A GREAT SURGEON SPEAKS


A scientific furlough devoted to a book on the pathological anatomy of flat feet helped to finish the book but not the carbolic eczema of my hands. On the contrary it grew worse at the slightest irritation, and developed into a regular idiosyncrasy against any antiseptic, whether carbolic, sublimate, or iodoform. I was to learn that I was absolutely unfit to be a surgeon in the Lister era.


My Life and Work.

Decades ago many parents gave their children Samuel Smiless Self-Help and other volumes by that industrious writer, which describe the lives of numerous individuals who, notwithstanding the greatest difficulties, had risen from the utmost poverty to eminence. Smiles also wrote the lives of the great English engineers and inventors in full detail, but his books are not much read nowadays.

However, the interest in self-made men remains. Every schoolboy is familiar with the life story of Henry Ford, John D. Rockefeller, Andrew Carnegie, and other kings of industry who rose from poverty.

The lives of business men, however successful, are less interesting to the great majority of people than the lives of eminent physicians and surgeons. Money-making is a dull occupation compared with health-giving. Very few doctors have written their lives. Those who have done so successfully have been greatly compensated. Some years ago Dr. Axel Munthe, an eminent Swedish physician, wrote his life story, quaintly entitled

The Story of San Michele. It had a fabulous success. I believe more than 1,000,000 copies have been sold. The book was translated into twenty foreign languages and it has proved a best seller, not only in England and in America, but in many other countries as well.

Dr. Adolf Lorenz has written a book which may be compared to Dr. Axel Munthes celebrated volume. However, Munthe and Lorenz are totally different men. Munthe is a poet and a mystic, and his book may be called “Warheit und Dichtung”. Lorenz is not so poetical a soul as Munthe. He describes his life in simple and charming language. His life has been a most interesting one and his career may be compared to that of the great homoeopath, Samuel Hahnemann.

Samuel Hahnemann was the son of a poor porcelain painter, and he would not have been able to study and to become a doctor if he had not displayed the most extraordinary industry and perseverance which enabled him to overcome the financial handicap which would have proved insurmountable to most. Lorenz came from the poorest peasant and artisan stock. As a child he ran about without shoes and socks, and it is amazing that he succeeded in obtaining an education and earning at the same time a living while studying by acting as a tutor to other boys. Like Hahnemann, he succeeded in finding protectors among the well-to-do.

Like Hahnemann he got scholarships, passed all his examinations with the greatest distinction, and became a medical student. He wished to take up surgery. He wrote:. “At the beginning of my clinical studies, I wanted first of all to know what is cancer, and the savants did not in the least know what cancer was.

Is it a disease? Is it a symptom of disease? And they do not know up to the present time! Studying medicine, I felt very much disappointed and did not take much interest in internal medicine when I compared the facts shown up by the pathologists with the poor ways and means of combating them. Nature has its own methods and you cannot do much, if anything at all, to lead them towards another final goal. It seemed all so discouraging to me”.

Like so many young medical men, Lorenz discovered that modern medicine is very strong in diagnosis, in classifying and labelling diseases, but it has little to offer in the way of treatment. Therefore, the modern doctor hands over his patients very willingly to dentists, X-ray specialists, laboratory workers and surgeons. So Lorenz wanted to become a surgeon. Owing to his industry and ability, he became a favourite assistant to the great Vienna surgeon, Professor Albert.

Lorenzs book is full of delightful anecdotes. In one of them he tells his readers how terribly he upset Professor Albert by demonstrating to an audience a case of congenital displacement of the hip joints which had been considered absolutely incurable ever since the time of Hippocrates. Curiously enough, Lorenz was destined to discover ways and means by which this hitherto absolutely incurable condition could be cured. We read:.

“It was my task as assistant to introduce to the audience some interesting cases who had come for consultation. I had found a charming little girl about five years old whom I considered a most interesting case, though as I had to learn to my sorrow she proved not at all suitable for the occasion. In a state of nature, the girl was made to stand upon a table, exposed to the eyes of the whole class, and also, of course, to the scrutinizing eyes of the teacher, whose grim face (he looked like a Hussite leader in his slavic goat) was growing purple with rage.

If his eyes had been daggers, his unfortunate assistant could not have lived one minute longer. But why, for Gods sake? The child was so lovely, laughing at the unfamiliar aspect of the crowd. It was true that in spite of her feminine charm, she showed a peculiar deformity in her whole attitude; her buttocks protruded and her abdomen as well, while her lower back was hollow and her knees bent, with her arms reaching down far below her knees, like an apes.

When she took a few steps her body wobbled from side to side, like a ducks. Professor Albert had, of course, made the diagnosis from afar. Interesting as the case might have been on another occasion, it was just as ill-suited to the present moment.

