HISTORIC BACKGROUNDS OF ORTHOPEDIC SURGERY* By WALTER G. STUCK, M.D.

SAN ANTONIO, TEXAS

AS the developments and at- paleolithic age (25,000 years ago) as / vk tainments of modern sur- evidenced by primitive drawings on /\k gery are studied, and its the walls of paleolithic caverns in **“* divisions and specializations Spain.7 considered, it is easy to overlook the A striking parallelism continues distant past of each of these branches further in the knowledge of the his­ and to forget their collateral ancestry. toric backgrounds of these two major The legacy from primitive surgery is specialties. Except for the primitive not great and the debt to the surgeons circumcision knives discovered in before Lister’s time may be easily Egypt, the earliest surgical appliances paid; yet even so, there is still intense known are the splints found by the fascination in tracing and discovering members of the Hearst Expedition on the poignant contributions of all our two mummies in the same tomb at progenitors. Naga-ed-der. Smith examined these bodies, which were judged to be Ancient Surgery 5000 years old, and in one body, that The neurosurgeon of today beholds of a girl, aged about fourteen years, his earliest predecessors in those un­ there was a fracture in the middle known prehistoric medicine men who third of the femur (Fig. 1), and in trephined the skulls of men of the another, fracture of both bones of the neolithic age 10,000 years ago. Plastic forearm. These members were splinted surgery saw its birth in the early by wooden strips wrapped in linen rhinoplastic operations performed by with padding of coarse grass and the the ancient Hindus, and the ophthal­ whole bound by linen sheets. Ap­ mologists are the heirs to the skilful parently the early orthopedists made Greek, Antyllus, who mentioned re­ no effort toward extension; however, moval of cataract by extraction and criticism is unjustified when one con­ suction. siders the efficacy of such splints for But more ancient than any of immobilization and the singular thor­ these are the earliest evidences of oughness with which they are applied. techniques which began the evolution Nevertheless, in an extensive study toward two great modern branches of of paleopathology in Egypt, Sir Arm­ surgery, genitourinary and orthopedic. and Ruffer concluded that the final Lost in the mists of antiquity is the results of treatment of fractures in story of the origin of the operation of ancient times was bad, and that the circumcision, the first distinctly spe­ frequency of malunitcd and ununited cialized urological surgical procedure, breaks was high. and likewise, another rite, amputation Again the earliest portrayal extant of the fingers, a distinct orthopedic of surgeons at work combines the problem, goes back at least to the late backgrounds of these two specialties. *Read before the Salerno Medical History Club of The Mayo Clinic, Rochester, Minn., April 5, 1932. Max Muller,4 in IQ04, explored a tomb tained an important position in their at Lb ret, near ancient Memphis, and traditions. Likewise, in Ezekiel 30:20, there found a sculptured panel be­ is a casual consideration of the current

lieved to date not later than 2500 b.c. (4500 years ago). Here in the upper panels (Fig. 2) were pictured the surgeons at work on the hand, foot, and knee of their several patients, and in the lower rows of illustrations, the treatment of fractured extremities for genitourinary surgeons of a bygone it is stated: “Son of man, I have age were apparently cutting for broken the arm of Pharaoh, King of chordee or performing circumcision Egypt, and lo it shall not be bound up on two adults. In the accompanying to be healed, to put a roller to bind it, hieroglyphics are manifested intimate to make it strong to hold the sword.” sidelights of the problems of primitive Henceforth the subsequent story of practice. How familiar to us all is the genitourinary surgery passes to those cry of the patient, “Do this and let chapters describing the charlatanism me go!” or “Do not hurt me thus!” of the uroscopists (water doctors) and equally characteristic in its calm and the adroit maneuvers of the and respect for authority, is the sur­ prc-Listerian Iithotomists on its path geon’s reply, “I’ll do as bids me the to the final story of the complete king.” specialty today. Likewise the narra­ Furthermore, in the King James tive of the progress of orthopedics version of the Bible, only two surgical engrosses in passing the indispensable procedures are mentioned which at services of the early army surgeons the same time depict the beginnings and the unquestioned adeptness of the of our modern orthopedics and urol­ bone setters and brace makers who ogy. Circumcision, of course, is fre­ contributed to the composite back­ quently referred to; for as a sacerdotal ground of the present-day orthopedic rite among the Hebrews, it main­ surgeon. In the surgical thinking of primitive by fisticuffs and her subjects com­ man, orthopedics indubitably played monly wielding heavy clubs, we must an important part. Human life was reiterate that life among the ancients was unquestionably violent! The war wounds in ancient times, however, were not so important ortho- pcdically for, until the introduction of gunpowder in the thirteenth cen­ tury, injury to bones was much less common. Wounds from lance, spear, and arrow engendered much infection and loss of life, but it is significant that of the 250 wounds mentioned in Homer8 with a mortality of 75 per cent, there was not a single case of loss of limb.

