The ancients, in obedience to the precept of Hippocrates, fixed the arm against the breast, and confined it there by a bandage recommended by Celsus, and constantly employed by Paul of Egina. “Præstat antem, says he, brachium, ad thoracem moderate deligare, ut ne, si id commoveatur, figuram avertat.” Pare still preserved this process, which the moderns have now entirely abandoned, and which, taken alone, could properly fulfil only the first indication. The second indication was less happily fulfilled, by a kind of bandage added to the first, by Celsus, Paul of Egina, and the Arabians, the necessary effect of which was, to force the lower fragment outwards. It is surprising that Heister and Lamotte should have confined themselves to the use of this for the retention of the fragments.
What shall we say of the eighteen-tailed bandage exclusively adopted by Petit and Duverney? The arm, not being fixed by it, was liable to be moved, and the fragments to be displaced by the least shock. There was nothing to prevent the lower fragment from obeying the powers tending to carry it either inward or outward. Indeed the bandage was of no avail whatever in giving support to a fracture, as was observed by Louis, in his “Dissertation on Petit’s Diseases of the Bones.”
Suppose the arm, as some have advised, to be supported only by a sling. Not one of the indications just established (17) could by such means be fulfilled.
Perhaps the bolster of tow proposed by Moscatti, would have surpassed all these means, in the advantages it offered, had it not, by leaving the arm moveable below, and the shoulder above, still favoured a displacement.
Le Dran has also advised the use of a bolster composed of that of Moscatti, and bole Armenian. It fixed the arm more firmly against the trunk and in this respect, certainly approached nearer to the attainment of the object in view.
19. It is obvious, from this comparison between the indications of cure (17), and the means hitherto employed for the fulfilment of them (18), that nothing satisfactory had yet been done, and that a proper apparatus was still a desideratum. The success experienced by Desault, in the use of that which we are about to describe, has perhaps proven, that this desideratum exists no longer.
20. The pieces which compose it, are, 1st, Two rollers, the one from five to six, and the other from eight to ten yards long, each one about three inches wide: 2dly, Three strong splints, of different lengths, each about two inches broad: 3dly, A small bolster made of linen, from three to four inches thick, at one end, tapering like a wedge to the other, and of a sufficient length to reach from the arm-pit to the elbow; 4thly, A sling for the purpose of supporting the fore-arm; 5thly, A piece of linen to surround the whole apparatus.
Every thing being properly arranged, the reduction, effected in the manner already stated (14), and the assistants still continuing the extension:
1st, The surgeon takes the first roller, wet with vegeto-mineral water, fixes one end of it by two circular turns on the upper part of the fore-arm, and carries it up along the arm by oblique turns, moderately tight, and overlapping each other about two-thirds of their breadth. Having reached the upper part of the limb, he makes some reversed turns to prevent the wrinkles that would be caused by the unevenness that occurs in this place. He then passes two casts of the roller under the opposite arm-pit, and bringing the ball to the top of the shoulder again, gives it into the hand of an assistant.