“The whole staff was aghast at the fury of the boss. What had happened to him? At last Professor Albert quieted down and in a timid voice, a voice quite strange for him, said: Pride goeth before a fall. Boastfulness deserves to be kicked in the neck. I have just finished extolling to you the progress of modern surgery, and now it comes to pass that the first case I present to you shows the helplessness, the inefficiency, the utter inability of modern surgery to cure that lovely child. Old Hippocrates knew and even described this condition.

For twenty- three hundred years medical science has tried to help these children; it is still trying. All efforts have been in vain. Not long ago the famous French surgeon Dupuytren tried it again, only to fail again. He declared once more that this congenital condition is absolutely incurable; that it cannot even be improved..

“The condition we were looking at was that of congenital displacement of the hip-joints. I had witnessed this unforget- table scene abashed, and unaware of the future which destined me, exactly me, the abdominal surgeon of that time, to take up the difficult task of curing a condition which had baffled all efforts through twenty-three centuries and to succeed at last. The incident was soon forgotten, but it emerged ten years later out of the unconscious mind to stick forever in my memory”.

Vienna was the capital of Austria and the whole life of the capital centred around the Imperial family and the Palace. The great professors of the Vienna University frequently came in contact with the Imperial family.

We read on page 68:.

“Many funny stories were told of Professor Skoda. He was consulted not only by people from all over the world, but also, of course, by the members of the Austrian imperial family. The Spanish etiquette of the Austrian Court prescribed that every visitor should come in full evening dress, even in daylight. The tail-coat was indispensable, but Skoda had never possessed such a thing. He always donned a walking-coat and went to court in his usual costume. When he entered the ante-room of Her Imperial Majesty, the valets would tell him that they dared not admit him to the room of Her Majesty because only a person attired in a swallow-tailed garment could be admitted to the room. Oh! Is that so? I did not know it excuse me, please. Its all right Ill go home and send you a tail-coat from the next tailor shop, and he would leave the room”.

Lorenz intended to become a surgeon, as previously stated. He had undoubtedly great gifts for surgery but his intention was frustrated by the rise of Listerism and the use, or rather the abuse, of powerful disinfectants. Germicides which kill germs also kill healthy cells and are therefore dangerous. Homoeopaths are aware of this and they prefer to use Calendula, a non- poisonous plant juice which has the most wonderful healing power. Lorenz was one of the numerous victims of antisepsis. He tells us:.

“It was all because I had chanced to be born in the so-called Lister era during which carbolic acid reigned supreme. The surgeons at that time all but drank carbolic acid. They literally bathed in it, inhaled it, washed their hands in it, and lived in the sickening, suffocating fog of the carbolic spray. This last was really the worst of all tortures. Let alone the fact that you could not see anything while a good spray was on, hissing like an irritated viper, it made the skin pale as a corpse and macerated it until there was danger of gangrene. The time had not yet come when the German surgeons unanimously cried Fort mit dem Spray! Away with the spray!.

“I became its victim. I had stood slow poisoning through four years: then my whole system revolted. But that was not the worst of it. My hands, from one day to the next, were covered with big, repulsive blisters which left the skin raw and bleeding. No possibility of washing such a skin, no possibility even of touching a surgical instrument. As a surgeon, I was like a man with no hands at all.

A scientific furlough devoted to a book on the pathological anatomy of flat feet helped to finish the book but not the carbolic eczema of my hands. On the contrary it grew worse at the slightest irritation, and developed into a regular idiosyncrasy against any antiseptic, whether carbolic, sublimate, or iodoform. I was to learn that I was absolutely unfit to be a surgeon in the Lister era. I was so desperate as to curse the holy name of Lister. God have mercy on the sinner!”.

“And so, against his will, Doctor Lorenz was forced by necessity to become an orthopaedic surgeon, and had moreover to be his own teacher. With the money saved from his lectures he hired an office, put in some gymnastic apparatus, and hung out his shingle: Specialist in Orthopaedic Surgery. To justify the title, he sat down and wrote a book on the pathology and therapy of lateral deviation of the spine, which was highly praised by certain German rivals.

But in spite of this, he felt that he had been switched off from the main road to a side-track. His aim had been to become a great clinical teacher, like Albert or Billroth, and, of course, a famous operator, preferably an abdominal surgeon. Instead, he found himself a teacher of gymnastics. His hopes of putting an end to his poverty had to be dropped once more”.

Lorenz was a man of the greatest ability who probably would have become the leading surgeon in Vienna, another Billroth. He turned by force of circumstance towards bloodless surgery, towards orthopaedic treatment which was looked down upon with contempt by doctors and surgeons of his time, and he raised the despised practice of manipulation to a science and art. He remained poor, earned little, and married his assistant. He tells us charmingly:.

“In his private practice he had for the most part to treat children, and he badly needed an assistant. This assistant was to be that same nice girl whom Professor Langer once had mentioned as a lure to bind him to his institute. The young lady belonged to a very good family.

She was twenty-four, of medium height, very healthy, of rich colouring. Her hair was auburn, her complexion rosy, her cheeks like red carnations, her teeth white and slightly prominent, her lips very red and luscious; sometimes her eyes would look as green as a cats. The doctor called her his colour-box. She was very energetic, and was just as poor as her lover.

