Fractures

Fractures

Ambroise Paré, Les oeuures d’Ambroise Paré … (Lyons, 1685), p. 328.

Image 1 depicts an extension apparatus, called a Glossocomium, which was described in the writings of Galen and used in the treatment of fractures. It exerted traction through a number of pulleys and a windlass, which simultaneously pulled the upper and lower components apart by rotating a handle, in order to align the bone ends.[1] Referring to a fracture of the thigh, Ambroise Paré (c. 1510-90), writes:

‘It is a hard thing to bring the fragments of the broken Thigh together to be set, by reason of the large and strong Muscles of that part; which whilest they are drawn back towards their original, by a motion both natural and convulsive, they carry together with them the fragment of the bone, whereinto they are insetted: Therefore, when as the Fracture of this bone shall be restored, the Patient must lie upon his back with his Leg stretched forth, and the Surgeon must strongly and with great force extend the thigh; but if he alone shall not be able sufficiently to extend it, he shall employ two other strong attendants, by whole joint-help the fragments may be fitted and set each against other. For this purpose, when as the strength of the hand was not sufficient, the Ancients used an Instrument called a Glossocomium, whereof this is the Figure’.[2]

Guido Guidi, Ars medicinalis, in qua cuncta quae ad humani corporis valetudinem praesentem tuendam, & absentem reuocandam pertinent, methodo exactissima explicantur. Quae per Vidum Vidium juniorem diligentissime recognita … (Venice, 1611), p. 65.

Image 2 is an illustration of a portable winch called a Plintheum Nilei (Plinthium of Nileus) that consisted of a small frame carrying an axle, with or without a ratchet, which is reproduced from Worth’s copy of Guido Guidi’s Ars Medicinalis.[3] Guido Guidi (d. 1569), Latinized as Vidus Vidius, was born in Florence and went to Paris in 1542 to serve as personal physician to Francis I, king of France (1494-1547) and to teach at the Collège de France. Guidi returned to Italy upon the death of Francis I in 1547 and became the personal physician of Cosimo I de’ Medici (1519-1574) and taught at the University of Pisa. Ars Medicinalis was incomplete at the time of Guidi’s death and was finished by his nephew and published in Venice in 1611.

Ambroise Paré, Les oeuures d’Ambroise Paré … (Lyons, 1685), p. 328.

Image 3 is an illustration of a fractured arm, with a wound bound up, and laid upon a soft pillow, which Paré explains below:

‘If a wound also associate a fracture of the arm, then see that you put about it Plates of Lattin, or Past-board, and make a convenient ligature and that the fragments of the bones be kept in the same state wherein they were set and restored: Moreover, let him lay his arm upon a soft pillow, or cushion as the precedent Figure shews you’.[4]

Johannes Scultetus, Armamentarium chirurgicum olim auctum triginta novem tabulis … (Leiden, 1693), plate XXIX.

Image 4 shows the provisions to bind a broken leg, and Hippocrates’ advice on how dislocations and fractures should be bound. Johannes Scultetus (1595-1645), describes how it worked:

‘Fig. I. shews how Hippocrates, whilest the part is held stretched forth by the Assistants, roles the band E three times toward the right hand, about the part affected ; and then brings it upwards, untill it come to a good part of the lim, with four or five or more windings about it.

Fig. II. shews how he winds about the second roler F, which is twice as long as the former, the contrary way (for the first is roled about toward the right hand upwards, this is wound about towards the left hand downwards) namely, once about the fracture; then again three or four times, or oftner, below the fracture, unto some convenient part of the member: The remainder of the band, which the Chyrurgian [Surgeon] holds in his left hand, must be wound about upwards, untill it comes to the end of the first band.

Fig. III. explains how he laies the wet Plagets [Pledgets] I all at length up on the fracture (so that betwixt one and the other, there must be not more than two fingers breadth distance) and he binds them with the band with two ends G; winding the end G * upwards; and the other G downwards, after that upwards, untill it come where that ended.

Fig. IV. sheweth how, after the seventh day, whereon, for the most part, all fear of inflammation is past, he laies the Ferulaes [Splints] with the Plagets, and the upper Ligature made by the band G; and binds them fast with three girts’.[5]

Sources

Flynn, Sandra, ‘History of traction’, International Journal of Orthopaedic and Trauma Nursing, vol. 28 (2018), 4-7.

Manzini, Francesco et al., ‘The contribution of intellectuals to the history of traumatology during the Renaissance: treatment of femoral fracture through François Rabelais’ glossocomion’, International Orthopaedics, vol. 41, no. 2 (2017), 429-432.

Milne, John Stewart, ‘The apparatus used by the Greeks and Romans in the setting of fractures and the reduction of dislocations [Part I]’, Interstate Medical Journal, vol. 16, no. 1 (1909), 48-60.

Milne, John Stewart, ‘The apparatus used by the Greeks and Romans in the setting of fractures and the reduction of dislocations [Part II]’, Interstate Medical Journal, vol. 16, no. 2 (1909), 128-140.

Paré, Ambroise, The works of that famous chirurgeon Ambrose Parey, translated out of Latin, and compared with the French, by Th. Johnson … (London, 1678). This is an English translation of Paré’s Les oeuures de M. Ambroise Paré … (Paris, 1575). Worth had the 1685 Lyons edition.

Scultetus, Johannes, The chyrurgeons store-house : furnished with forty three tables cut in brass in which are all sorts of instruments, both antient and modern ; useful to the performance of all manual opperations, with an exact description of every instrument … and faithfully Englished by E.B. (London, 1674). This is an English translation of Scultetus’ Armamentarium chirurgicum  … (Ulm, 1655). Worth had the 1693 Leiden edition.

Text: Mr. Antoine Mac Gaoithín, Library Assistant at the Edward Worth Library, Dublin.

[1] Flynn, Sandra, ‘History of traction’, International Journal of Orthopaedic and Trauma Nursing, vol. 28 (2018), 4; Milne, John Stewart, ‘The apparatus used by the Greeks and Romans in the setting of fractures and the reduction of dislocations [Part I]’, Interstate Medical Journal, vol. 16, no. 1 (1909), 55.

[2] Paré, Ambroise, The works of that famous chirurgeon Ambrose Parey, translated out of Latin, and compared with the French, by Th. Johnson … (London, 1678), p. 337.

[3] Milne, John Stewart, ‘The apparatus used by the Greeks and Romans in the setting of fractures and the reduction of dislocations [Part II]’, Interstate Medical Journal, vol. 16, no. 2 (1909), 137.

[4] Paré, Ambroise, The works of that famous chirurgeon Ambrose Parey, translated out of Latin, and compared with the French, by Th. Johnson … (London, 1678), p. 337.

[5] Scultetus, Johannes, The chyrurgeons store-house … (London, 1674), p. 103.