Richard's back: death, scoliosis and myth making

The body of a mediaeval monarch was always under scrutiny, and Richard III's was no exception. In death, however, his body became subject to new forms of examination and interpretation: stripped naked after the battle of Bosworth, his corpse was carried to Leicester and exhibited before being buried. In 2012, it was rediscovered. The revelation that Richard suffered from scoliosis prompts this article to re-evaluate the historical sources about Richard's physique and his posthumous reputation. This article argues that Richard's death and his myth as 'crookback' are inextricably linked and traces attitudes to spinal curvature in the early modern period. It also considers how Shakespeare represented Richard as deformed, and aspects of performance history which suggest physical vulnerability. It then considers Richard's scoliosis from the perspective of medical history, reviewing classical accounts of scoliosis and arguing that Richard was probably treated with a mixture of axial traction and pressure. It demonstrates from the evidence of Richard's medical household that he was well placed to receive hands-on therapies and considers in particular the role of his physician and surgeon, William Hobbes. Finally, it shows how the case of Richard III demonstrates the close relationship between politics and medicine in the period and the contorted process of historical myth making.

Treatment of singultus by traction on the tongue: an eponym revised

Sir William Osler (1849-1919) is associated with a long list of contributions and eponymous entities including filaria, maneuvers, nodules, syndromes, and triads. Among the less known ones is the Oslerian pulling of the tongue for termination of obstinate hiccup (singultus). Janet Travell (1901-1977) , physician to two United States presidents, attributed the tongue-pulling maneuver to Osler. Dr. Travell cites Osler's Principles and Practice of Medicine from 1912, where mention of the remedy can be found. The therapy, however, is much older and (perhaps not surprisingly) of French origin. It can be viewed as a spin-off of attempts by Jean Laborde (1830-1903) to resuscitate the "presque morts" (almost dead) via rhythmic traction of the tongue. Lesser known physicians involved in the treatment of singultus by traction of the tongue are Jean Viaud (1862-1946) and Raphaël Lépine (1840-1919).

Management of proximal humeral fractures in the nineteenth century: an historical review of preradiographic sources

BACKGROUND

The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed.

QUESTIONS/PURPOSES

I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus.

METHODS

A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search.

RESULTS

Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years.

CONCLUSIONS

The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.

Prof. Vatroslav Florschütz and the Balkan beam frame

Prof. Vatroslav Florschütz constructed in 1911 an extension table for repositioning bone fracture fragments of the upper and lower extremities, after which a plaster splint was applied--this later became to be known as the Balkan beam frame. Florschütz's personal insistences of new techniques at the beginning of the 1900 have helped shape war surgery and traumatology.

Management of fractures of the humerus in Ancient Egypt, Greece, and Rome: an historical review

Fractures of the humerus have challenged medical practitioners since the beginning of recorded medical history. In the earliest known surgical text, The Edwin Smith Papyrus (copied circa 1600 BC), three cases of humeral fractures were described. Reduction by traction followed by bandaging with linen was recommended. In Corpus Hippocraticum (circa 440-340 BC), the maneuver of reduction was fully described: bandages of linen soaked in cerate and oil were applied followed by splinting after a week. In The Alexandrian School of Medicine (third century BC), shoulder dislocations complicated with fractures of the humerus were mentioned and the author discussed whether the dislocation should be reduced before or after the fracture. Celsus (25 BC-AD 50) distinguished shaft fractures from proximal and distal humeral fractures. He described different fracture patterns, including transverse, oblique, and multifragmented fractures. In Late Antiquity, complications from powerful traction or tight bandaging were described by Paul of Aegina (circa AD 625-690). Illustrations from sixteenth and seventeenth century surgical texts are included to show the ancient methods of reduction and bandaging. The richness of written sources points toward a multifaceted approach to the diagnosis, reduction, and bandaging of humeral fracture in Ancient Egypt, Greece, and Rome.

