Henry Ford Hospital Medical Journal Volume 25 Number 3 Article 2 9-1977 Milestones leading to the development of spinal surgery in the late 19th century D. J. Canale Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Canale, D. J. (1977) "Milestones leading to the development of spinal surgery in the late 19th century," Henry Ford Hospital Medical Journal : Vol. 25 : No. 3 , 131-144. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol25/iss3/2 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Henry Ford Hosp Med Journal Vol 25, No 3, 1977 Milestones leading to the development of spinal surgery in the late 19th century D.J. Canale, MD* The significant amountof spinal surgery in neurological practice today prompts a sur­ vey of the historical development of surgical treatment of disorders of the spine. Any discussion tracing the events leading to modern surgical practice must necessarily contain the contributions of men of medi­ cine through the centuries; therefore, neu­ rosurgery as practiced today is greatly indebted to the efforts of courageous and dedicated men in world history extending to the ear/y Egyptians. Overcoming seemingly insurmountable barriers of prejudice bred of ignorance, societal customs, and religious tradition, these fathers of medicine have contributed the knowledge and experimen­ tal evidence which form the cornerstone of modern medical practice. From the papyrus records of a surgeon of 2500 B.C. to Lister's paper on asepsis and Morton's use of anesthesia, the advance of surgery as an integral part of medical prac­ tice may be observed through the detailed records describing diagnostic procedures and treatment methods. Also viewed are surgical techniques employing remedies and instruments which bear little re­ semblance to those in use today. Historical precedent is a well-known * Clinical assistant professor, Department of neu­ motivator, prompting understanding and rosurgery, The University of Tennessee Center for inspiring progress. Building on these the Health Sciences, Memphis, Tennessee. milestones of the past, modern men of medi­ Address reprint requests to Dr. Canale at 1314 cine may further advance the practice of Peabody Avenue, Memphis, Tennessee 38104 spinal surgery. 131 Canale OINCE spinal surgery comprises such a however, as the chronological order in Fig­ ure 1 shows. significant part of neurosurgical practice to­ day, an account of the historical develop­ ment of surgery of the spine seems Ancient Egyptian particularly appropriate. This paper will re­ count and exam ine d iscoveries and events in The first references in recorded history to medical history that have contributed to the treatmentof disorders of the spine are found advancement of knowledge of the nervous in an ancient Egyptian writing, the Edwin system and the science of surgery and, more Smith Surgical Papyrus^ dated about 1700 particularly surgery of the spine and spinal B.C. The document is a copy of an earlier cord. writing dated about 2500 B.C., possibly written by Imhotep, the earliest known phys­ Successful surgical treatment of disorders ician and architect, with commentaries add­ of the spine and spinal cord was first accom­ ed by a later surgeon. This ancient record is plished in the latter part of the nineteenth concerned largely with surgical problems in century when William Macewen of that, of the 48 cases described, 27 are of Glasgow performed the first successful lami- trauma to the head and 6 of injury to the nectomyin 1883. Shortly thereafter, in 1887, spine. An idea of the treatment rendered by Victor Horsley of London successfully re­ the ancient surgeon can be shown in two moved an intraspinal tumorwhich had been examples. In case 29 of the papyrus, the diagnosed and localized preoperatively by ancient surgeon describes a gaping wound Sir William Gowers. in a cervical vertebra with no apparent neurological deficit. Treatment consisted of Their efforts had been preceded by two binding it with fresh meat on the first day and momentous events in medical history. In afterwards to "moor him at his mooring 1846 Dr. W. T. Morton first demonstrated the states" until the period of injury passed. practical use of ether anesthesia at Massa­ This, perhaps, was a method of splinting the chusetts General Hospital, a procedure wound. Case 31 is an example of a more which precipitated a remarkable increase in serious injury in which the ancient surgeon surgical procedures. Surgery of the nervous describes a dislocation of the cervical ver­ system, however, proved yet too hazardous tebra with paralysis of both arms and legs, since the problem of sepsis had not been incontinence of urine, priapism, and spon­ overcome. taneous ejaculation. The ancient surgeon declares the verdict to be unfavorable, and The publication in 1867 of Joseph Lister's no treatment is