Hippocratic Era From the time of Hippocrates on­ ward, surgical writings were not essentially violent and disordered so complete without a considerable por­ that in the pursuit of food, the defense tion being devoted to the subject of of homes, and the conquest of ene­ fractures, dislocations, and other mies, our ancestors frequently must problems encompassed in modern or­ have experienced fractures, disloca­ thopedics. In the Hippocratic writings tions, and other injuries of the ex­ preserved for us today, the four tremities. Smith has pointed out that treatises (“On the surgery,” “On since time immemorial the Egyptian fractures,” “On the articulations,” native has habitually carried a and “The mochlicus”) relating to “naboot,” a thick heavy staff about these subjects comprise more than a 5 feet long, which he utilized for third of the total. Adams, the trans­ sport or for more serious acts of lator, summarized: “When we reflect defense.29 This weapon, by its very on the admirable manner in which antiquity and usefulness, was no the whole subject is handled, and the doubt a most prolific source of cracked many important truths which are heads and fractured forearms. Those evolved in the course of it, we cannot of you who heard Lord Moynihan’s surely but regard with veneration the historic address in August, 1930, recall labors of our forefathers.” that he determined the shrewish iras­ Hippocrates, after a casual review cibility of the mother of King Tutank­ of the structure and function of the hamen by discovering a poorly-united skeletal system, proceeded directly fracture of one of her metacarpal to consider the care of injuries and bones. This injury, he explained, is disease sustained by it. His considera­ produced almost always by striking tion of dislocated shoulder is superb with the closed fist and is a common and was matchless until modern times: sequel to domestic brawls. What with “When, then, a dislocation to the the queen-mother settling altercations armpit takes place, seeing it is of frequent occurrence, many persons extended, the physician should apply know how to reduce it, for it is an the palms of his hands and adjust easy thing to teach all the methods the fractured parts, and then having by which physicians effect the reduc­ tions, and the best manner of applying them.” Follows then a detailed de­ scription of four successful maneuvers including the use of the heel in the axilla (a familiar technique to us all) and the “method with a ladder.” In the latter method he explained that “some round thing should be tied upon the step of the ladder which may be fitted to the armpit, whereby the head of the bone may be forced into its natural place” and then, with the wrist secured to it, the ladder is forced downward to the vertical posi­ tion. However, caution was advised in any methods of treatment since “it should be known that one con­ rubbed the parts with cerate ... it stitution differs much from another is to be bound up in this state.” as to the facility with which disloca­ This cerate dressing (Fig. 3), ante­ tions in them may be reduced.” dating the plaster-of-Paris cast by Hippocrates,1 in this connection, 2000 years, was a very tangible devised and described minutely his contribution to surgery and, if it was scamnum, an effective mechanical generally utilized, a source of much contrivance for extending limbs and benefit for centuries. bodies. He said: “By means of such Spinal deformities, with “subluxa­ machines and of such powers it ap­ tions” or “gibbosities,” called also for pears to me that we need never fail extension and correction by these, as in reducing any dislocation at a joint.” we see them today, enormous forces. Not altogether unjustified optimism Traction in the scamnum (Fig. 4), is this, however, when we study the accompanied by levering directly over mechanical powers enlisted. He coun­ the bony prominence, was an accepted sels that “there are many methods standard and may even have been of of making extension. But the best benefit in some cases of Pott’s disease thing is for any physician who prac­ with kyphosis. Moreover, the succus- tices in a large city, to have prepared sion treatment for spinal deformity a proper wooden machine, with all was of even greater severity and, the mechanical powers applicable in although Hippocrates carefully ex­ cases of fracture and dislocation, plained it, there is at the same time either for making extension or acting a strong condemnation. “Wherefore as a lever.” succussion on a ladder has never After reduction is complete, the straightened anybody, as far as I instructions for immobilization of frac­ know, but it is principally practiced tures are excellent. “When they are by those physicians who seek to astonish the mob. . . . But the physi­ ings, these