Galen describes the splenia as being pieces of linen folded three or four times, which are to be laid along the arm longitudinally. He directs us to spread them with cerate. He says that they support the limb. He says distinctly that all the folds of the bandages should be rubbed with cerate in order to give greater support. All his directions for the treatment of a broken limb are most judicious. When at first there is much pain and inflammation, he recommends bleeding and purging; but when the callus begins to form, he directs the patient to use a nourishing diet. Spiculæ and scales of bone are in general to be allowed to exfoliate of themselves, and not removed forcibly by the surgeon. (Comment. and Fragment. ap. Nicetæ Collect.)
Celsus lays down the principles of treatment in fractures of the arm, fore-arm, thigh, and leg so circumstantially, that we can afford room only for an outline of them. He recommends no time to be lost in getting the displaced parts properly reduced. For this purpose, if the limb be strong, two assistants may be required to pull in contrary directions; and if other means do not succeed, thongs of leather, or linen bandages, may be attached to each end of the broken limb to make extension and counter-extension with them. When the ends of the bone have been adjusted, (which is known by the pain and deformity being removed,) the limb is to be wrapped in linen cloths folded two or three times, and dipped in wine and oil. Six bandages or rollers (fasciæ) are then to be applied. The first is the shortest, which is to be three times rolled round the limb upwards in a spiral direction, and three times generally will be sufficient. The second must be one half longer, and is to commence wherever the bone projects; or if there be no projection, at any part of the fracture; and is to be carried first downwards and then upwards, so as to terminate a little above the former. These are to be secured by a broader linen cloth spread with cerate. The third and fourth bandages are then to be applied upon the principle, that the latter is to be put on in the contrary direction to the former; and further, it is to be observed that the third bandage terminates below, whereas all the others terminate above the fracture. Upon the whole, he adds, it is better to secure the limb with many than with tight bandages, these being apt to occasion mortification. When properly applied they ought not to be loose on the first day, yet such as not to give pain; slacker on the second, and loose on the third day. They are then to be removed and again applied, and a fifth bandage is now to be superadded to them; and again, these are to be taken off on the fifth day, and six bandages put on, in such a manner that the third and fifth may terminate below, and all the others above. Whenever the bandages are taken off, the limb is to be bathed with hot water, and proper fomentations applied to allay the inflammation, which will generally be found to have subsided about the seventh or ninth day. Then the bandages are again to be put on as directed above, and ferulæ or splints are also to be added, taking care to put on a stronger and broader splint at the side to which the fractured bone has a tendency to be protruded. These must all be rounded where they come in contact with a joint, to avoid injuring it; they are only to be secured with such tightness as to keep the bones in their place, and when they get loose their thongs are to be tightened. The bandages are to be removed gradually. These are his general directions for all fractures of the extremities, and it is to be remarked that his mode of treatment is essentially the same as that of Hippocrates. He afterwards describes at considerable length the method of setting the broken ends of the os humeri. After this is accomplished he directs us to bind the arm gently to the side. With regard to the splints, he properly recommends the longest to be applied externally; shorter ones on the brawn of the arm (over the biceps muscle?), and the shortest under the armpit. He advises us to remove them frequently when the fracture is situated near the fore-arm; and at these times the arm is to be bathed with hot water, and rubbed with a soft cerate.
It will be seen that the methods of Hippocrates and Celsus, although the same in principle, differ in the following respects. Hippocrates uses three bandages, Celsus six: Hippocrates uses small compresses, Celsus large pieces of linen: Hippocrates uses cerate, Celsus wine and oil.
The Arabians conducted the treatment in much the same way as the Greeks. In cases of fracture of the arm, Albucasis directs us to make the bandages of soft, thin linen cloth; but of broader and firmer linen if the thigh or leg is to be treated. Below them is to be applied a smooth cloth spread with a suitable liniment. After the under bandages have been put on in the manner already described, the splints are to be applied, provided no swelling nor inflammation be present, for in that case they are to be deferred for a few days. These splints are to be constructed from the middle part of the alcanna, or of pine, or of the palm-tree, or of a tree which he calls calingi.
Avicenna directs us to form the splints of the wood of alcanna, or of oleander, or of pomegranate tree, or the like. The length of the splints is to be made equal to that of the limb, and their greatest breadth about three fingers. They are to be secured with another bandage and pieces of tape made of linen cloth. There is to be an interval of a finger’s breadth between each splint. He says, it is best to apply four splints of such a length as to reach from joint to joint. They are to be smooth and even so as not to injure any part. In cases of fracture of the os humeri he directs us to surround the nearest joint with the bandages, and, if the fracture be in the middle, to make them take in both extremities. He recommends us to foment the limb with vinegar and water, or water alone. The arm is to be fastened to the side and the hand laid on the stomach.
Haly Abbas, in giving directions for the treatment of fractures in general, recommends the splints to be made of pieces of alcanna, or any hard wood. Afterwards he directs the limb to be laid upon a table having a pad (pannus) placed on it, which last is to be secured with fillets. He gives particular directions not to apply the splints over the processes of bones, and when inflammation comes on he forbids splints to be used at all; in that case the patient is to be kept upon restricted diet. The bandages are to be removed in the course of three days.
The directions given by the experienced Rhases about the bandages and splints are very similar to our author’s, and therefore need not be repeated.
See an account of the ancient splenia, or compresses, and of the ferulæ, or splints, in Scultet’s ‘Arsenal de Chirurgie.’ (29, 30.) See also Van Swieten’s ‘Commentary,’ (354.) Van Swieten remarks, that although the eighteen-tailed bandage be supposed a modern invention, a similar one is described by Hippocrates, (De Fract.) and by Galen in his commentaries on the same.
Le Clerc gives a pretty full description of the Celsian method of treating fractures. (Hist. de la Méd.) See also Fabricius ab Aquapendente (Œuv. Chir. ii, 3, and i, 4). We are certain it will be generally admitted that the waxed apparatus of the ancients in the case of fractures was probably quite as efficacious as the starched bandages which have been introduced of late years with so much advantage.