Meurice Sinclair CMG: a great benefactor of the wounded of the First World War

Major Meurice Sinclair was a Regular Army Medical Officer who revolutionised the management and treatment of gunshot fractures during the First World War, particularly those of the femur which carried the highest mortality. Not only did his methods reduce mortality but they increased the ease of nursing and hence the comfort of the wounded to a marked degree. His system of traction on the Thomas splint, in suspension, gained general acceptance such that he gave lectures and demonstrations to the medical officers of the allied forces, for which he was thrice mentioned in despatches and subsequently appointed CMG. Central to his method was the concentration of the fracture cases within certain hospitals to standardise and improve their management. This he was able to achieve through the good offices of Sir Almroth Wright who was Consultant Physician to the British Expeditionary Force. His methods reduced the death rate in open fractures of the femur from 80% generally, to 7.3% in his own hospital. He left a legacy that bore fruit both in the treatment of civilian fractures after the war but also in the second war of 1939-1945.

Medieval management of spinal injuries: parallels between Theodoric of Bologna and contemporary spine surgeons

In recent decades there have been revolutionary technological advances in the management of traumatic spinal column injuries. Despite these advances, the basic principles of reduction and stabilization of vertebral fractures and dislocations remain similar to those proposed by ancient and medieval physicians. Theodoric of Bologna, in his text Chiurgica de Theodoric (ca. AD 1267), described an extracorporeal approach to the management of traumatic spinal column misalignments. Surprisingly, his techniques are still used in many instances by contemporary spine surgeons, despite the availability of a more advanced technological armamentarium than that existent in medieval times.

A brief history of therapy for traumatic spinal cord injury

There are few more devastating injuries that afflict man than those associated with spinal cord injury (SCI). The economic, psychological, and social impact are encompassing and enormous to the individual and society. During the last several years, there has been a renewed interest in the study of SCI, with the hope of finding a cure. It is appropriate, then, to examine the efforts accomplished throughout medical history. With this retrospective view, potential avenues for future treatment become more apparent and clear. As in the past, the integration of basic science and clinical innovation will create the path toward progress for treatment of this disease.

History of posterior thoracic instrumentation

The term “backbone” appears in many expressions used in modern day society. In any scenario, it has one central meaning: stability. Best defined as a foundation that is able to sustain multiple stressors without adversely affecting integrity, the commonly and appropriately termed backbone of humans is the spinal column. As the central focus of stability in our species, the spine is subject to a great degree of trauma and mechanical forces. A variety of methods have been developed throughout history in the treatment of spinal column injury. Initial treatment involved the use of simple traction devices for the reduction of spinal fractures; these have evolved to include the current insertion of spinal instrumentation. The authors review the historical treatment and development of posterior instrumentation for thoracic spinal injury.

Hyphenated history: the Böhler-Braun frame

Throughout the history of medicine, many great physicians have originated or popularized ideas that have resulted in their names being attached to a device, procedure, or disease process. Hyphenated eponyms are especially interesting, for there are always underlying stories that explicate how people became associates in history. This paper will describe a bit of hyphenated history regarding orthopaedic trauma, specifically, the development of the Böhler-Braun frame. The lives of two great surgeons associated with this device, Lorenz Böhler, the "father of traumatology," and Heinrich Braun, the "father of local anesthesia," will also be reviewed.

Howard H. Hepburn and the development of skull tongs for cervical spine traction

The first use of skull tongs for cervical spine traction is credited primarily to W.G. Crutchfield. In 1933, Crutchfield described his application of extension tongs to the calvaria of a 23-year-old woman with a traumatic C2-C3 fracture. Less recognized are the contributions of Howard H. Hepburn, who designed skull tongs for cervical spine traction at the University of Alberta several years before Crutchfield's first case. Hepburn was the first neurosurgeon at the University of Alberta in Edmonton. On the basis of his experience treating wounded soldiers in World War I, he developed the hypothesis that traction would promote healing in cervical spine injuries. Hepburn designed skull extension tongs that were modeled on common ice tongs, and he used an automobile inner tube as an elastic to keep the tongs firmly applied to the patient's head. These tongs were first used in the mid-1920s, and by 1930 they were applied routinely. Crutchfield's 1933 report refers to the application of "Edmonton extension tongs." This suggests that he was at least indirectly aware of Hepburn's work, although how this information reached him is not entirely clear. Hepburn attended a meeting of the British Medical Society in 1930, and he is thought to have discussed his tongs during the conference. Hepburn's work has received some attention previously; his original tongs were included in a 1973 Smithsonian Institute exhibit on cervical spine traction as an example of an early cranial traction device. However, his contributions are underappreciated in the neurosurgical community and deserve wider recognition.