are the least ephemeral, cians who follow such practice, so the most accurate as judged by pres­ far as I have known them, are all ent standards, and withal the most valuable to subsequent generations. In short, these treatises, so briefly considered here, comprise the greatest single contribution to the historic background of orthopedic surgery. Of the several commentators who borrowed heavily from Hippocrates in succeeding centuries, none was able to add appreciably to the portion on traumatic surgery which has just been reviewed. Galen described the “glossocomium,” an instrument de­ veloped by the practitioners of his day for traction and countertraction to extremities, yet it was little differ­ ent from Hippocrates’ device. Paulus Aeginata added the details of a box stupid.” However: splint made of wood or earthenware If one should think of trying succus- for the lower extremity.15 This im­ sion, it may be applied in the following provement had many points of definite manner [Fig. 5]. The ladder is to be advantage and was, as a matter of padded with leather or linen cushions fact, in common use until less than laid across . . . (the patient) is then to a generation ago. Albucasis, the elev­ be laid upon the ladder upon his back enth century Arab physician, pub­ and the feet, at the ankles, are to be lished his great treatise on surgery fastened, at no great distance from one which included more additional details another, to the ladder with some firm but such as the mention of paralysis soft band. . . . When you have arranged following fracture of the spine. He these matters thus, you must hoist up also acknowledged his profound debt the ladder either to a high tower or to the to the writings of Hippocrates. gable end of a house; and then let go so that it falls straight downward and lands Medieval Orthopedics (Military Surgery squarely. and Quackery) Little hope of success is held out, In the long centuries of medievalism though, and the practitioner is warned which followed in the wake of the of probable failure. Also, he concluded downfall of Rome, the intellectual sagely: “It is disgraceful in every art, and ethical standards of contemporary and more especially in medicine, after surgery were debased almost to the much trouble, much display, and point of extinction. Following the much talk to do no good after all.” tendency of Galen to dissociate sur­ The teaching by the “Father of gery from medicine, the Arab physi­ Medicine” of orthopedic principles cians degraded even more the lot could afford countless other illustra­ of the surgical operator. Hence in an tions, for of all the Hippocratic writ­ era of empiric medicine, the few surgeons who meet the eye are per­ barons of Mercoeur as a consequence sonalities who stand forth by sheer to a rare caprice of fortune. A lady force of will or by the vigor of their of the household had fractured her preserved writings. The high water leg in a hunting mishap and, all other mark of medieval medicine was with­ means proving unsatisfactory, an ora­ out question reached at the great cle was consulted for advice. The school of Salerno; yet, even here, reply was that cure should be effected surgery received scant attention. by “an unlettered rustic” and by Two brilliant exceptions in this accident the choice fell on young period of decadence, Henri de Monde- de Chauliac. His mechanical intuition, ville and Guy de Chauliac, were each acute enough to procure satisfactory surmounters of great obstacles and results, ensured his future, for he each has left us an outstanding sur­ was sent to Toulouse, Montpellier, gical treatise.19 Although Mondeville Bologna, and Paris to secure the best was the first to write such a treatise, medical education available at the his book was not printed until almost time. His later life as physician to 600 years after it was written. Fight­ the popes of Rome, we can mention ing the rapid progress of pulmonary only in passing. The magnum opus, tuberculosis, he completed the first the “Great Surgery” written in 1363, three parts (1. Anatomy; 11. Wounds, the “solace to his old age,” described and hi. All surgical maladies ex­ the ligature, cautery, and compression cept wounds, ulcers, and affections bandage with marked distinctness two of bones) of his work in 1314, but centuries prior to the time of Pare, Part iv which was to encompass himself the accredited “Father of fractures, dislocations, and the affec­ modern surgery” and the reputed tions of bones was abandoned in the founder of the technique of ligation. face of his overwhelming malady. But, to us, the chapters devoted to Thus, in despair, he begins the diagnosis and treatment of fracture introduction to the last part, “I are found to be even more interesting, cannot live long, being asthmatic, incredibly