The Wisdom of the Past

I have just finished reading a paper put out in 1953, August, in fact, the month and year of my birth. It is called "The Kite Treatment of Congenital Talipes Equino-Varus," by A.T. Fripp and Martin Singer from the Institute of Orthopaedics, Royal National Orthopaedic Hospital, London. It was published in the Postgraduate Medical Journal. The paper described the Kite technique for conservative correction of club feet using plaster serial casting, and was a primary technique before (and during) the emergence of the Ponsetti method, which has now largely supplanted Kite. But in the Introduction comes a very curious piece of history, which I quote here:

"Among English surgeons interested in the deformity of club foot, the early work of W. J. Little stands out. Himself a victim, (italics mine) he traveled to the Continent and submitted to a tenotomy, which was performed by Stromeyer. Subsequently he practiced the operation in England, and his book, published in 1839, is based upon his experiences. But even more important than the introduction of the tenotomy was his statement:

"In many cases the slightest pressure exercised by the instrument will suffice to overcome the deformity without producing pain, provided attention be daily paid and the straps and screws be tightened whenever they become loosened by the progress the foot makes in the required direction. The surgeon must constantly bear in mind that after the performance of an operation he must not always to expect to restore the foot rapidly to its material position; he must guard against violence.""

Yes, the language is a bit old-fashioned, and like most medical writing, somewhat obtuse, but here is a real gem. First, Little himself had club feet! So I must correct my statement to Ms. Phipps - she will not be the first clubby to become an orthopedist! She will still be the only one in that situation today, however. And look what position he arrives at when writing his professional experience "...he must guard against violence." Even though his primary purpose in writing the book was to teach more doctors the tenotomy procedure, he remains focused on the patient's well-being, and retains the good sense of conservative treatment as the foundation of his practice.

He speaks of "...the straps and screws be tightened whenever they become loosened by the progress the foot makes in the required direction." At that time, bracing was very crude, and often caused more damage than it cured. Here, he is saying to other surgeons, "be gentle" with the child, yes, maintain pressure in the direction of correction, but do so gently.

I will try to get my hands on the work of Little. I suspect it will be worthwhile, and I promise to share more gems with you when I do.

By the way, I searched for a copy ofLittle's book, and found one. Its available, really. A mere $5,512.50.