X-rays as evidence in German orthopedic surgery, 1895-1900

ISIS

Volumn 96, Issue 1, 2005, Pages 1-24

  Warwick, Andrew ^a  

^a IMPERIAL COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; GERMANY; HISTORY; HUMAN; ORTHOPEDICS; RADIOGRAPHY; X RAY;

GERMANY; HISTORY, 19TH CENTURY; HUMANS; ORTHOPEDICS; RADIOGRAPHY; X-RAYS;

EID: 26944435601     PISSN: 00211753     EISSN: 15456994     Source Type: Journal    
DOI: 10.1086/491543     Document Type: Review

References (102)

1. Stuart Blume, Insight and Industry: The Dynamics of Technological Change in Medicine (Cambridge, Mass./London: MIT Press, 1992), pp. 22-31;
2. Joel Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore/London: Johns Hopkins Press, 1995), pp. 103-107;
3. Bettyann Holtzmann Kevles, Naked to the Bone: Medical Imaging in the Twentieth Century (New Brunswick, N.J.: Rutgers Univ. Press, 1997), pp. 38-69.
4. Quotations, respectively, from Blume, Insight and Industry (cit. n. 1), p. 171;
5. and Olga Amsterdamska and Anja Hiddinga, "The Analysed Body," in Medicine in the Twentieth Century, ed. Roger Cooter and John Pickstone (Netherlands: Harwood Academic Publishers, 2000), pp. 417-434, 418.
6. See also Howell, Technology in the Hospital (cit. n. 1), pp. 107-109.
7. On early histories of X-rays, see Monika Dommann, Durchsicht, Einsicht, Vorsicht: Eine Geschichte der Röntgenstrahlen 1896-1963 (Zurich: Chronos, 2003), pp. 25-26.
8. Recent studies drawing on the sociology of scientific knowledge include Bernike Pasveer, "Knowledge of Shadows: The Introduction of X-Ray Images in Medicine," Sociology of Health and Illness, 1989, 11:360-381;
9. Bernike Pasveer, " idem, "Depiction in Medicine as a Two-Way Affair: X-Ray Pictures and Pulmonary Tuberculosis in the Early Twentieth Century," in Medical Change: Historical and Sociological Studies of Medical Innovation, ed. Ilana Löwy (Paris: INSERM, 1993), pp. 85-104;
10. R. G. Arns, "The High-Vacuum X-Ray Tube: Technological Change in Social Context," Technology and Culture, 1997, 38:852-890;
11. Arne Hessenbruch, "Calibration and Work in the X-Ray Economy, 1896-1928," Social Studies of Science, 2000, 30:396-420;
12. and Dommann, Durchsicht, Einsicht, Vorsicht (cit. n. 3).
13. On the social history of medicine and its lack of attention to medical sciences, see John Harley Warner, "Science in the Historiography of Modern Medicine," Osiris, 2d ser., 1985, 37-58;
14. Michael Hagner, "Scientific Medicine," in From Natural Philosophy to the Sciences: Writing the History of Nineteenth-Century Science, ed. David Cahan (Chicago: Univ. of Chicago Press, 2003), chap. 3;
15. and Roger Cooter, " 'Framing' the End of the Social History of Medicine," in Locating Medical History: The Stones and Their Meanings, ed. Frank Huisman and John Harley Warner (Baltimore/London: Johns Hopkins Univ. Press, 2004), pp. 309-337.
16. The lack of serious historical attention to surgical concepts of disease and their relation to surgical practice is noted in Christopher Lawrence, "Democratic, Divine, and Heroic: The History and Historiography of Surgery" in Medical Theory, Surgical Practice: Studies in the History of Surgery, ed. Christopher Lawrence (London/New York: Routledge, 1992), pp. 1-42, 10.
17. Notable contributions to the Historical Sociology of Medicine are David Jones, "Visions of a Cure: Visualisation, Clinical Trials, and Controversies in Cardiac Therapeutics, 1968-1998," Isis, 2000, 91:504-541;
18. Thomas Schlich, Surgery, Science, and Industry: A Revolution in Fracture Care, 1950s-1990s (Basingstoke/New York: Palgrave Macmillan, 2002);
19. and Sally Wilde, " 'See One, Do One, Modify One': Prostate Surgery in the 1930s," Medical Histoiy, 2004, 48:351-366.
20. Studies of the sociology of contemporary surgical practice appear to be confined to Stefan Hirschauer, "The Manufacture of Bodies in Surgery," Soc. Stud. Sci., 1991, 21:279-319;
21. and T. Pinch, H. M. Collins, and L. Carbone, "Inside Knowledge: Second Order Measures of Skill," Sociological Review, 1996, 44:163-186.