accurate, and timely in coughing, phthisical, and in consump­ their delineations. When de Chauliac tion” and at that point his efforts stated that in the late stages of cease. So, dying in harness, he be­ fracture healing “callus is engen­ queathed to us his incompleted works dered . . . with the help of God,” which unfortunately skipped the sec­ few of us would take exception and tion that would have revealed the fewer still could offer appreciable orthopedic practice of his age. supplementary details to that incon­ Happily de Chauliac3 affords a trovertible fact. His portrayal of the striking contrast in this connection. physical signs of fracture is excellent His “Great Surgery,” a far more and his warning of the dangers of distinguished authority, is preserved infection specious. De Chauliac di­ intact and the section “On wounds vided the purpose of treatment of and fractures” is fascinating by its fracture into four parts: first, to very clarity and its anticipation of equalize (reduce) the bone; second, modern methods. Tradition has it to preserve the equalized bone; third, that the boy Guy de Chauliac was to bind it with callus, and fourth, taken under the patronage of the to remedy complications. Reduction is to take place by manual traction in orthopedic history and a just until the fractured limb is restored, cause for profound veneration of Guy “using the healthy limb as an exem­ de Chauliac, the Father of French plar,” then it is to be splinted with surgery. light willow strips. After splinting, Although the works of two great “let one have a cradle or suspensory medieval surgeons and writers have in which the limb will be firmly and just been reviewed, it is necessary evenly placed ... a mattress bed to remind one’s self that most of the on which the patient sleeps and, if it is operations performed in these cen­ necessary, let it be perforated so turies were by the army or field that he may go to stool . . . [and surgeons who followed the troops have] a cord hanging over the bed that were at battle. These generally or some other thing for him to catch were men of far less ability or culture. and help himself when he wishes to The care of the wounded fell, in go to stool or straighten or turn Roman times, to the hands of an army himself.”* physician of very low rank. As a To cite a few other general recom­ matter of fact, in the time of the mendations; in fracture of the ribs Emperor Augustus26 these practitioners he advises that the thorax be bound were humiliated in the eyes of the tightly; in fractured jaw, the teeth soldiers by being forced to bear a are to be wired together with gold slave name. When, in the twelfth thread, and spinal fracture is con­ and thirteenth centuries, the barber­ sidered to warn against neglect of surgeons came into being, they were signs of involvement of the central also enlisted to serve in the menial nervous system and the dangers mani­ capacity as camp surgeons to the fest by urinary and fecal incontinence. current military leaders. Senn stated: In summarizing, then, it seems “many of them, besides practicing inconceivable that these instructions their healing art, were required to and precautions should have been serve in the ranks as privates and as set down more than 500 years ago servants and ordinary barbers to when one considers other contempo­ their officers. Many of them lacked rary practices and the status of the elementary education and had no surgeons of de Chauliac’s day. But idea of anatomy and the art of of more compelling interest than any surgery. Most of them came from procedures already cited is the men­ the lower walks of life imbued with a tion of traction by weights, the first servile spirit and without originality I have been able to discover. “With of thought.” Until the sixteenth cen­ regard to myself,” he said, while tury, the barber-surgeon was little considering fracture of the hip, “the better than a craftsman. The physi­ thigh being bound with long splints cian was supreme in both medicine to the feet. ... I attach to the foot and surgery, and to him went the a leaden weight, passing the cord over privilege of deciding when operations a little pulley so that it will keep should be required and who should the leg in its proper length.”3 This, do them. The contemporary surgeon, to me, is one of the finest passages to whom the technical problems were * An excellent description incidentally of referred, possessed little more than our present-day “Balkan frame.” a most superficial knowledge of anat- omv and some manual dexterity with European surgeons, the idea evolved the knife. The outstanding practi­ rapidly. Suetin, of Brussels, suggested tioners of this age, in which surgery starch paste as a fixative, Schultz, was the prerogative of the camp of