Posts tagged: Orthopedics

The BackBlog: Dr. Lloyd T. Brown’s Orthopedic Braces

By , February 25, 2020


In the early stages of the sorting process for this project, while we were still creating guidelines, I found a child’s leg brace in a box of miscellaneous items. The brace started with a hard shoe at the bottom connected to metal splints, which led up to a leather-covered metal band that went around the waist. The tag attached to the brace stated that it was made for a four of five-year-old child to keep the toes from pointing inwards. Later on, I found five other braces from the series in another box. Some braces were for daytime and some were to wear overnight. The smallest ones were for an infant, and the largest was for an eighteen-year-old.

Photo of a child's orthopedic brace with a shoe and attachments at the hip and knee

Orthopedic brace for a 4-5 year old. The metal post and waistband help to prevent internal rotation of the foot. Circa 1885. From the Warren Anatomical Museum in the Center for the History of Medicine, Francis A. Countway Library of Medicine (WAM 13255.006A)

Luckily, each brace had a tag with a description, object number, and accession number. This gave me more information to start with than most objects in the backlog did. I was quickly able to find out that Lloyd T. Brown donated this series of braces to the museum in 1943. Based on my initial reading of the accession record, I was under the impression that Brown was the physician who had created the braces for a child. This made sense, as Brown was an orthopedic surgeon. However, the dates didn’t line up, as the earliest braces were made in 1880—the same year that Brown was born. With a bit more research it became clear that Brown was not the physician attached to these objects, but the patient.Lloyd T. Brown was born with a club foot. He was seen by the orthopedic surgeon Edward Hickling Bradford. At the time, Bradford was working at Children’s Hospital and had recently joined the faculty at Harvard Medical School. Bradford was well-known in his field. He co-authored “Orthopedic Surgery” in 1890, which was considered the standard text on orthopedics for many years. He was influential in founding the American Orthopedic Association and was the co-founder of the first school in the United States for children with physical disabilities.

Bradford created the orthopedic braces that I found in the backlog and used them as the primary treatment for Brown during his early childhood. However, this was not enough. Brown received tendon surgery, which helped for some time, and then, at the age of eighteen, a surgery to remove a small amount of bone in his foot. Bradford made one more brace for him post-surgery, and while Brown still had difficulties with his foot throughout his life, this was the last brace that he ever needed.

Brown was so inspired by this experience that he followed in Bradford’s footsteps. Like Bradford, Brown attended Harvard Medical School, where he eventually joined the faculty. He worked at the Massachusetts General Hospital and Children’s Hospital, where he specialized in chronic diseases and orthopedic surgery. During his career, Brown had many patients who were children with disabilities similar to his own. Brown wrote about and discussed his own treatment and felt that it put him in a unique position as a doctor, because he could speak to the results of the treatments later in life.

These orthopedic braces show that medical treatment can have an impact on much more than just physical health. They tell the story of a patient who became a doctor. Lloyd T. Brown chose to donate his childhood braces to the museum, suggesting that he wanted that story to be told. And now that we have rediscovered them, we can tell that story once again.

MHL digital highlight: Lewis Sayre’s treatment of spinal curvatures

By , November 8, 2011

(above) One of a series of triptychs from Lewis A. Sayre's "Spinal disease and spinal curvature: their treatment by suspension and the use of the plaster of Paris bandage." (London: Smith & Elder, 1877)

Lewis A. Sayre (1820-1900), was a surgeon of significant renown and an important figure in the history of orthopedics in America. He was a charter member of several medical societies, including the American Medical Association, and served as its president in 1880. Among the procedures that he pioneered in his private practice was a process during which the patient was suspended, hanging by the arms, in order to stretch the spine and relieve stresses caused by an irregular curvature, while a plaster of Paris “jacket” was fitted in order to hold the spine in place after suspension. In this particular book, Sayre details his experiments treating scoliosis and Pott’s disease (spinal tuberculosis) with the plaster jacket. He also includes an extensive series of clinical comparisons between his jacket and the more expensive and cumbersome iron braces that were in use at the time. The case studies, which describe a range of successful outcomes, are richly illustrated with drawings and photographs like the ones above.

Recalling his first use of suspension before the application of the jacket, by which he intended to accomplish nothing more than a temporary alleviation of symptoms until a commercially-available brace could be acquired, Sayre writes:

In November 1874 a little boy, four years of age, was brought to me having a sharp posterior curvature of the three last dorsal and the first lumbar vertebrae, together with partial paralysis of the rectum and one leg … I directed one of my assistants to suspend the boy by the arms, in order to see what effect would be produced; and I noticed that, as soon as the body was made pendent, there was more motion in the paralysed limb than before, that the pain was very much relieved, and that the patient was breathing with greater ease. While he was suspended in this manner, I pulled down his shirt and tied it between his legs, thus making it fit the body closely and smoothly; and then, commencing at the pelvis, I applied rollers saturated with plaster of Paris around the entire trunk. At first I was anxious concerning the effect that would be produced on the respiration, but inasmuch as the boy cried lustily, all my fears in that respect were quickly dispelled: so I went on, reversing the bandage, bringing it back to the pelvis, again carrying it upwards, &c., until the body was completely encircled by four or five thicknesses of the roller. The child was then laid with his face downwards on a sofa, and was instructed to remain there until the plaster had become firmly set. When I returned shortly afterwards, I found, to my surprise, that the little fellow had got up from the sofa and walked across the room to a window … When this dressing had been completed, I requested the parents to bring back the child after an interval of ten days, when I proposed to apply and adjust a Taylor’s brace. The above-described plaster jacket had been put on simply for the purpose of rendering the child comfortable whilst being carried home. I did not see either the child or its parents until the following February.

This book is just one of over 70 titles dealing with spinal diseases and abnormalities, from the 18th- through 20th-centuries, that have already been added to the Medical Heritage Library, including one of Pott’s original works on spinal tuberculosis, which the Countway digitized in March of 2011.

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