as may seem proper, and they must hold the rest of the body steady, in silence, and listening to the commands of the operator. 7. There are two views of bandaging: that which regards it while doing, and that which regards it when done.' It should be done quickly, without pain, with ease, and with elegance; quickly, by despatching the work; without pain, by being readily done; with ease, by being prepared for everything; and with elegance, so that it may be agreeable to the sight. By what mode of training these accomplishments are to be acquired has been stated. When done, it should fit well and neatly; it is neatly done when with judgment, and when it is equal and unequal, according as the parts are equal or unequal. The forms of it (the bandage?) are the simple, the slightly winding (called ascia), the sloping (sima), the monoculus, the rhombus, and the semi-rhombus. The form of bandage should be suitable to the form and the affection of the part to which it is applied. 2 8. There are two useful purposes to be fulfilled by bandaging:' (first,) strength, which is imparted by the compression and the number of folds. In one case the bandage effects the cure, and in another it contributes to the cure. For these purposes this is the rule-that the force of the constriction be such as to prevent the adjoining parts from separating, without compressing them much, and so that the parts may be adjusted but Commentary remarks, is meant in this place not only mechanical contrivances, such as the ambe and bench, used in the reduction of dislocations, but all the apparatus used by the surgeon in performing operations. The meaning of this clause, although rather quaintly expressed, seems pretty obvious. It is thus rendered by Verduc: 'We must observe, with Hippocrates, that with regard to the first difference drawn from the time of the operation, we must consider a bandage while it is yet amaking, by way of distinction from one that is already made. For the former there are three conditions required, which are couched under these three words, cito, tute, jucunde, i. e. speedily, safely, and dexterously, etc." (On Fractures, Bandages, etc.) 2 Our author here describes, rather confusedly and indistinctly, six sorts of bandages, namely, three simple, and three compound: the simple are, the circular, the ascia, and the sima; the compound are, the monoculus, the rhombus, and the semirhombus. The circular cannot be misunderstood; it consisted of a single roll of bandage carried circularly round the limb or member. The ascia (σKÉTарνov) and the sima were two forms of spiral bandage differing only in this respect, that in the former the edges of the bandage passed each other to a small extent, in the latter to a greater. The oculus, or monoculus, was a bandage adapted to dressings on one eye. The rhombus and semi-rhombus took their names from their figure, and were used principally on the head and feet. It being very difficult to convey a correct idea of these bandages in words, I will give figures of them taken from Vidus Vidius, from which their construction will be readily comprehended at a glance. 3 As Galen states in his Commentary, it does not clearly appear from the text what are the two purposes which bandaging supplies. M. Littré supposes that the exposition of the second begins at § 9. seems pretty Hippocrates, operation, we tion from one quired, which , safely, and sorts of ban- circular, the and the semisingle roll of αρνον) and the , that in the in the latter dressings on their figure, ult to convey n taken from ehended at a rom the text upposes that not forced together; and that the constriction be small at the extremities, and least of all in the middle. The knot and the thread that is passed through should not be in a downward but in an upward direction, regard being had to the circumstances under which the case is presented; to position, to the bandaging, and to the compression. The commencement of the ligatures is not to be placed at the wound, but where the knot is situated. The knot should not be placed where it will be exposed to friction, nor where it will be in the way, nor where it will be useless. The knot and the thread should be soft, and not large. 9. (Second.) One ought to be well aware that every bandage has a tendency to fall off towards the part that declines or becomes smaller; as, for example, upwards, in the case of the head, and downwards, in the case of the leg. The turns of the bandage should be made from right to left, and from left to right, except on the head, where it should be in a straight direction. When opposite parts are to be bandaged together, we must use a bandage with two heads; or if we make use of a bandage with one head, we must attach it in like manner at some fixed point; such, for example, as the middle of the head; and so in other cases. Those parts which are much exposed to motion, such as the joints, where there is a flexion, should have few and slight bandages applied to them, as at the ham; but where there is much extension, the bandage should be single and broad, as at the kneepan; and for the maintenance of the bandage in its proper place, some turns should be carried to those parts which are not much moved, and are lank, such as the parts above and below the knee. In the case of the shoulder, a fold should be carried round by the other armpit; in that of the groin, by the flanks of the opposite side; and of the leg, to above the calf of the leg. When the bandage has a tendency to escape above, it should be secured below, and vice versá; and where there is no means of doing this, as in the case of the head, the turns are to be made mostly on the most level part of the head, and the folds are to be done with as little obliquity as possible, so that the firmest part being last applied may secure the portions which are more movable. When we cannot secure the bandaging by means of folds of the cloth, nor by suspending them from the opposite side, we must have recourse 'The meaning of this sentence is doubtful. See Galen's Commentary, and Littré's notes. 