22. For a contemporary account of the rise of "subcutaneous orthopedics" see C. C. Schmidt, Encyklopaedie der gesammten Medicin (Leipzig: Otto Wigand, 1842), vol. 6, "Tenotomie."
23. See also August Rütt, Geschichte der Orthopädie im deutschen Sprachraum (Stuttgart: Ferdinand Enke Verlag, 1993), p. 24.
24. This cannot be the whole explanation as surgeons in other countries continued to develop these techniques. See Rütt, Geschichte der Orthopädie (cit. n. 7), pp. 14-26.
25. Rütt, Geschichte der Orthopädie Ibid., pp. 14, 29.
26. Rütt, Geschichte der Orthopädie Ibid., pp. 19-30.
27. Adolf Lorenz, "Allgemeine Erfahrungen über die mechanische Reposition der angeborenen Hüftverrenkung," Berliner klinische Wochenschrift, 1897, 34:953-956. At this time the fetal joint was thought to "dislocate" in the womb.
28. The terms blutig and unblutig correspond roughly to the English terms "surgical" and "nonsurgical," respectively. The term "surgical" referred to any unblutig treatment carried out in a clinic.
29. For an overview of these developments, see Bruno Valentin, Geschichte der Orthopädie (Stuttgart: Georg Thieme Verlag, 1961), pp. 117-134.
30. Hoffa's life and work is discussed in N. Buschinger, "Albert Hoffa: Eine biographische Darstellung und Interpretation seines Lebens und Wirkens in Würzburg" (Inaugural-Dissertation der Hohen medizinischen Fakultät der Julius-Maximilian-Universität Würzburg, 1971, unpublished).
31. Albert Hoffa, "Zur operativen Behandlung der angeborenen Hüftgelenksverrenkungen, mit Krankenvorstellung," Verhandlung der Deutschen Gesellschaft für Chirurgie, 19th Congress, 1890, pp. 44-53, 46.
32. See Albert Hoffa, Lehrbuch der orthopaedischen Chirurgie (Stuttgart: Ferdinand Enke, 1891), pp. 515-537. Editions 2, 3, and 4 appeared, respectively, in 1894, 1898, and 1902. References to Hoffa's operation normally refer to his textbooks rather than his research papers.
33. Lorenz's life and work are discussed in Norbert Steingress, Adolf Lorenz 1854-1946: Etappen eines langen Lebens (Vienna: Wiener Medizinische Akademie, 1997).
34. Norbert Steingress, Adolf Lorenz 1854-1946: Etappen eines langen Lebens Ibid., p. 29.
35. According to Lesky, aseptic surgery was introduced to Vienna in 1891. Erna Lesky, The Vienna Medical School of the 19th Century (Baltimore/London: Johns Hopkins Univ. Press, 1976), p. 439.
36. Albert Hoffa, "Review of Lorenz (1895)," Deutsche medicinische Wochenschrift, 1896, 22:73-75, 74;
37. and Alfred Schanz, "Zur blutigen Reposition der angeborenen Hüftverrenkung," Zeitschrift für orthopaedische Chirurgie, 1896, 4:207-246, 234.
38. By mid-1897, Hoffa was prepared to acknowledge that Lorenz deserved the highest praise for insisting on the importance of complete muscle protection during the surgical relocation of the hip. Albert Hoffa, "Die Endresultate meiner letzten blutigen Operationen der angeborenen Hüftgelenksluxation, " Deutsche Medicinische Wochenschrift, 1897, 23:305-306, 326-331, 305.
39. Adolf Lorenz, My Life and Work: The Search for a Missing Glove (New York: Charles Scribner's Sons, 1936), p. 98.
40. The method was, respectively, first mentioned in and then described in detail in Adolf Lorenz, Pathologie und Therapie der angeborenen Hüftverrenkung (Vienna/Leipzig: Urban and Schwarzenberg, 1895);
41. and Adolf Lorenz, idem, "Über die unblutige Behandlung der angeborenen Hüftverrenkung mittels der funktionellen Belastungsmethode, " Centralblatt für Chirurgie, 1895, 32:761-764. In the latter, Lorenz mentions (p. 762) that his earlier references to the technique were intended to guarantee his claim to priority.
42. Paci's work is discussed in Valentin, Geschichte der Orthopädie (cit. n. 13), p. 132.
43. Lorenz's account of the dispute with Paci is given in Adolf Lorenz, Über die Heilung der Hüftgelenks-Verrenkung durch unblutige Einrenkung und functionelle Belastung (Leipzig/Vienna: Franz Deuticke, 1900), pp. 358-359.
44. Hoffa, "Review of Lorenz (1895)" (cit. n. 20), p. 74.
45. Schanz, "Zur blutigen Reposition" (cit. n. 20), p. 208.
46. Paul Paradies, "Die operative Behandlung der doppelseitigen angeborenen Hüftverrenkung aelterer Patienten," Zeitschrift für Orthpaedische Chirurgie, 1896, 4:258-283, on p. 258.
