Nursing, history, and orthopedics in manuals (1875-1928)

OBJECTIVES

to discuss the content of manuals, with emphasis on orthopedics, in support of the development of nursing care culture.

METHODS

cultural-historical method articulated with document analysis technique. The sources were nursing manuals - Portuguese, French, English, and Spanish - from 1875 to 1928.

RESULTS

this study pointed to 12 works - 6 authored by physicians, 2 by nurses, 3 institutional, and 1 by a Sister of Charity - that presented, in a transversal way, the professionalization process initiated in Europe. The manuals addressed first aid care and immobilization methods, from the simplest, such as improvised splints, to the application of plaster casts.

CONCLUSIONS

the nurses' work, even in a limited capacity, showed that they were able to observe warning signs so that doctors could act, with some exceptions.

The Historical Background of Plaster Cast

The pivotal role of plaster of Paris (POP) cast as an immobilization tool to promote healing in complex and/or other types of fractures is irrefutable. We clearly know that Antonius Mathysen extensively applied plaster cast during Crimea and/or other wars and reportedly saved thousands of lives. However, the exact origin of using POP in orthopedic cast is yet to be clear. In his famous report from Bandar-e Rig, a city in Iran, William Eton paved the way for the conclusion that POP cast might have originated from the Persian Empire. In this paper, we provide more supporting evidences which make the aforementioned claim more probable.

[Mathijsen and plaster casts]

In 1851, Antonius Mathijsen (1805-1878), a Dutch military surgeon, developed a practical method for immobilizing limb fractures with plaster casts. Previous attempts had been made by using soluble material for moulding casts to replace the traditional methods of traction or splinting. Disadvantages included the long drying-time required (e.g. with glue) or the requirement for hot water plus the resultant skin irritation (e.g. with gutta-percha). Plaster of Paris had occasionally been tried but proved unwieldy. Mathijsen used plaster of Paris in various different ways, the most successful being cotton bandages impregnated with plaster in powder form to which water had been added. His method was adopted worldwide within a decade. Mathijsen never married and spent his old age with relatives in the south of the Netherlands.

The classic: observations on pathogenesis and treatment of congenital clubfoot. 1972

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Jeronimo Campos, Observations on Pathogenesis and Treatment of Congenital Clubfoot. An accompanying biographical sketch on Ignacio V. Ponseti, MD, is available at DOI 10.1007/s11999-009-0719-8 and a second Classic article is available at 10.1007/s11999-009-0720-2. This article is ©1972 by Lippincott Williams and Wilkins and is reprinted with permission from Ponseti IV, Campos J. Observations on Pathogenesis and Treatment of Congenital Clubfoot. Clin Orthop Relat Res . 1972;84:50–60.

The history of fracture fixation of the hand and wrist

The treatment of fractures of the hand and wrist has evolved over the centuries from one of rest and immobilization to internal fixation and early motion. Although today's technology (anesthesia, antibiotics, metal implants) has allowed us more freedom in treating these injuries, a number of our patients continue to experience stiffness, nonunion, malunion, and chronic pain. We explore the techniques used to treat hand and wrist fractures throughout the centuries and determine what beneficial aspects of fracture care have been maintained and those that have changed as a result of new technology. We are now realizing that rigid immobilization of fractures at the expense of the soft tissues can be just as damaging as the ancient physician's techniques of prolonged immobilization with frequent dressing changes. New implants and lighter cast materials have allowed improved digital motion and early functional use of the extremity. This has become especially important in the treatment of the aging population, which demands improved function and a quicker return to activities. The optimal treatment of these fractures for each patient remains elusive, however, and there remains a tendency to rely on technology at the expense of sound clinical care. We must not loose sight of the goals of fracture treatment and should heed the lessons learned throughout centuries of treating these injuries.

LEVEL OF EVIDENCE

Level V (expert opinion).

A functional below-the-knee cast for tibial fractures. 1967

An experimental method of treating tibial fractures with use of the below-the-knee total-contact weight-bearing cast is discussed. The success of this method appears to depend on the careful application and molding of plaster to the fractured leg after the swelling has been reduced to a minimum and a closed reduction has been obtained. Good alignment is essential, but slight shortening or overriding of fragments can be accepted with the expectation that little or no increase in the amount of shortening will occur. The results obtained indicate that this type of cast not only holds reduction well but also permits healing of tibial fractures in a relatively short period of time. The maintenance of the limb in a near physiological condition throughout the entire reparative process is offered as an explanation for rapid healing. Treatment of tibial fractures by this method offers the advantages of retaining functional activity of the extremity during healing and eliminating the need for extensive rehabilitation of the knee and thigh muscles after healing has occurred.