Professional Documents
Culture Documents
M*-
C H A P T E R
cording to historian Field H. Garrison, was to disassoci ate medicine from religion and philosophy. Hip pocrates' astute clinical observations, presented in 70
books, laid the foundation for the scientific method in
medicine.
Hippocrates appears to have been particularly interested in fractures and dislocations and wrote three
books on the skeletal system aione: On Fractures, On
Articulations, and Instruments of Reduction. Because
of their detail, it can be safely assumed that Hip pocrates had extensive practical experience in the
management of fractures and dislocations. Here's how
Hippocrates described fracture of the arms (Fig 1-2):
when the arm is broken, if one stretches the forearm
and adjusts it while in this position, the muscle of the
arm will be bound while extended; but when the
dressing is over, and the patient bends his arm at the
elbow, the muscle of the arm will assume a different
shape. The following, then, is the most natural plan of
setting the arm: having got a piece of wood a cubit or
somewhat less in length, like the handles of spades, suspend it by means of a chain fastened to its extremities
at both ends; and having seated the man on some high
object, the arm is to be brought over, so that the armpit may rest on the piece of wood, and the man can
scarcely touch the seat, being almost suspended; then
FIG 1-2.
Management of a broken arm as described by Hippocrates.
FIG 1-1.
Hippocrates, who laid the foundation for the scientific
method of medicine, appears to have been particularly interested in fractures and dislocations. (Redrawn from a drawing by Peter Paul Rubens, in Bettmann OL: A Pictorial History of Medicine. Springfield, IL, Charles C Thomas, 1962.)
quadrilateral frames, circular frames have been designed. Ilizarov in the Soviet Union has devoted years
of his life to the study of external fixation (particularly
with regard to bone lengthening) and built his own
hospital exclusively to study his circular fixator with
tensioned transfixion wires.
EVOLUTION OF MEDICAL
MANAGEMENT OF FRACTURES
AND DISLOCATIONS
Medical and military history are often related. The battlefield gave physicians ample opportunity to find alternative methods of fracture management and wound
healing. During the Napoleonic wars of the 18th century, major progress was made in treating open and
closed fractures. Faced with large number of battlefield
casualties, surgeons of the day quickly learned new
techniques. One of those battlefield surgeons to gain
prominence was Dominique Jean Larrey (1766- 1842),
who eventually became the Surgeon General of Napoleon's Grand Army. Thanks to Larrey, who performed
200 amputations in a period of 24 hours after the battle of Borodino in the Moscow campaign (Sept. 5 6,
1812),2'9 mortality rates were significantly reduced.
Larrey built on some of the ideas advanced by the
French surgeon Joseph DeFault, who was the first to
define the need for surgical debridement. Larrey also
advocated early amputations and immediate surgery
for open fractures and devised what may be regarded
as a primitive ambulance service for dealing with such
conditions. After participating in more than 60 major
battles and treating thousands of men, Larrey wrote in
his memoirs on the need for early amputations:
When it is well known that tetanus is caused by a
wound, we ought not to have any hesitation in amputating immediately on the appearance of the symptoms.
We may be assured that it is traumatic, by the nature of
the wound, the progress of the first symptoms, and by
considering the time of their appearance, which is
from the fifth to fifteenth day, or later.
Amputations of the limb being made on the first appearance of the symptoms, all communication with the
original of the evil is cut off. This operation unloads the
vessels, and convulsive motions of the muscles. These
first effects are followed by a general collapse, which
promotes the excretions and repose, and re-establishes
the equilibrium of the body.31