St. Petersburg, modified it further physician or in civil life the quack, by using salicylate of soda and, were Felix Wurtz (1518-1575) of finally, in 1852, Matthysen, a Hollan­ Zurich, Ambroise Pare (1510-1590), der, first proposed and utilized plaster- barber-surgeon to the King of France, of-Paris for the supporting bandage. and Robert Clowes (1540-1604), Peter Here, then, in brief, is the story of Lowe (1550-1610), and Richard Wise­ development of the most indispensable man (1620-1676) in England. Their appliance in the armamentarium of additions to orthopedics, however, modern orthopedic surgery which was were meager and their fame rests on brought from the ancient world by other pedestals. Nevertheless, a gem a military surgeon. worthy of note, is a passage in rhyme Apart from the actual surgery of from Wiirtz20 (“Surgical Practice,” the limbs, the development of pros­ 1563) wherein splinting for fracture thetic or artificial appliances also is described: owes a great debt to the army surgeons of the past. In addition to the enor­ Bind the patient not too strong, Else he’s choak’d and his bloode gone; mous loss of limbs from anesthetic leprosy or ergotism in the Middle In the binding be very cautious, Ages, or from judicial or inquisitorial Not too hard, nor yet too loose; mutilations, there was on the battle­ The band must hold the fracture stiffely, field an appalling number of amputa­ Yet the pulse must have its way thoroughly. tions performed for grave lacerating Few of the strictly military surgeons injuries. of this or subsequent eras can be Obviously, and most commonly, credited with major contributions to reconstructive suggestions came from the practice of orthopedic surgery, the military surgeon who encountered although in all major combats, includ­ these cases so frequently. To cite a ing the World War, their department few outstanding instances, the elder has initiated much needed reforms Pliny mentioned that Marcus Sergius, in the care of injuries to the extremi­ the great-grandfather of Catiline, who ties. For example, centuries later, lost his right hand in the second Napoleon’s army surgeon, Baron Lar- Punic War, later fashioned a hand rey, introduced into Europe the fixa­ of iron to supplant it.8 A very cele­ tion bandage which was to develop brated appliance also was made for into the plaster cast of today. During Gotz von Berlichingen (the robber­ the campaign of 1798-1799 in Egypt, knight of the sixteenth century who is he observed the Arabs using a stiff described to us in an early drama of bandage of straw covered with a Goethe) to replace his right hand, mixture of egg-albumen and lead- lost by musket shot at the siege of water.27,28 Apparently this appliance Landshut in 1504. Ambroise Pare was little changed from the original enlisted the skilful aid of the armorer12 cerate bandage described by Hip­ to produce several of his noteworthy pocrates for immobilizing fractured corrective devices. His “corselet for extremities. But once suggested to the correction of a twisted body” and the “little boots” for the treat­ later centuries, the public executioner, ment of deformities of the legs “of whose communion with the gods of which the sufferers are called Vari darkness was more intimate, was and Valgi and for too weak or slender recognized as a healer of merit. In legs,” are valuable contemporary ad­ Saxony, the executioner was an au­ denda. In Napoleonic times, Larrey, thorized practicing bonesetter as late Surgeon-General von Langenbeck, and as the eighteenth century. Graefe, all army surgeons who wit­ Nevertheless the physicians and nessed the frightful destruction of surgeons of the sixteenth and seven­ limbs, were very cogent factors in teenth centuries can share much of hastening the progress of prosthesis. the odium of this new growth for they Allusion has been made to another fostered the development of bone- group of practitioners, the boneset­ setters to avoid the frightful mortality ters,* who also contributed much to that accompanied any type of sur­ the historic background of orthopedic gical maneuver done by themselves. surgery. Unfortunately, the descend­ Pierre Franco (“Chirurgie,” 1561) ants of these mechanotherapists, far tells that the surgeons, afraid to from supplementing modern medicine, operate, often employed the quacks. are today the major menaces of “In some towns,” he added, “the legitimate practice and the bulwarks surgeons have their bonesetters think­ of quackery. In ancient Greece and ing it degrading to reduce a dislocation Rome, the gymnasiums and public or set a fracture.” Even the great baths were widely distributed and Cheselden described a cure of clubfoot largely patronized. Heat, massage, by “Mr. Presgrove, a professed bone- hydrotherapy, and manipulative pro­ setter then