Orthopedics: a history and iconography

LEONARD F. PELTIER, MD, Orthopedics: a history and iconography, Norman Orthopedic Series No. 3, Norman Surgery Series No. 6, San Francisco, Norman Publishing, 1993, pp. xxvi, 305, illus., $225.00 (0-930405-47-1). This companion volume to Fractures: a historv and iconography oftreatment, by the same author and publisher, is equally well researched and produced. In addition to 332 illustrations of patients, apparatus, x-rays, instruments, operative procedures and practitioners, there are apposite quotations, often lengthy, from authors who advanced the speciality of orthopaedic surgery. This well-balanced selection of material offers a coherent portrayal which will appeal to a wide readership and should be obligatory study for all trainee orthopaedic surgeons. As Dr Peltier indicates, "orthopedics" may not be an appropriate title because of its special association with children. This deformed adjective used as a noun is more clearly "orthopaedic surgery" or more concisely "orthosurgery", that is rectifying or corrective surgery which spans all ages. Claimed to be "a history orientated towards the patient and disease rather than toward the physician", there are many observations and photographs of actual patients, yet inevitably long sections are devoted to discoveries and discoverers, accompanied by brief biographies and usually a portrait. The introductory chapter surveys "crippledom" across many centuries, and the second an eighteenth-century origin for orthopaedic surgery, attributing unproven influence to Nicolas Andry who in 1741 introduced the word "orthopedie", which remained dormant for almost a century, and whose treatise, written exclusively for parents, lacked any substance for surgeons. Before Ludwig Stromeyer's pioneering minimally-invasive subcutaneous tenotomies in the 1830s, undue credit is bestowed on Jacques-Mathieu Delpech for a procedure he never performed, for his was an open heel tenotomy utilizing two incisions, undertaken once and never repeated. Subsequent chapters focus on pathological themes, embracing congenital deformities, deficiency diseases, infections (including tuberculosis and poliomyelitis), neurological problems, arthritis and tumours. The frontispiece reproduces a procession of thirty cripples by Hieronymus Bosch which includes twelve amputees, highly unrepresentative of orthopaedic ethic and practice. In similar vein, the rationale of circumventing amputation by joint exsection, arthrodesis, excision arthroplasty, trephining for chronic bone abcess, malignant tumour resection and skeletal replacement is not emphasized. Curiously neither the spectacular metallic prostheses which have transformed the lives of adolescents with sarcomata, nor joint prostheses which have revolutionized arthritis are illustrated. These points apart, Dr Peltier has summarized succinctly and illuminated superbly the development and flowering of a major tree in the field of surgery, now two centuries old and still growing vigorously. The references and index are comprehensive and meticulous. Only the price is controversial.