47. Franz König, "Die congenitale Luxation des Hüftgelenks, " Berliner Klinische Wochenschrift, 1897, 34:21-22, on p. 21.
48. Numerous overviews of the treatment of congenital hip dislocation appeared in the spring of 1897, especially in connection with the use of X-rays. See, e.g., Max Levy-Dorn, "Verwertbarkeit der Röngenstrahlen in der praktischen Medicin," Deutsche Medicinische Wochenschrift, 1897, 23:119-122;
49. and L. Wullstein, "Über Aufnahmen des Rumpfes durch Röngenstrahlen," Berliner klinische Wochenschrift, 1897, 34:334-338.
50. Albert Hoffa, "Zur operativen Behandlung" (cit. n. 15), p. 48.
51. Hoffa routinely demonstrated numerous cases when he presented his recent surgical work. See, e.g., Albert Hoffa, "Über die Endresultate der blutigen Operation der angeborenen Hüftgelenksverrenkung," Vereins-Beilage der Deutschen Medicinischen Wochenschrift, 1896, 22:190;
52. and Albert Hoffa, idem, "Die Endresultate meiner letzten blutigen Operationenen" (cit. n. 21), p. 306.
53. Adolf Lorenz, "Über die unblutig-chirurgische Behandung der angeborenen Hüftgelenkverrenkung durch Reposition und functionelle Belastung," Berliner klinische Wochenschrift, 1896, 33:530-531, 531;
54. and Adolf Lorenz, idem, "Bemerkungen über die unblutige Reposition der angeborenen Hüftverrenkung, mit Demonstrationen an einem pathologisch-anatomischen Praeparate," Münchener medicinische Wochenschrift, 1898, 45:1254.
55. Adolf Lorenz, Über die Heilung (cit. n. 24), pp. 18-19. This public display of camaraderie helped to heal the tensions between Hoffa and Lorenz. Further public demonstrations are mentioned in this passage.
56. Lorenz, Über die Heilung (cit. n. 24);
57. and Albert Hoffa, Lehrbuch, 4th ed. (1902), figs. pp. 494-496.
58. Schanz, "Zur blutigen Reposition" (cit. n. 20).
59. The interest of orthopedic surgeons is confirmed in Oskar Vulpius, "Zur Verwerthung der Röntgenstrahlen," Deutsche medicinische Wochenschrift, 1896, 22:480-481, 480.
60. Oskar Vulpius, Deutsche medicinische Wochenschrift, Ibid., p. 480.
61. On Wolff's life and work, see G. Joachimsthal, "Julius Wolff," Berliner klinische Wochenschrift, 1902, 39:203-204, 203.
62. Hoffa, "Zur operativen Behandlung" (cit. n. 15), pp. 47-18.
63. It is unclear why Buka made these pictures but see note 40.
64. Wolff thanked several military doctors for the care they had taken making pictures of his patients in the Kaiser Wilhelm Academy. Julius Wolff, "Die Bedeutung der Röntgenbilder für die Lehre von der angeborenen Hüftverrenkung," Fortschritte auf dem Gebiete der Rö ntgenstrahlen, 1897/98, 1:22-28, 130-136, 211-221, 224. The academy was probably the forum that brought surgeons and physicists together.
65. Julius Wolff, "Zur weiteren Verwerthung der Röntgenbilder in der Chirurgie," Deutsche medicinische Wochenschrift, 1896, 22:645-648, on p. 645. Wolff noted (p. 646, note 2) that a Prof. Goldstein had made similarly beautiful pictures of the hip joint at the Kaiser Wilhelm Academy.
66. It is unclear how Wolff showed the pictures to his audience. He later projected them on a screen, but on this occasion it is likely that he showed the plates to his audience.
67. Wolff, "Zur weiteren Verwerthung" (cit. n. 41), p. 646.
68. Wolff, "Zur weiteren Verwerthung Ibid., p. 647.
69. Wolff, "Zur weiteren Verwerthung Ibid., pp. 646-647.
70. Wolff, "Zur weiteren Verwerthung Ibid. pp. 646-647.
71. Röntgen held a public lecture on X-rays before the Physical-Medical Society of Würzburg on 23 January 1896. The lecture included a demonstration of X-raying a human hand and made an enormous impact on the audience. See August Blencke, "Vierzig Jahre im Dienste der Röntgenstrahlen," Radiologe, 1995, 35:302-310, 303. Previously unpublished notes for a talk given in January 1936.
72. Unlike Wolff's physicist colleagues in Berlin, Röntgen seems to have taken little or no interest in helping with the medical application of his discovery.
