Medical advances abound

Like many students, I found history extremely boring during high school and college. The teachers and professors, at least in my classroom, presented this subject in very general and dry terms. This does not have to be. In the last 20 years, I have become increasingly interested in history. The secret is to find topics that have some personal attachment or colorful individuals that are interesting.

We have just celebrated Memorial Day as well as the 74th Anniversary of the D-Day invasion. The 155th anniversary of Gettysburg and the Spirit of 1776 occur next month. Like most surgical trainees, I was taunted by anesthesia staff early in my experience by the phrase, “They used to judge a surgeon by how quickly they could take a leg off.” After doing a little research, I found that this quote had historical accuracy. During the Civil War, surgeons’ survival rates were largely related to how quickly they could amputate arms and legs shattered by bullets and shrapnel during battles.

Nicholas Andry, a French professor of medicine at the University of Paris coined the term “orthopedia”. This was a combination of the Greek words orthos, which means straight or without deformity, and paidios, which means child. Some ancient fossils have been found that reveal fractures that had healed straight, which implied they had been cared for. In North America, the Shoshone Indians had a technique of treating fractured limbs by covering animal hides with mud to create a primitive version of a cast. Similarly, in ancient Egypt, bamboo and reed splints have been found in tomb sites. The Edwin Smith Papyrus described a technique of how to set a variety of fractures, including the clavicle, or collarbone. Since those early days, the history of orthopedics largely follows the history of war.

Hippocrates has been considered the father of medicine. When I graduated medical school at the University of Virginia in 1989, I recited the Hippocratic Oath, as all graduates do. Much of Hippocrates’ experience was with Greek athletes and soldiers. He treated their injuries much as today’s team doctors care for schools. His technique of relocating a dislocated shoulder included one person pulling the arm while another stabilized the patient’s trunk.

Throughout the dark ages and middle ages, medical science stagnated. There were descriptions of battlefield surgeons in the middle ages using bandages soaked in horse’s blood as a primitive casting material, but no major new developments. The American Civil War was a time of great advancement. Locally, the first land battle occurred in Philippi. Many people do not know that the war’s first amputee was John Hanger, who lost his leg to a cannonball. He designed a better prosthesis, or artificial leg, and manufactured it for himself after he suffered his loss. Joseph Lister was a Scottish surgeon who was credited with beginning sterile technique. His first success in orthopedic care was healing a boy’s leg which had a compound fracture after being run over by a cart wheel in 1865. He placed a rag soaked in carbolic acid within the wound and to his great surprise, it healed without infection or complication. He, at the same time, began spraying carbolic acid on surgical instruments as well as misting it into the air. Prior to this, most surgeries were unthinkable due to the high rate of infection and death with any operation. In World War II, German soldiers and pilots were returned to service much quicker than their allied opponents. Dr. Kuntscher, a German surgeon, developed the technique of placing an intramedullary nail inside the bone of the femur to straighten it and accelerate healing. Patients didn’t have to lie in hospital beds for months in traction. Dr. Ilizarov used bike spokes to try to help Russian soldiers with complicated orthopedic fractures and dislocations heal. He placed the spokes through bones, then attached them to bars like tinker toys. His techniques have been greatly expanded and are used to correct many deformities and complex injuries even today.

As technology has exploded, orthopedics continues to expand and modernize at incredible rates. In the late 1960’s, Sir John Charnley of England pioneered modern total hip replacement. John Insall, in New York City, began the first successful knee prosthesis implantations. Both of these procedures have become some of the most successful treatments known to modern medicine, as well as being my personal favorites. Dr. Masaki Watanabe was a Japanese surgeon who first used an arthroscope to fix a torn meniscus or knee cartilage. His techniques have exploded to allow us to perform many surgeries arthroscopically through small or keyhole-type incisions on most joints. By performing the surgery in such a minimally invasive way, recovery is often quicker and the risk of complications is smaller.

It is amazing to me to see how closely we follow some of the surgical techniques first pioneered in the times of Egyptian pharaohs and Roman gladiators.

In conclusion, for you students just finishing another year, look for a personal area of interest in next year’s history class and you may be surprised.

Topping is the founding partner and president of Tygart Valley Orthopedics in Elkins.