The superabundant callus of fractures occasions always a deformity, and sometimes also lameness if it be formed near a joint. If, therefore, the callus be newly formed, we use very astringent medicines, and bring it to its form by bandages; and sometimes we effect our purpose by applying a plate of lead to it. But if it is of a stony hardness we make an incision, and pare it off, removing the prominent part by chisels, if need be, and boring it with trephines.
Commentary. Celsus directs us to rub the limb with oil, salt, and nitre; to pour a great quantity of hot salt water upon it; to apply an emollient ointment; to bandage it tightly, and to give an emetic. He also recommends us to produce revulsion by the application of mustard to another part.
Albucasis recommends nearly the same plan of treatment as our author. When the case is recent, he directs us to make astringent applications, such as aloes, olibanum, and myrrh, with an astringent wine or vinegar. He also speaks of applying a plate of lead; and when the callus becomes hard, he approves of scraping and sawing it off, as directed by our author.
No additional information is to be got from the other Arabians.
Theodoricus, and the other surgical authorities of that age, describe the treatment exactly as the ancients. When the callus is hard, they direct us to scrape or saw it off.
SECT. CIX.—ON DISTORTION FROM THE UNION BY CALLUS.
When bones heal distortedly by callus, no little lameness takes place, more particularly if in the feet. The method then of breaking them over again is not at all to be admitted, as it may occasion the utmost danger; but if the callus be newly formed, we must have recourse to the allusions of a relaxing nature, and to cataplasms, such as those from fat olives and pigeon’s dung, and the other medicines for dissolving callus; and we also dispel it by friction with the hand, and bending it every way. But if it be of a stony hardness, we make an incision of the skin with a scalpel, and separate the union of the bones with chisels, and then cure the fracture as formerly said.
Commentary. Celsus approves of breaking the bones over again. With this intention he directs us, in the first place, to bathe the limb with much hot water, and rub it with liquid cerate; the callus is then to be moved with the hands, and the ends of the bone properly set; or if that cannot be thus accomplished, a rule is to be wrapped round with wool and bound upon the part, so as to restore it to its proper shape.
Avicenna agrees with Celsus in speaking favorably of breaking the bone over again. He also speaks favorably of the other treatment recommended by our author.
Rhases recommends emollient applications, and gentle attempts to restore the figure of the limb. Albucasis mentions the proposal of breaking the bone again with disapprobation.