living in Westminster,” cedures were doubtless practiced ex­ and he admitted, “I recommended tensively and the operators must have the patient to him, not knowing how become quite skilled. However, the to cure him myself.” In a village near gymnast soon overstepped his sphere Moscow, as late as 1781, lived a and began to treat all bodily ills peasant so very skilled in manipula­ by this mechanotherapy. In Greece, tive procedures that Catherine the these men enlisted the aid of scribes Great decreed that pupils of the great to compose paeons of praise to their War Hospital at Moscow should study abilities, which I suppose are the first with this peasant, two at a time, for solicited testimonials of the irregular two months each. practitioner. There followed a flood In England, for 200 years, the of quackery so extensive that, in lore of bonesetting was passed from Galen’s time, he compared the Roman generation to generation (an apparent physicians to a band of robbers. essential to the acquisition of this The tendency spread and, in those quasimedical skill) in the Taylor fam­ days of unregulated medicine it was ily and other families of Lancashire. difficult to distinguish the physician They were the source for most of the or surgeon who had completed the ensuing flood of practitioners in that required studies of the times. country, including the celebrated and Black magic also was added to the wealthy Mrs. Mapp of Epsom. She it tenets of this profession, and, in was whom Percival Pott described * Ref. 5, 6, 9, 13, 18, 21, 22. as “an illiberal drunken female sav­ age” and who occupies the upper cen­ of this infamy, they required Meekren, tral position in Hogarth’s caricature, under ban of excommunication, to “The Company of Undertakers.” remove the portion of foreign bone. A similar family prospered in this Three years later, in 1685, Isacius country, and for several generations, Minius, another Dutch surgeon, sev­ the progeny of Job Sweet4 in Rhode ered the tendons in the neck of a Island and Connecticut were locally twelve-year-old boy to combat the famous as bonesetters of renown. deformity of wryneck.25 The genius of the clan, Benoni Sweet, The following century the specialty carried on an extensive and lucrative received its generally accepted name consultation practice in New York and, although it leaves much to be City in his later years, and at one desired, it is doubtless permanent. time numbered Governor De Witt Nicholas Andre (1685-1742), profes­ Clinton among his patients. sor of medicine at the University It is not of interest to pursue further of Paris, published a manual in 1741 the extension of bonesetting into the on the prevention of deformities in many cults of mechanotherapy as children by corrective exercises. For they are seen today. Nevertheless the title he coined the term, “Ortho- the bonesetter, of venerable memory, paedia” which, although limited in doubtless introduced many of the scope, has now come to encompass the procedures which are now recognized entire field of bone and joint surgery. in orthopedic surgery, or at least in A less famous contributor and one the practice of physiotherapy. whose name is associated with no out­ standing innovations was Jean Andre Advent of Orthopedic Surgery Venel (1740-1791) who is credited At last the beginning of modern with the founding of orthopedic sur­ orthopedic practice is reached, the gery in 1780 at his orthopedic institu­ era in which the treatment of fractures tion at Orbe, Switzerland, the first and dislocations is no longer the entire of its kind in existence. field and in which amputation ceases Far more timely was the develop­ to be the sole operation of conse­ ment in France fostered by Jacques quence. From thence, its growth may Delpech (1777-1832), professor of sur­ be followed until the advent of anti­ gery at Montpellier. His thorough sepsis in surgery where the historic volume “L’orthomorphie,” published phase ends and the present-day prac­ in 1828, was a complete study and tice of the specialty begins. description of deformities of bone and Orthopedic surgery had its advent joint. With the aid of friends, he in Holland late in the seventeenth established an idyllic orthopedic insti­ century when the first bone-graft tution at the edge of the city where operation, and the first tenotomy his theories of treatment were put for the correction of deformity were into effect in classic sylvan surround­ performed. Jobi Meekren,14 in 1682, ings.11,17 He also described the bene­ transplanted a piece of bone from the ficial effect of section of the Achilles skull of a dog into a defect in a tendon for the deformity of clubfoot, soldier’s cranium produced by injury which operation he performed in 1816. in battle. Healing was perfect, al­ Although this