History of the Study
of Locomotion
Instruction concerning a dislocation of a vertebra of the neck: if you
examine a man having a dislocation of the a vertebra of his neck, should
you find him unconscious of his arms and legs on account of it......then
you should say an ailment which cannot be treated
The seventeen columns on the recto comprise the first surgical treatise
thus far discovered. It consists exclusively of case reports, systematically
organized - beginning with injuries of the head and proceeding downward
through the body, like a modern treatise on anatomy. The treatment of these
injuries is rational and chiefly surgical; there is resort to magic in
only one case out of the forty-eight cases preserved. Each case is classified
by one of three different verdicts: (1) favorable, (2) uncertain, or (3)
unfavorable. The third verdict, expressed in the words, 'an ailment not
to be treated,' is found in no other Egyptian medical treatise. This unfavorable
verdict occurring fourteen times in the Edwin Smith Papyrus marks a group
of cases (besides one more case) which the surgeon cannot cure. It is likely
that the patients described in the 48 cases were injured by falls (maybe
from working on monuments or buildings) or were victims of battle (many
wounds appear to be caused by spears, clubs or daggers.) The brain is mentioned
7 times throughout the papyrus. However, there is no use of the word "nerve."
The
48 cases contained within the Edwin Smith Surgical Papyrus concern:
-
27 head injuries (cases #1-27)
-
6 throat and neck injuries (cases
#28-33)
-
2 injuries to the clavicle (collarbone)
(cases #34-35)
-
3 injuries to the arm (cases #36-38)
-
8 injuries to the sternum (breastbone)
and ribs (cases #39-46)
-
1 injury to the shoulder(case #47)
-
1 injury to the spine (case #48)
Edwin Smith, was born in Connecticut in 1822, the year that Egyptian hieroglyphic
was first deciphered. On January 20, 1862 in the city of Luxor, Smith bought
the surgical papyrus from a dealer named Mustapha Aga. Two months later
the same vandals sold him the remaining fragments glued onto a dummy roll.
Although Smith recognized the fraud, pieced the two together, and made
an attempt at translation, it was not until 1930 that James H. Breasted
translated the treatise and established its importance. According to Breasted,
the Edwin Smith Papyrus is a copy of an ancient composite manuscript
which contained, in addition to the original author's text (3000-2500 B.C.),
a commentary added a few hundred years later in the form of 69 explanatory
notes (glosses). It contains 48 systematically arranged case histories,
beginning with injuries of the head and proceeding downward to the thorax
and spine, where the document unfortunately breaks off. These cases are
typical rather than individual, and each presentation of a case is divided
into title, examination, diagnosis, and treatment.
The
scribe of over 3,500 years ago had copied at least eighteen columns of
the venerable treatise and had reached the bottom of a column when, pausing
in the middle of a line, in the middle of a sentence, in the middle of
a word, he laid down his pen and pushed aside forever the great Surgical
Treatise he had been copying, leaving 15½ inches (39 cm.) bare and
unwritten at the end of his roll.
Case Eight
Title: Instructions concerning a smash in his skull under the skin of his
head.
Examination: If thou examinest a man having a smash of his skull, under
the skin of his head, while there is nothing at all upon it, thou shouldst
palpate his wound. Shouldst thou find that there is a swelling protruding
on the out side of that smash which is in his skull, while his eye is askew
because of it, on the side of him having that injury which is in his skull;
(and) he walks shuffling with his sole, on the side of him having that
injury which is in his skull...
Treatment: His treatment is sitting, until he [gains color], (and)
until thou knowest he has reached the decisive point....
Gloss: As for: "He walks shuffling with his sole," he (the surgeon)
is speaking about his walking with his sole dragging, so that it is not
easy for him to walk, when it (the sole) is feeble and turned over, while
the tips of his toes are contracted to the ball of his sole, and they (the
toes) walk fumbling the ground. He (the surgeon) says: "He shuffles," concerning
it...
Case Thirty-One
Title: Instructions concerning a dislocation in a vertebra of [his]
neck. Examination: If thou examinest a man having a dislocation in a vertebra
of his neck, shouldst thou find him unconscious of his two arms (and) his
two legs on account of it, while his phallus is erected on account of it,
(and) urine drops from his member without his knowing it; his flesh has
received wind; his two eyes are bloodshot; it is a dislocation of a vertebra
of his neck extending to his backbone which causes him to be unconscious
of his two arms (and) his two legs. If, however, the middle vertebra of
his neck is dislocated, it is an emissio seminis which befalls his phallus.
Diagnosis: Thou shouldst say concerning him: "One having a dislocation
in a vertebra of his neck, while he is unconscious of his two legs and
his two arms, and his urine dribbles. An ailment not to be treated."
Gloss: As for: "A dislocation in a vertebra of his neck," he is speaking
of a separation of one vertebra of his neck from another, the flesh
which is over it being uninjured; as one says, "It is wnh," concerning
things which had been joined together, when one has been severed from another.