2 Galen explains the meaning of this expression (kar' işw) by stating that in bandaging the head, the fold of the bandage is to be brought from the top of the head straight down below the chin and is to be carried thence to the part affected, and then again in like manner, either twice, or thrice, or as often as is thought necessary. a The propriety of these directions for bandaging the knee will readily be acknowledged. By lank parts (2añapà), Galen explains, were meant loose and slender parts, as opposed to such as are full and prominent. seam.1 10. The bandages should be clean, light, soft, and thin. One should practice rolling with both hands together, and with either separately. One should also choose a suitable one, according to the breadth and thickness of the parts. The heads of the bandages should be hard, smooth, and neatly put on. That sort of bandaging is the worst which quickly falls off; but those are bad bandages which neither compress nor yet come off. 11. The following are the object which the upper bandage, the under bandage, or both aim at: The object of the under bandage is either to bring together parts that are separated, or to compress such as are expanded, or to separate what are contracted, or to restore to shape what are distorted, or the contrary. It is necessary to prepare pieces of linen cloth, which are light, thin, soft, clean, having no seams nor protuberances on them, but sound, and able to bear some stretching, or even a little more than required; not dry, but wetted with a juice suitable to the purpose required. We must deal with parts separated (in a sinus?) in such wise, that the parts which are raised may touch the bottom without producing pressure; we must begin on the sound part, and terminate at the wound; so that whatever humor is in it may be expelled, and that it may be prevented from collecting more. And straight parts are to be bandaged in a straight direction, and oblique obliquely, in such a position 1 The meaning in the last clause of this paragraph is difficult to determine. See Galen, Vidus Vidius, and Littré. 2 Verduc translates and explains this passage as follows: "Hippocrates enjoins further, that the bands be smooth, plain, soft, and light; by smoothness and plainness he excludes unevenness, or the least puckering and rising unequally; by requiring softness, he insinuates that they must not press, or wring, or wound the part; and fineness is requisite to facilitate the passage of the liquors through its substance; and the inconveniency of overloading the affected part makes lightness a necessary quality." On Fractures, Bandages, &c., p. 231. Though the general drift of this paragraph be sufficiently clear, there are many things in it by no means easy to be understood. Indeed, Galen finds the language so unworthy of Hippocrates, that he does not scruple to give it as his opinion that the work had never been finished for publication by the author. By heads Galen says, that some of the commentators understood the ends, and others the edges of the bandages. The text in the last clause seems evidently to be corrupt. 4 + The epidesmis and hypodesmis, which are both described in a very distinct manner in this paragraph, evidently apply principally to fractures and other injuries of the extremities. There is little in this description that requires explanation. The application of them in the case of a fractured arm, we shall find minutely described in the work On the Articulations. This description seems evidently to apply to a sinus, or collection of matter below the skin. In this sense it is understood by Galen, and by Verduc, in his work on Fractures and Bandages. he form of a One should rately. One nd thickness smooth, and quickly falls et come off.' e, the under e is either to -h as are ex• shape what eces of linen or protuber ng, or even a itable to the a sinus?) in tom without terminate at - and that it rts are to be ch a position as to create no pain; and so that there may be no constriction nor falling off on a change of position, either for the purpose of taking hold of anything, or laying the limb; and that muscles, veins, nerves, and bones may be properly placed and adjusted to one another. It should be raised or laid in a natural position, so as not to occasion pain. In those cases in which an abscess is formed, we must act in a contrary way.' When our object is to bring together parts which have become expanded, in other respects we must proceed on the same plan; and we must commence the bringing together from some considerable distance; and after their approach, we must apply compression, at first slight, and afterwards stronger, the limit of it being the actual contact of the parts. In order to separate parts which are drawn together, when attended with inflammation, we must proceed on the opposite plan; but when without inflammation, we must use the same preparations, but bandage in the opposite direction. In order to rectify distorted parts, we must proceed otherwise on the same principles; but the parts which are separated must be brought together