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History of Spinal Deformities and the Hippocratic Board
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History of Spinal Deformities and the Hippocratic Board
Hippocratic Board
- Device for the treatment of scoliosis or spinal deformities
- Manual pressure was applied to the patient’s hump while traction was simultaneous applied.
- Instructions of making this device was mentioned in Part 47 of “On the Articulations”
Building Instructions
Building Instructions
Materials: a strong and broad board, oaken bench of a quadrangular shape, robes, leather straps
Instructions:
1. Fasten the board into the ground about a cubit above the floor, or at any suitable height.
2. Lay an oaken bench, of a quadrangular shape, along the wall at a distance from the wall, which will admit of persons to pass round if necessary.
3. Cover the bench with robes or other soft materials.
4. Patient is to be stoved with vapor or bathed with hot water.
5. Stretch patient along the board on his face with his arms laid along and bound to his body
6. Wrap two straps of leather along the middle of the patient's breast, as near the armpits as possible.
7. Attach the ends of these straps securely to the board.
8. Another leather band is wrapped above the knees and the ankles and the ends of the straps are attached to the board.
9. Another leather strap is wrappped tightly around the loins as close to the hips as possible and then what remains of the straps must be fastened to the piece of wood placed at the patient's feet.
10. Extensions of these fashion are to be made upward and downward
Purpose Of Parts
Purpose of Parts
The straps bound the body together creating a flat surface. It also prevents movement and makes the body one whole.
Traction applied from both ends to create tension and stretch out the body when pressure is applied.
Pressure is applied to the deformity in the spine in order to push it back into place. Pressure can be applied with hands, body, or feet.
Timeline
2.
4.
Nicetas Codex
On the Articulations
Part 47 of Hippocrates “On the Articulations”:
“The apparatus for the reduction in this case must be managed in the following manner: a strong and broad board, having an oblong furrow in it, is to be fastened in the ground…and then something like an oaken bench, of a quadrangular shape, is to be laid along (the wall) at a distance from the wall, which will admit of persons to pass round if necessary, and the bench is to be covered with robes, or anything else which is soft…and then he is to be stretched along the board on his face, with his arms laid along and bound to his body; the middle, then, of a thong which is soft, sufficiently broad and long, and composed of two cross straps of leather, is to be twice carried along the middle of the patient's breast, as near the armpits as possible, then what is over of the thongs at the armpits is to be carried round the shoulders, and afterward the ends of the thong are to be fastened to a piece of wood resembling a pestle; they are to be adapted to the length of the bench laid below the patient, and so that the pestle-like piece of wood resting against this bench may make extension. Another such band is to be applied above the knees and the ankles, and the ends of the thongs fastened to a similar piece of wood; and another thong, broad, soft, and strong, in the form of a swathe, having breadth and length sufficient, is to be bound tightly round the loins, as near the hips as possible; and then what remains of this swathelike thong, with the ends of the thongs, must be fastened to the piece of wood placed at the patient's feet, and extension in this fashion is to be made upward and downward, equally and at the same time, in a straight line. For extension thus made could do no harm, if properly performed, unless one sought to do mischief purposely.”
Hippoc. Art. 47
- Apollonius’ Treatise on Joints was preserved in a manuscript and kept in a collocation of the Byzantine physician, Nikitas.
- Contain 30 images illustrating the commentary of Apollonius on the Hippocratic treatise
- Now housed in the Laurentian Library of Florence
- This work comprises three books on the joints of the shoulder (Book 1); elbow, carpal bones and vertebrae (Book 2); and femur, knee and talus (Book 3). The text is accompanied by 30 exceptional sketches depicting reduction techniques to help clarify descriptions in the text.
- He describes several practical reduction techniques that can be used in a gymnasium in case of emergency injuries.
- Several were used by Apollonius himself and others he learned from his teacher Zopyrus, who followed the teachings of Hippocrates meticulously.
Timeline
Hippocrates
Apollonius
- Collection of about 60 Ancient Greek medical works
- Foundation of Western medical practice
- Covers many diverse aspects of medicine: Hippocrates’ medical theories, ethical practices, diagnosis and treatments of various illnesses
On the Articulations:
- Hippocrates spoke about the treatment of dislocations, deformities, and reduction
- As an agrarian society and heavy emphasis on athleticism, Greeks has greater risk of injuries
- Discusses symptoms and treatments
- 87 parts
- Apollonius was active at the court of the Ptolemies around 80-58 B.C.