Breasted, J.H., The Edwin Smith Surgical Papyrus, Chicago: University
of Chicago Press, 1930.
Plato (428-348 BC)
First, then, the gods, imitating the spherical shape of the universe,
enclosed the two divine courses in a spherical body, that, namely, which
we now term the head, being the most divine part of us and the lord of
all that is in us: to this the gods, when they put together the body, gave
all the other members to be servants, considering that it partook of every
sort of motion. In order then that it might not tumble about among the
high and deep places of the earth, but might be able to get over the one
and out of the other, they provided the body to be its vehicle and means
of locomotion; which consequently had length and was furnished with four
limbs extended and flexible; these God contrived to be instrumnets of locomotion
whith which it might take hold and find support, and so be able to pass
through all places, carrying on high the dwelling place of the most sacred
and divine part of us. Such was the origin of legs and hands, which for
this reason were attached to every man.
Timaeus (360
BC), translated by Benjamin Jowett
Hippocrates (460-370 BC)
When, then, a dislocation has not been reduced,
but has been misunderstood or neglected, the leg, in walking, is
rolled about as is the case with oxen,
and the weight of the body is mostly supported on the sound leg, and the
limb at the flank, and the joint where
the dislocation has occurred is necessarily hollow and bent, while on the
sound side the buttock is necessarily rounded.
For if one should walk with the foot of the sound leg turned
outward, the weight of the body would be
thrown upon the injured limb, but the injured limb could not carry it,
for
how could it? One, then, is forced in walking
to turn the leg inward, and not outward, for thus the sound leg best
supports its own half of the body, and
also that of the injured side. But being hollow at the flank and the hip-joint,
they appear small in stature, and are forced
to rest on a staff at the side of the sound leg. For they require the
support of a staff there, since the nates
inclines to this side, and the weight of the body is carried to it. They
are
forced also to stoop, for they are obliged
to rest the hand on the side of the thigh against the affected limb; for
the
limb which is injured cannot support the
body in changing the legs, unless it be held when it is applied to the
ground. They who have got an unreduced
dislocation inward are forced to put themselves into these attitudes, and
this from no premeditation on their part
how they should assume the easiest position, but the impediment itself
teaches them to choose that which is most
conformable to their present circumstances. For persons who have a
sore on the foot, or leg, and cannot rest
upon the limb, all, even children, walk in this way; for they turn the
injured
limb outward in walking, and they derive
two advantages therefrom, to supply two wants; the weight of the body
is not equally thrown upon the limb turned
outward, as upon the one turned inward, for neither is the weight in a
line with it, but is much more thrown upon
the one under the body; for the weight is in a straight line with it, both
in
walking and in the shifting of the legs.
In this position one can most quickly turn the sound limb under the body,
by walking with the unsound limb outward, and the sound inward. In the
case we are now treating of, it is well that
the body finds out the attitudes which
are the easiest for itself. Those persons, then, who have not attained
their
growth at the time when they met with a
dislocation which is not reduced, become maimed in the thigh, the leg,
and the foot, for neither do the bones
grow properly, but become shortened, and especially the bone of the thigh;
and the whole limb is emaciated, loses
its muscularity, and becomes enervated and thinner, both from the
impediment at the joint, and because the
patient cannot use the limb, as it does not lie in its natural position,
for a
certain amount of exercise will relieve
excessive enervation, and it will remedy in so far the deficiency of growth
in
length. Those persons, then, are most maimed
who have experienced the dislocation in utero, next those who have
met with it in infancy, and least of all,
those who are full grown. The mode of walking adopted by adults has been
already described; but those who are children
when this accident befalls them, generally lose the erect position of
the body, and crawl about miserably on
the sound leg, supporting themselves with the hand of the sound side
resting on the ground. Some, also, who
had attained manhood before they met with this accident, have also lost
the faculty of walking erect. Those who
were children when they met with the accident, and have been properly
instructed, stand erect upon the sound
leg, but carry about a staff, which they apply under the armpit of the
sound
side, and some use a staff in both arms;
the unsound limb they bear up, and the smaller the unsound limb, the
greater facility have they in walking,
and their sound leg is no less strong than when both are sound. The fleshy
parts of the limb are enervated in all
such cases, but those who have dislocation inward are more subject to this
loss of strength than, for the most part,
those who have it outward.