73. On one occasion, Hoffa locked Blenke in the darkroom and threatened to leave him there until he had produced the desired picture. See Blencke, "Vierzig Jahre im Dienste der Röntgenstrahlen" (cit. n. 47), pp. 304-305.
74. Blencke, "Vierzig Jahre im Dienste der Röntgenstrahlen Ibid., p. 305.
75. Hoffa claimed that the willingness of so many parents to bring their children to the meeting was a mark of the success of his operation. Hoffa, "Die Endresultate meiner letzten blutigen Operationenen" (cit. n. 21), p. 306.
76. Albert Hoffa, "Address to the 26th Congress of the German Society for Surgery," Berliner klinische Wochenschrift, 1897, 34:394.
77. Hoffa, "Die Endresultate meiner letzten blutigen Operationenen" (cit. n. 21)," pp. 330, 331.
78. On the collaboration between Viennese physicists and doctors, see Lesky, Vienna Medical School (cit. n. 19), pp. 303-307.
79. Schanz, "Zur blutigen Reposition" (cit. n. 20), p. 208.
80. Hoffa claimed in 1898 that the nonsurgical procedure rarely achieved a "real" repositioning and used X-ray illustrations to show that his surgical procedure achieved an anatomical healing ("anatomische Heilung"). Hoffa, Lehrbuch, 3d ed. (1898), pp. 579, 595.
81. This issue is discussed in Hermann Kümmell, "Discussion über den Vortrag des Herrn Kümmell," Vereins-Beilage der Deutschen Medicinischen Wochenschrift, 1899, 25:201-203, 202-203.
82. Lorenz, "Allgemeine Erfahrungen" (cit. n. 11), p. 955.
83. Julius Wolff, "Die Bedeutung der Röntgenbilder für die Lehre von der angeborenen Hüftverrenkung," Fortschritte auf dem Gebiete der Röntgenstrahlen, 1897/98, 1:22-28, 130-136, 211-221, 22-24.
84. Wolff, "Die Bedeutung der Röntgenbilder," pp. 212-221. Wolff claimed (p. 221) that the "ideal goal" of the treatment would be reached when the joint was seen to assume a normal anatomical relationship. He anticipated that further X-ray pictures would bring the required confirmation.
85. Otto Büttner and Kurt Müller, Technik und Verwerthung der Röntgen'schen Strahlen (Halle: Wilhelm Knapp, 1897), p. 107.
86. Hermann Kümmell, "Die congenitale Hüftluxation in Röntgen'scher Durchleutung und die Resultate ihrer Behandlung," Münchener medicinische Wochenschrift, 1898, 45:1656-1657.
87. Julius Wolff, "Über die unblutige Einrenkung der angeborenen Hüftgelenksverrenkung," Berliner Klinische Wochenschrift, 1899, 36:381-385, 414-417, 468-472, 384-385.
88. Julius Wolff, Berliner Klinische Wochenschrift, Ibid, p. 470.
89. Julius Wolff, Berliner Klinische Wochenschrift, Ibid. p. 470.
90. Franz König, "Freie Vereinigung der Chirurgen Berlins," Berliner klinische Wochenschrift, 1898, 35:1071. König added that he nevertheless considered Wolff's judgment somewhat too favorable.
91. Lorenz, Über die Heilung (cit. n. 24), pp. 92-93, on p. 270. Lorenz claimed (p. 75) that X-ray control had enabled his treatment to produce the "complete anatomical result," and that (p. 267) it had since spread "extraordinarily fast" throughout Germany.
92. Hoffa, Lehrbuch, 4th ed. (1902), pp. 631-638.
93. Carl Deutschländer, "Die blutige Reposition der angeborenen Hüftverrenkungen," Zeitschrift für Orthopädische Chirurgie, 1908, 20:189-253, on p. 191. Deutschländer had been a student of Hoffa's.
94. Schlich, Surgery, Science and Industry (cit. n. 6), pp. 65-85;
95. and Wilde, " 'See One, Do One, Modify One' " (cit. n. 6), pp. 362-364.
96. Schanz, "Zur blutigen Reposition" (cit. n. 20).
97. Jones, "Visions of a Cure" (cit. n. 6), pp. 531-534.
98. This makes an informative comparison with the case of tuberculosis in which early X-ray evidence disagreed radically with accepted conceptions of the disease. See Pasveer, "Depiction in Medicine as a Two-Way Affair" (cit. n. 4).
99. Schlich, Surgery, Science, and Industry (cit. n. 6), pp. 86-109, 248-252.
100. Schlich, Surgery, Science, and Industry Ibid., pp. 88-89.
101. Wolff's work is outlined in Joachimsthal, "Julius Wolff" (cit. n. 37), pp. 203-204.
102. It was for this reason that both Hoffa and Lorenz published series of photographs in their later textbooks (see Frontispiece) showing how the operating staff, the anesthetist, and the patient were positioned during a difficult maneuver.