operation had been done though when the church got wind previously by Lorenz of Frankfort in 1782, by Scarpa in 1803, and by extensive work at Paris and Hanover, Sartorium in 1812, it fell to Delpech Mott was immensely enthusiastic for to reveal to the medical world the the future of this new specialty. He value of tenotomy in correcting con­ prophesied that “as the discovery tracture deformities in extremities. of Jenner has rid the world of a The therapeutic worth of massage loathsome pestilence and banished and graded exercises was further pro­ from our sight those disfigurations mulgated in Stockholm, about 1813, which made the most lovely linea­ by Pehr Henrik Ling (1779-1839), ments and complexions hideous to although the rise of “Swedish mas­ behold, so will orthopedic surgery, sage” methods is of slight import here. by its magic touch, unbind the fet­ tered limbs (and) restore symmetry Influence of Stromeyer to the distorted form.” On his return The teachings of Delpech were to this country, he conceived the developed, extended, and widely dis­ development of a large orthopedic seminated through Georg Freidrich sanitarium in New York, but his Louis Stromeyer (1804-1876) who, death disrupted the plan. after studying his principles, devoted And now this story approaches its his life to the correction of deformi­ finish in the similar careers of two ties. Stromeyer, a young Hanoverian, great pioneer orthopedic surgeons who was professor at Freiburg and Mu­ absorbed the tenets of Stromeyer and nich, and later surgeon-general of transported them to their respec­ the Hanoverian armies. Successful tive countries, England and America, tenotomy for clubfoot in 1831 estab­ namely, William John Little (1810- lished his fame, and soon the hospital 1894) of England, and Buckminster at Hanover became the fountain head Brown (1819-1891) of Boston. Both for the promulgation of the rapidly were crippled from childhood and growing art of orthopedic surgery. were intensely interested in the al­ Pupils of Stromeyer were the founders leviation of their deformities, both of the great orthopedic groups in studied at Hanover for a time, and London, Paris, Boston, and New each initiated in his homeland the York, and to him is due a great first orthopedic surgical clinics of tribute as the pioneer teacher of this consequence. These men deserve great specialty. commendation for their inception of Ditmold2 introduced the principles two outstanding present-day ortho­ of Stromeyer to New York at Bellevue pedic centers in the world. Hospital in 1841. His contemporaries In early childhood, one of Little’s in that city (Louis Bauer, Lewis lower extremities became palsied and Sayre, Henry Davis, and Charles F. deformed; the condition has been Taylor) were all affected profoundly described as a typical clubfoot. Not by the theories of Stromeyer that to be thwarted by such a physical subcutaneous tenotomy was a valu­ handicap, he consulted Delpech at able cure of bodily deformities. This Montpellier and operation was dis­ school was represented in Paris by couraged. Later, however, he saw Jules Louis Guerin (1801-1886) with Stromeyer, who, in July 1836, severed whom Valentine Mott of New York the Achilles tendon and achieved a studied for three years. After his fairly satisfactory result. Little was vastly impressed, and on his return bcr of years. Throughout this period to England in 1838, he set about to father and son applied themselves establish the Orthopedic Institution vigorously to the study of orthopedics (later the Royal Orthopedic Hospital) and became possessors of superior of London. In the first ten years of knowledge in the field. Buckminster the life of this great charity more than Brown, in 1844, received his medical 12,000 patients were treated and its degree from Harvard, and for two noble service has been carried on until years studied with Stromeyer and the present day by the descendants his proteges, Guerin and Little. On of the founder. Furthermore, the his return to Boston he assumed the contributions to orthopedic surgery orthopedic portion of his father’s from London, Edinburgh, and Liver­ practice and established himself as pool in ensuing decades arc in them­ the first orthopedic surgeon in this selves tributes to the profound and country to devote his professional lasting influence of William John life to the specialty. Fifteen years Little, Great Britain’s first eminent later, at the Home of the Good orthopedist. Samaritan, he developed in 1861 a In New England, orthopedics began special ward for the exclusive treat­ in 1838, when John Ball Brown2-6 of ment of deformity. This was the first Boston undertook the care of nine orthopedic clinic in America and the cases of spinal disease in a small inception of the great New England private