Some likewise cut out a hole in the middle of the bed, that the patient may void his urine and fæces by it without requiring to be moved until the callus has become formed.
Commentary. We have already mentioned that Hippocrates approved of the straight position of the limb. With respect to the canals (σωλῆνες) mentioned also by our author he expresses himself in equivocal terms. He says that they prove useful, but not to the extent generally believed. He properly remarks that they do not prevent the body from being moved, and that consequently they cannot be supposed capable of securing the limb entirely from derangement. He is decidedly of opinion that unless they extend from above the ham to the heel they do no good in fractures of the leg. (De Fracturis, 16, ed. Littré.)
Celsus gives the following description of the canals: “Is canalis et inferiore parte foramina habere, per quæ, si quis humor excesserit, descendat: et a planta moram, quæ simid et sustineat eam, et delabi non patiatur: et a lateribus cava, per quæ loris datis, moræ quædam crus femurque, ut collocatum est, detineant.” Galen, in his Commentary on Hippocrates (l. c.) describes these machines as being round externally and hollow within, so as to inclose the limb all around:—περιλαμβάνει τὸ σκέλος ὅλον ἐν κύκλῳ. From these words one might think that the canal of which he speaks was a complete cylinder or cone. But from our author’s direction to lay the limb upon the canal, it would appear that the machine he speaks of was open above, and as such it is represented and described by Scultet (Arsenal de Chirurg. xxii, 6.) His words are: “Il faut que le canal embrasse plus de la moitié du membre;” this, therefore, is a sort of trough. Sprengel calls it a box (boîte, Fr. edit.) Littré translates it by gouttière, l. c. For an account of these and other machines anciently used in fractures of the lower extremities, see Van Swieten (Comment. 354), and Heister (Surgery, ix, 9.) Brunus and Theodoricus make mention of these canals, but do not much approve of them.
Galen informs us that the canals were made of different kinds of wood. He speaks of a surgeon in his time who made them from the wood of the phillyrea. He makes mention of a method of supplying their place by means of a bolster laid below the limb and tied round it with fillets. (Nicetæ Collect. and Comment. l. c.)
Avicenna and Albucasis take notice of these machines, but neither of them with approbation. They also speak of securing the limb in the way described by our author.
The canals would appear to be the machines which Rhases mentions by the name of barangi. (Cont. xxix.)