Orthopaedics versus surgery: two rehabilitation models during the First World War

This study analyses the opposing rehabilitation paradigms of Božidar Špišić and Miroslav Čačković in Croatia during the First World War. It examines how differing concepts of the body, technology, and labour shaped professional positioning and authority over amputee rehabilitation.

The paper employs a historical-comparative and discursive analysis of contemporary medical literature, focusing on Čačković's 1916 article Work Prosthesis or Working Stump?. It also evaluates the use of medical photography as an instrument of professional rhetoric.

The debate highlighted two epistemologically opposed models: Špišić's orthopaedic mechanical-prosthetic approach, prioritizing standardization, early prosthetics, and industrial resocialization; and Čačković's biological-adaptive model, emphasizing stump adaptation, sensory feedback, and bodily autonomy from mechanical devices. While Špišić used visual series to justify orthopaedics' institutional autonomy, Čačković utilized a single case study to challenge dominant prosthetic enthusiasm.

The polemic reflected a conceptual conflict between traditional surgery and emerging orthopaedics over rehabilitation authority. Institutionally, Špišić's model prevailed, establishing orthopaedics as an independent academic specialty in Croatia. Biomechanically, both paradigms anticipated modern rehabilitation, which combines a neurologically active body with advanced prosthetics.