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Fractured hips: surgical authority, futility and innovation in nineteenth century medicine
1The Unit for the History and Philosophy of Science, University of Sydney, NSW 2006, Australia. c.degeling@usyd.edu.au
Insights
Hip fracture treatment evolved from palliative care to restorative approaches. Early beliefs that hip fractures never healed were challenged, revealing how clinical methods perpetuated therapeutic inertia.
Area of Science:
- Orthopaedics
- Medical History
Background:
- Historically, hip fractures were managed palliatively due to patient demographics and perceived incurability.
- Nineteenth-century orthopaedics faced clinical uncertainty and professional disagreement regarding hip fracture treatment.
Observation:
- Sir Astley Cooper's "treat the patient and let the fracture go" approach dominated hip fracture care.
- Evidence from clinical experience, post-mortem studies, and animal experiments suggested intra-capsular hip fractures did not heal.
Findings:
- Nicholas Senn contested the prevailing evidence, highlighting isolated cases of intra-capsular healing.
- Senn identified that the empirical nature of contemporary clinical methods created self-perpetuating therapeutic justifications.
Implications:
- Challenged the long-held belief in the non-healing nature of hip fractures.
- Underscored the need to critically evaluate established clinical practices and their underlying evidence.
- Paved the way for exploring restorative treatments for hip fractures.
Abstract:
Orthopaedists have long found hip fractures to be a significant source of clinical uncertainty and professional disagreement. For much of the nineteenth century, surgeons were happy to follow Sir Astley Cooper's directive to 'treat the patient and let the fracture go'. Most sufferers were elderly, near the end of their lives and at significant risk from morbid complications. This palliative posture was further justified by a substantial corpus of medical evidence. Any attempt at therapeutic innovation was unwarranted because clinical experience, post-mortem studies and animal experiments indicated that fractures within the hip joint never healed. Yet as there were isolated cases of intra-capsular healing, surgeons such as Nicholas Senn began to contest this evidence. To his consternation, as he tried to demonstrate the possibility of restorative treatments, Senn found the fundamental problem with hip fractures was that the empiricism of current clinical methods created and perpetuated their own therapeutic justifications.
