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”.