Part 52
When persons have attained their full growth
before meeting with this dislocation, and when it has not been
reduced, upon the subsidence of the pain,
and when the bone of the joint has been accustomed to be rotated in
the place where it is lodged, these persons
can walk almost erect without a staff, and with the injured leg almost
quite straight, as it does not admit of
easy flexion at the groin and the ham; owing, then, to this want of flexion
at
the groin, they keep the limb more straight
in walking than they do the sound one. And sometimes they drag the
foot along the ground, as not being able
to bend the upper part of the limb, and they walk with the whole foot on
the ground; for in walking they rest no
less on the heel than on the fore part of the foot; and if they could take
great steps, they would rest entirely on
the heel in walking; for persons whose limbs are sound, the greater the
steps they take in walking, rest so much
the more on the heel, while they are putting down the one foot and raising
the opposite. In this form of dislocation,
persons rest their weight more on the heel than on the anterior part of
the
foot, for the fore part of the foot cannot
be bent forward equally well when the rest of the limb is extended as
when it is in a state of flexion; neither,
again, can the foot be arched to the same degree the limb is bent as when
it
is extended. The natural state of matters
is such as has been now described; and in an unreduced dislocation,
persons walk in the manner described, for
the reasons which have been stated. The limb, moreover, is less fleshy
than the other, at the nates, the calf
of the leg, and the whole of its posterior part. When this dislocation
occurs in
infancy, and is not reduced, or when it
is congenital, in these cases the bone of the thigh is more atrophied than
those of the leg and foot; but the atrophy
of the thigh-bone is least of all in this form of dislocation. The fleshy
parts, however, are everywhere attenuated,
more especially behind, as has been stated above. If properly trained,
such persons, when they grow up, can use
the limb, which is only a little shorter than the other, and yet they
support themselves on a staff at the affected
side. For, not being able to use properly the ball of the foot without
the heel, nor to put it down as some can
in the other varieties of dislocation (the cause of which has been just
now
stated), on this account they require a
staff. But those who are neglected, and are not in the practice of putting
their foot to the ground, but keep the
limb up, have the bones more atrophied than those who use the limb; and,
at
the articulations, the limb is more maimed
in the direct line than in the other forms of dislocation.
Part 60
On the Articulations
(400 BC)
Aristotle (384-322 BC)
On
the Gait of Animals (350 B.C.)
Questions (part 1)
-
what are the fewest points of motion necessary to animal progression
-
why sanguineous animals have four points and not more, but bloodless animals
more than four
-
why some animals are footless, others bipeds, others quadrupeds, others
polypods
-
why all have an even number of feet
-
why the points on which progression depends are even in number
-
why are man and bird bipeds, but fish footless
-
why do man and bird, though both bipeds, have an opposite curvature of
the legs
Solutions
-
the moving creature always changes its position by pressing against what
lies below it (3)
-
the beginning of movement is on the right: nature of the right is to initiate
movement, that of the left to be moved
-
all men carry burdens on the left shoulder
-
hop easier on the left leg
-
all men lead off with the left
-
men guard themselves with their right
-
spiral-shaped Testaceans have their shells on the right, go forward in
the direction opposite to the spire
-
all animals then start movement from the right
-
the right is more dextrous than the left
-
men and birds are biped because they have the superior part distinguished
from the front (5)
-
animals which have the superior and the front parts identically situated
are four-footed, many-footed, or footless (6)
-
the animal must act with opposite limbs, shifting the weight from the limbs
that are being moved to those at rest (8)
-
without flexion there could not be walking or swimming or flying (9)
-
when then one leg is advanced it becomes the hypotenuse of a right-angled
triangle (10)
-
its square then is equal to the square on the other side together with
the square on the base
-
the one at rest must bend either at the knee
-
If a man were to walk parallel to a wall in sunshine, the line described
(by the shadow of his head) would be not straight but zigzag, becoming
lower as he bends, and higher when he stands and lifts himself up.
-
birds are hunchbacked yet stand on two legs because their weight is set
back (11)
-
their being bipeds and able to stand is above all due to their having the
hip-bone shaped like a thigh
-
one in the leg before the knee-joint, the other joining his part to the
fundament - not a thigh but a hip
-
all creatures which naturally have the power of changing position by the
use of limbs (12)
-
must have one leg stationary with the weight of the body on it
-
and when they move forward the leg which has the leading position must
be unencumbered
-
and the progression continuing the weight must shift and be taken off on
this leading leg
-
it is evidently necessary for the back leg from being bent to become straight
again
-
while the point of movement of the leg thrust forward and its lower part
remain still
-
bird though a biped is not erect, and has the forward parts of the body
lighter than the hind (15)
Archimedes (287-212 BC)
Another Greek, determined hydrostatic principles governing floating
bodies that are still accepted
as swimming. In addition, Heath (1972) suggests that his inquiries
included the laws of leverage and determining the center of
gravity and the foundation of the oretical mechanics.
Galen (131-201 AD)
Roman citizen
who tended the Pergamum's gladiators in Asia Minor and is considered to
have been
the first team physician in history. He used number to describe muscles.
His essay De Motu Musculorum (On the Movements of Muscles) distinguished
between motor and sensory nerves, agonist and antagonist muscles, described
tonus, and introduced terms such as diarthrosis and synarthrosis. He taught
that muscular contraction resulted from the passage of "animal spirits"
from the brain through the nerves to the muscles. Snook (1978) suggested
that some writers consider his treatise the first textbook on kinesiology,
and he has been termed "the father of sports medicine." Due to his era’s
discouragement of human dissection, the majority of Galen’s work was based
on the dissections of dogs, pigs, and apes.