“Why shouldnt we marry after seven years of courtship? she asked him. Ill be a better assistant to you than any of your plump colleagues, who never will learn how to handle your young girl patients. What she said was true, and in the next fifty years she was Doctor Lorenzs most helpful assistant and will be his assistant for as many more years as God may grant her.

“So the wedding was arranged. Just at that time the young doctor was very hard up, having spent nearly all his cash for his instruments. The question of buying the wedding-rings gave him some qualms. His bride naturally insisted on a nice golden wedding-ring. For himself he ordered one of brass, which he felt would glitter like gold and would do very well for the ceremony. What is a ring good for, said the bridegroom, if as a surgeon you never wear it? Besides, who will notice it? But somebody did.

During the ceremony, the sexton, while he held the tray with the rings, was obviously comparing them, making them clink slightly on the tray, and weighing them in his hands; finally he shook his old head, having evidently grasped the situation. The bridegroom felt sure that the sexton would make some sinister prophecy as to the duration of a union which relied on brass, and hastened to make him take a brighter view of the situation by a better fee than could be expected from the wearer of a brass wedding-ring.

The bridegroom was very sorry that the brass ring was lost later on, for it would have enabled him to prove that the happiness of married life does not depend upon golden or preciously jewelled wedding-rings”.

Numerous children came to Lorenz for treatment because of misshapen, stiff or unusable limbs. Long before the sunlight treatment for tuberculosis of the bones was introduced, Lorenz initiated a new form of treatment of great efficacy. He wrote:.

“Children with tuberculosis bone and joint diseases were my most frequent patients”.

“Everyday experiences soon proved that a child with hip-disease could walk and even jump around all day long without any pain, but as soon as it fell asleep, the slightest movement of the body caused terrible pains, with the dreaded night crying. It was clear that pain was avoided during the day by the spastic contraction of the muscles, which prevented any movement of the joint.

As soon as the muscles fell asleep with the child, motion became possible and the least suggestion of it was a source of acute pain. I resolved to imitate nature, adding to the muscular fixation of the diseased joint an artificial fixation by means of a well-fitting plaster-cast which had to be left undisturbed for many months, sometimes a whole year a so-called Dauerverband (permanent bandage). How to keep the skin clean and healthy? By giving it a dry wash several times a day with a scratch bandage inserted between the skin and the lining of the plaster- cast.

In such a cast the children lost their pain and could even walk, and in mild cases nothing else was necessary. The treatment had become very simple and effective. The children could even go to school with their casts on; instead of being bedridden, they could enjoy open air and sunshine. The effectiveness of the sun- treatment and the X-ray treatment was at that time not yet known. Nowadays the tendency is to neglect the mechanical treatment and to rely almost entirely on air, food, and sunshine.

But this does not alter the fact that, so long as pain prevails, a fixing plaster-cast is by far the best means of relieving it. In my lectures I used to say: Give my children good food, with their bandages on; they will be all right without special sun treatment because they can enjoy open air and the sun as far as he shines for all creatures. I had great success with this treatment, and my name spread. The treatment is still in use, as the best and most effective.

“A very interesting problem for me was that of doing away with the terrible pains which the poor children who suffered from tuberculosis of the spine (spondylitis) and to endure. All available appliances were inadequate. It was my happy thought that for these children the hardest bed would be the best. So I made them beds of stone, the so-called plaster-bed, which is nothing but a well-upholstered plaster mold taken from the back of the patient.

The child lies in his plaster-bed like a watch in an open case or like a tortoise in its shell when turned upon its back. In this plaster-bed the child was bed-ridden, to be sure, but he could enjoy open air and sunshine in his perambulator. The pains were relieved to such an extent that the children didnt mind even if the perambulator was rolled over rough pavement.”.

“The plaster-bed and the plaster spica are now known to surgeons the whole world over. I was very proud to see that cases which had been kept under heavy drugs, without relief, were made painless and later on actually cured by so simple a procedure, which acted like a magic wand. It was a solace to know that those victims of the World War most to be pitied, the ones who had been shot through the spine, could be and were relieved of their terrible pain by the plaster-bed. By this simple means they could be made fit for transportation to the Hinterland, where they would find proper treatment.

One of my own patients told me of the excruciating pain he endured when transported in a cattle car with his spine shattered by a bullet. In captivity in Russia he found a Viennese surgeon who fixed his spine with a plaster-bed, and from then on transportation was painless. He was sent home and recovered, and for years he travelled with his plaster-bed because he could no longer tolerate soft beds”.

“The chief aim of my work was not to invent new operations, but rather to do away with dangerous operations, substituting for them simple mechanical appliances. Except in very rare cases, the plaster-bed makes osteoplastic operations, such as transplanting a piece of bone from the shin to between the split spinous processes, superfluous”.

Adolf Lorenz