The history of modern spinal traction with particular reference to neural disorders

The last 200 years of the history of spinal traction is described in the present article. The study starts at the end of the 18th century with the works of JA Venel (1789) who tried to apply the Hippocratic idea to modern surgery. Orthopedic specialists of the last century were mostly preoccupied with corsets and the method gained broader popularity when neurologists paid attention to the similar method of suspension. The Russian neurologist Osip Mochutkovsky described suspension as a method for the treatment of tabes dorsalis in an article published in the Russian magazine 'Vratch' in 1883. His works became known in Europe when JM Charcot paid attention to it and published a special short monograph on this subject in 1889. This work was translated into English (1889) and Russian (1890) and the method became popular in the treatment of tabes dorsalis and other neurological diseases. The eminent Russian neurologist VM Bekhterev proposed the combination of body suspension with cervical traction (1893). Some years later Gilles de la Tourette promoted the use of spinal traction in his neurological clinic (1897). Unfortunately neurologists worked without the cooperation of orthopedic specialists. During the first decades of the 20th century suspension was also replaced by traction in neurology. This method was used by both neurologists and orthopedic specialists but in the last decades neurologists lost their interests in it and it found greater use in traumatology and in spinal surgery where it is still in use today.

Spinal deformity and axial traction

Axial traction to correct spinal deformity is a very old concept. The oldest reference available is in ancient Hindu mythological epics (written between 3500 BC and 1800 BC) where it is mentioned how Lord Krishna corrected the hunchback of one of his devotees. Later, Hippocrates (460 BC to 377 BC) described certain devices. Galen (131 AD to 201 AD), a follower of Hippocrates, used axial traction with direct pressure. Ibn Sena (980 AD to 1037 AD) in the Middle East also used similar methods. Osteopaths of Turkey also used axial traction to correct spinal deformities. But gradually mechanical methods for the correction of the spinal deformity went into disrepute due to the invariable production of paraplegia. In the past few decades, interest in the correction of spinal deformity has been rejuvenated due to better understanding of anatomy, physiology, and pathomechanics of spinal deformity. Controlled axial traction has been the keystone of several modern procedures such as Cotrel traction, Halo traction, and Harrington Outrigger instrumentation, etc. It appears that the primitive ways of application of axial traction by crude methods did not totally vanish but have been modified. In Indian tribal areas, bone setters still practice it in modified form.

Leg lengthening: the historical perspective

An overview of lengthening is presented from the scarlet cloth through skeletal traction, screw distraction, and patient mobility. Unquestionably, significant advances have been made in the technology and techniques of lengthening legs, but more are yet to be made.

Carpenter's nails, phonograph needles, piano wires, and safety pins: the history of operative fixation of metacarpal and phalangeal fractures

This century has witnessed advances in basic sciences that have led to and resulted from advances in operative fixation of fractures. In addition to the sweeping changes in medicine and surgery, the development of corrosion-resistant alloys underpins all current concepts of fracture surgery. Most of the techniques were originally borrowed from work on large bones and most of the materials came from workshops or sewing boxes. Today, as improved understanding of bone healing and appropriate application of mechanical principles to skeletal injuries have become indispensable for appreciating the relative value of these techniques, operative fixation of hand fractures has emerged as a science in its own right.

Gardner tongs and cervical traction

Treatment of cervical spine injuries dates from 4000 B.C.; however, the development of safe and effective methods of cervical traction did not appear until the 20th century. Although many devices have been introduced to stabilize the cervical spine, the invention of spring-loaded tongs by Gardner in 1973 was a significant technological advance. Gardner tongs are easily applied, have little tendency to become dislodged, and cause few complications.

History of skeletal traction in the treatment of cervical spine injuries

✓ Therapy of cervical spine fractures is reviewed from the time of the Egyptians (4000 B.C.) to the present day. Immobilization has been practiced for slightly more than a century; devices for exerting traction upon the skull have been in use for 37 years. The Renaissance surgeon, Fabricus Hildanus, designed a tool for exerting traction upon the cervical vertebrae, but this method did not become popular. Until the 20th century, few physicians considered the therapy of this common injury.