- Wrote several books on medicine
- His most important (and the one that survived) is Peri Arthron written in Cyprus
- Book includes 30 hand-painted pictures, believed to be copies made from the original book written by Hippocrates himself
- Copy of this work was found in the library of the Byzantine doctor Nikitas (10 century AD)
- Now kept in Florence
1.
3.
How to Perform
Part 47 of Hippocrates “On the Articulations”:
“But the physicians, or some person who is strong, and not uninstructed, should apply the palm of one hand to the hump, and then, having laid the other hand upon the former, he should make pressure, attending whether this force should be applied directly downward, or toward the head, or toward the hips. This method of applying force is particularly safe; and it is also safe for a person to sit upon the hump while extension is made, and raising himself up, to let himself fall again upon the patient. And there is nothing to prevent a person from placing a foot on the hump, and supporting his weight on it, and making gentle pressure; one of the men who is practiced in the palestra would be a proper person for doing this in a suitable manner”
Hippoc. Art. 47
How to Perform such Practice
Some of the hand-painted images by Apollonius show the Hippocratic Board and treatment for spinal deformities suggesting the audience was physicians in the gymnasia.
Peri Arthron
Practical Uses
Effects on Orthopedics Today
Orthopedics
A review of Hippocratic texts suggests that actual surgery on the spine was a great rarity. Stabilization of the spine with external splinting was common. Injury to the spinal marrow was believed to be quite serious and resultant problems with urinary retention were considered to be indicators of the gravity of the injury. From this brief clinical note one can see that Hippocrates and his school clearly did not favor surgical intervention. External stabilization and immobilization remained the treatment of choice. Besides the expected poor outcomes, there was still the risk of infection, the lack of an antiseptic technique, and minimal anesthesia that kept the Hippocratic school and subsequent generations of surgeons from following any form of aggressive surgical intervention in spine injury.
Changes to the Hippocratic Board
Oribasius (325–400 AD), a Byzantine physician, added a bar to the Hippocratic board for the treatment of scoliosis, as well as spinal trauma.
Changes to the Hippocratic Board
VAX - D
A non-surgical procedure referred to as the Vertebral Axial Decompression (VAX-D) has been developed for treating certain patients with lower back pain. Patients undergoing VAX-D are fitted with a special pelvic harness and then placed on the VAX-D table. The device then applies controlled tension along the axis of the spinal column, while the harness assists in providing decompression of the lumbar spine. The decompression process is controlled by computer program with supervision by a human technician.
Citations
Resources
Hippocrates. On the Articulations. 47. Rev. ed. Loeb Classical Library.
Hippocrates, Hippocrates, Hippocrates, Jones W H S., and E. T. Withington. “Part 47.” Essay. In Hippocrates: With an English Translation. Cambridge, MA: Harvard University Press, 1979.
Hippocrates. “The Internet Classics Archive: On the Articulations by Hippocrates.” The Internet Classics Archive | On the Articulations by Hippocrates. Accessed September 18, 2022. http://classics.mit.edu/Hippocrates/artic.44.44.html.
Markatos K;Korres D;Chytas D;Karamanou M;Sourlas I;Androutsos G;Mavrogenis A; “Apollonius of Citium (First Century BC) and His Work on the Treatment of Joint Dislocations.” International orthopaedics. U.S. National Library of Medicine. Accessed September 18, 2022. https://pubmed.ncbi.nlm.nih.gov/29313095/.
“The Nicetas Codex.” Historyofmedicine.com. Accessed September 22, 2022. https://www.historyofmedicine.com/d/the-nicetas-codex.
Power, D'arcy. “The Scamnum Hippocratis.” Proceedings of the Royal Society of Medicine 18, no. Sect_Hist_Med (1925): 15–17. https://doi.org/10.1177/003591572501801703.
Scoliosis, Hudson Valley. “Treatment of Scoliosis a History.” Strauss Scoliosis Correction, May 11, 2021. https://www.hudsonvalleyscoliosis.com/what-is-scoliosis/history/.
Truumees, Eeric. “A History of Lumbar Disc Herniation from Hippocrates to the 1990s.” Clinical Orthopaedics & Related Research 473, no. 6 (2015): 1885–95. https://doi.org/10.1007/s11999-014-3633-7.