sanitarium. His interest in school of orthopedists. In his will, the subject had been aroused by Brown provided for a professorship the gross incompetence of the prac­ of orthopedic surgery at Harvard titioners of his day to care for his and this fact, coupled with the suc­ son, Buckminster Brown, and he cession of able teachers who have had cast about for all the related held the post, are ample evidences information obtainable. Buckminster, of the far-reaching effects of Buck­ at fourteen years of age, fell on the minster Brown. ice* and was an invalid for a num- Of the later developments of this art, many are cognizant and the * In an obituary of Buckminster Brown, field has been well surveyed by Keith10 John Ridlon mentioned a fall on the ice at the and Osgood.17 But with this conclusion age of fourteen years which precipitated some form of hip disease. However, in a recent to a brief review of the historic communication, Dr. Ridlon wrote, “ I saw backgrounds of orthopedic surgery, Buckminster Brown only once, and that was many characters of compelling interest in 1888; and that is forty-three years ago. have been found, and veneration Dr. E. H. Bradford took me to call on him at for our forebears has, I hope, been his residence. ... I only remember a frail correspondingly heightened. little man sitting at his desk. I have the feeling that he was a cripple; but do not References remember any deformity.” 1. Adams, F. The Genuine Works of Hip­ Dr. Robert Osgood, of Boston, has kindly pocrates. N. Y., Wood, 1886, vol. 2, supplied this additional information: “I am 366 pp. quite sure that Dr. Bradford once told me his 2. Bradford, E. H. The President’s address. (Brown’s) trouble was an old Pott’s disease Tr. Am. Orthop. Assn., 2: 1-18, 1889. and I have consulted Dr. Brackett and Dr. 3. Brennan, W. A. Guy de Chauliac (a.d. Augustus Thorndike who are of the same 1363) on Wounds and Fractures. impression.” Chicago, Brennan, 1923, 154 pp. 4. Comstock, J. On the study of living 16. Osgood, R. B. Backgrounds of ortho­ anatomy. Boston M. & S. J., 49: 500 paedic surgery. J. Orthop. Surg., 3: (Jan. 18) 1854. 259 (June) 1921. 5. Fischer, G. Surgery one hundred years 17. Osgood, R. B. The Evolution of Ortho­ ago. J. A. M. A., 28: 308-313 (Feb. paedic Surgery. St. Louis, Mosby, 13) 1897. 1925, 70 pp. 6. Fox, R. D. On bone-setting (so-called). 18. Paget, J. Cases that bone-setters cure. Lancet, 2: 843-845 (Nov. 18) 1882. Brit. M. J., 1: 1-4 (Jan. 5) 1867. 7. Garrison, F. H. An Introduction to the 19. Pilcher, J. E. Guy de Chauliac and History of Medicine. Phila., Saunders, Henri de Mondeville, a surgical retro­ I9B, 763 PP- spect. Ann. Surg., 21: 84-102, 1895. 8. Garrison, F. H. Prosthetic appliances in 20. Pilcher, L. S. Felix Wurtz and Pierre war-time (historical resume). Mil. Franco, A glimpse of sixteenth century Surgeon, 39: 507-509 (Nov.) 1916. surgery. Ann. Surg., 24: 505-534, 9. Hood, Wharton: On the so-called “bone­ 1896. setting,” its nature and results. Lancet, 21. Quackery in the past. Bril. M. J., 1: 1: 336-338 (March 11) 1871. 1250-1263 (May 27) 1911. 10. Keith, A.: Menders of the Maimed. 22. Read, W. Some notable quacks. Brit. London, Oxford Univ. Pr., 1919, 335 pp. M. J., 1: 1264-1274 (May 27) 1911. 11. King, D. Hereditary skill in bone-setting. 23. Ridlon, J. Buckminster Brown m.d. of Bostoii M. & S. J., 50: 12-15 (Feb. 1) Boston. N. Y. AL J., 55: 272-273 1854. (March 5) 1892. 12. Little, E. M. Orthopaedics before 24. Ruffer, M. A. Studies in the Paleopath­ Stromeyer. In: The Robert Jones ology of Egypt. Chicago, Univ. Chi­ Birthday Volume. London, Oxford cago Pr., 1921, 372 pp. Univ. Pr., 1928, 434 pp. 25. Sayre, L. A. The history of orthopaedy. 13. Lynn-Thomas, J. Bonesetters versus the N. York Al. J., 37: 116-118 (Feb. 3) science and art of surgery. Brit. M. J., 1883. 2: 222 (Aug. 7) 1920. 26. Senn, N. Ancient military surgery. Surg. 14. Meekren, J. Chirurgicum ossis cranii Gynec. Obst., 4: 690-700 (June) 1907. fragmentum anferre jussit, sicque, cura- tione alia adhibita excommunicationis 27. Senn, N. Modern military surgery. vim effugit. Jobi A. Meekren observat Surg. Gynec. Obst., 8: 113-120 (Feb.) medico-chirurg. Ex Belico in Iat. transl. 1909. of A. Blasio, Amsterclami 1682. pp. 6-7. 28. Senn, N. The evolution of the military Quoted by Janeway, H. H. Autoplastic surgeon. Surg. Gynec. Obst., 8: 393-400 transplantation of bone. Ann. Surg., (April) 1909. 52: 217-228, 1910. 29. Smith, G. E. The most ancient splints. 15. Milne, J. S. The apparatus used by the Brit. M. J., 1: 732-734 (March 28) Greeks and Romans in the setting of 1908. fractures and the reduction of dis­ 30. Walsh, J. J. First pictures of surgical locations. Interstate M. J., 16: 48-60, operations extant. J. A. AL A., 49: 128-140, 1909. 1593~1595 (Nov. 9) 1907.