suggested. In this case one famous paper,^ On a New Method of Treat­ can assume that the surgeon recognized the ing Compound Fractures, Abscesses, etc. futility of treatment and, perhaps, declined with Observations on the Conditions of Sup­ to treat the patient because of fear of being puration, introduced aseptic or antiseptic accused of contributingto the fatal outcome. surgery, and helped initiate surgery of the From the writings of other civilizations in nervous system. The importance of Lister's existence during this period, such as the work cannot be overestimated. Horsley re­ Babylonian and Assyrian in Mesopotamia, ferred to surgery done prior to Lister as the as well as the Hebrew, Hindu, and Chinese, "pre-scientific epoch of surgery," Surgery, as there are not found any specific references to a definitive treatment for certain disorders of injuries or disorders of the spine. the spine, was then establ ished by Macewen and Horsley in the last quarter of the nine­ teenth century following the contribution of Classical Greek period Morton and Lister. The first attempts at spinal The rise of Greek medicine is recorded in surgery occurred much earlier in history, the writings of Hippocrates, the "father of 132 Milestones of spinal surgery MIL£STO^ES IN THE HISTORY OF SPINAL SURGERY yiN SMITH wiCAL PAPYRUS HIPPOCRATES. 5TH CEriruRY^ B.C. 6AL£N 164 A.D. PAUL OF AEGENA, 7TH CENTURY VESALIUS m5 HlUMNUS WHYTT CONTUGNO HEISTER POTT CLINE COOPER /VJESTHESIA k>W-SEQUARD. 1850 jviL WAR 1861 -ISTER 186/ CLINICAL NEUROLOGY Figure 1 In addition to the dates shown, othermilestones in spinal surgery were reached in the late 19th century by Macewen in 1883 and Horsley in 1887. 133 Canale medicine," during the classical period of the probably following closely the methods of fifth century B.C. He did much to advance Hippocrates. Galen was the first to section the science of medicine by separating medi­ experimentally the spinal cord at various cine from religion and by accurately describ­ levels in animals and to study the effects ing diseases. Although he does not describe thereof. For this reason, he may be called the any actual surgery of the spine, he describes first experimental neurologist. His influence a gibbous deformity of the spine in which the was profound, and his writings have been spine is "contracted to a hump" from dis­ followed for centuries. Unfortunately his ease, most likely tuberculosis. He also de­ idea that suppuration was an essential part of scribes scoliosis of the spine which he notes heal ing retarded the development of surgery occurs in persons in good health. In these and was not entirely overthrown until the cases he describes treatment which included time of Lister. extension and pressure on the deformity. He notes that fractures of the spinous processes may occur without other serious injuryto the Middle Ages spine and that these will heal rapidly In The work of Paul of Aegina, the last of the addition to his observations regarding the great Byzantine physicians, provides the spine, he gives detailed descriptions for trep­ next milestone in surgical history of the spine hining the skull for head injuries. Regarding during the early part of the Middle Ages. dislocations of the vertebrae, he describes Paul, practicing in Alexandria, is said to have two types. The first is that in which the been the first surgeon to operate on the vertebrae are displaced forward, compress- spine. He recognized that the bodies of the ingthe spinal marrow and resulting in insen­ vertebrae may be fractured, with resulting sibility, paralysis, and retention of urine and compression of the spinal marrow. Regard­ feces. For these cases he declares there is no ing treatment he says: satisfactory treatment and deplores the use of cupping and extension as methods of Wherefore having first given warn­ treatment for forward displacement which ing of the danger, we must, if possi­ ble, attempt to extract by incision he declares to be usually fatal. The second the compressing bone, or, if not, we type of dislocation is that of backward dis­ must soothe the part by the anti­ placement of the vertebrae which he notes is inflammatory treatment.'* rare but carries a better prognosis and is usually not associated with paralysis but This may be also one of the first examples may be confused with simple fracture of the of informed consent for surgery of the spine. spinous processes. He states that one rarely It is doubtful that the surgery which he succeeds in straightening the dislocation, recommended could be compared with a and inthisparticularcase,condemnsthe use true laminectomy as we know it today of succussion on a ladder.^ In general, medicine and surgery declined duringthe medieval period, with surgery, for Graeco-Roman the most part, being divorced from medicine and held in disrepute.