Ortopedie in die Grieks - Romeinse era
Suid-Afrikaanse Tydskrif vir Natuurwetenskap en Tegnologie/South African Journal of Science and Technology
| Field | Value | |
| Title | Ortopedie in die Grieks - Romeinse era Orthopedics in the Graeco - Roman era | |
| Creator | Cilliers, Louise Retief, François | |
| Description | Die gevorderde hantering van afwykings van bene en gewrigte, Ortopedie, het in Mesopotamië en veral in antieke Egipte sy ontstaan gehad. Dit was egter die Griekse geneeshere wat in die laat 5de eeu v.C. in die Hippokratiese Korpus ’n merkwaardig doeltreffende samevatting van die ortopediese beroep vasgelê het, waarop vir minstens ’n 1 000 jaar nie beduidend verbeter sou word nie. Gebaseer op die onderskeiding tussen toe en oop frakture en ontwrigtings (lg. met oorliggende velwond, en aansienlik swakker prognose) is hierdie afwykings so spoedig moontlik gereduseer (selfs deur middel van meganiese tegnieke), die oorliggende vel met seraatsalf gesmeer en dan met kompresse en verbande geïmmobiliseer. Gedurende die eerste 12 dae is die letsel herhaaldelik weer oopgemaak om die fraktuur of ontwrigting te herbelyn indien nodig. Eers hierna is ferm immobilisasie met onder andere spalke aangebring. Beduidende druk op die letsel is vermy omdat daar geglo is dat dit sepsis en gangreen aanbring. Dit is aanvaar dat genesing 20 dae (by byvoorbeeld voet-, rib- en sleutelbeenfrakture) en 40 dae (by been- en bo-armfrakture) sou duur. Benewens algemeen geldende prosedures is die spesifi eke hantering van 18 verskillende frakture en ’n groot aantal ontwrigtings in besonderhede uitgespel. Oor ander ortopediese afwykings soos degeneratiewe artritis en jig verskyn daar min in die Hippokratiese werke, maar later geneeshere in die Romeinse era (bv. Celsus, Soranus, Aretaeus en Galenus) het dit wel beskryf. Daar is aanduiding dat die hantering van siektes van gewrigte en bene by die mens (die dissipline van ortopedie in moderne terminologie) reeds in antieke Egipte deeglik bestudeer en aangeteken is. 1 Tydens die klassieke era en die Romeinse tyd is beduidende verdere bydraes gelewer. In hierdie studie word die ewolusionêre ontwikkeling van ortopedie as kliniese studierigting in die antieke tyd, onder die loep geneem. In this study the evolutionary development of orthopedics (management of diseases of bones and joints), which commenced in early Mesopotamia and Egypt, is followed through Classical times.The Greek infl uence probably commenced in the 6thcentury BC with Democedes of Croton who cured the Persian king’s dislocated ankle. The Corpus Hippocraticum laid the foundation of orthopedic practice in antiquity. Although knowledge of anatomy was limited, its four books on orthopedics (The Nature of Bones, Mochlicon, On Fractures, On Joints) count amongst the outstanding contributions of Hippocratic writers. In systematic manner the general recognition and management of fractures and dislocations are covered, followed by the handling of individual lesions. Hippocrates differentiated between closed and open fractures (with overlaying skin wounds). Closed fractures were reduced to as normal a position as possible – manually where possible, but with large bones and in the presence of formidable muscle mass, mechanical traction was often employed (e.g. the Hippocratic bench and the bizarre succusion ladder for spinal deformities). There is no mention of the use of analgetic drugs. After application of cerate (mixture of olive oil, soda and pitch) to the skin, the fracture was immobilized by a combination of plasters and compresses (often fi rmed up with gum-mixtures) – but never very fi rmly. On the 3rd, 6/7th, 9thand 12th days the bandaging was removed, the lesion inspected and if considered necessary, re-aligned, A variety of splints were then applied. Strict bed rest was enforced, as well as a light diet (no wine or meat for 10 days). It was believed that fractures of the feet, clavicle, ribs and jaw healed after 20 days, of the forearm after 30 days, and fractures of the upper arm and leg after 40 days. Open fractures were considered very serious injuries, and reduced very carefully. Protruding bone fragments were removed (sawn off if necessary) and the wound was covered with black cerate, compresses and light bandages. Pressure and heavy splints were thought to induce infection and gangrene and thus avoided. Dislocations were reduced as soon and as effectively as possible, before muscle spasm set in. As with fractures manual reduction was, where necessary, complemented by mechanical traction. After extensive washing of the joint area with warm water, cerate was applied to the wound and specialised bandaging (even splints) ensured immobilization. Open dislocations like open fractures were considered very serious and reduction was not attempted. Again all pressure bandaging was avoided. A non-functional joint was commonly the end result. The management of 18 specifi c fractures is described in detail. Jaw fractures were fi xed by the binding of contiguous teeth. Fractures of the spinal column clearly presented a major problem. Although knowledge of spinal anatomy was surprisingly good, the diagnosis of fractures was very difficult and its association with spinal curvatures presented almost insurmountable problems of management. It was recognized that rib fractures could cause serious damage to the lung and pleura. Complex problems caused by arm fractures involving the elbow or shoulder joints, and combined radius and ulna fractures, are addressed. Femur fractures presented major problems and permanent leg deformity was very common. Open femur fractures were extremely serious and Hippocrates even stated that a physician who could ethically avoid becoming involved in treating such an injury, should do so. Fractures of femur necks were not recognised. The Hippocratic work, Wounds of the head, dealing with fractures of the skull, is not covered in this study.Management of the major joints are individually described. Seven different techniques of reducing a dislocated shoulder joint are mentioned The original description of the management of the dislocation of the wrist and hand is lost. Proper reduction of hip-dislocation was essential to avoid muscle atrophy and life-long limping, and was achieved by intricate mechanical suspension. Strangely enough, lateral dislocation of the knee was a common occurrence and not seen as a serious problem. Congenital club feet were effectively treated by prolonged fi xation in the correct position by way of tight bandaging with compresses stiffened in glue-mixtures.There is abundant skeletal evidence of osteo-arthritis in Neolithic man, but no clear description of it in the Corpus Hippocraticum. Gout is repeatedly mentioned in the Corpus but without detailed descriptions of the disease. In the Roman era authors like Heliodorus, Antyllus and Celsus in particular, wrote authoritatively on orthopedic subjects, Osteo-archaeological evidence is that fractures were treated expertly in the Roman army. Conditions consistent with degenerative osteoarthritis and true gout (as podagra and chiragra) were described by Celsus and Aretaeus of Cappadocia. Soranus, Rufus of Ephesus and Galen also wrote on orthopedic subjects. We will today differ from many statements made in the Corpus Hippocraticum, but it is clear that the orthopedic basis laid by those documents was not seriously challenged for 1 000 years. | |
| Publisher | AOSIS | |
| Date | 2009-09-06 | |
| Identifier | 10.4102/satnt.v28i2.63 | |
| Source | Suid-Afrikaanse Tydskrif vir Natuurwetenskap en Tegnologie; Vol 28, No 2 (2009); 87-100 Suid-Afrikaanse Tydskrif vir Natuurwetenskap en Tegnologie; Vol 28, No 2 (2009); 87-100 2222-4173 0254-3486 | |
| Language | eng | |
| Relation |
The following web links (URLs) may trigger a file download or direct you to an alternative webpage to gain access to a publication file format of the published article:
https://journals.satnt.aosis.co.za/index.php/satnt/article/view/63/54
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