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Orthopedics

Until the late 19th century, breaks and fractures were usually treated with simple immobilization and close reduction (i.e. non-surgical repositioning of bone fragments). Orthopedic surgery was avoided due to high mortality rates from blood loss and postoperative infection.1 The recommended treatment for open fractures (especially those caused by firearms) was amputation, which was the most common type of surgery performed at the time.2 Orthopedics, like all medical fields, benefited powerfully from the introduction of and improved access to inhalable anesthesia (circa 1850s), antiseptic technology (circa 1870s), and radiography (circa 1896): diagnosis became more accurate, and surgery became safer and less painful.3 Internal fixation—the process of using implanted screws, nails, plates, and wires to hold bone fragments in place—was developed around 1886.4

Elaborate braces, corsets, slings, racks, and casts (often made from plaster of Paris) were used to treat bone deformities in patients with scoliosis of the spine, Little's disease (spastic diplegia), Pott's disease (spinal tuberculosis), clubfoot, and rickets.5 Rickets—a disease characterized by softening (osteomalacia) and subsequent distortion of bones, especially in the legs—was identified as a separate condition from scurvy in 1859; its cause (usually a deficiency of Vitamin D, sometimes also of calcium or phosphate) was only identified in the 1920s.6 It has been suggested that the extraordinary prevalence of rickets in the 19th century may have been a side effect of the Industrial Revolution, specifically of coal dust pollution blocking children's exposure to sunlight.7

Notes

  1. Bartoníček, "Early history of operative treatment," 1385-6.
  2. Bartoníček, "Early history," 1386; see images related to amputation in the Surgery section of this exhibit. 
  3. Bartoníček, "Early history," 1386.
  4. Bartoníček, "Early history," 1388-90.
  5. Peltier, Orthopedics, 28, 131, 211; see also Dede and Sturm, "A brief history," 405-407.
  6. Peltier, Orthopedics, 86-89; Mersch, "Rickets."
  7. Hardy, "Rickets in the nineteenth century," 337-8; Peltier, Orthopedics, 94.

Bibliography

    • Bartoníček, Jan. "Early history of operative treatment of fractures." Archives of Orthopaedic and Trauma Surgery 130.11 (2010): 1385-1396. DOI:10.1007/s00402-010-1082-7.
    • Dede, Ozgur and Peter F. Sturm. “A brief history and review of modern casting techniques in early onset scoliosis” Journal of Children’s Orthopaedics 10.5 (2016): 405-411. DOI:: 10.1007/s11832-016-0762-4.
    • Hardy, Anne. "Commentary: Bread and alum, syphilis and sunlight: rickets in the nineteenth century." International Journal of Epidemiology 32.3 (2003): 337-340. DOI:10.1093/ije/dyg175.
    • Mersch, John. "Rickets (Calcium, Phosphate, or Vitamin D Deficiency)." Medicinenet.com. Last reviewed 12 December 2017. Accessed 3 June 2018. https://www.medicinenet.com/rickets/article.htm.
    • Peltier, Leonard F. Orthopedics: a history and iconography. San Francisco: Norman Publishing, 1993.