tHe BiZaRrE wOrLd oF sCoLiOsIs

Historical Treatment of Scoliosis

The existence of scoliosis probably predates the existence of man. There is a long history of its presentation from King Tutankhamun to Hippocrates. Because of this there is a vast and fascinating history of the both the condition and its treatment. Interestingly, many of the bygone forms of treatment are very similar to the treatments still in use today.

An article published in 2009 Scoliosis Journal, details the history of spinal deformities and their treatment in Ancient Greece. In Ancient Greece “Medicine” was practiced at Asclepions (temples dedicated to Aesculapius, the god of health) A priest-physician conducted treatments such as hydrotherapy, physiotherapy, hygienic rule, diet, drug therapies, and minor surgical procedures. The authors suggest that such practices were most likely also used to treat spinal deformities.

Hippocrates (460-370 BC) recommended diet and extension for the treatment of scoliosis. During the time of Hippocrates, spinal manipulation was widely used as a treatment for scoliosis, however, he was the first to invent devices based on principles of axial traction and three points correction of spinal curvatures. Hippocratic books do not contain illustrations but Apollonius of Kitium (1st century BC) wrote of Hippocrates techniques in On Articulations and illustrations were found in Florentine surgical manuscript (Laurentianus 74. 7, 9th century AD).

Hippocratic Ladder

The Hippocratic ladder was developed to reduce spinal curvatures. The patient underwent “succussion” or shaking while being tied on a ladder. If their hump was near the neck, the patient was held in the upright position. If the hump was lower, the patient was held head downwards. The weight of the body pulled the spine into a  straighter position. Hippocrates said the board was the most efficient method for the correction of spinal deformities because the physician could easily control the forces applied to the spine.

“for the pressure forces the protruding parts into place, and the extensions according to nature draw the parts that have come together”.

Hippocratic Board

Hippocratic board was another device for the treatment of scoliosis. Manual pressure was applied to the patient’s hump while traction was simultaneous applied.

“But the physicians, or some person who is strong, and not uninstructed, should apply the palm of the hand to the hump, and then, having laid the other hand upon the former, he should make pressure, attending whether this force should be applied directly downward, or toward the head, or toward the hips …”

For patients with more resistant scoliosis:

“One may fix in the ground a strong broad plank having in it a transverse groove. Or, instead of the plank, one may cut a transverse groove in a wall, a cubit above the ground, or as may be convenient. Then place a sort of quadrangular oak board parallel with the wall and far enough from it that one may pass between if necessary; and spread cloaks on the board, or something that shall be soft, but not very yielding.”

“A soft band, sufficiently broad and long, composed of two strands, should be applied at its middle to the middle of the chest, and passed twice round it as near as possible to the armpits; then let what remains of the (two) bands be passed round the shoulders at each side, and the ends be attached to a pestle-shaped pole, adjusting their length to that of the underlying board against which the pestle-shaped pole is put, using it as a fulcrum to make extension.”

Oribasius (325–400 AD), a Byzantine physician, added a bar to the Hippocratic board for the treatment of scoliosis, as well as spinal trauma.

Hippocratic Scamnum

Hippocratic scamnum was another device used for the treatment of scoliosis.

“But the most powerful of the mechanical means is this; if the hole in the wall, or in the piece of wood fastened into the ground, be made as much below the man’s back as may be judged proper, and if a board, made of lime-tree, or any wood, and not too narrow, be put into the hole, then a rag, folded several times or a small leather cushion, should be laid on the hump …when matters are thus adjusted, one person, or two if necessary, must press down at the end of the board, while others at the same time make extension and counter-extension along the body, as formerly described.”

Galen of Pergamon (130–200 AD), was another eminent Greek physician, recommended the use of the Hippocratic board  for traumatic deformities. Correction of the scoliosis was attempted with the use of both traction and pressure and the Hippocratic ladder for kyphotic deformities. He himself doubted he effectiveness of this technique.

Another article from 2009 Spinal Cord, detailed issues that existed with historical methods of scoliosis treatment that resulted in paralysis! The authors write that it was recognized as an issue as early as 1820 in France when surgeons were using powerful mechanical means to perform traction on the spinal column to correct deformity leading to paralysis. The Royal Academy of Medicine got involved and certain practices were discredited. As a result, surgeons set up a research society to monitor complications. There were many causes but one preventable cause was excessive traction on the spinal column with applied force on the spinal cord and the nerve roots after the spine was destabilized by cutting the ligaments.

Mechanical Traction

The authors of the article give a very detailed outline of some of these antiquated treatment methods:

Jean-André Venel (1740–1791) founded an institute in Orbe, Switzerland, treating patients with an extension bed at night that eliminating gravity in the horizontal position and a corset during the day. In 1816 Würzburg, Germany,  an orthopedic mechanic founded the first orthopedic institute where scoliosis patients were treated using a bed adapted from Venel’s extension bed. The Würzburg bed involved springs and an adjustable inclined plane.

In 1764, Francois Guillaume Levacher de la Feutrie (1732–1816) developed the first mechanical bed in France. The machine was designed to ‘push on the bumps’ in an attempt to cure rickets. The bed was only used on children (because their bones were still soft), intermittently, for at most 2 weeks at a time. The bed did not exert traction on both ends of the body and used gentle pressure, therefore there were no negative effects. Levacher developed other devices used to treat scoliosis, as you can see from the images below.

Charles Gabriel Pravaz (1791–1853) thought scoliosis was due to unequal growth or activity. He criticized the Würzburg bed for being horizontal and claimed its use was not recognized by the medical authorities. He instead created extension equipment that allowed the patient to remain in the upright position and believed it was essential that the patient to be able to adjust the traction themself. Pravaz used gentle fixation for no more than 2 hours a day and with no more traction than they could bear. There were no adverse effects.

In the 1820s Charles-Auguste Maisonabe (1779–1851) introduced his version of a mechanical bed. It differed from the Würzburg bed, in that it used weights attached to straps which were then tied to the patient’s pelvis and head and used very strong traction. It also had a  scale to show how far the weights had moved to measure the force applied. Maisonabe realized that the resistance of the spinal column could not be measured and so it was very difficult to gauge the amount of weight needed. He suggested pulling the head manually to gauge the weight needed for each patient and to err on the side of caution.

Scoliosis Brace

Ambrose Pare, a famous French army surgeon, is considered the founder of modern surgery and treatment with prostheses and orthotic devices. He developed the first scoliosis brace in the 16th century made of iron plates. The brace was further developed in the 18th and 19th in France and Germany.

In 1835, J. Hossard made the first brace that could be mechanically adjusted to correct spinal column curvatures in the corset.

The next image is from 1879 -1883  and was taken by one of the first female photographers in Sweden, Augusta Zetterling. On the bottom of the photograph is the name of the patient depicted.

The photo below is of the Hessing brace from Germany circa 1888.

Also in the 1800’s,  Lewis Sayre began using the plaster jacket. They would suspension in which the patient stood under a tripod while their head appears to be in a traction device and the cast was formed while the spine was in a straightened position.

Treatments in the 19th century and early 20th century included exercises for strengthening the back muscles, casts and braces and combinations of traction, suspension, bracing and postural corrections.

L. Wullstein’s 1902 publication “Die Skoliose in ihrer Behandlung und Entstehung” covered his clinical and experimental research on scoliosis and had some important insights and understandings of the condition. Below are some images of Wullstein’s scoliosis therapy.