Of Medicine, in Eight Books

by Aulus Cornelius Celsus

The foregoing rules are general; the following peculiar to each bone. If the humerus be fractured, the extension must not be made as in another limb; but the patient is placed in a high seat, and the physician in a lower one opposite to him. Then the patient’s fore-arm is to be supported by a bandage passed round it, and fastened behind the neck. This done, a second bandage, with two heads, is to be rolled round the upper part of the humerus, and have its two ends tied into a knot above the head. Lastly, a third bandage of the like kind is to be fastened to the lower part of the humerus, and carried downwards, its two ends being also tied together. Then, from behind the patient’s head, an assistant stretching his own arm through the loop of the second mentioned roller, his right, if the right humerus is to be extended, his left, if the left humerus, takes hold of a stick placed between the patient’s thighs; the physician also sets his right foot, if he be to operate upon the left humerus, his left, if upon the right, on the third of these rollers; and at the same time the assistant raises the one roller, and the physician depresses the other; by which means, the humerus is gently extended. If the fracture be in the middle or lower part of the bone, shorter rollers are required; if in the superior, longer; so that they may be extended from thence over the breast, under the other arm-pit to the shoulders. In binding it up, the fore-arm must be so inclined, and the affected part put into such a position by the bandages, that the suspending of the forearm afterwards, do not turn the humerus any other way, than when it was bound up. And the fore-arm being hung, the humerus is to be also gently tied down to the side; by which means it will be prevented from moving, and therefore the bones continue as they have been set. When we come to the application of splints, these ought to be longest on the external side, shorter on the fore-part, but shortest of all under the arm-pit. And when the humerus is fractured near the cubitus, they must be pretty often removed, lest the tendons there grow rigid, and the fore-arm be rendered useless. Whenever they are removed, the fracture must be held in the hand; and the cubitus fomented with hot water, and rubbed over with soft cerate; and splints must either not be put upon the processes of the cubitus at all, or they must be somewhat shorter than the others.

Of a fracture of the fore-arm.

But if there is a fracture in the fore-arm, it must be first of all considered, whether one bone or both be broken: not that there is any different method of cure to be used; but first that the extension may be the stronger, if both bones be fractured, because the tendons must necessarily be less contracted, when one of the bones is entire, and keeps them upon the stretch; in the next place, that every thing which relates to securing the bones, may be done with the greater accuracy, if one of them does not help the other: for where one is unhurt, it helps more than rollers and splints. The fore-arm ought to be tied up with the thumb turned a little toward the breast; for that is the most natural posture of the fore-arm: and after the bandages are put on, it is best held in a scarf, the full breadth of which is under the fore-arm, with its ends, which are very narrow, fixed over the neck; thus the arm is conveniently suspended from the neck, and ought to hang a little higher than the other elbow.

But if any part of the top of the cubitus be fractured, it is improper to secure it by bandages, because the fore-arm becomes immoveable. And if means only are found[(18)] to remove the pain, it remains as useful as before.

Fractures of the thighs and legs.

It is of equal importance in the leg for one of the bones to continue entire. Both in this and the thigh it is fit after binding it up to put it in a box. This box ought to have holes below, through which any humour that is discharged, may descend; and at the foot a prop, which may both sustain, and not suffer it to slip; and holes in the sides, through which straps being past, some bars[ IC ] may keep the leg and thigh in their position. If it be a fracture of the leg, this ought to reach from the foot to the ham; if of the thigh, as far as the hip; if near the head of the thigh-bone, so as that the hip likewise may be within it. We ought not to be ignorant, however, that a fractured thigh becomes shorter, because it never entirely returns to its former state; and that the person ever after supports himself upon his toes in that foot, which occasions great weakness; however it is much worse, where the misfortune has been encreased by neglect.

Fractures of the fingers.

It is sufficient to bind a finger to one small twig, after the inflammation is gone.

General rules.

The foregoing directions are confined to the cases relating to particular limbs; the following are general: fasting for some days at first; then when the callus is growing, a pretty full diet; long abstinence from wine; plentiful fomentations of hot water, while the inflammation continues; when that has ceased, they must be more sparing; lastly, a pretty long but gentle rubbing of liquid cerate into the more remote parts. Nor must the limb be immediately put upon exercise, but by degrees returned to its former motions.