by an under bandage, by agglutinants, and by suspending it (the limb?) in its natural position. And when the deformities are the contrary, this is to be done on the contrary plan. 12. In fractures we must attend to the length, breadth, thickness, and number of the compresses. The length should be that of the bandaging; the breadth, three or four fingers; thickness, three or fourfold; number so as to encircle the limb, neither more nor less; those applied for the purpose of rectifying a deformity, should be of such a length as to encircle it; the breadth and thickness being determined by the vacuity, which is not to be filled up at once. The under bandages are two, the first of which is to be carried from the seat of the injury upwards, and the second from the seat of the injury downwards, and from below upwards; the parts about the seat of the injury being most compressed, the extremities least, and the rest in proportion. The upper bandages should take in a considerable portion of the sound parts. We must attend to the number, length, and breadth of the bandages; the number must be such as not to be inferior to what the injury requires, nor occasion compression with the splints, nor prove cumbersome, nor occasion any slipping of them, nor render There is great uncertainty about the meaning of this sentence, as may be learned from the Commentary of Galen. He informs us that some read it negatively, that is to say, with the negative particle (un), and that Asclepiades put an entirely different sense on the passage, understanding the words to apply to the loosening of the bandages, and not to the condition of the part to which they are applied. Foës inclines to adopt this interpretation, which I must say is, in many respects, more feasible than the other. Galen seems undecided. * This passage refers apparently to fractures of the fore-arm, which we shall. find treated of very fully in the work On Fractures. The suspension of the limb in a napkin, or other cloth. constituted a very important part of the process of treatment. five, or six cubits in length, and as many fingers broad. The folds of the strings (selvages?)' should be such as not to occasion pressure; they are to be soft and not thick; and all these things are to be proportionate to the length, breadth, and thickness of the part affected. The splints are to be smooth, even, and rounded at the extremities; somewhat less all along than the upper bandaging, and thickest at the part to which the fracture inclines. Those parts where there are tuberosities, and which are devoid of flesh, such as the ankles or fingers, we must guard from the splints which are placed over them, either by position, or by their shortness. They are to be secured by the strings in such a manner as not to occasion pressure at first. A soft, consistent, and clean cerate should be rubbed into the folds of the bandage.' 'There is a good deal of difficulty in determining the exact meaning of this term (apaiρnua); indeed, there is considerable uncertainty about the reading. Consult Galen, Vidus Vidius, Foës, Littré, and Schneider (Lexicon). Both Foës and Littré incline to render it by lisière in French, that is to say, the list or selvage of linen cloth. That this should have been used to secure the compresses, and keep them in position, seems very natural, and I am inclined to adopt this explanation of the term, as it suits so well with the sense. See Avicenna, iv., 5, 2, 7; also, Sculteti Armamentarium Chirurgicum, tab. 29. In plate 4, the appearance of the bandaged limb, having the splints secured with strings, is well represented. I need scarcely remark that this description of the process of treating a fractured limb is remarkable for precision and clearness, and it may well be doubted whether in the whole compass of medical literature there be a passage which contains so judicious an exposition of the principles upon which this surgical case should be managed. An important point connected with the ancient mode of treating fractures was the use of cerate, or a composition from wax, in the application of the bandages. Unfortunately our information regarding the use of this article by the ancient surgeons in bandaging is very limited, being mostly confined to this passage of our author, and the Commentary of Galen on the same, which, it is to be regretted, has come down to us in a corrupt state. It appears from it, however, that the wax was rubbed not only into the skin of the part to which the bandage was to be applied, but also upon every fold of the bandage as it was put on. It was applied in moderate quantity. See Chirurgici Græci, ed. Cocchi (p. 66). There can be no doubt, then, that applied in this manner, the waxed bandages must have been fully as secure as the starched bandages now in use. The wax used for this purpose was cleansed from all impurities, and probably bleached. On the ancient mode of bleaching wax, see Dioscorides (ii., 105). The Arabians adopted this and all the other steps of this process from the Greeks. See, in particular, Avicenna (iv., 5, 2, 6). I may be allowed to remark in this place, that it is not unlikely that the Arabs in Algiers, from whom it is well known that the French surgeons learned the process of treating fractures by the immovable apparatus, may have derived their knowledge from their forefathers. How or when this excellent practice fell into disuse in civilized Europe I cannot pretend to explain. I may mention, however, that Verduc, who.professes to follow Galen and Hippocrates implicitly in describing the application of ban |